Inward and Outward

Years ago, I worked with a young woman who had gotten married a few years prior and had a two-year-old daughter.  She came to see me because she was depressed.  The depression had begun while she was pregnant and suffering from fatigue, anxiety about her changing body, and fear of the changes that parenthood might mean for her career.  Shortly before she was to give birth, her husband informed her that, if her depression continued as intensely as it had been for the previous several months, he didn’t think he could stay in the relationship.  

The baby girl brought the young woman tremendous joy and fulfillment and, for a time, relief from her depression.  But the more she thought about what her husband had said shortly before she delivered their first child, the more depressed she became.  She couldn’t stop wondering whether he truly loved her and whether, if she continued to be depressed, or other aspects of their marriage became more difficult, he would leave her.  Many times since their baby was born she had considered talking to her husband about what he had said; each time, she decided not to, afraid that bringing up the incident would negatively affect him and push them further apart.  And yet it had been two years since they had made love, and she felt more distant from him than ever.  Clearly, not speaking up about the painful interaction had not only affected their marriage but also had triggered a relapse of her depression. 

In the weeks that followed, I worked with the woman to speak up more about what was bothering her, starting with smaller interactions and leading up to the one that had triggered her relapse.  Each week, as she shared a success story of speaking up, she noted that she was feeling a bit better.  When she finally discussed the pivotal incident with her husband, what followed was a long, emotional outpouring wherein each shared with the other how it felt as the emotional distance between them had grown.  In contrast to the anger she had fearfully anticipated, her husband expressed relief to finally know what was going on with her and to have an inroad for discussion.  Rather than prompting him to leave her, her greatest fear, the discussion, and the many that followed as they began to share more with one another, paved the way for greater intimacy between them.  For the first time since their baby had been born, they made love. 

Freud was wrong about many things, but one thing he seems to have been correct about was his assertion that depression is “anger turned inward.”  In my patient’s example, the hurt and anger she felt towards her husband was turned inward on herself as she became increasingly depressed after the birth of their first child.  Suppressing her thoughts and feelings about this painful interaction did nothing to address the issue and perpetuated the couple’s growing emotional distance from one another.  

As I often tell my patients, when we suppress, we depress.  Humans were built in such a way as to make verbal communication a crucial part of our existence.  When we don’t communicate, we suffer emotionally.  People who have difficulty communicating often turn to substances outside themselves that aid them in suppression of thoughts and feelings: alcohol, drugs, even food.  While clearly not a one-step solution to resolving depression, learning constructive ways of communicating, and pushing one’s self to practice these skills, can help a person overcome depression and lead a more fulfilling life.