Manufacturing depression (17 page)

Not so with melancholia
, whose cause is hard to discern and which overstays its welcome until interfering seems like a good idea. For Freud, however, the true mark of melancholia, what distinguished it from its domesticated cousin, was not so much its irrationality or its persistence as the melancholic’s loss of self-esteem. “
In mourning
, the world has become poor and empty,” he wrote, “in melancholia it is the ego that has become so.” It may be hard to see why a person is mourning, or why he mourns for so long, but it isn’t until mourning turns to self-loathing that you can say for certain that the patient has crossed the border into pathology.

But the fact that the melancholic is ill and that his illness takes the form of being sick of himself should not lead the doctor to conclude that the patient is wrong in his assessment.

It would be fruitless
…to contradict the patient who levels such reproaches against his ego in this way. In all likelihood he must in some way be right…He seems only to be grasping the truth more keenly than others who are not melancholic…[If] he describes himself as a petty, egoistic, insincere and dependent person, who has only ever striven to conceal the weakness of his nature…he may as far as we know come quite close to self-knowledge and we can only wonder why one must become ill in order to have access to such truth.

Some melancholics may be mistaken, Freud argued, but the validity of their self-evaluations is not germane to the question of whether they are suffering from melancholia. The true mark of illness is the melancholic’s failure to maintain the sense that he is not petty, egoistic, etc.,
even if he is.

And rest assured he is. Your mum and dad may have fucked you up, but they had plenty of help from you. Like every other child, you loved your parents when they gratified you and hated them when they didn’t, and you started doing that as soon as your
mother’s breast was offered and withdrawn (or perhaps as soon as you were ejected from your timeless, painless, intrauterine life into a world of hunger and need). If you have a strong constitution and parents who know how to do their jobs, you eventually learn to control your love and your hate, to grow an ego that can find strategies to make life less confusing and chaotic, that spares you (and those you love) from your titanic feelings. And one of the first thing that the ego does is fool itself into thinking that it is better, more substantial, and less in thrall to our darkest impulses than it really is.

In “Beyond the Pleasure Principle,” Freud describes how the ego gets this idea in the first place—and how important it is that it does so. He tells us about the time he observed his eighteen-month-old nephew playing a game with a wooden reel designed to be pulled along the floor by a string. The nephew never used it in this fashion; instead, he repeatedly threw it out of his crib and retrieved it, saying
“fort”
(“gone”) and
“da”
(“there”) as he did. This game, Freud said, was “
related to the child’s
great cultural achievement—the instinctual renunciation (that is, the renunciation of instinctual satisfaction) which he had made in allowing his mother to go away without protesting.” By finding a way to control his rage at being abandoned by his mother, the boy had renounced the pleasure of vengeance and taken a decisive step toward reining in his destructive impulses. This, Freud said, was the basic building block not only of maturity but of civilization itself.

Freud also noticed that his nephew seemed much more interested in the throwing than the retrieving, which he took to mean that mastering loss was more compelling than seeking the pleasure of return, that getting hold of himself “
carried along with it
a yield of pleasure of another sort but none the less a direct one.” It’s the pleasure of self-control, of efficacy and self-reliance, and of living in a world where effect follows upon cause, where what happens next can be predicted and controlled. The boy’s delight in his game was the precursor of a grownup’s comfort in the civilized world.

No matter how well a child accomplishes this task, however, the hatred and violent impulses remain, held at bay by individual effort—particularly the conscience—and by the collective force of civilization. Without this achievement, life would be nasty, brutish, and short; with it, however, the nastiness is merely pushed back to the distant reaches of our minds, into the unconscious. The unconscious never forgets, and trouble like melancholia is kindled when the original hurt and the violence it conjured reemerge to consciousness—a catastrophe that doesn’t require anything as dire as death, that could be as simple and banal as the demise of a bad marriage or any other disappointment through which an opposition of love and hate can be introduced to a relationship or an ambivalence already present can be intensified.

Whatever insult set off
the hatred in the first place can’t be avenged—maybe the loved one is dead or just not available or doesn’t see what he has done—and whatever history gives the ambivalence its peculiar shape is long past. Not only that, but unconscious longings are deep and intense, their satisfaction forbidden.

For some unlucky people—those with parents who repeat those insults and disappointments, who thus provide a feast to feed our ambivalence—melancholia is the only available currency with which to buy off their hatred.

Patients manage to avenge themselves
on the original objects along the detour of self-punishment, and to torment their loved ones by means of being ill, having taken to illness in order to avoid showing their hostility directly.

This is why, Freud says, “
Prince Hamlet has ready
for himself and everyone else” a catalog of his own shortcomings, and why so many other melancholics do the same: “Because everything disparaging
that they express about themselves is basically being said about someone else”—the person who died or left or didn’t come through, and all the other people who did that, and so on back to the original objects of ambivalence: mum and dad. Whom you cannot hate or kill because, incompetent or mean or neglectful as they may be, they are all that you have.

This is also why self-reproach is the identifying mark of melancholia, whether the occasion is the loss of love or the rise of ambition and success: because it signals that the crucial fiction—that we are wholly on the side of our own better angels, that we don’t also hate those whom we love or want to destroy the people who have hurt us—has failed. “
The loss of the love-object
is an excellent opportunity for the ambivalence of love relationships to come to the fore,” Freud wrote, which means that it is a likely time for us to glimpse the bottomless, destructive desires that haunt our conscious lives. The melancholic is the person whose mum and dad made it impossible for him to maintain the illusion that normally keeps this awareness at bay.

The biggest weakness in Freudian theory—and perhaps the major factor in its fall from grace—is that it is, as philosophers of science like
Karl Popper
would put it, nonfalsifiable and therefore not subject to scientific test. Psychoanalysis is a self-contained system, its basic tenets impossible to verify. How do you test for the presence of the unconscious, which exists largely as an absence? The answer is that you don’t. You accept it on faith and go from there. In this respect, psychoanalysis is a throwback to Hippocratic medicine, to a time when wise men postulated forces that no one could see but that must be lurking behind, and causing, what was visible.

But every so often, one of Freud’s theories is inadvertently supported by science. The central idea of “Mourning and Melancholia”—that the disease consists of the loss of an illusion—is one instance. In the modern version of melancholia, the story that I
would have told my doctors—the one in which I concluded that I had no business writing books, that my success was at least as much a fluke as the just reward for my effort—is not a clearheaded assessment, but the sign of pathology. Indeed, according to a theory developed in the 1960s, depressives make themselves sick by persistently and pervasively overestimating just how bad things are. This cognitive distortion is actually the pathogen. Something has gone haywire in a patient’s thinking—and, in later versions of this theory, in a patient’s brain—and caused him to become unduly negative. Cognitive-behavioral therapy, in which a therapist helps a patient correct this bleak outlook, is the cure.

This theory, it turned out, could be tested. You could, for instance, break the unspoken rat-experimenter pact, the one that says you reward and punish a rat depending on what behavior you want to reinforce, and instead administer electrical shocks at random. And when you find that the rat eventually just curls up in a ball and stops eating, you can call that
learned helplessness
and extrapolate that this is what happens in
depressed people—they get the idea that they can’t make things better and give up. Then you can offer to help them by showing them that they aren’t helpless, that they can improve their circumstances, that their lot is not as bad as they think. And you can turn to your Freudian friends and say that things just aren’t that complicated and dark. You don’t even need a human mind to get depressed, just an expectation that no matter what you do you are going to get hurt.

But a funny thing happened to learned-helplessness theory. Cognitivists predicted that depressed people would be significantly more likely than non-depressed people to blame themselves when things go wrong. In 1979, a couple of psychologists, Lauren Alloy and Lyn Abramson, decided to check out this hypothesis. They set up
a series of studies
revolving around a green light and a button. In the first experiment, subjects were told to push the button and decide whether or not it made the green light come on, a condition that was controlled by the experimenter. Over and over again, the depressed people were better than their normal peers at assessing their role in the light’s status.

Then Alloy and Abramson introduced money into the equation. They gave some subjects five dollars and told them that they’d lose money every time the green light failed to light. They gave other subjects no money but told them that they’d get money if the light came on. What they didn’t tell them was that the button was completely irrelevant and that everyone who started with money was going home broke, while everyone who started with nothing was going to win five bucks. Then they asked them to estimate the extent to which they were responsible for their fortunes—a task at which depressed people excelled. And when the experimenters started to give subjects control over the light, the nondepressed people turned out to think that they deserved to win but not to lose regardless of the actual facts. Depressed people, in the meantime, continued to be superior at figuring out their role in events. The experimenters concluded that “
depressed people are ‘sadder but wiser’
…Non-depressed people succumb to cognitive illusions that enable them to see both themselves and their environment with a rosy glow.”

Alloy and Abramson noted that depressive realism, as this phenomenon came to be called—and, by the way, this work has never been refuted; cognitive theory, as we will see in later chapters, chugs along as if it never happened—raises
a “crucial question”
: Does “depression itself [lead] people to be realistic, or [are] realistic people more vulnerable to depression than other people?” They did not mention that Freud had already posed this question when he wondered why we have to get sick in order to have access to the truth. But then again, Freud wasn’t bringing up the question in order to answer it. He was making a point: that an excess of truth is bound to make a person suffer. Just ask Job.

It would be tempting to see Freud’s increasing pessimism about the prospect for escaping ambivalence—or, to put it more directly, to
achieve happiness—as his response to the excess of truth imposed by World War I, in whose shadow he wrote “Mourning and Melancholia.” That cataclysm, as he put it in “Transience,” an essay published in 1916, “
brought our instincts
to the surface, unleashed within us the evil spirits that we thought had been tamed by centuries of education.” It was in the aftermath of the war that Freud developed the idea of the tripartite self, an ego stretched between id and superego, never quite up to the task of mediating between these protean forces. Eventually he would liken the ego to a garrison occupying a rebellious city, one whose walls would sooner or later be breached by the rest of the unruly psyche.

But historian Eli Zaretsky reminds us that the war’s depredations showed up for Freud and other clinicians in a very specific way: the veterans on both sides of the conflict returned home plagued by nightmares and agitation and depression, by what the DSM now calls post-traumatic stress disorder, but which Freud knew as
shell shock
. Shell shock, Zaretsky argues, forced Freud to reconsider the significance of trauma in mental suffering. Although he once had seen external events—specifically, childhood sexual abuse—as the culprit in the hysterias he was treating, he had come to think of the memories of abuse as fantasies spun out by the psyche as it manufactured a Manichaean reality in an attempt to come to terms with its own divided nature. But the whole world had witnessed the horror that gave rise to shell shock; there was no use denying that the trauma was real.

Still, it took an active mind to turn shells into shell shock—which it did, according to Freud, by what he came to call the “repetition compulsion.” The veterans’ psyches forced them to repeat their experience in flashbacks and dreams and in the unending anxiety—so much like their lives in the trenches—that plagued them. Freud had no question that this was an attempt to master the experience in fantasy if not reality, but he also saw something darker at work. It wasn’t only wars and sexual abuse and other overwhelming experiences that breached the garrison; it was a desire, built into
our animal nature, to return to our inorganic origins, to obliterate life—or, as Freud named it, Eros—before it obliterates us. “
What lives, wants to die again
,” wrote Freud’s earliest biographer by way of explaining this. “Originating in dust, it wants to be dust again.” A veteran relives the trenches for the same reason that another man recreates the trench warfare of his family—not only to revisit and “work out” that formative trauma, not only to have the opportunity to play out the drama with the odds evened up a bit, but also out of an inborn and perverse attraction to horror itself: the
Todestrieb
(“death instinct”)
, Freud called it.