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How Psychoanalysis Understands Depression

UnderstandsDepression is one of the most common mental health conditions that bring people to therapy. Similar to anxiety, a diagnosis of depression tells us little about the person coming to see us, about their life or about the reasons behind the depression. Also, just like with anxiety, it is common for people to feel depressed under special circumstances such as losing a loved one, going through a divorce or undergoing a drastic change in life. Usually, we don’t even call it depression because it doesn’t warrant professional intervention and we somehow manage to get out of it using our innate resources.

Signs of depression

What we refer to as clinical depression, however, is different and includes a number of other, observable symptoms and behaviors for a prolonged period of time, typically longer than six months:

  • poor or increased appetite,
  • drastic fluctuations in weight
  • lack of motivation,
  • feeling apathetic or lethargic and/or “heavy”
  • social withdrawal/limited social interactions
  • unwillingness or inability to engage in productive activity, missing out on school, work or family events
  • feeling hopeless and/or helpless
  • thinking about death or suicide; wanting to just put an end to it, end the pain
  • suicide intent and/or suicide attempt – In extreme forms of depression, the risk of suicide can be severe and it is our number one priority in therapy to make sure that our clients stay safe. This is usually the point in treatment when the treating psychiatrist will prescribe medication to ensure that the person’s mood stabilizes and the risk for impulsive, self-harming behavior is reduced.

Depression is a (psychoanalytic) symptom

As I explained elsewhere, from a psychoanalytic point of view, depression is a symptom; a symptom of something else that has not been put into words, has not been expressed and is finding a way out through our body, making us depressed. That something could be years of childhood abuse and/or neglect; other traumatic experiences, including war, loss, death, rape, violence, or any kind of physical, emotional or political hardship; hurtful family or personal events; living with an abusive parent or a partner, etc.

It is impossible to name all circumstances that could lead to depression and honestly, it would be fruitless. Every person is unique and what may be traumatic and leading to depression for one person may not have the same psychological impact for another. What’s important is that we recognize that something is off and that we need help to address it.

The cure is in the therapeutic process

As psychoanalytic psychotherapists, we are not just interested in treating the symptom of depression but rather, we want to find the cause of the symptom, the reason why you are depressed. However, simply naming the reason for the depression is not enough to overcome it either.

The therapeutic process itself, which goes hand in hand with the therapeutic relationship, is what brings about change, not so much the facts named or spoken about. As human beings, therapists cannot change what happened to people even if we wanted to. But we can change the way people are treated, the way they think about themselves and the ways they allow themselves to feel about themselves and others in their lives.

It takes time

With some forms of depression, this takes time, sometimes years. The more severe the depression, the longer it takes to overcome it. Relationships are often impacted by the devastating effects of depression and regaining a sense of trust in people cannot happen with medication alone and outside of a therapeutic relationship.

I wish I could say it is easy to cure depression but unfortunately, I can’t. Nothing really comes easy in life but one thing is for sure, those who haven’t tried, haven’t succeeded.


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How Psychoanalysis Understands Depression

Mihaela Bernard, MA, LCPC

Mihaela Bernard, MA, LCPC is a licensed clinical professional counselor and founder of Inside Family Counseling, LLC in Chicago. She is a Professional Member of the American Counseling Association and a member of Chicago Psychoanalytic Circle of the Freudian School of Quebec, Canada. She is the author of Mental Health Digest electronic magazine, your free, easy-to-read electronic resource on common mental health issues affecting you and your family, plus some suggestions on how to address them. She specializes in psychoanalytic psychotherapy for troubled children and adolescents, who face behavioral and emotional challenges at home and at school. Her mission is to empower, support and guide children, adolescents and their parents to a happy and healthy family. Mihaela also writes a Parenting Blog, where parents find helpful resources and practical tips on how to support their child and adolescent's behavioral and emotional development. You may find out more about her at

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APA Reference
, . (2019). How Psychoanalysis Understands Depression. Psych Central. Retrieved on July 12, 2020, from


Last updated: 28 Mar 2019
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