Hidden in plain sight: Creating space for the elusive “me” of depression.

Abstract

Institute for the Psychoanalytic Study of SubjectivityThe setting is a psychiatric inpatient unit where I conduct groups for patients diagnosed with depressive disorders. In some respects, the group members' presentation fits with the symptoms for the depressive disorders outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). However, there is an emotional configuration of depression that also emerges during the group therapy sessions that is less easily defined. It is a self-state that is not dissociated but, rather, experienced by the patients as distant and only somewhat recognizable. It is what I call a state of "distant or unfamiliar me." For many reasons, these patients struggle to give voice to this emotional experience. Yet, they seem to have greater access to this self-state when attending group therapy on the inpatient unit. In this article, I describe the nature of this self-state and the act of "witnessing" that occurs on the unit and that facilitates access to what often remains a shameful, sequestered aspect of self. In addition, I focus on the complex system created by the integration of psychoanalysis and the medical model, and how this unique configuration impacts the patients' access to different self-states. Finally, I describe how utilizing my own history of suffering contributes to the therapeutic process and aids in the patients' capacity to create meaning and bridge the gap between distant states of self.