- A report on APPI Congress 2009
The papers presented to this day-long Congress covered a range of clinical phenomena: depression, melancholia, mourning, grief, suicide. A single theme unified these diverse presentations: that the treatment of depression requires an understanding of the unconscious – in transference, memory, affect, speech and the diagnostic structure of the analytic subject. According to the World Health Organisation, depression is a global political and socio-economic problem. It poses the second greatest public health concern today, after cardiac illness. The figures on suicide in Ireland are even more unsettling; Ireland has one of the highest youth suicide rates in the EU and our suicide rates continue to increase alarmingly as our economy contracts.
According to one paper, the recent flurry of suicide-containment strategies has been ‘politically acceptable but is not evidence-sustainable’. Depression, often self-diagnosed by the client, is the most popular diagnosis in today’s clinic. In a discussion of depression as a cultural phenomenon, it became clear that the modern discourse of ‘entitlement’ – the ‘right’ to happiness – has contributed to the universal complaint of depression. In a culture obsessed with possession, there is no articulation of loss or lack. In the psychotherapeutic clinic, depression – Freud’s melancholia - is a dis-ease of the unconscious, an ‘illness of truth’.
Psychotherapy does not promise a ‘quick fix’ or an easy answer. It is a treatment aimed not alone at treating the presenting symptoms but at developing insight and self-awareness so as to improve the overall quality of life. It is a complex process that can be quite difficult at times. Then the judicious intervention of the therapist in the transference holds the client, modelling containment and facilitating the continuation of the work to its resolution. The psychodynamic treatment of depression differentiates between sub-types (melancholia and mourning) and structures (neurotic and psychotic) and between stages of affect: pathological, reactive, acute, etc.. This method of treatment is at odds with that offered by other disciplines, such as psychiatry and psychoactive medication.
In the analytic discourse, within the transference, we explore the symptom in the context of the client’s history and speech in order to reveal the unconscious, underlying truth of the relation to the lost object. In analytic therapy it becomes possible over time for the client to paint a self-portrait s/he can live with, a story of him/herself that is grounded in a coherent narrative that integrates loss. MarieWalshe/Agalma/2010