Depression and anxiety are closely related because each feeling is a reaction to stressful events. Patients who have endured such events in the past or present will often feel depressed about it, while they will feel anxiety because they are worried about such events happening in the future.
Patients may suppress the impulses that they associate with stressful events, if they believe that acting on a given impulse led to a stressful event. They would rather avoid a repetition of that event than satisfy an urge that they believe played a part in leading to it. The very act of pursuing pleasure can lead to feelings of displeasure.
In addition to defensive measure against impulses that cause them problems, some patients will take steps to ward off feelings of depression and anxiety, and these defenses can be so effective that these patients will not feel these sensations at all. The cost of suppressing these unwanted feelings so thoroughly is often some functional impairment, as well as some loss in the ability to feel more pleasant emotions.
In his 1982 book, The Mind in Conflict, New York analyst Charles Brenner outlined some of the ways that adults will strike bargains between conflicting impulses. These “compromise formations” represent a middle ground between a given desire and the prohibition against it. Each of these opposing impulses arises in the same person, creating a conflict that people must resolve well enough to go on functioning.
In the chapter entitled, “Anxiety and Depressive Affect in Pathological Compromise Formations,” Brenner states that conflicts generally lead to anxiety and depression, regardless of whether a person’s compromise solution is healthy or unhealthy. They become pathological when, among other problems, the anxiety and depression that they generate becomes too much for the patient to bear.
In these instances, when patients may feel as if they can no longer bear the burden of anxiety and depression, they may appear to have no conscious awareness of either sensation, Brenner says. In fact, patients whose anxiety or depression appear as physical symptoms like paralysis may have no concern about their paralysis itself, no matter how crippling it may be. They may also have no conscious experience of the depression and anxiety that led to it. “Counterphobic” patients who rush into dangerous situations rather than avoiding them may also have no conscious sense of anxious or depressive feelings, as do patients who manifest very overt or exaggerated feelings of elation.
A more common experience among analysts is patients who do not care that their symptoms are interfering with their ability to find satisfaction in life or even to avoid pain. Analysts frequently encounter patients who may glory in an eccentric lifestyle full of incapacities and inhibitions serious enough to warrant the label of “pathological compromise formation.”
In addition, some patients may avoid the situations that cause them anxiety – such as flying, going over bridges, or using public toilets. Others may engage in rigid patterns of thought and behavior. As long as they can continue these patterns, then they may be able to hold anxiety and depression at bay, unless something keeps them from using these avoidance tactics.
In cases such as these, analysts will try to determine what events precipitated these problematic patterns of thought and behavior. They will try to determine what kinds of memories have taken root in the patient’s mind and how they have affected the patient’s development and functioning. Analysts will use such methods as free association and dream interpretation to gather this information.
Psychoanalysis can help patients recall memories they may have blocked, memories that have led to distressing feelings that they suppress at the cost of higher functioning. The memories patients recall often have to do with childhood fears that analysts can help them work through. Simply explaining or clarifying the problem often brings patients significant relief.
