Clinicians with a psychodynamic orientation have long recognized the role of suppressed anger in the onset of depression. One body of research has found that releasing anger in therapy sessions can help allay some of the symptoms of depression, particularly for patients whose condition has not improved using other therapeutic methods. A group of European researchers writing in 2021 found that some patients suffering from depression improved in treatment by expressing anger. This group of patients experienced relief from symptoms if they were able to form an alliance with their therapists or if they were able to achieve insight into the factors contributing to their depression.
In his 1917 essay, “Mourning and Melancholia,” Sigmund Freud developed his theory that depression is anger turned inwards. While Freud’s concept has been vigorously disputed, it has survived more than a century and still informs research and treatment for depression. The authors of the study, “The Anger-Depression Mechanism in Dynamic Therapy,” recognized Freud’s lasting influence when they wrote, “The conceptualization of depression as a psychological state of inverted anger is a central principle when treating [depression] in psychodynamic therapies.”
Lending further support to Freud’s original formulation, Joel Town and his fellow researchers in this study noted previous literature in which patients with depression reported suppressing anger, and those patients experiencing higher levels of symptoms. Town and his co-authors also found that no previous studies on this topic had looked at how the expression of anger in treatment sessions affected subsequent levels of depression symptoms.
Patients who report feeling depressed have often experienced some sort of loss in relationships. These losses can lead to anger toward relationship partners, which leads to guilt over the anger, which then leads to turning the anger against oneself, and finally to symptoms of depression. Town and his co-authors said their study was the first one to record improvement in symptoms following patients’ expression of anger in treatment sessions.
Their study also noted two possible pathways by which this reduction in depressive symptoms could occur. Patients who had difficulty maintaining a healthy sense of self and others after releasing strong emotion benefited from a close and supportive relationship with their therapists, the study said. Patients with a more stable sense of self and others benefited from an “insight-oriented” approach that supported their desire to find meaning in the expression of strong emotion.
Our Treatment Center therapists and analysts employ both relational therapy methods and insight-oriented treatment techniques. They recognize the connection between anger and depression that analysts with the Institute have cited down through the years.
Institute analysts who have observed this connection in their own work include Barbara Fajardo, who noted nearly 40 years ago that turning anger into humor can sometimes help new mothers in emotional distress avoid post-partum depression; Roy Grinker, whose own research into anger and depression predated the study mentioned here by more than 50 years; and Bernard Kamm, who observed a “grouchy, sulking, pouting” type of depression in many of the military veterans he treated in the late 1940s.
