Damian Ruiz
Major depression affects between five and seven percent of the American and European population.
At the therapeutic level, the combination of psychotropic drugs plus psychological treatment is what is commonly used for people suffering from this disorder. In severe cases, brain stimulation therapies have been tried.
The results are ambivalent but, to date, nothing has been shown to be sufficiently effective to consider that there is a single adequate therapy. It will always depend on the patient and their idiosyncrasies and complexity.
As far as I am concerned, I work on the hypothesis that every psychological disorder has a biological component, probably a genetic predisposition, plus a circumstantial trigger. And the biochemical cannot be influenced because it sets the trend, but what can be done about what has been embedded in the psyche of the person, whether it is something experienced in the womb (Frank Lake, 1914-1982), in the first moments of life (Wilfred Bion, 1897-1979, Donald Winnicot, 1896-1971) or later.
In any case, the experiences suffered with a clear traumatic component, be it one-off or over a shorter or longer period of time, are, in the vast majority of cases, essential for the biological predisposition to be activated and even become chronic.
So let us imagine someone who, in the depths of their unconscious psyche, all that information that cannot be processed by the rational brain but that conditions the person’s life, experiences a conflict of very opposing psychological forces, for example the tendency towards self-destruction (thanatic impulse, Freud, 1856-1939) and the tendency towards transgression in real life, transgression, for example, of the moral code of the surrounding family or ethical environment. These are very powerful nervous energies that can lead to prostration and disqualification from life.
Let us imagine that through various techniques, dream analysis, projective exercises, therapeutic and analytical dialogue, etc., we discover the great underlying conflict. The question is, in that case, what we do from there.
Psychopharmaceuticals, which I am in favour of if they improve the patient’s condition, can also strengthen the conflict because they act in a generic way, in a way of providing new reinforcements to each of the combatants.
Therefore, once the patient recognises the internal struggle, the inner oppositions that are latent internally, and this has required previous therapeutic work, it is necessary, in my opinion, to move on to action.
But the action must have a meaning, it is not a matter of going for a walk, doing sport and distracting oneself, if only it were that simple. The action must be focussed on getting the eros (life) drive, even if it is in an inferior condition, even if the death drive is much more powerful, to come to a point where it wins and brings the patient back to ‘real existence’.
This action, at the beginning, must be almost unique, and must be repeated over and over again until the person incorporates it as a routine and even if it takes an enormous amount of work to perform it.
In some cases the combination of body exercises and a certain type of breathing, a contact sport such as boxing or the practice of African dance, as an example, can begin to be the turning point, not in itself the solution, but that which initiates the change. If the patient does not feel capable of initiating these movements, it will be necessary to start little by little and perhaps in a much simpler way, but the action, however small it may be, is essential. But I insist, not just any action, but one that makes sense. Personally I detest the idea that a person affected by a non-organic psychic disorder should have to distract himself or learn to manage it in order to make it more bearable. A therapist must go, by all appropriate means at his or her disposal, to try to overcome the problem or reduce it significantly, and sometimes this is achieved and sometimes it is not, but if the starting idea is limited there is probably little that can be done. Another thing is when there is a real organic condition diagnosed and confirmed by medical tests.
Throughout my life, besides psychology in its biological and psychoanalytical aspects (especially Jungian, my training), I have been interested in anthropological and ethological questions, reading about the behaviour of animals, especially primates (Frans de Waal, 1948-2024), but also about different rituals and actions of primitive tribes used to heal mind and body, and although all of these are discarded nowadays, perhaps those linked to ayahuasca or other hallucinogenic substances, which can become addictive and, of course, counterproductive for people with a fragile psychic structure, it is information that can offer interesting aspects to take into account.
Deep depression is, at present, so personal, i.e. it responds so much to the idiosyncrasies of each patient that treatments can only be personalised. Perhaps one day science will find ‘the method’, but today we have to work therapeutically with all the procedural complexity that this implies.