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THE ROOTS OF DEPRESSION IN A SUICIDAL
CRISIS: A TRANSPERSONAL APPROACH
This paper was presented at the Symposium 'The Psychopathology of
Depression', organized by the World Psychiatric Association, Department
of Clinical Psychopathology, Helsinki, Finland, 10 - 12 June, 1979 and
published in Psychiatria Fennica Supplementum 1980.
Léo Matos
ABSTRACT
In this paper an attempt is made to define depression and to explore
its roots by bringing it into the context of human experience of
reality. Also discussed is the issue of dualism in cognizing inner and
outer reality as an important factor in the formation of depression.
Symptoms of depression are defined and a theory about the reasons of
suicidal behavior is presented. The author further introduces the
technique of psychological ego-death-rebirth for treating depression
and suicidal tendencies.
Depression is defined in the Webster Dictionary as something lower than
its surroundings, and the verb to depress means to press down.
Accepting this semantic significance of the word depression, we can ask
what the depressive patient is pressing down which causes his disease.
Attempting to throw some light on the roots of depression I want to
elaborate the hypothesis of what a depressive patient is pressing down,
which then emerges as the symptoms of depression.
Freud (1953) showed in his paper "Mourning and Melancholia", first
published in 1917, that there was a similarity between mourning and
melancholia (as depression was then called):
"a profoundly painful dejection, abrogation of interest in the outside
world, loss of capacity to love, inhibition of all activity".
Freud concluded this article assuming that:
"melancholia consists in mourning over loss of libido"
Loss of libido could be equated with loss of his aliveness.
The basic characteristic of life is change, although very often we
experience life as composed of an almost infinite number of separated
objects, people and situations, more or less fixed and predictable.
When we lose a loved object, or lose an illusion of an expectation we
may get depressed because we had directed our life energy (libido)
towards a fantasy, a constructed reality of how the future should and
would be. Lowen (1976) says that:
"A depressive reaction occurs when an illusion collapses in the face of
reality".
REALITY
Reality is experienced differently by different people at various times
of one's existence. We know that the experience of reality, or better
realities, is dependent on a series of factors, as for example our
social conditioning, the environment stimuli, our age, and above all
the specific state of consciousness we are experiencing at a certain
time.
In an ordinary state of consciousness we assimilate and interpret
sensory data in unities of meaning. We look at the world around us and
our eyes select certain information which will ultimately be "archived"
as a partial picture of the physical reality. Our senses are not able
to grasp the whole process and interchangeable way of existence of the
outer and inner universe. We see the world as composed of many
different things, which are separated from each other by space and
consequentially we are cognizant of a picture of the world as
consisting of more or less static entities. If I look for example at
the solid and beautiful building of the Royal Library in Copenhagen, I
will be somehow
experiencing that firm construction as something almost eternal. I will
not give any thought to the possibility that those aggregates which
compose that specific house were not there in that specific place five
hundred years ago, and I do not even think that those aggregates of
molecules and atoms are in constant movement and change. I cannot see
the building getting old, but as a matter of fact, every second this
apparently very solid construction is in constant deterioration, and
even if well kept and repaired, in the long run those aggregates,
dispersed by the wind of time will not be there any longer. This
psychological issue of the cognitive dimension makes us hardly aware of
the change from birth into old age towards death that is happening in
our bodies at this moment. This specific human mode of grasping reality
is probably the main cause of the conceptualization of the universe in
a dualistic manner, making sharp separation between I and you, body and
mind, life and death.
CONSEQUENCES OF DUALISM
The existential consequences of the dualistic way of being cognizant
reflects in our environment representing a wide social spectrum. This
specific way of being conscious of something, may make the individual
feel like an isolated ego flowing in a more or less dangerous ocean,
where he must secure to himself some specific devices to survive in
this specific society. His aim, which is basically the conscious or
unconscious aim of every human being, will be to attain a feeling of
pleasantness in the physical, psychological and social context. In
order to attain his short - or long term goals - he will negotiate with
his social world. It is a clear fact that he will deal with existence
according to the way he is cognizant of his universe. And negotiating
with his universe based on an inaccurate view (the way he is ordinarily
cognizant of his environment and himself) he will have similar results.
He may attain temporary "happiness" but he will always feel threatened
by his environment and the prospect of loss, of being hurt and
eventually dying.
Our actual science and technology is based in a Newtonian-Cartesian
view of reality where the universe is basically experienced in a
dualistic sense and this universe is suggested to be composed of almost
an infinity of separated objects. This concept of separateness is
viewed differently today in modern physics where the universe is
conceived as one gigantic dynamic web. Capra (1975) says:
"In modern physics, the universe is thus experienced as a dynamic,
inseparable whole which always includes the observer in an essential
way. In this experience, the traditional concepts of space and time, of
isolated objects, and cause and effect, lose their meaning".
In the dualistic context the human being is living in at least two
different worlds: one which is the physical world of his everyday life
and the other is his conceptual world, i.e. how he feels, senses,
cognizes, recognizes and computerizes the myriad of information which
he receives from his inner and outer universe. In this case he creates
a consensual reality, which he understands and comprehends in unities
of meaning and in the linear context of past, present and future.
REALITY
It seems that this conceptually created reality of more or less sharp
separateness ( I and the world) starts from the moment we are born and
anatomically separated from our mother, and more specifically when we
learn a code-system called language. One of the first unities of
meaning we apprehend in this system of language is the concept of the
I, or ego (Ego here means the individual's conception of himself, the
way he imagines he is). . In order to identify this ego I need to
separate and add certain qualities to it. In this way I create an image
of myself. This image is not really permanent and changes in the course
of one's lifetime. There are certain elements which are constant in
this image (or identity) such as sex, the quality of being a human
being, etc. There are other qualitative attributes which may vary with
time as for example social and financial status, feelings and personal
qualities and capacities. In this way the human being creates an image
of himself, believing he knows who he is. He identifies himself. And
this identity sometimes appears to him as being very pleasant and
sometimes as being unpleasant, all depending on how his life is
unfolding. He creates an image of how the future should be (he more or
less tries to eternalize or program the future in a certain way). He
has his expectations and hopes that people, himself and situations will
fit the more or less clear or unclear pattern that he has
pre-fabricated or planned. When the world does not react to his created
fantasies of how it should be he may become frustrated and repress
these unpleasant situations. In this way he is storing these traumatic
situations as blocks of static energy, or in other words he is blocking
or storing pain. Other sources of 'stored pain' or traumas have been
situations the individual has been experiencing from pre- and perinatal
experiences to all experiences in the psychodynamic level where the
person was not able to meet his natural needs of development (motherly
nearness and warmth in early infancy, adequate physical conditions for
normal physiological development, emotional security offered by parents
and the general environment, appropriate intellectual stimuli, etc.).
The frustrations and traumatic past situations which the person has not
been able to express were printed in the self image (ego), and later
eventually repressed (forgotten but still being very alive, like a film
with painful emotional connotations in the subconscious). These blocked
painful situations, which now are repressed, may then appear as
depression (or other mental dis-order) and/or as bodily symptoms such
as tenseness, pain and even psychosomatic diseases.
THE SYMPTOMS OF DEPRESSION
The most common symptoms of depression are sadness, feeling of
inferiority, pessimistic views, feeling of tiredness, of being
insufficient, of being discouraged, of hopelessness, tenseness and
change in body position. A feeling of melancholia may pervade the whole
scene with feelings of anxiety, body dis-orders like headache, feeling
of tightness in the head area, lack of appetite and constipation and
eventually suicidal thoughts will be frequent.
Analyzing the above symptoms we will observe that:
Sadness: Feeling produced by the unconscious or semi-conscious
interplay of three different pictures: (1) the subject expects in the
future something from someone, from himself or from some life
situations and he believes that really will be realized; (2) when this
future becomes now and the actual reality shows to be different from
the S's expectations S experiences frustration; (3) S now is seeing
pictures 1 and 2 which are somehow contradictory and then he creates an
image (picture 3) where he sees himself in a situation where he is
dejected and he may stand as 'the little poor abandoned one'. As he
looks at himself in this way (picture 3) a feeling of sadness arises.
As a matter of course what is causing his sadness is not the departure
of a loved one, is not the loss of something precious, and is not the
non-fulfillment of his expectations, but what is causing his sadness is
just a picture (3).
Feeling of inferiority: The S is viewing himself (the self image) as
being poorly equipped in one or various aspects in relation to other
human beings, he is blocking and pressing down (depressing) an image of
himself as inferior, and this image returns to him the feeling of
inferiority. As a matter of fact inferiority is not a feeling but an
image.
Pessimistic views: The S is projecting his image in the future where
some negative event is happening to himself. Again we see him creating,
fixing, pressing together (or pressing down) and depressing an image
which transmits to him an unpleasant feeling.
Feeling of tiredness: The individual is using very much of his
available energies in his repressed conflicts and specially is pressing
down (depressing) himself. Actually what he is pressing down (i.e.
fixing) is some aspects of his self-image, but, as he, in his confusion
and pain, has forgotten that the self image is just an image and not
himself, he presses himself down getting depressed.
Feeling of being insufficient: The S has created an image of himself in
a certain fantasy context where he is not capable of satisfying his own
expectations of a specific performance. Again we note the S fixing and
pressing down a certain image.
Feeling of being discouraged:>/I> The S feels he has no courage
to cope with a certain situation. This feeling comes from an image he
creates of himself of inadequacy. On fixing this picture he gets a
feeling of being discouraged.
Feeling of hopelessness: It is the image or imagination of a hope that
the future will be without accomplishment of the realization of a
positive expectation. The S is fixing an image of a negative future and
in most cases he will not be aware of this fantasy because he has
repressed it.
Tenseness: It is blocked energy and when not duly used but stored in a
block for long period may be experienced as unpleasant, may become pain
and eventually a psychosomatic disease. Here we see the S now blocking
himself, and pressing his own body down by making the body tense. Of
course his making his body tense is done unconsciously, however by no
one else but by the individual himself. Here the body may take a
slightly curved position in the direction of the ground as if the
person would be carrying some heavy load or being pressed down by
something or by himself.
Feeling of melancholia: It is a feeling of sadness (see "sadness") and
dejection. The S fantasize himself being dejected. As he blocks this
picture, he immediately creates another picture (which may appear for
him in a semi-conscious or totally unconscious way) where he sees
himself as 'a little man not loved by anyone and 'pushed down', which
he may call 'poor me', and this picture will give him this feeling of
melancholia.
Anxiety: This feeling is often produced by a fear concerning the
future. The S creates a fantasy of a disastrous future and very quickly
he represses this unpleasant future possibility, and from an
unconscious level this image feeds back fear of an unknown cause to the
person. The person is between the present moment (now) and the future.
He has pressed down the picture of a negative future.
Headache: It may often be produced by tenseness which is a form of
pressing muscles down as in a situation of danger. As the tension is
never released it becomes a headache.
Lack of appetite: It could be interpreted as an unconscious way of
mistreating one's own body in order to make this body sick and in the
long run destroy this body. It could be seen here in this case as a
form of unconscious suicidal tendency.
Constipation: It is another form of pressing some system of the body
down for, unconsciously, not allowing a free flow of noxious material
for natural body purification. This could also be seen as another form
of mistreating one's body towards an ultimate issue of self-murder.
Suicidal thoughts: These are an expression of an attempt to eliminate
(to kill) the self image, which now has been introjected and is
actually confounded with the body (Matos, 1977). This is one way the S
is trying to cure himself from his depression, but as he is mistaking
the body by the self image he may actually murder himself.
THE SUICIDAL CRISIS
In the turning point of his wish for dying the person, who has most
likely been contemplating suicide for sometime, now is ready for his
final act in this life and may be presenting a desperate state of mind,
or be at peace with himself when this final decision has been taken. If
this person is not helped by someone who can handle such a crisis
situation, this person will be in close danger of meeting his
biological demise.
To understand the mechanism of the language of suicide within a
theoretical framework, I propose that the act towards self-elimination
is caused by five basic, often unconscious, wishes. These wishes or
psychophysiological needs are the motivations and purpose for
committing or attempting suicide:
1. Attention
2. Revenge
3. Moving away from an unpleasant situation
4. Moving to a better situation
5. Peace (Peace in this context means harmony with oneself and with the
environment)
Any type of suicide will fall in one or more of the above categories
and the ultimate motivation of all suicidal persons is to attain a
final state of peace. Rechardt (1976) elaborating further the theories
that Freud presented in his work "Beyond the Pleasure Principle",
states that the 'Instinct of destructiveness" is a psychological
mechanism to get rid of inner and outer disturbing stimuli. And seeing
this in relation to the self destructive act of suicide we can easily
comprehend that this endeavor to free oneself from physical and
psychological pain is one way of attaining peace.
Achte (1976) clearly states:
"Today it will hardly be denied that very often - if not in most cases
- the wish "to be dead" in the mind of the person concerned only
amounts to a wish to attain peace and safety and to regain a previous
state of security".
The obvious question in this context is why then, a human being
searching for peace, will attempt to kill his body.
Charon (1972) says that the notes left by most suiciders indicate a
striking preoccupation with the things of this world, especially human
relations, which contrasted oddly with the wish to die. Here it seems
that we are facing a paradox. And this paradox is explained when we
realize that the individual is not trying actually to kill his body but
is trying to eliminate a disturbing self image. The only problem now is
that he may be merged in pain and confusion and mixes issues, i.e.
instead of eliminating the negative self image he will attempt to
destroy his body bringing eventually his biological death.
THE TRANSPERSONAL APPROACH
Transpersonal psychology is a science which approaches and studies man
in his wholeness. Here man is not only seen as an individual per se or
an individual in society, but the ecological and cosmic relationships
are of utmost importance. In this way transpersonal psychology
encompasses other scientific approaches such as medicine, anthropology,
sociology, physics, chemistry, mathematics, astronomy and metaphysics.
This "new" science is basically intercultural, and in this way other
cultures from all times, with their various approaches to life
(psychological, religious, medical, etc.) are studied.
Transpersonal psychology uses elements of other schools of psychology
such as behaviorism, psychoanalysis, Jungian psychology, humanistic
psychology, and specially studies human consciousness which transcend
the person and the ego concept. Therefore transpersonal psychology can
be defined as the scientific study of states of consciousness.
The model of transpersonal psychology is very close to the
quanta-relativistic model presented by modern sub-atomic physics (see
Matos, 1978).
Among the many psychotherapeutic techniques developed by the school of
transpersonal psychology and psychiatry it seems that the most powerful
approach for treating and eventually curing suicidal tendencies is the
psychological ego-death-rebirth experience.
PSYCHOLOGICAL EGO-DEATH-REBIRTH
EXPERIENCE
In ancient cultures, and in Oriental countries in particular, learning
to die is considered an indispensable and integral aspect of the art of
living. In various mystery religions, temple mysteries and initiation
rites performed over millenia in many different countries of the world,
persons were guided to experience their psychological death and
rebirth. This procedure performed up to our days within a shamanistic
and tantric frame of reference is supposed to result in spiritual
enlightenment and make possible for the initiated to live for the rest
of his life in a more fulfilling and meaningful way. Concomitantly this
experience is supposed to prepare him for dying. Manuals for dying as
old as the Egyptian and the Tibetan books of the dead revealed
intricately complex psychological practices and were considered manuals
preparing a person for the ritual of death-rebirth, as well for the
actual experience of death.
Grof (1970, 1972, 1972a, 1972/1973, 1977) working independently of
other investigators with LSD therapy and without previous knowledge of
shamanistic and tantric practices of the death-rebirth technique
encountered this therapeutic issue when applying psychedelic peak
psychotherapy (Grof, 1976).
As we know, from ancient cultures, this technique can as well be
employed without the use of any drugs. Working within a transpersonal
framework and without the use of drugs I have developed a technique for
bringing a person to this psychological issue of ego-death-rebirth.
This technique can be illustrated by the following clinical example:
John is a radio telegraphist, 31 years old and he has been traveling
around the world several times serving in ships bearing flags of
various nations. He is in a very depressive mood, which he claims he
has been coming in and out during the last five years. He had tried to
commit suicide in several occasions and came to therapy in a suicidal
crisis. He told me that he had fought again with his girl friend,
beaten her and was beaten by her, was very depressed and wanted to
commit suicide. He seemed to be in a desperate mood and complained that
destiny "did not let me die 3 months ago when I prepared everything for
a beautiful death". The following dialogue took place:
Therapist: How did you try to commit suicide?
(The attitude of the therapist here is of paramount importance, he
accepts the genuiness of John's wish for committing suicide because he
knows that John is in pain and confused and what he wishes really is to
attain peace by eliminating his negative self image. Verbal
communication and specially meta-communication play a decisive role in
the unfolding of the therapeutic process. Here the therapist does not
ask John why he tried to commit suicide, but asks how to allow John
feel again the emotions connected to his self-destructive reaction).
John: I took some sleeping pills.
T(herapist): How?
John: Well, I prepared everything to have a beautiful death.
T: Tell me your experience.
John: I was very depressed, it seems that everything went wrong to me
in my life, I was feeling hopeless and there was no future for me. So I
decided to plan my death. Near my apartment is a very beautiful park
and I decided that I would take some sleeping pills and before they
would start to take effect I would drive my car to that park, lie under
a tree and let myself die among that beautiful green nature.
T: And what happened?
John: Well, the pills took effect before I had expected. When I started
to drive my car I fell asleep and they found me out in my car and took
me to the hospital.
(The therapist notices that John is beginning to relive his past
suicidal experience, and gently asks John to lie on a couch, to relax,
close his eyes and tell again his experience in the present tense, as
everything would be happening now.)
John repeats his story in the present tense, now much more involved in
his whole drama, which when told in the past tense was just like the
story of someone else. Now he was living again every detail and emotion
of his suicidal adventure. When he came to the point of falling asleep
in his car, the therapist gently intervened telling John:
T: Now I want you to fantasize that no one will find you in your car
and that you will really die from the effect of the sleeping pills.
(Usually it is not difficult to the patient to let his own unconscious
fantasize - like in a dream - the continuation of a whole scene which
he is living now in describing it in the present tense, lying down
relaxed and with closed eyes.)
John keeps silent for few seconds and then continues.
John: I am dying now, it's soft, I am not afraid... now my breath has
stopped... I am dead.
T: What are you seeing now?
John: ... I can see my body lying in the car... it's like I am floating
out of my body.
T: Where you are now, that you can see your dead body?
John: ... I am in the air... I am floating. I can see the car down
there, my body, the street and the houses.
T: How do you feel now?
John: I feel good. It's a very pleasant feeling to float. Now, there is
a very wonderful space... I feel I am floating upward, like an
irresistible force is gently carrying me upwards... Now I see
everything down there as far away and unimportant...
John continued in this inner journey for about 45 minutes, describing
unusual scenes of great beauty, some of it frightening. He encountered
archetypical phenomena, finally ending with an awesomely beautiful
vision of a golden sun. He could feel the warmth of this magnificent
sun replenishing him with life, and in his words he was feeling like he
was being born anew.
After this experience John felt elated, his eyes were shinning with
light and he seemed to be at peace with himself. He declared that he
was experiencing at that moment a profound peace, and that all his
previous problems which he had seen as overwhelmingly disturbing and
unsolvable were now of little significance. And he realized that most
of his problems were caused by the workings of his own mind. Asked how
he felt about suicide now, John replied that it did not exist for him
now. He was feeling himself now young and the prospects of life for him
were like an exquisitely peaceful and fulfilling adventure.
His feeling of elation and profound peace lasted for about 2 weeks.
After that he told that he had become "visible again". He meant now he
was feeling well without being depressed, but not any longer
experiencing a pleasant high state of consciousness.
In the 5 years following this experience John did not feel any need for
regular therapy and his depressive suicidal states never occurred
again. He felt, what he explained, in the course of these last 5 years,
some experiences of "mild depression" but soon he was feeling all right
again.
Not all persons undergoing the psychological ego-death-rebirth process
have exactly the same experience as John. Some persons have very much
difficulty in passing the threshold of life into this psychological
experience of dying. A few persons will first come to a dark space or
tunnel, will hear sounds (usually described as ringing bells) and see
different places described as fairy tales scenes with preternatural
colors. Others may have very unpleasant experiences, seeing places
reminiscent of the descriptions of the Christian purgatory and the
hells of various cosmologies, before entering into spaces of more
pleasant experiences, and finally being able to experience their own
psychological rebirth.
It seems that the experience of psychological ego-death-rebirth has a
powerful effect on treating depression and suicidal crisis, however the
material we have accumulated until now is too restricted to come to a
final conclusion. It seems to me that this technique could be used with
other methods of transpersonal approaches in conjunction with methods
developed by other schools of psychotherapy with beneficial results.
REFERENCES
Achte, K. (1976). On some psychodynamic mechanisms associated with
suicide. Proceedings of the Seminars of Suicide Research Foundation
1974-1977, Psychiatria Fennica Supplementum, 1976.
Capra, F. (1975) . The Tao of Physics. Berkeley: Shambala
Charon, J. (1972). Suicide. New York: Charles Scribner's Sons.
Freud, S. (9953). Mourning and melancholia. Collected papers, Vol. IV.
London: Hogarth Press.
Grof, S. (1970). Beyond psychoanalysis: IV. A conceptual model of human
personality encompassing the psychedelic phenomena. Paper presented as
preprint at the Second Interdisciplinary Conference on Voluntary
Control of Internal States, Council Grove, Ka., April 1970.
Grof, S. (1972). Varieties of transpersonal experiences: Observation
from LSD Psychotherapy. Journal of Transpersonal Psychology, 1, 45-80.
Grof, S. (1972) Theoretical and empirical basis of transpersonal
psychology and psychotherapy. Observation from LSD research. Panel
discussion on transpersonal psychotherapy at the Annual conference of
the Association for Humanistic Psychology at Squaw Valley, September
1972.
Grof, S. (1972/73). LSD and the human encounter with death. Voices: The
Art and Science of Psychotherapy, 8, (4), Issue30.
Grof, S. (1976) Realms of the human unconscious: Observations from LSD
research, New York: E.P. Dutton.
Grof, S. and Halifax, J. (1977). The human encounter with death. New
York: E.P. Dutton.
Lowen, A. (1976). Depression and the body. New York: Penguin Books.
Matos , L. (1977). The language of suicide: A psychotherapeutic
approach. Paper presented at the IX International Congress on Suicide
Prevention and Crisis Intervention - Helsinki June 20-23, 1977.
Matos, L. (1978). Transpersonal psychology. Paper presented at the
Jubilee-Congress of the International Psychology Society, Luzern,
Switzerland, October 1978.
Matos, L. (In Press). Body and mind: The Interplay between muscular and
cognitive states.
Rechardt, E. (1976). Tuhoavuuden psykologiasta. Medisiinari, 1, 19-23.
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