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Can we talk?

Or should we just wash the car and chop some veggies?


I was not exactly a sunbeam for Jesus as an adolescent. I had a habit of holing up in my bedroom, listening to Bob Dylan and reading morbid poetry. I was, in short, depressed most of the time.

My father, garden shears in hand, sometimes stood outside my window and dispensed advice. "Turn off that depressing hillbilly music," he'd yell. "Get out in the sun and do something physical. You're just making yourself depressed." Indeed, I'll never forget the Saturday afternoon that my parents, first prodding me awake with brooms, dragged me away from my bed full of books and threw me into the sunlight and fresh air like a vampire. They ordered me to wash my car. I confess I became a compulsive washer of my beloved MG.

I have been depressed most of my life. I've done more therapy than Woody Allen. Although the enterprise has often been interesting, it hasn't done nearly as much as pharmaceuticals for relieving my symptoms.

My experience is quite typical, according to the Feb. 23 issue of The New York Times Magazine. Lauren Slater's article, "Repress yourself," brings into question the enterprise of talk therapy in favor of an approach more like the one my father recommended.

Slater's article is immediately inspired by observations of what happened when droves of psychotherapists descended on New York City following the Sept. 11 tragedy. Therapists urged the survivors to retell their experience. The idea is that the resulting expression of feeling is inherently healthful. Instead, many people got worse. This is consistent with findings of several recent studies.

The significance here is that the notion that trauma needs to be remembered and catharted is at the core of psychotherapy since the genesis of most psychological disturbance is presumed to be trauma of some sort. The dirty secret is that this often doesn't work. Primal therapy, for example, depends almost entirely on memory and catharsis but often turns into something like a lifestyle for its clients, who organize getaways at resorts to scream at the ghosts of their mothers many years after first entering therapy.

The new research suggests to some clinicians that instead of encouraging memory and expression, they should be encouraging repression. The use of the word "repression" in this context is problematic. For Freud, repression was an often necessary defense but an unconscious one. In his theory, the ego protects itself from a conflict between the instinctual id and the socially adapting super-ego. The threatening material, sexual in his imagining, is pushed into unconsciousness to relieve the conflict. This is only problematic when the repressed material, because of its degree or intensity, erupts by creating what we call neurotic symptoms.

Contrary to the understanding of many clinicians, Freud posited suppression, willful conscious control and a better word for what is being advocated in Slater's article, as one means of resolving conflict. (You can't willfully repress something since the process is unconscious.) He also recommended sublimation, by which the problematic id's energy is redirected into a more productive enterprise, or, if possible, satisfaction of the id's demands by opposing conventional values.

Thus the idea that Freud posited rumination and catharsis alone in every case is yet another invention of the American psychological industry. As Slater writes, the trauma industry is very profitable.

I find myself conflicted about this subject. It is absolutely true that about 11 years ago when I went on Prozac, the most astonishing effect was to be able to put dark ruminations aside. This in turn resulted in a remarkable increase in my productivity, which seemed in turn to increase my general sense of well-being. It is also true that this effect eventually wore off.

However, I did glean from the experience some truth in my father's advice: Depression is fed by rumination. And activity is one way of disrupting that process -- if you can find the energy to do that. In Slater's article one therapist, who says she healed her neurosis by taking up tennis, devotes her practice to helping clients find the energy to become active. Clients in her women's shelter are encouraged to cook or type their resumes instead of sitting and talking.

For me, the truth lies somewhere in-between. After my own clinical training, I became very disenchanted with talk therapy but equally unimpressed by new cognitive therapies preoccupied with symptoms. I don't mean that this approach might not be of use. I, as cursed as Oedipus always to ask "why?" just find it uninteresting. I don't find relief unless I find meaning.

When I look back to my adolescence, I do think it would have made a huge difference had there been someone sympathetic there to hear what I was going through -- maybe even to suggest that "why?" is not always the right question. My father could never have understood how vast a space he was asking me to travel by "getting outside" -- and unfortunately, an adulthood of therapy later, I often still find that space very difficult to travel. But I usually manage to.

Next week, I'll write about my own solutions in this respect.

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