Yours, mine or the machine's?

She had walked in to my office with a slightly deferential air but through the veneer of respect, I could tell she was seething.  So, she said moments after the pleasantries, we have been telling Manish that he needs to get it together, for the sake of his family, for the sake of his children, and for his own sake. I listen silently, wondering what is coming next.  But doctor, I hear you have been telling him that whatever he is feeling is ok? I open my mouth and then close it.  Do you know doctor, she says looking me through eyes that suddenly looked veiled with pain, how much I would like to be the one having a breakdown?  But I can’t afford to, he can’t afford to and we need your help in getting him to buck up, move on, stop feeling sorry for himself and starting acting normal.

Breakdowns are often seen as being irresponsible and selfish.  This is particularly true amongst people of Indian origin for whom family responsibilities and role-expectations typically play a huge role in an individual’s psychic make-up.  When a breakdown happens, what has typically worked does not work anymore, and the family system feels a shift in its overall levels of efficiency and functioning.  Yet efficiency is not life’s only goal. Reacting with compassion to other people’s breakdowns, difficult though it may be, is critical to helping heal it.

I struggled for weeks with Anjana’s conceptualization of her depressed son—who had recently made a suicide attempt—as someone who was lazy and avoidant of his family responsibilities.  While I do think its possible to use emotional problems to avoid responsibilities, I don’t think its fair to say that emotional difficulties are generated by a desire to avoid responsibilities.  In other words, not going to work may be an outcome of a terrible depression but it’s rarely the case that someone is generating a depression principally to avoid work.  At the hospital where I saw Manish, the biomedical model of depression offered this counter to Anjana: “your son is not lazy, he has an illness called depression that can be treated by a medicine and some psychotherapy”. I myself always felt the need for an explanation that was a little more lucid than “it’s a disease”. Depression is much more complex than the common cold or the chicken pox and to group them together as “diseases” may appear efficient in some ways yet is rather limiting, not to mention peculiarly disempowering to the person experiencing it and strangely empowering to the medication  (to be discussed further in another blog post). 

My own counter to Anjana was two-fold: first, I told her I thought Manish needed some time to process and accept the fact that he had been abandoned by his wife (a recent event that occurred prior to the onset of this “depression”) and second, being characterized as lazy and avoidant by his family was making him feel worse, not galvanizing him into improving himself as they had expected.

However talking to Anjana about this did very little. I had to show her—by pointing out Manish’s defensive body language and responses to her during a three-way meeting —that Anjana’s injunction to him to “buck up” was actually putting him down.  When she could actually notice visually that her son was reacting very poorly to her comments Anjana quickly capitulated.  An intelligent woman who was truly fond of her son, once she could see that she was hurting him further she became willing to drop the repetitive rhetoric about family values that she had been spouting and was available to listen to Manish in a different way.

My guess is that although there was a breakthrough in that moment, unless she became very motivated to change, Anjana would probably tell Manish again that being depressed was a dereliction of duty. Although she wanted Manish to get motivated and change she herself—apart from that breakthrough moment when she saw how much her son needed her to change—did not have a motivation to change. Manish was the designated patient, not Anjana.  As a therapist, though I had intervened to facilitate more productive, less violent communication between the mother and son, because she had not identified herself as a patient, I had not addressed Anjana’s sense of anger in our first meeting, nor her envy.  Yes envy.   Days after they left the hospital and years later today, I still hear the poignancy of her words echoing: Do you know doctor, how much I would like to be the one having a breakdown?

Family Systems theory in psychology—embodied by psychologists such as Murry Bowen, Salvador Minuchin and Virginia Satir—conceptualizes individual breakdowns as manifestations of dynamics that are taking place in the bigger system of the family.  According to Family Systems theorists, if we are going to think of depression as “symptoms” of an illness then at minimum it's important to acknowledge that the illness is also happening in a larger whole, even if the symptoms are happening in one person (anyone who has felt physically sick or unable to speak for hours after reading a photoessay on the war in Afghanistan can understand the logic of this argument).

There’s plenty to read about intersecting family dynamics and it impact on individual mood in the popular press as well as in the psychological literature so I won’t say much more about it here.  What I want to emphasize is that breakdowns—periods of time that demand authentic attention and where we cannot or must not continue living the way we have been living—do not stand aside from human experience, they are part of the human experience.  Ignoring your own sadness or anger in order to “get on with it” not only begs the question of what the it is we are getting on with, but also demands from us the automaticity of efficient machines.  Shutting out the voices in ourselves that are asking for healing by robotically continuing with our day to day functioning robs us of the very humanity that distinguishes us from the glass and plastic computers that serve us.