Against Hanna’s will, a smile spread unevenly across her features. Gone were the dark clouds surrounding her pale eyes. Her voice was stirring, audible, and she no longer, with ivory knuckles, hugged her knees protectively against her fear, her vulnerability.
Her short hair, newly washed, ruffled under the ersatz spring breezing gently through my open windows next to her. It was after all March in Chicago and the warmth was an impostor wheedling us to lock away our coats, hats: our protection.
I shouldn’t have been afraid of her bolting again from my office for the nearest lethal instrument to end the growing disaster of her despair.
Her winter was lifting. Mine just began.
Her smile spread its inchoate terror through me and I shuddered as if a wild fire pushed by maniacal Santa Anna’s blistered a blackened swath through my heart. I Listened to Hanna’s rising hope, a hope I’d never heard from this young woman before, a hope lifting the dark lethargy strangling her for years, propelling her towards a new…what? I was afraid to know.
All I could see out there was the roiling nimbus of psychosis relentlessly stalking her, an unseen single minded stalker ready to carry her off.
Sounds dramatic, doesn’t it? Although I’ve changed identifying information, the immediacy of her stalker palpably remained, demanding and insistent, outwitting Hanna, laughing at me.
While Hanna didn’t suffer from physical pain, she did suffer the equivalent psychically and emotionally. I had been working with her twice weekly for 3 years and kept preparing myself for her ultimate suicide. I was as infected by her despair as she was. It felt like we were fighting a rear guard action until Hanna found the ignition for hope. Time ran fast and low.
As I sat with her, Hanna became agitated and the agitation grew as she refused to talk with me. After several attempts she bolted up from her chair and ran from my office out into the hall and down to the elevator where I met her. I was surprised by this as she was doing, against odds, much better. I attempted to get her to come back into my office by she met my entreaties with the silence of marble, cold and mute.
Two hours later I got a panicked call from her mother saying that Hana had swallowed the whole bottle of her anti depressants. I then helped her hospitalize her daughter.
This same scene repeated itself several times over the next year. As the year went on with Hana keeping to her schedule to with me I was convinced that she would, after all our efforts went for naught, would finally end her life. It was as if I was mourning her death even as she sat before me.
It took me months to remember an essential piece of working with people in a life or death struggle with psychotic depression. It also took me months to realize that the mourning I felt for her impending death was a reflection of the mourning Hana was experiencing for all the wasted years gobbled up by the depression. She was also mourning a death that had already ocurred in her. The early death of her sane self. The Hanna that briefly flourished before the depression darkened her world and sent her careering from one angry explosion to the next and always followed by a severe attempt on her life.
I had forgotten that many people with severe disturbances often project onto the therapist those things they don’t like thinking or feeling. It was through Hana’s behavior that I felt that her death and my mourning were close at hand. These were things Hanna couldn’t on her own feel or thing.
Her explosive rages had two origins but one trigger. The rage was the hyperattenuated anger that she felt towards the behavior of her family towards her while also representing the anger that people eventually feel as they pass through the mourning process. I was the trigger. If I wasn’t completely attuned to her, or mildly distracted by my body, she would be exquisitely aware of my temporary withdrawal and experience it like the prolong withdrawal as she saw it of her parents.
It was my job to help her figure out the sequence of events with me after the storm and suicidal behavior spent itself. It was the breaks in empathy with me and the healing of the rift with me accepting and explaining my part in the interaction. It was this very process that led to her improvement and then her extended retreat into psychosis.
What I failed to remember, and this is so important in the lives of those of us struggling with the depression and despair of pain, is that as we begin to recover from the lethargy of depression and despair, we see clearly the wreckage of our lives.
What is so lethal about this is that we genuinely begin to mourn while the snarl of the depression and despair is still very audible but now, as unlike before, we have enough energy to kill ourselves.
When someone is in the grip of a major depression, it’s difficult for them to organize themselves to actually commit the act. But when their minds just begin to clear so they can see the damage they’ve left in their wake while their energy begins to return, the actual act of suicide becomes a real possibility.
This is also a part of the process of mourning.
It’s by way of example of Hanna’s struggles that I want to make two points. First, mourning is always a part of depression and the suicidal aspect of that mourning appears often with people suffering major depression. For those in therapy for major depression, this entity that can haunt many of us. It shows itself through urgent suicidal thoughts that intrude on us any time, anywhere.
The second point is that cognitive therapy is proven to be quite helpful. But also helpful are therapists trained in psychoanalysis who know in their bones the process of projection and the power of the therapeutic relationship to bring about change.
Taken together, these two notions can go a long way to helping us recover from the unspeakable power of what Churchill named as the black dog of depression.