Life is an energy-process. Like every energy-process, it is in principle irreversible and is therefore directed towards a goal…. Life is teleology par excellence; it is the intrinsic striving towards a goal, and the living organism is a system of directed aims which seek to fulfill themselves….
Jung (1934)[1]
Depression should therefore be regarded as an unconscious compensation whose content must be made conscious if it is to be fully effective. This can only be done by consciously regressing along with the depressive tendency and integrating the memories so activated into the conscious mind—which was what the depression was aiming at in the first place.
Jung (1952)[2]
Depression is always an introverted condition.
Jung (1935)[3]
This essay arose from a student’s remark that Jung wrote so little about psychiatry. In actuality, Jung wrote quite a bit in the area of his professional training,[4] but since the Jungian Center is an educational organization and not a Jung Institute nor a clinic, we focus on the non-medical aspects of Jung’s thought. Hearing this remark, and knowing how Jung felt about one-sidedness, I decided to add to our blog essays an example of how Jung went about handling a fairly common mental health problem:[5] depression.
We’ll begin with some definitions—dictionary, contemporary medical, and Jung’s own definitions. Then we’ll examine the current standard psychiatric protocol for handling depression, and finally we’ll consider Jung’s approach.
Definitions of Depression
A standard dictionary has many definitions of “depression,” from the economic (“a serious and extensive reduction of business activity”) to the meteorological (“an area of low barometric pressure”). For our purposes, it refers to “a lowering of the vital functions or powers,” often characterized by “sadness, gloominess, low spirits.”[6]
The National Library of Medicine’s Web site[7] offers a much more specific set of definitions, as it parses the subject of depression into “agitated depression,” “anaclitic depression,” “clinical depression,” “major depression,” “manic depression,” “major depressive disorder,” and “bipolar disorder.” Generally, contemporary psychiatry regards “depression’ as “a mood disorder marked especially by sadness, inactivity, difficulty with thinking and concentration, a significant increase or decrease in appetite and time spent sleeping, feelings of dejection and hopelessness, and sometimes suicidal thoughts or an attempt to commit suicide; a reduction in functional activity, amount, quality or force,” as in “depression of autonomic function.”
“Agitated depression” is “a depressive disorder characterized especially by restlessness, overactivity, and anxiety.” “Anaclitic depression” is “impaired development of an infant resulting from separation from its mother.” “Clinical depression” is “depression of sufficient severity to be brought to the attention of a physician and to require treatment,” as in “major depressive disorder,” which is
…a mood disorder having a clinical course involving one or more episodes of serious psychological depression that last two or more weeks each, do not have intervening episodes of mania or hypomania, and are characterized by a loss of interest or pleasure in almost all activities and by some or all of disturbances of appetite, sleep, or psychomotor functioning, a decrease in energy, difficulties in thinking or making decisions, loss of self-esteem or feelings of guilt, and suicidal thoughts or attempts.”
In situations with “intervening episodes of mania,” the disorder is called “bipolar disorder,” “any of several mood disorders characterized usually by alternating episodes of depression and mania or by episodes of depression alternating with mild nonpsychotic excitement—called also bipolar affective disorder, bipolar illness, manic depression, manic-depressive illness, manic-depressive psychosis.”
Note all the descriptive words in these definitions: sadness, sleep disturbances, reduced functioning, restlessness, anxiety, lasting loss of interest, poor appetite, lack of energy, guilt—all features of outer life. All these are external qualities that mental health professionals call “symptoms” and use to diagnose the patient’s problem. Jung took a very different approach.
As a medical doctor Jung was aware of symptoms, but his focus was not so much on getting a diagnosis as on relieving the patient’s suffering.[8] He recognized depression as one of many unconscious compulsions, like anxiety states and obsessive thinking,[9] characterized by a “state of reduced adaptation” due to libido (psychic energy) that had fallen into the unconscious.[10] He defined it as “… an unconscious compensation whose content must be made conscious if it is to be fully effective.”[11] In multiple places in his Collected Works and his Letters [12] he relates encounters with depressed patients. In the early volumes of Collected Works [13] Jung described his clinical treatments and techniques, while his later work offers examples of his very different approach to treating depression. To see just how differently Jung handled this common ailment, let’s examine first how the mainstream American medical profession treats depression now. Then we will contrast Jung’s method in dealing with it.
The Current Way Psychiatry Handles Depression
In examining how depression is treated in the modern American health care system, we must bear in mind the key features of the system. First, it is run nowadays by insurance companies, which determine what will be paid for, how much the doctor will be reimbursed, based on his/her diagnosis, and how quickly the problem can be resolved. The focus of insurance companies, of course, is not on patient care, quality of care or individual need, but money—saving money, reducing overhead, improving efficiency—all the features one would expect in any business (the “health care industry” being one of the “growth industries” now in the American business landscape).[14]
Another key feature of this system is the diagnosis. The psychiatrist must determine what’s wrong with the patient, and must do so fairly quickly in our current system, because the treatment protocol—and hence, what the insurance company will pay for—hinges on the diagnosis. Different diagnoses have different payment schedules, and a whole sub-industry has grown up within the health care system that provides help to physicians in determining the correct “codes” for billing Medicare and other insurers. Thus the suffering patient gets slapped with a label for what ails him or her.
When “efficiency” is one of your major concerns, time becomes of the essence. Such a focus on quick resolution of the problem suits the American temperament: We are an impatient society. “Need, greed and speed”[15] are major features of our society, and when we visit the doctor we want relief and we want it fast. Not only fast relief but convenient relief, relief in some simple, easy form, like a pill.[16] “Gimme a pill, doc” is the standard mantra.
“Big pharma”—the major drug companies making millions from our desire for the quick fix, easy to swallow pill—is all too happy to oblige. The result? The gradual transformation of psychiatry away from the “talk therapy” of Freud and Jung[17] to the current psychopharmacological, materialist approach that treats the symptom with one or more pills (which often have “side effects”).[18]
Note that “treating the symptom” does not mean that the root cause gets addressed.[19] The whole process often remains at a superficial level, oriented not so much to the cause—finding out what’s going on and why—as to eliminating, or at least reducing the symptoms. Because side effects are common, patients often discover that, in treating the presenting symptoms, they acquire other problems. These problems provide the physician with the opportunity to prescribe yet more drugs, and eventually the patient can wind up consuming hundreds of dollars worth of medications a month![20]
It is perhaps obvious that I see very little merit in our current health care system, and I believe that Jung would also find it distasteful. Certainly he had a very different approach to treating patients, addressing causes, handling symptoms and understanding depression.
How Jung Approached Treating Depressed Patients
Jung was Swiss, working in the first half of the 20th century,[21] at a time and place where health insurance took a different form from our current system. He was married to a very rich woman,[22] so he had little concern about money and was notorious, in the circle of Jungian analysts practicing in Zurich, for the modest amounts he charged his patients.[23]
Having traveled multiple times to America,[24] Jung was aware of the external nature of the American temperament,[25] with its superficial focus and reluctance to look within, to go to the inner depths. He would not be surprised at our collective eagerness to go for the approach that works on symptoms, but he would not approve of it.
As for our lust for the quick fix, Jung would be horrified. A stress on efficiency and the whole business/industry mentality were utterly foreign to his approach. He understood the principle of kairos—that the psyche operated outside the ego’s time-bound reality, that the soul lived within natural time, in which events (like healing) unfold very much on their own rhythm and on a timetable the ego cannot control or force.[26]
Jung also was very independent,[27] and the idea that some paper-pushing functionary in some far-off insurance office would tell him how to treat his patient would have been anathema! He found it hard to put up with Freud’s direction. He would never have tolerated the directive aspect of our modern medical insurance system.
Which raises another point: Jung was not systematic—not in his writing style, not in his writing content, not in the development of his thought, not in his handling of his patients.[28] Those closest to him, his students and colleagues, all agreed that he treated each patient differently.[29] He had little use for theory and was not interested in systematizing his thought by founding a school.[30]
There was one way in which Jung and our modern system are similar: the issue of cause. Our modern psychopharmacological approach avoids examining the possible causes for a patient’s depression because it can’t afford the time that such work entails; insurers now are reluctant to pay for long-term “talk therapy.” Jung also tended to avoid a focus on causes, not because of time pressure, but because he felt such a focus was oriented to the past.[31] While he recognized the value of identifying a patient’s wounds, and went right to the source of them in his initial handling of a patient, he didn’t stay there, because he was more interested in the future, in helping the patient grow into a more positive, health-filled future.
As the quote at the beginning of this essay indicates, Jung was a teleologist: From his own experience and his many years of treating patients, Jung had come to recognize that life has direction. The life force in each of us has goals and aims. As living organisms we are “systems of directed aims which seek to fulfill themselves….”[32] Jung also recognized that “stuff” doesn’t just happen to us. If we get sick, have accidents, or experience misfortunes, life is trying to get our attention (which it tends to do more effectively through negative things than by positive things). Depression can be one of the negative things that can get our attention.
So Jung operated with the assumption that conditions like depression are meaningful, that symptoms are messages, that the unconscious wants our attention and the symptoms are ways it is speaking to us. More than just speaking to us, Jung believed that the unconscious holds treasures for us,[33] if we are willing to do what it takes to see them.
Rather than try to eliminate symptoms, Jung would try to use them to “listen” to the unconscious. For example, with a depressed patient, he might encourage the person to become as conscious as possible of the mood he was in, to sink into it without reserve and to note on paper all the fantasies and other associations that come up. He would tell the patient to allow the fantasy the freest play possible, but to stay with it (i.e. not to wander off the fantasy as in Freud’s form of association). Such a preoccupation with a mood, Jung felt, would allow its complete expression, and provide “a picture of the contents and tendencies of the unconscious that were massed together in the depression.”[34] In this way contents in the unconscious would become available to be integrated into consciousness.
Jung would expect a depressed person to look not outside, but inside. The whole nature of depression he saw as “an introverted condition,”[35] i.e. as a life situation that demanded a turning within, an inward focus, and a willingness to experience our inside. Often this experiencing would take the form of working with fantasies, images and symbols that arose when the patient gave himself over to painting, drawing, sculpting, carving, moving, or writing—some creative endeavor that fostered the reproduction of the content of the depression, either concretely or symbolically.[36] The whole procedure was an enrichment and clarification of the affect, which served to bring the feeling and its content closer to consciousness.[37]
In this way, the libido (psychic energy) that had been withdrawn from the conscious world (thus causing the depression) would be converted into conscious content and made available to the patient.[38] Jung recognized that the state of depression was a “challenge for the patient,”[39] and finding out the cause was not as important as knowing what to do, that is, understanding the purpose or goal of it.
Given his belief in teleology—that life has purpose—Jung operated with the assumption that any life situation holds a learning, a lesson, some message for us. If a patient was repressing something (unconsciously, of course), a depression might result;[40] once the “screen causes” were identified (that is, the patient eventually recognized what had been pushed down into the unconscious) the healing work could proceed.[41] The lesson here? That the guilt/shame/pain/negative memory needed to be brought up to consciousness, handled on the feeling level, and dealt with so it could then be released.[42]
With some patients Jung saw depression being an issue of age, hitting in some men around age forty, for some women, a few years before this—the time of the classic “mid-life crisis,” when we enter an important transitional phase in life.[43] Jung felt that depression around this time in life was often the result of trying to carry youthful attitudes over into the new phase, when such attitudes were inappropriate.[44]
Depression could also arise if life-energy got “caught in the past,”[45] or if the patient shrank from risks that were meant to move life forward. We thwart the life-force at our peril: “…Life is teleology par excellence; it is the intrinsic striving towards a goal, and the living organism is a system of directed aims which seek to fulfill themselves….”[46]
Jung found that, in some patients, depression was caused by the death of a relative or close friend. In such instances, depression resulted when the feelings that had bound the person lost “…their application to reality and sank into the unconscious where they activated a collective content that had a deleterious effect on consciousness….”[47] Other patients got depressed when they were on “reducing diets.”[48]
Smarts, high intelligence levels, even intellectual enlightenment from a lengthy analysis were of little value in facing depression, because the key, Jung felt, was the unconscious.[49] In a depressed person, the unconscious has “…withdrawn libido from the conscious world and thereby produced a ‘depression,’ an abaissement du niveau mental (Janet).”[50] In such situations, insight alone would not bring about a cure. But the fact that the mental level had been lowered meant that consciousness was closer to the unconscious—a time ripe for gaining access to the wisdom held in the unconscious, via non-intellectual methods.
People sometimes wrote to Jung complaining of depression. To an anonymous woman who had been forced to leave her homeland and live in a foreign country, Jung wrote a reply that reveals much about both the man and his method:
I am sorry you are so miserable. “Depression” means literally “being forced downwards.” This can happen even when you don’t consciously have any feeling at all of being “on top.” … I would seek out one or two people who seemed amiable and would make myself useful to them, so that libido came to me from outside, even though in a somewhat primitive form, … I would raise animals and plants and find joy in their thriving. I would surround myself with beauty—no matter how primitive or artless—objects, colors, sounds. I would eat and drink well. When the darkness grows denser, I would penetrate to its very core and ground, and would not rest until amid the pain a light appeared to me, for in excessu affectus Nature reverses herself. I would turn in rage against myself and with the heat of my rage I would melt my lead…. I would wrestle with the dark angel until he dislocated my hip. For he is also the light and the blue sky which he withholds from me.
Anyway that is what I would do. What others would do is another question, which I cannot answer. But for you too there is an instinct either to back out of it or to go down to the depths. No half-measures or half-heartedness.[51]
Not one who usually looked outside, Jung here suggests just that: take up with others and be useful, so that there might be some source of libido. To cope with the stuckness of inner growth, Jung suggests a focus on forms of outer thriving. He recognizes the healing effect that beauty can have on the soul, and how the body in moments of depression needs mothering via “comfort foods.”
Jung reveals his courage and style of working with the unconscious in his suggestions for coping with the deepening of the depression: No running! No repression! Rather, much like the Buddhist idea of going into a pain, rather than falling into aversion,[52] Jung urges the woman to “penetrate to its very core,” without flagging. Such a tactic would take advantage of the principle that, in situations of extreme affect (intense feeling),[53] at a certain point, there comes a shift and the whole situation turns around.
The reference to melting lead harks back to Jung’s work in alchemy. Lead is one of the symbols for depression,[54] and the alchemists saw the “leaden state” as an inevitable feature of the process of soul growth toward individuation. Wrestling with the dark angel calls to mind Jacob wrestling with the angel of the Lord,[55] and insisting that he be given a blessing, whereupon he was renamed “Israel.” Jung recognized that such hard inner work results in our achieving a new sense of self, via contact with the Self (the light and sky that the depression keeps from us).
Jung leaves his correspondent with a challenge: back out or go down to her depths. Clearly Jung did not worry about legal vulnerability. I would tell readers of this blog essay not to try any of this without the presence, support, guidance, and direction of a certified Jungian analyst or mental health professional!
Conclusion
As the American health care system lurches slowly to critical dysfunctionality, more and more Jungians are wondering about the future of analytical psychology,[56] as Jung practiced it and as it has been passed on via the Jung Institutes. Is there a place for the long-term inner work the psyche requires in a “give ‘em a pill” system? Or will Jung’s healing method be available only to those wealthy enough to afford to pay out of pocket? If a client base can be drawn only from the rich, is analytical psychology a viable career choice? What might ordinary people do who have an interest in Jung, but lack the financial wherewithal to pay for years of analysis?[57]
These are difficult, unanswerable questions. As someone devoted to Jung, his thought and his healing modalities, I hope that circumstances will bring us a totally new cultural paradigm—one more aligned with Nature and the workings of living systems—and with it, a new health care model to replace the corrupt, debased disease-care model currently operative in the United States. If we can achieve this shift, Jung’s work will certainly come to play a central role in the practice of mental health and healing.
Bibliography
Brome, Vincent (1978), Jung. New York: Atheneum.
Comer, Ronald (1995), Abnormal Psychology, 2nd ed. New York: W.H. Freeman.
Covitz, Joel (1983), “Myth and Money,” Money, Food, Drink, and Fashion and Analytic Training: Depth Dimensions of Physical Existence, ed. John Beebe. Fellbach: Bonz.
Hannah, Barbara (1976), Jung: His Life and Work, A Biographical Memoir. New York: G.P. Putnam.
Jung Carl (1970), “Psychiatric Studies,” Collected Works, 1. Princeton: Princeton University Press.
________ (1973), “Experimental Researches,” Collected Works, 2. Princeton: Princeton University Press.
________ (1960), “The Psychogenesis of Mental Disease,” Collected Works, 3. Princeton: Princeton University Press.
________ (1961), “Freud and Psychoanalysis,” Collected Works, 4. Princeton: Princeton University Press.
________ (1956) “Symbols of Transformation,” Collected Works, 5, 2nd ed. Princeton: Princeton University Press.
________ (1966), “Two Essays on Analytical Psychology,” CW 7. Princeton: Princeton University Press.
________ (1960), ”The Structure and Dynamics of the Psyche,” CW 8. Princeton: Princeton University Press.
________ (1970), “Civilization in Transition,” CW 10. Princeton: Princeton University Press.
________ (1967), “Alchemical Studies,” CW 13. Princeton: Princeton University Press.
________ (1954), “The Practice of Psychotherapy,” CW 16, 2nd ed. Princeton: Princeton University Press.
________ (1954), “The Development of Personality,” CW 17. Princeton: Princeton University Press.
________ (1976), ”The Symbolic Life,” CW 18. Princeton: Princeton University Press.
________ (1975), Letters, ed. Gerhard Adler & Aniela Jaffé. 2 vols. Princeton: Princeton University Press.
Kirsch, Thomas (2000), The Jungians: A Comparative and Historical Perspective. Philadelphia: Routledge.
Mipham, Sakyong (2003), Turning the Mind into an Ally. New York: Riverhead Books.
Salzberg, Sharon & Joseph Goldstein (1996), Insight Meditation Correspondence Course Workbook. Boulder CO: Sounds True.
[1] Jung, Collected Works, 8, ¶798. Hereafter Collected Works will be abbreviated CW.
[2] CW 5, ¶625.
[3] CW 18, ¶63.
[4] Cf. CW vols. 1-4 and 16, as well as parts of vol. 18.
[5] Note well: The Jungian Center is not a clinic; we do not dispense medical advice, nor is anything in this essay meant to represent or suggest cures or treatment protocols. The intention in this essay is to describe the way Jung approached depression. Neither the author nor the Jungian Center is engaged in presenting specific medical, psychological or emotional advice. Nor is anything herein intended to be a diagnosis, prescription or cure for any specific kind of medical, psychological, or emotional problem. Each person has unique needs and this essay cannot take these individual differences into account. Any person suffering from depression should consult a certified Jungian analyst or health care professional.
[6] World Book Encyclopedia Dictionary, I, 535.
[7] Go to http://www.merriam-webster.com/medlineplus/depression for all these definitions.
[8] CW 4, ¶365; CW 8, ¶166.
[9] CW 8, ¶266.
[10] Ibid.
[11] CW 5, ¶625.
[12] Cf. CW I, ¶s 197-210; CW 3, ¶s 148, 181, 547; CW 4, ¶365; CW 5, ¶504; CW 7, ¶s 75, 344-7; CW 17, ¶141; and Letters, II, 492-3.
[13] See especially CW, vol. 1.
[14] See www.nasrecruitment.com/…/Healthcare-Workforce-Outlook-2018.pdf.
[15] This assessment of American culture is Sakyong Mipham’s; Mipham (2003), 21.
[16] American culture refuses pain, fails to recognize the value of pain and turns away from the idea that pain might hold important messages for us. Jung recognized that pain—both psychic and physical pain—is a powerful way the Self can get our attention.
[17] Comer (1995), 749.
[18] Read through the small print on any ad for a pharmaceutical in the allopathic armamentarium and you will find a long list of potential side effects; e.g. the ad for Abilify, an anti-depressant, in Time magazine (April 16, 2012), 27.
[19] The root causes of mental illness are now the focus, not so much of psychiatrists but of medical researchers, many of whom work for pharmaceutical companies. Given the materialist orientation of current science, these causes are defined in terms of brain chemistry and the operation of various pharmaceutical concoctions on the brain and nervous system. Because the paradigm upon which this science is based is fundamentally erroneous in its assumptions, the resulting drugs don’t work well in the human body.
[20]I vividly recall standing one day a few years ago near the cash register of the local drugstore, trying on reading glasses, when an elderly woman came up to pay for her month’s supply of meds. The cashier explained what each one was for; 17 of the 19 meds were to treat side effects!
[21] His professional life stretched from 1900 to c. 1955, although he cut back his practice severely after his heart attack in 1944. Hannah (1976), 295.
[22] When Jung married Emma Rauschenbach in 1903, she was the second-richest woman in Switzerland, having inherited a fortune from her father, who had owned a watch factory.
[23] Covitz (1983), 43.
[24] Brome (1978), 119.
[25] CW 10, ¶957.
[26] Ibid., ¶585.
[27] “Letter to Father Victor White,” 2 April 1955; Letters, II, 242.
[28] Covitz (1983), 39.
[29] Hannah (1976), 202.
[30] Kirsch (2000), 5.
[31] CW 8, ¶166.
[32] Ibid., ¶798.
[33] CW 18, ¶260.
[34] CW 8, ¶166.
[35] CW 18, ¶63.
[36] CW 8, ¶166.
[37] Ibid., ¶167.
[38] CW 7, ¶349.
[39] CW 8, ¶166.
[40] CW 3, ¶148.
[41] Ibid.
[42] Jung recognized that none of us emerges from childhood without some sort of wound(s), and so we all carry guilt, shame, pain or difficult memories going back into our early life. While he would not exclude childhood material, he kept his eye on the potential for healing as the patient moved into the future.
[43] CW 8, ¶773. As the average life span is lengthening, some Jungians now consider the mid-life shift to begin closer to age 50 than to 40; personal communication with Lynda W. Schmidt.
[44] Ibid., ¶776.
[45] Ibid., ¶798.
[46] Ibid.
[47] Ibid., ¶598.
[48] CW 1, ¶204.
[49] CW 7, ¶344.
[50] The French means “a lowering of the mental level.” Jung is quoting Pierre Janet here, one of the pioneers of psychiatry, with whom he spent a year in Janet’s Paris clinic in 1902; ibid.
[51] “Letter to Anonymous,” 9 March 1959; Letters, I, 492-3. The Latin means “in excess of affect,” i.e. when there is intense feeling Nature will shift, under the principle of the enantiodromia, a running to the opposites.
[52] Salzberg & Goldstein (1996), 27-30.
[53] “Letter to Anonymous,” 9 March 1959; Letters, I, 493.
[54] CW 13, ¶445.
[55] Genesis 32:22-30.
[56] See the Web site “the futureofanalyticalpsychology.eventbrite.com/”
[57] Some analysts have developed payment systems in which the rich pay for the poor, i.e. those who can pay “full fare” do so, while those who can’t are subsidized by the rest. A viable analytic practice, if it is to be balanced, needs both the rich patient and the poor.
