Depression Builds Slowly Between Past and Present, Says Psychiatrist

The complexity surrounding the manifestation and treatment of mental health problems is didactically dissected in “Depression is the Loss of an Illusion”, a book by psychiatrist and psychoanalyst Juan-David Nasio.

The author, born in Argentina and based in France since the late 1960s, presents a relatively unusual look at his patients, combining his practice as a therapist with what we know about the neurobiology of depression.

In fact, one could say that Nasio’s approach involves a kind of trip to the past – in a good way. Centered on the careful observation and description of the emotional state of patients, his clinical strategies and the way he writes about them resemble what you read in descriptions made by doctors of the late 19th and early 20th centuries.

There are similarities with the tone adopted in the books of British neurologist Oliver Sachs (1933-2015), who was also inspired by this older (and kinder) era of medicine. But Nasio seems to delve even more deeply into the minds of people who visit his office.

The book brings together five “lessons” on the subject presented by the specialist at conferences held in Paris, which were originally attended by both health professionals and lay people. In these lectures, one of the great virtues of Nasio’s reflections is to highlight the essentially multifactorial nature of the genesis of depression.

For the author, the existence of genetic predispositions that facilitate the appearance of the problem in some patients is undeniable, as is the correlation between depression and changes in the balance of production and reabsorption of neurotransmitters (the chemical messengers of the brain).

Taking these aspects into account, Nasio argues that collaboration between psychiatrists (who can prescribe antidepressant drugs to patients who need them) and therapists such as psychoanalysts is essential to improve the mental health of those who face the problem.

However, another well-established finding about the onset of depression is the link between depression and stressful life history events, such as traumatic situations during childhood.

According to the psychoanalyst, his clinical experience usually indicates the importance of these factors, but they would act indirectly, in “layers”, also taking into account traumas and difficult situations during adult life that act as triggers.

“A depression is never formed suddenly! All depression is made by a slow penetration of the past into the present”, writes Nasio.

According to the specialist, particularly difficult situations throughout the person’s development – which can correspond to more specific and serious events, such as sexual abuse, mistreatment or the sudden loss of parents, but also to a succession of minor traumas. – create what he calls a “pre-depressive neurosis.”

It is at this point that he introduces the thesis announced by the expression “loss of an illusion” in the title of the book. Difficulties in the person’s emotional development can lead them to create the illusion that they would be able to permanently protect themselves against future traumas.

“My idea is that the depressive state is installed after an emotional shock, more precisely after a cruel disappointment caused by the loss of a deified love object (person, thing or value), causing the loss of the illusion raised by that object”, analyzes he.

To illustrate how he detects and tries to combat this process in practice, Nasio assembles a small gallery of patient-characters with fictitious names and narrates their stories, another procedure that has become a tradition in mental health books.

One of the examples he addresses is that of Laurent, a 50-year-old man who faces fatigue at work and who, as Nasio’s conversation with the patient reveals, lost his father at the age of two in a car accident.

“I delved into the depths of Laurent’s gaze, discovering there an anguished child in the heart of the sad man who tries to be tough”, recalls the psychoanalyst. In these and other passages, Nasio underlines the need for a relationship of empathy between therapist and patient, in which the person responsible for the treatment strives to understand the details of the physiognomy, behavior and feelings of the person who is attending.

It is inevitable that an approach such as this carries with it a considerable burden of subjectivity. But, faced with something as complicated as the human mind, there may be no other viable way to bridge the gap between the patient’s suffering and the therapist’s performance.