Numerous events and circumstances can cause depression but often at the root will be anger (here it is again) turned against the self. We don’t feel this anger, as anger, because it is in the unconscious. When it emerges into consciousness it is disguised - similar to the real meaning of a dream— and can take a variety of forms including feelings of malaise, weepiness, hopelessness, exhaustion, listlessness, helplessness, worthlessness and, if serious enough, the wish to self destruct.

Let me tell you about “Karl.” His primary residence was an estate on a waterfront canal in Fort Lauderdale, Fl. His 60-foot yacht was docked behind the house. Karl and his family enjoyed watching the large, beautiful cruise ships coming and going from Port Everglades. They practically passed through the family’s backyard and were almost close enough to touch. He also had a second home in the Colorado mountains. Everything he owned was mortgage free. Karl’s wife loved him and he loved her. They had three happy, healthy kids. Life couldn’t be better.

During our first session, Karl told me that after graduating from college he had an idea to make money in the computer business. He borrowed $5,000 as start-up capital and lived a Spartan existence while he got his idea up and running. Before long he was able to hire an assistant and then another and another. Within five years Karl’s company had 500 employees and went public. Ten years later he sold his shares to a Fortune 100 company for over $1 billion. He was 33 years old at that time. He remained with his company working as a consultant for two more years and then fully retired. Karl’s life embodied the American dream. He told me he was thinking of killing himself.

Karl was a very bright guy, formally educated in the finest of schools, and wise to the ways of the world. He knew, consciously, how fortunate he was, yet it made no difference in his mind. “I see no purpose in life, Jim. It’s all going to end anyway, why wait for it?”

Applying logic, reason and common sense to Karl’s suicidal thoughts would get us nowhere, but I pointed out, of course, that if he killed himself it would be devastating to his wife, kids and other loved ones. Karl, of course, knew this. I also could have pointed out to him that he had more to be thankful for than almost anyone who ever lived; that he should be ashamed of himself for being depressed; that he should get on his knees and thank God for all he’d been given and that he should pull himself up by his bootstraps, put a smile on his face and get the hell out of my office. He then would have killed himself for sure.

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One of the nice things about being a shrink is knowing that when a person is as screwed up as Karl, the cause of the condition almost invariably goes back to his childhood. He was not terminally ill nor was there a serious illness of a person dear to him; his finances couldn’t be better; he was not on his way to prison for fraud; he loved his family and they loved him; his name had not been in the newspaper for doing something embarrassing or dastardly. Life had not been cruel to him as an adult, just the opposite. The self-destructive feelings must come from an early time. They did not come from something he ate. I explained this to him.

It’s a good idea to talk to potential suicides in the most candid of ways. They need something to grab onto — even if it sounds like nonsense and Karl’s coming to see me of his own volition was a positive sign. I did not talk him off of a ledge.

When I told Karl that his feelings of hopelessness probably came from his childhood it sounded foolish to him and he said so. I agreed with him that it sounded foolish. I told him he would have to trust me and that I wanted to know every single detail he could recall from his childhood beginning with his first memory. Skeptical as he was, he began talking.

Karl was raised in a small city in the South. His father had been an insurance broker and his mother an accountant. Karl excelled in school and earned an academic scholarship to an Ivy League college. His first memory was at his grandparents’ home playing on the front porch with his younger brother, his older sister, and “a whole bunch of cousins.” His mother was on the swing with his grandmother, his dad and uncles were playing horseshoes in the yard. Norman Rockwell couldn’t have painted a more pleasant picture.

I learned that his folks had few arguments, were affectionate with each other, and were still alive, having recently celebrated their fortieth wedding anniversary. They were now living at the old homestead of his grandparents. I also learned that Karl’s depression, which had intermittently plagued him since his early twenties, had become particularly severe of late. His first serious thought of suicide began two months before entering therapy, shortly after his parents’ anniversary celebration weekend. “OK, let’s hear about the weekend,” I said “Then we’ll get back to your childhood.”

“I made the mistake of going to the river,” he said. “I thought it might be good for me but it made me feel even worse.”

“What river?”

“Where my brother drowned,” he said, as though I knew about his brother. Karl was already transferring on me, as if I was a parent, assuming that I knew all about him. This was our fourth session and I’d not heard about his brother.

“What happened?” I asked and Karl related the story. He and his brother had wandered away from the grandparents’ house to the banks of a rapidly running stream. His little brother had fallen into it and was swept away.

“How old were you?” I asked.

“I was 4 and my brother was 3,” he answered as his chin quivered. “I’m responsible for his death.”

I asked Karl to tell me everything he remembered about this awful event. He didn’t remember any details except his brother calling out to him as he was carried down stream.

Karl and I worked together for a year or so as he recovered from his depression. My mission was to get this intelligent man to realize that 4-year-olds are not responsible people. This led us to the obvious question: Who was supposed to be watching his brother and him? Children 3 and 4 years old should not be allowed to wander, especially if there’s water near by. He did recall that his devastated parents told him he was not to blame for his brother’s death and they loved him. They also made him promise never to talk about it and to get it out of his mind. With such advice these well-meaning, naïve people, planted a time bomb in Karl. Fortunately we were able to diffuse it. His anger could now be properly vented at those negligent adults who allowed (caused) the tragedy.

Karl’s depression was an easy one to remedy because it was directly linked to an isolated event. Most causes of depression are not so pure and are the result of unfair treatment or attitudes, and inconsistencies stretching across many years. This kind of background is much more difficult to deal with for a patient, and a therapist, than a single traumatic event. They are full of ambivalence and we hear words like: “Yes, but; on the other hand; sometimes; not always; maybe; only when they were drinking.” Inconsistencies lead to ambivalence that torques the mind. Strangely, a child is better off having a parent who is consistently mean or negligent rather than having one who bounces from angel to devil.

Naturally, there has never been a completely consistent parent, so we make allowances for the occasional lapse and, paradoxically, an occasional inconsistency may help to build character. “Frustration in childhood equals character in adulthood,” is an old saying with merit. But when parents are consistently inconsistent, emotional problems in their offspring will result.

Perhaps the toughest cases to treat are patients from families where there is nothing going on. “Louise” was 31 years old, married with two children, a boy and a girl, ages 1 and 2, respectively. She was married to “David,” a fast-rising executive in a large stock brokerage firm. They had been married eight years. Louise described her marriage as “very good.” Both were college graduates. They shared the same Christian religion and attended church on a regular basis. They had no health or financial problems. Louise was an attractive woman; David was a handsome man. They were the perfect young family except for one thing — Louise was no longer able to function. Getting out of bed was an effort, getting dressed was a challenge, doing any sort of household chore sapped her energy in minutes and she went back to bed. She spent most of her waking hours weeping. She was not consciously entertaining thoughts of suicide but told me in our first session that if she died it would probably be best for her family.

“I want to get better but I don’t even remember what it’s like to feel good. I am worthless and I’ve lost all hope,” she said, crying softly. Louise, like Karl, was depressed for no apparent reason.

David, who drove his wife to her first session, was the catalyst for her being there. He told me they had been to numerous medical doctors who could find nothing wrong with Louise. The last one suggested psychotherapy. “What have I done wrong?” he asked me in a brief meeting after the session.

“I doubt you’ve done anything wrong,” I told him.

We agreed Louise would see me the next day and then three times a week for the foreseeable future. “Be patient and understanding” I said. “She will get better.” His relief was palpable.

Some would say I went too far in assuring David his wife would get better. After all, in only 50 minutes I knew practically nothing about Louise and the dynamics of her life. But I felt very comfortable making that assurance because Louise had not yet sunk to the level of being non-conversant. She was motivated to get better and, by now, many years into the profession, I had seen dozens and dozens of depressed patients. They all got better — after I figured out what I was doing.

The next day Louise and I went to work, beginning in the recent past. She told me she first sensed her depression about six months after her second child, the boy, was born. She was bathing him, a fun time for both of them with “big sister” helping, when she had an image of her little boy becoming a man.

“I saw his face getting older and older and then I saw him as an old man dead in a casket. I broke out crying, the kids freaked out. God, I’m embarrassed to tell you this,” she said. “How could I have such a terrible vision, fantasy, or whatever it was? I made my darling little boy an old man and killed him off! God, that is so sick!” she exclaimed, “How could I do that?”

This was not a rhetorical question. She was looking directly into my eyes and she wanted an answer. “That’s an easy one, Louise,” I said pausing for emphasis. Then I smiled and said, “The mind is a terrible thing to have.”

She looked at me like I was nuts, then thought about it for a second and laughed out loud. Everyone has terrible thoughts from time to time, I told her, although most won’t admit to them. I told her I had a male patient once who confessed, with great shame, that in church, he observed the women and wondered how many of them he could have an affair with. He fantasized about them throughout the service. He was certain he was going to hell. She laughed at that, also. Then I told her of another patient who kept having the fantasy of her ex-spouse being hit by a train. Louise liked that one, too, and I assured her once again that evil, dastardly thoughts were not only common, but quite normal. They, like dreams, are psychic release mechanisms.

I explained to her that no matter how much she loved her little boy, and would never really hurt him, there was a part of her, buried in the unconscious, that wanted him out of her life. She gave me a strange look but did not protest.

“For instance,” I continued, “babies are a lot of work, their needs are many and sometimes seem insatiable. You also have a toddler, your little girl, who is no doubt a handful and who is jealous of her brother. Both kids are in diapers. I wouldn’t be surprised if you missed the alone time you had with your daughter, just the two of you, which you’ll never have again. Babies wreck your sex life for a multitude of reasons. Lots of other things could make you wish the baby would go away, so your unconscious mind bumped him off. Naturally you’d never do it, but there’s no harm in thinking about it. As a matter of fact it’s good for you.”

So far I had been doing much of the talking. This dynamic would end shortly, but at the beginning of therapy a patient should be made comfortable with the fact that a shrink is not a judgmental “tsk tsking” parent. As quickly as possible the patient should realize the analyst not only understands “evil” thoughts but has them himself. I told her one of my kids had been an incessant crier who had colic for over a year. I used to fantasize throwing him out the window. She really liked that one.) Candidness from therapists alleviates the natural defenses patients bring into a session and makes it very clear they are there to be understood, not judged.

One of the first things patients learn when they come to analysis is that their unpleasant thoughts and fantasies are not only normal but are also universal. Show me a person who hasn’t secretly wished, at least a few times, that he (or she) could be free of their spouses and their kids and start all over again. Show me the person who has not wished someone would lose their job instead of getting the big promotion. Who among us isn’t jealous of those who inherit their wealth instead of earning it themselves? Who hasn’t secretly wished the boss would have a coronary or cancer so we could get his job. People hate it when a sibling makes more money than them, gets more acclaim, marries better. To deny these dastardly thoughts is dangerous to emotional health. It’s the unconscious talking, the little kid “Id,” and to think such thoughts will go away is, psychologically speaking, silly.

One of the great fallacies of our western culture is the concept of: “To think something evil is just as bad as doing it,” the “lusting in your heart” business. This is not only nonsense, it can be crippling to the mind. It wasn’t until the Second Vatican Council in the 1960s that the Catholic Church finally proclaimed that there’s a real difference between thinking about doing something bad and actually doing it. That corrective dictum has yet to penetrate our Western psyche, however, including Catholics. The “think it” stuff has been around too long and still produces enormous, neurotic guilt.

Louise’s depression seemed to begin when she had her second baby, but as we took a closer look it became clear there’d been evidence of it for many years, though not to the current severity. She said there were times in her life when she was happy, “But they never lasted very long.” When people asked her, in a friendly way, “How are you doing?” her reply was either, “OK, I guess” or “pretty good.” It was never “Great!” Joie de vivre did not apply to Louise.

Naturally I was most interested in her early years to see if there had been specific trauma such as physical or sexual abuse, or the death of someone dear to her, but there had not been. She had two siblings, a brother two years older, and a sister two years younger. To this day, and as far back as she could remember, she felt close to them. Next we tackled her parents to see how they may have contributed to her life-long semi-sad state, now culminating in intense depression.

Louise described her dad as a “nice enough man” but also as “sort of cold.” He was an administrator for a government agency and had attained moderate success. He never laughed out loud and rarely smiled. He wanted everything, and everybody, to be “just so.” He lived by a thousand rules – the proper times to eat, go to bed, get up. His clothing was impeccable, his desk was compulsively neat; he got his hair cut every two weeks at the same time, on the same day, by the same barber.

“Dad didn’t like change or surprises,” she said. “I guess he was the perfect bureaucrat. And, oh, he never kissed us and only lately has he been able to give us kids a hug but there’s no emotion in it. But he never laid a hand on us in anger. Whenever we’d do something he disapproved of he would withdraw even more into himself and not speak to us — sometimes for days. That really hurt.”

Louise then described her mother. “She, like my dad, was not affectionate with us kids. Hugs and kisses were not part of our growing up. At the same time Mom did all the right things. She washed and ironed our clothes, prepared good meals, cared for us when we were sick, drove us wherever we needed to go. In a way she was the perfect mom in the things she did, but none of us felt close to her. It’s like she was acting at being a mom but not really feeling it or, now that I think about it, I’m not sure she wanted to be a mother.”

Louise had just described two emotionally depressed people. No wonder Louise was down in the dumps. Her childhood taught her the way parents are supposed to be — without joy. Louise’s parents went through life “by the numbers,” robotic towards each other and toward their children.

Louise was a tough case because the sources of her depression were subtle. Frequent causes like a broken home, sexual or physical abuses were not there. Even the emotional background seemed fine, at first. There’d been no screaming, fighting, crying or throwing of objects. No one was a drunk. On the other hand there’d been no laughter either. The more Louise talked, the more she realized there’d been no nothing — emotionally — on the up side in her childhood home. The emotional atmosphere she grew up in was either flat, sad, or stoic.

When we say that environmental factors can cause emotional illness people think we mean specific events and certainly that may be the case. But the mood in the home is also a contributor — perhaps the strongest — and every home has a mood. Homes can be anxious, dreary, fearful, suspicious, contentious, contemptuous, spiteful, overly competitive, gloomy, tense, et al. These negative moods create the atmosphere that is incorporated into the developing minds of kids. This was at the heart of Louise’s depression. She grew up in a home that was devoid of joy and laughter. Therefore life, to her, was a serious, sad business.

Louise was a motivated patient because somewhere along the way she determined that she wanted her kids to love life, not to merely exist in it the way she had been programmed. But to pass this legacy to them she would have to love life first. Louise and I were together over three years. During that time she did lots of yelling and crying and, of course, laughing. In the safe house of therapy she could be a whole human being and say anything she “fucking well wanted to say.” She learned early on that I would not be shocked, appalled, or judgmental. Her psychotherapy provided Louise a truly corrective emotional experience. For the first time in her life she felt free to say whatever came into her mind no matter how “evil” it was.

Many people, including professionals, believe that depression and other mental illnesses are hereditary like skin tone, eye color and shape of ears. They think it’s a biological condition. I don’t think so in most cases. I don’t believe there’s a gene for depression anymore than there’s a gene for joy. Mental illness is sort of hereditary, however, in that depressed parents are more likely to raise depressed kids. Being joyful towards life is a learned response. So, too, is seeing it as drudgery.

One of my first patients, “Suzanne,” a woman in her late 50s, gave me my first hard look at what it felt like to be depressed. During our first session, without a trace of emotion, she matter-of-factly stated, “I want to die and I wish I had the guts to kill myself but I don’t, so I’ll just have to wait for it to happen naturally. And I hope there is no such thing as an after-life. I want to cease to exist.” (Yikes.)

Part of Suzanne’s depression stemmed from a teen-age pregnancy. She’d carried the baby to term but was forced by her parents to give it up. She never saw the child. “They wouldn’t even tell me if it was a boy or girl.” She said she felt like someone had reached inside of her, grabbed her soul, and ripped it out.

Losing an infant, the death of a sibling or having parents with flat, oppressive affects caused depression in Suzanne, Karl, and Louise, but there are a multitude of other causes. If they are not obviously from present circumstances then into childhood we must go. When someone loses someone, or something, dear to them, or experiences serious illness, depression is a natural emotion. There is a tangible, current reason for this kind of sorrow and it is appropriate. But it will also go away in time. Chronic depression must be treated.

Depression is a step to suicide, of course, and losing a patient to suicide is a psychotherapist’s greatest fear. Normally we are aware when a patient is a potential suicide and can deal with it. If it takes two sessions per day, and phone calls in between, the terrible wish can be talked out. Also, medication is certainly advised. But if the patient gives no clues we can indeed be fooled. There was a case in a psychiatric teaching hospital where a young man with depression was being evaluated by some of the institutions top practitioners. He asked to be excused to visit the bathroom. When he didn’t return they went looking for him and found him hanging by his belt from a pipe. Nobody realized his depression’s depth. Shrinks only know what they see, hear and feel. We are not mind readers.

Suicide has been called the ultimate act of rage against the self. It can also be the ultimate act of revenge against loved ones — an everlasting “Screw you.” It is especially cruel if the person leaves children.

Suicides essentially take two forms. There’s the obvious: a bullet to the brain, hanging oneself or jumping from a tall structure. Then there are the more subtle forms that leave doubt in the minds of those left behind: drug overdoses, slashed wrists and single-vehicle auto accidents, for instance. Did they really mean to die, or was it only a cry for help that went bad? Terrible stuff.

Although the act of suicide is selfishness to the extreme, some suicide cases are thoughtful people. I had a great-uncle who did himself in with a shotgun blast to the chest. He pulled the trigger in the middle of the night, waiting until the loud freight train went by, so he would not awaken my grandparents who lived nearby. Everyone agreed what a nice person he had always been so were not surprised by this final considerate gesture. Although this suicide took place about 100 years ago, we family members still occasionally talk about it. It’s a glitch in our family’s history. Fortunately, the man was a widower with no children.

A colleague had a patient who swallowed enough sleeping pills to put down an elephant, then stepped into an extra large garbage bag and pulled it over her head. She went to sleep but, incredibly, didn’t die. “I couldn’t even do that right!” she wailed.

“Why the garbage bag?” My colleague asked, not interpreting the obvious symbolism.

“Because I figured I’d lose control of my bowels and urine. I didn’t want anyone to have to clean up after me,” she said. Very thoughtful.

On the other hand there’s the especially mean-spirited suicide. I had a female patient, an accountant for an insurance company. She was 25 years old, drop-dead gorgeous, 5’5”, hourglass figure, long, straight, silken, coal black hair, bee-stung lips, blue eyes like you’ve never seen, a bust line ... sorry, I’m digressing. She was a perfect 10 and did I mention her California tan? OK, I’m done.

When “Dorothy” was 12 her mother and father divorced. The mother, an alcoholic, ran off with another man. Dorothy remained at home to care for her father. He, too, was an alcoholic. There were no siblings.

Dorothy wanted to be psychoanalyzed because she could not keep a steady boyfriend. She’d been through dozens. She then said, I believe, the dumbest thing I have ever heard from a patient. “I know why I can’t keep boyfriends. It’s because I’m ugly.” She added that she hoped analysis would give her a better personality to make up for her homeliness. “I want to become a more interesting person,” she said. At first I thought she was trying to be funny, but she wasn’t. She truly thought she was ugly. Unbelievable.

Dorothy was exceptionally talkative and during her first few sessions she rambled on as I listened for the messages between the words — that “third ear” kind of listening. I didn’t pick up much except that, obviously, she had a lousy self-image. I also learned she was disgusted by her mother. “She calls me about twice a year. It’s always to tell me she has changed boyfriends and she always asks to borrow money. She’s never paid me back so I quit sending it to her. She’s a loser and a liar.”

We were well into her therapy when I asked her about her dad. She had not mentioned him since the first session and we’d been together for four weeks. Mom was a disaster as a mother so I thought he was probably a more positive parental figure. Her eyes welled up, she clasped her hands together on her lap and gazed at the floor. “Too hard,” she said, almost inaudibly.

Minutes passed as tears dropped from her eyes onto her dress. She made no attempt to wipe them away. I offered the Kleenex box and she shook her head. It was pure, childlike crying with mucous running from her nose. At last she looked up at me took the Kleenex then half sobbing and half talking told me about her dad.

One evening she and her father had finished supper and Dorothy got up to clear the table as usual. Her father had been drinking whiskey throughout dinner. He would then drink himself into a stupor and go to bed without a word to her — his nightly routine. But this night was different. As she was putting the dishes in the sink he asked her to leave the room. She asked why and he said, “For just a minute. I have a surprise.” She did as requested and a few seconds later heard a loud “bang” from the kitchen. She ran back to find her father’s brains all over the room. She was 15 years old. That was one mean, rotten way to commit suicide. (And that’s why his daughter thought she was ugly.)

Dorothy and I spent a year together until her career forced her to move away. She was doing OK. Not great, just OK. The image of her dad’s brains and blood were still vivid in her memory.

Children of suicides have difficulty experiencing the joy of life, and when they do it is difficult to sustain. Parents who commit suicide cause cancer of the spirit in their children. The only way to cure this cancer is to see a shrink and vent the pen- up rage at the deceased parent. They must scream and cry until they are spent ... and then do it again ... and again. In between the screaming and crying they must attempt to understand why their parent committed suicide. In this endeavor the analyst will be invaluable. He will also get them to the point where they know, for sure, it was not their fault, and help them to understand that their parent was most seriously ill, a condition they couldn’t possibly have caused. The child of a parent who committed suicide must, eventually, forgive that parent, and here, too, the therapist will be of much value. This could take years, and that’s fine, but it must be done. Peace, and a capacity for sustained joy, will come only from forgiveness.

Waynesville resident Jim Joyce’s memoir, Use Eagles if Necessary, is being published in weekly installments in The Smoky Mountain News. Each week we begin a chapter in our print edition and then put the entire chapter on our Web site. All previous chapters are available online. The book can be purchased at rockpublishing.com/eagles.htm, and may be ordered through bookstores.