“With each new failure, my father became more bellicose and dismissive. And as his attitude worsened, he found it ever more difficult to succeed. The defenses one chooses to avoid shame often afford relief while breeding more shame. Addiction experts have termed this pattern a “shame cycle.” The covertly depressed man’s defensive maneuvers or addictions can be experienced by the man as shameful in themselves or else they can create difficulties in his life that intensify his sense of inferiority, leading in either case to an increased craving for the defenses. This cycle reminds me of a little round my friends and I found amusing when we were kids.

“Why do you drink?”
“Because I’m depressed.”
“And why are you depressed?”
“Because I’m a lush [heavy drinker].”

112

Current research on drinking and depression gives credence to this cyclic pattern. Research indicates that depressed people may experience the effects of alcohol and other drugs more strongly than nondepressed people do and have a higher expectation that such substances will help them to feel better. Other research, however, reports that the high incidence of depression in alcoholics stems not from an underlying mood disorder but from the fact that alcohol in general, and prolonged drinking in particular, actually causes depression. The debate has been framed as: Does depression lead to alcohol abuse or does alcohol abuse lead to depression? One way to synthesize these perspectives, as well as the apparent contradiction in the findings, is to understand that alcohol both provides relief from depression and simultaneously creates more of it. What is true for alcoholism is true for all of the defenses used in covert depression. Addictions do to shame what saltwater does to thirst. The defenses used in covert depression tend to grow, providing ever decreasing amounts of relief while requiring ever increasing amounts of indulgence.

News anchorman Jim Jensen, who has spoken out about his struggles with cocaine and depression, describes his experience of that escalation:

 

You never recreate the same feeling that you had the first time, and you’ve got to use more and more and more and you never get back. It takes on a life of its own. Then it controls you. And when you fall off cocaine, there’s the depression. And depression was the main cause of it all.

Because of the insidious capacity of self-esteem supplements to “take on a life of their own,” therapy must first treat the addictive behavior as an addiction per se. Before AA and other addictions recovery programs won grudging acceptance by the medical establishment, many lives were damaged when mental health professionals tried to treat addictive behaviors like any other therapy issue. In my early years as a family therapist, I often encountered individuals who had spent years in psychotherapy, never confronting their runaway addictions. The addicted man would speak to his therapist each week about all manner of interesting issues — childhood wounds, marital tensions, new areas of growth in his personality — all the while driving his family to the brink of despair with his drinking, drugging, or other compulsive behaviors. Many believed that one could cure such behaviors using traditional therapy techniques that addressed the patient’s underlying emotional dynamics. But the evolving expertise in addictions recovery has convinced most mental health professionals that they cannot cure addictive behaviors with five days a week on the couch, any more than by simply throwing antidepressant medication at them. Only after the shame cycle has stopped, after the addictive pattern itself has been broken, and after the person has moved into “sobriety” can the pain of covert depression be addressed.

This double-edged approach, stopping the addictive cycle and dealing with the emergent depression, calls for the “dual diagnosis” of both depression and addiction. Covertly depressed men who self-medicate with substances have the greatest chance of a correct diagnosis and of receiving effective treatment for both aspects of their disorder.”

Pp. 80-81 in Real, Terrence. 1997. I Don’t Want to Talk About It: Overcoming the Secret Legacy of Male Depression. New York: Scribner. [Bold and pictures not in original.]

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