The Alchemy Of Despair
by Miriam Greenspan, M.Ed., LMHC

Editor’s Note:  Miriam Greenspan, M.Ed., LMHC, is a psychotherapist in private practice, consultant, writer, and internationally-known workshop leader. A pioneer in women's psychology and psychotherapy, her first book, A New Approach to Women and Therapy, helped define the field.

For the past two decades, her work has focused on a holistic mind/body/spirit approach to emotional healing. Challenging current clinical and cultural trends which pathologize "negative" emotions, she teaches how honoring our grief, fear, and despair can lead to profound healing and transformation on the personal, social, and global levels. Ms. Greenspan's latest book, Healing Through the Dark Emotions: the Wisdom of Grief, Fear, and Despair (Shambhala, 2003), is a Boston Globe bestseller. It won the 2004 Nautilus Award in the category of psychology for “books that make a contribution to conscious living and positive social change” and it was chosen as one of the best spiritual books of 2003 by Spirituality and Health Magazine.

In our era, which has been called the Age of Melancholy, depression has been called the common cold of mental illness. Estimates vary— somewhere between 20 and 35 million Americans each year will suffer this emotional  plague. From its shamed obscurity of fifty years ago, the culture has brought depression out into the open. Everyone now knows that depression is an illness affecting a person’s emotions, thought process, body, relationships, and capacity to work.

The disease that depression is most often compared to—in informational pamphlets at the doctor’s office and advertisements for anti-depressant medication on television—is diabetes. Doing so enables us to de-stigmatize depression and treat it on a par with other physical illnesses. I’m all for anything that de-stigmatizes human suffering. But here are some ways that depression is most definitely not like diabetes: There is no blood test or biological marker for depression. There is no one medication that works for everyone who is depressed, as insulin does for diabetes. One has diabetes for life, while depression can follow the death of someone we love, and then never recur. People suffering from diabetes are not shamed for being emotionally weak, lazy, or spiritually un-evolved. Depressed people often are.

Depression is not just a disease of a particular organ—the brain; it is an affliction of the psyche or soul. (In fact, the exact neurological and biochemical mechanism of depression is not really known). Diabetes is not bound up with fundamental questions of meaning such as Who am I? Why am I here? whereas these kinds of meaning-questions are often integral to a person’s experience of depression. People who suffer from diabetes don’t usually feel the wretched self-loathing of the depressed. I’m a failure, I’m a bad person, I’m unworthy of love—these kinds of thoughts both breed depression and constitute it.

Let’s face it, mental illness is not exactly like physical illness. And depression is not exactly like any other mental illness. Relatively few of us are schizophrenic or have any experienced-based idea of how a person diagnosed with schizophrenia sees his or her world. But few of us have never experienced depression. Most of us have some idea what this ‘illness’ is all about.  

Depression, in short, is a very human problem. At its core are a number of overwhelming, afflictive emotions: sorrow, helplessness, hopelessness, fear, panic, self-loathing. Its cognitive ground is an unremitting flow of negative thoughts about the self and the world. Here is where the comparison to diabetes just doesn’t cut it.

The reason we compare depression to diabetes so much is that right now, we are embedded in a culture of biological psychiatry. This wasn’t always the case. Barely more than thirty years ago, psychoanalysis held hegemonic sway over the world of psychology, and through this framework, depression, as a mental illness, was not a biologically-based brain disorder but a psychological ailment rooted in early childhood conflicts. The history of any particular disorder is always illuminating, and since depression has been around for as long as human beings have lived on the earth, the history of how we think about depression is very telling. 

For more than a thousand years, our understanding of depression and mental illness in general has alternated between biological and psychological theories. The Greeks thought of depression as an imbalance of the four basic humors: blood, phlegm, yellow bile, and black bile. Later, Romans thought of it as a mental affliction of reason that could be cured through ‘philosophy’—a process that would now be called psychotherapy. The Catholic Church introduced the idea that the mentally ill are possessed by the devil.  The advent of 17th century science during the ‘Age of Reason’ rescued us from the terrible abuses of this religious tyranny by introducing the idea that psychological disorders had social causes. Robert Burton’s Anatomy of Melancholy, for instance, described poverty, fear, and solitude as causes of melancholia. It took many decades for the mistreatment of people suffering from the tortures of mental illness to begin to be treated as human beings worthy of attention, respect, and care. In this sense, it is fortunate for those suffering from depression today that we now have a medical system that recognizes depression as a bona fide illness for which people need treatment—though we still have a long way to go before all of the social stigma and injustice of how this illness is treated by insurance companies is redressed.

Having said all this, I want to make the case that whatever depression is—brain disorder, soul sickness, cultural malaise—it is not one thing but many. And at its core is the very human experience of despair. For more than three decades as a psychotherapist in private practice, I’ve listened to people who are depressed. They often describe their emotional states in very stark images: I’ve descended into a dark abyss. There’s an empty hole inside me. I’m trapped in this dark place. I don’t feel I’m really alive. I’m wandering through a desert. Nothing makes sense. The imagery of descent, stasis, captivity, sterility, and darkness vividly communicates the interior terrain of depression as a place of inner paralysis, abject loneliness, spiritual barrenness, existential meaninglessness. Depression is a state of chronic, unyielding despair that has taken over a person’s entire mental landscape. It is never to be taken lightly, for death is always a possible exit for someone severely depressed, and approximately six percent of people in this category end up taking their own lives. 

Despair is a profound dispiritedness; a fatiguing emotion which saps the life force. The smallest action may seem to require a gargantuan effort. Apart from all the theories, common sense tells us that such dispiritedness is both mental and physical, belonging to the soul as well as to the body. Wracked with self-loathing and hopelessness, fear and apathy, the spirit in despair has gone down to the underworld where existence is a state of death-in-life.

This kind of despair is on the rise throughout the world. The World Health Organization has recently predicted that within twenty years, more people will be affected by depression than any other health problem. Officials have called it a “silent epidemic” that will cause more early deaths and severe disability than any other illness.

The poor, women and lawyers will be unduly represented in these alarming figures. We can easily understand why the poor, who daily have to face fundamental survival issues like feeding their families, endure the kind of stress that predisposes one to depression. But what is the story with women and lawyers? Why do almost four times as many lawyers as other professionals get depressed? And why are women twice as frequently (some statistics say three times as frequently) depressed as men? And what about women lawyers—who get the worst of both worlds? Do lawyers and women have inherently more vulnerable brains? Do they have worse genes for mental disorders? Are they temperamentally disposed to go down into the underworld of despair? Obviously, this is where biological psychiatry reaches its cul de sac. There is no biological explanation for these statistics. Lawyers and women are more prone to depression for cultural reasons.

While genetics may play a part in depression, I believe this is a very small part. I doubt very much that scientists will ever discover the ‘depression gene.’ The bulk of the risk for depression is environmental: people get depressed because they live and work in environments that make depression a natural response. The answer is not in our genes but in our world that we are so afflicted with depression. Economies, social structures, cultural attitudes and environmental crisis are deeply implicated in what makes women and lawyers as well as men and non-lawyers depressed—and what gives rise to the continued escalation of depression in our time.

One of the most consistent predictors of escalating depression is a declining economy. There are some standard high risk categories for depression that have been noted repeatedly: caregivers of the young, the sick, the elderly and the disabled; victims of violence including rape and domestic abuse; the poor. Women are the largest group in all of these categories. In the western so-called ‘post-feminist’ world, adding the stress of wage-earning to that of caregiving is putting many women over the top in terms of depression and anxiety.  Until our society structures itself to meet the needs of women and children differently, the statistics about women and depression will continue.

As for lawyers—well it’s easy to see why women lawyers would be at terrible risk. They have to prove themselves in a field dominated by culturally masculine values such as aggressiveness, competitiveness, and non-emotional objectivity, not to mention the macho work ethic that would have lawyers work a 60 hour week without batting an eyelash. How are women, who are also still primarily responsible for raising children, supposed to keep up with this kind of work ethic?  In addition, women, culturally conditioned to be nurturing and emotional caregivers, are in a double bind in the typical work environment of a high-pressure law firm. Too feminine if they can’t play hardball with the big boys; and too masculine if they do.

But the problem for lawyers is not just a gender problem for women. Male lawyers too are profoundly stressed by the competitive, aggressive, hyper-rational show-no-emotion, take-no-prisoners, masculine mystique of the lawyer culture.  In many ways they are even more stressed, because, as men, they do not have the option of ‘letting it all out’ with their colleagues or friends. Trained to hold in emotion and be manly, many male lawyers feel they have to endure the unendurable alone—a bona fide recipe for depression and other problems such as alcohol and drug abuse.

To be honest, the clients I have seen who seem to be most challenged by the therapeutic process tend to be lawyers. Smart and verbally agile, they tend to view therapy as another battlefield, like the courtroom, in which the object of the game is to outsmart the therapist, or in which there is a winner and a loser. This is also the way they tend to view relationships in general. What works in the courtroom just doesn’t work the same way in intimate relationships—and is a barrier that must be let down if therapy is to be productive.

Another factor that contributes to lawyer depression has to do with the kind of work lawyers actually do. Attorneys, like therapists, work in a field in which they are exposed daily to the darker side of human nature. Conflict, betrayal, crimes of passion and of deliberation, murder, thievery, and other ‘sins’ against fellow human beings, competition for the economic spoils—all of these and more are the bread and butter of many attorneys. Unlike therapists, however, they are not trained in how to deal with the emotions—fear, sorrow, despair, disgust—aroused by these challenging issues. Also, while therapists often treat people for emotional crises or events that took place in the far past, lawyers have to contend with these crises while they are ongoing in the present or in the immediate aftermath of traumatic events.  Confronting rampant evil and heartbreak takes its toll, resulting in the often silenced emotion of despair.

What is despair? In my book, despair is a universal and altogether human emotion that we experience when we come face to face with the darkness in the world or in ourselves. It arises under conditions where meaning and purpose seem lost, and where energy for life needs to be recharged. It asks us to slow down, take our time, be still. Sometimes, it compels us to stop everything in order to painstakingly remap our world. Though its discomfort makes us want to push away from it as soon as possible, doing so actually aggravates despair and makes it more chronic. If we don’t panic in the face of despair, if we can see it as a powerful call to transformation rather than just debility or illness, we can then embark on an emotional/spiritual journey that I call the alchemy of despair.

This is not a journey through the vernal hillsides of Tuscany but an uncharted descent into the Dark Night of the Soul. Most people in despair want life to be normal again. But this is just what despair won’t allow. Transform yourself or die, despair seems to say. If we can hear this as a call to spiritual death and rebirth, rather than an invitation to suicide, we can mindfully navigate our way through it. The journey takes enormous courage and stamina and the willingness to learn from an emotion that our culture regards as totally negative and completely distrusts and judges as an emotional and spiritual defect. But the reward of conscious despair can be greater than anyone suffering from depression—which is really chronic, congealed despair that is stuck in the body—would ever expect.

Philip Slater put it this way: “Despair is the only cure for illusion. Without despair, we cannot transfer our allegiance to reality—it’s a kind of mourning period for our fantasies. Some people do not survive this despair, but no major change within a person can occur without it.”

Despair’s journey often hits the shoals of grief before arriving at the shore of a renewed faith in life. All kinds of un-grieved losses and traumas are often at the heart of the chronic despair that we in our culture’s medical model call depression. It is the depression that actually alerts us to mourn these losses and move into a more vital, authentic and spirited life than we have ever known. This major change in oneself or one’s life is brought about through despair rather than in avoidance of it. In this sense, can depression be called an illness? If so, it is often an illness that can be described in non-medical, shamanic terms as a ‘healing crisis.’

Increasingly, living in an age of global threat in which terrorism, economic decline, and ecocide are features of the world as we know it, people in this country and around the world will be undergoing this kind of healing crisis. Despair, fear, grief, and other so-called ‘negative’ emotions haunt us all, not because we are sick but because we are human. No one looking at the world today with open eyes doesn’t feel a twinge of these emotions. In addition to psychiatric medication and reliable therapy, we need to know that the dark emotions are honorable markers of our humanity in the face of the darker side of human experience.

Mindfully experienced, despair can bring us to a more resilient faith—by which I don’t mean religious faith, but a fundamental faith in life as it is. The most profound faith is that which confers value on life even after having looked into the worst. This is the gift in despair’s alchemy—a gift that cannot be measured by psychiatric assessment. The great Hasidic rabbi Nachman of Breslov said: “Regardless of what happens to you, in the end you will find that all your descents will be turned to great ascents…because the purpose of the descent is the ascent.” The philosopher Albert Camus put it more simply: “In the depth of winter, I found there was in me an invincible summer.”

Don’t be afraid of your despair or depression or judge yourself for it. Be gentle with yourself. Call out for help. Treat your body with respect and care. Take your time with this journey. Depression doesn’t have to be a curse. Treated with respect, it can open you to profound transformation, guiding you to a new found self or sense of meaning, and to faithful service of a re-affirmed world.