In this article, I am departing from the usual method of presenting psychological information and then leaving the reader to imagine how it applies. This time, I will present “experience-near” case data(part 1), first, and then discuss the psychological issues(part 2), second, and for very good reason. In my practice, it is becoming increasingly clear how clients often fail to accurately recognize psychological issues at play in their relational difficulties. Once the actual problem is defined, people are liberated to respond to it in different and constructive ways. Frequently, the actual problems are much less severe and hopeless than initially imagined, as the case study below illustrates.
Amy S. (not her real name) initiated therapy to discuss relationship problems. Amy was 32, and had been married to Chris, 33, for 4 years, after having dated for 2. They met through friends who shared their mutual interest in outdoor activities including hiking, camping, and cross-country skiing. They are both professionally employed in related fields of work that both find challenging, at times stressful, but generally engaging and rewarding. They enjoyed their social life with friends and family, participated regularly in mutual (hiking, skiing, folk-music listening) interests as well as pursuing individual hobbies (motorcycling, vs. arts-and-crafts and scrapbooking).
Amy complained that she could not pinpoint when, but over the preceding 12 to 18 months she had begun feeling dissatisfied with certain changes in Chris. She reported he no longer engaged in much conversation at home as before. “It used to be we talked openly about everything, lamenting “it’s a big part of who we were.” She observed that Chris had withdrawn from her and that, increasingly, when she tried to talk to him, not only was he uninterested, he was distracted and seemed not to listen to her. It had been months since they participated in any of their hobbies, and the last few times they did were no fun, as “he wasn’t into it.” Their previously satisfying sex life had also become non-existent. Amy felt hurt, sad, but also angry at being rejected by Chris. It was obvious to her he did not did not desire her, feared he may no longer love her, and wondered if he had effectively left the relationship. When she confronted him directly, he told her “I don’t know what’s wrong, I really don’t know what I want anymore, but I’m just not feeling it.” Amy was understandably devastated, and since then always felt herself “on egg shells” at home, just waiting for the “other shoe to drop.”
Amy presented a compelling description of “problems at home,” and was quite rightly alarmed that the situation was serious and could not continue as it had. Perhaps the most serious and immediate aspect of the crisis was that the problem had been wrongly defined by Amy. Their relationship was actually not “on the rocks.” Chris’ lack of participation, which was certainly very real, was not the primary problem, but instead a consequence of his unidentified depression. In an earlier blog article titled Are You At Risk of Depression, I discuss depression and its symptoms in some detail, and the reader is referred back to that earlier post for background.
This vignette about Chris and Amy illustrates quite well how symptoms of depression can be expressed in daily life, and how their impact is often expressed in one’s intimate relationships. It may seem remarkable that Chris’ depression was not identified before, but he did not feel especially sad and blue. While a depressed, sad mood is commonly thought to be a defining feature of a depressive disorder, it is not actually the case. Many depressed individuals never actually “feel depressed” in this sense.
When I met with Chris, it became readily apparent that what Amy took as distracted disinterest was actually an inference based on the outward signs of Chris’ difficulty concentrating and thinking. This, combined with a lack of energy, also a symptom of depression, made Chris look like he “couldn’t bother to pay attention.” The truth was, he was unable to pay attention as before. Lack of energy, fatigue and disrupted sleep were also behind many ways in which Chris no longer took initiative in the relationship. What appeared to Amy as no longer caring about shared interests was clearly related to these symptoms, as well as to social withdrawal, which is another typical symptom of depression. Loss of sex drive is also common, which Amy mistakenly took as a rejection – that Chris was no longer attracted to her. By far the most devastating symptom of depression affecting the relationship was Chris’ anhedonia, or lack of interest in and joy gained from things that used to bring pleasure.
The most insidious aspect of anhedonia here–something I have not read in the professional literature about depression—is the way it went beyond merely denying Chris of interest and pleasure, it deprived him of desire. It is one thing to gain no pleasure or feel no interest, but to have no desire strikes deeper. Desire functions in the psyche like an emotional compass, giving us direction, while interest and joy propel us along that path of what we desire. To lack interest and joy is to be stagnant, but to lack desire is to be lost and adrift. For Chris, lack of interest and joy manifested in not wanting to go out, or participate in the usual activities. Lack of desire, however, caused him not to know what he wants, including his relationship with Amy.