Barbara Dowds wrote this book to challenge claims that depression is a genetic disorder or an isolated human phenomenon “without any understanding of what it means to be a human living in a particular society in a particular time” (xiii). She posits that the increase in depression in our society is not an individualistic concern but is a question for us collectively, and proposes a biopsychosocial model which locates the origins of depression in interactions between childhood relationships, the social environment, and genetic vulnerability. Dowds argues that we need to desist in viewing depression as a mood disorder and more as a ‘disorder of the self’. Her exploration of the self makes up the first part of the work. Drawing on the memoirs of published accounts of depressive breakdown written by poets, authors, writers, journalists, psychologists and a psychiatrist, she explores two major themes that run through them: “loss and a fragile or false sense of self” (60).

The first part of the book examines the true versus the false/adaptive self, using the writers’ narratives to expound on what it takes to build and develop a sense of self, and showing the many ways in which their core integrity was compromised. She explores how we can somatise our psychic pain as a more culturally acceptable means of expression.

In ‘Childhood Development’, Dowds opens up a relational attachment perspective through the lenses of attunement, affect regulation, mentalisation and the intergenerational transmission of depression. Here she explores how a non-facilitating environment in childhood erodes the adult self-structure to become more fragile and non-resilient. In the second part, ‘The Science of Depression’, she argues “depression is a message that something is wrong that must be attended to, not medicated away” (88). She explores the social and adaptive advantages of low mood and, in ‘Emotional Processing’, considers learned helpfulness theories (Beck, Seligman), reflecting on how women are more prone to depression.

In her analysis of genetic predisposition, she concludes: “most of the causes of stress and depression are environmental. However, our genetic makeup plays a role in our susceptibility” (134). She outlines how ancestral trauma can be epigenetically passed on through generations, not only through parenting, but in how it marks key genes in the stress response pathway/HPA axis. She notes that “under reparative environmental conditions, epigenetic changes can be reversed” (127).

The final section expands on Dowds’ thesis of the ‘non-facilitating environment’, viewing our subjectivity from a sociocultural perspective and examining the rise in depression alongside our rapidly changing society. In her contemplation of how ‘selfish capitalism’ impacts our relationship with ourselves and with each other, she writes:

I would argue that, increasingly, the citizens of advanced capitalist societies live in just such a nightmare and suffer widespread underlying depression as a result of their disconnection and shallow experiencing. We are disconnected from ourselves, thanks to the narcissism project, where we confuse the ego with the self. We are disconnected from each other in becoming more individualistic and avoidantly attached, and through the mediation of interpersonal contact by technological devices. Finally, we are disconnected from the greater web of being: our place in the natural world and/or the transpersonal (226).

In this section she notes how “our very identity is being shaped into a twisted form by this competitive individualism” (145), fostering anxiety disorders, addiction, narcissism, somatic symptoms, self-commodification and lack of meaning. As capitalism increasingly devours itself by creating false needs that can only be purchased, we become disenfranchised from our intrinsic needs – freedom, spiritual longing, creativity and genuine fulfillment.

The concluding chapter examines subjectivity and the subject/object split. Dowds proposes that the self is the outcome of the child’s facilitating environment and is, therefore, never willful. In contrast, identity, which is formed largely in adolescence and young adulthood, is the outcome of the interaction between this self and the culture and society into which it emerges. Both self and identity can vary in degrees of authenticity.

At the end of this ambitious analysis of depression, Dowds examines what sustains us, asking us to pay attention to how depression is calling us to reconsider the world we have created. We may then, “by implication [discover] what a fulfilled and humane life might look like” (259).

This highly creative, compassionate study will stimulate and reward the reader. Dowds’ blistering analysis of depression names our “unthought known” (Bollas, 1987: 17): that our society is making us sick. It is not, however, an easy read. Her visceral portrait of how we strive to exist amidst the commodification and atomisation of our culture is deeply relevant. She is critical of how psychotherapy needs to widen its lens and reflect on its blindness to the impact of ecopsychology and the non-human world. For parents, educators and clinicians, this clarion call of a book will make you reconsider the impact our externally-referenced culture is having on the young.

I particularly enjoyed how Dowds weaves together her background in research, genetics and psychotherapy. She sprinkles literary and philosophical quotes throughout the study, which left me feeling satisfied on a creative and intellectual level. The writing style is economic and crisp, with a strong ability to translate complex research. I particularly enjoyed the lucidity in her writing on attachment theory. Her arguments on depression, society and lack of meaning are eloquently ardent.

Belinda Kelly is an accredited Specialist Adolescent and Adult Psychotherapist. She works from her private practice in south Dublin.

Reference:
Bollas, C. (1987). The shadow of the object: Psychoanalysis of the unthought known. New York: Columbia University Press.