The will to perfection drives people into spiritual exhaustion

The secret logic of depression

What does it mean in today’s society, where we all work, function and deliver the goods like hamsters and yet suffer from depressive moods? How does depression manifest itself, and how do sufferers themselves feel? What can family members do, and how do attending physicians and pharmacists approach the symptoms of a depressive state?

According to the Stiftung Deutsche Depressionshilfe, a German foundation for the promotion of research and public awareness of depression, there are four million people in Germany suffering from depression. In an extensive study undertaken at the initiative of Pascoe Naturmedizin, the Cologne-based rheingold institute conducted a depth-psychological investigation of the topic of depression. The investigation found that family members as well as pharmacists and physicians face uncertainties in their dealings with depression sufferers. Because people suffering from depression are not easy patients or customers. The study also managed to explore the inner logic of depression, making it easier to understand.

The inner structure of depression

All of the respondents suffering from depressive moods reported an inability to continue sharing in the happiness of this world. They feel ‘paralysed’, ‘sad’ and overwhelmed in everyday life. They are under the impression that they can no longer meet the social, family and professional requirements and demands placed on them. And yet the depressive diseases are often enshrouded in silence. It is as if our culture had a secret pact that identifies something called ‘depression’ but remains stubbornly silent about the real circumstances that surround it. The symptom of ‘inner restlessness’ or ‘burnout’, on the other hand, is apparently easier for sufferers to convey. ‘Burnout’ in particular is an accepted symptom in our culture. Those who feel an inner drive bear witness to activity and movement.

The mere mention of ‘depression’ or ‘burnout’ is merely a label that fails to do justice to the unique inner logic of mental illness. A description of the individual traits that make up the internal structure of a depression must be based on sufferers’ own experiences.

Highest standards

Sufferers try to fulfil all of their tasks – both the demands they place on themselves and the demands of everyday life. These expectations have the effect of a restless, driving force. They often feel as if they are solely responsible for everything – for career success, family needs, organisation of everyday family life and the care of children or relatives. A surprising feature of the interviews was that sufferers did not seem depressed and withdrawn at all, but agile and energetic instead. This, too, was a reflection of the high expectations that sufferers have of themselves.

Experiencing limitations

Sufferers find that they cannot always live up to these standards. They suffer from a discrepancy between their ideal image, on the one hand, and feasible reality on the other. All people experience this difference between their own dreams and the ‘normative force of the factual’. For depression sufferers, however, the limitations they experience in the face of conditions of life and everyday demands are enough to throw them off-track: a situation-based limitation – coming up short of expectations on occasion, or making a mistake – leaves sufferers feeling that they have failed completely.

Shutting down

If a sufferer fails to meet his or her expectations, this certainly does not mean that their ambitions will be revised, mourned or angrily challenged. There is no active grappling with the situation, and instead these people withdraw and literally shut down. It is precisely the vitally important yet painful process of mourning that does not occur. Mourning permits people to bid farewell and irretrievably part ways with individuals and situations of which they have grown fond. Because this painful letting-go ultimately does not occur, these individuals do not relinquish their own expectations and instead freeze and preserve them in depression.

Growing indifferent to the everyday

Sufferers stabilise this shutdown by unconsciously fending off or growing indifferent to all of the triggers that might encourage activity. The tasks and stimuli of everyday life are all assigned the same validity, i.e. there is no longer any prioritisation of activities or themes in life. They often have a feeling that the actual problems have gone unresolved. Persistent symptoms also give them the right to be treated gently by their surroundings and handled with kid gloves.

Stewing in one’s own juices

Outwardly, sufferers appear lethargic and seemingly paralysed. This also requires a great deal of tolerance on the part of family members. Yet sufferers themselves do not experience this shutdown as a withdrawal or time-out; despite outward appearances of inactivity, inwardly they are overheating. This internal drive keeps sufferers from taking a deep breath and robs them of their sleep. Even though they are constantly grappling with the same topic, they sense that they are not making any progress. This ‘stewing in one’s own juices’ is also a gigantic intensification of the self: All one can see is oneself and his or her own misery. The sufferer is intimately close to him- or herself in an undivided way.

Resigned-bitter treatment of symptoms

Ultimately, those affected wind up in a resigned-bitter treatment of their symptoms. They accept that they will not emerge from their depression, from these limitations, and merely try to dim the symptoms down or manage them. They medicate themselves not to free themselves from the disease but to gain control of the symptoms. But these sufferers often have a feeling that the actual problems have gone unresolved. Yet at the same time the symptoms are also proof or a bitter indictment against themselves and the world that the restrictions they have experienced are unfair and thus incapable of meeting their high expectations.

Forms of self-treatment

Prior to but also during the depressive illness, sufferers will have developed an entire array of forms of self-treatment. They try to distract themselves with the aid of various activities, redirect their thoughts and seek contact with nature and the soothing rhythms of the seasons. They take time for self-pampering rituals such as hot baths or wellness treatments. They often also try to channel their inner restlessness and doubt by compensating through performance and seeking escape in senseless bustling about. In most cases, though, sufferers relocate treatment of depression to the treatment of physical symptoms. But this keeps their depression alive.

Dealing with sufferers

The treatment of depressed patients requires an empathetic approach on the part of doctors and pharmacists, as they are treating not just a disease or a set of symptoms but the entire person, who is very sensitive and easily insulted. This requires a balancing act on the part of physicians and pharmacists. They should be listeners and confidants on the one hand, while not coming too close to the patient on the other.

Demanding patients for doctors

It is striking how difficult it is for many physicians to deal with depressed patients. They experience these patients as demanding individuals who overstep boundaries. Consultations often take too long and are difficult to control. Doctors often view the demands of depressed patients as an imposition. These unpredictable factors disrupt the flow of their daily practice of medicine. Depressed patients cost them a great deal of time and nerves. Doctors also feel blackmailed by patients’ threat of imminent suicide.

The physicians manifest a general sense of discomfort – including that of our culture. When dealing with depressed patients, doctors feel as if they are getting caught up in something deeply frightening to them, something on which they cannot get a direct grip. This causes cracks in the image of the physician as healer and miracle-worker. Psychologically, then, doctors find themselves in a situation almost similar to that of their depressed patients. Because they too experience fundamental limitations in treatment.

Difficult customers for pharmacists

Pharmacists, too, have difficulties dealing with depressed customers. They need to correctly decode and interpret customer complaints. Customers typically do not dare to discuss their depression. Instead, they report on ‘inner restlessness’ or physical symptoms that they can discuss more readily than their depression.

If customers open up, pharmacists must provide therapeutic assistance. This requires time, empathy and competence, however. On the one hand, some pharmacists see this as an opportunity to occupy a confidential, advisory and treating position; on the other hand, many feel uncomfortable and at times overwhelmed.

The internal structure of depression

Eight recommendations for family members:

01 –
The risk of a depressive illness increases if people no longer find time to consider and reflect on themselves in the course of their hectic everyday lives. Family members should advise those affected to prophylactically incorporate expansion joints into their daily lives, e.g. extended breaks, days with no planned schedule and moments of boredom and idleness.

02 –
In dealing with these very sensitive patients, it is important on the one hand to take them seriously in their suffering, but on the other hand also to help them to scale back and edit the expectations they have of themselves.

03 –
Family members or physicians should offer them support towards locating a more open, more targeted way of dealing with annoyances: actively defending themselves, not simply accepting losses or defeats, but mourning them.

04 –
Family members often experience it as stressful to see patients constantly circling around themselves. It is helpful to join the patients in this movement, following their orbits empathetically while also helping them carefully open their eyes to other things.

05 –
With herbal medicines, sufferers can effectively alleviate early symptoms, such as restlessness and sleep disorders, without side effects.

06 –
Given the mental shutdown that this disease involves, there can be no expectation of rapid success through treatment. Expectations of speed create a burden for treatment, often producing new experiences of limitations. It is important for relatives and doctors to agree on small steps and develop a treatment outlook with patients.

07 –
The only way to escape the self-destructive ‘all-or-nothing principle’ is to initiate a process of reflection with the patient around the things that are truly important, and of the expectations or tasks to which he or she wants to bid farewell in the short and long term.

08 –
It also becomes important to gradually assume or transfer responsibility over the course of the (self-) treatment process. The message: the will to perfection is a spectre that drives people to exhaustion. Even in this day and age, personal development is not possible without personal guilt and confinement.

The rheingold expert

Birgit Langebartels

Birgit Langebartels

Birgit Langebartels, psychologist, is Account Manager and Head of Kids & Family Research at the Cologne market research institute rheingold. She researches in the areas of women, society / culture / trends and pharmaceuticals / health and has been successfully working for rheingold since 1999. Tel .: +49 221-912 777-14 E-Mail: