PINING FOR THE ABSENT UNKNOWN

Author: By David Mehegan, Globe Staff

Date: SUNDAY, January 18, 1998

Page: L3

Section: Books

But real depression is a more pointed and poignant experience: the flattening of emotion and verbal expression, the detachment from friends, family, and the surrounding world, the paralysis, the loss of a sense of time, the inchoate sadness, and, sometimes worst of all, the inability to make sense of it all or to know when it will end. Unlike words like ``neurotic,'' however, which gained a measure of comedy from such artists as Woody Allen and Jules Feiffer, society takes depression seriously and recognizes the need to treat it.

However, as Cambridge psychotherapist Michael Vincent Miller points out in his eloquent, crystalclear (and long, at 29 pages) foreword to French psychiatrist Jacques Hassoun's ``The Cruelty of Depression,'' current American clinical practice sees depression primarily as biological, ``a congenital disease . . . a defect in how the brain functions.'' The broadly accepted remedy is pharmacological, often employing so-called SSRIs (selective serotonin re-uptake inhibitors, of which Prozac is the best known). Miller writes, ``The restoration of well-being now seems to require little more than swallowing so many micrograms per day.''

Without denying the real benefits of these drugs, Miller contrasts the clinical outlook they represent to the almost quaint but fascinating and attractive view of Jacques Hassoun, who represents in this odd little book a much older, more philosophical, more passionate approach to the experience of depression.

Hassoun is one of the foremost exponents of the psychological doctrines of the French psychiatrist Jacques Lacan. Lacan is more influential in the United States for his aesthetic and cultural teachings than for his ideas about emotional pathologies and their treatments. The contrary seems to be true in France. As Miller points out, ``the French do not imbibe their Freud straight, but take him as directed'' by Lacan. Whereas American, English, and German psychoanalysis concentrates on the predicaments of the individual ego, the French model as articulated by Lacan (and Hassoun) stresses the person as a social, cultural, relational being. For Hassoun, depression has fundamentally to do with connection and disconnection, with the exiles and homelands of the heart.

So loathe is Hassoun to understand depression in narrowly biological terms that he calls it by the ancient term ``melancholy,'' which he understands to be a kind of passion, a passion for the absent unknown. The melancholic pines for something missing, something lost or misplaced long in her past (in contrast with the anxious person, who worries about the future), but she does not know what that something is, and so does not know how to look for it, nor know how she will recognize it when she finds it.

While that makes an appealing kind of sense, Hassoun's idea of what that missing something is is quite specific; it is, in fact, Mom's breast. He argues that depression is the aftermath of bungled weaning. In order for a child to relate successfully to the world, to be a subject relating in a fruitful, healthy, and joyful way with objects -- life and the world -- as Hassoun sees it, its mother must ``give up'' her breast, allow it to be converted from an emblem of her sexuality to a transmitter of maternal care. Then in time, the child too must give up that breast. In Hassoun's model, if the mother withholds the breast, lends it coldly or grudgingly, or forces a too-early weaning, the child cannot naturally mourn this inevitable primal loss, nor move naturally toward the forging of relationships with other great objects, the successors to the breast.

That experience, or lack of experience, in Hassoun's view accounts for the melancholic's inchoate feeling of loss and deprivation: ``For the melancholic is tormented not by a loss, but by the lack of possibility for naming and designating this loss.'' While the paranoiac ``manages successfully to create external persecutory objects, the melancholic founders in a universe of misfortune with no assignable cause.''

Miller, who has read Lacan's and Hassoun's works in French and has heard Hassoun lecture in Boston, is powerfully drawn to the more humane, more philosophical, ontological, even spiritual way of looking at depression that Hassoun's work represents, as compared with, in our country, ``the efficient technology demanded by competitive, profit-oriented economies.'' And yet he seems to reveal a grain of skepticism about Hassoun's particulars: ``Hassoun's insistence on liberation from the maternal breast, accompanied by mourning the loss, may strike many people not only as a strange idea but also as an unpalatable one,'' mainly because it is so politically incorrect -- seeming to be another blame-Mom theory. ``French psychoanalysis,'' he acknowledges, ``is a combination of wild speculation and strict schematic theories concerning the subterranean territories of unconscious life.''

Whether one believes in the biological/pharmacological model of depression or the Lacanian model, to this lay reader, at least, it seems reasonable to ask: Has Hassoun or anyone else ever tested this theory? Oh, yes, he includes cases in this book, but no psychological theorist (except perhaps, as Miller once pointed out to me, for Freud himself in the famous Dora case) introduces cases that place his own suppositions in question. Cases are anecdotes; they prove nothing. It would seem, if Hassoun is correct, that all bottle-fed babies must grow up to be depressed. Is it so? If it is, think of the fantastic class-action case there might be against baby-formula makers -- of course, millions of moms and grannies would have to be co-defendants.

Miller is a fine writer, with an understated wit. Consider for example this drollery: ``Reading Hassoun is not easy.'' Hassoun's writing is often stimulating and strange, and full of beguiling literary allusions, but one must say that much of this little book is as clear as a July afternoon in San Francisco. Here is a fairly typical passage, which would doubtless be of great help to any depressed reader:

``Lacan points out that if the formula of desire, as it is determined by the first object, is written D (a) in anxiety, the first object, a, is replaced by the anxiety. At this point, he adds, the formula for anxiety might also be written D (a), but here the object a -- cause of desire -- is substituted by anxiety, which is characteristically objectless.''

But in fairness, this is not a self-help book. It is understandable, for the most part, with careful reading, and Hassoun's vision of the experience of some kind of depression (the more lively, plaintive variety) is affecting: ``The baffling absence of what cannot be represented, of what has failed to present itself, can only underscore the lack of markers and relay points, the impossibility of a boundary line that greets melancholics on a daily basis . . . unaware of what insult has been dealt them and what they lack, they barely even know how to envision what failed to occur; so in the long, slow monologue they lock themselves into, they will spin out harangues that are at once aggrieved and cruel.''

There is no mention of drugs in this book; it would appear that in Jacques Hassoun's clinical model, relationship is as much the solution as lack of it is the problem. He writes, ``in the analysis of melancholics . . . we work to establish the object, work toward a mourning that was never carried out, bearing in mind -- as Francois Baudry notes -- that `the new love that is the very formula of the (analytic) act' tends to establish an object that can allow the subject to mourn.''

For all their benefits, SSRIs do not encourage mourning. Whether Hassoun's theory of bungled weaning is plausible or not, his outlook represents an older way of understanding the cruelty of depression. It seeks to assuage the pain by reconnecting the sufferer with the experience of being human-with-others, and in that reconnection, extending the hope for healing.