Is Martin Depressed?

I am ready to return to posts about the many topics of interest we have explored previously. The first subject I find fascinating is whether we are correct in diagnosing ME as suffering from Major Depressive Disorder. Of course, the reason I came to this question is by reading an article in the NYTimes in March that mentions accelerated experiential dynamic psychotherapy. This type of therapy is new to me, although the therapists in our group may be familiar with it. The article is intriguing, however, because of the example used.

The patient in the article had been diagnosed with intractable depression and “he had been through cognitive behavioral therapy, psychoanalytic psychotherapy, supportive therapy and dialectical behavioral therapy” without success. He had also been medicated without a significant change other than intolerable side effects. Most importantly, he had grown up in a very detached and cold family atmosphere. The therapist recalls that “Brian had few memories of being held, comforted, played with or asked how we was doing.”

The therapist writes: “Based on what he (Brian) told me, I decided to treat him as a survivor of childhood neglect — a form of trauma. Even when two parents live under the same roof and provide the basics of care like food, shelter and physical safety, as Brian’s parents had, the child can be neglected if the parents do not bond emotionally with him.” It is the emotional engagement that is so important to children.

The therapist goes on to say: “One innate response to this type of environment is for the child to develop chronic shame. He interprets his distress, which is caused by his emotional aloneness, as a personal flaw. He blames himself for what he is feeling and concludes that there must be something wrong with him. This all happens unconsciously. For the child, shaming himself is less terrifying than accepting that his caregivers can’t be counted on for comfort or connection.”

Furthermore, this therapist explains that “to understand Brian’s type of shame, it helps to know that there are basically two categories of emotions. There are core emotions, like anger, joy and sadness, which when experienced viscerally lead to a sense of relief and clarity (even if they are initially unpleasant). And there are inhibitory emotions, like shame, guilt and anxiety, which serve to block you from experiencing core emotions…Children with too much shame grow up to be adults who can no longer sense their inner experiences. They learn not to feel, and they lose the ability to use their emotions as a compass for living. “

This description strikes me as being analogous to what we’ve been told about Martin’s childhood and what we see in his behavior as an adult. (Again, I am not proposing that the writers thought this all through when they created the character of Martin Ellingham. I am simply continuing to do more armchair analysis.) The portrayal of ME is weighted more towards the inhibitory emotions in general, although we’ve seen occasions during which he has appeared either joyful or sad, e.g. when he holds Louisa’s hand after the concert or when she accepts his proposal of marriage, and when Louisa tells him she doesn’t want to see him anymore. By the end of S6, ME has begun to experience many of the core emotions, particularly joyfulness and sadness. We know he feels joy during his wedding ceremony and the initial arrival at the lodge, and we know he’s sad during much of the latter episodes, but most especially when Louisa tells him she’s going to Spain and departs for the airport. (We see him tearful in the hospital following the AVM operation, and that’s a sign that he has begun to be in touch with his core emotions even though his tears are due to a mixture of relief and concern.) We may see him squashing his core feelings at the very end of S6 when he once again has trouble expressing any emotion in Louisa’s presence, but at least we know he can access his core emotions.

In the article the therapist encourages his patient ” to inhabit a stance of curiosity and openness to whatever he was feeling. This is how a person reacquaints himself with his feelings: to name them; to learn how they feel in his body; to sense what response the feeling is calling for; and in the case of a grief like Brian’s, to learn to let himself cry until the crying stops naturally (which it will, contrary to a belief common among traumatized people) and he feels a sense of visceral relief.”

I am pretty sure we will never see anything like this sort of therapy take place on the show, and they appear to be using couple’s therapy rather than individual anyway. Nevertheless, we’ve never shied away from considering the best form of therapy for someone in these circumstances and I don’t see why we should stop now! It certainly seems true that Martin’s childhood was similarly lacking in emotional attachment to either of his parents and that he could easily have developed a sense of shame.

There is much action for S7 that has been filmed in interior locations where no one outside of the cast and crew knows what has taken place. It’s possible that we may see some tears from ME and/or LE, and we may see some openness to expressing core emotions to each other beyond Louisa’s displays of anger we saw in S6. I hope to hear what all of you think of this distinction between core emotions and inhibitory emotions as well as what anyone knows about AEDP therapy. Actually, anything this post brings to mind is welcome!

Originally posted 2015-07-10 14:03:49.

17 thoughts on “Is Martin Depressed?

  1. Carol

    Karen, I think this may be your best post by far, for me anyway. I have always thought of Martin as depressed but the points in the article really do make far more sense for him. In thinking about my own personal similarities to the character, I would say that much of this is spot on for me as well, and I have never heard it put exactly this way. But I do know that I often will be, for example, terribly anxious about something, but have no physical awareness of this. If you ask me, I would say that “No, I’m not anxious or nervous,” and wonder why someone was even asking me that.

    It is only as I have come further down my own journey that I have realized that if I pay attention to how my body itself is feeling, I will realize that yes, I am anxious. It is as if at some point I learned to stop paying attention to my body’s sensations. I wonder exactly how that happened?

    A good example of this is that my daughter is getting ready to go to college out of state this fall. People keep asking me how I feel, am I nervous, sad, etc. On the surface, my first answer is that I am fine about it. But now that I know I should do it, I have been paying attention to my body’s signals and I know that I am indeed quite anxious about it. In fact the anxiety is with me much of the time and affects many things that I do, although I am really happy for her to be starting this new part of her life.

    Knowing the truth about myself helps me to be easier on myself, something I find extremely difficult, and helps me remember to do my breathing and try to get exercise, etc., so that I can handle the anxiety in a positive way. Otherwise I will go to my default habits which are much less healthy for me all the way around. Just like Martin does.

    I would dearly love for a therapist to address this with Martin on the show. I think there could be a lot of humor in Martin hearing this philosophy for one (big scowl) and then trying to actually listen to his body. With Martin Clunes’ expressive face, can’t you just see him struggling with that in your mind’s eye? I think it could be hilarious. I fear though, that they won’t want to go into his issues this deeply. Though in real life that is probably the only way things would get better for a person like him in the long term. Can’t wait to see what they do with the therapist.

    Well I wait with eager anticipation to read other comments. Glad you had fun on your trip and here is hoping your scenes don’t end up on the cutting room floor!!

    Carol

  2. kjacobson@mindspring.com Post author

    Thank you Carol. I am very interested in psychology and find the many theories and approaches to treatment of each person’s predicament a demonstration of how difficult it is to define the origins of their afflictions as well as the most effective way to ameliorate them. Perhaps due to this very reason, choosing a psychological condition for a character has the ambiguity that lends itself to providing a good storyline.

    It’s also true that we can all directly relate to many of the interpersonal challenges these characters face, and that makes the show most engaging.

    I’m still hoping to hear from other readers. Also, I hope to publish a follow-up post soon.

  3. waxwings

    Yes Karen, I also think you have written a very fine post. Thank you. It has evoked a lot of thoughts and reflections, and I will risk a quick reply. I know nothing about AEDP therapy, beyond what you have described, so my response is truly “arm chair.” But from what I learned about AEDP, it feels like a good possibility for our Doc’s seemingly intractable condition.

    While WE all can see that Martin Ellingham is depressed (esp. Series 6), I believe he would never think of himself that way, because he has resisted emotions that make him feel “depressed” for so long, he can’t recognize them for what they are now.

    He knows something is terribly wrong, but he seeks desperately to discover a physical cause (stethoscope to the heart, urinalysis test, etc). He is so well used to shutting down emotional responses — both to other people, and esp. to what he might be feeling himself — that a diagnosis of “depression” would be anathema to him. (In truth, if he could only open up, explore his emotions and accept such a diagnosis, it would be a blessing, so he could at least be on his way to dealing with it. But no, Martin Ellingham has steeled himself against all exploration of past emotional injury….)

    What he is feeling is so deep and buried that he can’t recognize it, and this has caused him to further shut down because he knows subconsciously that what has provoked his condition (esp. in Series 6) is what he is feeling for his new family— love, intimacy, connection— which are good, powerful and real things, but core emotions that he has always blocked, and replaced with feelings of being unworthy, distrustful, and repulsed. These core emotions (love, joy) are all feelings that have been sources of danger for him in the past. He has trained himself to avoid them, and now he finds he has stepped into the breach—to the very place he has avoided—and is now paralyzed by it.

    I think the article that you site Karen is marvelous and spot on for understanding our Doc. Only he hasn’t read it. And won’t be able to until he gets the help he needs to confront his past: like Brian in the article, ME is “a survivor of childhood neglect — a form of trauma.” He comes to his new family lacking the “emotional engagement” from his own parents that he must now supply to his own son and to Louisa. He is revisiting the SHAME he felt for not being worthy (or so he believed) of his own parents love, and thus, deserving of their neglect. How could he possibly give love and emotional support to his new family when he never felt it himself? He wouldn’t know how because his past “shame” and view of himself as unworthy have blocked out those required core emotions (love, joy, even anger) that lead to clarity about self and how self can then relate to others in a healthy way. So he is confused. Very confused. The sentence from your AEDP article really sums ME up well:

    “Children with too much shame grow up to be adults who can no longer sense their inner experiences. They learn not to feel, and they lose the ability to use their emotions as a compass for living.”

    Martin is without a true North. His compass is haywire. He needs re-orienting, getting in touch—really NOTING his body reactions —for what he is feeling, in order to rebuild his internal navigation skills. This may actually work for our Doc, because it is based on PHYSICAL sensitivities, not psychological, non-scientific ones. He would be asked just to be open to observing his physical, bodily reactions, and re-learning how to recognize them and not go to the default position of shut down and blockage. To let the emotions act as a valve for the past to flow, ultimately to give him release and a sense of clarity about his history and past traumas. Seems far fetched for our Doc, but he just might go for it, and maybe it can be the key to unlocking and healing ME’s injuries from so long ago.

    I have always believed, and said so on this site many times, that ME needs to deal with those issues before he can move forward with Louisa and a family. AEDP therapy may be the way. I also agree that it could make for some high hilarity on the DM show if they work that into the homework of ME’s healing. Can this be done in couples counseling? Doubtful, but in the hands of those skilled DM writers, maybe it can be. I too, look forward to Series 7. Thanks again for writing another very thoughtful and enlightening post on our wonderful favorite character and show. Best to all.

  4. kjacobson@mindspring.com Post author

    Welcome back Marta! I really like what you’ve written and how you’ve applied the article to ME. I especially like what you say about how the core emotions of love and joy have been sources of danger for him in the past and now, after avoiding them or suppressing them for so long, he has put himself in a position that forces him to grapple with them and he is paralyzed by that.

    I also like what you say about how he would be more open to accepting physical rather than psychological sources for his difficulties.

    During the courtship period Martin might have been so driven by the act of winning Louisa that he didn’t think about the reality of being married and having a family until the day of his wedding, and then he backed out (along with Louisa). The appearance of pregnant Louisa sped up the next stage of preparing to have a family and he didn’t have adequate time to get in touch with his feelings. Then, after living together and managing a baby together, they had another upheaval in their relationship followed by a unified effort to deal with a major event (the abduction of JH) which led to what seemed to be a breakthrough in Martin’s defenses. He finally tells Louisa he loves her and will always. Unfortunately, getting married and making the adjustments necessary for that commitment has led to a setback of major proportions. Maybe now he will reconnect with his core emotions because he doesn’t want to lose what was so hard to gain and such a huge achievement for him.

    I think we’re all anxious to see what exactly they choose to do with therapy. It should give us a lot to talk about.

  5. Linda D.

    This was a really amazing article Karen. I have read it over several times. The comments already given have been amazing and I cannot add much to the discussion that can compare to what has already been written. Still, I found the article and ensuing comments fascinating! As you say, much of this is analogous to Martin Ellingham – amazingly so. Having no emotional bond with parents is obviously very devastating. This points well to the fact that it is the nurturing and caring for a child that makes him/her who he/she really is. I think the issues of childhood neglect do indeed amount to a serious trauma as seen by Brian and by Martin Ellingham. Our Doc is struggling to give Louisa and James love and emotional support but he brings nothing to the table owing from his own neglect by his parents. He simply has no skills in relating to his loved ones in a healthy way and this has caused Louisa so much heartache because she does not understand him. People criticise her reactions to him quite a lot without remembering that she is in the dark about his wretched upbringing. He has some idea of what she needs and is most certainly very frightened by the feelings he is now accessing that were once so deeply hidden. How sad for Martin to have found love and yet to be so distressed because he can’t figure out how to make it work. If his belief system makes him think that he does not deserve happiness and love, it is no wonder that he is depressed. He is watching his family implode. He is sitting back and letting it happen because he knows no way out.

  6. Santa

    I don’t think that the exact diagnosis we give Martin is as important as the formulation, in this case that he has been physically and emotionally abused from infancy on. The idea that these children almost always believe that they somehow deserve their abuse, and therefore grow up with shame, is pretty widespread among those who work with these children, and I don’t think it took any special acuity of the writers to pick up on it.

    To me, the most amazing thing about Martin Ellingham, is his amazing defensive structure, which keeps most of these “primary ” feelings at bay, unless he’s in extraordinary distress, where they break through. Heretofore, we have seen that breach quickly repaired. I do hope that the scene in the hospital bathroom, where he allowed his grief to emerge, signals a more lasting breakthrough.

    It has always seemed to me that it was the experience of living as a family, and parenting an infant, that stressed his defensive structure to the point of a breakdown. I think he was trying to ward off the feelings of his own childhood, which it must have struck him, at some level, as so painfully and drastically different than what James Henry was experiencing.

    I doubt that we’ll see much of this explicitly addressed. Maybe the hillside scene with Aunt Ruth was meant to provide the insight he needs to start healing.

  7. kjacobson@mindspring.com Post author

    I can agree that almost everyone recognizes that children who have been neglected by their parents tend to blame themselves. What I would not have been so clear about is the division between core emotions and inhibitory ones or the use of a therapy that emphasizes physical means of treating these such that the patient overcomes his/her barriers to allowing them to be expressed. The only reason it might matter what the diagnosis is would be how to treat it. If being diagnosed with depression leads down a path like Brian went through with no success, then abandoning that diagnosis and trying a new approach is important.

    I think the frequent scenes in S6 in which Martin watches James in different settings are there to reveal how that impacts him. We are left to consider in what way. Those times when he sees James with his mother are probably meant to be the most revelatory because he can directly relate and wants to intercede so that JH is protected from her. In general Martin touches James in some way nearly every time James is in his vicinity and that makes clear how emotionally attached he is to James. It also shows Martin can express physical affection even while struggling with his condition, etc. Now he needs to do more of that with Louisa. That doesn’t seem like such a huge step for him to take if he wants to save his marriage.

  8. Abby

    I agree with your assessment of the proximal etiology of Martin’s breakdown, Santa. I think by the end of S6 his defenses had been sufficiently breached to make growth possible.

    I had heard of AEDP but didn’t know much about it until reading your post. It sounds like a synthesis of a somatic approach and an emotionally-focused approach. The interventions you described are ones I use in my practice, so perhaps AEDP is a more formalized way of using commonly used interventions. I have to qualify that last statement. More and more therapists have become aware of the importance of mind/body unity, but many have not. Helping a client be curious and open to his feelings is, in essence, mindfulness, which to me is the key to healing. Teaching a client get in touch with how those emotions are expressed in the body is part of being mindful.

    There is an exercise I have been doing with clients to help with this. You may want to try it. Here it is: Close your eyes and, paying attention to your body, say the word “no” out loud 10-15 times. Then do the same with the word “yes”. Notice the difference in how they feel in your body. This exercise demonstrates to most clients the subtle changes that happen in the body that can be a source of information about their internal experience. I have to thank Dr. Daniel Siegel, MD for this exercise.

    I think this approach would be difficult, but nevertheless important, for ME, because he has closed himself off from his internal experience for so long. I imagine it would be frightening for him to feel his core emotions, so treatment would have to be done with great care. I do think that, for someone as cerebral as ME, the initial approach should be psychoeducation, specifically providing him with research papers on the newest discoveries in brain science. I think he would need a buy in for the deeper work, and having him understand what is happening in his brain as he becomes more mindful would provide that.

    Of course, as has been said before, we will likely see little if any of this in S7. Nonetheless, it is fun to play with.

  9. kjacobson@mindspring.com Post author

    Thanks Abby. Now that you have described what you do with some patients, this form of therapy does seem to be closely related to Mindfulness. There’s no doubt that therapy must do best when it is tailored to the patient and his/her personal inclinations.

    It sure helps to have a practicing therapist give us the lowdown. All of us are quite certain that the show won’t provide many scenes with the therapist, and it shouldn’t. If that were to happen, we would all be unhappy about it because it would leave out too much of the other elements that we like. We are just having fun and learning for our own purposes at the same time.

  10. Abby

    If anyone tried the yes/no exercise I referenced, I would love to hear your thoughts. What did you notice, if anything?

  11. Maria

    Abby, thank you for making us aware of this! I found it to be quite a powerful exercise. I did notice differences in my body, physical manifestations of the change in my mental state as I said the words. “No” brought a feeling of being closed off, unreceptive, defensive, while ‘yes’ did just the opposite – it created a feeling of curiosity, openness, and possibility. I felt those differences in the body as well. But they were subtle, which indicates to me – again – the importance of actively paying attention, being mindful about what is going on in the mind and the body (either order can work, it seems to me). Since you referenced Dr. Daniel Siegel, I did some cursory googling and am intrigued by his concept of mindsight and how our focus of attention can influence/change brain structure.

    I am getting off topic so will stop here, but I find this whole area of inquiry endlessly fascinating.

  12. Maria

    I meant to also mention a book on this topic called Your Body Knows the Answer by David I. Rome, which focuses on the ‘felt sense’, the physically felt experience of emotions.

  13. Abby

    Maria, thank you for letting me know your experience with the exercise. Your comment that the effect is subtle is so true. I like this exercise because it allows people, maybe for the first time, to experience just how much information they can gain by paying attention to their bodies. Without doing something like this exercise most people are unaware of the subtle changes you described.

  14. kjacobson@mindspring.com Post author

    Thanks for joining the conversation Maria. I tried it too and wonder how much the mere change in the movement of our tongues and mouths affects what we feel. When we say “no,” we place our tongues on our upper palate and press against it while drawing our lips together. When we say “yes,” our tongues are at the back of our mouths and we are almost smiling. Wouldn’t all of that do something to our sensations?

    Thank you for the reference as well. We are going beyond the scope of the show, but all of this expands what the show introduces. I’m so lucky to have found a group of people who enjoy thinking about all of these phenomena also!

  15. kjacobson@mindspring.com Post author

    Abby, would the fact that Martin says “yes” fairly often in response to various remarks have anything to add to this? I don’t think they have him do that for any reason other than it’s a noncommittal way of brushing people off. Nevertheless, since we’re just throwing out ideas here, would this habit of his have any effect on him?

  16. Carol

    Abby, just tried it and wow, very interesting . The first thing I noticed is just the tightness with no and loosening with yes, around my mouth and face. The second is a definite closing up of the body with no, and an opening with yes.

    Thanks for this.

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