[This is the fifth post in a series on anxiety and depression. See Part 4 here.]
This is a case study of anxiety used as a defense against a return to a depressive state.
Robert left an urgent message on my voicemail. He said that he was anxious and panicky. He wanted an appointment as soon as possible. I returned the call and arranged an intake appointment for him the next day.
When we met, this is the story that he related to me. The remarks made in brackets [...] are some of my clinical impressions of his situation.
Robert is a first generation Portuguese American. He is single and in his early twenties. Robert's speech came in rapid bursts. He complained that his thoughts were racing almost faster than he could speak them. He felt that any number of bad things could happen to him in the near future.
His problems began a number of months ago. He had met a woman, Rosaline. He said she was "rich in beauty" and had fallen in love with her. Unfortunately for Robert, this woman believed that she had a calling to the Catholic convent. She was kind to Robert and admitted that she had strong feelings for him. However, Robert could not persuade her to give up her calling. Seeing that Robert could not settle for a simple friendship with her, she told him it was best that they not see each other.
Robert began to isolate himself. He called out of work frequently. During the day, he would remain in his room and close the curtains. He ate little. Sleep only came in fits and starts. He cried often. This went on for a number of weeks. He got no pleasure out of his hobbies, music or day-to-day life. Robert despaired of ever getting Rosaline to love him and he believed that no other woman could replace her. Robert ruminated relentlessly about Rosaline. He was convinced that he would remain depressed forever.
[Clearly, at that time, Robert met the criteria for Major Depressive Disorder.]
His friends worried about him and tried to get him to go out with them. Robert refused their invitations for quite a while. However, a friend learned that the woman Robert loved was going to attend a party later that week. The friend convinced Robert to go with him to the party if only to be able to see the woman from across the room. The friend said to Robert,"Make yourself lovesick by looking at some new girl, and your old lovesickness will be cured." Reluctantly, Robert agreed.
A funny thing happened at the party. Robert did see Rosaline but she did not return his gaze. He was shattered. In looking away, he saw another woman and he says that he instantly fell in love.
He remembered thinking that "her beauty is too good for this world; she's too beautiful to die." In the fit of this new love, he thought, "did my heart ever love anyone before this moment? No!"
[Here we can see overvaluation, idealization of the new woman and devaluation of and perhaps reaction formation against Rosaline. Robert is probably also using displacement to redirect his assessment of and affections for Rosaline onto Julia. Anxious not to return to his depression, he is employing some primitive defenses.]
He went over to her and held her hand. Surprised, she turned to look at him. Robert gave her one of his best lines.
"If you're offended by the touch of my hand, my two lips are right here, ready to make things better with a kiss."
He quickly kissed her. She teased him back by saying: "You kiss like you've studied how from books."
Yet, the young woman was taken by him. They flirted and talked for the next hour or so. Each told the other that they had fallen in love at first sight.
Then, the more they talked, the more they revealed the details of their lives. An unfortunate fact came out. Their families were both from the same island in Portugal. There was a lot of bad blood between the families. Moreover, this new girl, Julia, planned to go back to the island in a few short weeks. There, her family hoped, she would settle down and marry a man who was a family friend. If she returned to the island, they both knew that there was little hope of a long-term love between them.
Neither quite knew what to do. Robert became acutely anxious.
[Anxiety comes in as a defense against the loss of his new love and against the return to his depressive state.]
As the party broke up, both of them promised to call each other the next day.
In the parking lot, Robert could not stand the tension. His mind filled with fears of losing his new love. He bitterly remembered how depressed he was only hours ago. He got in his car and followed Julia to the house where she lived with her parents. When she went into her home, Robert got out of the car and went into the backyard. He waited there until he saw a light turn on.
He gently rapped his knuckles on the ground floor window and Julia looked out. She scolded him and said that her parents would kill him if they saw him in their backyard.
Robert replied, "one angry look from you would be worse than twenty of your relatives with knives. I'll hide in the dark. And if you don't love me, let them find me here. I'd rather they killed me than have to live without your love."
Julia whispered to him:
"You can't see my face because it's dark out. Otherwise, you'd see me blushing about the things you've heard me say tonight. Do you love me? Robert, if you really love me, say it to me. Or if you think it's too easy and quick to win my heart, I'll frown and play hard-to-get, as long as that will make you try to win me, but otherwise I wouldn't act that way for anything. In truth, I like you too much, so you may think I'm loose. But trust me, I'll prove myself more faithful than girls who act coy and play hard-to-get. I should have been more standoffish. So excuse me, and do not assume that because you made me love you so easily my love isn't serious."
Robert jumped at this chance and swore that he would love her forever.
They then returned to difficulties that their new romance faced. Eventually Robert suggested that they elope as soon as possible and get married by a justice of the peace. He figured that, after a while, both families could come to accept their marriage. Then they could have another, more formal marriage in a church.
[The idea of getting married within hours of first meeting Julia is Robert's impulse to stave off both anxiety and depression. Unfortunately, it ignores all sorts of reality-based considerations.]
Julia agreed. Sometime later, they said good night and promised to see each other the next day.
All of this had occurred two days ago. Since then, Robert had suffered several panic attacks. He had called me to get treatment for those symptoms. His anxiety and difficulties thinking clearly were getting in the way of preparing for his elopement.
At this point, I need to acknowledge my sources for this story. It is the tale of "Romeo and Juliet" by William Shakespeare. I have modified only minor elements of the plot. The dialogue is taken almost verbatim from the No Fear Shakespeare's modern translation of "Romeo and Juliet."
This is a story tested by time. According to Wikipedia, it was first translated into English from its Italian original in 1562. Before that, Wikipedia tells us that the story has origins "stretching back to antiquity." For that reason, it shows that anxiety as a defense against depression has old roots. The outcomes of this strategy, however, were no better for Romeo than they are now. Recall Donovan Campbell's plunge into depression when anxiety finally failed to protect him against the reality of his situation.
My plan for the next post is to discuss treatment options for Robert/Romeo's condition.