Working Through Depression

Michael Ebbinghaus • September 8, 2021

Depression is an insidious form of mental illness tantamount to a magic spell where the victim becomes mired in an echo chamber of their own self-deprecation. Constantly an enemy to themselves, they will attribute all negativity and perceived shortcomings to moral or characterological deficiencies. This creates a pernicious cycle in which these self-representations, or schemas , perpetuate and reinforce themselves through behavior. If we think ourselves wretched, we shy away from opportunities for positive engagement. Even when these opportunities present themselves, we may maddeningly self-sabotage and misplace all our competencies and disintegrate in a wreck of self-consciousness. This is the pattern that can increasingly isolate and grind down the depressive individual, who may look to suicidal fantasies not only as an escape from pain but experience it as a moral duty.

These descriptions illustrate a seed site for depression in the form of disowned or shadow narcissism. Those that have experienced depression can speak to the frustration of being hopelessly self-centered, unable to expand beyond the barrier of one’s own unending narrative. A key feature of depression is a tendency towards shadow aggrandizement: we are the most wretched, least capable, deserve our misery, perhaps even unworthy of the gift of life. Linguistic analyses of journal entries by depressed individuals indicate that their first-person pronoun usage is significantly higher than controls. This may seem to be the last thing someone suffering from depression needs to hear, but it is in the reclamation of a healthy narcissism where the tormented may find a route to recovery, healing, and wholeness.

What is Narcissism?

When we are exposed to the word “narcissist” or “narcissism,” generally a picture of a powerful and somewhat sociopathic person arises, most commonly a man that is repulsively self-centered, unable to take others’ needs into account, manipulative in close relationships and protective of their spotless image (much as the depressive is protective of their tarnished one). This is only one side of a concept that is neither good nor bad, so it would benefit us to explore it as such.

The nature of our experience is self-centered. This is unavoidable and necessary. As children we develop this sense of self before we learn to apply it to others, because their physical embodied experience is not immediate to our own. None of us our privy to the experience of another. At this moment you are reading this with your eyes, on your screen, on your commute. This is the basic sense of narcissism, and to be able to be aware of and meet one’s needs, drives, and desires is an ability we would be hopeless without. We need to know when to defecate, to eat, play, and how to integrate into our social systems. Narcissism is needed!

When we interact with someone that is depressed, we might describe them as anything other than narcissistic. Unless they are in a severe episode, it may be difficult to discern they are depressed at all. Beneath the hood, we’ll find thoughts arising out of and contributing to low self-worth, efficacy, and image. This dissonance is frustrating as well, as the sufferer feels a ghoul of themselves maintaining the façade of “everything is fine,” or worrying constantly that others are weary of their needs, growing more isolated with each passing moment. One has retreated into the tower of their internal experience where they can do nothing but concern themselves with themselves, paralyzed in the cacophony of their own head, their position vigorously defended. Depression and narcissism possess that same stubbornness. The narcissist is assured of their greatness, the depressive their worthlessness. Vulnerability to addictions of all sorts intensifies as hope for salvation is rationally considered to be outside this wretched and deficient self, but this is exactly where we will find it.


"This dissonance is frustrating as well, as the sufferer feels a ghoul of themselves maintaining the façade of “everything is fine,” or worrying constantly that others are weary of their needs, growing more isolated with each passing moment."

Part of the path to healing must include a recognition of and reclamation of one’s inherent narcissism or sense of self-worth. Once we have accepted that self-flagellation, self-torture, and suicidal ideation are manifestations of profound self-centeredness, we realize that there is no getting around it, and to further berate ourselves is to boast of anguish. Why do we call them “self-fulfilling” prophecies? Here I can speak amply from personal experience. One of my favorite ways to drag myself down was to tell myself that I was not worthy of life, that this was exactly what I deserved , something I would not think towards the most objectionable of people. There was no one worse than me. What a thing to say. Is saying that we are the absolute best much better than saying we are the absolute worst? This is the atrocious self, as opposed to the grandiose self of the true narcissist. Beneath this depreciation and masochism is the fetid maw of disowned narcissism. This is where the choice is made. The reclamation of a healthy sense of self is the first step in self-compassion and self-love.

Unselfish Narcissism

Patterns of negative internal narratives are one of the main symptoms and etiologies of depression, and the simplest way to begin to shift the sunken trenches of the brain is to reverse the stream through the conscious use of positive self-talk and mantras. This will help no matter where one is in the pit, and can pave the way for more convoluted, fun, and idiosyncratic self-love practices (cooking, dancing, singing, passions, etc.). Such an approach will also benefit from mindfulness practice to better apprehend the emergence of habitual behavior. Be prepared for the shadow narcissist within to intensify their attacks. Just like a true narcissist in the external world, the internal shadow narcissist does not enjoy limitations on its power, so it will attempt to further denigrate and depreciate you! Understand this as a naked admission of its fear. It knows that it maintains its power through our identification with its spells. Speak to it as you would an unruly child, with respect and understanding but with the full knowledge of what you need, which includes the well-being of this angry and disowned piece. Continue the practice as it wales, moans, and tears. “I am worthy. I am self-love.” 2-5 minutes of repeating this mantra will have an effect, and grow more profound as it is cemented into habit.

This is the conversation we must have in ourselves. If we find speaking well of ourselves repulsive, then we know that this is where we must venture if we are to ever have a life that does not purely just happen to us. Selfishness must be given its proper place within our internal hierarchy. We have no choice in whether or not it exists, and if we attempt to deny it will eat us alive. This is the path of humility, harmony, and healing. The art of relationship is not only for others. We must relate to our own experience as a kind and compassionate caretaker would.

This task is simple but not easy. There are many rational and external justifications for questioning our self-worth, and many people on many sides of the political spectrum will attempt to seduce our power away from us so that they might lay claim to it. There will be further stumbles and returns to the pit. That is okay. Each time we exit, we learn the route and venture out faster and further. Eventually we may become so enamored with the world beyond that we’re able to leave our hovel entirely, our narcissist restored to its proper abode, the proper seat given to the source of awareness.

Helpful Resources for Those Struggling With Depression

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What is Ketamine-Assisted Psychotherapy? Ketamine-assisted psychotherapy (KAP) is a modality that uses low dose ketamine alongside talk therapy to access non-ordinary states of consciousness, helping clients process trauma, depression, and anxiety in a new and deeper way. One of the most common complaints about traditional psychotherapy is that it can take a very long time for unconscious material to surface, even after a solid relationship has formed with your therapist. While there are techniques we utilize in our practice that do not require substances (e.g. dreamwork, sentence completion, automatic writing/drawing, etc.), the introduction of intentional medicine work can reliably shift one into an altered state of consciousness, catalyzing access to unconscious material. After a brief introductory period, you will take ketamine under supervision from your therapist either in-office or virtually in the comfort of your own home. The therapist will guide you to take your own journey as well as direct you towards areas that might benefit from exploration in an alternate perspective. Learn more What is Ketamine? Ketamine is a dissociative anesthetic acting primarily on the glutamate neurotransmitter system. This differentiates it from the traditional psychedelics like LSD and psychedelic mushrooms which are much more prominent in the serotonin system. Ketamine increases neural plasticity, meaning that the brain becomes more flexible to change, open to new insights and behaviors. Ketamine has been used for over 50 years as a surgical anesthetic. It has no impact on the respiratory system, making it one of the most safe and effective medicines available. It is classified as a WHO top 10 essential medicine, and it is so safe that it is still the anesthetic of choice for children. It is a schedule III medication approved for off-label use in assisted psychotherapy, meaning a healthcare professional must be supervising in some capacity. Screening is essential, see below for more information. How KAP Works One of the things we like to stress is that the medicine is taking you to a place within yourself. It is not the ketamine "doing" anything other than relaxing your emotional defenses and allowing for exploration of consciousness. That said, you will feel a degree of relaxation in your body as well as your mind, which allows things which we keep buried to come up to the surface. By shifting into an alternate state of consciousness, we are able to sublimate many of the barriers we have in place that remain opaque to us. Oftentimes simply allowing this material to surface creates greater harmony, and you ma find yourself saying "Oh - this is what I've been afraid of for so long? It's not so big and scary after all." This is not always the case, of course. The nature of what is hidden can also be very painful, which is why the presence of the therapist as well as the therapeutic relationship is imperative when first working with alternate states of consciousness and healing trauma. What Does KAP Treat? Ketamine's claim to fame comes from its potent and immediate anti-depressive effect . While this requires lifestyle change and further exploration - greatly benefitted by depth psychotherapy - this can be incredibly helpful to those experiencing treatment resistant depression. It does this primarily through breaking up rigid neural networks (enhanced neuroplasticity), limiting one's ability to ruminate. Ketamine for depression can be powerful, indeed. In a meta-analysis of over 2,500 patients, it was found that 45% of people had significant drops in clinical depressions inventories, with 30% in remission. The benefits were often sustained at 6-month follow up. Ketamine-assisted therapy can be helpful for those who experience post-traumatic stress disorder or PTSD . The clinical evidence here is quite strong, with multiple meta-analyses and an open label study showing durable and significant reductions in PTSD symptoms in as many as 69% of respondents and up to six-months' follow up. Ketamine for trauma is widely studied and efficacious. Anxiety is also significantly reduced after brief KAP treatments. In a glimpse, ketamine can treat: Treatment-resistant depression PTSD and trauma-related symptoms Anxiety and existential distress Addiction and maladaptive coping Spiritual exploration or life transitions What Does Treatment Look Like At Ebb & Flow Depth Psychotherapy, we believe in the importance of a strong therapeutic relationship to help sustain the positive effects from ketamine treatment. To this end, prior to any medicine session, there are 6-8 preparation sessions (this can be reduced to 2-4 if you are already working with another therapist). From there, we will conduct two initial dosing sessions with an integration session in between each. We would then conduct another 6-8 dosing sessions, also with an integration session in between each. Our Approach During each session, you will be gently guided into your body utilizing a simple meditation or, if preferred, ambient music. We utilize sublingual lozenges, tablets which will be dissolved and swished in the mouth for 10-12 minutes, then spit out. This offers a psycholytic approach rather than a psychedelic approach. We prefer the psycholytic approach for two main reasons: 1) This helps to make ketamine-assisted psychotherapy more affordable, as the presence of a medical professional such as an RN is not needed as they are in IM (intramuscular) or IV (intravenous) injections. 2) Psychedelic ketamine therapy can be effective, but in our hustle and bustle world, the subtle work often gets overlooked, and it is the subtle work that carries us the farthest. If you’re seeking a full psychedelic experience, I often recommend doing so on your own time and terms, ideally in nature or a supportive setting. There are few practitioners I would trust to guide me through such an experience, and they come at an extraordinary financial cost more often than not. With psycholytic ketamine therapy, we are nudging gently and entering into an altered state but not breaking open the doors of reality. Through the experience and through the journey you've taken thus far, which includes your triumphs and your traumas, we will expand not only on who you are but who you are meant to be. Your exuberant and mature presence is sorely needed in this world, and it requires reconciliation of our darker nature and highest aspirations. Who is KAP for? Ask yourself now: "Am I in a place where I am ready for deep self-exploration?" "Am I open to the idea of letting go of things which both pain and comfort me?" "Can I remain off of substances and away from process addictions (such as pornography, over-eating/bingeing and purging, sex, etc.) for at least three days?" You may not be ready for KAP if: Are experiencing active psychosis or mania Have untreated Bipolar I or II disorder Have a personal or family history of schizophrenia Are currently struggling with active substance dependence If you are in a grounded place and ready to make shifts in your life, KAP may offer the support you've been looking for. Ketamine Therapy In Austin, TX - How to Get Started Contact me today for your free consultation to see if ketamine assisted depth psychotherapy might be right for you. Myself and the fine clinicians over at Journey Clinical are ready to help you find deeper meaning in life and be the change in the world you wish to see. We conduct ketamine-assisted therapy in Austin, Texas as well as virtually all over the state. Reach out to us today!