Counselling Psychology Quarterly

Vol. 23, No. 4, December 2010, 399409

The top of my head came off : A phenomenological interpretative
analysis of the experience of depression
John Rhodes
a
*
and Jonathan Smith
b
a
Brent Adult Psychology Service (CNWL), Mental Health Resources Centre, Brent;
b
Birkbeck College, University of London, London, UK
(Received 29 August 2009; final version received 5 October 2010)
This study explored what it is actually like to be depressed, that is, to
capture the content and complexity of this experience from the view point
of the sufferer. We present a case study using interpretative phenomeno-
logical analysis (IPA) of one man diagnosed with reactive depression.
A semi-structured interview explored the experience of depression. The
interview was transcribed and analysed using IPA. We describe how his
depression occurred in the context of work and financial difficulties and
note how a sense of vulnerability emerged and contrast with his reported
experience of conventional masculinity. The process of becoming depressed
involved the eruption of old negative memories and a catastrophic view of
the present and future involving failure and death. We present a detailed
analysis of two metaphorical constructions of depression. The features of
depression form an interconnected whole. The experience of depression is
so extreme that it is reported as if the person or self is dying. Onset appears
to involve the destruction of highly valued life projects of the person. For
some individuals, metaphors and images may be an actual part of the
experience itself and contribute to it.
Keywords: depression; phenomenology; metaphors; narrative; images;
masculinity
Introduction
What is it really like to be depressed? It is tempting to think that we must understand
given the large amount of research carried out in this area, or that as clinicians we
have observed many cases. Yet some who have been depressed claim that others do
not really understand, that the non-depressed, as it were, stand on the outside and
cannot see within. We hope, however, in this paper to show that our attempts to
understand can be facilitated by the use of in-depth, idiographic, qualitative analysis,
in particular, by the detailed exploration of an interview with such an individual in a
way that experiential qualities are retained.
Qualitative research can be thought of as complementary to quantitative research
and it is not our intention to dismiss the many findings and theories generated in this
tradition (Hammen & Watkins, 2008). It may not, however, as suggested above,
capture the complexity and meaning of changes occurring over time for an
individual, nor what these experiences feel like.
*Corresponding author. Email: [email protected]
ISSN 09515070 print/ISSN 14693674 online
2010 Taylor & Francis
DOI: 10.1080/09515070.2010.530484
http://www.informaworld.com
There are a small number of qualitative studies focused on the personal
experience of depression. One tradition is the publication of actual first-person
accounts of depression, for example, Plath (1971), Styron (1991), Smith (1999), and
Solomon (2001). These accounts tend to underline the utter extremity of depressive
experience and its ineffability. The limitation of the above first-person accounts,
however, is that such work tends to be published by those who are highly literate and
often by people who have achieved major success in areas such as literature.
There has been relatively little qualitative research by psychologists into
depression. We will describe two recent interesting examples. Granek (2006)
suggested that the core experience of these participants was depression as social
isolation and alteration in relationships with others. She argued that the DSM-IV
(American Psychiatric Association, 1994) list of symptoms tends to ignore relational
features. Emslie, Ridge, Ziebland, and Hunt (2006), argued that we know little about
mens experience of depression. They noted how several participants reported being
the victims of bullying, often involving insults and attacks relating to areas such as
masculine status. They note how, for some men, the very idea of being depressed may
be in conflict with self-conceptions of masculinity, and hence may prevent such men
seeking help.
Within the tradition of psychoanalysis there has been considerable writing and
theorizing about depression (Lucas, 2004). The case material presented is, however,
interpreted in terms of psychoanalytic theory. In this paper by contrast, we employ
interpretative phenomenological analysis (IPA) (Smith, 2004) an approach with a
different set of theoretical imperatives. IPA tends to focus on the conscious, that
which is presented, and begins with an interpretative stance of empathy.
In sum, there is now an enormous literature on depression, yet, we believe, the
area of qualitative investigation, particularly within psychology, has been underde-
veloped. There is a need for more research that systematically investigates depression
from the first person perspective. Furthermore, while there is a need for studies that
take a comparative perspective, there is also a need for studies examining the
experiences of unique individuals. In this paper we wish to present one such study,
that is, a single case study exploring the reported experience of reactive depression.
Method
Participant
The case study we present is of one man who we shall name as Paul. Paul was one
participant amongst others in a wider study of depression, but chosen to be the focus
of this paper due to the richness of his description of depression. Paul was aged 46 at
the time of the research, married with two teenage children. For many years he had
run his own business with some colleagues. He had spent most of his youth in a
British city, except for one year abroad. He had left school at 16 and had worked
ever since. His general self-presentation was of someone who appeared quite
conventionally masculine, with for example, an interest in sport.
Data collection
Paul was recruited for the research (Ethics Committee approved) from a waiting list
for therapy; he had been diagnosed as having major reactive depression.
400 J. Rhodes and J. Smith
The interview was semi-structured (Smith & Osborn, 2008), that is, the researchers
had discussed the possible areas of relevance and from this constructed flexible open
questions. The central focus of the interview was to ask the participant what the
experience of depression was like now and during the initial stages.
Analysis
The transcript was subjected to IPA (Smith, 2004, 2007; Smith & Osborn, 2008).
First there was a close reading of the text and notes written. The second stage
involved reading the text again in an attempt to transform the initial notes into
themes. The third stage, involved clustering and organizing the many themes. The
sequence was repeated many times until a level of conceptualization of the data could
be achieved which best captured the core themes and the whole text. Each stage of
analysis was discussed with the second author who thus acted as an independent
audit (Smith & Osborn, 2008). The resulting analysis was written by both authors.
Results
The context for depression
Paul was asked what was happening in his life before the depression began. He first
described several long-term difficulties: he had run a small business that had
struggled to make money over the years. He had also worked excessively long hours,
and had often stayed out in the evenings drinking. He did not mention any specific
problems with his wife and children, but noted that due to his drinking he had often
not seen his family.
He was then specifically asked about the time just before his depression started
and as it took hold. He explained that he had not paid his tax for a couple of years
and also had debts. At one point a large tax bill arrived. He went to the tax office and
what he owed was reinforced:
I actually remember actually saying to him, Im going to join Dr Kelly at this
rate . . . and I really just felt so low.
Dr Kelly was well known at the time as someone who had committed suicide. Paul
went straight to the doctor where he cried. Paul stated that he thought that this time
was the actual beginning of his depression. After discussion with his wife, the only
solution they saw for the debt was to remortgage. On being asked what this situation
meant he said:
It meant the end. It meant the end.
Features of depression
Paul stated:
The reason I can look at this and say oh, clinical depression, because I cant motivate
myself, I dont want to. Which is just not me. Its not me at all. Or maybe it is?
It is interesting to note that Paul picked out these features of depression as central, in
particular, he underlined that in the past he had had that normal black cloud that
Counselling Psychology Quarterly 401
floats over, but had been good at snapping out of things, at motivating
himself. Now he found that the most ordinary every day activities were difficult. He
gave an example of needing to go to buy some ready-made meals: before the
interview, this had been on his mind:
Will I buy the right things? Why bother? . . . . I do care, but I dont.
Paul seems to be portraying a fundamental change in motivation, and motivation
understood not only as having desires or aims to do certain things, but also the
ability to get himself to do these things. The change in motivation and capacity to act
is linked by him to not being his normal self. Although, interestingly, after asserting
that it is just not me, he immediately questions that, suggesting a concern that this
lack of motivation may indeed be creeping in to become a core feature of himself.
Beginning with his lack of motivation and lack of capacity to act, he went on to
describe a series of interconnecting key features of his depression:
I suppose its like I dont care, you know, to get myself out of this hole. Many things
have been put in front of me to do. Meditation, err, anything. Its just a complete
nothingness . . . what is the point? . . . err, its the fear, as well, the fear, its terrible . . .
. . . The hopelessness brings on the fear. I feel that everything I do, everything Ive done,
has been a waste . . . I know this moment of calm is going to go. I know it is going. Its
almost like theres a big wave out there. A big tsunami outside that door . . . Im waiting
for that fearfulness to come on like a wave. Err, the fear of the day, of the next day and,
if I think too much then Ill be thinking about the whole picture and then the future,
scary.
The various features or aspects of his state interconnect: hopelessness brings a
crushing wave of fear and both lead him to excessive thinking, it brings
everything in, and this everything involves both the past and future. The fact that he
cannot stop thinking such thoughts also damages his relationship with his wife.
Itll turn into something dark, you know about our, our circumstances.
He mentioned going for a walk in the morning sun with his wife who has suggested
that he should just imagine good things. However, he said I couldnt see it . . . I
focus on negatives. He could only imagine being homeless, a tramp, and when
asked explicitly what would happen stated:
I know I will die but what kind of, horrible death would that be?
Death, or its potential, is a theme he returned to at several points. As discussed
earlier, he compared himself to someone who had committed suicide and when he
got a letter finalizing the remortgage he said out loud in the presence of his wife, bye
bye life. At this moment he appears to have blended (Fauconnier & Turner,
2002) at least two conceptual areas (dying and remortgage) into one complex
emotional experience.
Masculinity and vulnerability
Paul reflected on a particular change he noticed in himself:
Never thought it would come to me, to a state where Im just so helpless or feel helpless.
I almost feel like theres something inside me that makes me want to be helpless. You
know, I want to be looked after. You know, I just want somebody to hold my hand.
402 J. Rhodes and J. Smith
Over and above specific experiential features, he felt that he was not acting like
himself and experienced something utterly new, a feeling of being vulnerable,
perhaps weak. He emphasized how all his life he had been, or wanted to be, a
strong person:
youre supposed to be, as a young man, youre supposed to be something . . . I think I
always wanted to be a, a fearless person, I wanted to be not scared of the big bad
world . . .
. . . you know, just, Im going to become someone, Im going to be strong.
Depression for Paul seemed to involve a central coming apart of these assumptions
and/or what might be thought of as fundamental desires to be a certain sort of
person. And to his shock and bewilderment, he has now found a vulnerable self:
I want someone to come and put an arm around me and say come on, youre alright.
Youll be alright mate, Ill help you.
We can only speculate, but it seems reasonable to suggest that, this newer unfulfilled
yearning for care, to be someone looked after and not always the one out fighting
and snapping out of things represents both a contribution to depression but also
one possibility of a way forward out of it.
The horror of depression
We have now described the context of difficulties in Pauls life and several features of
being depressed. We next wish to turn to two complex and extended images or
scenarios he used to vividly capture life at its worst.
In that pit
At several points Paul described his state of being depressed as if he was in a pit or
hole and that this image had actually occurred to him many times during the
depression. The pit or the hole is one of the most common metaphors in depression
(Emslie et al., 2006). However, each persons pit will be particular to him or her,
drawing on details, implications, memories, fears, connections and unique symbol-
ism generated from specific biographic experiences.
And at one point Paul recounts the following:
P: There were points where I would say to my wife, err, I feel like Im in a hole, in a big
well type hole with my hands tied behind my back, sometimes gagged. And water
seeping in from the sides, with no way out . . . just filling up with water.
J: And how far has it got, the water?
P: I wont let it rise. I wont let the water rise. Its almost like I can hear it. But I wont it
let rise. No, no, no I wont let it rise.
J: Its a deep hole, what kind of sides?
P: Oh rough and err stony, like its been dug out. Its not like a well of bricks or
anything like that. Just all rough and edgy . . . I had a vision, you know, a conjured
vision of erm Silence of the Lambs with err Buffalo Bill, and as it keeps the, in that pit,
and it was that, that sort of hole, you know, lots of stones, . . . just an earth hole. But it is
a feeling of hopelessness, I get tremendous, tremendous fears sometimes . . . very scary.
Cos that image to me is one of no escape. Its not one of those, there wasnt a ladder by
the side. I didnt think, well, you know, gonna get saved here you know, a ropes gonna
come down. Cos my hands are tied anyway, err, no no no no way out.
Counselling Psychology Quarterly 403
We would suggest that this image vividly captures a number of central features of
Pauls experience of depression.
At one level he is completely helpless, his hands tied, gagged, with no
escape. The hands here may be symbolic of his practical ways of coping, of the
normal ability to do useful things. In the pit, however, he cannot use these hands
to escape. And even if he did try to use his hands to grasp the sides of the pit, he
would only get hold of earth, earth and stones which perhaps would crumble, fall
off. Making an effort he would still fall back. And his mouth is gagged so he cant
shout for help nor talk his way out.
In an anxious tone, he says that he will not let the water rise, but this is not said
with confidence; it comes across more as a desperate plea, recreating his futile
attempts to stop it rising. So there is also an implicit suggestion of a slow agonizing
death as the water rises and drowns him. So he will be cut off from his very breath.
And breath is one of the root meanings of the Greek psycho. The psycho was
breath but also that which contained the very essence of being alive, in fact, is life.
Water will fill his nostrils slowly. He is not blindfolded, he will see everything, he will
see his destruction. There is no easy clean and sudden escape. This serves then as a
powerful image of the terrible death he has earlier described as being in fear of. It is
interesting to note that it is water here that would kill him and it is water in
the earlier wave of fear: perhaps the idea of water emphasizes for Paul the notion
of suffocation by a force that cannot be handled, of not being able to take
anymore, of an amorphous substance that cannot be easily escaped once a person is
immersed in it.
The image also suggests being abandoned: in the earth, forgotten, un-mourned
and not ceremoniously buried by others. He will be alone. Elsewhere in the
interview, we have already seen that he thinks he will end up homeless on the
street, alone, and then will die. The idea of being alone permeates his imagination.
Part of depression seems to crucially involve a sense of utter loneliness. And this
loneliness at the point of death is perhaps one of our deepest terrors. In
Kiarostamis film, The Taste of Cherries, a man cannot bring himself to kill himself
using sleeping pills until he can persuade anyone, any stranger, recruited at
random, to go the next day to a chosen spot to bury his body or, if he wakes up
with a response to a shout, to take him home. He could face the act of suicide, but
not the loneliness of an abandoned body. The image of the pit for Paul violates
this dread: he will die alone.
Who is Paul the victim of? Who has tied his hands and left him in the pit? This is
left unclear. The reference to the film Silence of the Lambs emphasizes the
anonymous, sadistic horror and his terror. Elsewhere in the interview, he speaks of
the fear of being attacked:
P: I wanted to be able to go out there and if necessary, protect myself and protect my
family.
J: From what?
P: . . . the aggressors that are out there, you know, like, lets say muggers,
hooliganism etc.
Yet in some ways this particular torture seems like it is uniquely his. The descent into
depression is the descent into his personal hell, perhaps the Room 101 of Orwell? His
situation is both real and external to him, yet it is one imbued with symbols perhaps
emitting from past suffering. It is as though his worst terror, worst nightmare is
404 J. Rhodes and J. Smith
made concrete in the pit image. It is a sort of congealed image of past and present
terror. It expressed his experiences now, but also draws up terror from the past.
And in some ways perhaps the nightmare represents some retribution, or self
inflicted punishment. Elsewhere in the interview, he recalls both being bullied and
being a bully at school and these are significant and painful memories. So being in
the pit replays how others treated Paul and how he treated others; it may also
represent his fear of being attacked, either because it is a senseless world or because
he will be punished for his cruelty. Finally it is a symbol of self directed loathing, of
an attack by the self on the self.
The top of your head would pop right off
In another vivid sequence, Paul recounts the following:
P: And then it brings on this dread. It just brings everything in, the brain is mad.
J: Your thoughts link up you mean?
P: Everything starts to link up then, and as much as sometimes you can, you would you
would actually pop, your head would pop off, the top of your head would pop right off,
it if you just.
J: Like blow up, you mean?
P: Yeah if you let everything come in all at once. And I have experienced that on a
number of occasions at the beginning of this.
J: What was that like then?
P: Absolutely awful.
J: Can you describe it?
P: Yeah like you want to scream and scream and scream as hard as you possibly can to
dispel it.
J: Dispel what though, youre in this state you want to scream, its popping. What is it?
P: What happened to me was everything I had ever done had come into my head over a
period of time. Say, initially over a, three to six week period.
J: OK in that six week period, everything you had ever done in the past.
P: Yeah.
J: Was reviewed?
P: Yeah.
J: It came through your mind?
P: It came into my head. . . All the dark things, all the bad things came into my head.
And eventually it was like the sensation of having a hinge here [He pointed to the back
of his neck] . . . a little hinge that grew and grew. And then the top of my head came off
and all of it came out. Thats what it was like. All these thoughts and they caused so
much, I suppose frustration, physical frustration that you want to scream. And I did
actually one morning I was in my car driving to a therapist. I was stuck in a traffic jam, I
was shaking with fear. And I screamed in the car, and screamed and screamed and
screamed and screamed and screamed, shouting. No, no words, just Aahh. Didnt do
me any good. I didnt feel better.
So Paul begins by describing how negative thoughts are accumulating. Their volume
and the increased toxicity caused by their interactions leads to a point where the
brain is mad, reaches overload, needs a release. However the sequence is confusing
and ambiguous. At one level, it appears that the screaming is in reaction to the
frustrating build up and is acting as an attempt to facilitate the release, the explosion.
At another level the screaming could represent the cathartic release itself.
Pauls description of the potential explosive release is particularly unusual.
Describing the fault line which will allow the opening as a hinge introduces a
depersonalized form. Perhaps accompanying the distress and self-directed anger,
Paul sees himself becoming less human, more mechanical. A robot, terminator, or
Frankensteins monster is more likely to have a hinge which allows the head to swing
Counselling Psychology Quarterly 405
free, or the trap door to swing open. So maybe he is worried about both going mad,
of becoming unhinged but also that the toxic brew of bad thoughts is eating away
at his very humanity.
Is there something else going on at the same time? An iconic image of the top of a
head popping right off while sitting in a car remains in the personal and collective
memory of many people and that is the assassination of John F. Kennedy. Maybe
Paul is in part invoking the ultimate release from his agonizing suffering, in this case
through the violent death from a bullet to the head. And remember Paul had earlier
suggested that he thought he might be found like Dr Kelly who it is generally
assumed had committed suicide. So it is possible that one reading of the symbolism
here is that Paul is actually describing a suicide fantasy. This reading connects with
another important cultural referent, the lyrics in A day in the life by the Beatles:
He blew his mind out in a car; he didnt notice that the lights had changed. The
song itself is open to multiple interpretations but it may just be that Paul is here at
one level describing a fantasy that committing suicide might have led to the final
release from his agony.
Discussion
In this paper we have attempted to present the experience of one mans reactive
major depression. Our results suggest a profound and near total change in his
experience of self. Before, he worked, was competent, very social. During the onset
of depression his self unhinged and then he found himself dying in a pit. The
metaphor of the hole emphasizes the notion and feeling of no escape, loss of normal
living experience, and ideas of imminent death.
Using DSM-IV diagnostic criteria, we could tick the diverse and separate boxes:
he has no pleasure, is miserable, sleeping excessively, etc. Our account, however,
demonstrates links not only between events and his reactions, but how his experience
itself forms a whole of interconnected features. Nothing can be done, so he feels
hopeless. But if hopeless, worse will come and he fears this. Feeling a tsunami of
fear leaves him exhausted and hence less able to act. As this happens, he wonders
how it is that he has become so weak.
Vulnerability and masculine violence
As he became depressed, he examined the dark things: more details of these
memories emerged over the interview. Many concerned his childhood, and a
distinctive part of that concerned memories of violence, bullying and racism carried
out against him, and violence he himself committed against another boy. These
topics concur with the findings of Emslie et al. who noted that many of their
participants recounted episodes of a harsh macho early environment, one in which
homophobic bullying, and the use of violence, were common.
Metaphors
The metaphors, or complex imaginative scenarios, particularly the hinge and the pit,
suggest great suffering. It is crucial to remember that none of the key metaphors or
scenarios was produced just for the occasion of the interview. The hinge, the pit, but
406 J. Rhodes and J. Smith
also his bye bye life on receiving a remortgage, were all images that occurred to
him at various times throughout his depression. It seems possible that the greatest
moments of suffering come imbued with metaphor or other forms of figuration
(metonymy, personification, conceptual blends and so forth). What the person
experiences is not something utterly separate from these figurations (Lakoff, 1987;
Lakoff & Johnson, 1980). Rather, the metaphors express, constitute, and amplify the
very experience of the person. Mental experience is like this.
The images we have presented, we believe, illustrate the agony, horror, and
extremity of depression. They might also be said to illustrate two sides of depression,
that is, the explosion in a frenzied state of agitation and fear, but also the implosive
collapse, the weight of being trapped, being helpless, weak and buried.
The metaphors given by Paul appear rich in meaning. It is fascinating to note that
when we paid particularly close attention to explicit and implicit details of these
scenarios, the details seem to resonate with information given throughout the
interview. For example, the unhinging suggests an explosion and he had spoken of
daily life as a battle. We do not believe Paul has deliberately set about composing all
these details and implications and aimed for thematic consistency. It seems
reasonable to suggest that metaphors and images in general say more than a
person deliberately and consciously intends. This concept of saying more has been
long considered in therapy (Cox & Theilgaard, 1987).
Narration
A striking fact reported by Paul was that during his breakdown all the dark things
came back to him rapidly over a 3-week period. The dark things were memories of
his apparent mistakes, that is, negative actions such as bullying another boy at
school. It would appear that this content was not something he would dwell upon
before and some may have been long forgotten.
Given that a person at various points in time might tell a typical story of his or
her life (White, 2007), then we can imagine that in earlier times Paul would have told
a story of strength and success. If so, it appears that a crucial step in becoming
depressed was the, apparently involuntary, catastrophic re-narration of his life.
Depression as a form of dying
Both metaphors analysed in depth hint or speak of death and dying. Shweder (1985)
in a review of several anthropological texts suggests that in many cultures depression
is expressed as a death or loss of a persons very soul, the latter standing for many
things but certainly includes a feeling of being alive and being ones self.
Given the many comments made about dying, and comments suggesting a
fundamental transformation of the self (It is me and its not me), we wish to
speculate that depression is not so much a bereavement for something lost, as
Freud (1917/1961) famously suggested, but rather is a sort of wounding, reduction,
or mortification of ones normal self. It is a movement to dying of the normal self.
This may seem an extreme claim, yet must be put in the context of the horror,
strangeness and ineffability of depression as discussed in the introduction, the fact
that many dread this condition, and further, that in severe cases the person literally
stops normal life functions. Depression, is not just an emotion, for example, an
Counselling Psychology Quarterly 407
extreme feeling of sadness, but rather an un-hinging and alteration of all systems of
the self, including motivation, emotions, thought, action capacities and ultimately
the experience of being the same person over time.
But what destroys the self? In the case of Paul it seems to be that the trigger
involved the ruin of his core identity and core motivational projects (for a house,
money, success), his way of exiting in the world. The symbolism, meaning, of
success are also central, but these are not just abstract interpretations of events.
Rather, these are core projects to which he has committed his life. These are the
essence of that he really cares about (Frankfurt, 1988).
Implications for therapy
Our analysis of this single case suggests several implications for working with
depression. First, that when we approach someone with depression we should
attempt to bracket, to put aside, our assumptions, our stereotypes of depression as
a general thing, and explore with the person their unique experiences, the
distinctive constituents and experiences for this person. And furthermore, we need to
grasp how each aspect fits a complex whole. Second, our study points to the
centrality of understanding a persons real struggle in a difficult real world, yet also
how experience is imbued with metaphor and other images. Third, our case study
also points to the importance of aims, purposes, and projects constituting a persons
way of living. Not only that a way of living has not worked for a person but that it
was obvious in the interview to Paul that he could not just go back to his old way of
living. There is a clear implication that in working with mens depression, there may
be issues concerning attempts to live up to strong man stereotypes which have lead
to a suppression of the ability to seek care.
Declaration of interest: The authors report no conflicts of interest. The authors alone are
responsible for the content and writing of the paper.
Notes on contributors
John Rhodes is a consultant clinical psychologist working in Brent, North London: previously
he has worked in Haringey and Hackney. He was a lecturer at the University of Hertfordshire
and is an Honorary Lecturer at University College London. Over several years he has
specialised in working with psychosis and depression using CBT, solution focused approaches,
and narrative therapy and has written articles in these areas. In 2009 he published Narrative
CBT for Psychosis with Simon Jakes.
Jonathan A. Smith is Professor of Psychology at Birkbeck University of London where he
teaches social psychology and qualitative research methods. Prior to that, he held
appointments at Keele and Sheffield Universities. He has developed interpretative
phenomenological analysis as one particular experiential qualitative methodology and
employed it in a wide range of areas. Much of his current research is in family and health.
He has published many journal articles and edited a number of books. He is the lead author of
the recently published book Interpretative Phenomenological Analysis (Sage, 2009, with Paul
Flowers and Michael Larkin).
References
American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders
(4th ed.). Washington, DC: American Psychiatric Association.
408 J. Rhodes and J. Smith
Cox, M., & Theilgaard, A (1987). Mutative Metaphors in Psychology. London: Tavistock
Publications.
Emslie, C., Ridge, D., Ziebland, S., & Hunt, K. (2006). Mens accounts of depression:
Reconstructing or resisting hegemonic masculinity. Social Science and Medicine, 62,
22462257.
Fauconnier, G., & Turner, M. (2002). The way we think: Conceptual blending and the minds
hidden complexities. New York: Basic Books.
Frankfurt, H.J. (1988). The importance of what we care about. New York: Cambridge
University Press.
Freud, S. (1917/1961). Mourning and melancholia. In J. Strackey (Ed.), The standard edition
of the complete works of Sigmund Freud (Vol. 14). London: Hogarth Press.
Granek, L. (2006). Whats love got to do with it? The relational nature of depressive
experience. Journal of Humanistic Psychology, 46, 191208.
Hammen, C., & Watkins, E. (2008). Depression. Hove: Psychology Press.
Lakoff, G. (1987). Woman, fire, and dangerous things: What categories reveal about the mind.
Chicago, IL: University of Chicago Press.
Lakoff, G., & Johnson, M. (1980). Metaphors we live by. Chicago, IL: University of Chicago
Press.
Lucas, R. (2004). The management of depression analytic, antidepressants or both?
Psychoanalytic Psychotherapy, 18, 268284.
Plath, S. (1971). The bell jar. New York: Harper & Row.
Shweder, R.A. (1985). Menstrual pollution, soul loss, and the comparative study of emotions.
In A. Kleinman & B. Good (Eds.), Culture and depression. Berkeley, CA: The University
of California.
Smith, B. (1999). The abyss: Exploring depression through a narrative of the self. Qualitative
Inquiry, 5, 264279.
Smith, J.A. (2004). Reflecting on the development of interpretative phenomenological analysis
and its contribution to qualitative research in psychology. Qualitative Research in
Psychology, 1, 3954.
Smith, J.A. (2007). Hermeneutics, human sciences and health: Linking theory and practice.
International Journal of Qualitative Studies on Health and Well-Being, 2, 311.
Smith, J.A., & Osborn, M. (2008). Interpretative phenomenological analysis.
In J.A. Smith (Ed.), Qualitative psychology: A practical guide to methods (2nd ed.).
London: Sage.
Solomon, A. (2001). The noonday demon: An atlas of depression. London: Chatto & Windus.
Styron, W. (1991). Darkness visible. London: Picador.
White, M. (2007). Maps of narrative therapy. New York: Norton.
Counselling Psychology Quarterly 409
Copyright of Counselling Psychology Quarterly is the property of Routledge and its content may not be copied
or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission.
However, users may print, download, or email articles for individual use.