Depression: Components Of The Mental Pain Experienced By Sufferers

We have seen from numerous other articles that I’ve published on this site that if we experienced severe and chronic interpersonal childhood trauma we are, as adults, at an elevated risk of developing clinical depression (as well as a plethora of other psychiatric and, indeed, physical conditions).

We have also seen that, if we are unfortunate enough to develop borderline personality disorder (BPD), a psychiatric condition which is very strongly associated with the experience of early life trauma, together with comorbid depression then the emotional pain generated by the disorder is likely to be especially excruciating (one in ten sufferers of BPD die by suicide as a result of this literally intolerable pain).

An Analysis Of The Mental Pain Associated With Depression:

Klein suggests that depression has three main neurobiological underpinnings which are as follows:


INHIBITED CENTRAL PLEASURE: This refers to the inability to derive positive feelings such as pleasure from external events (e.g. meeting up with friends or loved ones) or from internal events (e.g. memories of past experiences). The inability to feel pleasure is sometimes referred to as anhedonia (see my previously published article: ‘Childhood Trauma Leading To Anhedonia by clicking HERE.’

DISINHIBITED CENTRAL PAIN: This involves a lowering of endogenous systems (involving sleep, mood, appetite and other functions) which, in turn, leads to the spontaneous creation of pain that the nervous system is unable to inhibit. This results in the brain processing pain on an emotional level producing mental, or ‘psychic’ pain (Forstenpointner et al.). The brain becomes hyper-responsive to negative stimuli leading to morbid rumination (see my related article: Desperation To Escape Mental Anguish Caused By Childhood Trauma) and intense adverse emotions and feelings such as guilt and agitation (to see my article on agitated depression and 14 other types of depression, click HERE).

INHIBITED PSYCHOMOTOR-RELATED MECHANISMS: Psychomotor retardation can involve slowed movement (when my depression was at its worst I was essentially immobile much of the time and when I did get up to walk around my walking speed was probably about one-third of what it had previously been), slowed speech (again, I experienced this; sometimes I was mute for long periods and, when I did speak, my voice was weak, tremulous and almost inaudible) as well as slowed thinking and cognitive functioning in general. What we previously considered mundane, everyday tasks which could previously be undertaken on automatic pilot may become all but impossible (e.g. getting dressed, washing, shaving, brushing teeth, cooking a meal or writing a shopping list – again I have experienced all of these problems at first hand). Psychomotor retardation may be particularly common in psychotic depression and it may be linked to irregularities in the brain’s dopaminergic pathways and basal ganglia (Buyukdura et al., 2011).


Forstenpointner et al., The cornucopia of central disinhibition pain – An evaluation of past and novel concepts. Neurobiology of Disease Volume 145, November 2020, 105041