Counselling and Psychotherapy Author, Consultant in Equalities and Diversity, Counselling and Self-Awareness Trainer
A Fresh Look at Depression
Talk given in Radom, Poland on 8 April 2002 to
psychiatrists, psychologists, social workers, trainees and clients
First of all, thank you for inviting me to speak this evening. I am pleased to be here and to have this opportunity to present some of my thoughts and experiences concerning depression.
I want to begin by exploring briefly the causes of depression, and I will group these under 4 headings for simplicity and because I think that this differentiation provides a useful basis for not only recognising the causes of the problem, but the treatment responses that may be helpful:
1.Depression resulting from chemical imbalance within the body
2.Depression resulting from environmental factors
3.Depression resulting from psychological factors
4.Depression resulting from energy changes within the person
Depression resulting from chemical imbalance in the body
This is perhaps the most easily treated so long as the appropriate medication can be prescribed for the individual. However, we must be aware that not everyone reacts the same way to medication and so a range of anti-depressants or other medications may be required to help achieve the necessary chemical changes. I do not propose to say much more about this other than to acknowledge that for some people depression is a simple effect of chemical imbalance and the treatment response is appropriately a chemical one.
Depression resulting from environmental factors
This covers a wide range of factors and can include living conditions, economic factors, employment problems, lack of employment, relational difficulties. Environmental factors are essentially those things that impact on us from outside, that can leave a person feeling unable to cope, stressed, no sense of hope or direction, disempowered. The effects are generally connected with psychological factors for, as we know, there is a constant interplay between our psychology and the world outside of our internal processes. For some people a change of environmental circumstances can be the appropriate treatment intervention to combat depression.
Treatment can often mean spending time with people. Loneliness is a huge factor in depression. We also need to get people interacting in normal, non-medicalised settings as well. I see too many people who’s whole life seems to be taken up with being a professional, each day a seemingly endless series of contacts with either professionals or other people with similar problems. It can be too much and can have an institutionalising effect on the person. Other forms of interaction are essential, voluntary work can be helpful, or simple, part-time work.
Many women in mid-life experience a crisis of identity. The children are growing up, perhaps leaving home and no longer in need of a mother figure in quite the same way. What is the mother to do? What new role can she create for herself? Support networks for women are developing all over the world. Women are looking for far greater roles in society, as true partners. Speaking as a man, I believe we must listen, we must learn to communicate and share ideas and be open to new ways. It is an exciting time but we must be prepared to be open to new possibilities.
At the same time many men are unsure as to their role as well. No longer the sole breadwinner in a family, and frequently struggling to provide what advertising tells us we need to be happy, men can feel under a lot of pressure. Many men find it hard to talk about the pressures they are under and often it is released through displays of violence sometimes triggered by excess alcohol use. It can also, of course, remain unexpressed leaving the individual feeling life is futile. "what’s the point?" with mood lowering into depression.
I well remember a client of mine who I was seeing for an alcohol problem, but who also had depressive symptoms as well, remarking on a feedback sheet that was given to her after her therapy had ended "my counsellor helped me to realise that I did not so much have an alcohol problem as a what to do with my life problem". I have seen many people in a similar situation, people for whom life has lost its meaning and they are struggling with the psychological effects of realising this to be the case.
Depression resulting from psychological factors
Here the list is endless. People feel depressed as a result of what is happening to them in their current lives, and as a result of experiences from the past. Experiences contributing to the appearance of depressive symptoms include: physical and/or sexual abuse, constant criticism, bullying, death of close relatives/friends, other losses, feeling out of control, traumatic episodes. In these cases, whilst an intervention with medication may relieve symptoms, it will not resolve the underlying cause, and counselling, psychotherapy or other psychological interventions will be necessary.
I work at one doctor’s surgery where I sometimes see clients before they have been prescribed anti-depressants so that I can assess with the client whether they feel medication would be helpful. Sometimes it is for it can help the person to stabilise their mood in order to work with the underlying issues. However, any mood-changing medication does affect the person’s ability to be fully in touch with their emotions and sometimes medication can block clients from experiencing emotional material that needs cathartic release as part of their treatment.
Depression resulting from energy changes within the person
This category may seem rather strange, but it is something that I have become increasingly interested in. The idea is that we not just physical forms but that we exist within fields of energy. That underlying the physical body is an energy or vital body through which subtle energies flow, energies that, for instance, the acupuncturist can access, or other forms of healing. This energy field has seven major centres, sometimes referred to as ‘chakras’ each focusing particular energies which govern areas of human experience. They are said to located at the base of the spine, in the sacral area, in the solar plexus region, between the shoulder blades in the region of the heart, in the throat, between and a little above the eyes, at the crown of the head.
Beyond this are possibly other energy fields, a field of emotion and a field of thought, for instance, and possibly subtler still a spiritual field or what we might term the Soul or psychologically the Self.
Changes occur in the nature and focus of the energies flowing through us. This can be the result of natural changes as we move through life, shifting to different areas of emphasis on our lives, for instance, opening up to feelings or to our thought life, or to spiritual experience. Life is seen as a progression through various energy states, a stream of constant adjustment as we progress through the individual life-cycle. The perspective has been termed ‘esoteric psychology’ (Bailey, 1942)
As we go through life we adjust to changes and opening up to areas of ourselves. For instance, discovering we have emotions can be a time of traumatic adjustment, and later of realising ourselves as independent thinkers and the power of the mind. Further on life we may open ourselves to greater spiritual sensitivity as well, each stage offering opportunity, but also crisis. In terms of the energy system underlying the physical body it can be said that at different stages of life-emphasis particular centres control (Bailey, 1942)
1.Centres below the diaphragm in control indicates material and very basic physical desires are in control and dominating
2.Where the major emphasis is in the solar plexus, there has been a shift towards emotion and desire, the emphasis is on feelings
3.As the throat centre awakens then a shift of energy to this centre can result in increasing creativity with the mind and thought much more active and present. The centre between the eyebrows becomes more active and what we might term ‘the creative and integrated personality’ emerges.
4.As the heart centre awakens energy rises from the solar plexus and feelings are transmuted in the sense that personal desire becomes aspiration to deeper and spiritual matters. The emerging sense of spirituality also encourages decentralisation as the person moves away from self-centredness to a greater emphasis on the greater good and/or on group work.
5.The awakening of the head centre indicates increased connection between the body and the Soul, between form and spirit.
It is not recommended that attention be placed on these centres in order to stimulate development. They awaken and energy flows naturally in response to experiences. However, energies can be blocked, often due to psychological trauma and dealing with this psychologically can naturally lift the blocks. Where energy is blocked, depression can be a result.
When a person opens up to the higher centres it can lead to a sense of feeling overwhelmed, of feeling inferior and a sense of futility. This is a natural response which, given support and encouragement, will resolve itself. However, the person can be left with a temporary sense of cleavage, as if they have been psychologically split. This can occur, for instance, when the person is awakening to a more spiritual sensitivity yet their nature rebels against this, holding them to old patterns of feelings and behaviours. This can lead to:
acquiescence with the previous state leading to a life of experienced futility, depression, frustration, negativity and possibly even suicide
a furious inner conflict, a refusal to be contained by environment and circumstances and the individual drives themselves towards a more spiritually fulfilling life, or is psychologically broken by the effort.
Healing the splits
We need to help people understand and heal their psychological splits. We need to help people also discover the art of living once again, or perhaps for the first time. People can become too obsessed with their own feelings and we need to raw people out, extend their horizons. It brings me back to the need for ‘joined-up’ treatment responses, offering people a range of activities and interests to engage with, to help them build up aspects of their nature that are positively experienced.
The human body is very good at self-healing, and often we need to provide it with the necessary environmental conditions for it to recover. The same is true for psychological problems. Hence my personal emphasis in my work as a counsellor and in the training that I offer on the therapeutically relational principles of Carl Rogers.
I wish to emphasise the importance of the relationships that we form with our clients. Relationship is, I believe, key to successful therapeutic intervention. We need to treat our clients with respect. Bear in mind that many people with mental or emotional health problems may have experienced a lot of negativity in their lives, and may have a distorted perception of what ‘normal relationship’ actually is. I am reminded of the work of the American psychologist Carl Rogers who formulated a set of six ‘necessary and sufficient conditions for change. Among these are included:
•unconditional positive regard from the therapist communicated to and experienced by the client
•empathy from the therapist communicated to and experienced by the client
•congruence from the therapist communicated to and experienced by the client
We need to feel and communicate warmth to our clients. They can be very lonely and isolated people, feeling perhaps that no-one cares, or that they are not worth bothering with, attitudes that can have developed over many years but have their roots in a difficult childhood. The client needs to feel that we are listening to them and that we have an appreciation of what they are experiencing. It is helpful not to feel so alone, that someone is trying to be a companion with you in you desperate inner world. Finally, the need to be real with people. There is something refreshing and healing about being with someone who is genuinely themselves, and who can be trusted to say it how it is for them. It helps the client to be more open and honest with the therapist and with themselves, not easy when you may have had a lifetime of being deceived and not knowing who you could really trust.
Avoiding excessive medical emphasis
I also think that we need to be aware of avoiding over-medicalising depression. It is very often a natural and human reaction to circumstances, part of what I would suggest is a normal coping mechanism. Let me give an example by way of analogy. I have worked with a lot of clients who have depression in association with what we would at one time have termed a ‘breakdown’. The person has basically come to a halt psychologically, overwhelmed by some factor or factors in their lives. Often this is not a conscious choice but the system of mind-emotion-body saying "enough is enough". The person experiences symptoms of losing energy, losing motivation and generally entering into a depressed state. I see this as rather like overloading an electrical circuit. The circuit breaker has blown, or the fuse. Now there is no energy flowing. We cannot switch the power back on as it will cut out again. We have to understand why it has blown, in this analogy because the system has been overloaded with appliances. We must then slowly turn the power back on, but not everything at once as this might overload the system again.
It is the same process psychologically. Where someone is depressed in this way they will need to take time understanding what has overloaded their system, and what may need to change in order for them to function freely again. Again, they must build themselves up slowly, taking care not to overload themselves or else they will switch off and lose the energy flow again. This can take time and it is a slowly, slowly process to be sure that the changes that are formulated and applied are genuinely sustainable over time.
We speak in the UK of ‘joined-up’ treatment responses. We also hear a lot about holistic treatment. For me it is about recognising where the cause of the depression is seated and then seeking to offer an intervention suited to that focus. Or it may require a package of care. This means agencies talking to each other. The person with depression may need some social outlets, or something to do that is not overwhelming but helps them feel that they are contributing something positive in their lives. Befriending organisation may have a role to play as well. It can require social workers, psychologists and family members to work together to help rehabilitate the person.
Alcohol and depression
I see a lot of this in my work as a specialist alcohol counsellor, a role in which I also work with many people who have complex needs that involves both depression and alcohol use. Alcohol, we know, has a depressive effect and whilst it can initially relieve symptoms of depression, it generally deepens it and can lead to heightened risks of self-harm and suicide. We see more and more people experiencing problems with depression (and other mental health problems) and who are using alcohol or drugs either to relieve symptoms, or their addiction is out of control and it is simply exacerbating the mental health problems. It is a huge and growing area of concern and the need for specialists to work with this client group is becoming increasingly apparent.
I work to a client-centred model within a model of change which I describe more fully in my book (Bryant-Jefferies, 2001). The model of change used widely in addiction services in the UK is based on one formulated in the 1980s by two American psychologists Prochaska and DiClemente.
Before I conclude I want to say something about supervision, or what I call " Collaborative review". All health and social care professionals need supervision in the sense of a place to go to explore their reactions to their client work, to resolve issues that have been triggered by their encounters with clients and to basically help them to further develop their own understanding of the work that they are doing. As a counsellor, supervision is a necessary part of my profession. I learn enormous amounts through it which benefit me as well as my clients.
Working with people struggling with depression can be heavy going. Agencies can so easily parallel-process the feelings of the clients: lack of motivation, sense of helplessness, struggling to take responsibility for choices and decisions. Individual supervision and group supervision can help identify problems and resolve them for everyone’s benefit. Over-stressed professionals are not healthy for clients. We need to look after ourselves.
I think we have to broaden our understanding of both the causes of depression and the range of treatment responses that can be offered. I think we have to see our client with depression as the unique human being that they are and work with their unique experience of depression. I think we have to draw people out, expand their horizons, offer them more fulfilling roles in life, encourage them into social networks, build up their self-esteem and self-confidence and having done so, ensure that there are opportunities for them to express their new found sense of self.
I think that societal changes today make depression more widespread. I believe it is potentially an epidemic that is spreading in response to people realising that life is not offering then enough to help them fulfil themselves as human beings endowed with physical, emotional, mental and spiritual talents. We must be radically creative and we must be positive. People are people. We need to work person-to-person.
I want to leave you with an experience of a medical doctor working in the field of psychiatry. At the end of many months of working together the doctor asked the client "What has been the most helpful and meaningful aspect of the treatment? What made the greatest impression on you and helped you?" The client, "the time that you opened the door for me in the corridor".
For me this sums up the impact we have on people, and how easy it is to overlook the psychological impact of simple human responses, and of the need to always treat our clients with respect for they are not primarily mental health patients, but people like all of us who just happen to be faced with a particular problem - depression.
Bailey, A A (1942) Esoteric Psychology Vol II, A Treatise on the Seven Rays. Lucis Press Publishers, London.
Bryant-Jefferies, R (2001) Counselling the Person Beyond the Alcohol Problem. Jessica Kingsley Publishers, London