I’m a Clinical Psychologist based in Co. Monaghan. Fiona kindly asked me to write a guest post for her page and it was my intention to write something helpful for people experiencing depression and similar problems. Unfortunately I’ve noticed that some of the ideas that I think should be helpful just seem to irritate and annoy quite a few people when I share them on mental health forums and websites. So rather than me trying to be helpful to you I’m hoping that you could be helpful to me and tell me where I am going wrong.
I have received a lot of criticism from people experiencing depression for suggesting that depression is not a “mental illness”. I believe the term “illness” perpetuates the idea that depression is a medical/biological/ genetic problem, involving faulty genes, brain wiring or brain biochemistry, for which a medical solution needs to be found. That solution is always just around the corner. It my view that the medical view is completely wrong and it is the widespread certainty of this view that has prevented the mental health professions from reaching a true understanding of depression and actually being able to eliminate it. From my perspective the “illness” model promotes the hopelessness that leads to many suicides because depression is seen as a life-long incurable condition that needs to be managed, and continually struggled with. It promotes the idea of the incurable broken mind, or the broken unpredictable person, that fuels the stigma that is associated with it. I believe that the very idea of being “mentally ill” makes depression 10 times worse for many people and it crushes them. In the last 12 months I have treated 2 people who were experiencing depression and anxiety simply because they believed that they were still “mentally ill”, and therefore deeply inferior to ‘normal’ people.
In my professional life I have helped far too many people to completely eliminate their depression to believe that anything about the medical model has any truth to it. Over the last 5 years I have been using an approach that is quite different to mainstream treatments and it is based on the removal of the trauma and emotional pain associated with difficult experiences in the past.
Research tells us that between 70% and 90% of people presenting with mental health problems experienced trauma or adverse events, particularly in childhood. These would include sexual, physical or emotional abuse, neglect, exposure to death or violence, parental separation, parents with mental health problems like depression, addiction, psychotic disorder, and so on. Researchers tend to look for these obvious things, but if they looked beyond the obvious that number would rise to almost 100%. Children can be ‘traumatised’ by things that an adult would barely notice. A life of depression, anxiety or addiction can begin with small events like toileting accidents, a fight in the school yard, rejection by peers, or attending a funeral.
When events like these are traumatising it means that the thoughts and emotions that the child experienced during these events become ‘locked in’, and they affect how we see and react to things in the present. When you see mental health problems with this eye it is common to notice the thoughts and emotions of a child mixed in with those of the adult sitting in front of you. Think of a grown man running from a room at the sight of a 10 gram mouse, or someone washing her hands 40 times each day because of a child’s idea about germs. People experiencing depression usually feel a locked in shame or guilt, or sadness or anger, and sometimes a mix of these emotions, that began when they were children or young teenagers. They usually have the locked in childhood thoughts and beliefs that accompany the emotions, like “I am worthless”, “I am a dreadful person”, “I am a failure”, “I am unloveable” and “anyone that sees who I truly am will hate me or reject me”. These beliefs have no more validity than the child’s belief in Santa Claus, and they can be dispelled almost as easily.
Anxiety disorders usually begin with the ‘locked in’ fear of frightening events. The reason this is not obvious to us is because such events are often minimised, forgotten or buried. A mix of thoughts and emotions locked in by a single event can make it appear as if a person has two or three different disorders. Depression and Anxiety disorders frequently appear together simply because they are different expressions of the same disorder. That disorder is “unprocessed emotionally painful experience”. Most psychological therapies used today tend to focus on trying to change the ideas and beliefs that are common to depression, and anxiety, but they don’t look for or treat the traumatising events that keep these ideas locked in place, and therefore the failure rate, and the rate of relapse, is very high.
I use a therapeutic approach that brings the painful things of the past into the mind, to allow the adult brain to look at them, to understand them, to process them, and remove the painful thoughts and emotions from them, to transform them into harmless memories. This removes the foundation on which the mental health problem has been constructed.
The medical/biological school of thought believes that ‘cures’ aren’t really possible, that depression is a life long condition that needs to be managed. Anyone that uses the word ‘cure’ is irresponsible, unscientific and they don’t know what they are talking about. The medical/biological approach cures no-one. I use a trauma-oriented psychological approach that allows 6 out of 10 clients to walk away from therapy completely free from depression/anxiety. 2 out of 10 are just as curable but they don’t want to talk and think about the history that causes their problems, so they discontinue therapy. 2 out of 10 are on brain altering medications, like anxiolytics or anti-psychotics, that make therapeutic progress impossible.
I assumed that if people could define their condition differently they would understand it better. They would realise that there was a way to eliminate their mind problems completely and therefore feel hope and optimism, which would change their experience of their condition. That really isn’t happening. Some of the responses received on mental health forums can be paraphrased as “How dare you suggest that I don’t have a mental illness? Maybe some depressions are caused by traumas but certainly not all. I never had any traumas. My depression is caused by biochemical imbalance and antidepressants saved my life”. The idea that the problem might be fixable is ignored because it seems like delusional thinking. I don’t understand this but it is a fact that I have to accept.
One theory I have is this, and I would like to hear peoples thoughts on it. At the core of most depressions is a strong certainty, a wildly inaccurate certainty, that “I am a person with dreadful unfixable character flaws”. A client once said to me, “I’m no good. On the ladder of goodness I am on the bottom rung and everyone else is above me. I’m not even on the ladder. I’m in the pool of shit that the ladder is standing in. No, I am the pool of shit the ladder is standing in”. Its possible that a diagnosis of mental illness is a comfort to some, because they can say to themselves that “I’m not really such a dreadful or pointless human being. It’s just faulty brain chemistry. I have to keep reminding myself of this”, and they don’t want that comfort to be removed.
(The reason this guy felt that he was a ‘pool of shit’ was because of adult reactions to him when, at the age of 5, he threw a book in a classroom at another 5 year old who was teasing him and bloodied his nose quite badly. He was shouted at and told that he was a “terrible” and “bad” boy by his teachers and his parents. “He could have lost an eye and been blinded. Forever.” The young 5 year old was traumatised by the event, he believed what he was told, and he refused to think about the horrible incident ever again, until it emerged in therapy at the age of 35 years. The thoughts and feelings became stuck in time. After 20 years of depressive episodes, a suicide attempt and a hospitalisation, his adult brain finally reviewed the event and he realised that the 5 year old’s understanding of what had happened was naive and childish, and the certainty that he was no-good just vanished.)
Another theory, one that I know there is a lot of truth to, is that unless “the scientists” say it is true it is just fanciful hokum, and the scientists have been telling us about the genetics and the brain biochemistry of mental illness for a very long time. Today it is an article of faith. There’s not much to be done about that, except to say that since the days when Freud and Jung were vilified by the Science Police, psychological science has provided us with very little and mental health problems continue to escalate. You won’t hear much about it in Ireland but the psychiatric biochemical illness model no longer has unquestioned scientific support and to my mind it has been completely discredited. The golden child of Psychology, Cognitive Behavioural Therapy, has as much scientific support against it as it has for it, and recent research suggests that it is only half as effective today as it was 30 years ago. Which is a bit weird.
I like to put it like this. Only scientific information is given any value in today’s world. Psychology had to become a science to achieve respectability and compete with Psychiatry. In order to become a science Psychology had to stop studying the mind and focus only on those things that could be studied with scientific methods, like words that can be heard and behaviour that can be observed. While mental illness (mind illness) occurs in the mind and is experienced in the mind, the mind is inaccessible to scientific methods, so psychology and psychiatry have literally ignored the mind for nearly 100 years. This is why mental ‘illness’ remains a mystery.
A final notion is that many people who experience depression build up an extensive expertise on the subject over many years, and that expertise is important to them despite the fact that all their knowledge fails to help them rid themselves of their problem. It is possible that some would prefer to be ‘right’ than consider other ways of thinking that might be helpful to them.
I would like to hear the thoughts and reactions of readers who have been struggling with depression/anxiety for some time. My real question is this. Why is it that depressed people seem to believe that this approach might be relevant to some people but definitely not to them in particular? Why are they not immediately intrigued by the idea that the ‘black dog’ could be released forever? I would appreciate any feedback that I can get, but please try to be gentle 🙂
I have long realised that the mental health establishments and professions are like enormous oil tankers with a momentum that will require many decades to alter course but I have been hoping that people who actually suffer with depression/anxiety would be strongly motivated to explore new and more optimistic ideas. Today in Ireland we have up to 450,000 people suffering with depression and we lose over 600 each year to suicide. I believe that virtually all of them are ‘curable’. The idea of waiting 50 years to turn this around drives me crazy.
BSc.(Hons), MSc., DPP(Clin), Reg. Psychol. Ps.S.I.