Hi Everyone,

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.

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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.

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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.

Michael Fox
Clinical Psychologist
BSc.(Hons), MSc., DPP(Clin), Reg. Psychol. Ps.S.I.

This article has 41 Comments

  1. Thank you for your Post – it is really though provoking. I am glad you are pushing boundaries around dealing with clients who have depression. what is important is to treat each client as an individual – look at their history – but ultimately it is listening and understanding that person. Labels are just labels, – I just wish I had the fortune to have you as my clinical psychologist when I was treated in Donegal, unfortunately I had a recently graduated Clinical Psychologist that was demeaning in her manner, very curt, kept checking time during sessions ( I told her to buy a clock so she wouldn’t have to keep checking her mobile for the time). I had a bad experience – in my opinion, I never got to look at the reasons of my depression – just understanding labels.

    1. Hi MD. Thank you for your supportive words. They are so welcome. I get where you’re coming from because I was once that same up-tight trainee. Not as bad maybe. Trainees in clinical psychology, like many professions, are essentially indoctrinated in ‘professional’ behaviour. It creates an ‘us’ and ‘them’ mentality, or the ‘sick client’ – ‘well practitioner’ thing and it’s misguided in my view, because it limits sensitivity and empathy. One key thing is that clinical psychologists are not required to undergo therapy as part of their training, so they are without important experience. The ‘therapeutic relationship’ should be an interaction between two entirely equal human beings. At our core, and beyond our facades, we are all essentially the same, people struggling with our own particular histories in our own unique way. It is a little publicised fact that the incidence of depression and suicide among mental health professionals is the same, or marginally higher, than the general population. The ‘sick client – well practitioner’ is an illusion that both clients and practitioners alike buy into.

      In her defence, the HSE requires that psychologists see a certain number of people each week, like a conveyor belt generating client and appointment numbers for the minister to talk about in the Dail. The HSE, and the ministers, aren’t concerned about outcomes, and as far as I know they are not even measured in either psychology or psychiatry. At present we have 450,000 people in Ireland experiencing depression, up from 300,000 in 2004, and no-one is asking what exactly the mental health services are doing and wether it is working. Part of the reason I left the HSE was because I couldn’t give clients the treatment they needed. It might sound unusual but sessions of 2 and 3 hours are needed to make progress quickly because the brain has barely slipped into gear at the end of a one hour session. That means I can see a maximum of 2 clients a day, instead of 4 or 5, and that doesn’t sit well with managers trying to impress other managers and politicians. The longer session approach (using the trauma model) would mean shorter waiting lists in the long run, but the electorate have become accustomed to long waiting lists.
      I seem to have ranted a bit there MD. Thanks again for your supportive words.

  2. I live in the United States in a medical town in MN. (Mayo Clinic) Even in this town, it is almost impossible to get therapy due to lack of professionals. How do you think people will be able to go your route and get better? I have been through many different kinds of treatment and still take meds, but it isn’t easy to find a therapist anymore.

    1. Honestly, Laurie, I have no idea. Like I said, it’s like trying to alter the course of an oil tanker. The manufacture and sale of pharmaceutical products is a trillion dollar industry and it spends many billions on shaping health policy all over the world. Until policy makers are convinced to do things differently and reallocate resources, talking therapies will continue to be regarded as the wilted salad that may or may not be served along with the medical main course.

      All I can do is talk about an alternative idea in the hope that it will gain some traction. It is entirely true that I’m talking about a solution that will remain professionally unavailable to most people for decades to come, and I’m truly sorry about that.

      But..and I hesitate to emphasise this…it is an inherent feature of the description of mind/brain functioning that I use that the therapy is largely about creating the conditions that allows the brain to heal itself. In theory no therapist is needed.

      The simple version is this, and I hope to finish a short book expanding on this subject within a few months.

      The brain’s primary function with respect to mental health is the ‘processing’ of painful experience. In doing this the emotional pain is removed or discharged as the experience is understood, placed into a more functional perspective and stored as untroubling memories. The brain does this naturally and automatically unless it is prevented from doing so. It is our modern way of life that prevents this from occurring naturally. The brain needs to think about experience to do this work but today we are encouraged to spend all our waking hours keeping our minds busy, avoiding boredom, avoiding painful thoughts, and our modern technology and lifestyles makes this all too easy to achieve. If left to its own devices the brain will process all of the painful history that causes mental health problems.

      So, the theory goes, if someone with depression walked a hundred miles of El Camino, alone, without earphones or other distractions, at a gentle and unhurried pace, they will collapse in an emotional heap, maybe several times, as the pain of the past emerges for processing, and they will arrive at their destination as the person they were supposed to be.

      There’s a bit more to it but it’s a remarkably simple idea. In fact it is so simple that it seems preposterous. Mental health sciences demand answers that only highly qualified experts can understand and own but the reality, in my view, can be understood by a 10 year old child.

      To be clear, I can present no scientific evidence to support this view, only my personal experience and the experience of many clients who no longer suffer with depression/anxiety, all of which is anecdotal. I have no resources to conduct research. And if I did I’m not sure that I would. Life is too short and precious to waste in decades of the pointless academic squabbling which achieves so little.

  3. Laurie, I was going to say something similar. I live in Ireland. I have a medical card so I can afford to go to a doctor but there’s no way I could afford to go to a psychologist. I don’t find medication helpful but feel like I have to comply with/pretend to comply with taking it just to have some supportive human contact. If I say I don’t want to take anything then I will have no justification for going to them as there is nothing else they can offer. A few years ago I was told I would be put on a waiting list for the hospital psychologist but then by chance, after waiting for quite a while, I found out I hadn’t even been put on the list. I eventually got to see someone but then they ended things after 3 sessions without explaining why, which was pretty traumatising and shaming in itself. Sorry, I feel like I’m stuck in a constant whinge about this, I guess I’m just wondering if you have any ideas what to do…

    Also when you kind of go into a complete mental collapse over things that happen in the world and it’s not about your perception of yourself or your life, what helps then?

    1. Hi M,
      I was unemployed myself for over 4 years, and I still ‘feel’ unemployed, so I have some insight. I think all health care should be a human right and yet I am now in private practice because I couldn’t do the work I wanted to do in the HSE. Charging money is a dreadful embarrassment.
      Ideas about what to do….? I’ve been agonising over how to respond to that. Maybe if I knew a bit about your story I would have a better idea of what might help. How would you feel about sending me a message or email? You could go to my FB site (Michael Fox – Clinical Psychologist) and do that.

      I was debating wether to share a bit of my own story that might be helpful to some unemployed people. And others. It won’t do any harm I guess and maybe some will find it interesting.

      During my first year of unemployment (1984) I became quite depressed. I was new to Dublin, had no work and had just two friends in the city who I didn’t want to annoy, so I rationed my time with them to a few hours a week. A lot of my time was spent waiting for those hours of company to come around again. I walked the streets, walked slowly through shopping centres, or stayed in my crappy rented room doing crosswords. I still hate crosswords. I was lonely and bored all the time and I just hated who I was.

      I was pathetic, stupid, unattractive to women, not particularly likeable to men, I mumbled and looked at the ground when I talked, and I was just an all-round worthless, useless human being. Does this sound familiar? To be honest, I don’t think the idea of suicide ever occurred to me but it would have eventually. At the time I believed that a relationship with a woman and money to drink would fix everything. A few years earlier, at the age of 19, I was capable of drinking 2 bottles of vodka, and I was kinda proud of that, but a stomach ulcer slowed me down a lot.

      One day I was in a very dark and isolated state of mind and I was walking into the Swan Centre in Rathmines. I held the door open for an old lady and she gave me the most amazing authentic smile and said “thank you very much”. That single moment of connection filled me with a surge of shocking pleasure that felt like a seizure. The short version is that I decided there and then that I wanted to feel more of that. At that time I’m not sure that I had even heard of the word “Depression”, so I started to read about happiness to see how I might get some (and I opened a lot of doors for old ladies). I hadn’t read anything but fiction since I left school, so that was new, and I spent a lot of time thinking about what made me happy and unhappy. It turned out that thinking about myself and how to be happy started to make me feel good. I liked feeling good so I kept doing it. Sometimes I was lost in thought for days. On one memorable occasion I felt so good, and so complete and fulfilled that I realised that I could die the next day and it would be ok, because I had finally lived (google “peak experience”. It’s a thing). Within a few months, maybe 6 or 7, I had become someone else entirely. I became smart, confident in myself, I liked myself a bit too much, and, importantly, I grew to love my own company. I still had a lot to learn, and it took years to reach a maturity, but living became easy after that. From that time I have never experienced a single moment of loneliness or boredom, and for most of the time I have been an exceptionally happy person. I adore being alive. To me, this is how everyone should be and can be.

      I spent much of the next 30 years trying to figure out how exactly all those changes came about, and how to communicate it. Here I am today still trying to tell people what I learned. The real point I am making is that real change and transformation is possible for almost anyone, and it begins with spending time with yourself, to examine yourself, to explore the ideas and beliefs about yourself and the world that make life so difficult. This is what the cliche “Know Yourself” is all about. So many different things had to come together for me to have that experience. Luck doesn’t begin to describe it. I had to be in a dreadful place to appreciate the moment of sheer joy that held my attention for so many years. My unemployment became a gift because it gave me all the time I needed to change. I didn’t have a big social life or a partner, which would have redirected my efforts. But if I was to single out the biggest piece of luck of all, it was that I couldn’t afford to buy a TV. It is hard to describe but you need to live without a TV (or computers, game consoles, smart phones, social media etc) for a while to even begin to grasp how it impacts on our quality of life. Living with screen addiction (which most of us have) is the equivalent of keeping the brain sealed in a plastic bag to prevent it from breathing and functioning. The brain in the modern world has no time or space to deal with all of our ‘stuff’, particularly the painful stuff. The real cause of mental illness is the ‘normality’ of modern living and no amount of gene, brain, or behavioural research will bring the mental health sciences closer to realising that.

      Ridding ourselves of the imaginary character and personality defects that underly the condition we call depression requires us to do something we have come to believe is completely unnatural and unthinkable. We have to do the very opposite of what we have been doing our entire lives. We have to give our miraculous brains all the time they need to think about whatever they need to think about.

      For the religious and spiritual among you, consider this. The Buddha spent 49 days, alone, under the Bodhi tree until he was enlightened. Christ spent 40 days and nights, alone, in the desert before he began his ministry. Muhammad spent three weeks each year, alone, in a cave which generated the ideas that became central to the Koran. The single experience of the brain completely free to do its thing inspired the powerful ideas that have shaped the humanity for millennia. The self-esteem of these guys was pretty good too.

      Too much?

      1. Thanks for your reply.
        I’m not unemployed actually. You don’t necessarily have to be unemployed to have a medical card. I can’t really relate to what you’re saying – but thanks for trying, I know it’s hard to find common ground blindly with some one you don’t know. I guess I also just wanted to point out that one answer to your question: ‘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? ‘ is that they can’t access it. Some one who can afford a private psychologist is probably functioning quite well already or has access to financial support in some other way.

        1. Hi M,

          There’s a website that has free worksheets called http://www.studentsagainstdepression.org

          It’s not a replacement for professional help by any means however I hope that it may be of some help to you. There are some low cost counselling centres and therapists that may operate on a sliding scale (reduced fee). There’s MyMind in the Dublin area.

          The HSE also does a bibliotherapy scheme whereby you can get books recommended from the library. Books I found helpful from this list were:

          “The Feeling Good Handbook” by David Burns

          “Mind Over Mood” by Christine Padesky and Dennis Greenberger

          “Overcoming Depression” by Paul Gilbert.

          There’s also a free CBT course at living life to the full and moodgym (check the resources section of this website for the addresses). Aware also does a free web based CBT course.

          1. Thanks s, I appreciate it. If you happen to know of any good books for BPD too that would be great, although i’m sure some of the ones you mentioned could be applied to that too. All the best

          2. One that I’ve been getting an awful lot out of is The Compassionate Mind, by Paul Gilbert. It’s less self help, more about understanding how our brains actually work, and why we think and react to things the way we do. It’s going a long way towards helping me understand my thought processes.

          3. Thanks Sunny Scattered, I’ve heard of that one, i’ll definitely have to look into it. I read ‘Self Compassion’ by Kristin Neff a few years ago, which is maybe in a similar vein and which has definitely been one of the more helpful books I’ve read – and also not too long/convoluted for times when you’re frazzled and it’s difficult to read. She has lots of resources on her website too, eg meditations. But yes I think I’d definitely find it really useful to learn about the ‘how our
            brains work’ stuff. (Sorry I think I’m replying in a weird place, couldn’t see a reply button by your post – I guess it might appear in the right place anyway!)

            Best wishes 🙂

        2. Hi M,

          I don’t have BPD however I do have mood swings.

          There’s a book “The Dialectical Skills Workbook” by Matthew McKay, Matthew Bantley et al. DBT or Dialectical Behavioral Therapy is recommended for BPD.

          Mindfulness for BPD by Blaise Aguirre and Gillian Galen

          Coping with BPD by Blaise Aguirre

          The websites

          http://www.dbtselfhelp.com

          Healing from BPD

          Mindfulness apps like Headspace

          If you go onto amazon, you’ll see lots of books on BPD.

          The website http://www.mind.org.uk has a good pdf of BPD..explaining symptoms.

          1. Thank you for those S, I’ll have a look for them, kind of you to share them Another book I’ve found very helpful is ‘Complex PTSD’ by Pete Walker, in case that would be of help to anyone – first time I’ve felt there’s someone who understands me! Even though it’s just through a book it made me feel slightly less isolated.

  4. I have been living with depression for many years and have become quite frustrated with therapies and medications that did not help at all. It’s more than obvious that the common models most people use (e.g. antidepressants against chemical imbalances) are not correct.

    Therefore, I think it’s a really interesting approach and I’m glad there are people in this profession who think outside the box and don’t just follow the mainstream – which has failed so many… If you feel that you have an approach that might help people it would be immensely important to get the word out there!

    1. I agree. Mainstream treatments have failed so many. Pity we can’t all work together with depression or whatever as the common enemy and people valued more than money. Hats off to anyone who is proposing alternatives to traditional treatments.

  5. Hi, this is a very interesting read and I would like to offer my thoughts. For me I think a big factor here comes in distinguishing between cause and effect. When severely depressed I was ill, no doubt about it, I was very ill. But in order to get better I knew that I needed to look at the way I think about and interpret events in my life, past and present.

    In this sense I never believed that I had faulty brain chemistry therefore I was ill, rather I was predisposed / vulnerable to my brain chemistry being affected by my thoughts in such a way that it made me very ill.

    To make a comparison, I guess I see it like someone with a predisposition to heart disease eating a terrible diet and then having a heart attack – when that person has the attacknthey are gravely ill, but there are a lot of things they can do to prevent them being ill again.

    From this perspective the fact that you are ill doesn’t lock you into a mindset that there is nothing you can do about it because it is about your brain chemistry, quite the opposite, it’s about realising that this is an effect, and we can influence the cause.

    Once again, in the depths of severe depression and the physical nature of many of its effects, there was no doubt to me that I was very ill. The danger with not acknowledging this, in my opinion, is that an individual will wholly blame themselves, their condition will not be treated with the seriousness it deserves, and at a time when they can be without hope this can make their situation seem even worse, not better.

    Thanks for offering an interesting perspective and I hope this is useful.

    1. Hi Matthew. Thanks for responding. I suppose I make a distinction between ill and being in a dreadful place psychologically, and maybe that distinction isn’t as necessary as I imagine. And as I suspected, the idea of being ill might actually be helpful in many cases.

      I do have the view, and I’m open to contradiction, that the depressed brain is working exactly as it is supposed to, by drawing attention to a problem that needs to be addressed, much the same as a physical wound. To me it draws attention to unprocessed trauma and painful experience, by placing thoughts and feelings associated with those experiences in the conscious mind, which is the only place this material can be processed. All of these things are expressed biochemically in the brain. The depressed brain is biochemically different than one that is not, in the same way that a brain that is out for a walk is biochemically different from one that is watching TV or mulling about financial problems.
      Thanks again for responding. I think this kind of dialogue is vital.

  6. I don’t agree with your analysis at all. No-one is 100% sure why people get depressed. Some of it is biological i.e. a chemical imbalance, psychological i.e. their thinking styles, neurotism or social i.e. poverty, homelessness, unemployment, financial issues, bullying, domestic abuse, loss of a relationship/ friend etc. So actually, there’s various different factors present.

    Ireland is over-reliant on medication however that’s because A Vision for Change’s plan of CMHT’s (Community Mental Health Teams) wasn’t implemented. Lots of GP’s would like more training in mental health but the resources just aren’t there at present. And some people need medication.

    There’s not a lot that can be done for schizophrenia besides medicating the person. Bipolar disorder is a chemical imbalance and as such, requires medication. There are different types of depression. Some mild cases of depression may not need medication however someone with severe depression won’t be able to get out of bed because depression causes physical changes in the body like fatigue, loss of appetite or comfort eating, inability to sleep etc. So it’s very worrying that you’re oversimplifying a very complex issue and just blatantly assuming that every mental health issue is due to trauma when that may not be the case.

    I do think it’s a biased, subjective opinion on your part and that’s concerning because psychology now has RCT’s (Randomised Controlled Trials) to prove that treatment is effective. And different therapeutic treatments work well for different populations. For example DBT works well for BPD and CBT works well for OCD, anxiety, depression. It’s unscientific and unprofessional of you to list stats like “2 out of 10” etc without appropriate citation. If anything, I think your views are harmful and will further stigmatise patients who require medication to manage their mental health.

  7. I also would like to draw attention to the rise in suicides in both Ireland and Greece since the economic crash-proof that social factors can be a leading cause of mental health issues..not just trauma.

    I feel strongly that I have been *harmed* by psychologists insisting that I’m traumatised but failing to give me a treatment plan, coping skills etc even when I was experiencing suicidal ideation.

    I heard how CBT was “reductionist” (their words, not mine) yet when I bought a CBT book and did the exercises, it helped me immeasurably. I feel angry that there’s not more of a focus on evidence based therapies..that every therapist I’ve gone to is “eclectical” or “person-centred”. I also bought books on Compassion-Focused Therapy (CFT) and DBT (Dialectical Behavioral Therapy)…both evidence based treatments and again found them very helpful.

    There should be a *choice* of therapeutic treatments for service users as opposed to being boxed into old-fashioned treatments thst are totally ineffective. A lot of Freud’s theories have been discredited..even psychoanalysts moved onto object relations theory. Psychoanalysts are realising the importance of RCTs and now Mentalisation Based Therapy and Transference Focused Therapy are both evidence-based treatments.

    I’d like to know what your opinion is on BPD. From what I’ve read, they typically don’t respond well to treatment as usual and that’s precisely the reason why they need evidence-based therapies. And who can afford psychodynamic therapy?? You haven’t even addressed access to therapy..the elephant in the room. People on medical cards are on lengthy waiting lists for therapy when they urgently need treatment.

    Mental health services have been farmed off to the charity sector…to charities like Pieta House. Incidentally, I found Pieta House really unhelpful..a total case of the Emperor’s New Clothes if there was one. The therapist there told me that I wasn’t “bad enough” to be there despite me suffering from severe suicidal ideation.

    I’ve been told that repeatedly..that I’m “not bad enough”, that it’s “just a phase”, that I’m “immature”, asked “how old do I feel” as opposed to getting any real help. All the while my mental health is deteriorating! I’m sure I’m not alone in this but any time I’ve complained about finding therapy unhelpful, I’ve been told that I “just didn’t find the right one yet” by other health professionals. It’s worrying that there appears to be such a cavalier approach to mental health..basically just sticking mud on a wall really..as opposed to a systematic, timely, affordable aproach.

    1. Hi S. I think I would agree with most of what you are saying about the services, psychology, etc. You have brought up so much material that I’ve no idea how to respond. I’ll have a think about it and try to find a way of replying. Soon.

      1. Hi, thanks for getting back to me. I guess my question was really this: do therapists call clients who are difficult-to-treat traumatised because it engenders empathy? That they can’t address problematic behaviours right away because that might harm the therapeutic alliance? I would rather a therapist be completely blunt and brutal with me. I just end up losing faith in the therapeutic process when I’m given diplomatic answers to questions I ask…that it must be fake..not genuine. I wonder whether they’re only sparing my feelings and whether they’re harbouring feelings of resentment towards me.

          1. Hi S.
            I’ve no idea what other therapists are thinking. But if a therapist believes that the client in front of him is experiencing a problem that he understands incorrectly, he will find that client “difficult to treat”. And then, some disorders are very tricky to treat. I was just thinking that I would find you difficult to treat, because the clients who know a great deal about the various therapies always are. You are clearly well versed in many of the ideas, models and treatment approaches that are out there, and in some ways you “know too much”. I believe that those models are wrong or incomplete because they seek to manage the problems and for the most part they are incapable of eliminating them. The idea that different therapies work for different people, and “you have to find the right one” is part of mainstream thinking, but to me it just indicates that none of them are complete. They are just descriptions of separate parts of the same elephant. At the heart of the elephant, below the surface and unseen by most current schools of thought, is trauma and painful experience.

            I’ve no idea what it is that you are dealing with S, but reading between the lines you probably have some obvious trauma symptoms if you were told you were traumatised. The problem is that the treatment of trauma is regarded as a highly specialised skill and therapists have to source such training for themselves and pay dearly for it. They feel they don’t need it because trauma appears to be rare enough, so very very few mental health professionals have the skill or value the skill.
            My own journey into the understanding of the importance of trauma began in 2010 when the local mental health services refused to take a referral from me because “We don’t treat trauma”. My choice then was to try to treat it myself or turn the lady away. I have no reason to believe that other mental health services around the country are any different. This explains some of your experiences I think. To most mental health professionals trauma is best left to specialists. To me it’s a skill that all therapists need at the very core of their training if they are to be effective.
            I hope this is useful to you S.

  8. Michael I will put it this way. I would be very happy to be your guinea pig because at this point I would try anything to not have to live with depression.

    1. Hi Majella
      Maybe if you live in Ireland and were within driving distance of Monaghan I could help you find the right path. If you like you could go to my Facebook page (Michael Fox-Clinical Psychologist) and send me a message or an email. I promise you wouldn’t be a guinea pig. It’s an odd thing to say but I actually love to see people with depression. They are always so certain that nothing substantial can be done, and so surprised when they begin to change.

  9. Hi Micheal,

    Thanks for that Article – well worth the read. I’ve been trying to sit out withdrawals from anti-depressants & sleeping tablets (cringe…it’s horrible) I’ve been doing a little research & came across some tidbits regarding psychotherapy & medication – it seems to me that brain altering medication can hinder the therapy process? If you had any information that would help it would be great. I ask because I’m also engaged with an Eating Disorder Therapy Center who were really interested when I said I’d come across this information & it may be helpful to others in the same situation: would eating disorder therapy be more effective if mediation were discontinued? (in a safe way obviously). My recovery has taken a very long time & I personally believe that it has only been since stopping medication that my mind is clear enough to be able to process what I need to be doing in order to maintain recovery & stay strong enough to not give in to the depression. Your thoughts/feedback on this would be really useful.

    1. Hi Trish. I didn’t realise that people were still responding. I’ll get back to you tomorrow if I can. Let me say this now though. Most modern Antidepressants don’t interfere with therapy that I do, at least I haven’t noticed it. Maybe if the dosage was particularly strong it might. A clear unsedated mind is needed.

      1. To continue Trish, I have found that antipsychotic and anxiety meds dull the thinking, sometimes in a very subtle way, which makes painful past experiences difficult to come to the surface, and prevents the leaps of reasoning required to alter problematic thinking patterns. Alcohol and marijuana create the same problem. I don’t think antidepressant would affect your eating disorder therapy, but sleeping meds might, particularly if you were attending morning appointments. I hope you cut down your antidepressants very gradually.
        I suppose you can guess that from my point of view recovery is slow when the core of the problem isn’t known, understood or acknowledged. Most of the time the core is easy to find when you realise it is the one thing clients won’t think or talk about. To anyone. Because they keep it so tight to themselves it never comes up, even in therapy, and the problem continues. (Or they kept it so under wraps in the past that it was eventually forgotten about). The collaborative person-centred approach that is so much in vogue at present actually discourages the search for things the client wants to hide from the therapist. It is another odd feature that when the core events become known, and the client is asked if they would like to talk about them, they say “no”, and will always say “no” if they are given the choice. But if they are simply asked immediately to “Tell me what happened”, the emotional dam just gives way.

        I would add this. Your struggle to “stay strong enough to not give in to the Depression” represents the way virtually all people think of depression and other mental health problems. But it is the struggle to keep the memories, thoughts and emotions away, or suppressed, that allows the Depression to live and stay in place. Another way of saying it is, if I keep my mind busy enough at all times I can keep the pain or fear away. But keeping the mind busy at all times prevents the events that caused the problem in the first place from ever bubbling up into mind. It is only in the mind that the emotional pain of past experiences can be removed forever.
        Depression is the brain’s struggle to process painful experience in circumstances where we won’t allow it to, because we think we have to keep our minds fully occupied during every waking moment. The brain pushes ‘depressive’ thoughts and feelings into the mind to say “Give me time to think about this stuff and sort it out, for God’s sake!”.
        The theory is simple Trish, but not straightforward to someone trying to go through it by themselves. For instance, if someone was traumatised by sexual abuse at the age of 8, and the trauma is still present and causing ‘mental illness’, asking the adult to think about and feel the emotions of that event will feel much the same as asking the 8 year old to go back into a room with the abuser, for however brief a period. And yet this is what has to be done for the brain to heal itself, to look at the events again for the very first time as an adult.
        I hope that is food for thought Trish.

  10. I have recently been diagnosed with Bipolar Disorder, I am 45yrs old. I was brought up in the care system so lots of trauma there. My parents both diagnosed with mental health, autism also runs in the family, their siblings also and their children etc. My siblings also have mental health issues and its now affecting the next generation.

    I was recently hospitalized for a manic episode and my experience was exactly like Fiona’s dreadful. I was re-traumatised as my stay was institutionalised and brought back memories of my childhood. Same regiment and routine shocking really. Fiona’s description is so accurate. I was offered nothing but medication whilst in hospital. I am now an out-patient and still offered only medication. I have to self educate myself, I know some from family history.

    I fell into a bipolar depression which was horrendous thought I would never come out the other side. This depression lasted 7 months I am just starting to feel somewhat right now. Can your therapy help with the highs and lows of Bipolar disorder, or does it only treat depression. What are your views on Bipolar Disorder do you think this is also down to trauma? My family history is so strong, my opinion is the genetic side plays a huge role. If your approach can work I would be also willing to give it a try. I am hoping to never experience a stay in hospital or go through the pain again.

    1. Hi Ann. I have little experience with Bipolar or psychotic disorders because people with this presentation usually get sent straight to psychiatry. I am certain though that most bipolar disorder begins with trauma and painful experience, but I don’t know why it manifests as bipolar rather than depression or anxiety. I know that when people with bipolar experience highs and extreme lows they aren’t really capable of the clear minded thinking that allows therapy to work. I also know that people on lithium are very difficult to treat psychologically, so overall bipolar is extremely tough to treat. But I must emphasise that bipolar disorder is unfamiliar territory for me. Could I suggest you send me a message and we could exchange a few ideas?

      1. Just wondering how you can state that you have little experience with bipolar and yet are “certain” it began with trauma?

  11. Hi Michael,

    While your article is indeed thought-provoking and it is refreshing to hear such an opinion from someone in a position such as yours which garners such respect, I cannot say I agree with it…

    I feel acceptance is the key to a relatively balanced mental state. And of course, in order to accept something, we must first recognize it.

    For example, I have many anxieties… Mostly social anxieties. But what makes me really happy, is that I still manage to love myself, despite the fact that I have held myself back from doing/expressing many things in life.

    I needed medication at the start. I NEEDED it.

    We know about physiology. We know about physical manifestations of anxiety. Does the heartbeat start to beat faster first? Or do you start to think anxious thoughts first?? So with depression, does the negative vibes/feelings/thought content start to change the chemical make-up of the brain, or was it always ‘out-of-whack’?

    What i’m trying to say is: I myself don’t believe i will ever be an anxiety free person. And i’m pretty sure there are many people who feel the same. Its unimaginable to me! Really is!!

    But it kind of makes me sad that it is suggested here that we cannot accept ourselves the way we are. That guy who thought he was a bad person, ‘the shit at the end of the ladder’… Would a bad person feel guilt about being a bad person??? Sometimes people just need support, & time, to really see themselves…

    What i’m trying to say is: from my point of view, this perspective could be damaging to many sufferers of depression. It certainly is a comfort that the ‘illness’ is not their fault.

    But i also get what your saying about people slipping, or feeding into, the ‘sick role’. Great point.

    Long story short, this approach could undoubtedly help some people, but unlike physical illness, mental health is not a ‘one-size fits all’ approach.

    I do believe psychology, ultimately, is stronger than chemicals though… if that makes any sense…?!?!! Like, they say if you win the lotto, (most likely) you will feel insurmountable joy!! But you always go back to your ‘pre-morbid’ personality. We just need to learn to accept (love), who that is? No??

    To the lady who commented before me, who has been diagnosed with Bipolar Disorder… I’m so sorry to hear that… The dizzying highs and crushing lows…. as you seem to think, I too think that is almost defintely a physical manifestion, a brain-imbalance… It has to be, right??? So, i guess that can be accepted too?? It is, what it is… =( At least there IS medication there nowadays, and over time, our bodies adjust to the, not so nice side-effects, even though it may take a couple years even.

    But, how could you start and use therapy, until your mind and mood were at an even keel?? There is a place for medication. People did not make this stuff for fun… Like all good things, made by good people, exploited by bad ones…. whoever the heck they are..! =D

    Sorry to jump from topic to topic, and yet not really go deep into anything!! But yiz get my general drift…

    Peace and Love =P (and acceptance)

    1. Hi Sarah,
      Thanks for that. There’s a lot in there. I’ll try and organise a response tomorrow or the day after. But I’m beginning to realise that talking about generalities without details is not easy. 🙂
      M

      1. I really tried Sarah. The only way to address everything you have said is through a long and interesting conversation. I would enjoy that though 🙂

        1. Hi Michael, I think I would like that interesting conversation.. How do I contact you? Feel to email me there, if you can.
          =)

  12. Hello Micheal and thankyou for sharing your knowledge. Having recently overcome a major depressive episode, and actually finding them worsen as I get older, I can say I have much expieriance on this matter. Yes from dealing with psychiatrists to psychologists I am of the opinion that the whole ‘mental health’ strategies used to label and treat people is wrong. As you put it it keeps people locked into a very narrow view of what it is to be suffering from mental problems, even making the expieriance far worse for people. Being told to take psycho-active drugs and being terrified of the next bad episode because this is wat my dr says is gonna happen. It’s a frightening existence and with much compassion and learning I too am beginning to change my beliefs and negative unhelpful thinking patterns which protected me as a child but has caused me to become stuck as an adult. Please keep up your great work on trauma and the depression link. It gives me hope which my dr will never b able to give me.
    K

    1. Hi Kristin. Thanks for your kind words. I’m 100% certain there is a path out of your Depression. There is a difference between being certain there is no way out, and being certain there is in fact a way out, is huge. The latter has energy, hope and optimism. And if you can identify where the depressive thoughts and emotions are coming from, that is half the battle. Most people already know at some level. As I mentioned above, it’s usually the one area of history that we deny or refuse to think about. Sometimes it’s an event and sometimes it’s an entire childhood, and the biggest trick is in allowing ourselves to face it and think about it. If it is something forgotten or buried (this is what so-called ‘endogenous’ depression is all about) we have to allow it to surface by just stopping the busyness and endless distractions. Or meet someone like me who will help you dig, by insisting you stop the busyness and endless distractions 🙂
      I hope that offers a clue Kristin.

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