Experience With Depression
I’m surprised when a prospective client asks me during a phone interview whether or not I “have experience with depression.” Yet I get this question quite frequently. On such calls I imagine being a medical doctor and the caller is asking if I treat people who “don’t feel well.” Could I be licensed and not have such experience? Are there colleagues who turn away clients with “depression”?
DSM-V Is Not About Development
In the field of mental health, the subject of treating depression is perhaps the most frequently written about and researched, largely because it is so common. I think of depression as part of the human experience. That’s not a novel idea, but to think about it in this way, one must step outside of the world (and the paradigm) of the DSM (Diagnostic and Statistical Manual of Mental Disorders) published by the American Psychiatric Association. It defines depression symptomatically, not in terms of personal or self development.
In this other way of thinking, the “medical model”, with its specific criteria, levels of severity and tightly defined time periods take a back seat. Depression for one or more periods over a lifetime is a nearly universal – and functional – part of human development.
My formal diagnostic training was learned in some pretty intensive and conventional psychiatric settings, so I don’t usually miss a clinically severe depression. I recognize that recurrent depressions initially require a more focused symptom-relieving approach. But that’s not what many clients present with, nor what I am mainly discussing here.
As much as you may want to be rid of a depression, it may be familiar emotional turf. You yourself may want out of it, but if you’ve ever had someone (including a therapist) try to “talk you out of it”, persuasively, coercively, pleadingly, etc. you probably know that does not work. For these depressions, some of which are situational (driven by life events), the depression functions like a retreat, a way of withdrawing to deeply think about what is going on, what actions will be taken, and how sense of self will change.
Purpose Of Depression
I respect these depressions because they serve a purpose. The thoughts that people can have, even amidst the hopelessness, resentment, shame and disconnection are not all bad. They are self-examining, negative feedback to an inflated self. The self-criticism (“I am a burden to others”) can, with adequate reflection, lead eventually to a new, affirmatively defined sense of self, one that has made it through something difficult with some help from others (“We are truly inter-dependent with one another as long I can care for myself”).
What’s positively learned in a depression can stick, provided that there’s relatively low amounts of alcohol or recreational drugs – preferably minimal to none – in the picture. Drugs tend to put people into developmental limbo while under the influence and for days afterward. The idea, so simply put by David Schnarch, is that we “trade pain for growth.”
Learning From Depression
“One great anxiety associated with depression is that it will never end, that life will never again be joyful and active. This is one of the feelings that is part of the pattern–the sense of being trapped, forever to be held in the remote haunts of Saturn. In my practice, when I hear this fear I think of it as Saturn’s style, as one of the ways he works the soul–by making it feel constrained, with nowhere to go. Traditionally, there is a binding theme in saturnine moods. This anxiety seems to decrease when we stop fighting the saturnine elements that are in the depression, and turn instead toward learning from depression and taking on some of its dark qualities as aspects of personality.”
Growth & Meds
Should the picture in fact worsen, our therapeutic alliance should allow us to agree that reducing or eliminating symptoms does not confirm “being defective.” My thinking is more along the line that after a certain point, very prominent or intrusive symptoms tend to obstruct the growth and development that Moore so elegantly describes.
While I of course cannot prescribe medication, if it becomes part of what you choose to do, I can support that choice. The idea might be that medication is there to help you get through the challenge of developing your self, it does not define a self.