Advances in medication for the treatment of depression within the last 20-30 years have alleviated tremendous suffering for many individuals. In addition, new counseling and psychotherapy treatments, such as Cognitive-Behavioral Therapy, have done the same Neuroscience, in its greater understanding of neurotransmission and genetics, while providing some ethical challenges, also holds promise for the amelioration of depressive symptoms. In short, society has benefited greatly from medical and technology innovations. However, pulling the collective attention to growth in these areas, while helpful, has also created a narrow understanding of depression. Viewing depression through only a biological/medical or faulty-thinking lens can eclipse other important ways of understanding and treating depression.
In the area of pharmacology, medications such as Prozac, Paxil, and Lexapro, among others, have augmented the arsenal of practitioners who prescribe psychotropic medications, who were previously relegated only to using older anti-depressant medications. The newer classes of antidepressants, Selective Serotonin Reuptake Inhibitors (SSRIs) and Selective Norepinephrine Inhibitors (SNRIs), have increased efficacy in the treatment of painful depressive symptoms such as hopelessness, suicidal thoughts, helplessness, guilt, and low energy/motivation, while simultaneously decreasing side effects.
Research has shown Cognitive-Behavioral Therapy to be effective in the treatment of depression, although many of the gains made with this type of therapy are a result of a good client-therapist relationship, something more valued in other theoretical orientations and longer-term treatment approaches. Cognitive-Behavioral Therapy focuses on distortions in one’s thinking and faulty core beliefs about oneself and the world. Identifying these distortions and belief systems allows the practitioner to help the client combat them with more rational and reality-based thinking which, in turn, lifts the depression. Much like a computer, CBT suggests that the input of corrupt data (or a virus, to extend the metaphor) will lead to corruption and breakdown of the entire system. Righting the thinking through healthy input corrects the system.
To be sure, biology and thinking are integral parts of our human functioning. However, they are only two of multiple and fundamental aspects of what it means to be a person. Collapsing people into their thinking or biology runs the risk of viewing humanity through rose colored glasses. For example, the important insights of existentialists and various spiritual leaders on depression is missing from our dominant cultural ethos. The sage wisdom from people like Scott Peck, Rollo May, Ram Dass, and Parker Palmer, to name only a few, understands that depression can be a sign, a warning sign if you will.
While the existentialists see depression as an indication that one is living an inauthentic life, not forging a meaningful existence in the face of powerful forces that seek to coerce one to conform, the spiritual perspective suggests one is not aligned with some higher power and will for their life. From these perspectives, depression and other emotional struggles are signals that, not only is your car overheating and/or having mechanical problems, but it is also off course. Correction of the course leads to a fix of the system. Scott Peck eloquently and personally makes this point when he states, “Since patients are not yet consciously willing to recognize that the “old self” and “the way things used to be” are outdated, they are not aware that their depression is signaling that major change is required for successful and evolutionary adaptation,” (Peck, 1978, p.71). Peck goes on to say that, in depression, the subconscious is ahead of the conscious. In other words, a deep part of us that is usually out of awareness is urgently trying to get our attention to let us know that we must make significant changes.
How do we get off course in a way that leads away from our true selves and into depression? While we know that there can be a genetic predisposition to depression, sometimes those who experience depression suffered stressors such as loss or abuse in childhood. Recent research suggests that those who experience mental health issues are more vulnerable to environmental events and internalization of these experiences, thus making them more prone to internalize trauma. Peck says, in relation to the contributions to depression, that psychological support is taken away from the child getting what they need developmentally. Of course sexual, physical, verbal, and emotional abuse contributes to the loss of psychological nutriment and the internalization of this loss and/or trauma. The emotional pain is internalized and embodied. The trauma is emotional and occurs in the context of relationships with caregivers. The internalization of this trauma and loss leads to unhealthy relational patterns and an inability to appreciate and develop one’s uniqueness, gifts, and vocation.
A 2010 meta-analysis by Jonathon Shedler, while showing the efficacy of CBT and other brief interventions, suggests that feelings and relationships should be the primary focus of treatment for greatest efficacy and the most lasting and meaningful changes. Shedler’s analysis suggests the importance of an approach with multiple mental health issues, including depression, that emphasizes not just the cognitive aspect of people’s functioning but rather unresolved feelings as they contribute to unhealthy relational patterns which, in turn, contribute to depressive symptoms. Shedler’s work suggests this emphasis goes way beyond cognitive growth. His analysis suggests that focusing on feelings, relationships, and patterns can enhance relational and sexual intimacy, happiness, creativity, humor and a host of areas that make us fully human.
Building trust with a therapist to remember, feel, and externalize these feelings takes time. Awareness of these experiences and feelings about them is essential in permanently rooting out depression. Simply focusing on one’s thinking may temporarily help but does not access or lead to a working through of long-standing problematic patterns and painful experiences that inform the thinking. Understandably, clients (consumers) and insurance companies want efficacy and efficiency. But the kind of treatment that gets at the roots of depression usually takes time and cannot be done through a quick fix. Cooperating with an insurance company’s criterion that treatment should focus on returning one to their “previous level of functioning” through a brief “shoring up” can be a disservice to the individual who could be helped to examine patterns, feelings, needs, and a purpose in life that may match their gifts and calling.
Bryan Duckham, PhD, MSW, LCSW has over 28 years’ experience in the treatment of depression, anxiety and addictions. In addition to private practice, Dr. Duckham has worked in a variety of outpatient mental health and addiction treatment programs. He was the director of the FlexCare Dual Diagnosis Treatment Program. He believes that often, people’s religion and spirituality are essential parts of their recovery and sensitively integrates his clients’ beliefs into treatment.
In addition to maintaining his practice at West County Psychological Associates, he is an Associate Professor of Social Work at Southern Illinois University Edwardsville and teaches theory and practice courses in the undergraduate and graduate social work program. His research interests include the intersection of theory, practice, and religion/spirituality, as well as philosophy.