Depression:Can Psychotherapy Help? (2)

 

Minstrel Man
by Langston Hughes

Because my mouth
Is wide with laughter
And my throat
Is deep with song,
You did not think
I suffer after
I’ve held my pain
So long.

Because my mouth
Is wide with laughter
You do not hear
My inner cry:
Because my feet
Are gay with dancing,
You do not know
I die.

 

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Image: Nik Shuliahin. Unsplash.

Can psychotherapy help those who experience the hellish afflictions of depressive illness? The answer to this question is that it is possible to treat some people through psychotherapy. Obviously, there is no universal panacea, no magic cure and this treatment is not for everyone.

However, there are several kinds of psychotherapy which have been shown through research to help depression. A GP or therapist will make an assessment to help the person decide which modality might suit them. Many have found different forms of psychotherapy helpful. 

There is a combination of factors in relation to the origins and causes of clinical  depression; it has both chemical and psychological origins. Therefore treatment often needs to address both of these, in terms of medical or psychiatric help and therapy. It is up to the individual to decide, along with professional advice, which treatment or treatment combination may be right for them.

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Medication for depression certainly has its place and has been proved to be effective. Indeed, it can be life-saving. Obviously different drugs suit different people, and some work generally better than others.

However, there is still plenty of room for further research:

New treatments are badly needed, the experts say. Most of the drugs in the study are known as SSRIs, which are thought to work by increasing levels of a chemical messenger called serotonin in the brain, but nobody knows for certain. “We don’t have any very precise treatments for depression at this point in time,” said Geddes.

Guardian

 

Dr Tim Cantopher, in his helpful book Depression:The Curse of the Strong, underlines the fact that depression does not happen to weak people. He refers to the increase of stress in our society, which he feels is the commonest cause of clinical depression:

This illness nearly always happens to one type of person. He or she is strong, reliable, diligent, with a strong conscience and a sense of responsibility, but is also sensitive, easily hurt by criticism and has a self-esteem which, while it may look robust on the outside, is in fact quite vulnerable and easily dented. This is the person to whom you would turn in times of need, and they would never let you down.

 

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Keeping quiet about one’s depression can make it worse; sometimes people share with friends or family and that may be helpful. At other times, being able to talk with a professional therapist may be the best way though one’s problems.

The therapist will help look for meaning, for what might lie, psychologically speaking, at the heart of the depression and emotional suffering. Insights may be gained into past experiences that may have been damaging, into negative ways of thinking and destructive behaviour patterns, all repeated in the present.

Long repressed thoughts, feelings and significant dreams can come into consciousness in the accepting and non-judgemental atmosphere of the therapy room.

Sometimes, a depressed person feels so isolated, so alone, in a very dark place. As a therapist, it seems often like a privilege to have someone try to communicate this pain of loneliness, of feeling locked inside, trapped in a dark hole, vessel. or tunnel.

Rather than attempt to ‘pull out’ the person, I wonder if there is any way I can be in there with her, even for a second? Of course I cannot know exactly what it feels like for her, but I have been in my own ‘dark spaces’ , so I know them inside myself.

Having someone even express the wish to be in that terrible place with her, may make the depressed person feel less afraid, less alone. Of course, this has to be handled sensitively and, crucially, with an awareness of timing.

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Issues like unresolved anger, grief, disillusionment, may be explored and worked through in a way that can provide understanding into the roots of the problems. Then perhaps new ways of managing such feelings may be discovered.

Gradually, such understanding may lead to re-evaluation and change, so that old patterns can be broken and new ways of being discovered.

People become trapped in their past, which is very depressing. Coming to terms with long-held feelings and disappointments can be a releasing experience, for these can inhibit personal growth and development. Adjusting to newly-found truths about oneself and one’s past may be difficult, but it often leads to increased energy for life and the wish to move on more hopefully and constructively.

Do you have thoughts about this post? Has psychotherapy helped you with depression? Feel free to share whatever you can in the comments. 

Snap out of it!! How Depression gets Misunderstood.

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‘It Hit Me’ Claudia Unsplash.

I felt a Funeral, in my Brain
I felt a Funeral, in my Brain,
And Mourners to and fro
Kept treading – treading – till it seemed
That Sense was breaking through –
And when they all were seated,
A Service, like a Drum –
Kept beating – beating – till I thought
My mind was going numb –

 

(Extract of poem by Emily Dickinson)

 

The whole of this poem above was recited during a brilliant Ted Talk on depression by the writer and Professor of Psychology, Andrew Solomon. Do watch this; it is both personal and professional and highly informative.

2015 PEN World Voices Festival of International Literature: On Africa © Beowulf Sheehan/PEN American Center

Andrew Solomon (Wikimedia Commons)

‘Anxiety is ‘being afraid all the time but not even knowing what you’re afraid of.’

‘The opposite of depression is not happiness, but vitality.’

(Solomons.)

What Some People Say……..

Often, people with depression say that others around them do not recognise their symptoms and feelings as indications of a ‘real’ illness. By ‘real,’ they often mean physical.

Physical illness might appear more tangible; there may be a rash, a temperature, a visible lesion or wound. People may develop physical symptoms (somatisation) if their depression is not recognised or if they cannot allow the depression to become known, even to themselves.

In his powerful, complex and highly analytical book, ‘Conversion Disorder’, Webster regards such bodily symptoms as a way of ‘not wanting to know.’ His role as analyst is to respond to this, somehow. Not by knowing, but by containing and processing:

‘I prefer to think of my vocation as a psychoanalyst as a quiet liturgy to the power of the symptom, to this intimate world where very little information can be given, even when there is so much to say. Inside this multitude, I see one of the greatest intimacies on offer- one I know daily in the demand turned upon me  by a patient who needs me to know something. Needs me to. With urgency. With great shame, I return this demand to them, even if I supply a placeholder, a stopgap, given to ease the anxiety that hurtles through their flesh….’

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Somatic symptoms can be just as painful  as any other illness. Again, such symptoms may be easily dismissed, seen as ‘imagined,’ rather than as real and genuinely distressing indicators of inner mental pain. If we find a sensitive doctor or therapist, such symptoms should be recognised as the body giving vital clues to psychological ills.

The ‘wounds’ of depression are visible in the depressed person’s weepiness, inactivity, frozen expression or general misery; however these may be downplayed or ignored by others around.

Thus there have developed the expressions snap out of it, pull yourself together, stop being so miserable, you have everything to be happy about.

Many people find depression in others difficult to cope with and they may react impatiently and unsympathetically. Perhaps witnessing depression in another person unconsciously stirs something hidden or repressed inside themselves.

Such unempathic comments will pile guilt on top of the depression. The depression may then be masked.

Masks….

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The term ‘smiling depressive ‘ may refer to someone who is reacting to what they perceive as society’s lack of understanding, or to their own shame; the smile is a cover- up. The depressed person may appear happy and functional in daily life, but the smile hides desperation.

The smiling depressive may feel that their symptoms are weak, that ‘no-one loves a moaner’ and that talking about it will upset others. They may feel that no-one will understand or be able to cope anyway.  So they smile and say ‘I’m fine.’

What are some of the terms popularly used to describe depression?

We hear them often, the expressions used to describe this excruciating illness:

Blues, black dog, black cloud, low, down in the dumps, slough of despond, the doldrums,

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Image:Creative Commons Zero – CCO.

How have sufferers described their Illness?

Clinical depression is a serious and debilitating illness. It is more than feeling sad. The depressed person cannot ‘pull themselves together.’ If they could, they surely would. Do not underestimate how despairing a depressed person might feel.

Those who suffer it have described themselves as ‘Floating helplessly in the middle of a vessel , groping for the sides,’ ‘In a dark tunnel, with no light at the end of it,’ ‘Trapped,’ ‘In a dead end,’ ‘Utterly hopeless,’ ‘Paralysed, static, unable to move or do anything,’ ‘Desperate, isolated and unable to ask for help,’ ‘As if I’m nobody, rubbish, stupid,’ ‘Not interested in anything .’

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Image:Creative Commons Zero – CCO.

Symptoms

There are several different kinds of depression and  it has many symptoms, which might last for any months or perhaps years. Often a depressed person may appear antisocial, cancelling social dates, unable to get up to go to work in the morning, or to get dressed, washed etc. Such is the feeling of utter inactivity, numbness, lack of energy and helplessness.

There may be irritability, low self-esteem, feelings of guilt and shame. Sometimes, people experience low libido, bodily aches and pains, loss of appetite (or perhaps the opposite), inability to think or concentrate, early waking. They might feel the need for more cigarettes, drugs or alcohol in an attempt to numb the pain.

Other symptoms can be sleep difficulties, ruminative and dark and suicidal thoughts, self harm, loss of interest and a lack of motivation. Often there is much anxiety and a sense of impending doom.

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Andrew Solomon said ‘we know depression through metaphor.’ This is an important statement.

Art is a way of expressing such feelings, through metaphor and symbol. Artists like Rothko, Pollock, Van Gogh and Munch all experienced mental illness and various kinds of depression.

These states of mind were expressed through painting and I will end this post with a look at a the work of some of the greatest artists who were able to graphically express their depression in paint:

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Van Gogh. Sorrowing Old Man.

 

Edvard_Munch_-_Melancholy_(1893)

Munch. Melancholy.

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Pollock. Greyed Rainbow. . (Image:Mark Mauno, Flickr.)

Next week’s post is about How Therapy May Help Your Depression.

If you have had depression and feel able to share something of your experience, do please comment below.

The Real Truth About Mindfulness

‘Many benefits and fruits of Zen practice are real, but they are not to be gained, nor pursued. Just sit, regularly, for a sustained period, and see what is here right now.’

Rosenbaum and Magid

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Mindfulness and Psychotherapy

Many psychotherapists find that mindfulness is of value in terms of their practice. There is a considerable evidence base that it can be an effective therapeutic tool. (Also see Baer, R. A.  and  The Lancet,)

Psychotherapists using mindfulness techniques help patients to understand, for example, that ‘thoughts are not facts’ (Christine Dunkley & Del Loewenthal) Self- awareness is vital, and such therapy can help people understand how they might be contributing to their own distress. For example, we might learn to accept the impermanence of life, instead of denying it:

“It is not impermanence that makes us suffer. What makes us suffer is wanting things to be permanent when they are not. We need to learn to appreciate the value of impermanence. If we are in good health and are aware of impermanence, we will take good care of ourselves. When we know that the person we love is impermanent, we will cherish our beloved all the more. Impermanence teaches us to respect and value every moment and all the precious things around us and inside of us. When we practice mindfulness of impermanence, we become fresher and more loving.” Thich Nhat Hanh

There are three main ways in which mindfulness is used in therapy: (Barker)

  •   Teaching mindfulness to clients
  •   Practising mindfulness themselves in order to cultivate therapeutic qualities
  •   Attempting to create a mindful encounter in therapy itself

The techniques of mindfulness are used in several different therapies. For example, Mindfulness-Based Cognitive Therapy blends mindfulness with Cognitive-Behavioural therapy.

Mindfulness Based Stress-Reduction Therapy, developed byDr Jon Kabat-Zinn, aims to help alleviate some of the anxieties of daily life.

It is often used in the treatment of chronic diseases, with some beneficial outcomes. It is frequently offered as a group therapy, focussing on such aspects as staying in the present moment and the importance of the individual taking regular time out for meditation.

Critique of Mindfulness 

‘The commodification of mindfulness and meditation is increasingly prevalent and problematic’ Rosenbaum and Magid

 

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Whilst there is no doubt that mindfulness can be helpful and therapeutic, it has limitations. It is not for everyone, and needs to be used professionally.

Whilst there is considerable value in using mindfulness to reduce stress and increase self-awareness, it must be emphasised that it is not a panacea for all ills.

‘There is a contemporary shift in its use and meaning, which actually distorts mindfulness, taking it far from the original Buddhist emphasis on ethics and consideration of others. The danger is that it will be diluted into a corporate, self-serving and over-secularised commodity.’ Rosenbaum and Magid

An increasing backlash against this popular trend is occurring, in that it is becoming fashionable and commercial. It is often promoted as a kind of designer cure-all, another ‘one size fits all’ solution to life’s ills. Another criticism is that it encourages a narcissistic focus on the self.

Thus, there are mindfulness colouring books, mindfulness apps and books like Mindfulness for Dummies, The Mindfulness Diet, Mindfulness for Dogs, Mindfulness is Better than Chocolate, Mindfulness on The Go, Mindful Birthing and so on.

‘…this new corporatised McMindfulness – which in the long term will do as much as a McDonald’s Happy Meal to sate a person’s gnawing hunger for a richer life.’

 Daily Telegraph

 

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Incredibly, a Chicago burger bar sells ‘a more mindful burger.’ Joiner.

I wonder how they might advertise this product? Your ideas are welcome in the comments box below. Please contribute whatever comes to mind!

Here’s my take on it:

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One American headline asks:

‘Does L.A.’s Absurd, Narcissistic, and Pricey Mindfulness Trend Have Its Benefits? 

In Los Angeles, mindfulness has become a hot commodity (Los Angeles Magazine)

The writer’s conclusion is that it does: ‘Bring on the chakra exorcism and $24 hemp smoothies,’  she adds, entranced by her experiences. One of these ‘experiences’ is lead by a woman ‘spending the full 15 minutes with a hand over her heart, head tilted dreamily to the side, whispering, “May I forgive myself” over and over again.’

There is criticism of mindfulness as a process that prevents thinking, that it can be used as an avoidance of considering difficult situations, merely by an unquestioning acceptance of them.

Although the NHS supports mindfulness, an Oxford academic claims it stops people thinking deeply:

‘I think mindfulness and meditation are bad for people, I absolutely think that. People should be thinking.’ ( Theodore Zeldin)

This misuse of the concept surely constitutes another form of mindlessness; there is  criticism that corporate organisations use mindfulness in order to stop employees thinking about problematic work issues. (Hackspirit.com)

In similar vein, some schools and universities have used mindfulness to reduce student stress. However, there has been criticism that, as in the corporate setting, such use masks institutional flaws by focussing the problem on the students’ mental health.(Harriet Swain)

Another criticism resides in the ‘infantilising’ nature of this approach, in that it implies that students are going to be troubled emotionally if they do not engage in mindfulness.

Of course, some children are troubled emotionally; at this present time, the evidence of this in terms of child suicides is painfully apparent.

Offering mindfulness exercises is not going to help such children:

Pooky Knightsmith, vice-chair of the Children and Young People’s Mental Health Coalition, said such exercises could be actively harmful for those who are particularly vulnerable or have a history of trauma.

“If a child is suffering abuse at home, being given space and time for thoughts to drift through your head isn’t necessarily good,” she said. “Schools need to be aware of the potential risks, even with the most seemingly nice of interventions.”

(Independent,2017)

Have you had experience of mindfulness? What do you think of it? DWill you let me know in the comment box below?

Metacognition and Mindfulness: Do You Know What You Don’t Know? Part 1

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Image: Denise Krebs: Metacognition, Flickr.

Contemporary Approaches to Metacognition

‘That which has been is what will be; that which is done is what will be done. And there is nothing new under the sun.’ Ecclesiastes. 1:9

The extensive range of contemporary approaches to thinking have roots stretching far into the past; the origins of the concept of metacognition can be found in the work of the great Greek philosophers such as Socrates and Aristotle.

When Socrates stated that ‘I only know that I know nothing’ (a somewhat roughly translated but succinct version of lines 21 a-e in Plato’s Apology), he was using metacognitive skills to acknowledge his lack of knowledge.

The wise Confucius said:

‘Real knowledge is to know the extent of one’s ignorance.’

He, too, was using metacognition to asses and monitor his own mental abilities.

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Image: Lentina_x.  Socrates. Flickr.

 

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Image: Confucius the Scholar. Qing Dynasty. Wikimedia Commons.

Whilst the term metacognition has its etymological origins in Greek (meta = above) and Latin (cognitio= thought), the concept was not termed metacognition until 1979, when American developmental psychologist, John Flavell, described it as ‘knowledge and cognition about cognitive phenomena.’ (Flavell)

This new – and ancient – concept has many dimensions and many applications. Metacognition, is popularly defined as ‘thinking about thinking,’ or, more technically,

‘a ‘recursive sense of consciousness…..the capacity to think about one’s own mind.’  Dehaene

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This ‘recursive’ aspect of metacognition is interesting, in that it signifies the ability to be self-reflective, self-referential, to have thoughts about one’s own thoughts and beliefs and, in so doing, to function as both subject and object.

Such reflexive thinking, is, in itself, a time-honoured concept. It involves holding up a virtual mirror to the self and then identifying one’s subjectivities, one’s personal perspectives and biases.

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Self-Monitoring: The self in the Mirror

Metacognition is thus about monitoring, control and regulation of our thoughts; it is a skill that is highly relevant to education and learning.

An example of a metacognitive thought might be ‘I know that I have a problem with science, but I am good at art.’ This is a ‘self-monitoring’ thought, which might lead us to action and strategy that could help us understand ourselves and our learning skills better.

The theory of metacognition can be applied to many different disciplines; as it relates to self-understanding, metacognition may be used in certain therapies. Over recent years, Professor Adrain Wells has developed ‘metacognitive therapy,’ which offers techniques to treat many psychological disorders.

It focusses on facilitating patients to recognise and manage their responses to their own negative and worrying thoughts. They are encouraged to explore their ways of handling, for example, ruminative thinking and a pervasive sense of threat.

Wells’ message is

‘Thoughts don’t matter, but your response to them does.’

Wells.

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The content of the thought is seen as less relevant than the way of thinking about the thought. Metacognitive therapy aims to enable people gain flexibility in the way they respond to their negative thoughts. They are helped to be less rigid in their ways of thinking and less dependent on unhelpful ways of managing such thoughts.

Metacognition and Advances in Cognitive Neuroscience

Using the tools of contemporary neuroscience, scientists are now beginning to identify the brain mechanisms that govern metacognition.
(Fleming)

Scientists at University College London (Fleming) have conducted a series of trials in which they identified that ‘the people with better metacognition had more gray matter in the anterior prefrontal cortex.’

Disorders like schizophrenia, stroke and dementia can adversely affect metacognition. Deficiencies in this area can have disastrous consequences, leaving a person unable to have ‘insight into his or her own illness.’ (Fleming)

Research has been conducted into the use of various medications to help improve metacognition. Some people do have better metacognitive skills than others; there are, however, ways to improve these self-assessment skills. It has been discovered that meditation and stopping to reflect on one’s learning can help with the process of metacognition.

METACOGNITIVE SKILLS

Mindfulness

How can we think mindfully? The process of mindfulness uses metacognitive skills; the term signifies an awareness and acceptance of one’s thoughts in the present moment, attending to them without judgement or censure.

Thinking mindfully involves acknowledging thoughts, without criticism, watching what happens to the thought in the thinking process. Although there is some overlap between metacognition and mindfulness, the former extends and develops the process further, perhaps into action.

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Theravada Buddhist Nuns Meditating

The term mindfulness originated in Buddhist meditation practice; it is now widely used, and in a variety of settings. It can be helpful in reducing stress levels and in enhancing enjoyment of life.

It can help us to become aware of what is happening both in and around ourselves, encouraging us to pause and notice sounds, smells and sensations.

Mindfulness provides a way of becoming aware of thoughts, especially intrusive and troublesome ones. These can have a powerful negative effects on our lives if they take over and appear to wield power over us. We can learn how to control them, gaining new perspectives:

A teacher walking with his students points to a very large boulder and says, “Students, do you see that boulder?” The students respond, “Yes, teacher, we see the boulder.” The teacher asks, “And is the boulder heavy?” The students respond, “Oh yes, very heavy.” And the teacher replies, “Not if you don’t pick it up.”

(Shapiro and Carlson)

This story illustrates how mindfulness can help manage fears about ‘obstacles’ that may be insurmountable only in one’s thoughts. A mindful approach would involve being aware of the boulders, but not to feel one is necessarily compelled to rearrange or shift them.

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Mindfulness teaches an approach of  acceptance, an awareness of the impermanence of life. Has this technique helped you? Let me know in the comments below.

Discover more on this subject by checking out next week’s post: Mindfulness: The Real Truth.