Thinkpiece Archives
Depression Treatment
Recently I had one of my relatively new clients come to me with the announcement that her long time health provider had decided that she was going to be a “lifer”. That is, she could expect to remain on anti-depressant drugs for the rest of her life. This woman is in her early 40’s and this piece of news made me wonder how it is that anyone could possibly know that this woman was in for potentially another 40 years of being both depressed and medicated. It sounds akin to a prison sentence (“lifer”, “40 years”). What kind of a message is this to give a patient? It certainly doesn’t seem like a hopeful one.
My reservations about this “diagnosis” had little to do with the alleged benefits of anti-depressant or other forms of medication. Indeed, I find it unusual these days to encounter a client who isn’t on some form of medication. Also, I would hope that if I were suffering there would be some medication that would relieve my suffering. What I find objectionable is the “knowingness” of the health care professional who made this diagnosis. How can anyone know for certain what one’s long term prognosis (particularly with such an affliction as depression which seems to come and go) will be? This makes me mindful of the old aphorism to be suspicious of those who claim to “know” and speak with authority.
Such a diagnosis (“you’ll always be afflicted with depression and always need medication”) seems to fly in the face of good sense and the evidence that we can actually do something about the way we feel. It isn’t just a matter of taking a pill and then expecting to feel better. Study after study has shown that the best treatment for depression is a combination of anti-depressant medication and talk therapy (often cognitive behavioural therapy or CBT). It seems to me that it might be comforting to know that we have some agency in the treatment of our ailments and have it within our power (sometimes with the help of others) to at least ameliorate our symptoms if not entirely “fix” them.
Sometimes depression feels so deep and overwhelming that people feel that they don’t have the energy to fight it. Or, they are so overcome with the embarrassment and shame that often accompanies being depressed that they avoid others and hide out. Others tend to “own” the depression as if it were an intrinsic part of who they are. Instead of experiencing being depressed, they refer to their ailment as “my depression” as if it were central to their being or as much a part of them as an arm or a leg. Of course, none of this is helpful and can aggravate the symptoms.
So, what is there about the therapeutic experience that I believe can help alleviate depression? In the Specializations area of this website, I talked about my own experience of having been seriously depressed many years ago and how with the help of a caring and competent psychotherapist, I was able to emerge from that dark time in my life. When I look back on that period, I am convinced that it was the relationship that I forged with this therapist that made all the difference in the world. I had consulted with other professionals (including my family physician and a number of psychiatrists). The physician prescribed anti-depressants which had no effect on me. The psychiatrists, I feel, approached the job of psychotherapy as if they were technicians and I was an object to be worked on, to be fixed. What they did not do was engage with me. Instead, I was prescribed more drugs and treated to a psychiatrist sitting behind a clipboard taking notes about me as if I were a problem to be solved rather than an individual to be engaged with. I found this to be a very alienating experience. The psychiatrists developed only the most formal of relationships with me and I felt as though I were something to be tinkered with rather than encountered and related to. My tolerance for this kind of treatment was limited. I did not want to feel worse; I wanted to feel better. I wanted and needed to be touched by the humanity of another. R.D. Laing put it well when he stated that the treatment was in how the patient was treated. This seems to me to be contrary to the medical model of treatment which focuses on supposed “technical” cures as opposed to engaging with the client or patient and treating them in a humane way.
I am grateful that I persisted in my efforts to find someone who would respond to me, not as a problem to be solved but as a human being to be encountered, to be engaged with. I believe the humanity in both of us was touched and through this there was great healing. I came to believe that there were people who care and that depression is not simply a matter of prescribing the right combination of drugs or tinkering with the individual with the psychological equivalents of screwdrivers, wrenches and even hammers. Psychology is not technology.
I believe that there is a more hopeful message than the one that presumes that any of us is fated to a life of misery and medication.
My hope is to offer the same kind of compassion, caring and engagement that was offered to me. In this, I believe that there is healing. However it takes someone who is interested enough in the suffering of others to listen, to attend, to be patient and to be compassionate.
Depression Counselling
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