It seems pretty certain that diseases like mononucleosis and hepatitis can have long-range psychological consequences and a very high percentage of people with major affective disorder (depression) have a positive blood test for Epstein-Barr virus as well as other evidence of infectious or allergic disease. A very high percentage of youngsters who suddenly become morose, or rebellious, or incompetent has a history of mono or have been misdiagnosed and have a positive blood test when it is examined long after psychotherapy has been attempted.
On the other hand, defeats (even as trivial as loss of a football game), demoralizations, and long experience of helplessness or being trapped in a demeaning relationship can provoke serious biochemical imbalances and are the trigger for diabetes, allergy, or receptiveness to infectious disease.
Herpes is a notoriously odd infection, becoming active because of dietary indiscretions, fights with boyfriends, too much sunlight, and other events that common sense would not suggest as causing an infection. These stressing events don’t cause the infection; but they make the body weaker so that the agent which is already present has a chance to flourish. The immune system is intimately connected with the nervous system and stress in one equal stress in the other. Herpes can make you nervous, and nerves can give you a crop of herpes blisters.
If you are married to a depressing person you can suffer major depression, and have major imbalances in the flow of your neurotransmitters. A there is a type of controlling, superficially “perfect” person who almost invariably provokes a major depression in his wife. The result of being helpless in any degrading relationship (marriage, job, or other association) can be a lasting derangement of your neurobiology.
If you are depressed it is important to exercise and to rest. You should make your nutrition as good as possible and you need more dietary supplementation than a person who isn’t depressed. You should find out if you are allergic, diabetic, or have thyroiditis. You should control the stress in your life and stop or moderate your use of alcohol, caffeine, tobacco, or other drugs.
Xanax, Atarax, Librium, and Valium are particularly depressing drugs and if you take then regularly you must suspect that these drugs are causing depression. You should regularly read the PDR or package inserts and know about the effects of drugs which may even have been prescribed for your condition, but can make it worse. You should have a thoughtful discussion with your doctor about drug effects, the interactions of drugs, the effects of diet on your drugs, and the vitamin deficiencies caused by drugs.
Antidepressant medications are not like the ‘tranquilizers’ and they are not like hypnotics or pain-relieving medication. I have never read of anyone abusing them or being addicted to them. When they are taken for 20 weeks after the end of symptoms very few clients relapses. Alcohol and its tranquilizing relatives like Valium do not cure anything and frequently cause addiction. Drugs that get you drunk don’t treat anything but sobriety.
It may be very difficult to treat your depression, anxiety, phobia, or obsessiveness without an antidepressant. However, research shows that therapy directed at perceptions, thinking, learning, and behavior is just as effective in treating emotions as prescription medicine has proved to be. When we combine psychotherapy with medicine we get the best results. Good psychological methods aim at rapid changes in perceptions, thinking, and learning to help change behavior and relieve congested and painful emotions.
Even those individuals who have depressing illnesses, or are severely allergic or hypersensitive to medications can benefit from psychotherapy, and their biochemistry can be altered through psychotherapy. Psychotherapy is essential for those clients who are so sensitive to medicines that they cannot take them at all. Psychotherapy may be essential even for those clients whose illness responds quickly to medicine without side effects.
A broken leg, measles, asthma, hepatitis, and all other diseases respond more quickly when effective psychotherapy is used. A recent Blue Cross study showed that the average client who takes psychotherapy in a given year uses $500 less of all therapeutic care in the next year. This includes drugs, doctor care, and hospitalization. Also, the typical psychotherapy client enjoys a 20% rise in income or more in the year following psychotherapy. Even if you haven’t broken your leg, psychotherapy makes good economic as well as personal sense.
Psychological Causes and Psychological Treatments of Depression
There are at least nine ways in which your perceptions, thoughts, learning, and behavior contribute to your inappropriate emotions including depression:
Self-hypnosis; self-programming through negative thinking;
Poverty, emotional and material;
Poverty, social and personal;
Inhibition, fearfulness, and self-consciousness;
Relationships which are binds;
Inappropriate grief and loss;
Frustration and anger;
1. SELF HYPNOSIS
WHEN YOU ARE DEPRESSED you may be superstitiously attached to a conviction that you cannot change. You repeat and repeat negative thoughts. You are self hypnotized into feeling bad and convincing yourself that you cannot change yourself or your circumstances. You repeatedly assure yourself that you are in a corner with no exits and that nothing can be done about it. You repeat negative assessments of yourself and other people over and over again. You tell yourself “I can’t stand it anymore.” This phrase, taken literally, means “I am going to quit.” If you take the phrase to its extreme, “I can’t stand it anymore”, means “I am going to die if this keeps on.”
Depression often accompanies repeated self-assessments which sum up to a zero. You may tell yourself that life is not worth living because I am not perfect, I haven’t done what I should, I am not living up to my potential, I am a disappointment to my …., I am a failure, I am not … enough. All these imperatives form a list of “shoulds”, which become more important than enjoying life. When you are depressed the “should list” can become more important than life itself.
This preoccupation with how bad a trap you are in is an arrogant posture presuming that “I am so bad that God cannot forgive me”. Depressed people are often exceptionally preoccupied with themselves and their failures. They only want to think about their negative attributes and sins, and repeatedly affirm how fearsomely impossible their world has become.
TREATMENT requires that the client find a therapist whom the client respects. The client has to believes her therapist is acting skillfully in good faith, and that the therapist has goodwill and affection for the client. It is probably more important than the client respects the therapist’s skill than that the client likes the therapist as a person. But respect and liking are both good bases for progress. Trust is more important than credentials and experience.
TO BE SUCCESSFUL IN OVERCOMING DEPRESSION you have to change your hypnotic set – you must reprogram the constant barrage of negative messages you give yourself.
With a good therapist you will first expand the hope which brought you to seek help by learning that you are not alone; and second, by learning that change is possible. You and your therapist will systematically work through positive self-evaluations and predictions about yourself. You must change the messages of self-hate and condemnation you give yourself into messages which affirm your positive worth. Then you need to make positive assessments about your goals and resources.
If you have been telling yourself “I will just die if I don’t have a cigarette soon,” it is awfully hard to convince your subconscious mind that it is healthful to stop smoking. You may be one of the millions of people who barrage themselves with self-limiting and sick-making messages all day long, “I can’t stand it… “Isn’t it awful …”It just makes me sick ….”I’m dying…” You have to discover these messages and replace them with positive affirmations.
2. POVERTY: Material and Emotional
A lot of depressed people just don’t have a good time. When is the last time you did something nice for yourself? You may be one of those people who day by day do not enjoy much of anything at all. If you do have some positive experiences you may not treasure the enjoyment. You may seldom remark on your little joys; you fail to remind yourself about small pleasures and you never tell anyone else about the good things. You may forget to aim to have more good experiences. Depressed people don’t celebrate.
Good emotional health is based on having many positive experiences every day. A natural antidepressant is simply repeating to yourself the good, positive experiences which happen during the day. Pleasures as simple as eating, sleeping, watching the clouds, being dry and warm are worth remarking, remembering, talking about to yourself, sharing with others, and listing on a piece of paper. A good therapist focuses you on your positive experiences and helps you become conscious of all you have to be grateful for.
Be good to yourself. Buy a small present for yourself. Take an extra break. Get an extra treat. Read a book you have already enjoyed. Think of different ways to be good to yourself. A way to get better is to start being good to yourself. Depression is a self-punishing form of false humility.
You may not be able to make yourself a multimillionaire, but you can make yourself rich in experience and small pleasures. Poverty is depressing.
3. POVERTY: Social and Personal
I have seldom treated a depressed person who believed she had someone to care for who needed her. I have treated many depressed women who were married, who had children, who had aged parents, or others who needed them. Unfortunately, the women felt trapped and couldn’t believe they were needed. Rude, angry, depressed, and silent, inhibited people are depressing to care for unless you have marvelous internal resources. You may have convinced yourself that they really would be better off without you.
It helps if you believe somebody needs you and if you don’t feel trapped by the relationship. You may have a loving spouse, but if you perceive your spouse as self-sufficient and believe your spouse has no need you are in trouble. If you believe your spouse doesn’t want you the reality of their need makes little difference. It is interesting when people take on a new partner how radically different they may become, and how differently they are perceived by others. Perception can count for more than reality. If you perceive yourself as unneeded then you will be at risk for depression.
Depressed people are seldom volunteers in hospitals, you don’t find many in scout work, you don’t often find them visiting nursing homes. They can’t be bothered, and because they couldn’t be bothered they are often lonely, and repeatedly tell themselves how awful and lonely a place the world is. The world full of needing people escapes their perception.
One of the most antidepressant actions is to begin caring for someone else. This does not mean that depression never strikes the caring, loving, helping person – diseases are no respecters of morality. It does mean that the person who never tries to help is a very high risk of depression. The person who has someone to care for and who wants to care for that person is protected against the worst of depression.
Charity begins at home, and doing good may help you to do well. Lonely people have chosen to be lonely.
A good therapist helps you develop social skills and social settings in which you can feel comfortable and needed. It is very hard to escape the blues when you are lonely. If you enjoy being alone you have great internal resources and a lot of play or work to do by yourself. Sometimes therapy helps you accept the fact that you are a loner. Perhaps your favorite sound is silence. Good for you. Find a way to fill your aloneness. Boredom is a sin that punishes itself.
4. INHIBITION: Fearfulness and Self Consciousness
You might ask yourself, “Why is depression so common, and so persistent?” Well, depression has a biological purpose. When an animal is busily sought by predators, it pays for it to be still, afraid of new things, very conservative, and inhibited. It pays for a hunted animal to have good timing and to be nervous.
Since the biochemistry of depression has the function of keeping an animal still and quiet in a dangerous environment, stress, disease, and inappropriate mental conditioning can cause the brain to be flooded with inhibiting neurotransmitters that convince the brain “there are tigers out there”. One of the ways this flood of chemicals can start is through a life-long trickle of self-interrupting.
Depressed people often don’t talk to other people, don’t smile readily, don’t gesture, don’t react to people and scenes around them. People with blocked energy are moody, dull, and sad as a rule, and are prone to major depression. Overcontrolled, self-conscious, rule-abiding, conventional people often are unable to relate to other people appropriately, they have rules for themselves which are too strict, and they always worry “what will the neighbors think.”
Generalized inhibition is always a source of pain. Grown-up people often have to inhibit desires and change goals. However, this mature process is a fluent exercise of choice. This kind of inhibiting through a change of goals is often difficult for a person suffering a pervasive inhibition of the entire central nervous system.
People who are very aggressive and loud are usually just as many victims of generalized inhibition as are shy, quiet people. Aggressive inhibited people constantly fiddle with themselves; they are self-conscious and self-preoccupied; they get little information from other people and seem to have little or no ability to “read” a situation, gesture, or facial expression. Naive friends are often startled when such “up” people wind up in the hospital for depression or from trying to kill themselves. It is hard to realize that some inhibited people are noisy and active, some are quiet and restricted. It is especially true of men that depression often appears as grouchiness and unrelieved anger. It is easy to see that some men cannot teach or correct other people without getting angry to accomplish the correction or teaching. Anger is disinhibiting after a fashion, but the emotion is really a defensive form of inhibition and is seldom an efficient emotion.
An emotionally free and responsive person does not refuse to steal because he is inhibited by a fear of punishment. An open and functioning person is seeking positive relationships with others and the joy of creating and earning his way. A thoughtful and appropriate sense of ethics and morality is based on the pursuit of clear cut goals. When morality is based on fear, the behavior is inhibited, constricted, ineffective, and emotions are depressed. Appropriate inhibition is caused by switching from a positive goal to a positive goal. Inappropriate inhibition is a fearful shrinking from a possibility. Fearful self-dimming forms a defensive reflex that suppresses and distorts behavior and emotions.
If you are shy, you know that it is almost impossible to become outgoing.
Surprisingly, the simple verbal act of complimenting is a way to begin disinhibition. Sometimes the therapist’s job is to reassure a shy person that some very simple social gambits are useful tools for gaining emotional well being. Compliments are the most acceptable form of social interaction. Paying an appropriate compliment usually feels good to the one who gives as well as the one who receives it. The simple act of speaking up disinhibits the overtrained verbal niceness and permits more extensive social interaction to develop.
TREATMENT is based on a positive therapeutic relationship in which the therapist teaches communication skills, expressiveness and enables the client to replace aggression with the assertion. Complimenting, self-disclosure, sharing free information about self, and positive assertion of your own goals are all good methods of disinhibition.
TREATMENT is also accomplished by thoughtfully considering specific goals; visualizing those goals in concrete, simple, and do-able terms; and by making detailed, step by step plans for realizing specific, concretely visualized goals. Inhibited people are frequently depressed because they do not have achievable goals.
If you are depressed it is a good idea to practice noticing other people and make yourself a goal of complimenting them on some small aspect of themselves. Just the comment “You look good today” begins the process of disinhibition.
Complimenting is followed by simple statements that give some free information about yourself. “I’m taking a dance class this week, and I’m excited about it.”
5. INAPPROPRIATE GUILT
It probably helps from time to time to meditate upon your sins, but then it is humanly and religiously appropriate to give those sins up. As that great psychologist, Satchel Paige, once said “Don’t look back, you never know what’s catching up to you.”
If you are a Christian the appropriate place for your guilt is in the Hands of Jesus. A Jew has an appropriate time and ritual of atonement. Humanists have a harder time dealing with guilt because, existentially and emotionally, it is easier to feel worse than the positive. This makes good biological sense. When things are happy and safe it is easy to find the good times (when you don’t have a big memory and a lot of words to inhibit you – and most of our emotional equipment was designed for a nonverbal animal).
Evolutionarily, it pays to remember where the tigers hang out and to inhibit yourself from going there.
Whatever your religious perspective maybe, hanging on to guilt is a self-centered way of failing to cope. Guilt is not productive, and does not solve problems. Persistent guilt is always inappropriate and self-defeating.
Treatment of guilt often involves nothing more than restoring a person to her religious roots. People who are estranged from their religious home can find a way back home again. A client who insists on absolute self-responsibility can begin a rational assessment of her own choices, willfulness and her responsibility for her bad actions, and make a plan for restitution. Paul’s injunction to the Romans reminding them that no one should evaluate another man’s servant applies in the self-evaluation as well. If you are God’s servant, only God can judge you. It is a waste of time to judge yourself, better spend the time planning how to make amends and go on with your life.
In one manner of thinking, guilt is another form of inhibition. It can be seen as a compulsive form of rumination – chewing the cud of thought – and obsessively repeating “I am bad because of….”.
Rumination is a waste of time and another form of negative self-hypnosis. The past cannot be changed. The appropriate disinhibiting action is to make a plan of restitution and change and to repeat and repeat the positive goal of paying your debts. Always phrase your goal positively. “I will drink only water.” This is a more effective statement than “I’ll never drink booze again.”
6. BINDS: Double or Otherwise
“On your way to pick up the beer take the garbage out to the curb, please.”
The statement above is an example of a healthily phrased double bind. You will be much more effective at getting kids or husbands to do things you want them to do if you phrase your requests in such a fashion. Notice how much more likely you are to get the garbage taken out than if you asked:
“Why don’t you ever take out the garbage?” or stated,
“You never take out the garbage.”
In fact, with the double bind, you don’t raise the issue of garbage, it is only on the way to the more pleasurable goal of fetching beer that the garbage request is inserted.
Imagine the effect of saying, “I would think that when a husband and wife respect each other they remember to get each other gifts.” This statement is reasonable, but when uttered by a spouse such a rational comment would invariably create a defense. The large, grand issue of mutual respect has little to do with a tiny act of courtesy.
Spouses create frustration and depression in each other by sending double messages.
“If you loved me…..”
“Your sister always….”
“You never ……”
“Why don’t you ……”
In general, messages which begin with “why”, “you” and include “never”, “always” and “if” or “really” are invitations to fight. These judging comments are almost always attempting to control and seldom reflect competent efforts to communicate.
Defensive responses usually create defensive responses. Query: “Did you carry out the garbage.” Defense: “I was busy putting up the screens.” An undefensive answer is “No, I haven’t done it yet.” An unargumentative follow up is “I’ll be happy when you do.”
Some spouses are gifted at seldom making a direct request, “I would like it if you ….”
Unfortunately, such spouses seldom clean up their communications without assistance. They usually dig the depression ditch deeper and deeper.
The role of the therapist is to help the couple get rid of the ambiguity in the relationship and to convert hidden binds into open relationships. The couple needs to learn to ask for what they want simply, and positively. They need to learn to ask in terms that are easy to act on. Do-able requests build positive emotions. Abstract judgemental requests are invitations to fight, e.g. “Why don’t you stop treating me like a three-year-old?”
Positive requests to carry out some small action are usually granted. Then both the person requesting and the person giving the action feel good.
The couple needs to learn to say “please” and “thank you”, simply to state “I like it when you …..” Keep negative statements simple, too, “I don’t like it when you …..”.
The superficially “perfect” spouse creates an impossible array of “shoulds”. These paragons embed rules in “I love you, but …” and create a depressing reality. Sometimes the moral relationship can be improved and communication established. Other times the only effective antidepressant is to get rid of the relationship.
We have a biological reflex that causes us to be inhibited, slow, unreactive, and sad after a loss. Our responses vary from person to person, and across the dimensions of loss, but losing something or someone is depressing. Some individuals have an exaggerated, often learned, response to trivial loss and can’t be taken quite seriously by their family or friends. Others seem to be inappropriate, crying more for the loss of a pet than of a parent.
Exaggerated or inappropriate grief can be a learned reaction or it can be a technique of control. Grief can be a function of disease. In any of these three cases, learned grief, manipulating or misplaced grief, and symptomatic exaggeration of grief, the sufferer is in trouble and needs sympathy, understanding, and help.
When people have lost children or parents they seem to recover better when their family and friends are supportive rather than rational and judging in their sympathy.
That is the kind of people who say things like “I’m here anytime you want me”, “Let me know how I can help you”, “we love you, hang on” seem to be useful. Those sympathizers who tell you things like “She’s better off now,” “he’s finally at rest,” “they are in a better world” don’t seem to be helpful. It is as if rational messages inhibit the flow of grief. More simple support seems to allow the grieving person emotionally to reorient.
The appropriate ‘therapy’ for loss is grieving, with the support and love of family and friends, and by using reminiscence happily and hopefully.
Inappropriate and exaggerated grief is often a symptom of biological dysfunction and responds dramatically to medication. Inappropriate grief may be an appropriate way of tempering real grief until the person can cope with the major loss. The therapist helps the client think through relative values, and to treasure, what relationships and values remain after the loss.
Sometimes expressing old grief is dramatically valuable – this is especially true when inappropriate guilt is inhibiting the expression of grief and sorrow.
It is sometimes valuable to hold a formal ceremony recognizing a loss. This is particularly valuable for losses that we have been taught to deny or to be tough about. Miscarriages, abortions, or other misfortunes are often not formally recognized or grieved over. Since the misfortune or loss was not dealt with the remaining scars actively promote depression. Most people seem to like an informal style these days and many people avoid ceremony. But this loose style frequently fails to discharge grief. Since the loss doesn’t come into focus through a self-conscious and mutual effort, there is no permission to grieve, and no relief of sadness. Many depressed clients are victims of superstitious attitudes about what is appropriate feeling or what is appropriate behavior.
8. FRUSTRATION AND ANGER
Loss can be frustrating, but blocked goals are more likely to create frustration. Anger is probably seldom an appropriate emotion when a person is effectively pursuing a goal. If you enjoy nature films you have seen great cats, or wolves chasing down their prey. They are not angry, and when their pursuit is frustrated they express no anger. The tiger just walks away. “If at first, you don’t succeed, ‘to heck with it.’ “, seems to be the attitude of most predators.
Men and women can’t react like that. Our style of hunting is quite different from other predators. Since we are weak and not too fast we learned to persevere – unfortunately we also perseverate. “Damn it!”, is a statement no bear, owl, tiger, or mongoose ever made.
Anger is a defensive emotion, it helps an animal which is not pursuing a goal to create the energy to protect its territory or its offspring. Anger is draining and painful. When effective tactics result in success there is no anger.
Effective therapy for a frustrated and angry person is to teach her how to be assertive. Learning to assert your needs results in winning more easily than the wins which result from angrily demanding your wants. An undefensive assertion is always more powerful than one which is based on angry defensiveness or aggression.
“Invincible agreement” is the name of an assertive tactic which defuses anger and permits you to move toward your own goal. “Yes, I agree it does seem to you that I am being unreasonable, but I am going to the football game.”
If you meet every argument with at least the agreement that you understand the other person to have the feelings they express; or agree that you agree that they believe the judgment they uttered; or, yes, you agree that they want the goal they assert, then the arguer has no basis for persisting. You are then free to put your own goal simply and positively “I want my engine repaired on warranty.” “I agree that you think I am unreasonable, I want my engine repaired on warranty.”
It helps to list the sources of frustration and anger in your life and to make plans to resolve the frustration and assertively to express your goals. Save the anger for its biologically appropriate time – defense of home and family in conditions of extreme threat. Be angry at the burglar, not your husband. If you make a list of the things your wife does that make you angry, they also make a list of the ways you can help her change. Then make a list of all the things you want her to do and how you can help her do those things. Positive goals are effective, negative demands are not.
Many people in marriages and other relationships characterized by binds don’t realize how helpless they are and how they have learned to accept being helpless. Even when they are using helplessness as a tactic they may not realize it.
We know that we can train animals to die readily by teaching them that there is nothing that can be done about some awful stimulus. Rats will dive to the bottom of a tub and drown after being trained in a cage in which they cannot escape a nasty shock.
People, too, learn to give up, to accept the intolerable, and to have an attitude “nothing can be done.” Sometimes the relationships are simply overwhelmingly controlling and there is no patina of verbal bind. One member of the relationship is a slave. These clients can be helped only if they are ready to struggle or to end the relationship. These people often say, “I can’t stand it anymore”, but then they keep on maintaining the relationship which they can’t stand.
A very common cause of depression is the job. Probably the second most useful thing a therapist can help a depressed client to do is to get a new and appropriate career. Sometimes just thinking through goals is a powerful tool to break up a pattern of helplessness and establish a new pathway to success.
The therapist helps the client visualize specific achievable goals. These goals are concrete prizes the client wants to win. Then a series of plans, details, steps which can be taken day by day, are created and begun. It is surprising how many depressed people have never thought in specific terms what it is they want in life. Vague terms like “happiness” and “success” are not useful. It is essential to have concrete, positively expressed goals which are visualized: A specific dollar amount for retirement; A clear set of plans for holidays and recreations; A specific set of plans for a home with an exact number of children. All plans can be changed, and all dreams are dynamic.
DEPRESSION: A Complex Product of Biochemistry and Experience.
The major affective disorder is a biological disease characterized by sadness, lethargy, malaise, poor sleep, psychosomatic complaints, irritation, hopelessness, anomie, and dysphoria. A depressed person doesn’t enjoy life and doesn’t believe that life can be enjoyed.
The biological imbalances which characterize depression are treatable by a series of medications that often dramatically resolve the disease without much change being required by the client at all.
However, we know that intolerable psychological realities can create biological imbalances that result in depression. Depressive symptoms can be relieved by overcoming existential limitations, and by improving or escaping relationships, and by reorganizing the perceiving, thinking, learning, and behavior of clients.
Research has demonstrated that a thoughtful combination of medication and therapy more thoroughly and quickly resolves depression than by treating with either therapy alone.
Depression is often associated with or caused by forms of:
- the self-hypnosis of negative thinking;
- the poverty of interpersonal relationships and values;
- a lack of friends or someone to need you;
- inappropriate guilt;
- binding relationships;
- loss and inappropriate grief;
- frustration and anger, and
- The resolution of these psychological traps can make life worth living again.
Psychology has made great strides in the treatment of anxiety, phobias, and depression and we can be very optimistic when the client brings these problems to us for help.