Sept 2010
I often hear about
people who have been advised to go and get counselling and medication for
depression; who go on antidepressants and then decide not to have counselling
or psychotherapy as well because they feel better. What they don’t realize is
that their problems aren’t going to go away; feeling “better” through
medication wont change fundamental things much. The ideal situation involves
looking after the whole self, and not just the chemicals in the brain.
Antidepressants
certainly level a person’s mood, but the highs go as well as the lows. When
they are deeply distressed this levelling can be very welcome. Over time,
though, not being able to feel much can be quite disturbing. Because we are
expressive responsive beings, the
sense of being disengaged can impact greatly on special relationships and even
just in everyday encounters. A loved one can feel left out, in some subtle way
and the depressed one is not even aware of this happening. By expressive responsive beings, I am
describing the beautiful lively
interplay that occurs in every face to face encounter where each person
responds to the other, back and forth. When one person isn’t so engaged – as
when their affect is flattened – the other person can feel excluded. This
partially blocked interplay is
even more clearly evident when one person has had a stroke and their face is
immobilized (as literature on face recognition describes it).
Another aspect of
this is the diminishment of a sense of being able to regulate one’s moods, and
not recognizing what moods are within the normal range and what is outside the
normal range.
Several years ago, I
knew a woman who had been on antidepressants so long that she no longer knew
which of her thoughts and moods were reasonable and which were outside the
experience of most of her friends. Any feelings of anger were attributed by her as requiring
increased doses of her medication. This is so topsy turvy and fundamentally
wrong. Psychotherapy would have
given her a more accurate sense of what is real and what is imagined. It would
have put her in touch with her inner world, giving her awareness of anger as a
useful emotion with its own energy for changing the dysfunctional in her world.
Instead she felt eruptions of anger as if these feelings came from somewhere
else and increasing the medication had the unfortunate effect of deadening her
creative encounters with her world even more.
Antidepressant medication can be useful in cases
of prolonged grief, such as sometimes occurs after the death of a beloved, but
here again, it should accompany counselling of some kind. Just the chance of
talking about the death with someone who will listen deeply is nurturing. A
counsellor generally will not shrink away from meeting a person at such a profound
place.
Loss of career, of
hope in relationships, of despair, loneliness, and a sense of powerlessness can
contribute to feeling depressed. Maybe such depression merits going on
medication, but more is needed.
The chance to develop other ways of seeing and instituting fundamental
change is an important part of counselling and psychotherapy. Counselling and psychotherapy moves
one’s internal dialogue from societal and family ideas of loss equals failure
and all the introjects of “get a grip on yourself,” “put on a stiff upper lip
and you’ll get through this,” and “think of the starving millions with greater
problems than you”, and so on, to actually finding new and creative ways of being
really here in this place, now, with your integrity intact.
Some, but not all
depression serves a purpose: it tells us when we are out of kilter with our
uniqueness; when we are not fulfilling our individual lives in ways truer to
ourselves. Some depression is actually more chemical than psychological
(endogenous depression), but here again, just going on medication is
insufficient. Dialogue in
counselling is very useful, in bringing awareness to feelings and thoughts
about feelings, as well as interactive communication with others.
