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Basically, there are two points of view about what causes depression. The first is that depression is caused by chemical imbalances in the brain. The second is that depression is caused by unresolved problems in living which result in feelings of sadness, grief, despair, and hopelessness. If you take the first point of view, then treatment of depression becomes a matter of changing the brain chemistry. That's usually attempted by giving medication. This is the basis of the current medical model for the treatment of depression. If you take the second point of view, then treatment of depression becomes a matter of helping people learn to understand themselves better so as to make better choices and to be in a more harmonious relationship with themselves and life. Psychotherapy is the usual method of treatment here. There are lots of different schools of psychotherapy, each of which defines the causes of depression somewhat differently. But, since psychotherapy research shows that how therapists do therapy has more to do with their personalities and experience than with their training, I don't think we need concern ourselves too much about what the various schools of therapy have to say about why people become depressed. There is a "chicken and egg" type question here: What came first? Do people become depressed because their brain chemistry becomes imbalanced, or does their brain chemistry become imbalanced because they are experiencing problems in life that they don't know how to cope with? There is a story about a man who scratches himself all the time, and a great philosopher is asked why the man does this. The thinker thinks as thoughtfully as he can about it, and then announces his decision: "This man scratches because he is itching." (From: The Magic Monastery, by Idries Shah, published by Octagon Press, London, available at http://www.sufis.org). To me, those who say that depression is caused by an imbalance in brain chemistry sound like the thinker who said that the scratcher scratches because he itches. What we don't know is what's causing his itching. The two points of view, biochemical and experiential, are not mutually exclusive. For example, psychiatrists who regard depression as the result of faulty brain chemistry may still provide cognitive therapy, to help their patients cope better with such symptoms of depression as negative thoughts. Psychotherapists, on the other hand, who see depression as originating in a faulty relationship of the client with himself and life, may refer some of their clients for medication, especially if they are so depressed that their ability to participate in psychotherapy is very restricted, or if they are suicidal. Psychotherapists may also encourage their patients and clients to exercise, or learn to relax through biofeedback (which can be extended into hypnotherapy to help therapy along), which are natural physical methods of influencing brain chemistry. ("The Healing Brain," by Robert Ornstein, Ph.D., and David Sobel, M.D., "demonstrates how the brain operates as a health maintenance organization." Published by Malor Books, available through ISHK Book Service at http://www.ishkbooks.com). Genetic inheritance probably plays a role in depression. People seem to be biologically predisposed to react differently under stress. Everyone will have emotional problems under enough stress, but the kind of emotional problems may differ from person to person. For example, three people may be exposed to a high degree of stress: one may become depressed, one may suffer physical symptoms such as ulcers or high blood pressure, and one may become manic. Another factor in depression is whether the person knows and applies basic mental hygiene. Regularly doing simple things like exercise, indulging in "Healthy Pleasures" (there is a great book by that name by Robert Ornstein and David Sobel, a psychologist and a physician, published by Perseus and available through Amazon.com), making time for relationships and taking care of them, and learning and practicing relaxation, are as important to mental health as regular brushing and flossing are to dental health. Dentists always complain that people don't take care of their teeth, and the same is true of our emotional health. In the case of exercise, for example, research shows that regular aerobic exercise, in general, works as well as an antidepressant medication for people with mild to moderate depression. Adaptation to change is another issue related to depression. "The times they are a-changing," Bob Dylan sang, and its true. The pace of economic and social change is accelerating throughout the world, and no one is really immune. This means that one has to have an outlook which is more anchored in enduring human values and less attached to appearances, and to have a more nimble and flexible type of attitude toward life, to be able to adapt. People who are not able to adapt to change may become depressed by it. For example, I recall a news report about a steel plant that had closed on the south side of Chicago. An entire community had grown up around it, where people lived whose whole way of life revolved around the plant. The report focused on two men who had been laid off after about 25 years of work at the mill; men who had known no other employment. One man was resourceful and, after trying unsuccessfully to get another job, went into business for himself and made a success of it. He was actually happier then he'd been before, and regarded being laid off as a blessing in disguise. The other man, however, was unable to adapt to the change. He couldn't imagine any other kind of work, and languished at home, using up his unemployment and sinking ever more deeply into depression. Another important issue is that of meaning. In our materialist culture, the deeply human need for meaning is neglected, and this may underlie many depressions. When society proves to be unjust, or life is unfair, when we're unlucky in love or in our careers, how are we to tolerate the disappointment and endure the loss without a deeper sense of the meaning of life? Substance abuse and addiction is clearly related to the need to have some control over one's inner life, to have special inner experiences that release one from the limits of ordinary perception and connect one with life in a larger way, and to provide a sense of meaning in life. The pathology of addiction need not blind us to the need for meaning underlying it. Psychiatrist Arthur Deikman has written a book, "The Observing Self," (published by Beacon and available through Amazon.com) about the potential relationship between mysticism and psychotherapy, which is very valuable in this regard. |
Copyright © 1999 by Jay Einhorn