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Chasing The "Why?" of Depression

"The Half Truth." Retold by Nossrat Peseschkian, "Oriental Stories as Tools for Psychotherapy."

A story is told about the Prophet Mohammed who came into a city to teach. Soon an adherent of his teachings came to him and said, "My Lord, there's nothing but stupidity in this city. The inhabitants are so stubborn. No one will want to learn anything from you. You won't convert any of these hard hearts." The prophet answered kindly, "You are right." Soon after that, another member of the community approached the prophet. Beaming with joy, he said, "Lord, you are in a fortunate city. The people long for the true teaching and open their hearts to your word." Mohammed smiled silently and again said, "You are right."

"Oh, Lord," said Mohammed's companion. "You told the first man he was right, and, with the second man who claimed the opposite, you said that he was right too. Well, black cannot be white." Mohammed replied, "Everyone sees the world as he expects it to be. Why should I refute the two men? The one sees the bad, the other the good. Would you say that one of them sees falsely? Aren't the people here and everywhere both good and bad at the same time? Neither of those two men said anything wrong, just something incomplete."

When faced with an unhappy patient each therapist does what he does best. The psychoanalysts analyse, scouring the depths of the subconscious; the behaviourists modify, interrupting the cause and effect conditioning; the hypnotists hypnotise, seeking an unconscious component; the General Practitioners prescribe, proffering scripts for the latest panacea; the counselors counsel, offering empathy and a listening ear; the scream therapist promote the scream, looking to hit the primal; the psychiatrists write another prescription, searching for the magic potion; and the New Agers, well, they are willing to try just about anything…

Putting the effectiveness of the different approaches aside, what all these approaches have in common is the relationship of the technique to the perceived cause of the depression. For example, in psychiatry where the cause of depression is believed to be organic, then organic interventions form the bulk of psychiatric treatments - namely drugs and/or electro-convulsive therapy. In psychoanalysis, the cause is believed to lie in an unconscious conflict and so the therapy aims at uncovering this. The disastrous recovered memory therapy believed that the problem lay in buried or repressed memories of abuse, so these therapists would set about encouraging a repeated reliving of traumatic life events, frequently with dreadful results.

What most therapies and indeed most therapists miss is the how of depression. Chunking down into smaller and smaller chunks, too many therapists fall down the rabbit hole chasing the reason why? Ultimately, if we chase the why down far enough we end up either in the realms of spirituality or in the realms of quantum particle physics, something few therapists are adroit at exploring.

Finding out why someone is depressed doesn't necessarily tell us anything about how to help that person get out of that particular state. If a psychoanalyst views depression as being the result of a subconscious event, then what of the biochemistry of that person's neurological make up? If we see depression as being merely biochemical (the "chemical imbalance") then what of that persons particular life experiences?

By exploring the how of depression, we learn what the patterns of thought and behaviour are that lead into, and are contingent upon, the depressive experience.

For effective and rapid resolution, we need to pay attention to these factors and work with what is relevant. I'm tired of seeing therapists make the patients fit into their own particular theories of how things work rather than working with the realities presented to them by their clients.

It's time to change.