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 cause-and-effect conditioning; the hypnotists hypnotise, seeking an unconscious component; general practitioners prescribe, offering scripts for the latest panacea; counsellors counsel, providing empathy and a listening ear; scream therapists promote the scream, seeking the primal; 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, organic interventions form the bulk of treatment, namely, drugs and/or electroconvulsive therapy. In psychoanalysis, the cause is believed to lie in unconscious conflict, and therapy aims to uncover this.
Recovered memory therapy, now widely discredited, assumed the problem lay in buried or repressed memories of abuse, encouraging repeated reliving of traumatic events, often with disastrous results.
What most therapies, and indeed most therapists, miss is the how of depression. Chunking down into smaller and smaller explanations, too many fall down the rabbit hole chasing the question “why?” Ultimately, if we pursue the why far enough, we end up either in spirituality or quantum particle physics, domains few therapists are equipped to explore.
Finding out why someone is depressed does not necessarily tell us how to help them exit that state. If depression is viewed as the result of a subconscious event, what of the person’s biochemistry? If it is seen as purely biochemical, what of their lived experience?
By exploring the how of depression, we uncover the patterns of thought and behaviour that lead to, and maintain, the depressive experience.
For effective and rapid resolution, we must work with what is relevant. I am tired of seeing therapists force patients into their own theoretical models rather than working with the realities presented by their clients.
It’s time to change.