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Daniel Rushton

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Is depression merely a keyword for a much larger field?

I can't help but feeling that depression is referred to in generic terms. I suffer from depression too, but almost nothing that was said in this video, (which was honest and beautiful,) would be a true statement about myself.
Is it possible that we have taken the humour we would use on say Freud's mother and apply it in a physiological sense too... only to invest the effort to look at the individuals for a 'happy pill' that seems to have at least some positive effects of the symptoms regardless of the underlying cause of why we had them in the first place.
To use the broken arm analogy; do we treat a sprain, a fracture, and a break with the same treatment? Or more horrifically still could we justify taking the psychological approach and tell the guy with the bone sticking out of his arm to come back next week, as fifty minutes just isn't enough?
Does the proverbial morphine just stop the patient complaining?


Closing Statement from Daniel Rushton

From the responses in this conversation, I would say that the general consensus I that yes - depression is a keyword for a much larger field. Though I would probably change one thing if I were to start this conversation again, (and replace keyword for place-holder.) There is clearly not enough known to be able to define all these problems explicitly - and a place-holder is better than nothing at all.

That being said, I think it is also clear from the broad spectrum within a small number of comments, that just how unmeasured in aperture this word is a place-holder for. The word itself almost seems to be addressed ad-hoc as a genetic condition, a physical disorder, a perceptional state of the world, a life-long ailment, and even in a spiritual sense. For those reasons it would be inappropriate to cite a specific comment or participant as it would merely be suggesting that depression should mean exactly what I have.

From a more personal place I think that when people know exactly what your 'issue' is, they tend - unsurprisingly - to be warm hearted an eager to help. As unrealistic as the prospect my sound, I think the medical world could help itself greatly if it were able to name individually as many of the conditions of 'depression' as possible. On a selfish day the place-holder can almost be a trigger itself. I sometimes want to be able to get out a book and say, "Here - that is what I have!... And no, it isn't the same as when your pet hamster died."

*Apologies to anyone who has recently lost a hamster.

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    Oct 10 2013: Because depression is not fully understood even by medical practitioners and practitioners of psychology, it is one of those 'open to interpretation' dilemmas as to what might be the best treatment for it. I think you are right - depression is merely a keyword for a much larger field.

    The severity of depression in some people means that the first-line treatment is the magic bullet of antidepressant medication, to try and make the depression 'safe' and less likely to be life-threatening. However, the medicalised state of 'being safe' is often left alone for too long - even becoming a life-sentence for some. This is contrary to the medication's original purpose as first-line treatment, and happens because the medical condition, for various reasons, never goes further than the patient's General Practitioner.

    What should happen, in my opinion, is that the medicalised route should have its place in moderate to severe depression, but it is absolutely essential that it should also be meshed in with counselling and psychotherapy, so that the very root of why depression has become a problem can be understood and come to terms with. Once that has been achieved, then the medication can be tailed off, as it has served its correct purpose.

    There are caveats to this, in that a psychotherapist treating a medicalised patient would not necessarily be treating the 'raw condition' of depression. He/she would be treating a condition altered by changes in neurochemicals, making it difficult to get at depression's roots. Then the patient discovers that if he is offered counselling, it is only six 50 minute sessions of CBT - and then that's it - even if the root has not yet been found.

    CBT has many limitations, because it is a standardised route to address all severities of mental health conditions (which of course, it can't). I'm an advocate of the Rogerian person-centred approach to counselling, which is open-ended and entirely cognizant of signs of recovery in the patient.
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      Oct 10 2013: I think you also bring up another element to this issue which is often forgot almost in its entirety. When we apply a medication for a symptom - even as a crutch - we are literally altering the brain chemistry of the individual. Are we then even dealing with the same condition?
      Would I be too far out of line to suggest that we have a preference to treat ourselves, and the empathetical discomfort we feel by making a sufferer leave the room with a smile on their face; regardless of the torture in their minds.
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        Oct 10 2013: Daniel, yes the altered brain chemistry can make psychotherapy tricky, because the smile sometimes does belie the torture inside. Having said that, it is important to realise that antidepressants do have a crucial role to play in patients whose pain seems to them to be unbearable.

        In touching and recognising the source of the internal torture during psychotherapy, sometimes the condition can momentarily worsen before it gets better. On balance then, it is better to treat someone who has been medicalised out of an initially dangerous condition, rather than one who isn't, and who runs the risk of going home after therapy with an even more unbearable burden.

        I can't stress enough the importance of the dual approach to treating depression. Using your example of the person with the broken arm - The Accident and Emergency Department at the hospital should be the equivalent of antidepressant treatment, and the following physiotherapy at the hospital equivalent to psychotherapy. Each treatment has its correct place, at the right time.

        It's also important to emphasise that it is the person being treated - not just the condition.
        • Oct 10 2013: Hello Allan,

          I agree with the importance of the dual approach to treating depression (and anxiety, which is my main problem.)

          Some of us literally end up in the Accident and Emergency Department because of the severity of the level of depression and/or anxiety that we're experiencing and in my case I was then admitted to a Psychiatric Hospital. I would say most if not all people in my situation would be.

          This is where medication is important, as you have pointed out, as the person is "in crises", as we refer to it, here. I was already seeing a Psychiatrist and on medication, but this was increased when I was admitted to hospital.

          While in hospital, we were expected (and rightly so) to attend Group Therapy sessions. This is another area where medication becomes important. In order to gain anything from any kind of therapy (we also had individual therapy in hospital), one has to be able to concentrate on what is being taught and discussed, something that a person in crises mode would find extremely difficult. Medication served to decrease our depression/anxiety to a level where we were able to concentrate and thus was seen as a way to help us to gain as much benefit as we could from the therapy that was offered.

          I was discharged after several months and my medications have changed over time, depending on my symptoms. Overall, my medications have decreased and my therapy continues. I hope to be medication free one day.

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