Depression has a range of meanings from a general sense of unhappiness and meaninglessness to persistent changes of mood and feelings, to psychosis (Hale & Davies, 2009). Depression is classed as an affective disorder involving a prolonged and fundamental disturbance of mood and emotions (Cross & McIlveen, 1996) which is associated with changes of behaviour and physical symptoms (somatisation) such as backache and headache (Hale & Davies, 2009).
Its core features are:
- pervasive low mood
loss of interest and enjoyment (anhedonia);
reduced energy and fatigue and diminished activity (withdrawal).
Other features include poor concentration attention and decision making, diminished or increased appetite, loss of libido, disturbed sleep (waking early or over sleeping), increased agitation (pacing about, complaining), ideas or acts of self-harm or suicide, low self-esteem and self-confidence, feelings of guilt and /or unworthiness, increased irritability (often presents in children and adolescents, or men), bleak or pessimistic view of the future and depersonalisation (I’m not me anymore). Some people may show multiple physical and behavioural symptoms in the absence of low mood (‘masked depression) (Hale & Davies, 2009).
Another feature of depression is a loss of reactivity, individuals will show a blunted or ‘flat’ affect to life events (Sims, 1995). They show a failure to express feelings either verbally or non-verbally, especially when talking about issues that would normally be expected to engage the emotions. The difference is in degree. The client himself is not aware of his deficiency but when pointed out to him, may agree that there is a lack of any sort of emotional reaction (Sims, 1995). This may be experienced as a feeling of a loss of feeling made worse by the client’s own questioning of himself, feeling guilty about the lack of feeling.
A depressive episode may be classed as mild, moderate or severe and diagnosis lies in skilled clinical judgement (WHO ICD 10), usually symptoms have to be present for at least two weeks. A diagnosis of mild depression requires that at least two of the core symptoms are present (low mood, anhedonia or fatigue) and at least two of the other symptoms. For more severe depression more of these symptoms are present.
The Hidden Side of Depression
Clients often come to therapy presenting the physical symptoms of depression: lack of energy; loss of libido; disturbed sleep; absence of periods; unexplained aches and pains; difficulty making decisions; low motivation and inability to start or complete things. However they may not call it depression.
In an intake conversation a client talked of many symptoms of depression but presented them as problems related to her ‘tiredness’: ‘when I get tired my default position is negative, like I’m useless and no one likes me’. This client was clearly preoccupied with her lack of motivation to go into work. Her fear of not being able to get into work, ‘I cannot afford not to go into work’.
Depression may also present itself as excessive alcohol consumption, this is perhaps more common in men (Rowe, 1983). Rowe (1983) observes that many men use alcohol to hide their weaknesses from others and to hide from themselves their own fear and despair. They drink excessively in social situations and also alone at home.
Anger and Depression
we all get angry
Many people learn early on in childhood that it is wrong to get angry. (Rowe, 1983). This may be through having seen too much anger expressed in parents’ relationships with each other or with the child and the child then ‘decides’ that to be angry is bad and so represses it.
Schiffer (1988) proposes that this leads to depression because when a young child’s needs are not being met they will protest loudly (raging tantrums), making them even more difficult for the parents to handle so that parents become threatening or unresponsive and eventually the child will become anxious (threatened) then ultimately defeated (depression) thereby establishing a limbic brain tendency towards depression. (Schiffer, 1988)
Freud and Abraham posit that depression is anger turned inward against self (Schiffer, 1988) when the child internalizes the parent figure and then attacks the parent inside. People often perceive depression as a failure or weakness and as humans we have an innate tendency to get angry with those that fail: this is why depressed people often attack themselves. In addition a tendency towards ‘identification’ with the persecutor means that sometimes when a person feels overpowered by someone else there is a desire to befriend them – the mind of an abused mistreated child seeks to befriend the abusing adult, but to join the tormentor the child’s troubled mind must take sides with the abuser and therefore turn to attack himself (Schiffer, 1988).
Exacerbating this for many clients is the critical parent that has been internalized in the child’s superego, and which will serve to torment the adult client with lifetime barrage of criticism and negative self-talk (Schiffer, 1988).
For MN anger was an alien emotion: he recognised that he rarely got angry and was proud to be a very placid man most of the time. He can remember two occasions when he did ‘lose it’ and he was shocked and scared at his reaction. This reinforced further repression of the emotion. In fact MN had a lifelong pattern of repression of emotions which meant that he was not in touch with emotions to be able to talk about or express them. It was clear to the therapist that he had unresolved anger, as well as sadness and guilt about his wife’s death: ‘I wasn’t brave enough to challenge them,’ and ‘why do bad things have to happen to good people?’
Repressing anger by burying it deeply , turning it inward, and denying that it exists, because of fear of rejection or that it may escalate out of control, may be a good coping strategy to survive childhood, but the trouble with this is that it is the coping strategy itself that becomes problematic in adulthood causing many of the somatic presentations. Another defence mechanism in dealing with anger is reaction formation where the unacceptable ‘bad’ feeling of anger is turned into its opposite extreme of needing others’ approval to feel good: people pleasing (Parker-Hall, 2009), putting others before self or needing excessive amounts of approval from others. External behaviour presents as trying to please others all the time, being the peacemaker, going out of one’s way to never offend others, or a preoccupation with what others think about you. (Rowe, 1983). These types of people often find it difficult to say no and get put upon alot and go to great lengths to avoid conflict.
We need men! On Sunday 12 November, I’m offering men the opportunity to learn how to listen to the wisdom of their bodies, change unhelpful, emotional states or patterns in their behaviour.
I will be running a free personal development workshop (What the Body Knows) which will help delegates understand what their bodies have to teach them, how to let go of the past and live a more fulfilling and happy future.
Have you ever realised what a crazy monkey your brain is? Have you ever been still enough to realise what tricks it gets up to and what considerable energy it uses? Constantly commenting on this or that.
Putting interpretations on things, making judgements – good or bad, right or wrong, like or dislike, nice or nasty. This constant need to comment, to judge is the default operation of our minds. It gives us a way to make sense of the world, gives us an illusion of control.
Our bodies know more about our experiences and the things that have happened to us in our lives, than our conscious minds are aware of. We may notice tension or tightness, and have no awareness of what's triggered it.
Our faces and other areas of our body hold onto negative experiences and emotions. Without knowing it our expression may show a subtle sadness, anger or fear. Certain areas of our bodies are more highly enervated than others: in particular the face (eyes, jaw, and throat), hands, abdomen (diaphragm), feet, and pelvic area. They are very quick to tense up and slow to release.
Many of us, from time to time, question who we really are. We may have moments where we feel we are truly being our ‘self’ and other times where we sense we are putting on a mask or a front. If we are more able to be true to our self we will generally feel less anxiety and more pleasure and peace in our lives.
Our bodies and our minds are intimately connected and how we use our bodies has an impact – positive or negative – on our mind. If we are suffering from anxiety, depression or symptoms of trauma such as numbness or dissociation, practising standing postures can help to ground us and bring us into our bodies in a way that is beneficial to the mind.
We’re made to be able to be happy, in an imperfect world, that is endlessly unfolding, and we on earth are the local agents of that cosmological unfolding“ ~ Al Pesso
Relationships are one of the most important things in a person’s life. As human beings, a sense of connection is one of the ‘fruits’ of a happy life, vitally important to our happiness. No matter how much we might try to kid ourselves that we want to be alone, we need contact and connection for our very survival.
The time of the year in which most people are happiest is summer, because of the brighter blue skies, warmer temperatures and longer days.
Back in 2015, nearly 150 adults aged 18 to 74 participated in a revealing study, which asked them to reflect on their own personal happiness over the course of the seasons and looked at times of the year when they were happier. Results showed that January and February were the least happy whilst summer months shot straight to the top of the scale.
I tend to think that we are living in a world that fosters addiction. We are addicted to our smart phones, to social media to TV, to exercise. Addiction serves a purpose: it keeps us out of our feelings, it keeps us safe. In addiction we are being controlled (by the substance or process) but we are out of control because we are at a loss to stop it. There is a stigma attached to much addictive behaviour that increases our tendency to deny it and not seek help.
We sleep to restore and rest the body and mind. The brain organises and integrates memories during sleep. And dreaming sleep can be an important way for the unconscious to process events and difficult emotions. Lack of sleep can affect our daytime functioning, hormonal balance, appetite and immune system.
It’s an old adage from neurolinguistic programming (NLP), and it was Richard Bandler, the co-founder of NLP, who said it: “it’s never too late to have a happy childhood.” It was controversial at the time; and of course we are entering the realms of magical thinking if we think we can change the past…
Have you ever watched ‘The Sound of Music’? I hadn’t. Until today. I had sat down to write a blog post and got completely absorbed in this wonderful film which, for years, I had avoided because I thought it would be a predictable Hollywood-esque love story with no depth…
I believe that psychotherapy is a key part of any transformational programme. It is not just for ‘clinical’ level of problems such as anxiety or depression. Anyone who wants to better themselves, to become the best person they can be, will benefit from psychotherapy.
Trauma and its symptoms are more prevalent in society than is often thought. Nearly half of us, that is about 6 of every 10 (or 60%) of men and 5 of every 10 (or 50%) of women experience at least one trauma in their lives. About 7 or 8 out of every 100 people (or 7-8 per cent of the population) will have post-traumatic stress disorder (PTSD, the most full-blown grade of trauma), at some point in their lives.
Many of us have an unhealthy relationship with anger: we flip between occasionally or often blowing our top or being scared of our own anger and trying our best to suppress or avoid it. I call this Anger (capital 'A'), it either blows outward in 'hot rage' or goes deep inward, buried as 'cold rage'. We may not even be aware of it; tending to pride ourselves on our ability to stay calm and be quite a placid type of person. But the symptoms may speak to us.
People often come to therapy wanting help with low self worth or lack of self esteem. They might call it low self confidence and then look a little puzzled and say, ‘but I am confident in some areas’.
Self esteem and self confidence seem to be two separate, and often mutually exclusive, things. But the lack of clarity between them is the cause of a lot of our problems.
Depression, anxiety and stress are all interrelated. Perhaps it starts with stress. We get ‘stressed’. This may be chronic (long term consistent level), or acute (short term intense spike) or both (ie acute on top of chronic). This stress affects our breathing, compromises our immune system and puts our sympathetic nervous system (SNS) into overdrive. This results in many psychological, physiological and behavioural symptoms that reduce the quality of our life.
“Anxiety is the state of twentieth-century man.” ~ Norman Mailer
If this is true, perhaps panic disorder is its 21st century progeny? Panic attacks are horrible: they come on suddenly, for no apparent cause, characterised by a severe fear that can peak within 10 mins. This is accompanied by symptoms such as excessive sweating, nausea, disturbing thoughts about harming oneself or others, fear of loss of control or that you are becoming insane.
Recently I have been working alot with clients who have a high degree of anxiety. Their symptoms range from panic, over worrying, phobias, chest pains, blurred vision, impaired ability to think clearly, headaches, inability to focus, loss of memory, muscle pain, dizziness and sleep problems.
“Attitude is very consequential stuff. It determines everything one does, from falling in love to voting for one candidate rather than another” ~ Anthony Grayling, philosoper
Many of us realise how important attitude is in determining our success and happiness in life. We may also realise that, with the wrong attitude, we can spend a lot of energy worrying. But when we say ‘he or she has a great attitiude’, what do we mean?