Some Mental Health Themes

(From my perspective based in New Zealand since 1981)

Within the Heath domain we are seeing an increasing agenda to practice and provide services holistically, which brings me to some themes.

The Health Professional Journey.

In this area, there have been fairly dramatic changes in my own area of expertise (Mental Health and Addictions). We have moved to some degree, from a Medical or Clinical model to a brief to be Dually Competent (“Clinical and Cultural competence”). This has come about within the Biculturalism agenda between Pakeha, (N.Z, Europeans), and Maori. (The Indigenous inhabitants).

The specific cultural make up here in N.Z. has I believe enhanced and directed focus on the way our Mental Health and Addictions services have been and are developing. This area is now riper regarding the spiritual as well as cultural components of the provision of health services. (Although less regarding health practitioner’s journeys). There is much going on in terms of cultural change to help me place my other themes. This cultural change also ties into the spiritual dimension, as indigenous beliefs practice retain a lot of this dimension.

Probably I’m focusing on a “mature” group of people, who are health professionals, who have significant consciousness about their life journey, (personal, and spiritual). The interplay of organisational or career and personal journeys is the reality, yet often the tendency is to try to minimise or ignore areas, which do not fit with the formally recognised agendas. (Including own experience of mental health issues)’

Historically

My approach regarding health professional practice is that I believe key factors are our professional, educational and spiritual/cultural/personal journeys. It has been an area where a liberal, commercial and technological priority has waxed or waned. Currently there is a resurgence of interest in the spiritual and cultural aspects of health care. It is an international issue, with the continued highlighting of conflict between religion, cultures and commercial interests. In the mental health arenas, there is a strong promotion in New Zealand of Strength & Recovery models, which seek to holistically work with consumers of health services. There is a promotion of a dual competency approach where cultural dimensions are, (sometimes theoretical), seen as of equal importance to an empirical clinical approach.

Depression and treatment

The term Major Depressive Disorder was used in 1972 and first introduced in the Diagnostical and Statistical Manual (DSM-III), which brought together all the affective conditions into a classification based on symptoms (Davison and Neale, 1990). The word, melancholia, was commonly used by Europeans in the 17th and 18th century, but can be traced back to the earliest periods of recorded history. The ancient Greeks recognised depression as a medical condition, and early Greek physician Hippocrates wrote about melancholia.

Depression as primarily a problem of mood. A true depression is possible if there are daily depressed moods over a period of two weeks or more. Nevertheless, loss of interest or pleasure (anhedonia) can be seen as more significant. Most clinicians seem to accept that both components are usually present.

In the “mainstream”, there are many treatment guidelines such as detailed in various countries government health department manuals. Usually with titles such as “Practice Guidelines for Major Depressive Disorder in Adults”. As such the guidelines available in New Zealand, give a good overview of depression and treatment, which is in mostly in accord with U.S.A. and the U.K. practices.

Currently agreement concurs that medication is a far more effective remedy when it is accompanied by some kind of “talking cure”. Those people with significant depression should then have the opportunity to receive both antidepressants and/or psychological therapy.

Interestingly only a range of therapies are usually identified as “mainstream” or “evidence based”. These therapies include Cognitive Behavioral Therapy. Cognitive-Behavioural Therapy is a “mixture” and works on the person’s negative thoughts, which are connected to a negative self-appraisal.

Tricyclic anti-depressant medication was among the first in the range of anti-depressants. (The term ‘tricyclic’ simply refers to the drug’s atomic structure).

I have tried anti-depressant medication – quite some time ago -with some benefit. (However, generally have experienced too many side effects to continue any medication except for brief periods). I had been able to tolerate St. John’s Wort for several years, with adequate effects, (for mild to moderate Dysthymic Depression), but over time found that the efficacy diminished for me considerably. It took me quite a while to even accept the term “depression” itself, as I have my own personal picture of what it means. I still hold such a view, but can also accept the clinical diagnostic perspective, (Interestingly, but perhaps not surprisingly health professionals can be very “slow” when it comes to accepting their own mental health issues!).

Specific Serotonin Re-uptake Inhibitors (SSRIs) were discovered, the most well-known being Prozac (fluoxetine). For some this drug and others that are similar, provided fairly quick relief from the symptoms of depression, without many of the unpleasant side effects associated with the older, tricyclic anti-depressants. (Such as dry mouth, constipation, blurred vision, sweating, and weight gain). I however did experience major side effects for everything I tried.

There are many resources and a wealth of information on mental health related medication. (Google!)

“The psychiatric stuff made sense about that view of feelings and thoughts, (and depression). I did have some lethargy and flatness. An old-fashioned antidepressant at night was great for my sleep.” (From one of my twenty-year-old notebooks)

Others experience of depression

A common view is that that stress, anguish or anxiety, when built up, leads to a range of mental, emotional and somatic symptoms, and any crisis thus needs to be acknowledged as being due to a negative build-up of emotion.

In a letter to a woman who lost her father, Lincoln said, “perfect relief is not possible, except with time”. He also talked about his view that sorrow comes to all because we live in a sad world. He mentions his own experience of such feelings, (and he is described as suffering bouts of severe depression). He said that he had experience enough to know what he is talking about, and that there is relief or change over time from such feeling associated with depression.

There seems to be both agreement and disagreement amongst writers, that often depression can be attributed to a chemical imbalance, and the need for medication or medical attention is highly regarded. However, even when medication has worked, there is sometimes resistance and uneasy acceptance of the need for anti-depressants. The quality of life on medication may not that much better than being drug free – but depressed. Some sufferers do talk about spiritual, religious and philosophical topics.

Fewer writers talk about their view or concepts about what depression actually is. Some have talked about a “conflict in faith”. A wall between oneself and God, which creates an internal struggle and distancing, (referred to as “inner demons”), giving a chance for depression caused by conflict to creep in.

More commonly and evident though are the individual reports of experiences and struggles, which describe a person’s struggle, studying, getting up to go to work, and even eating and showering. There is also the risk of suicide or self-harm, and the contribution of Major Depression to suicidal behaviour is well known.

Much that worries-us though is really unimportant, so instead of battering brains, we need to “learn to walk away”. Alternatively, “don’t sweat the small stuff”. On the other hand, “it’s all small stuff’.

Other models of illness

The Strengths Model emphasises environmental conditions through the individual, family and community strengths and builds on these. This is in contrast when a mental disorder is seen as a “clinically significant behavioural or psychological syndrome of pattern that occurs in a person”. This is a concept of mental disorders as conditions that primarily affect individuals. The focus of the International Classification of Diseases is similar and mental illness are seen as being similar to physical illnesses.

In contrast to the medical model, which locates the problem within the individual and equates mental illness with disability, is the social model of disability. In the social model of disability, disability is seen as a process, which occurs because people create barriers. Firstly, the world is designed to fit around “normal” needs and ways of living. Secondly, attitudes and behaviour are themselves seen as disabling and a social problem.

In New Zealand, Professor Mason Durie, has used the image of a house, The Whare Tapa Wha. (The Four-Sided House), to describe overall health and wellbeing. The house is held up by the four cornerstones of health, including Mental Health, Physical health, Spiritual health, and Environmental health. Each cornerstone relies on the others to support the house. If one fails, the house will fall.

Clinical depression is not a weakness. Depressive illnesses are serious problems that can occur in any woman or man at any time and for various reasons regardless of age, race or income. The contentious issue rests with the forms of treatment adopted, and this in turn is driven to varying extent by the individual’s beliefs as to what depression is, or what it means for them. The mainstream view may not fully agree with how perhaps a large portion of people see and then treat their depression.

My experience

I recognise depression it as happened in episodes when I was 11 years old, but I did not know what it was, until mid-life.

I have had Dysthymic Depression, which is chronic low mood, (a bit below “normal”).

Later, I realised that I had some severity primarily at the change of season, into winter. It was a regular occurrence and therefore is S.A.D. (Seasonal Affective Disorder). I now use therapeutic light glasses and a very small amount of a medication I can tolerate (Am otherwise unable to tolerate any medication that I have tried). Now by not experiencing S.A.D. I do not have this urge to start drinking alcohol at the onset of winter. (This seems to be where my drinking went astray – onset of S.A.D.)

For Dysthymic depression, I find it is under control with good diet, going to the gym, and judicious use of Naturopathic medication. The “herbals” I use include Adaptogenic, Ayurvedic and Chinese products. In addition, use of St. John’s Wort when needed.

Also now, I explore the good parts of depression not just the negative

A long time ago. Psychosynthesis suited me, and enabled me to deal with some trauma from my upbringing. Since then, I have tried other therapies, out of interest mostly.

The psychiatric stuff make sense to some degree also!

Much can also be genetic or of trauma origin!.

I have experience of therapy techniques now as a practitioner, and have also worked with clients with more severe issues, indicating medication use as well as other supports. Many experiences have shaped me, my life experience is cumulative, and contains a will to keep living. (Though even depression interrupted that will).

Sometimes I thought about “what’s the point, (of going on)”.

It can and did interfere with life, and is much more dreadful for some. It seems to hinder growth, but there are aspects that can be enabling.

My own practice as a health professional had at times been focused around the clinical models of psychiatry using diagnoses or more holistic models such as the Strengths Model.

However, “alternative” models work for me. For instance, Psychosynthesis, which recognises a “higher” or “deeper.” part of us, which is the source of inspiration, guidance, comfort, strength, peace, and hope.

The cognitive theory of depression connects depression to negative thinking, and this approach looks at distinguishing negative thoughts that lead to depression.

Depression, according to recent statistics, is practically an epidemic, with over 70 million people suffering from its affects, such as a feeling of moroseness, uselessness, lack of energy, inability to sleep, and a poor attitude toward life in general, among other symptoms. Depression causes a pessimistic view of things. It also discourages enthusiasm and stifles one’s initiative. It may also produce despair and bring about sickness in the mind and body. It can make one resort to rash and thoughtless actions that a person may later regret. Much of the time, such thoughts are completely unnecessary. Thus, it is imperative that we help cure depression so that people can live with more happiness, and energy, and are thus able to reach a higher potential in life.

The reason for depression may be different for each person, and there are a variety of causes. Therefore, it must be analysed and understood. So what can we do to help cure such an attitude, as long as it is not a biological problem?

Spiritually, there are many ways to help take care of this condition. So let us take a deeper look at this.

Depression and Spirituality Components

There is often a feeling of disconnection when depressed, particularly when suicidal ideation is present. Life can feel meaninglessness, and there can be overarching wish that “I was not alive”. Conversely when I moved in this direction, there was in me much more prayer at the same time. Craving for spiritual release also came also with increased craving for alcohol! It was a feeling of inner emptiness, (loss of pleasure), being filled with only fear, and reactivity to life around me. I felt like an alien in this world.

There is a concept of the “sick soul” or for alcoholics it is a “spiritual disease of the soul”, as per 12-step programs.

There are though lots of people who feel naturally connected with the world, and they have or are born with an inner resilience which is well balanced from the outset.

This speaks to the findings about inherited abilities disorders or the opposite – including “addictive personalities”. If one is not impulsive, and is steady on course to ones chosen career, relationships etc. then unnecessary trouble is kept at bay. On the other hand, those who are experiencing inner conflicts and/or strife in their environment will be lacking peace and serenity. The stage is set for mental disorders of depression/anxiety and obsessive behaviors. An original word was melancholia, as including the sense of incapacity for joyous experience. This is now one of two parts for the diagnosis of depression.

The low mood part is perhaps experienced as active anguish, with a sort of psychical “deadness” not present in healthy life. Loathing, irritation and reactivity combined with fear, do not make for a happy life! Alongside is the second major part. Anhedonia is the loss of enjoyment for what was previously enjoyable.

It is a dark experience, this depression. A black dog or black hole. Shame and blame then attaches itself, especially if there are episodes of substance abuse. Life can become a crisis, and the crisis mental health teams may well get involved if self-harm or suicide attempts occur.

So, what is this disharmony of the individual soul and self, and the world? Why have dark emotions and crazy impulses, and why aren’t we full of positive, harmonious, and peaceful emotions?

What wrong with God’s creation would say those who are skeptical about a kind and loving Creator!

My disconnection as a teen propelled me into becoming a monk in India at age eighteen. Then into a career in mental health, along with, on and off my own “negative” experiences.

My quest for self-understanding, of meaning, serenity and peace led me to surrender. Now there exists some form of Higher Power support, which draws me out of my ego based self-personality into the light of Truth. I have worked with the depressed, the anxious, and those who have suicidal ideation. Many claim something “other” holds them back from deaths door and offers hope. My depression led to disconnection with the world but not with some Force, and there remained an understanding inside that I would be all right. This awareness is still with me, and I write elsewhere of my personal pathway and belief system. (Which is more based on ancient practices from the East).

The disorders or mental health diagnoses connect me to my quest, through complex interweaving of soul and Cosmic Soul, leading to my own status. (Not just a spiritual trip, but also a space where I can realistically serve others in my space.

Meaning can exist in the depth of the dark places. The sick soul can find the healing light and receive the something unexpected that seems connected to something spiritual.

I saw the possibility of happiness but it is not the ordinary happiness. It is the Bliss of consciousness. Along with Awareness, and the Truth of all life. (In a nutshell it is the trinity of Existence-Knowledge-Bliss).