Paul J. Hannig, Ph.D. MFT
Depression: its Emotional, Interpersonal and Physical Impact
By the year 2020, depression will probably be the second major cause of disability. Depression is a very complex disorder that creates significant pain and discomfort for the sufferer (it's pretty rough on family members too). Its cost to the economy measures in the multibillions. It is quite often underdiagnosed, misdiagnosed and substantially undertreated. If you, someone you know or a loved one suffers from a form of depression, seek immediate treatment (contact www.psychotherapyhelp.com or call 818 882-7404) . If you fail to heed this message, things will only get worse!
Don't let depression rob you or a loved one of life itself!Recurring Problem...... lifetime Maintenance Program..... vigilant Maintenance
This section is going to try to help you understand theEmotional and Physical aspects of this disorder. You will also learn that depression, like many other disorders, is a recurring problem. Most treatment programs fall short because they only help the client reach a state of remission and totally ignore the necessity for a lifetime maintenance program. An analogy might be; people who have tried one diet after another, seem to lose weight, only to gain it back again. Depression, like other disorders, is a lifetime tendency and needs to be understood within a long-term view that stresses vigilant maintenance.
I have many people ask me when is it possible to stop taking medication and discontinue treatment strategies. This question arises for many disorders treated by psychotherapy and psychiatry. It is a mistake to believe that you can can cease using very effective therapeutic methods during periods of remission .......because of the illusion that the alleviation of personal problems will last a lifetime.
I'm sorry to inform you that no matter how hard you work on yourself and eventually reach a very solid and happy state of existence, certain tendencies will, in all probability return, given the right circumstances. Therefore, I am stressing that you begin toformulate a long-term, permanent, lifetime view of your personal tendencies and vulnerabilities towards depression.
Warning..... just because you have gotten over the hump, does not mean that you should suspend using the methods and techniques that helped transform your life for the better. Think in terms of lifetime personal growth and maintenance. Depression is a nasty visitor and once it's gone, that does not mean that it won't come back again!
Be prepared.... A vigilant, watchful patrol of your thoughts and physical symptoms must be a hallmark for your personal care and optimum well-being.
Depression, like obesity, personality, mood and anxiety disorders; and a host of other problematic occurrences must be seen within the framework offrequency. You will need to be treated to full and complete remission, otherwise you will fall into an ever enlarging pool of people who chronically suffer from the emotional, relationship and physical dilemmas of this disorder.
Another word of warning.... Do not allow yourself to believe that depression will just pass or that you can handle it all by yourself. Most people who suffer from depression do not seek professional help. Primary care physicians may not be fully trained and aware of how to assess and properly diagnose the complete and complex spectrum of problems that make up depression. Only 1 in 10 persons gets the proper treatment...... this includes looking at and dealing with the physical, interpersonal as well as the emotional demands of the disorder. Depression is far more costly when it is not substantially and adequately treated physically, emotionally and mentally.
If you are suffering from depression, it is imperative that you be fully treated into total remission and kept there.Only one out of three people treated for depression fully achieves this objective.
It would be a mistake to think that depression is only a disorder of mood. In my program you will be made aware of the somatic, physical and interpersonal aspects of this disorder. One third of the manifestations of depression are physical...... two thirds fall into theemotional, mental and interpersonal realms. It is your body, your mind, spirit, mood, feelings and relationships that are deeply involved in depression...... Let's not forget Your Brain....Many people apply for therapy believing that they have a relationship or a marriage problem; when in fact the cause of the problem lies in the brain itself! Learning relationship and marriage building skills will eventually run into a brick wall if the brain chemistry misfirings and incompatibilities are not addressed and corrected. People who apply for therapy in my program gain a greater understanding of their interpersonal, mood and life problems when they learn how a malfunctioning brain is affecting their lives. They also learn how to develop effective strategies for improving the function of their brain chemistry, as well as their relationships.
Depression manifests and exhibits as: feelings of hopelessness, Low self-worth, memory impairment, difficulty concentrating and experiencing pleasure (anhedonia); plus anxiety. I want to emphasize the importance of negative thoughts in depression.
Many depressed people will seek out their primary care physician with somatic complaints, while not recognizing what role the body and the brain plays in depression and other physical problems. The same mistake occurs with marriage, relationship and work problems. Usually there are complaints about fatigue, lack of energy, low motivation, sleep disorders, backaches, headaches and gastrointestinal problems. Also, there are a host of other physical ailments that are directly related to depression; but the connections are not recognized. Some of these ailments can be quite serious, even life-threatening.
Relationship problems will also become part of the clinical picture as personality problems complicate treatment and diagnosis. Sexual issues will certainly surface as well as self-destructive attempts at self medication with drugs, cigarettes, alcohol and various acting out behaviors. It is very important to connect seemingly unrelated problems to depression and the repression of affect. In my program, you will learn the interacting and inner looping connections between life, relationship, marriage, physical problems, work, mood, sexual problems and the brain itself. You will also learn how to develop a lifetime strategy for coping with and maintaining a healthy and happy lifestyle including improved brain functioning......... Be ready to work hard and commit yourself!
There are many different facets of depression that make it difficult for treating some individuals. The defensive structure that surrounds the depression nucleus may make it very difficult for some people to gain access to those deeper parts of the self that could overthrow the depressive façade and superstructure.
Chronically depressed people may not even recognize their own depression, since they have been depressed since earliest childhood. These people may construct elaborate cognitive defenses such as rationalization, justification and distancing from core body and emotional issues. The clinical picture is further complicated when a person presents for treatment of depression and doesn't want to touch their alcohol, drug, smoking, eating, sexual and relationship issues. It's like having a patient with a broken leg and he only wants you to trim his toenails.
Expand your view of depression to include all possible contributing factors!
The Ideal Scenario:.... occurs when a very cooperative (somewhat rare) depressed individual enters therapy and has immediate access to Limbic System Feelings, thoughts and memories. This scenario is also enhanced when the same individual is able to activate the basal ganglia system for the integration of deeply felt and expressed, emotionally loaded limbic feelings and thoughts. Such an individual can gain full access and express deeply contained pain filled feelings. This results in a thorough cleansing of the mind, body and emotional centers.
When such a deep feeling experience does occur for the depressed individual, pleasure is restored, negative thoughts are eliminated, physical ailments subside and the body resets its idling speed (anxiety levels). A lifetime devoted to a conscientious practice and maintenance of deep feeling release will give you the wonderful experience of joy and ecstasy. It will also help you to monitor and patrol your moods, negative thoughts and bodily symptoms. You will become familiar with the precursor/antecedent signals that pain and negativity needs to be removed from your body, brain and interpersonal life.
Advice: Devise a plan for maintenance beyond your cure!
Because of the recurring nature of depression, a life long plan and strategy needs to be devised in order to cope with and fight off the surprise attacks of depression. For some individuals, pain and trauma can be so overwhelming that medication is required in order to function and journey through the treacherous periods of debilitating depression and anxiety. Unfortunately, many general practitioners prescribe very effective antidepressant medications for the very rough periods. And then these same practitioners fall under the influence of the individual who wishes to discontinue the medication, after the crisis has supposedly passed.
Do not allow false hope to keep you from planning for long-term growth and maintenance. I have seen many professional people and organizations effectively treat depressed people into remission and then fail to provide them with the council and the resources for a lifetime of awareness and maintenance.
That's like treating flat tires by allowing yourself to ride on the rims. Even, after the gradual decreasing of the medication, if proper psychotherapy has not been appllied, you will experience a rebound effect that releases all of the repressed emotions, physical symptoms and negative thoughts that you have not completely exorcised and integrated.
I have seen this happen quite often. A person seems to be functioning quite well on a particular psychiatric medication and for whatever reason decides to come off the medication. All hell breaks loose as repressed anger, rage and pain rushes to the surface while the individual cannot fully express, resolve and integrate an overwhelming upsurge of negative thoughts and feelings. That is whyit is so important to keep a long-term view of full remission accompanied by a very effective maintenance program. If this is not accomplished, you can expect big problems!
Norepinephrine and Serotonin
In case you are not aware of how the symptoms of depression modulate physical symptoms; recognize that there are projections upward through the body's spinal cord into the brain and there are also neural pathways going downward from the brain into the spinal cord. Serotonin and norepinephrine are significantly involved with mood while also modulating and affecting physical symptoms.
In one study, 84% of the patients had no known organic cause for their physical symptoms. The implications of such a finding suggest that the more somatic symptoms that you have, the higher will be your risk for depression and the worst your depression will become. Physical symptoms predict a greater severity of depression. Continuation of your physical symptoms can make it very difficult for you to achieve remission.
Norepinephrine and serotonin are strongly involved in the experience of pain and depression. If you are depressed you will hurt more. You will complain more because you hurt so much. Norepinephrine and serotonin share a common neurochemical pathway implicated in depression and pain perception. These two neurotransmitters are negative modulators of the descending pain pathway. GABA is also involved in the descending pain track pathway. Gabapentin has been used successfully for treating chronic pain patients.A symbiotic, synergistic relationship exists between serotonin and norepinephrine. Therefore, it is recommended that a dual action strategy be applied. Doses of 150 to 225 mg/day of venlafaxine function as a dual serotonin and norepinephrine antidepressant. It seems that they act positively through the spinal cord before even affecting the prefrontal cortex. Low doses of amitriptyline work quite well even if it is not at antidepressant levels of application.
Medication alone does not constitute a cure. It regulates the brain's neurotransmitter functioning and chemistry. But, by itself, does not cure anything. The real problems lie deeply embedded in the brain, heart, soul and spirit of the person. Deep Feeling Emotional Release Therapy significantly penetrates and gets at those significant thoughts, feelings and patterns that make up the disease process. As such, medication is an adjunct for aiding in increasing your functioning; but does not constitute a cure for the underlying disease. Deep feeling emotional release completely transforms and resolves the underlying causes, repressed feelings and disordered thought processes that make up depressive illness and many other disorders.
The Deep Feeling Experience
How does a deep feeling, cathartic blowout of painful emotions and thoughts affect the brain, mood, physical symptoms and interpersonal behaviors?The deep feeling experience, when properly exercised, affects many different brain systems, mood parameters, physical problems and interpersonal issues. It is a superior therapeutic method for regulating mood, neurotransmitter functions, communications and relationship connections. A deep feeling experience involves the physical act of putting oneself in a therapeutic context and following certain procedures. These procedures involve engaging oneself in a therapeutic physical posturing, followed by deep breathing, introspection and implementation of sound emitting techniques. At some point in the procedure, verbalization is applied in the free association manner (Selected pieces of music are also implemented in order to facilitate focusing and emotional systems activation).
If a deep feeling emotional release is fully accomplished, the individual will experience a heightened state of normal functioning. This will include clarity of mood, speech, insight, integration and connection. Life changes occur through this experience. Physical ailments, negative thoughts, energy deficits, mood dysfunctions and relationship problems move closer to healthy resolutions.
This method along with other sophisticated psychological and therapeutic tools needs to be incorporated into a system that seeks total remission of all problems and difficulties. I also recommend that multimodality, eclectic strategies be incorporated into a long-term remission and maintenance program. Cognitive therapy should supply the necessary intellectual tools for understanding and implementing the proper thoughts, attitudes and strategies towards creating and sustaining long-term mental, emotional, physical and relationship health.
(Warning: Cognitive Therapy without deep emotional release and resolution is only partially effective and does not constitute a cure. It ignores the vital neural connections between the neocortex and the limbic system).
The Systems Strategies Approach
Depression, like many other disorders, does not operate in an isolated context. All human behavior exist within the parameters of a certain system. Once the system is examined and defined, effective strategic interventions can be applied in order to disrupt dysfunctional behavior and interpersonal patterns. Since most systems exist on unconscious levels, it is important to fully expose and delineate how the system is structured and the way that it functions.
It may seem odd to think and believe that a system can and does support pathogenesis. But, it does! Depression cannot exist unless there are environmental, genetic and emotional transmission processes in operation. Part of the intense effectiveness of a well-organized, systematic therapeutic system is its Warehouse System, fully supplied with extensive, effective therapeutic tools and techniques.
An example would include the genogram as applied to understanding family emotional and genetic (etc.) transmission processes. This tool has been very effectively used for premarital counseling, disease transmission processes and inherited behavioral family tendencies. A systems approach would indicate how personality, mood, mental, anxiety and emotional disorders effect interpersonal relationships. I should add that in many cases a dysfunctional relationship and its family genetics could and would present itself in full impact during the first contacts with the therapist.
Another example for utilizing the systems approach involves the recognition of the dysfunctional games that people play with one another. The "He Said/She Said Game,The Blame Game, The Labeling Game, TheFull Court Pressure Game, One Upsmanship Competition Game and the Manipulation Denial Game," are just some of the gamesmanship patterns that people utilize in interpersonal relationships. (Disorder in the brain can reflect the inter-looping and cyclical, self-supporting functions in gamesmanship).
Individuals and couples that suffer from interacting personality, mood, emotional, mental and behavioral problems unconsciously apply emotionally laden games in order to induce anxiety, intensity, mood, pain, elevated blood pressure and numerous physical ailments. It seems that depression requires some sort of external pressure to be applied in order to juice up and activate certain brain areas (neocortex, limbic system, basal ganglia).
In my book, "Sizzling Relationships/Ecstatic Marriages," I describe a series of very effective strategies for creating maximally healthy relationships. (See www.psychotherapyhelp.com or call 818 882 7404 for information on how to acquire this book). These strategies work exceedingly well with people who have overcome various disorders, achieved remission and are in full, complete and successful growth and maintenance. For those individuals and their significant relationships, these strategies will work quite effectively if the brain disorders and misfirings are treated adequately with a long-term view that includes maintenance and growth.
Depression and Emotional Pain Discharge
Every day your body collects, accumulates and stores pain and tension. Experiences outside of yourself move through and penetrate your sensory organs. For example; you could be in a situation where you are sitting quietly and have to listen to the toxic negativity of other people. Through your eyes and your ears you are internalizing all of the negativity coming from other people. Like a warehouse, you are storing that negativity. It starts to deeply wear at you and may even stress you to the point where it depletes critical stress fighters and eventually puts you into the early stages of Depression.If you are aware enough, you'll recognize these stressful incoming negative vibrations. At that point, you may make the decision to enter into a therapeutic, self cleansing emotional discharge and clearing process. By going to your safe sanctuary, you can cry and scream out all of the thoughts and feelings that are locked inside of you based on what was triggered during your original stress inducing event.
If you decide to do nothing, you will expose yourself to the continuous accumulation of negative inputs and eventually important parts of your brain will be deeply affected. Your limbic system will become over activated and heated up. The result will be Depression. Your amygdala, which surrounds part of your limbic system will create negative, self perpetuating depressive thoughts. Other higher cortical areas will also be affected. Your relationships, moods, motivation, goal seeking and judgments may become quite impaired. Eventually, these negative exposures can help shape your brain into negatively affecting your personality. You will then be vulnerable to borderline, obsessive-compulsive, narcissistic, self-defeating, histrionic (etc., etc.,) personality disorders. (I, also include in these categories the medical classification called Type A Personality).
Remember: The development of Depression, personality disorders and other malfunctions are your body's compromising mechanism for adjusting to and coping with the accumulation of toxic pain. The antidote is a full and complete emotional discharge of your pain.
I must stress that you will need periodic, scheduled Deep Feeling sessions and experiences to facilitate the release, discharge and resolution of your pain. By acquiring and practicing a lifetime of positive and healthy emotional maintenance, you will be insuring yourself of a higher quality of life, with positive and even ecstatic mood states.If you are truly interested in productive work experiences, excellent interpersonal relationships and superior physical and mental health, you will practice deep emotional pain discharge for the rest of your life. If you resist this recommendation, you will guarantee a return of Depression and negativity into your life. This statement is not meant to frighten you. It is just a warning that things could get worse if you do not take excellent lifetime care of your feelings, brain, interpersonal relationships and your bodily functions. You can reap the benefits of a healthier, happier, longer lifespan.
Case.. JohnJohn presented himself for therapy, suffering from a very severe Depression and extreme marital problems, complicated by his wife's disorders. He had a history of chronic and excessive overuse of every kind of illegal drug dating back to preadolescence. These attempts at self medications were eventually abandoned through various self-help, 12-step programs. His first session with me facilitated a release of a small amount of emotional pain, while he was sitting upright in the chair, facing opposite of myself, the therapist. I asked him if he would like to go over and lie down on the mat, in order to release more pain.
He refused. I knew that he would be resistant towards approaching any attempts at full emotional release. However, the small amount of pain release allowed him to substantially recover during the following week. His physical demeanor had substantially been altered upon his second visit to my office. The depressed posture, voice and facial appearance appeared more open and uplifted. He was able to reestablish contact with his wife and they both agreed to stay and live together (although their marital problems would have to be sooner or later acknowledged and confronted).Far from being out of the woods of Depression, John in his second session was less resistant to deep emotional release. I insisted that if he really was very serious about conquering his depressive illness and marital problems, he would have to physically get up off of the chair and go over to the mat in order to fully release his deeply repressed emotions. John agreed to this and I coached him on how to fully release his pain. The method that I use is what I call the limbic Emotional resonance approach. It allows me to get down on the floor with John and to simultaneously express the feelings that his Depression has blocked from expression.
This resulted in a very powerful mutually resonated limbic release, noted for its high-energy, positive feelings and emotional regulation. John was on his way to full recovery based on releasing blocked pain from deep inside of himself...... Outward...... instead of trying to fix himself from the outside/in.Prognosis: Excellent, Mutually Satisfying and Enthusiastic.
Case.. FlorenceFlorence decided to engage herself in deep feeling therapy, complaining of a lifelong Depression and intense interpersonal struggles with her current dating partner. As with many depressed individuals, Florence had been suffering from numerous physical problems and she was highly distrustful and conflicted towards her current romantic partner (Romantic partner is a very insufficient term when applied to a relationship that does not possess adequate emotional limbic resonance and connectedness).
She felt extremely ambivalent towards Marvin, her "lover" and eventually she decided to move in a different direction away from him. Of course, this caused great consternation in Marvin who suffered from a latent anxiety disorder underlying the cover of a Narcissistic Personality Disorder; Type A Personality variant.Florence did extremely well with my Limbic Emotional Resonance approach and during her session, she released a lot of pain and made many connections. She complied well with homework assignments that required continual daily home sessions in order to solidify gaining access to her limbic feelings and Depression. I assessed that her limbic system was highly over active and that deep emotional release experiences would normalize her brain and relieve her Depression.
Her relationship with Marvin was intensely, emotionally fused and highly enmeshed. Relationship counseling under these circumstances is next to impossible until Florence could individuate and separate herself out of a highly dysfunctional, enmeshed Borderline/Narcissistic relationship struggle. Dysfunctional couples such as Florence and Marvin may have to be separated from each other while either one or both can achieve some kind of centering and grounding in the real self. (See Separation Counseling at www.psychotherapyhelp.com).
People in these kinds of relationships do not see how their mutual overinvolvement and enmeshment causes them to feed into and nourish one another's illness. They need to be cured individually and when that is accomplished, they either move on with their lives and possibly receiveEcstatic Relationship Counseling.
Marvin eventually got that he could not capture Florence and keep her in a highly destructive and painful relationship, that they were both contributing to. He, finally, accepted the fact that he needed Deep Feeling Therapy for himself in order to discover how he kept making the same choices and mistakes over and over again. People, like Marvin usually suffer from impaired connections between the neocortex and the limbic system. This makes them have a very difficult time accessing those emotional feelings that would help them to bond successfully with other human beings.
Because of impairment of the neural connections between the neocortex and the limbic system, a raging Depression usually exists inside of the limbic system and is completely blocked off from awareness by neural mechanisms in the brain. People like Marvin feel internally driven with constant physical and behavioral signs of urgency. Their system is in perpetual stress, while their psychological defenses deny that anything is wrong with them (This condition could make Marvin a candidate for cancer or heart attack). Such a repressed form of narcissistic Depression may contribute to the formation of a relationship nightmare called Projective Identification.
This phenomenon can and usually occurs in intense negative love relationships and work problems. Projective identification is a dynamic existing between Florence and Marvin where each of them projects onto the other their own worst fears, doubts about self, repressed emotional pain and memories, that culminates in a highly over reactive self-fulfilling prophecy. These dysfunctional, fused relationships take on many hidden undertones, problems and themes. The people who participate in these dynamics, are prone to mutually dissatisfying and painful interpersonal sabotage.
Projective identification keeps these people from facing and recognizing particular problems and conflicts and how they, themselves contribute to them. In a sinister fashion, these brain disordered and depressive reactive individuals feel compelled to blame their own personal defects and problems onto others. The depressive theme is played out----- "The problem is with him/her, not me." A Deep Feeling Experience exposes to the individual their own internal repressed emotions that drives and fuels depression and projective identification.
Paul J. Hannig, Ph.D MFT w PsychotherapyHELP
Chatsworth, CA 91311 w 818.882.7404 w firstname.lastname@example.org