"Now, you need to understand that Olivia had been on and off Prozac and it's chemical variants for a couple of years herself, hoping to find a way to cope with her constant bouts of depression. Olivia had also recently insisted that her boyfriend either go on Prozac or take a hike because his sluggishness and foul moods were destroying their relationship. And I had, of course, been on Prozac for more than six years at this point. So when she called to tell me that now Isabella was on it too, we laughed. "Maybe that's what my cat needs," I joked. "I mean, he's been under the weather lately."
There was a nervous edge to our giggling.
"I think this Prozac thing has gone too far," Olivia said.
"Yes." I sighed. "Yes, I think it has."
Elizabeth Wurtzel. "Prozac Nation: Young and Depressed in America."
The very word "depression" will conjure up different things for different people. "Depression", "Prozac", "serotonin" etc have all entered into the lexicon of everyday speech so much so that a picture of a Prozac capsule has appeared on the front cover of Time magazine, "serotonin" is mentioned in pizza commercials and animal veterinarian/psychologists really do prescribe anti-depressants for pets. Elizabeth Wurtzel's litany of self-indulgent misery is a brilliant case study in the meta-programs and strategies of a "hopeless" (atypical) depressive, in particular with regards the externalization of responsibility/causality. But be warned: reading 321 pages of such tripe has a tendency to leave one feeling rather depressed oneself - be careful of what internal dialogue you choose to have processing within your auditory cortex.
As expected, psychiatry regards pretty much any form of depression as a biological disease that requires biological interventions - the proverbial "chemical imbalance". Although CBT is gaining ground as a concurrent treatment besides SSRI's as the treatment protocol of choice. From personal experience of CBT as practiced in the UK psychiatric industry, CBT is prescribed in the same way that an anti-depressant will be where the success/failure of CBT does not rest with the skill-ability of the therapist but within the technique itself. Once again the mental health practitioner is left out of the communication loop with the patient.
Despite depression being regarded as biological in origin psychiatric doctrines recognize that biological, genetic, environmental and socio-economic factors play an important part. But so as not to be cheated out of the opportunity to drug someone, even where there is a clear and definite extraneous factor in someone's depression, well, they clearly have an innate predisposition to this sadness.
Psychiatry divides depression into two major categories:
Endogenous. This is regarded as a spontaneous depression arising without recursion to
external events. Whilst working in Accident and Emergency a common response of people to those who
had attempted suicide was to ask, "What happened, why did you do it?" as though the attempt at
suicide must be response to a particular event. The sheer volume of numbers of people we saw each
and every day that had deliberately endangered their lives so that their suffering might ease I
found to be truly disturbing. I still repeatedly ask what on earth is going on with the way we
organize ourselves as a species that so many people either cannot cope or can only cope with the
help of medication that raise neurotransmitter (mono-amine) levels in their brains.
Reactive. Reactive depression is more understandable to most folk - ie the person becoming depressed is showing an comprehendible response to an external event. However, the criteria for people to suffer is changing. A newly bereaved widow might find herself being prescribed an anti-depressant within weeks of her husbands death. In South Africa I worked with a young woman who was given electroshock 'treatment' within a week of her husbands murder and after a failure to show 'improvement' after three shocks (over a 5 day period) was drugged into a barbiturate coma for 10 days in a bizarre attempt at helping her feel happy.
A term most people I meet seem to be familiar with is the concept of having a "chemical imbalance". This absurd simplification is almost as tragic as the psychotherapeutic attempt at an explanation along the lines of "depression is anger turned inwards". During my training to be a counselor we were taught that "catharsis" will help depressives release their anger and will teach them to direct their anger externally. But of course all this did was produce a bunch of angry depressives who, like the appalling Elizabeth Wurtzal learned to hold others responsible for their misery.
The advent of PET scanning and brain imaging technology has meant that the neurological activity of depressives is being revealed. The frontal lobes appear to play an important role in the mediation of depression. Depressed (reduced) function of the left frontal lobe results in:
- Tearfulness/weeping without relief
- Emotional blunting
- Loss of motivation
Stimulation of the left frontal lobe reduces depression. So, as NLPeople we need to know what the functions of the left frontal lobe are, which are:
- Thought and concentration on problems, problem solving
- Aspects of control of the autonomic functions such as breathing rate, blood pressure, etc - this is done in conjunction with the thalamus and hypothalamus
- Assists word formation in conjunction with the Broca's area
Lesions occurring in the frontal lobes will produce differing effects depending on which side they occur in. For example, a lesion occurring in the right frontal lobe may produce a happy indifference associated with inappropriate emotions whilst a lesion in the left lobe will produce a devastating depressive state. Whilst many depressives naturally worry that they probably have a tumour, with lesions, specific neuro-signs are most frequently evident. As a precaution, I would advise all NLPeople to ensure a medical checkup for their depressive clients in order to screen out possible neurological syndromes that require medical intervention. Having said that only once have I had a depressed client that I suspected to have a tumour. As well as depression, he also complained of difficulty looking laterally across to the right side, was finding he had episodes of incontinence and experienced periodic involuntary grasp reflexes. These text book symptoms had been developing and increasing from a normal baseline over a 14 month period.
The new generation of brain imaging devises have demonstrated the following neurological events occurring with depression:
- Enlargement of the lateral ventricles.
- Decreased blood flow in the dorsolateral prefrontal cortex and the basal ganglia.
- Reduced function in parts of the parietal and upper temporal lobes (the areas that mediate attention to the outside world).
- Over-activation of the amygdala (producing the "feelings"), and the upper part of the thalamus (which stimulates the amygdala) and the anterior cingulate (a bit that "lights up" when we register internal events such as pain).
Thus from this little list, we can see that the depressed brain is indeed "turned inwards" with
regards to it's attention, and has reduced function with regards to external events. From this, I
would hope, NLPeople will begin to understand the direction they will take with regards to pacing
and directing the neurology of their depressed client.
Typically, psychologists discovered that they could induce left frontal lobe depression in virtually any lab rat.
Imagine two rats in neighboring cages. They both receive electric shocks from the same source. Rat 1 has a little lever that when he presses it, it switches of the current for a little while to both cages. Rat 2 has no such lever. Unsurprisingly, Rat 1 starts to demonstrate signs that he is somewhat unhappy with the situation and keeps pressing the lever. Rat 2 who has no such control quite soon becomes a depressed little rat with a left frontal lobe depression, undoubtly very unhappy with his inability to exert any control over his suffering..
When people feel that they have little control over their environment they are more prone to depression and feelings of helplessness that can over-generalize across context. Thus we can see a depressive who is globally depressed rather than contextually depressed, such as the man who is depressed about failing to get a promotion, who soon becomes depressed about his relationships, his house etc and reframes his life into failure.
In "NLP and Health", McDermott and O'Conner list their "Depression Strategy":
- Blame yourself. It's all your fault. The outside world is fine. What is more, tell yourself it is because of the sort of person you are (identity), not what you did (behaviour).
- Think that things will always be this way, nothing will change. Nothing you can do will make any difference.
- Expect it to affect everything you do.
When anything goes well, reverse this procedure:
- Tell yourself it's just a lucky break and nothing to do with you or let other people take all the credit.
- Tell yourself it will not last.
- Expect it to have little or no effect on the rest of your life.
On a representation and submodality level there are some requisites that a depressive must follow. One of the most powerful being that of time coding - I have met so many depressives who are not only able to code their on going experiences with slow-time submodalities but are able to infect all those around them.
Anyone who has hung around depressives will be well aware of how painfully slow the time can pass
I quote at length from Prozac Nation:
'the attending physician at Stillman comes to see me a couple of times a day. I keep telling her I've never felt so low, I can't see any reason to go on like this. And she assures me that someday, when I've worked out a philosophy to live by and found the things that I like to do, I will be happy, I will be fine. She reiterates that the medication I'm on is excellent, has worked wonders for depressed people whom nothing else would help in it's pilot programs. She says things like, Give it time.
God, do I wish that every psychiatrist I have ever dealt with could know what it's like to be a patient and to feel desperate. I wish they could know what it is like to wake up every morning afraid that you're going to live. Dr. Sterling keeps telling me that this drug will start working in a week or two, but she doesn't understand that I don't have a week or two. She doesn't understand that the pain is so bad that I don't want to live like this anymore. If Dr. Sterling told me, if she promised me, if she guaranteed me beyond a shadow of a doubt that within ten days the fluoxetine would make me feel completely better, I wouldn't care at all, it would not make a whit of difference: It would not make it worth getting through these days, these hours.
It is this time distortion and urgency for relief that leads to far too many depressives
desperately looking for anything that will bring about immediate relief. Tragically, this is
typically sought as an external agency despite the experience of depression being entirely an
internal event. Thus Rat 2 (receiving exactly the same shocks as rat 1) desperately seeks a
lever to press in order that he at least feels some relief. It is this mediation of depression that
might partly explain why our society has become such an avid consumer of anti-depressant
For the NLP Practitioner who would like to have an empathic depressive experience, I suggest the following strategy:
- Code time with slow time submodalities and predicates.
- Make all the good pictures dark/blurred/black and white and far away, whilst
simultaneously making some crappy pictures close and big.
- Put the past negative events right there in front of them.
- Put the future anywhere that no-one, least of all you, can find it.
- Adopt a slouched posture, shallow breathe with intermittent 'sighs' and move slowly so to
preclude any aerobic exercise.
- Adopt meta-programs that reflect"away from", "externally referenced", etc
- Speak with a monotone voice (on the outside and on the inside).
This in itself will not produce an immediate depression - leave it a while and allow yourself to define your relationship with your environment in this way. Soon you might begin to develop some of the physiological symptoms as listed for diagnostic criteria:
Criteria for Major Depressive Episode:
(A) Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
(1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
(2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
(3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.
(4) insomnia or hypersomnia nearly every day
(5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
(6) fatigue or loss of energy nearly every day
(7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
(8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
(9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
(B) The symptoms do not meet criteria for a Mixed Episode.
(C) The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
(D) The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
(E) The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.
Whilst anti-depressant medication will raise mono-amine levels within the brain and reduce the physiological effects of low monoamine levels however "the actions of antidepressant drugs may not reverse the cause of the depression but may merely change the expression of the symptoms" (Oxford Text of Psychiatry).
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