Imagine this scenario: a client walks into my therapy room. They are are listless and don’t engage in eye contact. They move slowly and seem heavy, even though they may be physically slight. Their shoulders are hunched and look exhausted, unhealthy, disengaged. Eventually they shuffle across the floor, sink down on to the sofa, close their eyes and sigh.
As a psychotherapist I have seen depression many a time. It’s obvious when someone is suffering from it. It has permeated them to the core and they no longer recognise themselves, often saying, “What’s wrong with me? This doesn’t feel like me.”
They live in a world that non-depressives find hard to understand. This “not me” version of the person they love has taken hold and no amount of care or attention can shift it. This means people get frustrated with the depressives that walk among us. Being depressed is no fun. Being around depression is also no fun.
Those of us who don’t suffer find it hard to understand what clinical depression feels like. So people react by saying, “It’s a lovely day, why don’t you go for a walk?” Or “Why don’t you do a gratitude list? At least you’re not a refugee coming on a boat from Syria facing the imminent threat of drowning?” Others suggest seeing friends, engaging in an activity or learning a new skill– anything that will stop the depressed person from sinking low.
I understand. When we care for people we want to help them.
This week it was announced there will be an NHS drive to replace antidepressants for patients with art, music or gardening classes.
None of these are bad ideas. The attempt to try and “cheer” people up and wean them off prescription drugs comes with good intentions and there is a whole body of research showing that changing what we do, changes what we think. There is certainly something very therapeutic about painting, making music, ruminatively potting out plants. All this is about creating something, becoming attuned with something practical and life-enhancing which is designed to give a sense of self – a more connected self.
The problem with this is that if you are clinically depressed, none of this is available to you.
A client of mine who struggled badly with depression put it to me like this: “Every day I wake up and it’s as if I have a solid iron sheet lying on top of me.” This is a version of a description I have heard many times; the client is exhausted, hopeless, experiencing depths of sadness that has no end. They are exhausted, have no motivation and struggle to get out of bed, wash, go out, engage with people, talk, sometimes even eat. They sink into a trough of despair.
These people – the seriously depressed – just do not have the capacity to go out and do a bit of weeding.
And this is where the problem lies; it is hard for the non-depressed to really get depression and how to “cure” it. A brisk walk doesn’t cut it. So this is where drugs come in. I understand the fear of the threat of a Prozac nation (to borrow the term of the groundbreaking 1994 book) but in my experience antidepressants can feel like manna from heaven for the seriously depressed.
It’s a fallacy to assume therapy alone – or therapy combined with, for example, joining a choir which, don’t get me wrong, can lift the spirit and enhance human connection – can “cure” depression.
Therapy can do many things but it’s expensive and rooting out depression can take months if not years. Sadly the rates of depression are rocketing, yet therapy is also not easy to come by – certainly the type of therapy than can shift deep levels of trauma. The rise in young people being referred for mental health issues means that the NHS’s children and adolescent mental health service (CAMHS) has a lengthy waiting list. Most people cannot afford long-term private therapy and the number of cognitive behavioural therapy sessions – between six and 12 offered by the poorly funded NHS – is not a viable solution.
I have also found that it is not very possible to reach the root causes of depression with a very depressed person because they don’t have the psychological capacity to do deep therapeutic work.
Antidepressants, which can lift them out of that hole long enough for some therapeutic healing to take place, can be life saving.
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