The Mystery Known as Depression, Part 1/12

This is the first of a series of articles I wrote on Depression. The whole article has been published by ANS: The Journal for NeuroCognitive Research in October 2013. To see the full text: http://www.activitas.org/index.php/nervosa/article/view/157


1. INTRODUCTION
Depression has been considered a mysterious ‘monster,’ even in professional circles where it is still deemed an enigmatic illness.
The condition has proven so resistant to treatment that one therapeutic approach, based on cognitive-behavioral principles, calls itself “Taming the BEAST,” an anagram for “treatment modules” in Biology, Emotions, Activity, Situations and Thoughts. (Gilson & Freeman, 1999) Today, however, the most common treatment strategy is also the simplest. It involves the use of antidepressants, now the third most widely prescribed type of drug in the country, often administered by general practitioners untrained in psychology. (Mojtabai & Olfson, 2011) When neither drugs nor therapy are effective, some psychiatrists resort to that holdover from horror movies, electro-shock therapy, which is gaining renewed acceptance under a different moniker, electroconvulsive therapy (ECT).

Until recently, ECT was considered the last resort in the battle against the beast; it was used when psychiatrists concluded that the only option left was to blast the patient’s brain with electrical energy. Now, psychiatrists have gone beyond applying shocks from outside the skull and have opted for an even more radical alternative – brain surgery. (Mayberg et al., 2005) To say the least, it is a most drastic attempt at a solution. The procedure – known as deep brain stimulation (DBS) – involves drilling four holes in the brain with screws inserted into the skull. Surgeons then plant electrodes near the center of the brain in a region called Area 25, part of the subcallosal cingulate gyrus which has been identified as a having a key role in major depression. Activated by a pacemaker in the chest, the devices emit a steady stream of electric pulses to stimulate the area, thereby easing the otherwise entrenched symptoms.
Suppose, however, that we could access deep brain centers without any physical or chemical intervention and make alterations in the circuit – perhaps even rewire it – in a natural way. I submit that Primal Therapy does just that. It is possible to found a natural, non-invasive way to access the same deep brain structures that are affected by surgery and/or tranquilizers. And my opinion is that it is possible to successfully treat many deep depressions, and measure results through brainwaves and biochemistry. (For a detailed discussion, please see my book, Why You Get Sick and How You Get Well: The Healing Power of Feelings. [Janov, 1996]) By finding this psychotherapeutic avenue to the affected brain areas, we can avoid many misdirected approaches, especially the risky use of surgery and heavy drugs. Certainly, natural feeling methods are to be chosen over a serious brain surgery.

It is not that depression is refractory to psychotherapy. It is that psychotherapy is refractory to depression. In its current state, psychotherapy in many of its approaches is too superficial to change anything profoundly. It isn’t that depression cannot be touched by therapy because it is such a serious and unfathomable affliction; it is that conventional therapy is not designed to probe the depths of the unconscious where generating sources lie. And today it seems that the only way conventional therapists can get to those deep-lying imprints is through surgery or jolts of electricity. (The crucial concept of the imprint and its corollary, resonance, the gateway to deep brain levels, is explored in detail below.)

The reason we, as a profession, have had to resort to such drastic and dangerous measures is because most treatments thus far have addressed the neocortex; actually, the front left tip of the neo-cortex, the prefrontal area. Since clinical approaches such as talk therapy and behavior modification concentrate on the cognitive part of the brain, they may neglect the source and the site of the real problem. The success of the surgery itself, with some 80 percent of patients reporting their depression lifted, should tell psychotherapists that the site of the problem may lie deeper. The most serious cases are rightly referred to as “deep” depressions because the problem often emanates from the antipodes of the brain. To be clear, my opinion is that a psychotherapy for depression that fails to probe the depths of the brain, the depths of the unconscious, cannot be successful. The generating source remains untouched.
Diagnosis in psychotherapy too often is a matter of nomenclature, one that may not accord with neurology and the body that houses it.Conventional diagnosis is often symptom-based, focused on external signs – labored movements, lack of interest, and a bewildering array of other symptoms detailed below – while ignoring root causes. I propose a diagnosis, however, that encompasses the system as a whole – neurobiology, behavior and psychology as an ensemble, an integrated view.

Some leaders in the field acknowledge that psychology as a profession is in need of a radical overhaul. The debate about the confounding state of psychotherapy seems to escalate with every new edition of the Diagnostic and Statistical Manual of Mental Disorders (D.S.M.), considered the bible of mental illness and treatment. This year, on the eve of the publication of the D.S.M.-5, the first revision in almost 20 years, the calls for a whole new way of thinking in psychology seem more urgent than ever. On both sides of the Atlantic, there have been recent calls for a complete paradigm shift in the way we understand and treat mental illness.
In a prepared statement on the eve of the D.S.M.-5’s release, the British Psychological Association stated it was unhelpful to see mental health issues as illnesses with biological causes. "On the contrary, there is now overwhelming evidence that people break down as a result of a complex mix of social and psychological circumstances – bereavement and loss, poverty and discrimination, trauma and abuse," stated Dr. Lucy Johnstone, a clinical psychologist who helped draft the association’s provocative statement. (Doward, 2013) Meanwhile in the U.S., Dr. Thomas Insel, director of the National Institute of Mental Health, based near Washington, D.C., states that there can be no progress in the field so long as we continue to use the D.S.M. as our guidebook. He claims it leaves out the complexities of neuroscience, biology and genetics. The manual is even counterproductive, he argues, because it is used to deny funding to researchers looking for the real causes behind afflictions such as psychosis and depression, simply because their research proposals cut across the D.S.M.’s outdated categories. “Dr. Insel is one of a growing number of scientists who think that the field needs an entirely new paradigm for understanding mental disorders,” concludes a recent New York Times article about the controversial manual, “though neither he nor anyone else knows exactly what it will look like.” (Belluck & Carey, 2013)

According to my view the last part of that statement is fully true, the paradigm already exists. I am not a lone voice in the wilderness, but my opinion based on my experience and four decades of work is that for example “Primal Therapy”, that was in focus of my work and experience is one of them that offers precisely the new paradigm that is needed in modern psychology. But as with all new revolutionary theories in science, the status quo is slow to recognize fundamental changes in any field, and loathe to adopt them. (See the article by Agustin Gurza on Primal Therapy and scientific revolutions, originally published in the Journal of Primal Therapy (Gurza, 1976) and more recently posted online as an appendix to my book, “Grand Delusions.”(Gurza, 2005) What this paper seeks to address is precisely that paradigm shift, probing for causes and generating sources that have been neglected in our work. I agree that we need to reorient our field and provide a new understanding of mental illness, which I take as my task. What I am proposing is a total paradigm shift not only in our view of this affliction but also its treatment. We need to reframe our thinking about it, and recognize that what is missing is the "why?" We need to ask: What is depression, and where does it come from? Why is the patient depressed?

Since I first published The Primal Scream: The Cure for Neurosis in 1970, the subtitle became the lightening rod for criticism because we used the term “cure.” Nobody dares speak of curing mental illness. Yet the issue seems to be a double-bind. We utilize therapies that cannot cure, and then look askance at those who claim to have found one. “Cure” is not an opprobrious term. What is opprobrious is that we have given up on proper therapy and made it an unacceptable word. “Cure” is not a term to be avoided in the interest of pure science; it is a state to be sought after assiduously. We owe it to the millions who suffer from depression with no real hope of finding their way out of the darkness.

Depression has been a mystery for a long time because we have ignored the connection between a patient’s current mental and physical health and long-ago imprinted traumas experienced in childhood but also in the womb and at birth. That left us with a narrow range of choices: either drug the patient or operate on him. Preferably, we need to help him plunge deep into that unconscious. We need to help the patient find the nexus between his current state of depression and its deep-lying sources. Only the patient can make that connection inside himself; our task is to help him gain access to those deeper levels of brain function.
History will provide us with the answer; history is the cause and history is the savior.