DEPRESSION

1. DEPRESSION A Meta-Medical Approach

2. A world without depression? Without the depressive process we would live in a world gone mad, a “schizoid” world of fight, flight and frozen apathy. A world in which doing leaves no room for being, practical and economic busyness replaces all depth of thought and depth of soul, and the polite masks of positivity that we all put on merely intensify the mute pain felt by each.

3. Depressed - to be or not to be? We suffer depression to the extent that we do not allow ourselves to be depressed - to actively follow the depressive process. The depressive process is our most natural form of meditation, not raising us into the light but helping us to feel our way down to the innermost core of our being.

4. Immune to depression? A white-cell analysis of forty-three men diagnosed with varying degrees of depression showed that the most severely depressed of these actually showed significantly improved immune functioning, compared to the control group. (from Forbidden Science, Richard Milton, 4th Estate 1994)

5. What is “Meta-medicine”? Meta-medicine is not another form of alternative diagnosis or treatment but a new philosophy of health and healing for the twenty-first century. Challenging the biogenetic model of illness, it is based on a fundamental distinction between the human body and brain on the one hand, and the human being on the other. Its focus is the meaning of illness for the human being rather than its causes and cures. Processes of change in the human body are understood as the expression of processes of change in the human being. Illness itself is understand itself as a holistic healing process comparable to pregnancy - one which can help the human being to become more whole by birth to new and unborn aspects of themselves.

6. Diagnosing “depression” • It was only in the 1950’s that the word “depression” began to be used as a diagnostic category for a widespread psychiatric disorder affecting the general population. • Diagnosing people’s symptoms as the expression of a “thing” - an official illness - allows pharmaceutical companies to label and market anti-depressant drugs claimed to target this illness. • But by defining depression as illness we eliminate all questions about what the word “depression” actually refers to and what the symptoms of depression actually mean to the individuals to whom this word is applied. And people then begin to apply the word to themselves without question - as if it were self-explanatory.

7. Deconstructing “depression” • “Depression” is first and foremost a word and not a thing. What it is, cannot be separated from what this word is used to mean. • Different people use the word “depression” to mean differentthings in different contexts and at different times. But that does not mean it has no meaning. • The depressive process is the very process by which we digest the meaning of events at a level deeperthan words - letting things “get to us” and change us. • The personal meaning of something has to do with how it changes us. Only by following the depressive process itself can we can we find what “depression” means to us.

8. Defining “depression” • The word “depression” is part of a family of words connected with the verb press, such as impress, express, repress, oppress etc.. • Its basic meaning is “a deepening”. • The depressive process is essentially a deepening process, helping us to feel the meaning of events at a deeper level and respond to them from a deeper level of our being. • We suffer depression to the extent that we do not let ourselves be depressed - letting events deepen us through the depressive process.

9. The bio-medical view • The biomedical view of depression defines it as a diseaseof the brain which needs in most cases to be “treated” with anti-depressant drugs. • It makes no attempt to explore the relation between process of change in the human brain and processes of change in the human being, reducing the latter to the former. • It makes no distinction between depressive states and symptoms and the depressive process. • Mental health is defined as the individual’s ability to function normally in social and professional life whether or not they in touch with their inner being and nourished by a sense of meaning. • This bio-medical view sees no meaning in depression except as a medical condition or value in the depressive process except as a disturbance to normal “functioning”.

10. The meta-medical view (1) • The human body is the human embodiment of a human being. Beings cannot be reduced their bodies or brains. • We do not think because we have brains. We have brains because we are thinking beings. Beings think, not the brain. • The idea that the brain is the basis of our mental-emotional life, or that it causes depression makes no more sense than the idea that a musician’s instrument can “cause” them to play a certain type of music. • It leads to a fundamentally unhealthy way of relating to people suffering depression - treating some-one, the human being - asa by-product of some-thing, their genes and their brains.

11. The meta-medical view (2) • What we call “depression” is nota disease or a sign that there is something “wrong” with us. Depression is first and foremost a metaphorical word and not a “thing”. • The depressive response is a natural instinctual response --- a 4th. response beyond fight, flight and “freezing”, all of which are based on fear of facing facts or feelings. • Depressive states come from fighting, fleeing or getting stuck in the depressive process. • The depressive process is a natural deepening process that helps us to inwardly digest the meaning of events and get back in touch with our inner being.

12. The meta-medical view (3) • Depressive symptoms such as insomnia signal our need to enter the depressive process. • Depressive moods are a natural doorway into the depressive process, allowing us to feel and follow our feelings in a bodily way without having to verbalise them. • Depressive anxiety is anxiety felt at the threshold of the depressive process, expressing fear of this process. • The depressive position is the firm ground we find in ourselves by going down into ourselves and completing the depressive process. It is the basis of both creativity and sound decision-making.

13. “Treating” depression • All forms of treatment for depression imply that something must be done about it or done to the sufferer. • But the main purpose of the depressiveprocess is to help us to just be with ourselves without having to do or say anything. • The tension and torment of depressive states results from the continuing impulse to do which resists our need to just be - to reconnect with our core self. • The impulse to treat depression is a fight response to the depressive process which reinforces our fears of it.

14. Bearing depression (1) • Whenever we talk of “bearing up” or of finding something “unbearable”, we bear witness to the double meaning borne by the word “bear” itself. • On the one hand it means to “carry” something. On the other, to give birth. These two senses come together when we speak of bearing a child - carrying it and giving it birth. • The modern medical approach to depression fails to distinguish between bearing and suffering. To bear something is not to passively suffer it. It is to bear with it in a way that allows it to ripen and bear fruit. • The depressive process can be understood as a form of spiritual pregnancy - one through which we allow new feelings and a new sense of self to ripen and mature within us.

15. Bearing depression (2) • Though pregnancy has “symptoms” and can lead to medical complications, it is not an illness. Neither is the depressive process - although, as in pregnancy, medical interference can create its own complications. • The pregnant mother may feel fatigued and weighed down but learns to alter her physical bearing to accommodate the child she bears. The depressive process may tire and weigh us down too, but it also helps us find a new inner bearing towards life. • By learning to value this inner bearing and finding ways to embody it in our everyday life and relationships we give it its own body - we give birth to it. • The depressive response is a response of forbearance - not fighting or fleeing the burdens we bear and brood on within ourselves, but giving our inner gestation process time to bear fruit.

16. Anti-depressant drugs • The belief that consciousness is determined by brain chemistry can be a self-fulfilling. For the use of psychoactive drugs which affect the brain can have lasting and damaging effects on the mind. • Many people suffer severe and terrifying side effects from the use of anti-depressants such as Prozac. Others appear to thrive on them. In both cases the drugs prevent the user from following the depressive process and reaching the depressive position. • Anti-depressants, where “successful”, repress the depressive process as well as depressive states. By helping people to function normally they reinforce a superficial definition of mental health as a “normal” or “improved” functionality - undisturbed by any deeper feelings or life questions that intrude into consciousness.

17. The “cognitive” approach • The so-called “cognitive” approach to depression focuses on how the thoughts individuals have in response to events can affect the way they construe these events, generating feelings which make them feel depressed. • But the word “depression” is itself a mental construct - a way of negatively interpreting or “construing” certain inner sensations, feelings and processes. • Meta-medicine is a “metacognitive” approach to depression, focusing on the constructs with which we interpret and and respond to depression itself. Our beliefs about “depression” affect our experience of it - and can lead us to either affirm or block the depressive process.

18. The depressive response (1) • Fight and flight are two primary responses to events or situations which provoke fear. • Freezing and becoming stuck in passive immobility is a third type of response. • The depressive response is a fourth instinctual response - beyond fight, flight or freezing.

19. The depressive response (2) • Sparring animals show this response by surrendering without fleeing, nursing their wounds and appearing to “brood”. It stops them risking serious injury by further fighting. • The human depressive response takes the form of withholding immediate fight or flight reactions to situations, withdrawing into our selves and listening in silence to our own feelings. • This helps us to respond to people and events more creatively and in a more authentic way - from our core self.

20. The depressive process (1) • The depressive process is a natural part of life, but some people’s lives are more difficult than others. People facing intense difficulties in their lives need to follow the depressive process more often, more consciously, or more deeply than others. • This does not mean they are by nature depressive personalities or “prone” to depression. • Like sleeping and dreaming, the depressive process is an important part of the creative process, helping us to access inner sources, strength imagination and insight.

21. The depressive process (2) • is our body’s way of slowing us down • helps us to stop doing and start being • gives us time to recharge our batteries • stops our mind going round in circles • allows us to digest events inwardly • helps us feel our feelings in a bodily way • helps us to face facts and face feelings • allows new insights and responses to incubate • helps us to find our ground within ourselves • allows us to relate to others from our inner self

22. The depressive process (3) • The depressive process can be compared to the digestive process, allowing us to process and metabolise our experience on a deeper level after we have chewed things over in our mind. • Through it, we extract the energising nourishment of meaning - without which no human being could grow or even survive. • Insomnia, chronic fatigue, bowel problems and other psycho-somatic are not so much signs of depression as the result of a blocked depressive process. Their basis is not mind or body but the physiology of the soul - the life of meaning central to human beings.

23. The depressive process (4) We block the depressive process by… • ignoring depressive symptoms. • believing that we must “function” in a bright, alert and cheerful manner all the time. • following the advice of others instead of our own impulses, moods and feelings. • labelling certain feelings as “negative” and fighting them with positive thinking. • looking for quick-fix solutions and not giving ourselves time to incubate answers at a different level of consciousness.

24. The depressive process (5) • Just as people may find yoga positions painful to begin with so is the depressive process more painful for “beginners”. • Just as physical pain is essentially unspeakable so may the processing of unnameable or unspeakable feelings be painful. • Pain is essentially a feeling of apartness from ourselves or our bodies, one that comes to a focus in a part of ourselves or our bodies. • The depressive process is one through which we transcend this painful sense of apartness from our being by feeling it with our whole being.

25. Depressive moods • Depressive moods are a somatic and not just psychological states - our bodily way of entering and experiencing the depressive process. • Feeling “heavy” or weighed down helps us respond to the inner gravitational pull of our feelings - allowing ourselves to go down into ourselves and and feel them. • The word “feeling” is not just a noun but a verb. It refers not just to a thing but to an activity. • Feeling down can be the first step toward feeling down into ourselves and contacting our core self.

26. Depressive symptoms & states • Depressive states come from fighting or fleeing depressive process. That is why people who suffer depression often complain of feeling out of touch with themselves. • Loss of sleep and energy, loss of meaning and motivation, can all be symptoms of depression - signs that we need to enter the depressive process. • Depressive symptoms can be a doorway into the depressive mood and the depressive process or turn into chronic or acute depressive states. • Fighting the symptoms can be a way of fleeing the depressive process and result in the intensification of depressive states.

27. Depressive fatigue • Depressive symptoms can be compared to the natural symptoms of tiring that precedes sleep - not only mental and physical fatigue, but emotional fatigue, feeling “low” and uncommunicative, heightened sensitivity to stress etc. • In today’s world, however, “health” is defined as the ability to function with full alertness right through the day, and to delay the onset of the depressive process until we go to sleep at night. • This goes against the natural rhythms of body and mind, which require that we also “sleep into ourselves” at times during the day.It encourages a type of daytime insomnia which blocks the depressive process and can result in sleep problems at night.

28. Depressive anxiety (1) • Depressive anxiety is anxiety felt at the threshold of the depressive process and an expresses fear of this process (see Depressive response & Depression, fear and anxiety) • We feel anxious because we are out of touch with our bodies and core self, feeling an emptiness within. We feel our own lack of core contact with ourselves and others. As a result, we sense lack or loss of meaning and fear loss of being. • Reaching the depressive position means finding the firm and secure inner ground of our being. The depressive process is like climbing down slowly from a high peak to this firm ground - but entering it may feel, to begin with like coming to the edge of a terrifying abyss.

29. Depressive anxiety (2) • Anxiety is another name for fear. However “unspecific”, behind it there is always an unacknowledged but highly specific fear - one we may be afraid to admit. • The three instinctual responses of fight, flight and freezing are an expression of fear. The depressive response (see index) is a fourth instinctual response, beyond fight, flight and freezing - allowing us to transcend fears by confronting and experiencing them fully. • Anxiety is fear not fully recognised in its specificity. • Paranoia is the use of an object to reflect or mirror unrecognised fears. • Mania is the attempt to repress fear by a triumphing over its object. • Schizophrenia is disembodied, mentally refracted fear experienced as persecutory inner voices or thoughts.

30. Depressive thinking (1) • Psychologists concur that depressive states go together with a typical pattern of black-and-white, either-or thinking that can charge even minor events and issues with life-or-death emotions. • Yet so-called “positive” thinking” is also based on black-and-white verbal constructs: to “succeed” or “fail”, feel “good” or “bad”, “go on” or “give up” , be “positive” or “negative” in one’s attitude etc. • Depressive thinking is “negative thinking” of the most valuable, creative and profound sort - not negating the positive but negating the basic either-or of positive thinking, and replacing it with a both-and-neither.

31. Depressive thinking (2) • The depressive process takes us beneath our verbal mind and its black-and-white constructs, allowing us to think in a feeling and intuitive way. Following it lead us towards a wordless both-and-neither thinking. • Instead of construing our sensations, moods and feelings as either positive or negative we allow ourselves simply to feel them in a bodily way - to surrender to all feelings and at the same time to feel each as something neither positive nor negative in itself - but more like a meaningful musical tone or chord of our being. • Feeling tones are not positive or negative in themselves, any more than musical tones are. The depressive process lets thinking take shape in a feeling way, by listening to the inner music of our moods and feeling tones.

32. The depressive position (1) • The term “depressive position” was first used by the post-Freudian psychoanalyst, Melanie Klein. In meta-medicine, it refers to the deepest point of the depressive process, a point which is both a completion and a turning point. • In the depressive position we make a transition from doing to being, from fight and flight reactions to calm and reflective forbearance, from anxious unknowing to wordless inner knowing, from emotional ambivalence to acceptance of both love and hate, from either/or thinking to neither-and-both thinking, from mute pain to deep metaphorical perception. • The depressive position is the inner goal of meditation, achieved naturally through following the depressive process.

33. The depressive position (2) • From the depressive position we make better and more realistic decisions, unobstructed by fear of facing facts or fear of facing personal feelings. • From the depressive position we make better and more patient listeners, not reacting to others hastily in words but wordlessly digesting what we hear in silence. • From the depressive position we can more easily be with ourselves and others in silence, making contact with others from the inner core of our being, rather than through what we do or say. • From the depressive position we can be alone with other people, intuitively in touch with our inner or “core” self and therefore better able to hear and respond honestly to others from that self.

34. The depressive position (3) • From the depressive position we embody our feelings and communicate from them rather than analysing them intellectually or talking about them. • But whenever we merely talk about ourselves, our bodies or our feelings, we move our centre of consciousness to another position - the schizoid position. From the schizoid position we take an “objective” view of our ourselves, our feelings and our bodies, turning them into intellectual or emotional objects. • Both psychiatry and counselling operate from the schizoid position. This does imply cold, emotional detachment - but turning others into objects of compassion or “empathy” is not essentially different from turning them into objects of clinical diagnosis and treatment. Only by entering the depressive position ourselves can we help others reach it.

35. Degrees of depression • Different degrees of depression take us down, like a lift to deeper levels of our being. • The deeper we learn to go, the less intense the fear and pain we experience in the process of “going down”. • Getting stuck in a depressive state is like getting stuck in the lift on the way down. • To come back up to our usual state of consciousness we may first have to descend to an even deeper level. • If we try to bring the lift up or get out of it without doing this we may jam the depressive process. • The depressive position is our basement - the inner ground of our being which supports all its higher levels.

36. Depression and isolation (1) • All of us need times when we can creep into our shell, and create a safe space inside us where we can be with ourselves in silence, free of the pressure to act or speak. • Withdrawing into ourselves in the depressive process does not necessarily lead to feelings of isolation or of unreality. Only the contrary, it can put us in contact with our inner core and makes us feel real again. • From this position of inner contact with our own being - the depressive position - we are not less but more able to be with others - to listen and relate to them from our inner core and make contact with them on a core level.

37. Depression and isolation (2) • Others, however may not be able to respond to us from their core - to just be with us in silence - but instead look for things to do or say that will “bring us out” or make us “cheer up”, “look on the bright side” etc. • People who are depressed may appear dour and uncommunicative and give the impression of only wanting to be left alone. The alternative would be to act as if they were not depressed or withdrawn. • Looking for helpful things to do or say , or putting pressure on others to say or do something can have an isolating effect on them. It may reflect our own fear of the depressive position - of being with ourselves and reaching out to others in silence.

38. Depression and isolation (3) • In extreme depressive states, the individual remains detached from the depressive process, and loses touch with the self that has withdrawn. As a result they feel empty and isolated in a different way - utterly abandoned by their own core self. • When people lose their core sense of self in this way it is even more important that those who are with them are in touch with their own core self. Only then can they reach out and make core contact with the withdrawn self of the depressed person. • Without this core contact, everything they do or say will increase the other person’s sense of isolation.

39. Depression and stigma (1) • If someone is deeply distressed in any way, social communication is fraught with paradox. • If they reveal the full intensity of their distress, they risk being stigmatised as abnormal. • If they hide their distress or understate it they collude with the belief that it is abnormal. • If they put a brave face on, they may not receive sufficient understanding or support. • If they do not, they may appear to others - and to themselves - as weak, needy and dependent.

40. Depression and stigma (2) • The greater someone’s distress, the more deeply they need to enter the depressive process to find inner strength and insight. • Conversely, however, the more deeply they need to enter the depressive process, the more distress they may feel. • Part of this distress has to do with social stigma and the taboo against non-communication and silent “brooding” withdrawal. • The depressed person has either to communicate as if they were not depressed or withdraw from ordinary communication and risk stigmatisation.

41. Depression and delusion • The belief that experiences of intense inner anguish and despair are by nature abnormal, not shared by other ordinary or normal people, is a core delusion of many who suffer from depression, and often also shared by those who study or treat them. • It leads to a split between our ordinary social self and a secret self regarded as abnormal, sick or sinful. • The core delusion serves to keep our secret selves invisible from others, dividing people into those who succeed in keeping their secret self well hidden and those who fail to do so and are seen as mentally “ill”.

42. Depression and the self (1) • The secret self is not an unconscious self but a self many people are highly conscious of. • The secret self is in fact the expression of a missing sense of self - lack of contact with our core self. But its existence also threatens our self-image and mental idea of ourselves - our mentalself or “ego”. • The mental self is a mental expression of our core self. The bodily or embodied self is its physical embodiment. Our minds rely on our bodies to link us to our core selves. If we are out of touch with them our sense of self is weakened, and the inner distress this creates becomes the secret self that we hide.

43. Depression and spirituality (1) • The depressive process takes us down from our mental self through the embodied self to our core. • This core is our spiritual connection to Being and to other beings. It has nothing to do with ideas of spirituality connected with being this or being that: the spiritual “correctness” of being radiantly healthy, positive thinking, vegetarian, non-aggressive etc.. • But the less in contact we are with our spiritual core the more we tend to construct an idealised image of it - a spiritual superself representing all that we believe we shouldbe - in depressing contrast to all that we secretly fear we are - our secret self.

44. idealised superself mental idea of self secret self embodied self core self The depressive process as a movement down through layers of the self from an idealised superself, through the body to our spiritual core. Depression and spirituality (2)

45. Depression and feelings • The embodied self does not have feelings “about” things. Instead it touches and feels them - reaching out or withdrawing like an amoeba. • When it withdraws or contracts this is not because its feels “hurt” or “rejected”, “disappointed” or “depressed”. These are the minds interpretations of emotional experience, turning wordless, bodily feeling into verbally labelled emotions we call feelings. • Our mental interpretation of the feeling self and its feelings divides them into “positive” and “negative”, “spiritual” and “unspiritual”, relegating the negative or unspiritual to the secret self.

46. Depression and pressure (1) • The depressive process allows us to absorb the pressures and digest the stressesof life, providing a natural form of meditation. • It is the process by which we become aware of the felt impressions left by events - impressions which we cannot immediately express in words. • It allows ourselves to feel these impressions with our bodies, instead of repressing or expressing them. • Without the depressive process, repressed or undigested impressions and pressures can only be expressed through dreams or psycho-somatic symptoms.

47. Depression and pressure (2) • The world puts no direct pressure on the self. We put pressures on ourselves in response to our beliefs about what is required of us. If these pressures become to great we experience “stress”. • As a result, the self inwardly withdraws from the world in order to gather itself together, recreate itself and give us strength. • This depressive process is a natural response which helps us to de-stress and de-pressurise. • Depressive symptoms are made worse by puttingpressure on ourselves to continuously function and perform in a cheerful, sociable and extroverted way.

48. Depression and science • Biological medicine and genetics do not acknowledge any essential difference between the human body and brain, on the one hand and the human being on the other. • They focus on the biological causes and cures of depression rather than its meaning ie. on processes of change in the body and brain rather than processes of change in the human being. • Body and brain, genes and neurological synapses are “positive” realities - the object of a positivistic science. • Positivistic science cannot fully grasp negative realities connected with the absence rather than the presence of measurable phenomena. • As a result, it cannot deal with negative experiences rooted in what is missing in people’s lives and behaviour - with loss or lack.

49. Depression and loss • When the mind finds no reasons and nothing there to explains our feeling of depression, its easy for it to blame the body or brain. • The depressive process has to do with acknowledging what isn’t yet there or isn’t there anymore - with lack or loss. • If we lack something externally we must first find it in ourselves. If we lose something externally we must refind it in ourselves. • In the depressive process we let go of things outwardly and begin seeking them inwardly.

50. Depression and time • Lack and loss are not just aspects of our present but of our past andfuture. • In the depressive process we do not just slow down but enter a different sort of time - psychological time. • Psychological time includes what isn’t now, what could have been in the past - but maybe wasn’t - and what could still be in our future. • The “swamp” or “mess” that people often feel they enter in depression is actually a rich con-fusion of different dimensions and currents of psychological time - comparable to dreaming.