Physician…heal thyself

Over the years I have developed a meditative practice, i have a busy mind and meditation enables me to find a calm, grounded space within, which has helped me navigate some pretty steep personal terrain. I, like many others, am prone to entropy, to the breakdown over time of ongoing positive nourishing structures (like exercise, a good diet, meditation etc). The problem is that when i feel really good and in harmony with myself, i tend to stop doing the very things that have brought me to that point. With winter upon our doorstep i have chosen to stay warmly tucked in bed for the extra half an hour which i would’ve previously spent meditating, the effect of this has been subtle but increasingly noticeable. At first i find that my mind becomes increasingly restless, more prone to attaching itself to meaningless chatter, within a week, my mind is more vulnerable to stress. An image of a homeless person looking in a dustbin for nourishment comes to mind, my thinking becomes agitated and distractible and instead of reading and writing i watch crap on television, don’t go to yoga (for a variety of self defeating reasons) and start eating processed but tasty meals with little energetic content.

So, what happens on subtle levels of the mind when i begin to lose traction in my life? I am a great fan of Lord of the Rings, in the book, there is an evil character called ‘Wormtongue’ who whispers toxic lies into the King of Rohan’s ear, keeping him trapped and paralyzed with passivity. Sometimes, when my mind is restless, distractible and stressed, Wormtongue comes out to play and begins to cast doubt and anxiety into my thought-stream, polluting my thinking and puncturing my self esteem. Slowly all my scaffolding for living a connected, clear, creative life begins to break down leading into a stagnant quagmire of passivity, a low, flat mood and a general dissatisfaction with life.

Thomas Jefferson once said “the price of freedom is eternal vigilance”, in order for me to build evidence of a life well lived, to remain free, i too need to remain vigilant, to maintain those structures that allow for my growth and connection.

Warmth

Jamie

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Am i depressed?

THE BLACK DOG OF DEPRESSION-

“A man has many skins in himself, covering the depths of his heart. Man knows so many things and yet he does not know himself. Go into your own ground and learn to know yourself there”- Meister Eckhart.

I have often sat with clients and heard them say “ I don’t know if I am depressed…what exactly is depression?”

This article is aimed at people who are wondering whether they, or someone close to them is suffering from depression. It will provide basic information relating to diagnosis, causes, psychological treatment modalities and offer some useful resources to explore.

Below is a depression checklist adapted from the DSM IV-TR (The Psychiatric “Bible”). If your symptoms (or someone close to you) are congruent with some/ or many on the checklist, this does not necessarily mean you are clinically depressed. If however you recognise  6 or more symptoms which have lasted for a period of 2 or more weeks, more days than not, it would be advisable for you to visit your healthcare provider.

Checklist:

  • Significant loss of energy, fatigue, feeling slowed down
  • Feelings of emptiness, persistently feeling low and/or anxious
  • Loss of interest in pleasurable activities, including sex
  • Disturbances in sleep patterns (insomnia, oversleeping. early morning waking)
  • Moderate/significant appetite/ weight changes (gains or losses)
  • Recurring thoughts about death/suicide or suicide attempts
  • Pessimistic, hopeless feelings
  • Feeling worthless, guilty and/or trapped
  • Memory lapses, loss of concentration, inability to make decisions.
  • Physical symptoms: aches and pains not caused by a recognizable physical cause or disease. (chronic back pain, stomach or headaches)

The many faces of Depression:

Listed below are some  (and by no means exhaustive) examples of the many different paths that Depressive illness can follow.

  • Dysthymia is a chronic low-grade depression which lasts for 2 or more years.

 

  • Major Depressive Disorder is chronic, recurrent depression. It is characterized by sharp, severe episodes, which are often (but not always) triggered by environmental stressors (e.g. loss of employment). These episodes can also manifest when life is perceived to be going well.

 

  • Single episode depression occurs when a person who has previously been unaffected suddenly develops severe depression.

 

  • Postnatal (postpartum) depression is recognizable in that ‘feeling blue’ lasts longer than 1-2 weeks i.e. it is ongoing.

 

  • Bi-Polar Disorder (previously called Manic-depression) This form of depression is called Bi-polar because the person alternates between one emotional pole (down/depressive) and another (up/manic). The manic episodes can last for weeks or even months, as can the depressive episodes.

Manic Symptoms include:

Boundless energy

Decreased need for sleep

Grandiose ideas

Irritability

High levels of distractibility

Flights of ideas or racing thoughts

 

Some interesting statistics:

Although accurate South African depression related statistics are difficult to come by, the World Health Organisation claims that depression is one of the fastest growing illnesses on the planet. Depression can affect anyone, from any demographic, it does not discriminate with regards to age (approximately 3% of children and 5-8% of adolescents in the U.S. suffer from Clinical Depression). Those suffering from depression are 30x more likely to commit suicide than the general population. Approximately 2x more women attempt suicide than men. Men however are 4x more likely to die from their attempts due to using more lethal means.

So what actually causes depression?

Environmental Factors

Depression can come about because of personal loss, financial problems, physical illness and stress. Such events constitute environmental cues

Psychological and Chemical Factors

Powerful psychological forces also influence the course of depression. For example, an individual may have circular, self-defeating thought patterns which leave one feeling exhausted and “stretched”. When depressed, the mind often runs rampant, spewing all manner of toxic (often unsubstantiated) thinking into the thought stream. Imagine a swimming pool without a filter, soon the water becomes brackish and green. The brains neural highways carry this toxic thinking using neurotransmitters as surely as they carry any other feeling and thought in the human experience. Biochemical and psychological forces within the brain have a close relationship and need to be explored in order to re-establish equilibrium.

 

Genetic Factors

The origins of depression can also include genetic factors. Genetics, environment and biochemistry are also closely linked and while there clinical evidence of  depressive heredity, it does not mean that one will develop depression if a relative has depression. Excessive pressure on genetic loading through biochemical and environmental stressors may activate depression within the individual but the converse is also possible, that with an effective, integrative strategy for managing low mood and stressors one can offset powerful genetic precursors.

The road to healing.

We are no longer in the Dark Ages regarding the treatment of depression. There are a variety of chemical and psychological treatments which have been show to be incredibly effective in the battle against depression. The list below is a brief descriptor of current psychological strategies  for dealing with depression.

Cognitive-Behaviour Therapy (CBT)

The goal of CBT is to address the client’s self defeating patterns of thought and how those thoughts translate into negative attitudes and destructive behaviours. Therapy focuses on challenging self-defeating assumptions (cognitions/thoughts) as well as giving exercises designed to modify outward actions (behavioural aspects).  CBT is a tool based, short-term intervention which can range anywhere from 6-20 sessions.

Exploratory Therapy (Psychodynamically orientated psychotherapies)

The core goal behind exploratory therapies is to resolve long-standing, sometimes unconscious conflicts and repressed feelings within an individual.  An example of this type of work would be a thorough exploration of the complex relationship dynamics that exist between a parent and child  (father and son, mother and daughter) and what the individual has internalized, repressed feelings,  working models of the world (and how this model affects his/her world). Exploratory therapies are medium/long term interventions.

Mindfulness Based Therapy (MBCT/MBSR)

This type of therapy focuses on the restless nature of the mind and its role in generating depressive thinking. The individual is shown ways of developing the capacity to remain present as opposed to being caught in a ceaseless reactive or aversive cycle. I often tell clients that it shifts one from being an actor moving unconsciously through their script to a curious member of the audience who can observe the nature of their minds without constantly being caught up in the drama.

This brief outline is aimed at providing information and possibly a mere glimmer of hope to those of you in the grip of depressive illness. If you or someone you now is suffering from depression, I urge you or your acquaintance to undertake a  journey into therapy. Healing is not only possible, it is probable.

 

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The Invisible People

The Invisible People

The Invisible People

Words-Jamie Elkon

“You can judge a society by how they treat their weakest members” Gandhi

Since psychiatric care was decentralised last year in South Africa, patients have been moved from hospitals into community day hospitals that don’t have the appropriate resources to deal with mental illnesses. As a result, many of society’s most vulnerable have slipped through the cracks in the system and now walk the streets like invisible people.

You see some walking down the verge of highways, muttering and gesticulating to themselves, others crouch on the pavements outside busy eateries, invisible to the well-heeled patrons. The invisible are not ghosts of souls passed over, they are people who live among us, with beating hearts and blood flowing through their veins, mothers and fathers, sisters and brothers, each with a unique deep story to be told. This is one such story.

Nosipho* is a 36 year old woman who hails from the Eastern Cape. Although she grew up under Apartheid, she was able to attend a local convent school where she thrived under the tutelage of a benevolent English teacher. She was a bright student who enjoyed writing stories in which she fantasized of escape from her small, poor community. In her stories she was a gospel singer who would travel the world and sleep on soft beds with many clean crisp sheets, which would keep her warm and safe. Even at 15 she knew that she wasn’t going to be famous, that she would probably have to drop out of school soon in order to look after her small sister as her grandmother was ailing fast, but the fantasy lingered and soon she began to discover the signs…

At first, the signs were few and far between, a stone turned over in the dust was a clue to be followed, Nosipho heard her name mentioned on the radio whenever she came into her grandmother’s room and seemingly random events began to appear linked. Soon the signs multiplied, one upturned stone lead to another, she would hear her name whispered on the wind and yet when she turned around, no one was there. Her friends began asking her if she was smoking isango (cannabis) because she appeared entangled in a dream-like stupor. A grin became the mask she wore to fend off the constant questioning of her peers, a grin she wore to trap the tears at her grandmothers grave. After the funeral, her mother returned to Cape Town to look for work, leaving Nosipho with her eight-year old sister. It was hard to be a mother when she was still just a child herself.

The days were long and difficult and when she could finally come to rest the cacophony of voices would begin their weaving dance. The voices she heard sounded as if they came from the space outside of her, sometimes they would shout incoherent nonsense right next to her ear, at other times the voices would sound as if they came from far over the barren horizon. One of the voices was recognisable, it was her grandmother who told her that she had been bewitched by an inyanga (medicine-man) and that if Nosipho did not go and find her mother in Cape Town soon, her sister would die. Every day the voices grew in strength and soon Nosipho would not leave the house for fear of being attacked by spirits sent by the inyanga. She would leave the house just before dawn, when the voices were still asleep, to arrange small piles of stones around the home to protect the sisters. Soon she forgot to wash or get food and her worried sister brought shuffling, concerned elders into their cluttered room where they found Nosipho muttering into her tattered shawl.  People in the village began to look at her strangely and whispered behind their hands when she passed. One night, after a particularly harrowing day during which she been viciously beaten by other children who had called her cursed, she fled to Cape Town, to find her mother, a night some 20 years ago.

Today Nosipho is still searching for her mother. Miraculously she has managed to eke out a thin existence living on our streets or in caves scattered though the rain soaked mountains of Cape Town. For the past month she has sought shelter behind the blazing red bougainvillea beneath my balcony where she laboriously wraps black plastic bags around her head to fend off the razor sharp voices that continually torment her, even in her sleep. A few months ago, I went with Nosipho to the day hospital to see the Psychiatric Sister in order to get her antipsychotic medication which could radically change Nosipho’s quality of life, but after 3 hours of waiting in line (with no identification documents) I had to return to work and Nosipho fled soon thereafter citing the accusatory stares of others as the reason.

A 2007 study by the Medical Research Council revealed that 1 in 6 South Africans struggle with a mental disorder. Many of us have experienced bouts of mild depression and anxiety in our own lives, but living with severe mental illness requires great courage and the road to recovery is often long and hard. Patients admitted to Valkenberg often come from disadvantaged communities where there are not the resources needed to provide necessary support. Many families and communities are overwhelmed from the strain of caring for the person with a severe mental illness. Thankfully, there are small groups of volunteers who work diligently to offer people like Nosipho some measure of aid.

Organisations such as The Friends of Valkenberg Trust-021 447 2092 and Cape Mental Health- 021 447 9040 are always in need of volunteers and donations of any kind. As South Africans who have overcome so much in our own troubled history should we not open our hearts and find our compassion for those among us who are in such desperate need our aid?

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The Psychology of Addiction

On why addiction is largely a state of the mind so addicts are more addicted to their addiction, the temporary feeling of pleasure, rather than the drugs…

Addiction is primarily psychological although addiction is defined according to the physiological changes in the body, and addiction continues to be considered as a social, cultural, genetic and experiential process as well. Addictive behaviour could be explained as any behaviour that gives temporary or short term pleasure and also provides relief from discomfort although there may be long term adverse effects.

Addiction is generally described as dependence on any drug and results from substance abuse. Any drug or alcohol can produce addiction as can other things such as the internet, gaming, gadgets, chocolates etc. However the physical and psychological effects of drugs and alcohol are detrimental and actually result in loss of productivity, withdrawal and physical dependence and lack of attention and such other conditions. The primary feature of addiction is dependence as an individual shows increased psychological and physiological dependence on the substance he is addicted to and without the addictive substance the person is unable to return to normal life.

Dependence on anything may not be too bad and some amount of social dependence is expected of us as social beings. However when there is excessive dependence with inability to live without the substance in question, then withdrawal symptoms result and there are physiological changes in the body including pain and in some cases medical attention is required. Addiction is an extreme dependence and can cause people to lose sense of reality as people become cripple without the substance they are addicted to. Addiction leads to crime and anti-social behaviour as addicts can resort to violent behaviour, to stealing, to murder simply to attain what they want. Addiction to a substance could be separated from healthy use of the substance such as some amount of alcohol is considered acceptable and healthy in a social setting but being completely dependent on alcohol to that which amounts to addiction can have adverse social and personal implications for the individual. Some of the common addictive drugs and substances are opium, alcohol, nicotine and barbiturates. Giving up any addiction, requires strength and this is largely the strength of the mind that aids in stopping any addictive behaviour. Thus if addiction is a disease, the cure of addiction or even its prevention is largely a psychological process suggesting that the ‘mind’ is responsible for the addiction, the beginning of it and also the end of it.

Using addictive substances stimulate and release the pleasure inducing neurotransmitters in the brain and the dependence on this feeling of pleasure leads to more such pleasure seeking behaviour and this can spiral out of control and doesn’t remain within the control of the individual who then is completely controlled by his addiction rather than the other way round. Withdrawal or abstinence symptoms of an addictive substance could include anxiety, depression, craving, irritability, restlessness or even thoughts of suicide with fatal consequences. Craving, irritability, depression, anxiety are all psychological withdrawal symptoms of addiction although closely related to the physical withdrawal symptoms. So addiction is largely in the mind and if a person wants, he or she can overcome this extreme dependence on an activity or a substance through self control and with better insight into his condition.

Why do people develop addiction?

People who develop addiction are more prone to mental illnesses as addiction has been related to mood or affective disorders, to neurotic illnesses and obsessive disorders, to anxiety disorders and many other psychological problems. Addiction is largely akin to compulsion or the need to repeat any particular behaviour in an abnormal dependent manner and addiction like compulsion is an abnormal dependence. Addicts are obsessed with the substance or objects or activity that they are addicted to and show an abnormal dependence on the substance or activity. Individuals with mood disorders or people prone to frequent depression are prone to addiction as any addictive substance or drug or even activity such as sex that gives short term pleasure can cause the addict to return to this activity or substance again and again so that the depression is forgotten for a while. This need for short term pleasure leads to repeated pleasure seeking behaviour and thus creates addiction.

All human beings are necessarily pleasure seekers, we all like to experience that is good or beautiful or provides a moment of happiness but addicts are in turn addicted to this pleasure as well. In fact addicts are addicted to the pleasure and not to the drugs, which are simply catalysts to provide them this pleasure. The drugs and the objects as also the activities that they repeatedly engage in provide them a solace that they feel they would not find in other options. There are of course chemical changes in the body so there are substantive proofs that addicts do get short term pleasure. Thus a drug addict repeated uses drug because it provides a particular form of pleasure that he will not get by say watching films and a sex addict repeatedly seeks sex because the pleasure from sex according to her may not be found in other activities such as travelling or reading. However this is only a belief that the addict has and is not necessarily true. In fact there is a sort of fixation of want, and an obsession with the object of want so an addict repeatedly thinks about this want and convinces himself that without the addictive substance he will not be able to survive. When love becomes an addiction, it can lead to suicide or fatal consequences when the object of desire is not attained.

Addicts are thus obsessed and largely depressed individuals who sometimes use the obsession against the depression or to overcome the depression. They are socially withdrawn although they may apparently have a huge circle of friends with whom they may not be able to relate at all levels. Addicts are also susceptible to suggestion and they are vulnerable to opinions of other people. Strange that it may sound, it is easy to mould or change addicts and also easy to hypnotize them as they are very impressionable and easily affected by what people and society have to say about them. This weakness of addicts is also their strength as both negative and positive influences can act equally well on addicts and the right guidance would be necessary to show them what is good for them and what is bad.

How is addiction controlled and stopped?

Stopping or overcoming any addiction could be a challenge but as addicts are changeable and affected easily, it may be relatively easy to bring them back to normal life provided they have the right type of guidance and counselling.

One of the strategies that could be used to cure addictive behaviour would be ‘diversion’, providing alternative substances/activities or shifting their attention or interest into something other than the addictive substance or object. As a TV addict could be encouraged to develop more constructive habits of reading for instance.

‘Substitution’ would be another method and a person addicted to alcohol could be encouraged to take a drink that tastes like wine but does not contain alcohol.

‘Eradication’ or complete unavailability of the addictive substance or object can gradually lead to forgetting the pleasure giving substance and interests in other activities. The complete unavailability of a drug, even a sleeping pill can lead to lessening of addiction for that drug and help the addict to develop other interests, although this should not be done abruptly as physiological and psychological symptoms of withdrawal may result. So if someone is addicted to a specific medicine or pill, the doses could be slowly reduced before completely stopping intake of the drug.

Finally ‘suggestion’ or counselling to change behaviour highlighting the bad effects of a drug or an obsessive activity could be effective at a later stage after withdrawal from the drug or activity has been attempted as when in need of any substance, addicts lose all sense of reality and may not even want to listen to advice. So, only when their dependence reduces to an extent with the help of the other methods of substitution, eradication or diversion, counselling could help them to show more reasonable and socially responsible behaviour and prevent further conditions of relapse.

Reflections in Psychology – Part I – by Saberi Roy (2009)
http://www.lulu.com/content/5865445

Saberi Roy – Books
http://saberiroy.tripod.com/books

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