Healing Depression
by
Mitch Hall, PhD
Depression: Dark Night of the Love-Starved Soul
Abstract
This essay, based on a selective literature review, defines depression; critiques the prevailing materialistic, reductionist, genetic-biochemical-imbalance theory of depression and the treatments that derive from it; presents an overview of the physical, emotional, and behavioral symptoms of depression; discusses the neurobiology of depression; interprets causes of depression with reference to nutritional, developmental, interpersonal, traumatic, socioeconomic, and existential/spiritual factors; emphasizes developmental and interpersonal causes as explicitly affecting the neurobiology of depression; and discusses what interventions and life-style changes can prevent depression and help a person recover from this dark night of the soul and thrive. A few examples from the author’s work as a mental health counselor illustrate some points. The potential benefits of raja yoga practice for healing from depression are also reviewed.
Defining Depression
The World Health Organization (WHO) defines depression and describes its key features as follows.
“Depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration. These problems can become chronic or recurrent and lead to substantial impairments in an individual's ability to take care of his or her everyday responsibilities. At its worst, depression can lead to suicide, a tragic fatality associated with the loss of about 850,000 thousand lives every year” (WHO).
Calling depression a mental disorder is accurate yet also a bit misleading since it focuses on a single individual’s mind and behaviors. However, it is important to consider the condition more holistically and contextually for three reasons. For one, the definition may fail to convey how depression involves the entire human being, body and soul, not just the mind. Secondly, while depression manifests as individual suffering and dysfunction, it is not just an individual problem. Rather, depression is an alarming indicator that a human being has either lost a vital relationship or has not received, possibly from the earliest stages of life, the emotional nurturance, social support, and, at times, nutrition needed to develop optimally and to thrive. In other words, depression is a common relational disorder, not just an individual one. Thirdly, depression is a global social issue.
Another overview of depression comes from a medical doctor who has treated many patients with this disorder.
Depression in its most extreme expression is a kind of paralysis in which the patient wishes to withdraw most of the time, a state in which he loses all interest in the activities of the world, a state in which his whole being feels frozen in a single mood. The patient tends to meet positive suggestions with downcast looks and a flat statement that “it is all too hard” or “too impossible” to do. The depressed state of mind is one devoid of creativity (Cowan, 2007, p. 296).
Incidence of Depression
On a worldwide scale, 121 million people suffer from depression. It is the leading cause of years lived with disability and fourth leading cause of “potential life lost due to premature mortality and the years of productive life lost due to disability” (WHO). It may affect people of all genders, ages, and backgrounds.
“WHO reports that depression in adults will soon reach epidemic proportions” (Sunderland, 2006, p. 10). In the US, at any given time one in ten people suffer from some level of depression, and “about 17 per cent will suffer serious depression at some point in their life” (Gerhardt, 2004, p. 116). “About 2 in every 100 children in US are taking antidepressants” (Sunderland, p. 10). Depression costs America more than $50 billion per year (Lewis, Amini, & Lannon, 2000). “The rate of depression has been rising steadily since 1960. Suicide rates for young people have more than tripled over that time; killing oneself is now a leading cause of death in adolescence” (Lewis, Amini, & Lannon, p. 211). Fifteen percent of severely depressed people commit suicide (Gerhardt, p. 116).
Symptoms of Depression
To describe depression more thoroughly, we can look at its symptoms. With regard to physical appearance, researchers have not been able to find a facial expression that is necessarily indicative of depression (Ekman, 2003). However, it can often be recognized by a slumped, collapsed appearance, marked by “sagging shoulders, hanging stomach and inwardly turned feet and knees” (Cowan, 2007, p. 296), as well as “a severe loss of the longitudinal arch (main arch) resulting in feet that turn inward and down” (Cowan, p. 297). The depressed person shows low energy levels.
Emotionally, depression is often characterized by an empty feeling, an all-pervasive gloomy mood, a lack of normal variance in feelings, and a lack of enthusiasm and excitement. Mentally, depressed people ruminate a lot about past mistakes, humiliations, failures, and shame. They cannot stop themselves from thinking about these supposed failures.Their minds are full of frequent, negative self-talk and self-reproaches. They feel inadequate, ineffective, unwanted, worthless, hopeless, pessimistic, and a mistake. Depressed people lack will power. They are unable to take small, practical steps toward improving situations. They do not want to get up or do anything. They do not engage in active problem solving in collaboration with others. They either withdraw from others or react aggressively. While they crave approval from others, their interpersonal relationships are unsatisfying. They feel “there is no way of redeeming the self, of recovering other’ good opinion or love” (Gerhardt, 2004, p. 129). They blame themselves for their own supposed inadequacies and misery. “Psychologically, the depressed person fails to shake off negative thoughts and feelings” (Gerhardt, p. 128). Existentially, “they often ask questions about issues of love, family, God, meaning and their own purpose,” (Cowan, 2007, p. 289).
Neurobiology of Depression
The physical, behavioral, emotional, and mental symptoms of depression entail profound neurobiological factors as well. Depressed people tend to have high levels of stress hormones and deficiencies of neurotransmitters and hormones associated with pleasant feelings. “Depression is an illness in which the brain keeps pumping out more and more stress chemicals, and you can’t turn the pump off. This then blocks the release of positive arousal brain chemicals. The result is a form of hell-on-earth” (Sunderland, 2006, p. 265).
“Depressed people do usually have some combination of low serotonin and low norepinephrine” (Gerhardt, 2004, p. 113). Serotonin is a monoamine neurotransmitter that plays many roles involving temperature regulation, sensory perception, falling asleep, and feeling peaceful. Serotonin receptors are located in the brain and gut (BBC4, 2003). Norepinephrine is a catecholamine neurotransmitter, produced in the brain and peripheral nervous system, and involved in arousal, reward, and regulation of sleep, mood, and blood pressure (BBC 4). A combination of low dopamine and low norepinephrine in depressed people makes it difficult for them to concentrate (Sunderland, 2006). Dopamine is a catecholamine neurotransmitter involved in regulating emotional responses and some good feelings (BBC 4). “Dopamine flowing through the orbitofrontal cortex helps it to do its job of evaluating events and adapting to them quickly. It also helps the child to delay gratification...”(Gerhardt, p. 118-119). Decreased opioids in depression also contributes to increases in negative feelings, fear, and stress, and to decreases in positive feelings (Gerhardt).
It is important to question whether brain chemistry imbalances are truly causes of depression or are themselves effects of other forces. Cowan (2007) views “suppressed serotonin output in the central nervous system” (p. 289) as a result of other imbalances. Gerhardt (2004) has asserted that, “Clearly, it is not the presence or absence of biochemicals alone which creates depression. In fact, it is more probable that these biochemicals are depleted as a side effect of an overactive stress response” (p. 113).
In addition to biochemical imbalances in the brains of depressed people, structural and functional abnormalities have also been observed. Cozolino (2002) reported decreased hippocampal and amygdaloid volume due to cell loss from neurotoxic effects of high stress hormones, particularly cortisol, in depressed people. “The amygdala has a central role in the emotional and somatic organization of experience, whereas the hippocampus is vital for conscious, logical, and cooperative social functioning” (Cozolino, p. 96). The amygdala, which is functional at birth, is the fear center of the brain. It appraises safety or the lack thereof, appraises the emotional valence of incoming stimuli, unconsciously stores memories of trauma, and sends alarm signals for fight, flight, or freeze behaviors (Siegel, 1999). The hippocampus, which becomes functional in the second and third years of life, mediates explicit memory, creates links among different brain circuits, allows for factual and autobiographical memory, works with the orbitofrontal cortex to evaluate situations and anticipate outcomes, integrates traumatic experiences into verbal memory, is involved in a sense of self through narrative awareness with past, present, and future chronology, and coordinates memory with the dorsolateral cortex (Siegel). The optimal functioning and mutual regulation of the amygdala and hippocampus are essential for normal cognition, emotional regulation, and behavior. Depressed people have impaired, dysregulated hippocampal-amygdaloid circuits (Cozolino).
Further brain function imbalances have been observed in depressed people with regard to the most evolved areas of the human brain in the prefrontal cortex. fMRI studies have shown inactivity in some areas of the prefrontal cortex of people suffering from depression (Gerhardt, 2004). In emotionally healthy people, the left hemisphere of the brain tends to be more active than the right hemisphere. However, in people with depression, the relationship is reversed with a highly active right brain and underactive left brain (Gerhardt). Similarly, Cozolino (2002) commented on “lower levels of metabolism in the left-prefrontal cortex of depressed patients” (p. 308). This is significant because the left hemisphere mediates more positive, upbeat feelings and moods, whereas the right hemisphere mediates negative, unhappy ones. As we have seen, depressed people have overactive stress systems with high cortisol. “High cortisol levels are also associated with a highly active right brain and an underactive left brain....An active left brain is linked to positive feelings, cheerfulness and a willingness to approach others with a kind of extraverted outlook” (Gerhardt, p. 121). Depressed people have difficulty identifying their feelings verbally. Neurobiological imaging has found that in depression there is a “reduced density of neurons in the dorsolateral part of the prefrontal cortex, the area that is involved in verbalizing feelings” (Gerhardt, p. 126). Additionally, depression “may mean that the important regulatory connections between the prefrontal cortex and the subcortex are weaker” (Gerhardt, p. 119).
As we consider the implications of the neurobiology of depression, we can understand better why depressed people show a lack of self-regulation, initiative and creativity. “Brains that are emotionally underpowered by a lack of neurotransmitters and a less developed prefrontal cortex find it hard to generate new solutions, to find new ways of managing and calming the overactive stress response” (Gerhardt, 2004, pp. 131-132).
Causes of Depression
Having defined depression, looked at its incidence, and described its symptoms and neurobiology, it is now time to review relevant literature about its causes. The leading theory in allopathic medicine and psychiatry is that depression is caused by a chemical imbalance in the brain and that some people are genetically predisposed to develop such an imbalance. However, as far as I am aware, no clear genetic marker has been found to substantiate this theory. Furthermore, scientific developments in the field of epigenetics have demonstrated that experience in relation to environmental factors, including especially significant others, determines how many genes express themselves (Siegel, 1999). Also, there is no test of the blood or spinal fluid that indicates that an individual is depressed (Cowan, 2007). The lack of such solid empirical evidence for the theory that depression is due to a chemical imbalance calls into question the theory that it is caused by a chemical imbalance in the brain combined with a genetic predisposition. The depression-associated hormonal and neurotransmitter imbalances in the brain, along with structural and functional abnormalities in the brain’s neuronal networks, as described in the preceding section, are more plausibly derivative of other causes. If that is so, what are these other causes?
In the literature reviewed, I have identified six, often interrelated, types of causes for depression. They are nutritional, developmental, interpersonal, traumatic, socioeconomic, and existential/spiritual. Let’s consider each of these. When they operate singly or in combination, they induce the changes in brain chemistry, structure, and function that are biological markers of depression. These causes lead to an individual’s having a chronically activated stress system and a more “fragile sense of self” (Gerhardt, 2004, p. 114) than those who do not tend to become as easily depressed. A less robust sense of self leads to a reduced capacity to cope with the inevitable changes and losses life brings and with the unfortunate shocks and traumas that may occur. Depressive episodes may be cumulative and lead to a vicious cycle of depressed thinking, mood, and behavior unless therapeutic interventions, appropriate to the causes, are found and implemented. What may help a person heal from depression will be discussed in the final section of this paper.
Nutritional Causes of Depression
Regarding nutritional factors that may either cause or aggravate depression, the following have been identified: deficiencies in B-vitamins and Omega 3 fatty acids in the diet (Gerhardt, 2004); deficiencies in vitamins A and D and long-chain fatty acids found primarily in healthy animal fats (Cowan, 2007); excesses of carbohydrates that provoke excessive insulin production and thereby drive blood sugar too low, which can be another biological marker of depression (Cowan). Another nutritional factor is related to whether an infant is breast-fed or bottle-fed.
“Breastfed infants have higher levels of polyunsaturated fatty acids (PUFAs) than bottlefed babies. These essential fatty acids are involved in producing neurotransmitters such as dopamine and serotonin, especially in the prefrontal cortex...Interestingly, links between low PUFAs and human depression have also recently been established, although it has been found that PUFA supplements or a diet high in oily fish do help recovery from depression” (Gerhardt, p. 119).
The brain and nervous system vitally need the nutrients mentioned here in order to function optimally.
Developmental Causes of Depression
Developmental causes of depression have been well documented. These are intrinsically interpersonal because of the deep developmental need we each have for loving nurturance, care, attention, safety, and secure attachment with at least one primary care giver from the beginnings of life. When we do not receive such sustained, loving interpersonal care, on which our very survival depends in the womb and as infants, toddlers, and children, we experience the deficiencies as highly stressful and even traumatic.
There is remarkably little recognition that the adult’s brain is itself formed by experiences starting in the womb, or that these may have contributed to a predisposition to depression. Yet there is abundant evidence that an overreactive stress response underlies chronic depression, as well as other brain systems that are being orchestrated and fine-tuned in infancy (Gerhardt, 2004, p. 116).
Lack of secure nurturance in the earliest stages of life leads to chronically high stress response with high cortisol levels and fewer cortisol receptors. “There have been numerous studies linking depression with such a hyper-reactive stress response” (Gerhardt, 2004) p. 117). A depressed mother, usually the primary caregiver, is not able to give an infant, toddler, or child, the crucially needed care and attention that will regulate that child’s emotional development. “Children of depressed mothers have a 29 per cent chance of developing an emotional disorder compared to 8 per cent of children with a medically ill mother” (Gerhardt, p. 131). With regard to the specific emotional disorder known as depression, “when they grow up, these children of depressed parents have about a six times greater risk of succumbing to depression themselves” than do children of parents who are not depressed (Gerhardt, p. 123). Observational studies of interactions between infants and emotionally healthy mothers versus such interactions between infants and depressed mothers found the following. Emotionally health mothers’ interactions with their infants alternate between between friendly play half the time and neutral presence the other half of the time (Gerhardt). By contrast, depressed mothers are disengaged and unresponsive about 40 per cent of the time, and they are intrusive, rough, and angry 60 per cent of the time (Gerhardt). Infants experience as stressful and traumatic both the chronic indifference and the hostility from their primary care giver, the person from whom they are seeking, through their inborn attachment behavioral system, safety. Babies of depressed mothers do not have the normal left-hemisphere predominance associated with a more cheerful disposition. They are “less affectionate and less likely to approach their mother whilst playing” (Gerhardt,p. 122). A depressed mother cannot help her babies regulate their emotions or develop the neural networks that make affective self-regulation possible later in life. The stress response system of such children becomes set at a chronically high level. “Research shows that if your child has an over-reactive stress response system, he or she will be vulnerable to suffering from depression in later life, as a reaction to life’s hard knocks” (Sunderland, 2006, p. 31).
Another documented cause of an over-reactive stress response system and of depression, is losing a mother before the age of 11 (Gerhardt). A mother may be lost due to abandonment, prolonged separation, incarceration, severe illness, or death. “The alarm response in a child stressed by repeated or long-term separation from her mother is the same as that found in many adults suffering from clinical depression...” (Sunderland, 2006, p. 58). Whether a mother is depressed, abusive, or missing, a baby’s needs for secure attachment and care are not met.
Babies come into the world with a need for social interaction to help develop and organize their brains. If they don’t get enough empathic, attuned attention--in other words if they don’t have a parent who is interested in them and reacting positively to them--then important parts of their brains simply will not develop as well (Gerhardt, p. 126).
Repeated parental failure to soothe a distressed infant is a risk factor for depression throughout life. “The stress of unrelieved crying can leave an infant’s brain in a disrupted state” (Sunderland, 2006, p. 43). Babies who are neglected or abused, who do not feel safe, whose cries for attention and care are not met, have little choice but to try not to feel and to ‘play dead,’ in other words, to become depressed. “In this state of powerlessness and stress, high levels of cortisol are produced” (Gerhardt, 2004, p. 120). As already mentioned, excessive cortisol is neurotoxic. It is a primary biological need of infants, toddlers, and young children to received comfort from their care givers. However,
“if the child learns instead that he cannot turn to mum or dad for comfort when he is distressed, because they ignore him or punish him even more, then he will be stuck in stressful feelings, with cortisol running high, unable to turn it off. That is the parent’s job in early life as the child has no capacity to regulate himself” (Gerhardt, p. 129).
The connections between child maltreatment and subsequent depression later in life have also been robustly established.
A study of almost 10,000 patients in a medical setting...reported that persons with histories of being severely maltreated as a child showed a 4 to 12 times greater risk of developing, depression, substance abuse, and attempting suicide than those who did not suffer such maltreatment” (van der Kolk, 2003, p. 168)
How do early neglect, abuse, and trauma affect a developing person’s sense of self? Attachment research, which has been supported by the neurobiological findings, thanks to developments in imaging technology, has found that a strong sense of self depends on secure attachment in the early stages of life. When a child’s developmental needs for attuned, consistently caring, emotional stable parenting are not met, the sense of self is fragile, and this fragility can persist throughout life unless adequate restorative interventions take place. What does a fragile sense of self have to do with depression? The British psychotherapist Gerhardt (2004) stated,
“I believe that the core of depression is a fragile sense of self. It is a deep well of inner hopelessness, which brims over periodically when a vulnerable person’s stocks of well-being are depleted--whether by a lack of essential nutrients, a lost relationship, a humiliation, an illness, or a burglary” (Gerhardt, p. 114).
The foregoing discussion has elucidated that a fragile sense of self comes from “a certain negative atmosphere in which the depressed person has grown up” (Gerhardt, p. 115). Longing for parental approval, yet despairing of ever getting it, the child develops an unconscious internal working model of the self as unworthy of love, inadequate, or bad for not living up to parental expectations or winning their attention. This sense of being a flawed person is more tolerable to a child than the unbearably terrifying possibility that one’s own care givers, upon whom one depends for survival, are themselves at fault. This is a psychological defense that the Scottish psychologist Fairbairn called the child’s moral defense (Gerhardt). The internal working model of being an inadequate human being gets painfully triggered later in life from others’ criticisms, rejections, and indifference. This can be the excoriating experience of primal shame. It is the reason that, “experiences of feeling rejected or abandoned by other people are the most common triggers for depression” (Gerhard, p. 114) in adulthood. The failure to receive needed emotional, or at times practical, support that has been sought or previously relied upon taps into earlier wound to self-esteem and can precipitate a depressive episode. The seeds of an adult’s depression may have been planted in the earliest periods of that person’s life. The relationships and events that were stressful and traumatic and that disrupted neurobiological integrity are probably not explicitly remembered, but they are implicitly remembered in the very depths of the organism. Thereby, “early stress leads to a vulnerability for depression later in life. This, in part, is mediated by deficient organization of frontal circuitry and the establishment of lower levels of excitatory neurotransmitters and growth hormones during critical periods” (Cozolino, p. 312).
Socioeconomic Causes of Depression
Socioeconomic factors also need to be considered among the causes of depression. Parents who are poor, struggling to survive financially, lacking in access to social services, possibly from minority groups subjected to discrimination, and stigmatized as losers in a ruthlessly competitive, capitalistic economic system are likely to be highly stressed and, therefore, less able to give their children the attention, comforting, and security that the children need. The parents and their children are likely to suffer “more frequent triggers to depression, in the form of humiliations and frustrations” (Gerhardt, p. 125). Also, the parents may not be able, or well enough informed, to provide the high quality nutrition needed to nourish their children’s developing bodies and minds at a level adequate to provide the nutrients found to be essential for buffering against the risk of depression. In cases where financially disadvantaged parents succeed in raising emotionally healthy children, research has interestingly found about the parents that, “what mattered most was whether or not they had a good relationship with their own mother in childhood” (Gerhardt, p. 125). However, it has been noted that, on the whole, poor children may have unequal childhoods from those of children raised in more prosperous families. This is not tantamount to saying that children of the middle-class or the wealthy are spared the risk of depression. Clearly, emotional nurturance and care may be lacking in the child rearing of the privileged as well. Those who are more prosperous are only spared the additional burden of financial stresses. However, a comparative study of verbal interactions between parents and children in either professional or welfare households provided some evidence of why the poor kids are likely more at risk for depression later in life. By age 3, kids of professionals will have been told by their care givers 500,000 encouragements and only 80,000 discouragements. In harsh contrast, welfare kids will have received only 80,000 encouragements versus 200,000 discouragements (Tough, 2008, 2009). The negative attributions and discouragements that poor kids here in their earliest, most vulnerable stages of life are not conducive to a strong sense of being a worthwhile self deserving the best life has to offer. The negative messages can be additional fodder for depression.
Traumatic Causes of Depression
Sometimes an individual who has had the good fortune of growing up with relatively adequate nutrition, parenting, and socioeconomic security may suffer a severe catastrophic trauma that leads to a period of grief and post-traumatic stress disorder (PTSD) that may entail depression. For example, as a mental health counselor, I am currently helping a depressed adolescent client whose boyfriend was murdered in front of her eyes about 11 months ago. Whereas her grief and depression have been excruciating, she is slowly recovering. Her early life experience and her relatively good attachment with her mother have given her the resiliency and behavioral resources to survive from this traumatic loss with her sanity intact. It is awe-inspiring to witness her courage in facing life’s current challenges, despite her ongoing grief and depression. She has good prospects of recovery. Of course, the incident will pivotally mark the rest of her life. Nonetheless, depression is recognized as a significant phase of the cycle of grief, along with such reactions to traumatic loss as shock, denial, fear, anger, followed by depression and eventually some level of reconciliation. The progression through these phases of the cycle is not linear but more like a spiral. The depression phase is partly due to exhaustion of the resources of body and mind which calls for deep rest in order to recover.
Existential/Spiritual Causes of Depression
On the existential or spiritual level, depression can serve a function of calling a person to awaken to the purpose and meaning of his or her life, to make needed changes, to grow and to commit to self-transformative activities. A person who has not lived authentically, for whatever reasons, who is unconsciously stuck in an unfulfilling job, career, or relationship, or who has faced extreme hardships in life may sink into depression. This can be transformed into an opportunity for spiritual growth.
More than any other emotion, the dark mood of depression challenges us to self-analysis, challenges us to stand back and take account of how we live our life. Depression often occurs because changes are needed--changes in life-style, diet, work, relationships and outlook (Cowan, 2007, p. 297).
When we are supported appropriately in meeting the existential and spiritual challenges of depression, we may gain access to new depths of soul and insights, to renewed energy and more meaningful behavior, to greater compassion for the suffering of others, and to new skills for helping not only ourselves but other humans as well. In so doing, we will receive what one author has called the gifts and healing power of depression (Moore, 1992). We can integrate into a more robust sense of self the archetypal power and role of the wounded healer.
Interpersonal Causes of Depression
In the preceding sections, particularly the one on the developmental causes of depression, it is clear that the lack of a strong, caring, reliable social support network, especially in the closest relationships, is a cause of depression. This is the case, for example with postnatal depression (PND), which is suffered by one in five mothers (Grille, 2008). “Postnatal depression is virtually absent in societies where woman band together to raise their children in caring, cooperative groups” (Grille, p. 61). Furthermore, women whose childhood needs for empathy and emotional support were warmly provided for by their own mothers are far less likely to develop PND than women who were not supported in this way in their own childhoods (Grille, 2005). A further factor that may lead to PND is when obstetrical practices, such as caesarian section, anesthesia, and prolonged separation of mother and newborn, interrupt the biologically normative connection between them (Grille, 2005). At all stages of life, feeling wanted, valued, and understood in a network of sustained caring relationships, is a buffer against stress and depression, as well as a boost to our immune systems, self-esteem, security, health, and happiness (Pilisuk & Parks, 1986).
What Helps Heal Depression
The foregoing discussion of the causes of depression is already suggestive of measures that can help prevent it, reduce its severity, and heal it. Before exploring those implications, let’s consider how allopathic medicine and its mental health specialty, psychiatry, generally treat depression. Allopathic medical doctors and psychiatrists often tell a depressed patient that “the best bet approach to his genetically determined, chemical imbalance is to take certain medications, usually a serotonin reuptake inhibitor such as Prozac, Paxil, or Zoloft” (Cowan, 2007, p. 288). As noted above, essentially unscientific assumptions underly such a diagnosis “because no blood or spinal fluid tests have ever shown any value in making the diagnosis of depression” (Cowan, p. 288). Statistics regarding the effects of psychotropic medications for depression reveal that “as few as a third achieve a full remission of their symptoms” (Gerhardt, 2004, p. 113). Another third get some improvement with remaining symptoms, and the last third experience no improvement whatsoever. These are not stellar results. Nonetheless, WHO still maintains that, “antidepressant medications and brief, structured forms of psychotherapy are effective for 60-80 % of those affected and can be delivered in primary care” (WHO). The success rates claimed here combine psychotherapy with medications and appear to conflate those who benefit substantially from the recommended allopathic treatment regimen with those who get only partial, symptomatic relief. WHO is aware as well that, on a worldwide scale, the reach of this form of treatment for depression is limited because “fewer than 25 % of those affected (in some countries fewer than 10 %) receive such treatments. Barriers to effective care include the lack of resources, lack of trained providers, and the social stigma associated with mental disorders including depression” (WHO). A downside to medicating depression is that when symptoms are suppressed a side effect can be a reduction in the motivation to make the changes that will get at the roots of the depression in the first place and therefore lead to a healthier level of functioning (Cowan, 2007). However, at times, allopathic interventions may be needed and, in the case of suicidal patients, may save lives. Emergency mental health services, including involuntary psychiatric hospitalization in extreme cases, may be the best available option.
Beyond the allopathic medical approach, how can a person with depression be helped? As the old adage states, “an ounce of prevention is worth a pound of cure.” Preventing depression through healthy nutrition, adequate exercise, natural childbirth practices that support bonding between mother and infant, parenting that is nurturing and empathic, cultivating vibrant, supportive family and friendship networks, a social welfare policy that assures the well-being of all people in a society, and pursuing a meaningful life purpose grounded in self-understanding and a wise existential/spiritual philosophy can all synergistically go a long way to preventing depression, as well as to treating it. Let’s look some key components for the prevention and treatment of psychological depression.
How Nutrition Can Help Heal Depression
A balanced, healthy diet is essential for physical and mental health. Individual needs differ, of course, and there can be a wide range of health issues that call for appropriate dietary support. In general, however, based on what is currently understood about brain chemistry and the sorts of nutritional deficiencies and excesses that can contribute to depression, some dietary guidelines can be suggested (Cowan, 2007). Adequate B-vitamin intake is essential to nourish the entire nervous system, including the brain, as are vitamins A and D. Cod liver oil in adequate amounts to provide 10,000 IUs of vitamin A and enough vitamin D daily can be a part of the treatment diet. Getting out in the sunshine, when possible, can also enhance vitamin D reserves and is especially important for those who may suffer from seasonal affective disorder. Full-spectrum lamps can also help for those who cannot get enough sunlight. Healthy animal fats, such as found in ghee and cultured butter, are important. Organ meats, eggs, and seafood provide needed long-chain fatty acids, DHA and EPA. It helps if people with depression become mindful of their food and savor it as enjoyment itself counteracts depression. Carbohydrate consumption needs to be limited to no more than a fourth of any meal, and whole grains are to be preferred over refined ones. Trans-fatty acids should be assiduously avoided. In connection with the need to attend more to feelings and the inner depths of soul, it may be helpful not to eat after 7 p.m. so that one can be more in touch with dreams when sleeping (Cowan). An herbal supplement of Hypericum perforatum (St. John’s wort) has been the subject of research and promising clinical trials. Unlike antidepressant medications, it does not work as an MAO inhibitor or serotonin reuptake inhibitor. Rather it supports liver function and enhances liver enzyme efficiency. It active ingredient, hypericin, has the added benefit of being anti-viral. Castor oil packs over the liver one hour daily, three to five times per week, are also recommended for enhancing liver function, which is considered vital for a stable, good mood (Cowan). Because the left hemisphere of the brain is underactive in depressed people, it has been found “magnetic stimulation of the left hemisphere” can be a beneficial, noninvasive intervention to treat depression (Cozolino, p. 312).
Parenting to Prevent and Treat Depression
In light of the extensive discussion above about developmental causes of depression through the effects of inattentive parenting, depression in the primary care giver, and stress-inducing, traumatic child abuse and neglect, it is important that children be raised by emotionally stable, caring, balanced, attentive, empathic, nonviolent, supportive, loving parents and care givers. Because depression induced in the earliest stages of life can have devastating, life-long effects, and also because the effects of depression are cumulative, it is important to educate prospective parents as widely as possible about current understandings of optimal parenting practices. Several recent books, informed by current neurobiological and attachment research, contribute wonderful guidance along these lines (Gerhardt, 2004; Grille, 2005; Grille, 2008; Siegel & Hartzell, 2003; Sunderland, 2006). Books such as these ought to be the basis of educational curricula on parenting to be presented in all high schools and in community clinics and agencies concerned with children’s welfare. Societal as well as individual health can benefit from such curricula, and the mounting epidemic of depression can be greatly curtailed as a result.
As a historical note, we may add that US culture has unfortunately had some widespread influences that have aggressively promoted unwholesome parenting practices that are likely to induce stress and depression in children. These go back at least to the turn of the 20th century and continued to dominate for the next 50 years. The most popular child-rearing manuals of that era, such as those by the pediatrician Luther Emmett Holt and the behaviorist John Broadus Watson, advocated elimination of the rocking cradle, not holding babies to soothe them, not responding to or picking up crying infants, having babies sleep in separate rooms, feeding on rigid schedules, not giving affectionate touch, and coldly preparing children for emotional independence from the very beginnings (Montagu, 1971,1978). In more recent decades, and up to the present time, right-wing, evangelical leaders, such as Gary Ezzo and James Dobson, sell millions of books and influence large audiences by radio and television with their advocacy of harsh child-rearing practices that include physical punishment from the earliest ages to break children’s wills and hitting children even more if they cry beyond two to five minutes (Blumenthal, 2009). Such child rearing, claiming Biblical authority as its source, goes against the compassionate wisdom of loving human hearts and also against the well-documented, scientific knowledge that neurobiology and attachment research have developed.
Enlightened social policies that assure that parents will have the time and resources to give their infants and children the loving care and guidance they need are also needed. An elaboration of such policies is beyond the scope of this paper. Children’s protective services and community networks and agencies to support parents are also clearly needed on a level beyond what is currently in place.
Interpersonal Connections to Treat Depression
We human beings are open systems depending at all stages of the life cycle on meaningful, supportive, interpersonal connections in order to thrive (Lewis, Amini, & Lannon, 2000). When we are depressed, for whatever reasons, we need healing connections with others. The healthier and more sustained those healing relationships are, the more they can help heal the broken hearts of spirits of depressed people (Lewis, Amini, & Lannon; Schore, 2003). Sustained relationships with emotionally healthy people can directly induce beneficial changes in the neuronal networks and biochemistry of depressed people (Schore). Those relationships can be with friends, psychotherapists, pastoral counselors, family members, colleagues, and others. Whereas therapists may be trained to provide professional help, it is essential that they be as emotionally healthy as possible themselves so that their influences, both intended and unconsciously induced through direct limbic brain resonance, can be beneficial (Lewis, Amini, & Lannon). Therapists may use a wide range of techniques, including bibliotherapy, expressive arts, music therapy to evoke varied moods, dream work, movement, empathic dialogue, and more. The techniques may contribute to healing a person with depression, but the most significant healing factors are the emotional health and ethical conduct of the therapist. Emotionally safe, reliable, sustained human connections can provide help reduce cortisol levels, soothe a highly activated stress response and bring a person back into the sunlit field of human kindness from the solitary-confinement dungeon of depression.
Existential, Spiritual Approaches to Healing Depression
Life at its best inevitably entails some losses, disappointments, sadness, and grief. Recognition of this reality is an important component of a mature personal and spiritual philosophy. “The treatment of depression, therefore, should not so much help the patient suppress his bleak mood, but rather help him avoid becoming stuck in that mood, unable to experience--or even acknowledge--that other moods exist” (Cowan, 2007, p. 290). The dark night of the soul has been recognized in diverse spiritual traditions as an important preparatory stage for deeper initiation into the mysteries of life and a prelude to altruistic service to others and a more joyous life. Depression can be an opportunity to develop greater self-understanding, insight, wisdom, energy, and compassion for the sufferings of others. Therapeutically speaking, “when we are depressed, we must begin to pay attention to the realm of soul, to the world of emotion” (Cowan, p. 290).
The depressed person will undoubtedly need the guidance and help of others in order to transform the agonizing ordeal of depression into a spiritual opening. In my counseling work with a traumatized, depressed adolescent whose boyfriend was murdered in front of her eyes, I have been witnessing, respecting, and validating her spiritual awakening and self-discovery in her own terms and at her own pace. She reports that, along with her often-overwhelming grief, she now understands and feels so much more deeply and compassionately than before the suffering of others. She has been chosen by peers for a leadership role in a church-based youth group that aims to build peace among youth in a high-violence, gang-ridden urban area. As her helper, I can be there gently with her, open to listening empathically and unconditionally to whatever she shares, and letting her know again and again that all the grief she is going through is normal and that she has within herself the resources to build a new, meaningful life and to regain the capacity for interpersonal connection, finding a purpose in living, and even experiencing, whenever she will be ready, some joy in living. I believe that some form of altruistic service that is personally relevant to the individual can be an important aspect of healing from depression. Through altruistic service and dedication to a humane cause, the energies of the individual life stream may flow into and join the sea of humanity, just as individual suffering may be transmuted into a source of compassion.
Exercise and Movement to Treat Depression
“For no other medical condition is exercise so important as it is for depression... Exercise raises the levels of mood-enhancing chemicals called endorphins in the brain” (Cowan, p. 295). This advocacy of exercise to treat depression is widely recognized as sound advice. Daily walks in nature, if available, can be highly beneficial. Walking as vigorously as one’s condition allows, at least 20 to 30 minutes a day six or seven times a week is recommended. Depressed people can be encouraged to find the forms of exercise that appeal to them personally, whether dancing, walking, jogging, strength training, taiji, qigong, yoga, tennis, badminton, golf, bowling, martial arts, fencing, or team sports. Because depressed people tend to be collapsed, movements that extend the limbs outward and upward, that introduce levity and spontaneity are beneficial. Breathing is severely inhibited in depression, so enhancing the depth of breathing, thereby clearing the body of carbon dioxide and bringing in more enlivening oxygen to the cells and tissues is an important antidote to depression. Because depressed people tend to be energetically stagnant, rhythmical movement is especially beneficial. Exercise strengthens the will and energizes the person, thereby creating the capacity for making more needed changes in one’s life. Exercise improves metabolism, so food is utilized more efficiently.
How Raja Yoga Can Help of Depression
Raja yoga involves physical exercise in the form of rhythmical movement and comprehensive stretches (asanas) of the entire body, mindful breathing practices, meditation, and a profoundly evolved spiritual philosophy that promotes self-realization and selfless service. In addition to millennia of practice that has empirically demonstrated wide-ranging physical and mental health benefits of raja yoga, this holistic approach to cultivating the healthiest human potentials has also been the subject of scientific research into its therapeutic applications for a wide range of health conditions, including depression. Many controlled studies have been conducted along these lines. The findings are good news. “Available reviews of a wide range of yoga practices suggest that they can reduce the impact of exaggerated stress responses and may be helpful for both anxiety and depression. In this respect, yoga functions like other self-soothing techniques, such as mediation, relaxation, exercise, or even socializing with friends” (Harvard Mental Health Letter, 2009). As has been shown above, hyperactive stress responses are one of the core conditions of depression, so yoga’s demonstrated ability to regulate the stress response and bring it toward more normal levels is an important therapeutic benefit in the treatment and healing of depression.
Yogic breathing practices are particularly profound for treating depression, since breathing is a marker of emotions and moods. Each emotion has its characteristic breathing pattern. When a full, healthy breathing rhythm is practiced, a person can be helped to feel good. I have personal experience in teaching yogic breathing practices to depressed clients, and they have been amazed to find themselves feeling peaceful and relaxed, even if for moments. Deep, rhythmical breathing can help quiet the mind, and, as we have seen, the minds of depressed people are often tormented by painful ruminations. Mindful practice of asanas, breathing, and meditation is one of the most effective ways to develop a quieter mind. Depressed people have the opportunity through raja yoga to discover that beneath the tumultuous waves of their agitated minds, there has always been an abiding peace at the heart of their being. The more they can experience this peaceful core, the less depressed they can become.
Through prenatal yoga practice, pregnant women can offer the babies in their wombs a more peaceful, less stressed gestation. Through peri-natal yoga, mothers of infants can be helped to find more balance, resilience, and ability to cope with the challenges of child rearing more calmly than might otherwise be the case. Fathers and siblings of babies can, of course, also benefit from raja yoga.
For the reasons stated above in the section on interpersonal connections to treat depression, when a yoga teacher is emotionally healthy and mindful, she or he can intrinsically benefit yoga students who may be depressed, especially if a sustained educational relationship develops between the teacher and students. The yoga teacher gives the students time-tested, salutary practices they can do throughout life, principles of relaxation, centeredness, and mindfulness for applying in daily living, a healthy role model, and also an emotionally safe mentoring relationship that can itself be a healing influence. Through the quiet practice of raja yoga, an overly reactive stress response can be calmed, a fragile sense of self can be bolstered, and depression can be healed. The profound spiritual philosophy and ethical principles of raja yoga can provide needed guidance to help a depressed person become more open, altruistic, compassionate, soulful, and content. The community of fellow yoga students can provide the friendly, supportive interpersonal connections the depressed person needs to heal. Raja yoga is at its best cooperative rather than competitive, inclusive rather than exclusive, safe rather than dangerous, and altruistic rather than selfish. It can help a depressed person regenerate healthy mental and physical functioning. The potential of raja yoga, in all its dimensions, to help people heal from depression is profound.
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