Can we ‘unmake’ DEPRESSION, anytime soon?
synopsis — black fogs — Freudian slippage — the dog that didn’t bark — am I a fool? — self-perpetuation — my conclusion — 3 life stories — a befogged future?
black fogs
DEPRESSION makes no sense. That is its hallmark. Thoughts, memories, and yes, pains, billow up from below, unannounced, unstoppable, as if out of the blue. Into a sunny rose garden, an uninvited black fog instantly blights all, expunging every last ray of serenity and solace. It was this utter ‘insolvability’ that intrigued me, and which opened up an inkling, precisely 30 years ago.
It is surely unconscionable that something as cataclysmic as depression, would leave no clues as to where it came from. What was obvious was that neither the sufferers nor those around them could make head nor tail of it — which is of course, why it inflicts so much damage. It takes over. It doesn’t seem to care. And it so effectively covers its tracks that though there must surely be a potent reason somewhere, to account for such hideous turmoil, it keeps itself mighty close. Nevertheless, propitious circumstances all those years ago, lifted a corner of this impenetrable camouflage and revealed tell-tale signs that something quite definitive was regularly afoot, something which kept repeating the sickening old canards, like a broken cog in the mental system.
As with any Sherlock Holmes mystery, it pays to stick to the facts. In this case, listen carefully to those who suffer, or have suffered from depression. Two plangent cases, excerpted below, have recently appeared in the public domain [1], which speak volumes, if you know were to look. Sadly, looking in the wrong place is unnervingly easy — whereas exploring the right avenues is painfully hard, pathognomonically so, to deploy a spectacularly apt medical epithet. As with one of Sherlock’s fascinating mysteries, it wasn’t what happened that gave the game away, it was the dog that didn’t bark. Same here. I’d spent my earlier working life since 1963, chasing just such a hidden key, and it struck me that sufferers seemed to be leaving out several conspicuous factors — they were dodging round certain painful points, fudging significant items, as if traversing a mental minefield. What was going on? Which bits didn’t ‘bark’? And why?
Freudian slippage
Close study of Freud, didn’t help. Agreed, he had established ‘talk-therapy’ as the invaluable tool, but the fact that he lived in a Nineteenth Century Time Warp, believing in a Clock-Work Universe no less, meant that he had to conclude, like too many do today, that it is an illusion to suppose humans have free choice, options or self-determined spontaneous motivations. I bundle all these into the composite term ‘intent’, which to me, offers the only escape route. I therefore left Freud behind. He was looking for a supposed ‘fuel’ to drive the human machine — I was looking for ‘verbal spanners’ which could ‘unblock’ the broken cogs. So it was that, one day in September 1986, after I’d been working as a Family Doctor for two decades, a sufferer opened my eyes to a new avenue. I knew her, and her late father, well — a supreme advantage in Family Medicine. Also, by that time, she knew and trusted me — a further indispensible ingredient.
Ethel, as we can call her, toiled long and hard with me, trying to uncover where her emotions went awry. It was not obvious to either of us. She kept rebutting my gentle enquiries as to her feelings about her father, who we both knew had died some 4 years before. I had no particular wish to chase him down, but I knew that childhoods mattered, and both she and I were determined to find out how this impacted, if hard work would reveal it.
Ethel kept saying she didn’t want to ‘blame’ her father. While not making a great issue of this, I couldn’t understand it — how could he be troubled, if he was no longer alive, and so couldn’t be said to feel anything, either way. Could this be the one pathway she was reluctant to explore, the real escape hatch?
At first, this ‘breakthrough’ didn’t seem to help much, either. Indeed, we were making so little progress, that I decided to halve our sessions to 30 minutes — they had already being going on for too many months, so I thought I’d squeeze them for a little more time — I had so many other things that seemed to need doing. But it didn’t work out. In the event, it took her 30 minutes to get warmed up, accordingly after I’d arbitrarily shortened the sessions, we made even less progress. So, biting the time-bullet, I reverted to 60 minutes a go. Thank goodness I did. Shortly after that, she told me something which so altered my views that they’ve never been the same since. “Did I ever tell you”, she remarked casually one session, “of the time when I was aged 6, and my mum took us all up to the bedroom, and dad came up the stairs with a hatchet, and cutting holes in the door with it, threatened loudly to kill us all”. “No”, I said, meekly, “I don’t think you did”.
the dog that didn’t bark
Could this be the ‘non-barking dog’ I’d been looking for all those years? How could a really serious death threat (as it appeared) be decidedly the last thing Ethel ever told me about? She knew I wanted all the information she could possibly give me — how else can a doctor diagnose, if the most crucial item is ‘undisclosed’? A man with a broken leg who vociferously denies he’d ever fallen into a ditch would be just as impenetrably undiagnosable as any depression.
Ethel was as determined as I was to find what had gone wrong, so how could she possibly justify this gross obscuring of her verbal account of herself, her own ‘truthful’ emotional biography? Leaving out something so emotionally important as a dad trying to kill you (at least as it would appear to a 6-year-old) ran so counter to the joint enterprise that we were then both equally committed to, that it called for an unimpeachable, robust explanation. And that’s what duly emerged, to my astonishment and hers. It turned out that this ‘omission’ was indeed the diaphanous ‘smoking gun’.
I was struggling at this point. Bear in mind that as a locally established doctor in that small town, I had acquired a reputation of being good with children, and with ‘nerves’, yet here was a medical problem that flummoxed me. Ethel was well competent at work, she ran a civil service office with ruthless efficiency — yet paradoxically, she fumbled this quasi-lethal event, like someone eating a boiled egg while wearing boxing gloves.
So why hadn’t her manifest confidence and exceptional ability at work, helped her here? However proficient she was, and she ran up the career ladder with impressive speed, none of this competence elsewhere had managed to prevent her obvious distortion of what had actually happened to her. I knew her well enough by then to know that she would not be keeping it from our joint project, unless something really big was preventing her. Could it be that somehow she didn’t want to know? Was she misinforming herself as well as me? What force was potent enough to stymie our joint enterprise? Such ‘suppression’ helped neither me, nor her — and at this stage, we were both equally keen to unravel the issue.
am I a fool?
Bear in mind that at that time, I was not a small cog in a large, impersonal medical machine — I was solely in charge of my time, and my work — I ran a small 100% independent NHS General Medical Practice. I was paid for how many patients I cared for, not for what I did, or didn’t do for each of them. Essentially Ethel and I were equal explorers of her mental machinations, and as such could say and do things informally and unexpectedly. Just such a ‘preposterous’ statement came out one day — when pointing to the space above her head, she said in a light tone, almost jocular –“But the axe is still there (you fool).” This tone was fully permitted in the context of the type of relationship we had built up. It testifies to our being on an equal footing — a crucial point, as it turned out.
Listen to that statement — “the axe is still there”. It takes exceptional circumstances for anyone to say something which at one level is ridiculously untrue — the axe most assuredly was not “still there”. However the trusting nature of our working relationship was strong enough that she relied on me to listen, and not ridicule. As I remember the tail of that outburst, she was joking at me, rather than the reverse. A tough character she certainly was.
So let us suppose that contrary to what I could see, that there was indeed a sense in which the axe was still there. How would this work? What could it mean? Let’s assume that at one level, she was indeed telling a truth, a distorted truth, but a truth nonetheless. In a significant sense, the axe was indeed “still there”, not in her reality, nor mine, but still alive in her head. Now this was something to challenge a sober well-meaning doctor — something still existing inside her head, but nowhere else. Talk about shaking hard-won convictions about what was reasonable to suppose, and what was not.
And yet, it did make a curiously satisfying sense. It solved an otherwise intractable problem. Suppose, as I now do all the time, that the human mind is acutely vulnerable to trauma, especially in infancy. It’s as if the inner video ceases at that frame — the axe is about to fall, and the normal cognition turns off just before it does so. By stopping the ‘tape’ as it were, by ceasing to ‘record’, the worst of an intolerable situation could be averted. In her mind that axe had never fallen — but only because she had ‘frozen’ it at that micro-second.
So what Ethel had permitted me was a glimpse into her darkest secret — something that would have been quite out of the question had we not had this most unusual and constructive build up over a long period of time. Her initial reluctance to blame her deceased father was now laid bare — had she even breathed a word about the axe, even whispered it in the corner of her mind — it would inevitably, and fatally, fallen. Rather than contemplate such an axe-induced end, she ‘forgot’ it. As I later described it, she put it in a box, with as thick concrete walls as she could muster, so as to keep herself safe from an apparently homicidal father. To a 6-year-old mind, that must have seemed an eminently sensible, even rational way of resolving an intolerable challenge to her very existence. Perhaps the only one readily available.
self-perpetuation
But watch how self-perpetuating it is — any hint of rebellion, or of countering this blow, and the axe falls. No two ways about that. What has to happen, and indeed did happen between Ethel and I, was that we were able to provide a secure enough context for her to contemplate the next ‘frame’ in the video, as it were. Without extraordinary support, the very act of challenging this quasi-lethal event, such as reassigning it to the long ago where it really belongs, risks the very calamity this ‘forgetting’ was intended to avert.
Suppose, aged 6, that Ethel had concluded that shouting back at dad to prevent him decapitating her was decidedly the worst strategy, the one least likely to keep her alive — why should she change it now? Only by trying out this previously unthinkable tactic, would she know that the world was now a different place — but the very act of ‘going there’, in her mind even, would risk her death — better leave the lid on that box tightly shut — at least that’s what she had concluded then, and had never had any opportunity, previously, to re-assess. It had literally never occurred to her she had an option. The size of the initial horror is enough to build an enormous disincentive for such a option even to occur. Of course, people vary, trauma varies — people burn out, they sneak round the corner, and find the trauma really is over — but too many find this difficult if not impossible, unaided.
my conclusion
So, what I conclude is that the terror from the trauma stops that trauma being reconsidered in the least detail. It’s a simple enough concept, and readily observable. And it makes eminent sense both of the blanket obscuration of the event, and its self-perpetuation. Only by putting your head back into the lion’s jaws can you conclude that the lion is now obsolete, unreal, a figment — it certainly wasn’t, but now is. Only by risking the axe descending, doing a thought-experiment that allowed for this awesome eventuality, could Ethel convince herself that the axe need no longer feature in her life. Her emotions were now back under her control, the figment of a homicidal dad allowed to slip away into the past, where it should have been all along.
The chances of finding propitious circumstances to facilitate this are few. For one thing, the sufferer needs to overcome a deeply held belief that powerful people are dangerous people — every single man could easily be hiding an axe behind his back — what’s to stop him? (And people who are not powerful, are just as vulnerable as you are, so no point bothering with them.) For another, the person you turn to has to have overcome, 100%, their own fears — else they will be just as skilful as you in evading your and their emotional blind-spots. And finally, they need to know what they’re doing, what to look for, how to probe gently into potentially lethal mine-fields, with enough confidence that the pain this inevitably raises is 100% worth it, since only by lancing this particular emotional abscess, can normal healthy cognition be resumed. I call it ‘mind surgery’, akin to heart or brain surgery — handle only with care and with skill.
3 life stories
Let’s review how this would work in the two cases mentioned, and printed recently in the press [1]. Firstly, Maria, 21, wrote:
“I was sexually abused at the age of eight. . . I took multiple overdoses. I also self-harmed. I was in hospital quite a lot. . . . It was caused by the sexual abuse; I was having a lot of flashbacks when I felt I was in the moment again and living it all over again. I couldn’t get myself in touch with reality. . . . I needed someone to speak to, a therapist or counsellor. . . My feelings weren’t really addressed, I wasn’t listened to. . . It’s about keeping in touch with reality so I don’t slip into the dark places. I have night terrors; I can wake up and not feel like I’m in reality, I can have dreams of what happened to me that seem real. . . . . Professionals need to dig deeper and see what traumatic events have happened in your past. The biggest problem I hear from other people is there is not enough support.”
Kerry, 21, wrote:
“I was the victim of a sexual assault . . . I used to have flashback nightmares quite regularly and developed insomnia as a result. . . . When you’re having a flashback or panic attack it feels like you’re drowning in the weight of what’s happening and you can see what is in front of you but at the same time your mind is in the past. It’s hard to interact with the present when your mind is constantly trying to take you back to what has happened.” [my emphasis]
“You can see what is in front of you but at the same time your mind is in the past.” What an eloquent description. The account given above, ‘explains’ why. Your mind is preoccupied with a falling axe, or whatever it was, and is therefore far too busy to pay much attention to anything else, even to “what is in front of you”. Reality has been fixed at the time of the trauma — it takes propitious circumstances to unfix it. Otherwise you risk precisely what you have been running away from, unthinkingly, ever since. No need to do so any longer — but only once you have received enough support to face it all down — rather a tall order these days. Depression is an entirely expected reaction when faced with an insoluble problem — especially one where a solution must be found if you want to stay alive. What if you:– can’t go forward, can’t go back — got to go somewhere if you want to live — can’t — result — depression. However, the hidden key is that what was true in infancy, is no longer.
Here’s an excerpt from the latest letter I received from a similarly traumatised person, ‘Kevin’ aged 26, whose emotional abscess I was able to encourage him to lance. Can you hear the ring of truth in what he writes, or is it just me?
“. . . I now accept the past for the past and no longer let it control my life, there is no longer what ifs and buts — no paranoia, no sleepless nights — and I have recently got married, and me and my wife truly believe that most of the change and assertiveness in me now come from the help of Dr Johnson and I’m so grateful for everything he did, done and has taught me. Now I can look at my life without fear and a focus on having my happily ever after.”
a befogged future ?
In 1988, 28 years ago, I showed Dr Bessel van der Kolk and a group of his students in Boston, a video of how Ethel and I worked together. Both appreciated how, with my trustworthy support, she was able to mobilise her ‘intent’ to rid her mental furniture of the axe. The former dismissed me with a lame Freudian slur, and has since concluded that the reason sufferers cannot escape their obsolete torment, is that “The Body Keeps the Score” (his recent book). His students, on the other hand, were most encouraging and advised me, quietly, to disregard his censure. I was 51 at the time, and more energetic then than now.
This early exchange proved an ominous prediction. As I have continued to explore how by empowering ‘intent’, you can unmake the full gamut of psychiatric afflictions, including more recently, psychotic symptoms [2], that long-standing holy grail of mental health — the bulk of my psychiatric colleagues also still demur. Whereas a leap of the imagination is required to understand how sufferers become ‘stuck’ at the age the trauma occurred, which ‘stickiness’ they continue to ‘see’ as life-saving — this is chicken-feed compared to opening psychiatrists’ minds to ‘intent’. Since 1960, I have worked on the basis that we all have choice, options, ‘intent’ (and with it responsibility), as endorsed by the obvious fact that Evolution brings about acts which were never there before — nothing flew before the insects — unpredictably purposeful — whatever next? There is a rational scientific non-supernatural approach described elsewhere [3], but sadly the black fog mentioned in the opening paragraph still engulfs too many ‘scientific experts’ today. I see evidence for ‘intent’ in democracy, in the Law, in Human Rights, as well as in the biosphere at large, and I’m not about to give it up — are you ?
* * * * *
Dr Bob Johnson Wednesday, 5 October 2016
tags #depression, #talking_cure, #trauma, #flashbacks, #intent
health warning: never stop psychiatric drugs abruptly — your brain tissue has got used to them, and needs to be skilfully weaned off them. . . .
refs
[2] “A simpler psychosis — dispersing toxic day-dreams”. See my Twitter feed.
[3] Chapter 6: Consciousness: Using Clinical Evidence To Link Consciousness With Its Twin Perils Of Psychosis And Violence, in “Consciousness: Social Perspectives, Psychological Approaches & Current Research”. ISBN: 978–1–63485–023–0 Editor: Lloyd Alvarado. Nova Science Publishers, Inc. 2016. Free pdf. Synopsis: Abstract — Introduction — Simplifying Consciousness — Dethroning Newton — All The Unknowables — How ‘Simple’ Are Computers? — The Roots Need Pruning — The First Clinical Case: Violence — The Second Clinical Case: a prisoner’s letter — The third Clinical Case: Psychosis — Conclusion — IN SUM, my 5-rules-of-thumb — References
Dr Bob Johnson Wednesday, 5 October 2016
Consultant Psychiatrist,
Empowering intent detoxifies psychoses
P O Box 49, Ventnor, Isle Of Wight, PO38 9AA, UK.
e-mail DrBob@TruthTrustConsent.com www.DrBobJohnson.org GMC speciality register for psychiatry reg. num. 0400150. formerly Head of Therapy, Ashworth Maximum Security Hospital, Liverpool; formerly Consultant Psychiatrist, Special Unit, C-Wing, Parkhurst Prison, Isle of Wight, UK. MRCPsych (Member of Royal College of Psychiatrists),MRCGP (Member of Royal College of General Practitioners).Diploma in Psychotherapy Neurology & Psychiatry (Psychiatric Inst New York), MA (Psychol), PhD(med computing), MBCS, DPM, MRCS. Author Emotional Health ISBN 0–9551985–0-X & Unsafe at any dose ISBN 0–9551985–1–8
