Academic journal article Social Work

Riding the Mental Health Pendulum: Mixed Messages in the Era of Neurobiology and Seif-Heip Movements

Academic journal article Social Work

Riding the Mental Health Pendulum: Mixed Messages in the Era of Neurobiology and Seif-Heip Movements

Article excerpt

Whereas professional disagreement about optimum mental health treatment is commonly understood, recognized, and discussed, the influence of opposing philosophies on patients is less often addressed. This article examines the long-term distress created for the author, battling severe, recurrent depression, as she received advice from practitioners who offered widely varying treatment theories as the basis for differing recommendations. Medical knowledge based on advancing research in neurobiology has led to greater understanding of brain chemistry, more reliance on the use of pharmaceuticals, and an emphasis on other "physical" approaches to mental illness. At the same time, growing "self-help" recovery initiatives, with underlying theories analogous to cognitive therapy, continue a focus on emotional and behavioral self-direction. These messages can appear dramatically opposed in terms of expectations on the patient, when presented from separate perspectives that are not described in a context of the whole. T he resulting confusion is an unfair imposition of the personal differences of philosophy among practitioners on vp atients in crisis seeking help.

Key words: mental health; neurobiology; self-help initiatives; treatment theories

"Depression is a disorder of mood, so mysteriously painful and elusive in the way it becomes known to the self-- the mediating intellect - as to verge close to being beyond description. It thus remains nearly incomprehensible to those who have not experienced it in its extreme mode" William Styron, Darkness Visible[1]

I do not know fully anymore the experience of depression. More than once, on random occasions, I have walked into my psychiatrist's office, and to his unchanging greeting of, "Hello. How are you feeling?" I have replied, "Great. Why? Haven't I always been?"

It is a joke, sort of, between us, but it reflects a far deeper reality about the "mediating Intellect" and the experience of depression. Not only are the depths of its horrors nearly incomprehensible to others, they are incomprehensible, to a degree, to the self no longer in its clutches. Our being is always in the present, and although we can remember our past, we are not living it again.

Depression is not just a mood or a set of symptoms. It is a totality of self during that episode of time, which contributes to the difficulty of describing it and to the difficulty of others in understanding it. This sets the stage for a pendulum of causation and treatment debates utterly devastating to the very subjects of the debates, often without the realization of professionals who are simply doing their best in what they believe will help.

I will never forget first reading William Styron's essay, his writing skill enabling him to find analogies that helped bring the experience to words. I was crying out, "Yes! Yes!" and highlighting lines with a marker: "[my] thought processes were being engulfed by a toxic and unmanageable tide" 2] and "in ways that are totally remote from normal experience, the grey drizzle of horror ... takes on the quality of physical pain ... (the) despair, owing to some evil trick played upon the sick brain by the inhabiting psyche, comes to resemble the diabolical discomfort of being imprisoned in a fiercely overheated room." [3] Yes. Someone understood.

As Styron so evocably describes, in severe depression the inhabiting psyche has taken control. Totality of being defines both wellness and illness. I

cannot explain articulately when I know I am well, beyond describing mere symptoms, which fail to capture who I am as my true being. I can only say that when I am fully well, I know. It also feels as though it has always been that way--that the pain of the past is some vague, distant thing, even if it last tormented me only days before.

When I am well but I catch a glimpse of the state of "other," there is the stark terror of knowing that I cannot live through it again. …

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