Depression treatment beyond Jeff Kennett

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Jeff KennettUnder the Chairmanship of its founding father Jeff Kennett, Beyond Blue, the hitherto respected initiative, has been highly successful in countering the stigma attached to a diagnosis of depression.

Recently the organisation and Kennett seemed to have come to a fork in the road. There was an  outcry and calls for Kennett's resignation in the wake of his assertion that only children in the care of heterosexual parents could achieve optimum mental health.

Despite being criticised as alienating and exhibiting bias against the gay community, Kennett was re-elected by the Beyond Blue board.

Nonetheless this controversy should not eclipse more important questions. After ten years of good groundwork, do we need something new from Beyond Blue and other key mental health institutions?

According to the World Health Organisation, depression affects 'about 121 million people worldwide', is 'among the leading causes of disability worldwide', and, although it 'can be reliably diagnosed and treated in primary care', 'fewer than 25 per cent of those affected have access to effective treatment'.

Beyond Blue and the current zeitgeist has largely been identified with the medical disease model. Treatment has favoured a limited number of sessions — six to 18 sessions under Medicare, now reduced to ten. It has promoted a cognitive behavioural approach plus medication.

There are strengths and limitations in this approach.

The promotion of understanding, removal of stigma and encouragement to seek help requires the countering of stereotypical and unhelpful attitudes. In the bad old days those suffering from debilitating depression have been regarded as having character or personality flaws. People in a depressed state often have been judged as lazy, unsociable, and just not willing to make an effort.

It has therefore been necessary for Beyond Blue and similar groups to package a fairly simple message. The disease model is readily understood and has been progressively less imbued with moral condemnation.

However the one-size-fits-all view can foster problematic misconceptions. The notion that mental ill health is a bundle of symptoms and neurological processes can exclude the full range of human distress. Depression is not always readily or lastingly addressed by current approaches, and may remain intractable (in 20 to 40 per cent of cases, according to WHO).

How does this fit with the intimations of 'cure' implied by the statement that 'depression is treatable'?

The highest price paid for depression is suicide. Suicide Prevention Australia has emphasised the importance of social inclusion, having a sense of belonging, and feeling part of a community as being crucial in the reduction of suicidal depression.

The notion of inclusiveness captures the importance of paying attention to the anguish that may be engenderd by being part of a marginalised group, such as same-sex attracted groups, displaced persons, Indigenous peoples and people from diverse cultures.

Culturally sensitive, humanistic, spiritual and longer-term psychotherapy may have much to offer those afflicted.

Esteemed clinical psychologist Dorothy Rowe cautions against an oversimplified view of depression. In her view, the real problem arises from some kind of threat or insult to the sense of being a person. 'This can be hard to uncover, and difficult to ameliorate. It is never amenable to a quick fix.'

In Rowe's view, unprocessed sad events that become imbued with self blame and guilt can become depression. She emphasises the importance of truly hearing the person's story and their experience. This takes time.

The current disease models run the risk that sadness, mourning and grief may be unrecognised and treated only as symptoms. And the problem with the notion of eradicating and preventing depression as though it was a viral disease, is that it sidelines the 'human factor'.

One of my clients, a young woman aged 22, had been prescribed anti-depressants when her father was diagnosed with cancer. When he died two years later and she was referred to me, I suggested that her medication should be reviewed.

She told me of her session with the psychiatrist who had prescribed the medication. 'He asked me a lot of questions, was writing a lot but didn't look at me. He said "You are not saying much" and that he thought I was resistant. He said "You don't want to be here do you?" I said, "My father died four weeks ago!" He didn't even say "I'm sorry" or something normal like that. He just went on writing.'

We are all born to wrestle with the indisputable existential realities of life. We all suffer innumerable losses, and we all eventually surrender die. Depression is a state of mind that is reductionist. Its amelioration will thrive on expansion of our collective understanding.


Lyn BenderLyn Bender is a Psychologist and a former member of the Suicide Prevention Australia Board. 


Topic tags: Lyn Bender, Beyond Blue, Jeff Kennett, Depression, Suicide

 

 

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I commend Lyn Bender for pointing out that there is no one-and-only correct or "quick fix" method of treating depression. I have suffered from it, often severely, on and off for roughly fifty years. Two relatives of mine have committed suicide.But I would caution readers about taking the views of Dorothy Rowe too seriously. I find Rowe's "I will deliver you from the prison of depression you have created for yourself" approarch irritating, dubious, very patronising and possibly harmful. Nobody volunteers to be depressed!


Nigel Sinnott | 27 October 2011


Thank you Lyn for bringing this to the public notice and for looking further than a quick fix.

Four generations of women in my family have encountered depression in their journey and it has been wonderful to see the current treatments having a positive effect for my grandaughter.

Not ten or twenty sessions though, but three years of help, support, working through issues and contexts and learning how to manage them.
The quality/understanding of the cousellor and counselling is vital to support.
We found schools not cognisant of the medical condition so school was another hurdle to manage rather than a support
Lets keep this awareness in the public view and encourage a greater understanding of depression and other conditions which are able to be treated with appropriate care and time.
GAJ | 27 October 2011


A wonderful article. Thanks so much. Many of us, it seems, are unfortunately strong enough in mind to suppress and repress lives traumas and sadnesses without the resultant depression. We live in a culture, it seems, that sees a lack of ability/strength to not 'successfully suppress' as a weakness. Troubling indeed.
Andrew | 27 October 2011


The lack of empathy (or more bluntly, heartlessness) displayed by the psychiatrist is a characteristic of many in this so-called helping profession. This is the result, I believe, of an educational system that sees an astronomical tertiary entrance score as the sole prerequisite for entry to medical school, pushy parents whose greatest ambition in life is to boast to their friends, "My son/daughter is a doctor!" and individuals who become doctors simply because they got the "magic number" in the HSC. Others, of course, crave money and status.

A psychiatrist I know had a midlife change of career - she's now running a small business. She explained that she'd never been interested in psychiatry and only studied medicine to please her parents. A shame for her, and her patients!
Monty | 27 October 2011


Thank you Lyn for opening a window of light into this complex world of depressioin. I have recently discovered Eric Wilson's "Against Happiness" and his own biography of bi-polar "The mercy of eternity." Highly recommended. My study at MIECAT [Melb] and growing to understand being fully present to friends and people and "companioning" rather than "counselling" throws up, apart from other issues, the shared human journey. In 2008 I supported performers and staff at the Melbourne International Comedy Festival [under "The Big Ear"]as part of my commitment to the darker side of the arts while holding that melancholy [as Wilson says] is the womb of creativity. Beyond Blue were not interested in funding this project so I went pro-bono and found genius, joy, sadness, tiredness, disappointment, fun and more insight into the complex world of creativity and depression that under simple eradication formulas and medication models would slip by.
Peter | 27 October 2011


Thanks Lyn for this article, this is a highly important subject in our society. It seems that the attitude of the psychiatrist you mention is fairly typical of his profession and I wonder if it’s to do with the lack of spirituality in their training. In looking at the responses I feel Nigel Sinnott has failed to appreciate the basis of what Dorothy Rowe says about CBT: “what determines our behavior isn’t what happens to us, but how we interpret what happens to us.” Dorothy stresses the importance of mindfulness with how we interpret our experiences. My sense is that we are in the first instance ‘spiritual beings’ on a human journey. I’m convinced that somewhere in the human psyche we see things as they really are but biology gets in the way and so we interpret what we see through human eyes with many variant interpretations (influenced by such things as genetic makeup, brain chemistry and personal history). It is the disproportionate discrepancy between the spiritual ‘seeing’ and the seeing with human eyes that leave us with the ingredients for depression. For me, to find a compassionate therapist with spiritual training is a big start towards changing the way we think. This has been my experience with a committed compassionate therapist (over many years) who gave me the courage to address the issues in a new light. To feel peace and beauty inside is a wonderful thing.
Trish Martin | 27 October 2011


Thank you Lyn. It would be so wonderful if once, just once, someone would look at the world through my eyes and understand why I so often weep for it. Rather than dismissively handing me a tissue or a script (in either sense!) and demanding that I reprogram my mind to see the world through their eyes.
Margaret | 27 October 2011


I find the headspace and other programs puzzling because they pretend to predict who might become psychotic at some time and that is something that can rarely be done. My grand daughter had a break and ended up in mental health ward for a week last year after being abused by an ex boyfriend. She has completely recovered, had him convicted of assault, works full time, has a new and decent boyfriend and is unlikely to ever have another such break unless she is beaten again. She was put on sleeping pills and they did nothing but intensify the anxiety which faded once the criminal who beat and threatened her was convicted. Too many times sudden trauma is confused with depression.
Marilyn Shepherd | 27 October 2011


Thanks for your very interesting article Lyn. I entirely agree that the marginalised groups you speak of, Indigenous people, same-sex attracted persons and those from diverse cultures are at risk of developing differing grades of depression. In addition to these should be added those who suffer the severe and incurable mental illnesses of schizophrenia, bipolar 1 disorder and severe affective disorders. Many of these people suffer a comorbidity of severe clinical depression which increases their risk of suicide. They are also the group that beyondblue has persistently refused to help even though it has been publicly stated, by the Mental Health Council of Australia, that only some 50% of persons with such mental illnesses receive any specialised care. Indigenous people and those with these mental illnesses have a life expectancy of 56 years, compared to other Australians' 83+ years.
Caroline Storm | 27 October 2011


Thank you for highlighting the problems faced by people suffering from depression. Despite Beyond Blue, there is considrable lack of understanding and empathy, especially among employers. Recently a friend of mine had to seek psychiatric help following a fairly long period of bullying and harassment at work. The treating specialist was of the opinion that he was suffering from severe depression. However his employer, a well known doctor, questioned the specialist's diagnosis, a response that shocked and disheartened my friend. What hope do sufferers of depression have when the medical profession has this attitude?
Nila | 27 October 2011


The 'medical model' is a major cause, in my view, of the 'heartless' psychiatrist - or psych nurse. After all, what is the point of 'listening' to a patient's life story if the only cause of their condition is a 'chemical imbalance' which can be altered by a pill?

David Mithen | 28 October 2011


to DAVID MITCHEN: After telling my life to a psychiatrist, I would far prefer to receive help in the form of a pill than to have them just say... go away and try to change your behaviour. I find the cognitive behavioural therapies and other psychological methods to be akin to dog-training.
AURELIUS | 28 October 2011


Thank you Lyn Bender for an excellent article. I deal regularly in a counselling situaiton with people diagnosed with depression and agree the medical model is of limted usefulness, which is not to say it has no place in assisting the client.

The work I am currently doing to make Meaning Centred Therapy (Logotherapy) more readily available in Australia is but one step, I hope, towards provision of other options as alternatives to the CBT approach.


Dr Paul McQuillan | 31 October 2011


Kennet: not that the catholic church (I assume Eureka still has links) has a healthy attitude to homosexuality anyway!!!

We need to open up the whole dialectic about depression, maybe even call it something else.It's the how, what, where, when, and who of feeling deeply sad that counselling (and true friendship) must work on collaboratively (with clients) towards existential understanding, no matter how small.
andrea | 01 November 2011


I believe that most forms of depression are benign and caused by a breakdown in relationships and alienation. Our society has become individually focused and narcissistic with very little empathy between people. We have lost our sense of community and egalitarian culture. We have become a secular and materialist society with little interest in each other's soul - feelings, emotions and spiritualism. The people most affected are the marginalised and minority groups of people, including single people, indigenous people, poor people and homosexual people. I have recently returned from a cycling holiday in Viet Nam and was pleased to find a much more caring society than Australia, especially the road etiquette. Most of the mainstream media do not do anything to assist us have a better understanding of each other. However, there are some exceptions such as community radio stations such as 3CR in Melbourne, channel 31 community TV and several German TV programs such as the health and fitness program 'In Good Shape' - this program had an excellent program on all forms of depression awhile back.
Mark Doyle | 02 November 2011


Lyn well affirms the nature of variations of such as depression where I call /experience it as "blah", "overwhelmed", ";lack of concentration or real peace or reality engagment/ability to engage with reality'; "feeling disoriented"; "delayed shock quagmire of body,heart,mind,soul/spirit"; "blocked";
"anxious but not really feeling anxious or depressed"; "underlying angst, grumbling anger, stressed"; etc
Tadros | 10 November 2011


Good to discover Lyn's article. The spiritual and existential crises that are often experienced as depression will rarely be adequately understood through a cognitively focused prism - or alleviated by medication. The chilling description of the psychiatrist who could not meet the patient's eyes (or hear their story) is all too common. I suspect that learning to "see" our own selves with renewed compassion and trust is essential to any therapy that is genuinely transformative. We need quiet encouragement to achieve that, and someone to hold the confidence for us that it is possible. This asks a great deal of the therapist and is usually achieved not simply by training and supervision but also from the therapist him-/herself also experiencing and transcending dark nights of the soul.
Stephanie Dowrick | 15 November 2011


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