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| Saturday, 21 August 2004 |
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A new therapy for depression by Dr. H. S. S. Nissanka "Depression is one of the most common mental illnesses. All of us have friends, acquaintances or relatives who have at some time been clinically depressed. In fact, one out of 10 adults experiences one or more episodes of depression during his or her life time.
Researchers estimate the life time risk to be as high as 30%", says Prof. R. J. Waldinger MD Professor of Psychiatry, School of Medicine, Harvard University, USA. Depression, now recognized as one of the most prevalent worldwide mental illnesses, has become a dangerous development, which affects society at individual and family levels as well as in organized groups such as security forces and various guilds. This illness eats into productivity, efficiency and happiness in life. Therefore many researchers, mostly at university levels, are very active in trying to find new treatment for depression. Already several anti-depression drugs have came into the markets under a hundred odd names. About 50 years ago "depression" was found in people mostly above fifty years of age. When it occurred after 60 years of age, it was called "senile depression". With advancing age, some people lose interest in living, to the extent of neglecting normal everyday functions such as eating and bathing. Such people have to be hospitalized and treated by psychiatrists. But, now depression in no longer an illness confined largely to old age. Now it is found among all age groups starting from the early teen age. (I have treated several university and Advanced Level students of both sexes for depression.) Symptoms of depression According to Prof. Waldinger, "more than 90% of depressed patients experience moods of sadness. A small percentage of depressed patients do not experience a depressed mood but manifest other symptoms." The following are some of these symptoms: (1) Depressed mood (2) Inability to derive pleasure from previously pleasurable activities. (3) Anxiety - having distress and fear of some impending danger or dangers. (4) Exhibiting the following physical conditions: Inability to sleep, lack of appetite, loss of energy, diminishing sex desires and in some cases, feeling sleepy all the time. (5) Feeling of hopelessness and suicidal tendencies. (6) Difficulties in concentration. (7) Bodily aches and pains. (8) Retardation of normal bodily functions such as speech and other psycho - motor activities. (See: 'Psychiatry for Medical Students'- PP 103 - 07) A patient having depression exhibits some of the symptoms mentioned above. Some people become depressed due to deaths of dear ones, loss of property and positions, "Manic Depressive Psychosis" - a grave mental illness which is now on the increase, too causes depression. Depression is described as a psycho-somatic disorder, which means that this illness is a complex development involving the patient's mind and body. Depression cases can be divided into two groups namely "psychotic" and "neurotic". Causes The psychotic depressive patients, lose the sense of reality - they are carried away by delusions (visions based an unrealistic beliefs) and hallucinations (fearful and purely imaginative visions). In psychotic patients, their mind in sick and patients show progressive signs of losing normal mental functions. In psychotic depressive patients there are no physical impairments. In neurotic depression, their nervous system is affected causing functional disorders or physical impairments. But this form of depression too is psychogenic in origin. In medical literature there is a lacuna as the text book writers have failed to show what precisely is meant by "Psychological causes of depression." How many doctors really do distinguish between psychotic and neurotic depressive patients before they give the prescription for medication? This is a pertinent question. There is a lot of medical and psychological jargon which makes the issues concerning depression very confused and difficult to understand. These terms should be made simple so that even the average patient can understand what has gone wrong with him. Medical literature on the subject would not have been so confused if the text book writers had divided the causes into two groups namely physical and mental. Physical causes are organic causes. The following are recognized as organic causes of depression: (I) Reaction to use of certain medicines (II) Effects of infectious diseases (III) Endocrine disorders - malfunctioning of thyroid and adrenal glands. (IV) Anemia and nutritional deficiencies. For depression caused by the above-mentioned factors, there is no doubt that the patient should be provided with medication and even surgery where it is necessary. But, when the causes are of purely psychological in origin, medication is of limited effectiveness, it could be even harmful. The behaviour patterns of patients having depression can be changed by means of psychotic drugs, but only on a temporary basis. Such medication fails to cure depression completely. Thinamiddha Nivarana Depression springs from the unconscious motivation of the patient concerned. Psychogenic depression is a trick of the unconscious of the patient who has to cover up an unpleasant painful memory of an episode which resulted from a particular klesha. The Buddha has listed 16 kleshas in the Vatthupama Sutta which are capable of creating psycho-neurotic conditions. Let us take a baffling mental illness now known as the bipolar-disorder, here when a patient is treated for depression using anti-depression drugs, he retreats to the opposite pole which means that he now starts to exhibit hyper-tension and boisterous behaviour. When he is treated for this he comes back to the condition of extreme depression. (Thinamiddha Nivarana) When he is tensed and agitated is could be seen that he is being carried away by another nivarana called "Udahacca Kukkucca" (nivarana of agitation and restlessness) Thus the patient unconsciously uses these two conditions to hide his painful memory associated with a klesha even in case of a bipolar disorder. Therapeutic steps In the treatment of depression the following steps have to be followed: (1) Development of communication between the therapist and the patient (if the patient is in extreme depression he should be hospitalised for psychiatric treatment until communication with him is possible) (2) Helping the patient to develop awareness of his own body by means of meditation. (3) Helping the patient to develop awareness of his feelings - pleasurable and painful feelings of the body and the mind. (4) Probing the conscious and unconscious mind of the patient until "catharsis" takes place. (5) Analysis of memories and behaviour patterns of the patient to determine the klesha and the nivarana that caused the depression. The root causes of the depression-the klesha and the nivarana have to be contained and reduced by using some of the seven methods given in the Sabbasava Sutta. The following methods have to be utilized. (1) Getting the patient into the stream of seeing and knowing the klesha and the nivarana as they arise in him (dassana). (2) The patient should be guided in using the four requisites appropriately-food, clothing, shelter and medicine (patisevana) (3) The patient should be encouraged to practise the following forms of meditation (bhavana). Anapanasati meditation" The patient must be encouraged to begin the day with the following: The patient, after a cup of tea or coffee, should lie down in a bed without pillows. He should breathe in a long breath and while holding it he should bring his bended knees towards his chest and raise up the head and the neck. The breath, should be released after holding it for the maximum possible time, the head and the knees should be restored to normal lying down position. This should be practised in the morning and evening spending for about 15 minutes. This is a well tried out method aimed at creating body awareness. The basis of this exercise is the concentration on breathing, which is meditation, recognized as a meritorious act. There are several other forms of meditation which can be used in the treatment of depression. (4) The patient must he encouraged to read for pleasure, listen to music and to visit beautiful places and places of worship of his religion. He should go for regular medical check up for blood sugar, pressure and cholesterol and in case of need, he should be sent for further medical consultation. (5) Finally the patient must be given the impression that he is being given the best of care and concern by the members of his family. What was given above is a brief account of what I do for the patients having depression. Please note that many more points have be discussed to form a complete therapy for depression. (The writer is a visiting lecturer in Buddhist Psychotherapy at the Post Graduate Institute of Pali and Buddhist Studies of the University of Kelaniya. He is also, the author of the book "Buddhist Psychotherapy" which has gone into several editions) |
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