Depression is not the end. It is the beginning of a journey. A more prosperous life awaits us if we listen to the call for growth and change. James Gordon, M.D. is the author of “Unstuck” and talks with Tracy Picha.
Mindful suggests that anyone suffering from depression or mood disorders should consult a mental health professional before beginning or changing any treatment. Our articles are not intended to be a substitute for professional medical advice tailored to your specific circumstances.
In his book Unstuck: A Guide to the Seven-Stage Journey Out of Depression, Dr James Gordon says that Depression is not a medical condition. It’s a sign our lives are out-of-balance and that we are stuck. It is a wake-up and the beginning of a path that can help us to become whole and happy. A journey that could change and transform our life.
This view might be a surprise to anyone who has suffered from Depression. It may also come as a relief. Gordon’s view may be heresy to anyone whose doctor prescribes a medication at the first sign of Depression.
It’s about time.
Gordon says Depression is the “most incapacitating of all nonfatal diseases in the United States, and throughout the world.” Gordon calls it “the defining disorder for our time.”
Unstuck contains statistics that support this point. One in five Americans experiences a major depressive episode or dysthymia, which is a “disordered mood” (described as a “depressed mood”) at some point during their lives. This year, more than 13,000,000 Americans will suffer a major depressive episode. Many others will show symptoms that are not severe enough to warrant a clinical diagnosis. Depression increases the risk of heart disease, diabetes, alcoholism and other health problems. Lost productivity costs more than $50 billion per year.
Prescriptions of pharmaceuticals are becoming more common to treat Depression. Gordon believes antidepressants are a reasonable, sometimes necessary, last resort if other treatments do not work. He argues that drugs are not the first place to look.
Gordon’s approach to Depression is more optimistic and empowered, but it’s not a Pollyanna one. Consult your doctor if you are concerned about Depression. Take the time to talk with yourself. You may feel miserable and confused if you’re navigating Depression. But, as Gordon says, “that does not mean that you lack intuition.” “People have an intuitive sense for what is right for them.”
There is no quick fix for the rest. It takes personal effort. Gordon’s approach to counseling or training health care professionals to be more mindful is based on the active participation of listening to your body and exercising, eating well and delving deeper into the more significant questions of life. What lies on the other end of this Journey? You can live a life of greater resilience, health and appreciation with more balance.
Mindful talked to Gordon, the director and founder of The Center for Mind-Body Medicine, Washington, D.C., about the Unstuck method. Gordon is a Harvard Medical School graduate and clinical professor at the Georgetown University School of Medicine’s family medicine and psychiatry departments.
Depression is characterized by hopelessness and helplessness. My approach is based on hope and helping people to help themselves.
Mindful: Why is it a bad idea for you to define Depression as a disease?
James Gordon: In Depression, it’s hard to know what’s happening with your life. You feel unhappy and pessimistic and don’t want to interact with anyone. It’s not helpful to be called a “disease” when you are trying to manage that type of condition.
Mindful of: Why?
JG First, it is inaccurate because Depression does not have a set of pathological symptoms or signs. The symptoms vary from person to person. This implies that Depression is a condition that must be treated. Almost always, this will involve medication. We define Depression as a chronic condition that is beyond the scope of human understanding. We view it as an enemy. This view of Depression sees it as something to be rejected and suppressed, not as a way to learn what is wrong with our lives and to restore balance.
Be aware: What type of imbalance is this?
JG It can be physical, mental, conceptual or spiritual. Or all of them. All of them are connected. The idea is to examine how you’re out of balance right now. As I work with patients, I will need to address each of these dimensions sooner or later. Each of these dimensions is a part of our identity and profoundly impacts the other.
Mindful Can You Give an Example of Being Out of Balance?
You strongly yearn to reconnect with someone who has left your life. You’re obsessed with that person. It’s understandable, but it also creates a particular imbalance. You’ve already written the script. So, you need to know how your mind is making this imbalance.
Mindful – What first steps can you take to restore balance?
JG Healing relies on hope, connection and a more contemplative approach to life. You can start by knowing you can change how you feel and live.
Recovery is a gradual process. It is essential to feel connected with your body. You feel better when you move, even just a few steps. Even though you may be grieving for what you have lost, it is essential to acknowledge the good things in your life. You can gain perspective by beginning a meditation practice. It’s crucial to have a clear view of your imbalances. The more you know about them, the less likely you are to be thrown off balance.
The best treatment for clinical Depression and ordinary unhappiness is a combination of different methods. Psychological work can be combined, for example, with physical exercise, guided images, artistic expressions, yoga, nutrition and acupuncture.
Each of these methods has proven benefits. These methods improve moods in many people without causing side effects or numbing emotions. Combining these methods tailored to the patient’s needs will likely produce better results. It also has fewer emotional and physical side effects.
Mindful of: What do you mean when you say “meditative practices”?
JG Watch Your Mind Work As in the previous example, watch it as if you were never going to be in another relationship. When you pay attention to the thought, you’ll feel less overwhelmed and out of control. Meditation and mindfulness are a process that helps you relax and observe what is happening. It’s important to remember that the more relaxed we are and the more present we are, the less anxious we will be and the less depressed.
Depression can be a dead hand from the past. We are held captive by our longing for the things we miss. We are more likely to be depressed if we feel powerless and can’t change our circumstances. Our mood will improve if we can harness our hopefulness and see that it is justified. We are already well on our way to a better mood when we can express our feelings, commit to ourselves and help others.
Antidepressants do not seem to be more effective than other treatments. Several studies have shown that antidepressants are only slightly more effective than placebos.
Mindful Your book Unstuck: your guide to the seven-stage Journey out of Depression encourages people, with help, to be fully involved in working their way through Depression.
JG Hopelessness and helplessness are hallmarks of Depression. My approach should be based on hope, and I will help the people help themselves. It’s essential to have patience and be persistent. I tell my potential patients they must do 80 to 90 per cent of the work themselves. I can be there with them but cannot do it for them.
First, I call them to ask if they want to become patients. I want to ensure they know who I am and how we can work together. Most importantly, I want to make them feel like they’re no longer powerless and that we can work together to get them out of Depression.
I don’t have any magic cures. Therefore, I must find a fit between the patient’s needs and what I offer. People say, “I’m not interested in what’s happening inside me.” I can understand this. “I just want medicine to make it all better.” Unfortunately, for most people, there’s no simple pill that will improve things. What works often is not complete. I don’t know how often people have told me they feel better since taking the medication. I feel nothing at all.
Be aware: Today, we prefer to go through only a short process.
JG You can treat Depression as a disease that needs to be suppressed or an opportunity for growth and change. Over the last 40 years, I have observed that when you approach Depression in a second way, it becomes an opportunity to grow and change. The first approach may not cause as much discomfort, but it will prevent people from making the necessary changes to improve their lives.
Patients can feel depressed when taking medication. Patients often think, “Oh, something is wrong with me.” The doctor told me I had a chronic illness and would have to take these medications forever. Depression is equated with insulin-dependent diabetes and a sense of resignation. It’s nothing like insulin-dependent diabetics. No evidence exists that long-term drug use is better for people. Antidepressants do not seem to be more effective than other treatments. Several studies have shown that antidepressants are only slightly more effective than placebos.
We are preventing people from learning and changing by making them dependent on medications. Medication is a last resort for me. It is okay if you can’t bear the pain; nothing else helps.
Mindful of: Do we think life shouldn’t be hard?
JG: That’s true. We are expected to function in any situation with a positive attitude. The pain of life is not to be felt. Let’s avoid it. Let’s suppress this. You’re more like mind- than.
Be mindful: How did we arrive here?
JG Economic incentives in the healthcare system encourage doctors to talk less with patients and give them more medication. In the same way that economic incentives encourage obstetricians to perform more Cesareans than necessary, many psychiatrists are compelled to see more patients less frequently and, for less time for them, earn more money.
As Depression became more recognized, the pharmaceutical industry saw an opportunity to market drugs they called antidepressants. Insurance companies and HMOs recognized Depression as a disease that could be treated with medications. Psychotherapy was the other option, but it was much more costly and took a long time to complete. It was also difficult to prove its effectiveness statistically. To save money, healthcare providers offered incentives for drug treatment while reducing benefits for psychotherapy or other “talking cures”.
Introspection is also losing its respect. Mental and spiritual issues are often given the least priority in the health care system, even though they could be the most crucial. This is beginning to change. The increased interest of medical professionals in meditation has played a significant role. Meditation is one way to regain self-awareness psychotherapy was meant to encourage.