Dear Dr kennard,
I find what you say about depression interesting. I have been treating my depression as a kind of monster that tells me to do all the wrong things and pushes me to think negatively. My strategy has been not to listen to this monster and often do the opposite of what it tells me. If it tells me to stay in bed, I get up anyway even if it is a tremendous effort. That is because I have learned to do the opposite of what this monster tells me. The monster is not really there and I don't suffer with psychosis but I just name it a monster so that I can be aware of it. It is true that much creativity can also derive from depression. In fact there is no depressive period that has not lead to creativity at least for me. Not while I am depressed but after when the depression lifts. It would seem that something happens and that from the suffering some creative ideas come to the surface.
While this I am saying has a lot to do with understanding depression from the bio psycho social perspective I am still unsure as to what model are we really following today and this is what I would like to ask you: many commentators claim that we are moving towards a bio psycho social model of mental illness; and yet statistics on prescription dispensed would seem to suggest that we are still stuck with the biomedical model. Doctors (GPs) seem to rush fro the prescription pad to treat depression these days rather than suggest therapy or natural alternatives. And it is true to say that therapy is expensive, in Australia we have up to 10 free visits per year for poor people. In America I don't know the situation there.
What is your opinion on the biomedical vs. bio-psycho-social model if you don't mind me asking?
For those who do not know the biomedical model is a model that consider mental illness as a purely biological affliction to be treated with drugs; the bio-psycho-social model proposed that to really treat depression we have to help the person, her or his social situation and the biological aspects as well: one culture, psyche and biology need to be considered as a synchronised whole.
Some interesting observations, Alfredo.
Your question regarding models is interesting but actually quite hard to answer with any depth in this format. I guess a key phrase you use is moving towards a biopsychosocial model. Health and other professions are also meant to be moving towards more collaborative practice in order to reduce errors and improve communication. Movement is one thing - arrival quite another.
The biomedical model is strong for a whole variety of reasons but mainly because the medical profession have the main statutory responsibility for the delivery of diagnosis and treatment. Politically the medical profession is meant to guarantee an orientation to the patient that is underpinned by theory, ethics and time spent preparing for the role. Patient trust is then established through a claim to authority. Professionalism also restricts and controls entry and often has a system of self-government. Its claim that only its members are qualified to offer a particular service is often reinforced in law. This is the case with the medical profession who also laid claim to mental health some time ago. All other professions tend to feed in and out of the medical profession, rather like moons around a planet, although some (for example psychology) may diagnose and treat independently.
Medicine hasn't stood still and whilst they do embrace (some more than others) different models its roots still run deep - and for some very compelling reasons. My own background in psychology and health is firmly grounded in the biopsychosocial model. With the right team of professions the skills can be effective and complementary.
Thank you Professor Kennard. I have been following your posts for some time and I find what you write extremely interesting. It explains a lot from the perspective someone who works in the system.
I guess that a balance of the right medication, natural interventions (adequate diet, sleep, adequate work and leisure) and empowering clients (knowledge and self awareness) would be the way to go in the near future.
However, my concern is that the world's population is increasing, the world's economy is facing serious challenges, and there is a tendency to rely on short cuts because of necessity. These will prove to be a challenge and sometimes a barrier to the bio-psycho-social model.
Technology may come to our assistance especially computer technology. I am counting on that and we can see the results today. This web site is a step towards a bio-psycho-social model. And there are many self help websites out there. We do have access to knowledge and the opportunity to build a strong self awareness. I guess that we need to read what good people like you are saying and engage in a kind of debate that can empower us.But computer techology also poses problems in that we are social being and need human contact.
Using the bio-psycho-social model of mental illness I have been able to help myself and change my perspective on life. I have been very interested in Carl Rogers "client centered therapy" and that has also been helpful to me.
My problem was larrgely uncontrolled emotions that had great impact on my moods. Having learned to control my emotions, I have been able to better control my moods. I also recognise possible triggers for symptoms and have learn strategies to intervene before the triggers have a chance to set off full blown symptoms. It can be done.
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I agree with you, Jerry, about so much of depression being situational and sometimes a result of unrealistic expectations about what life should be like. I was also thinking that in some cases, it can be situational but if it goes on and on, unchanged, then depression can end up being a way to cope, maybe even changing our brain chemistry in the process. I guess I'm speaking from my own experience of growing up in an abusive home and, looking back, it's like I can hardly remember a time when I probably wasn't depressed. Then, as life went on, other things triggered that original depression. I don't think medication is THE answer, but if the depression is severe, it can help us feel good enough to be able to get some benefit from therapy. Sometimes it feels like a vicious cycle - when you feel badly, you end up doing exactly the things that make you feel worse until something breaks the pattern.
Sometimes you hear about situations that people are living with and it makes you think, "Who wouldn't be depressed?" Some people have more resilience than others, by nature, and they are the fortunate ones. Somewhere, one has to find hope that things can be different or that there is some meaning in what is happening. Sometimes that hope comes with a belief in something bigger than ourselves.
Seems to me that you've hit a few nails on the head with your comments, Judy. There's plenty of evidence that our bodies respond biochemically to changes in the environment, we only have to look at stress to see that. Personal resilience may certainly be a protective factor, as may be our generalised expectancy over whether we have the control to change things, or whether it's all down to fate.
So many issues interplay with our moods it's difficult sometimes to keep track of the dynamics. Some people suggest that depression isn't actually increasing but it's being diagnosed more and people are becoming too sensitized to their emotions - assuming normal reactions and emotions are abnormal. The truth is in their somewhere!