Depression ( Archived) (129)

That's an interesting point that you make about mania possibly being the opposite of depression, rather than happiness, Dragos.

I think for some people who have an underlying depression, it can almost be like there are two selves, or a disassociation from long term depression: whilst they might function on the surface, go to parties, work, joke around there may be an inner core that is struggling with depression. Maybe it's a bit like Russian dolls with a presenting self and an inner self who aren't matching up for some reason. Sometimes this can be difficult to recognise as we're so used to suppressing the inner self for the sake of others.

With reference to using language like 'depression' and 'mania', and also to reply to Berry's earlier post, I went to a workshop recently by a big wig psychiatrist who explained an alternative to diagnosis.

Diagnoses aren't necessarily the most useful way of dealing with this kind of health issue. A diagnosis is a relatively subjective assessment of how a cluster of symptoms fits into a category, or model. Diagnoses can have their uses (like ownership of the symptoms for the client), but they don't really tell us very much about the person and they can be detrimental in terms of taking people's identity away from them.

Another way of assessing a person's position is a model, or 'formulation', called the four P's:

PREDISPOSING: Factors such as isolation, genetic inheritance, substance misuse.

PRECIPITATING: Factors such as a bereavement, trauma, sometimes small life events which tip a person over.

PERPETUATING: Factors which maintain the position of the distressed person, such as negative self-talk, chronic illness, or pain, substance misuse.

PROTECTIVE: Self-esteem, support, personal development, company.

Factors may fit into more than one category, for example, isolation might a precipitating factor and a perpetuating one, trauma might be a predisposing and precipitating factor, especially if their is a link between each trauma such as an unresolved bereavement followed by another.

This formulation tells us so much more about a person than a diagnosis such as depression, especially when explored using the 5 w's - for each factor explore who, where, why, what and when.

By using alternative approaches to depression, each person may start to unravel the complexities behind their individual issues for themselves.

Yeah, I reckon I can have a multitude of feelings going on at once and sometimes very conflicting feelings. Isn't that why we use words like 'ambivalence'?