Hypnosis and the Treatment of Depressions
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Hypnosis and the Treatment of Depressions

Strategies for Change

Michael D. Yapko

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eBook - ePub

Hypnosis and the Treatment of Depressions

Strategies for Change

Michael D. Yapko

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About This Book

In this book, Yapko not only demonstrates hypnosis is a viable and powerful approach to the treatment of depression but also confronts traditional criticism of its use head on. He first lays the groundwork for the book's dual focus, opening with a discussion of depressions. He then focuses on the historical perspective of depression and hypnosis as "forbidden friends, " shedding new light on old myths about the use of hypnosis leading to hysteria, and even suicide. The result is a definition of hypnosis as a flexible and enlightened tool that offers precisely the multidimensionality that the problem demands.

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Information

Publisher
Routledge
Year
2013
ISBN
9781134856459
Subtopic
Psicoterapia
Edition
1

1

Depressions

The use of hypnosis as a therapeutic tool in the treatment of depression has been discouraged—both passively and actively—over the years. The reasons for this will be considered in depth in the next chapter. However, it must be emphasized at the outset that the fact is that the field of hypnosis provides many remarkable insights into the highly subjective realm of human experience. And since depression is a human condition rooted in subjectivity, increasing one's level of objectivity about life experience should be a core component of effective treatment (Beck, 1967; 1973; Ellis, 1979; 1987).
With hypnosis so clearly capable of altering subjective experience—one's interpretation of and response to life events—why isn't it used as a primary treatment tool in facilitating recovery from depression? The answer, in a general sense, stems from how hypnosis has been both misconceived and misapplied, rather than from its inherent nature.
This book encourages, and even demands, a reconsideration of what we know, or think we know, about hypnosis and about depression. When our desire is to help suffering individuals, it is simply too self-limiting to preclude the use of such a powerful treatment tool on the basis of outdated theories and techniques. Much has changed in the past few years regarding our understanding of hypnotic phenomena and of the nature of depression. It is my aim to help establish hypnosis as a viable, perhaps even necessary, component of effective treatment.
But first as a starting point for the ideas and methods to be presented later, we must go back to a description of the epidemiology of depression.

A PROBLEM ON THE RISE

Epidemiological data indicate quite clearly that despite the greater attention being given to mental health issues, despite the proliferation of countless approaches to psychotherapy, and despite advances in medical and psychological technologies for intervening, the rate of depression continues to increase (Charney & Weissman, 1988; Weissman, 1987; Klerman, 1988). Given this marked increase in depression, particularly in the last four or five decades, it seems eminently logical to ask these questions: Why is there so much depression today? What can mental health professionals do to provide more reliable and effective treatment for those individuals who are either depressed or at risk for depression? And only by asking further questions can we define an area of intensive study in an effort to obtain relevant answers. So, we may ask, “Could there be some new or preexisting, but dormant biological factor that would account for the increased rate of depression? Are there cultural or sociological explanations for its increase?”

CROSS-CULTURAL CONSIDERATIONS

One way to determine whether a problem is more biologically or more psychosocially influenced is to consider comparative data obtained in other cultures. In the case of depression, a considerable number of cross-cultural studies suggest that not only the prevalence of depression, but even the manner in which it is manifested, is influenced powerfully by cultural factors. In fact, the differences in the symptom patterns of depression between cultures, especially Western versus non-Western, are so great that some experts wonder whether it is even the same disorder under consideration (Marsella, 1979). This is the basis for my talking about depressions rather than depression as a well-defined, singular entity. (For the sake of readability, though, I generally use the term depression.)
In one example, anthropologist Edward Schiefflin (1985) studied the primitive (by Western definition) Kaluli tribe in New Guinea. According to Schiefflin, it appears that the incidence of clinical depression among the Kaluli is nearly zero. He described them individually as highly expressive emotionally and the tribe as largely community-based, with an emphasis on strong social ties among tribal members that is likely to minimize any personal sense of isolation or alienation. If one person has a grievance against another for some perceived wrong, the complainant is heard and responded to quickly, thus cutting down on the chances for feelings of isolation, hopelessness, and helplessness to arise.
Janice Egeland and Abram Hostetter, in their studies of the Old Order Amish in Pennsylvania, found that the rate of major depression (unipolar disorder) among them was somewhere between one fifth and one tenth that of the rest of the U. S. population (Egeland & Hostetter, 1983). Here, too, is a society that places a premium on family and community ties and stability of experience over time, that is, tradition. It is a society that shuns advanced technology and resists assimilation with others.
Other cultures show marked differences in the way life experience is interpreted and responded to, leading to a broad range in the rate of clinical depression, and in how the depression is manifested. For example, in China, the rate of depression appears to be close to that of the United States. Yet, it would be atypical for a Chinese person to complain of depression. Instead, he or she would be likely to complain of physical aches and pains (Kleinman, 1982). Similar somatization patterns for manifesting depression are found in many non-Western cultures (Marsella, Sartorius, Jablensky, & Fenton, 1985).

DEPRESSION AS A LEARNED PHENOMENON

The very fact that the rate of depression has steadily increased over the past 40 to 50 years (Sartorius & Ban, 1986; Seligman, 1988) suggests that some significant changes must have taken place in society during this time. In general, gene pools and biochemistry simply do not change that dramatically in such a short period. This is not to say that genetics and biochemistry do not play a role in depression; clearly, they do (Bertelsen, 1988; Willner, 1985). However, based on the epidemiological studies, the cross-cultural data, and the psychological research, it is apparent that most depressions are a product of experience, not biology (Brown, 1985; Brown & Harris, 1978; Dean, 1985; Seligman, 1990).
Still, it is evident that some forms of depression are the result of biological variables. If we consider that there are scores of diseases, as well as many medications, that have depression as a predictable side effect, or if we think about what is known about the seasonal affective disorder, it becomes clear that biology can play an important role in depression (Reich, VanEerdewegh, Rice, Mullaney, Endicott, & Klerman, 1987; Davis & Maas, 1983). However, it is important in diagnosing and treating depression to distinguish between biological causes and biological correlates, a distinction that has not yet been well made in the literature. The result has been a schism between those who take an exclusively biological view and those who take an exclusively psychosocial view of the origin and treatment of depression (Willner, 1985). I prefer a “both/and” perspective to an “either/or” view.
There is no reliable test to determine whether a depression is biologically based. Historically, when a patient demonstrated physiological symptoms of depression, or manifested depression in the absence of any clearly identifiable external stressors, the depression was assumed to be “endogenous” or biological in nature. Now it seems that such a narrow—and unprovable—approach may not always be a useful one for either diagnosing or treating the most salient dimensions of depression. The treatment data support this contention. Treatments of an exclusively biological nature, most notably antidepressant medications, unquestionably have demonstrated an ability to reduce symptoms of depression rapidly, and even to provide full recovery from depressive episodes. However, when the therapeutic intervention is solely a course of antidepressant medication, the relapse rate is significantly higher than when the depressed individual receives effective psychotherapy, either alone or in conjunction with drug treatment (Weissman, 1983; Becker & Heimberg, 1985; McGrath, Keita, Strickland, & Russo, 1990).
Studies indicate that an exclusively biological approach to the diagnosis and treatment of depression is not sufficient and may, in fact, be antitherapeutic in the long run (Akiskal, 1985; Weissman, 1983). If a depressed individual does not receive psychotherapy, and is more prone to relapses as a result, this would suggest that the relevant aspects of the person's depression have not been adequately addressed. Furthermore, the unwitting reinforcement in our drug-seeking society that drugs are the answer may actually work against real recovery. Is it just a coincidence that the marked increase in the rate of depression in recent decades parallels the increased societal emphasis on the use—and abuse—of drugs?
It is especially interesting that the epidemiological data show a particularly significant increase in the rate of depression among those born since 1945, the so-called “baby-boomers” (Klerman, 1988; Weissman, 1987). In writing about this trend, noted psychologist Martin E. P. Seligman (1988, 1990) contended that the baby-boomers’ high level of self-absorption and unrealistically high expectations fueled their higher rate of depression. Seligman's views reflect an awareness of the shifting cultural values that predispose individuals to depression. If we use the situation of the baby-boomers as a lens through which to examine the issue of depression as a learned phenomenon, we may be able to better determine the reason for today's high rate of depression.

WHAT CAUSES DEPRESSION?

Although depression has been described in countless ways throughout history, it has only been described meaningfully in the clinical literature for less than a century. The earliest attempts to explain who became depressed and why were steeped in abstract concepts and vague language that involved speculations about ambiguous personality constructs and hypothetical psychodynamics. Until recently, many of these earliest conceptions and their associated techniques went unchallenged and unclarified. The notion of depression as “anger turned against the self,” for example, was not originated by Freud, but he certainly popularized it (Arieti & Bemporad, 1978). This view dominated the clinical literature as the “proper” conceptual framework for understanding depression. Its noncritical acceptance would suggest that clinicians sometimes devote themselves to a theoretical model that may have little relationship to the actual nature of a disorder. What we have learned in recent years is that depression is not exclusively a biological illness; neither can it be understood only as anger turned inward, a reaction to loss, a condition that exists because the person is rewarded for it through secondary gain, or something the client wants to experience. Each perspective may hold true in some cases, but none of them represents the essence of the disorder. Rigid viewpoints of depression that emphasize a specific psychodynamic or behavioral contingency have proved to be so limited as to be potentially destructive frameworks for attempting diagnosis and treatment (Akiskal, 1985; McGrath et al., 1990; Yapko, 1988).
Emerging in the treatment literature in recent years has been a shift away from abstract issues of a person's life in favor of a focus on specific patterns the individual uses in organizing and responding to his or her perceptions of life (deShazer, 1991; Fisch, Weakland & Segal, 1983). Epidemiological, cross-cultural, and treatment studies have fostered a clear recognition that any of a variety of patterned ways of responding to life circumstances can lead to the phenomenological experience of depression. Thus, there is no single cause for depression—there are many.
What are these various depressogenic patterns that one learns and from where or whom does one learn them? The patterns that place a person at risk for episodes of depression are drawn from a variety of sources that can be broadly categorized as cultural, familial, and individual.

Cultural Influences

In recognizing the marked increase, perhaps as much as tenfold, in the prevalence of depression among baby-boomers as compared with their parents’ and grandparents’ generations (Seligman, 1988; Robins, Helzer, Weissman, Orvaschel, Gruenberg, Burke, & Regier, 1984), the suggestion is strong that cultural climate and social milieu play a significant etiological role. Whereas gene pools and biochemistry are unlikely to change so radically in such a short time, a culture can go through swift and dramatic changes almost overnight. Perhaps the most obvious examples are primitive cultures that have been contaminated by Western influences (Marsella et al., 1985). But even our own culture has undergone extraordinary changes in the post-World War II years. It is, of course, possible to fill volumes describing these extraordinary sociological changes, but I will focus on some of those that I consider to have the greatest impact on the escalating rates of depression. (It should be noted that these are not discussed in any particular order.)
1. Breakdown of family relationships.
In 1960, when John F. Kennedy ran for the presidency, the fact that he was Roman Catholic emerged as a volatile campaign issue. During that more conservative period in American history, it was hazardous for a presidential candidate to be a member of what the public considered the “wrong” religion. At that time, had Kennedy been divorced, rather than a “stable family man,” he simply could not have been elected. Twenty years later, when Ronald Reagan was a candidate for president, it was rarely, if ever, mentioned that he had been divorced. Would Reagan have been able to win the presidency if he had run 20 years earlier? One can speculate with a reasonable degree of certainty that his marital history would have been a target for criticism, and even used as an indicator of his (questionable) emotional stability.
Isn't it remarkable how in just 20 years, divorce has gone from being a relatively taboo practice to being widely accepted. What happened in the American psyche that led us not only to tolerate, but even to encourage, the breakup of marriages and families (Golden-berg & Goldenberg, 1985; Walsh, 1982)? Is it significant that most American families are no longer of the traditional nuclear type, but are blended families and single-parent families? It is true that in the psychological literature, the breakdown of the family is blamed for most of our problems, both as individuals and as a culture. However, in the case of depression, at least, it is entirely appropriate that we consider the negative influences of the disintegration of family relationships.
The breakup of the family results not only from divorce, but also from geographical separation. In the absence of ongoing regular contact with family members, the necessary social skills that such intimacy engenders (e.g., tolerance, communication, conflict management, sharing), are sorely lacking. It is clearly a statement about American culture that relationships are as troubled as they are. Dating relationships are largely brief and unsatisfying. Those who want to have relationships do not seem to know where or how to meet others. What other culture encourages the seeking of dates through classified ads?
When families break up, children are especially likely to personalize the occurrence as evidence of their own lack of worth (Lefran-cois, 1986). In fact, the divorcing partners may also conclude that the problems are personal, rather than interpersonal or situational. One's outlook on relationships and one's skill in obtaining and maintaining them are significant factors in the experience of depression, and there are numerous studies that reinforce this contention (Charney & Weissman, 1988; Beach, Nelson, & O'Leary, 1988). In at least 50 percent of those couples presenting for marital therapy, one or both partners are depressed and often other family members are as well. The reverse is also true: of those individuals presenting as clinically depressed, at least 50 percent are manifesting marital and/or family dysfunctions (Rounsaville, Weissman, Prusoff, & Herceg-Baron, 1979; Weissman, 1987; Beach, Sandeen, & O'Leary, 1990).
We have long known that relationships serve as a buffer against illness—either physical or mental (DiMatteo & Hays, 1981; Lin & Dean, 1984). In fact, when we look at the demographic data regarding who is most likely to become depressed, the highest risk category is found to be single women and the lowest risk category to be married men (Klerman, 1988). The evidence also suggests that the highest likelihood of relapse of depressive episodes is among individuals who continue in marital (and family) relationships characterized by poor communication, criticism and other verbal abuse, and lack of emotional support (Jacobson, 1985; Birtchnell, 1991). Thus, the evidence is overwhelming for a systemic approach to depression that involves partners and families in the treatment process when appropriate.
The key point is that relationships play a very large role in the experience of depression. Our cultural emphasis on isolation through divorce, frequent job changes, and geographical relocation is likely to continue to impair our ability to build the kinds of high-quality relationships that might help serve as buffers against depression.
2. The ambiguity of gender and other identity roles.
The concept of androgyny was touted at one time as a means to promote equality between the sexes by blurring the boundaries in traditional roles. Whether such blurring is desirable is not relevant here. What is relevant is that as gender roles have gone from being clearly delineated, almost scripted, to being vague and uncertain, there has been a double consequence. For those who can tolerate ambiguity well (who, in fact, are less prone to depression), the ambiguity of gender roles has not posed any significant problems. However, for those individuals who do not tolerate ambiguity well, the uncertainty of what is appropriate to expect of oneself based on one's maleness or femaleness, or the blurring of traditional gender roles, has led to significant emotional distress. For such people, it no longer is clear as to who does what in a relationship, thus creating further confusion about discrepancies between expectations and reality. Furthermore, as the role of women in the work force continues to increase, more and more households have dual incomes, which creates the potential for greater material gain. Thus, simultaneously, gender roles have become unclear and an emphasis on materialism has emerged.
The frustration arising from a lack of clear definitions of appropriate gender behavior, and, therefore, of appropriate behavior in many interpersonal contexts (business, family, etc.), is a predictable consequence of the diversity of views in our culture. The confusion beomes manifest as do...

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