Some years ago, when I was in Sudan, I went wandering around the ancient city of Omdurman – after dark. Omdurman is basically a medieval Arabian market place. It is a warren of narrow streets, lined with all sorts of stalls, with merchants crying their wares. In fact, it is a bit like stepping back into a much earlier time. At first, I was very nervous – expecting one of the dark-skinned, white-robed locals to slit my throat at any minute.
How wrong I was. There was such a happy, carefree atmosphere. I remember thinking: ‘But these people are so poor, yet they seem so happy.’ The atmosphere in Omdurman that evening was full of joy. When I attempted to buy some of the exotic spices on sale in one of the shops, the merchant refused to accept money from me. Instead, he said in his simple English: ‘Welcome to my country!’ Later on, a little boy ran after me to return a coin I had apparently dropped in the street earlier on.
More recently, walking around the streets of my native city of Dublin, I am struck by how unhappy and stressed people seem to be. I keep patting my pocket, to make sure my wallet hasn’t been pinched. Yet Dublin has experienced an economic boom in recent years. People are a lot more prosperous. But, is it my imagination, or do they not look as happy as they seemed to be when I was younger? Are they perhaps more depressed?
Depression is an insidious illness. It strikes both rich and poor. There is an awful irony – when people work hard to make a lot of money in order to be happy – only to end up rich and depressed as well. Depression affects people of all ages and walks of life. And it tends to be a ‘secret’ ailment. People who suffer from it, very often develop an external mask of sociability and bonhomie, to hide their inner turmoil. They fool the world – but never themselves.
Of course, people who never get depressed say it’s ‘all in the mind.’ And so it is – but in a very cruel way. We all have our own mental illusions about the world we live in. The mental world inhabited by the depressive is a truly horrific one.
The distress and mental agony suffered by depressives is very real for them. Having met many sufferers in my own practice over the years, I now believe that depression has to be the very worst illness of all. No physician or therapist can fully understand the horror of depression – unless they themselves have also been sufferers. And it is so difficult for the depressive to explain what it is like to the rest of us. That is why they often use metaphors such as ‘black hole’ or ‘black dog’ to try to describe it.
The reason I conclude that depression is the worst of all illnesses is that virtually all sufferers contemplate suicide – and many of them eventually succeed in ending their torment in this way. What other illness is so horrific that people want to kill themselves? Patients with cancer or heart disease want to live. Depressives often, unfortunately, want to die.
Chronic anxiety and panic attacks are part of the depression complex. Many people suffering from alcohol dependency are using alcohol as their own ‘medication’ for depression – only to find that alcohol itself can cause the depression to get worse.
It’s hard to imagine
If you know someone who suffers from depression, it can be difficult to imagine what they are going through. Here is one way for an outsider to begin to gain an understanding. Most depressives experience an extreme form of one of the ‘negative’ emotions, such as fear, despair, anger, self-hatred, grief, guilt, hatred, sadness, unworthiness, etc. Very often, there is no obvious cause, such as childhood trauma. But the feeling is there nonetheless, and it is very real to the sufferer. Let’s imagine that the negative feeling is anxiety, and the person can tell you that much at least. Then try to remember the most terrifying experience you ever had in your own life. Re-live that terror in your mind. Then try to imagine what it might be like if it was multiplied in its intensity by a factor of five – and that it continued indefinitely in your life, for no particular reason.
A government minister recently got himself into hot water by referring to suicide as a selfish act. Even though he had to apologise, he was in fact not that far off the mark. But ‘self-absorbed‘ might be a more accurate term. When you suffer from depression, you become totally absorbed in your own internal mental pain – to the exclusion of all else. When people commit suicide, they do not consider the suffering and grief they will cause their loved ones. The thought literally never crosses their mind. Such is the nature of this dreadful mental condition.
What about treatment?
First, let it be said that many sufferers tell nobody about it – and the condition goes undiagnosed. But if diagnosed, the GP will either refer the patient to a psychiatrist or a psychotherapist. It rather depends on the preferences and experience of the GP. Psychiatrists usually prescribe medication. These mood-altering drugs generally have the effect of ‘masking’ the symptoms somewhat. However, they do not, unfortunately, unravel or cure the underlying ‘programme’ which activates the condition. But they can at least pacify the patient temporarily – which can be a good thing. Many of the clients I see, who have been treated by psychiatrists, describe it as a ‘hit or miss’ procedure. First, we try one drug – if that doesn’t work, let’s try another – until hopefully, they hit on one that does the job.
Psychotherapy, i.e., counselling, at least has the merit that no drugs are used. It is sometimes referred to as the ‘talking cure.’ The idea is that the patient is encouraged to talk freely about his or her problems – until eventually the underlying cause is brought to light. This knowledge is then supposed to somehow lead to a cure. This therapy incidentally can often take many years. Unfortunately, however, there are a number of problems with psychotherapy.
For many patients, knowledge does not in fact lead to a cure. In other words, even if they do find out what caused all their problems, they still actually have those problems. Only now they can tell all their friends why they are so miserable. But they are still miserable. And quite often, after spending years in therapy, they are actually more miserable than when they started. By talking about their problems for years to the therapist, it has now become official.
Another worrying aspect of psychotherapy is the implied assumption that depression is caused by trauma, especially in childhood. I have to say that, in most of the cases I come across, the more likely cause seems to be an inherited genetic tendency. Besides which, focusing on the cause or even the problem itself can often paradoxically be counter-productive. A far more productive approach is to focus instead on the solution.
Cognitive behaviour therapy (CBT) at least offers a more practical approach to the problem. It is based on the idea that attitude and behaviour tend to match each other. First, change behaviour patterns through various exercises, so that eventually the attitudes will shift. And some sufferers, at least, have found CBT to be helpful with their condition.
The best solution of all
The positive outcome desired by every depressive is happiness. Simple, isn’t it? When you’re happy – you literally cannot be depressed. Happiness is actually the cure. And, of course, happiness is produced by your own internal ‘pharmacy’ – with absolutely no negative side-effects.
And, guess what, every person on this planet knows how to be happy – even if that knowledge is sometimes forgotten – buried deep in the subconscious mind. Given the opportunity to experience happiness again, the subconscious mind will gladly re-awaken the circuitry of happiness – and always enthusiastically seize it.
To the best of my knowledge, of all the treatments and therapies on offer, only hypnotherapy (when creatively operated) can actually trigger this profound type of change – where happiness replaces misery. Because hypnotherapy is ‘solution-oriented,’ the unconscious is only too happy to co-operate. That is why the positive changes are usually triggered faster and are also permanent and generative.
Larry McMahon is a hypnotherapist in Ireland. He has used hypnosis for many years and is now using Zoom to help clients.