Depression is one of the most common psychopathological disorders of our time. Like many other mental disorders, the most widely used form of therapy is pharmacological. Approximately one in every ten Americans takes an antidepressant. This ratio is more than double among women, especially those in their 40s and 50s. Although the most widespread, this treatment is not the best. Patients are forced to become drug dependent for years and sometimes life due to side effects. Antidepressants act only on curing the symptoms, not solving the causes. Counseling and psychotherapy can lead to the identification and resolution of the triggers of depression. However, there are limitations as well, including a higher initial cost than drugs and a level of effectiveness that is not always optimal. The higher cost is not an issue if the treatment is effective. Effectiveness is a real problem since most traditional psychological treatments are only decisive in 20-40% of cases (significantly increasing if integrated/holistic approaches are applied).
The Evolutionary Significance of Depression
From a holistic point of view, every disease (especially if chronic) is a message whose purpose is to inform our consciousness that something in our life is not going in the right direction. Depending on the type of disease, this “something” can relate to diet, lifestyle, relationships, work, identity, etc. Depression is an emotional disease; it is not about feeding the body, but rather, the soul. In fact, depression can be considered a form of chronic sorrow, informing us that something in our lives makes us sad. Some examples could be: unsatisfactory work, an excess of duties, lack of a life purpose, loneliness, poor relationship with one’s partner or with oneself, etc. In a painful way, depression exists to encourage our evolution, making us become aware of what should be changed in our lives, and pushing us to do so.
Although not all depressions are so simple, helping the patient understand what makes them sad is one of the main objectives of holistic psychotherapy. Why do so many people have to wait to get sick from depression to understand that something is wrong in their lives? Why do they not listen to the initial signs of sadness and wait until it becomes chronic? And further, why once they receive the message, do they fail to grasp its meaning? Some socio-cultural and other psychological characteristics are at fault.
The Socio-Cultural Causes of Sadness/Depression
As mentioned above, depression is a chronic sadness. This emotion is connected to frustration, the inability to meet one’s own needs, especially relational. Why is it so widespread, especially in countries where most of the population has money, freedom, and opportunity in abundance? The answer is simple: these resources are used in the wrong way, pursuing false needs and goals that, once achieved, give no real gratification. This illusion depends mainly on the excessive importance given by society to the materialistic values of having money, power, social success, consumerism, etc. These values come at the expense of having love, friendship, good relationships, personal development, spirituality, etc. This excessive importance leads many individuals to invest all of their resources and expectations, leaving them disappointed, sad, and hopeless. This is depression.
Another question arises: After the first disappointment, why do people continue on the same road? It depends mainly on insufficient emotional self-awareness. Individuals can prevent, perceive, and interpret the messages their soul sends to consciousness through sadness and other emotions. The fact that neither schools nor the universities are involved in the cultivation and development of awareness shows how much it is neglected in our society. The majority of depressed people are not aware that they are lacking important nutrients. Some of the people, activities, and rewards they consider to be desirable and beneficial in reality, are not.
The Intrapsychic Factors Related to Depression
Depression does not depend only on sociocultural causes. The illusion of misleading goals and intrapsychic factors come into play as: defense/self-deception mechanisms (as explained by psychoanalysis); erroneous beliefs (as evidenced by cognitive therapy); dysfunctional scripts inherited from one’s own family or self-made (as remarked by transactional analysis); the tendency to frequently think of sad memories in the past or of future negative scenarios (as outlined by ancient eastern psychologies). In these cases and many others, the goal of psychological treatment is not only to help the individual to become aware of his false goals. Psychological treatment also helps identify and change intrapsychic factors that make individuals dependent, preventing them from breaking free of the illusion.
The holistic perspective considers socio-cultural and intrapsychic factors as interconnected. Unfortunately, most of psychotherapists and counselors do not know this perspective (or do not agree with it), tending to focus only on the intrapsychic factors. Rather than the whole range being managed, only those that are recognized by the psychological current are addressed. The factors involved vary from person to person. In some cases the psychoanalytic approach may be valid, while in another, the cognitive one. In others still, the transactional approach may be appropriate, or rather the humanistic, bioenergetics, transpersonal, and so on. This is the main reason that led me toward integrative psychotherapy (using concepts and tools belonging to several approaches). Later, I moved move on to creating a holistic integrative psychotherapy model, which not only integrates different approaches, but also changes the worldview in which this integration is done.
This model includes contributions from other disciplines (sociology, medicine, biology) and even from the ancient psychologies of the east (yoga, tantra, Vedanta, Zen, etc.). Unfortunately, there are not many health care professionals who know the great opportunities offered by this kind of approach. Most universities continue to train medical doctors, psychologists, and other health professionals by means that are far from holistic. Only a few small, innovative universities are inspired by the new paradigm. Most of these universities are located in California, with a few exceptions including The Graduate Institute of Connecticut. This university offers interesting and innovative certificate and master’s programs in Integrative Health and Healing and Integrative Mental Health. The basic feature of these programs is to consider the human being as such, not as a machine. To do this, one must consider not only the body or the rational mind, but other interrelated dimensions as well, including: emotional, affective, intuitive, interpersonal, transpersonal and spiritual. In addition to internal dimensions, there are holistically relevant external ones. Relations between the individual and his environment extend the concept of mental health to also including the health of society and the ecosystem (well outlined by a course of The Graduate Institute titled Ecotherapy & Cultural Sustainability).
To conclude, we can say that depression is normally considered an individual and private pathology. From a holistic point of view, it should be considered a collective disease. Therefore, treatment requires changes not only in individual mental dysfunctions but also in society and ecosystem dysfunctions.
Enrico Cheli, a psychotherapist and sociologist, is professor at the University of Siena (Tuscany), one of the oldest and most qualified Italian universities. Here, he has created and directed several holistic master’s degrees and Ph.D. programs on relational counseling, emotional well-being, interpersonal relationship, and conflicts resolution. He is now the academic director of a new certificate program on Integrative Mental Health at The Graduate Institute of Connecticut. He has authored 27 books and more than one hundred articles. For more information visit: www.learn.edu/enricocheli.