Healing Depression Safely
By Bob Murray, PhD and
Alicia Fortinberry, MS
September 2002, published in Wellbeing magazine
New research shows that most treatments for depression, including cognitive
behavioral therapy, diet and antidepressants aren't enough. The only lasting
solution is the oldest of all: a supportive "band" of relationships.
One of the things we find most affecting in our program for people with depression
is how incredibly relieved people are to have a non-judgmental forum in
which to discuss the ongoing pain of this devastating illness. They feel
there’s something wrong with them for not being able to get out of
bed easily--and sometimes not at all--in the morning, or for bursting into
tears at work. Most believe that somehow it’s their failure that none
of the prescribed treatments have worked; that they haven’t “gotten
over it”. They are often afraid to “burden” friends and
family with their anguish. They scarcely dare hope that there really is
an answer for them.
Yet the truth is they are not alone. Also that the illness has even deeper
causes than we once thought. They are not “weak” or “lazy”
or “hopeless”. They are merely misinformed and isolated. Depression
is not a life sentence. There is a way out.
According to government statistics, everyone is affected by depression.
You are either one of three women, one in six men, or are close to someone
who is clinically depressed . Yet new research shows that the most common
treatments, antidepressants and cognitive behavioral therapy, are not long-term
The problem is probably even greater than these figures indicate, since
depression can take the form of anxiety, rage and many physical problems
such as chronic fatigue, chronic pain and even more serious physical illnesses.
Up to 80 per cent of people who go to physicians suffer from an underlying
depression . Although it’s been long known that depression is “involved”
in numerous diseases, ranging from alcoholism to osteoporosis, researchers
are now citing it as the “cause” of heart attacks, loss of vision,
certain forms of cancer and diabetes .
Antidepressants were hailed in the 80s and 90s as the cure-all for this
rapidly growing problem, particularly after the best-selling book Listening
to Prozac. Yet they don’t work for 47% of the population
[latest figures now cite the failure of antidepressants as high as 70% -- Ed, April 2004.] ,
have sometimes intolerable side-effects, and may lose their effectiveness over
time . In fact, the US Food and Drug Association (FDA) recommends taking
most antidepressants for no more than a short time . To make matters worse,
researchers have now discovered that the real culprit in depression is probably
not just insufficient levels of serotonin in the brain, which the antidepressants
target, but a surfeit of the stress-related hormone, cortisol .
We now also know that the brains of depressed people are not only out of
balance chemically, they also tend to have a smaller hippocampus, which
controls emotions and memory, and a less active frontal cortex, the command-and-decision
making center . The good news is that we can “grow” new brain
cells in those areas, through a process called neurogenesis . The bad
news is that as of yet there is no pill to help this process along.
One wonders, actually, why so many people do say that antidepressants help,
at least initially. It may be that the results reported for antidepressants
in the first place were due to the placebo effect . Several studies
have now shown that antidepressants work no better than placebos, and that
both relied for their effect on the relationship the patient had with the
prescribing physician . Since these studies were published, overviews
of other medications, such as the so-called wonder drug interferon (which
was going to cure everything from MS to cancer), have shown that they did
no better when compared to a sugar pill . Again, relationships seem
to play a paramount role.
Natural remedies for depression, which have the advantages of fewer side
effects, aren’t the answer for everyone either. St John’s Wort
is only suggested for mild depression, and many other supplements and foods
can only help at best, not heal.
Even drug companies are realizing that antidepressants alone aren’t
enough, and are offering therapy groups for Australian consumers. However,
the director of Beyond Blue, the government sponsored anti-depression initiative,
says the groups are too large to be much help .
The problem may not be just the group size. Doubt is now being cast about
the basic assumptions underlying existing forms of psychotherapy for depression,
including the most commonly used, cognitive behavioural therapy, or CBT
. Studies show that even patients who do well with CBT in the short
term tend to relapse a while afterwards .
“Depression is a recurrent disease for a lot of people just like cancer,”
said Jackie Gollan, lead author of a study by the University of Washington
factors in their lives beyond their mood need to be identified if we are
to help them stay well. We need to consider who people are and how they
interact with others to understand how patients remain non-depressed.”
Golan’s research showed that people who were more independent and
found it hard to relate to others were most at risk of depression. This
confirms the many studies which show that peoples’ happiness is in
relation to the number of close, supportive friendships that they have.
A recent study by Canadian researchers links loneliness to both depression
and alcoholism . And there is no question amongst health professionals
that good relationships are vital for physical health. For example, studies
link arguments with a spouse with physical illness, and traumatic childhood
relationships to adult illnesses .
To understand more fully why good relationships are the answer, let’s
look closely at how relationships gone wrong damage healthy development.
To do that, we have to take a step back and examine how we were meant to
live and raise children.
The old African proverb, “it takes a village to raise a child”
is just about on the money. In our hearts--or more accurately, in our genes--we
are hunter-gatherers. In a hunter-gatherer band (villages came later) there
were from 25 to 50 members, women shared child-rearing, and a child could
always find a comforting lap. Work only took up five to ten hours a week,
so no one was defined by their occupation. And there were many different
“role models”--aspects of styles and personality for children
to selectively adopt. Relationships were learnt easily and well in this
rich, safe, non-competitive environment.
What a far cry from the way we live now! The isolated, over-stressed family
simply can’t meet all the needs of its members. Many don’t get
enough of the four basic needs, which are for physical safety (which relies
on group inter-dependence), emotional security (knowing the rules, rituals
and expectations of those around you), attention (from people you live and
work with) and importance (not for what you do, but who you are). The child
in such a family is primed for depression in many ways. Firstly, there is
the trauma of living in such a stressful, non-human situation. Criticism,
neglect, parental conflict, divorce, parental addiction to drugs, alcohol
and over-work, lack of freedom to run and play in nature, narrow and inappropriate
expectations, emotional, physical and sexual abuse, family secrets, poverty,
violence and discrimination . . . the list goes on. Few escape.
This is why depression and post traumatic stress disorder (PTSD) have a
lot in common. Most people still think of PTSD as the result of war or natural
disasters. Yet for many of us, the family was an emotional, if not physical,
“war zone” and, compared to what it should be, a “disaster”.
The child can’t physically leave home, so he or she may “zones
out,” mentally takes a vacation, dissociates. The brain literally
slows down to limit exposure to the painful surroundings. Later on in life,
this defense mechanism will increasingly be triggered by the social environment.
Movement is slow, and the depressed person has trouble getting things done
and becoming motivated.
Anxiety and panic attacks, which are part of the depressive syndrome, can
also be reactions to events in adulthood that mimic those of childhood,
even subconsciously. Cortisol, a neurotransmitter related to stress, is
over-secreted, and other chemical imbalances occur. At the same time, the
very structure of the brain is compromised. As a result of extreme stress
and childhood trauma, the hippocampus, for example, doesn’t develop
as it should--it literally has fewer neurons. The result is difficulty in
handling emotions and often a loss of short-term memory. Traumatic memories
stored in the amygdala, a walnut-sized part of the central brain which stores
powerful emotions, flood the undeveloped hippocampus. This part of the brain
is then unable to differentiate properly between a real crisis or a minor
glitch in the present, or an experience in the past. The frontal cortex,
which is meant to sort out emotional transmissions and decide appropriate
actions, is also damaged.
No wonder the depressed person feels overwhelmed by feelings he or she can’t
control, as if hounded by internal demons or pitched into an abyss of despair.
No wonder they often make matters worse through inappropriate anger or actions!
Telling someone to “avoid negative thinking” is not helpful
if they are in the throes of emotional overload. Cognitive techniques to
put events into perspective and counteract negative thought patterns can
be useful, but may not be possible. Besides, even changing thought patterns
doesn’t go far enough.
In a calm, supportive, safe environment, the depressed person has a chance
to heal, and to learn new cognitive patterns. But here’s the catch:
the depressed adult will have sought out or recreated in their life many
of the abusive or traumatic elements of childhood. This again is not their
fault, or even the result of conscious decisions. Once more, the answer
lies in what happened to the brain in the first decisive six years. And
it happened through relationships.
When a baby is born, and the mother looks at it lovingly, a neural connection
is formed between eye contact, love, safety and home. When the infant is
fed, a connection is made between food, love, safety and home. (Is it any
wonder that food is such a ritual part of courtship, as in the “romantic
dinner for two?”) If, perhaps, Italian is spoken in the house, then
the child associates that language with love, safety, and home. But let’s
say the child is criticized or physically punished. The same thing happens!
Criticism and abuse become “wired in” to the child as, you got
it--home, safety and love.
These connections, when made in the formative years before the age of six,
form the “program” that will determine all the thoughts, beliefs
and actions a person has in adult life. Thus, if the child was criticized,
he or she will seek out criticism, if abandoned, abandonment, if abused,
then abuse. This does not make abuse his or her fault. The “program”
is not the person. It’s just something the person learned.
There are other factors at work, too. As hunter-gatherers, which we remain
despite our technological advances, we are genetically driven to “idealize”
other members of the band so that we feel secure. If a natural disaster
wiped out the rest of the group, each individual could recreate the rituals
and ways of the tribe. Through idealization, the brain has taken on this
information. Growing up we may idealize parents who have themselves inherited
faulty coping mechanisms. We try to make them right, in order to feel safe
and in control of life, and in doing so we may set ourselves up for failure.
This is the reason we usually marry Mum or Dad or both. We seek out those
characteristics which our parents (or older significant people in early
Making the ideal right can create even more problems. What if Dad said you
were “stupid and lazy, just like your Mum?” What will you become?
Stupid and lazy, of course! (At least in the eyes of others.) What if Mum
said you were never going to find a mate? It will be very difficult to relate
to a potential partner with that sentence hanging over your head!
If one or both parents were depressed, we take on the beliefs, characteristics
and even (probably in the womb) the chemistry of the depressive. Experiences
in the womb do not doom us. If, for example, a depressed mother recovers
from her depression, so will her infant.
But if we are born into such a family, we will have to do more than repeat
positive affirmations or attempt to counter our faulty belief systems to
recover from depression.
We also learn dysfunctional coping mechanisms if we are brought up in a
difficult family situation. If our parents don’t have enough one-on-one
time for us, we may fall ill to get the attention we so desperately need,
a strategy that can carry on through adulthood. We may be the “bad”
child who acts out in class and takes risks with the law as an adult. Or
we may be the “goody-goody” who helps everyone but ourselves,
falls prey to stress, and is so busy looking after others we can’t
take care of themselves.
How do you counteract this legacy of the battered nuclear family and a society
that lost the plot somewhere between five and ten thousand years ago? Since
we can’t all go back to hunting the woolly mammoth and living a traditional
hunter-gatherer lifestyle, how do we heal ourselves of the dysfunction of
our present way of life? Of the depressive cycle, the injured brain, the
feeling that we don’t belong, the agony of depression?
We may not be able to copy the free and natural lifestyle of our ancestors,
but we can recreate the most important aspects of their lives: the close
and supportive circle of friends, or “band.”
As we bring functional, lasting relationships into our lives, at work, at
home and even at spiritual gatherings, we heal the brain. What is a “functional
relationship?” One that meets our genetic, ancient needs as humans.
We find that most people haven’t a clue as to what these are. After
all, if we are to believe the ads on TV, all we need is the biggest house,
the best beer, the silkiest shampoo, and the fastest car!
Even more damaging than the consumer culture is the use of generalities.
When we initially ask people what they need from other people, we usually
get vague answers: “I need respect,” “space,” “love,”
“to be understood.” Yet what do these really mean? These generalities
act as barriers to relationships. We expect the other person to second-guess
what we really want. And they can’t! Others will filter these words
or phrases through their own childhood experiences, and they will mean different
things than they do to us.
If we want our relationship needs to be met, they must be specific and concrete.
For example, “I need you to listen to me, and by that I mean, look
me in the eyes, wait until I’m finished talking, and then ask me questions
to make sure you understood what I just said.” Now that’s specific.
The other person may not want, or be able to, meet that need, but there
can’t be any misunderstanding.
And if they are not willing to do that, what are they saying about the importance
of the relationship to them? Is this someone you really want to be involved
with? Are they reinforcing your dysfunctional program and beliefs (such
as unworthiness) if they criticize or refuse to listen? The answer is probably
yes. Are they part of the solution, or part of the problem of your depression?
We find that most people, if they really understand your needs, will try
to meet them. As you learn to state your needs clearly, you will probably
find that you gain the respect of many people in your life. You will begin
to feel safe and cherished. This is a positive environment, one which does
not constantly re-trigger the past, one in which your brain can heal. Without
constant re-traumatization, the brain can begin to grow new cells in pivotal
As you create a safe, secure relationship environment, you also undo the
programming of the past. If you were programmed to seek out criticism, you
require of those in your life that they do not try to control you through
criticism. New connections are made in the brain: I don’t deserve
to be put down, I am competent, I am worthy of being loved. If you lacked
attention, you tell people in your life, for example, how often you want
them to call and to be with you. If you lacked safety, figure out what would
make you feel safe and make sure everyone in your life complies by those
This needs process also creates chemical changes in the brain. According
to some researchers, for every concrete need you give, you receive a dose
of dopamine, the “feel good” chemical. Every time a need is
met, you get an increase in your brain’s uptake of serotonin, the
neurochemical that helps the overall function of the brain.
Is there room for negotiation in this process, or do you go around brandishing
your list of needs as if they were ultimatums, written in blood? Of course!
In our courses, articles, audio-workbooks and books we let people know how
to decide which needs are most important and which allow the most compromise.
We also teach how to clearly communicate what you need and why. Finding
out the other person’s needs of you, whether that person is your boss,
child, best friend or lover, is an important part of the process.
To summarize, depression is formed by painful or lacking relationships in
early life. It is not your fault, even if you can’t seem to get the
various treatments that may have been suggested to you to work. You can’t
rid yourself of this pervasive and increasingly common illness alone, or
even with the occasional help of a health professional. Ultimately, only
by creating lasting, supportive relationships will you finally heal your
brain, emotions and body. If you do so, you go far beyond depression, to
a happy and purposive life. If your childhood programming says you can’t
have these kinds of close connections, or that you’re not worthy of
them, it’s lying. You can do this.
This article was published in Wellbeing, September, 2002, entitled "Coming Together: Techniques That Heal Depression."
Top of page
Check our event schedule for workshops and seminars.
 “National Health Priority Areas Mental Health: A Report Focusing
on Depression from the Australian Institute of Health and Welfare”,
 Jacobson/Gollan report of study findings presented at Association
For the Advancement of Behavior Therapy, December 1999.
 Prof Steven Dubovsky, Mind Body Deceptions,
pub. Norton & Co, 1997.
 For diabetes: “Depression
in Adults With Diabetes” by Patrick J Lustman, PhD, and Ryan Anderson,
Psychiatric Times, Vol. XIX Issue
1 January 2002; for vision loss: see
article in Ophthalmology by Stuart
I Brown MD, chairman of UCSD's Department of Ophthalmology; for
heart disease: many, eg “Treating the Patient as a Whole
Person” by Elizabeth Fried Ellen, LICSW, Psychiatric
Times, June 2001 Vol. XVII Issue 6; also Prof Michael Frenneaux
University of Wales College of Medicine study for the British Heart Foundation;
for breast cancer: study by Johns Hopkins
School of Public Health reported in Cancer
Causes and Control, September 2000.
 “Rumble in Reno: The Psychosocial Perspective on Depression”
by David Antonuccio, PhD, David Burns, MD, William Danton, PhD, and William
O'Donohue, PhD, Psychiatric Times,
August 2000. Also findings of study by Royal College of Psychiatrists,
quoted in The Guardian newspaper,
February 13, 2002.
 For side effects: see many FDA warnings
about individual medications but also eg British Journal of Cancer, January
2002; for loss of effectiveness: see
also RCP statement quoted above, also Overcoming
the Dangers of Prozac, Zoloft, Paxil and Other Antidepressants with Safe,
Effective Alternatives by Joseph Glenmullen, MD, Simon & Schuster,
 Virtually all antidepressants have had recommended time limits placed
upon them by the FDA after which they say that they do not condone their
continuance, eg Zoloft warning on extended use, August 1996--recommended
9 weeks; Paxil, in Australia called Aropax, August 2001--8 weeks; Venafaxine,
October 1997--recommended 4-6 weeks; Anafranil, April 2001--10 weeks.
See also UK & German studies, esp. into Prozac, some reported in The
Guardian newspaper, October 1, 1999, others reported by Glenmullen
 Many recent articles, eg “Role of Cortisol in Development of
Human Psychopathology”, British Journal
of Psychiatry, Vol 179, 2001.
 For example Daniel Amen, MD, “Why Don’t Psychiatrists
Look at the Brain”, Neuropsychiatry
 Numerous recent studies, eg study by Prof Fred Gage, Salk Institute,
reported in Nature, March 2002.
 Many recent studies eg Irving Kirsch et al reported in Prevention
& Treatment, July 1998.
 See Kirsch above.
 Numerous recent studies eg study by Jon Stoessl and colleagues at
the University of British Columbia in Vancouver reported in Science
magazine, September 2001.
 Prof Ian Hickie quoted in The Sydney
Morning Herald, February 17, 2002.
 Jacobson/Gollan report cited above, December 1999.
 Study by Donald McCreary, PhD et al reported in Psychology
of Addictive Behaviors, June 2001.
 Many studies but eg The Sickening Mind
by Paul Martin pub. Harper Collins 1997, and “Childhood Trauma,
CRF Hypersecretion and Depression” by Deborah Lott, Psychiatric
Times, October 1999 Vol. XVI Issue 10.
Top of page
About the Authors
Dr Bob Murray is a widely published psychologist and expert on emotional health and optimal relationships. Alicia Fortinberry is a psychotherapist, health writer and executive coach. Together they are the founders of the highly successful Uplift Program, and authors of Raising an Optimistic Child (McGraw-Hill, 2006) and Creating Optimism (McGraw-Hill, 2004).
Disclaimer: The diagnosis and treatment of medical or psychiatric disorders requires trained professionals. The information provided in this article is for educational purposes only. It should NOT be used as a substitute for seeking professional help.
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