June / July 2004

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DEPRESSION
A Social Problem with a Relationship Solution
— Bob Murray and Alicia Fortinberry

Depression and its myriad allied disorders are symptoms of a society that has lost its way, forcing us to live in a manner inimical to our human, genetic nature and subjecting us to trauma and abuse. Yet we—and our clients —can create healthy and meaningful lives, largely through forming fully supportive relationships that meet our human needs, as did the hunter-gatherers, our ancestors.

First, we must see beyond the myths of depression perpetuated by ignorance and vested interests and understand the true nature and causes of depression. Drug companies and much of the medical establishment assure us that antidepressants are the solution to everything, from happiness to social success and our ability to relate to others. Their claim that the main issue in depression is the failure of the brain to uptake serotonin is a red herring. Depressed people do indeed experience a neurochemical imbalance, but this has been shown to be a symptom of a much deeper problem.

Depression is not a genetic lifesentence. There is a predisposition to depression, but it is simply that, a propensity requiring an environmental trigger. Neither is depression due solely to faulty thinking, beliefs, “schemas,” or even behaviors, although all these play a role.

WHAT DEPRESSION REALLY IS

Every recent study on the subject shows that the real culprit behind endogenous depression is childhood trauma resulting mostly from a failure of early relationships. The American Association of Pediatrics defines this trauma as “a repeated pattern of damaging interactions between parent(s) (or significant adult) and child that becomes typical of the relationship.” This includes criticism, unrealistic expectations, physical or emotional absence, parental fighting, divorce, addiction, and even violence on television.

These traumatic events inhibit proper development of the growing brain and create the anomalies that often show up on brain scans of depressed people. The amygdala, a key area of the limbic system that warns of signs of stress or danger, becomes overactive, sending out more highly emotionally charged messages. The frontal lobe, where key decisions are made, is slow to switch off the alarm signals coming from the amygdala. (Hence Daniel Goleman’s evocative term “amygdala hijack.”)

Problems in the frontal lobe are also responsible for the difficulty most depressed and anxious people sometimes have making even simple decisions. The hippocampus, which deals with learning and forming new memories, does not have the neural capacity to help the person remember and avoid circumstances that trigger depressive episodes. Obviously, antidepressants, which address neurochemical imbalance, are not the solution to these basic malfunctions.

DEPRESSION IN THE BODY

Depression shows up not just as symptoms of sadness, inability to experience pleasure, difficulty in making decisions, and lack of energy and enthusiasm, but in a whole spectrum of related problems. These include anxiety disorders, chronic pain, many illnesses, and even post-traumatic stress disorder (PTSD), bipolar disorder, and dissociative disorders.

Childhood trauma also lodges in the body as a “kinesthetic memory,” resulting in habitual muscular patterns of defense and restriction, which in turn send messages of fear, panic, distrust, anger, and sorrow to the brain. Dysfunctional ways of movement and posture can also lead to muscular pain and injury and reveal the person’s low self-esteem and vulnerability to others.

The list of illnesses that are causally linked to depression increases all the time—they include heart disease, back pain, and diabetes. Depression can also “somatize”—create symptoms of illness even when there’s no underlying pathology. Studies show that up to 80% of people who visit physicians do so for “functional complaints,” in which mood disorders mask as physical illnesses.

DYSFUNCTIONAL RELATIONSHIP PATTERNS

The incidence of childhood depression increases 23% a year, according to one Harvard study (not coincidentally, U.S. government figures show child abuse rising 10% a year). However, most endogenous depression surfaces later, triggered by stressful relationships that echo the childhood trauma.

Though we are genetically geared to form relationships, how we do so is learned. And, in the pressurecooker of the socially unsupported nuclear (or one-parent) family, the relationships most of us learned were dysfunctional.

In fact, the traumatized child is “programmed” to recreate the most difficult early relationships in adulthood. The child has to expend far more effort—and thus create more neural connections—to cope with unsatisfactory relationships. He or she in effect becomes “specialized” in dealing with criticism or abandonment, and as an adult will seek out or create situations where these forms of control and abuse occur. The result: a depressive episode—or anxiety, PTSD, or somaticized illness.

7 STEPS FOR A DEPRESSION-FREE LIFE 1 Identify and defeat the inner saboteur. 2 Reconnect to your body. 3 Create healing relationships. 4 Elevate your self-esteem. 5 Uncover your competence. 6 Access the power of shared purpose. 7 Deepen your relationship to the Divine.

DEFEATING THE INNER SABOTEUR

The first step in overcoming depression is to identify negative childhood programming, which we sometimes anthropomorphize as the “inner saboteur.” This involves pinpointing the negative “voices” (verbal or behavioral messages) from the past that lodge beneath our conscious thoughts and goad us into self-defeating behaviors and damaging relationships. They whisper: “You’ll never amount to anything,” “Why not leave before she leaves you,” “He’s only criticizing you for your own good,” “No one could possibly love you,” “You’ll never change, why try?”

As they say of alcohol in AA, the inner saboteur is “cunning, baffling, and powerful.” As with any system, it strives to perpetuate itself and to create the conditions under which it will flourish.

To defeat the inner saboteur and resist its siren song, the depressed person must first externalize these voices. Whenever possible, we recommend giving a face to the message, be it a parent, older sibling, teacher, or, if memory fails, even a made-up name. These ideas and beliefs are learned, they are not us, and they can be overcome. But while identifying dysfunctional patterns and attempting to make different choices is important, it is only the first step to healing the depression spectrum.

We cannot simply decide to have different thoughts, beliefs, and reactions to external events. To effect lasting change, we must change how others relate to us. Creating Optimism: A Proven, Seven-Step Program for Overcoming Depression by the authors (McGraw-Hill, 2004) offers an action plan focused on creating truly supportive relationships and other forms of connection required for authentic happiness. These techniques are also taught in the authors’ Uplift Program, sponsored by the University of South Florida in Tampa. According to follow-up questionnaires up to two years afterward, the program has a 94% success rate in enabling people to maintain an enhanced mood and fully supportive relationships.

THE RELATIONSHIP SOLUTION

The key to overcoming depression is a nexus of truly supportive, nurturing relationships that meet our functional needs. Positive relationships can help reprogram the brain by stimulating new neural connections. Research suggests that a nurturing relationship environment can even undo the neural damage caused by childhood trauma by stimulating neurogenesis, or cell growth. That good relationships are the key to healing depression— as they are in preventing heart disease and even slowing the HIV virus—is not surprising. Human beings are relationship-forming creatures, genetically geared to live in interdependent huntergatherer bands of 30 to 50 people.

Human beings can’t return completely to the hunter-gatherer lifestyle, of course, but we can each form circles of caring, supportive relationships around us. We define a relationship as a mutual satisfaction of needs. If the needs being met are functional, the relationship will be positive; if dysfunctional, it will be destructive.

6 Actions for Creating Healing Relationships 1 Discover your functional relationship needs in all areas of your life. 2 Prioritize needs and define your bottom line. 3 Give (say) your needs to others. Find out their needs of you. 4 Negotiate and set consequences. 5 Create the three Rs in relationships: rules, roles, and rituals. 6 Expand your network of lasting, strong, and supportive relationships.

WHAT ARE FUNCTIONAL NEEDS?

We teach people the fundamentals of getting their needs met in relationships. To identify functional needs, it’s helpful to understand that human relationship needs fall under only four categories: physical safety (covering everything from abandonment issues to salary), emotional security (trust issues often arise here), attention (on the face of it, fairly straightforward), and importance (including being involved in decisionmaking).

For our needs to be understood by others, and therefore more likely to be met, they should be communicated in concrete and action-oriented terms. By action-oriented, we mean that the needs you express must not be about cognitions, such as “I need you to believe, understand, sympathize with, think about, or want.” Rather, they must specify what actions the person would have to take for you to know that they believed, understood, etc.

Expression of concrete, specific needs draws people together, while expression of generalities creates barriers. For example, if I ask you to “respect” me, you may think you know what I mean, but in fact you probably won’t. And no matter how hard you try, I can always accuse you of falling short, because we never agreed on what you would have to specifically do to show me respect. The same of course is true of all generalities—from “loving me,” to “giving me space,” to (in the case of children especially) “being good.”

Even people who have great difficulty developing supportive relationships can begin to identify their functional needs according to these standards—and ask others to do the same for them. These simple actions form new neural connections that enormously add to self-esteem. If the needs are met, the giver’s feelings of worth and empowerment blossom, and the relationship improves dramatically. If the other person isn’t willing to meet or even negotiate the needs, the giver has a clear signal that this relationship is not going to help prevent or heal depression and may be part of the problem.

NEEDS IN THE FAMILY AND IN CORPORATIONS

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In what we call the “pow wow,” families can process and establish the rules of the house and thus help create clear boundaries that foster a sense of safety and security. This involves regular meetings in which everyone old enough to talk is invited to discuss their needs and house rules, and the consequences to each member for breaking them. We stress that once a child reaches the age of 12 or 13, they should be treated much more as an adult, and treating them as a child will only infantilize them. The exchange of information about needs is an extremely powerful tool in corporate training and coaching, too, where people must relate and function well, often under stressful circumstances. In fact, this structure has proven useful in our work with the multinational companies PricewaterhouseCoopers, Ernst & Young, and Oracle.

HEALING CONNECTIONS

There are many ways to use relationship techniques to enhance self-esteem and competence. For example, we urge students to enlist others’ help in ending negative self-comments such as “Gosh, I’m stupid,” “This is going to sound silly, but . . .” and “It was nothing.” Asking friends, family members, and colleagues to gently pull us up each time we put ourselves down is a good way of breaking the hold of the inner saboteur and enhancing our healing connection to others. We suggest that people get used to asking for appropriate praise. This includes praise for who they are as well as for what they do.

Joining others toshare a common purpose and to take action together is also a powerful antidote to depression. Our relationship to nature and to the Divine, which is essential to emotional health, can be enhanced by sharing experiences with supportive friends.

To heal ourselves—and our world —from the rift with our genetic heritage, we must powerfully reinvest in our humanity. Being fully human means being functionally connected to other people and to the world around us. To the extent that we do this, we can banish chronic depression from our lives, families, and communities.

BOB MURRAY, Ph.D., is a psychologist, and ALICIA FORTINBERRY, MS, is a psychotherapist and Feldenkrais Practitioner. For information about their method, their book Creating Optimism: A Proven, Seven-Step Program for Overcoming Depression, and their Uplift Program workshops and professional training, visit www.UpliftProgram.com and www.CreatingOptimism.com.

2nd Cover Story

INTEGRATING THE BODY’S FOUR “BRAINS”
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