What Was Happening When It Started?

Source: @mitlamk/Twenty20

One of the biggest problems with the 'disease model' of mental ill health is that it leads people to miss key information that would help them deal with it.

I’m thinking of Anne-Marie. She had struggled with problem drinking during an abusive marriage, ending up in a hostel after losing her home and her daughter. She was a delightful, capable person, who went through detox and seemed well on the way to recovery, during which I was asked to support her.

Then, one morning, I received an anguished call from the hostel: Anne-Marie had starting drinking again.

When I arrived, I asked a highly distressed Anne-Marie, ‘What happened?’

‘I don’t know,’ she said. ‘It came completely out of the blue. I just woke up feeling so bad and had to go out to get a bottle.'

‘So nothing happened that could explain this, when you were doing so well?’

She was adamant.

I asked her what she had done the day before. She told me that she had done her laundry and gone to a café in the evening with her boyfriend. They had had a row and she had broken up with him.

I learned that the boyfriend had been a tower of strength during her bad drinking bouts, during which she would quickly become so out of it that she would fall and hurt herself, burn her body with cigarettes without noticing, and lose bladder and rectal control. He would dress her wounds and clean her up with loving care.

However, when Anne-Marie was sober, she was a lively, independent woman, and he didn’t like that at all. So he tried to knock her confidence. On the previous evening, Anne-Marie had had enough. But, waking the next morning, her eyes fell on the photo of her estranged daughter. Feeling even more alone and desperate for oblivion, she went out to buy spirits—and get her ‘kind’ boyfriend back.

It took some time to extract all this, but suddenly Anne-Marie could see that she wasn’t a hopeless alcoholic; she was merely someone who had reacted to the loss of connection and security in a way that had become familiar for her. She has been sober for several years now, having found healthier ways to meet her needs.

Recurrences Have a Reason

Pauline, an acquaintance of mine, once mentioned that she had had a recurrence of ‘her’ depression. She told me this in passing, as the point of the story was that her GP had prescribed exercise for her and she was rather pleased to get taken once a week to the local gym. When I asked why she had felt depressed, she shrugged: ‘It just happened.’

Later, the conversation having moved on, I asked about her work at a local charity shop, where she had volunteered twice a week since retirement. I knew that, as a widow living alone, she thoroughly enjoyed the company and the sense of being valued and doing something with meaning. But a new manager had taken over, she told me now, and he treated the volunteers like paid staff, with demanding expectations.

No longer able to enjoy a chat with colleagues or customers, Pauline was constantly anxious that she wasn’t getting enough done quickly enough. ‘I don’t even like going in there anymore,’ she said sadly.

‘Was it around that time, by any chance, that you went to see your doctor about depression?’ I asked.

She looked at me, surprised. ‘Yes, it was, actually!'

In therapy, ‘What was happening?’ is a crucial question to ask. I once worked with a young man who had previously undergone two years of weekly therapy after a dramatic suicide attempt.

When I asked what had been happening before the attempt, he told me that his girlfriend had completely unexpectedly left him. I assumed that had been fully addressed in his previous therapy. ‘No,’ he said. ‘It never came up.’

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He had not been able to have a girlfriend in the three years since, as no one could hold a candle to her. In our next session, we used the rewind detraumatisation technique to put the trauma in the past and unpicked what turned out to have been an unhealthy relationship, in which he had put his girlfriend on an impossibly high pedestal, idolising her, yet never meeting her real needs or his own. He is no longer depressed and is now in a much more equal relationship.

So it is always worth asking people what was happening in their lives around the time that the trouble started. It might become crystal clear that the two are connected—and give them back a sense of control. With help, circumstances (unlike ‘genetic conditions’) can be dealt with.