Psychological depression is more widespread than we know. How an easy technique is helping people lift their moods, often without medication
A few months ago Arun, 29, consulted me under duress at the insistence of his girlfriend. He was very depressed and had stopped the anti-depressant medication prescribed by his family doctor after taking them for a few days saying, "What's the point? They won't work." He came to me convinced that nothing would help. When I explained that he should give two weeks for the medicine to start working, he shrugged in despair, "I don't see how. I should quit all this and go live in an ashram."
Nothing I said helped change his mind, until I tried a technique called Marbling (the name comes from the way meat is layered with fat). I had come across this recently in the book Out of the Blue by Bill O'Hanlon, which outlines various techniques, including Marbling. As a youngster, O'Hanlon had suffered from depression and nearly committed suicide. He was treated by Dr Milton Erickson, a gifted American therapist, and later even trained with him. Applying Marbling, I was able to help Arun map out, in writing, his mental state in two columns, one describing his depressed phases, the other the periods when he was not depressed. He listed out his thoughts, experiences and actions on both counts. After just ten minutes of this exercise, Arun started sounding more upbeat and surprised me by asking to resume his medication. He also enquired about the therapy.
There are way too many people like Arun around us, struggling with depression-36 percent of Indians suffer from major forms of depression, compared to 30 percent in the West. The vast majority of Indian patients do not get any treatment. The signs of depression are usually easy to recognize: disinclination
towards work or leisure, withdrawal from social interactions and insomnia. Depression affects our health adversely, worsening diseases such as asthma and diabetes. It also increases the risk of heart attacks and cancer. The incidence of accidents, addiction and suicide is much higher among the sufferers, making it critical that depression is treated urgently.
In O'Hanlon's book, Marbling is the first of a number of innovative techniques to help a person come out of depression. It can be used for patients like Arun and, of course, many more people outside the reach of modern medicine.
Marbling can be an effective option in combination, with or without drugs, or therapies. While O'Hanlon's book is written for therapists, I have also recommended it to family members of depressed people; even the mildly depressed could make use of this book to help themselves.
How does Marbling work? Like Arun, most depressed people are focused on their low feelings and forget that they have ever felt upbeat in their lives. Most therapists focus on the signs and symptoms of depression, but this often deepens their despair. In this simple technique, talking about the depressed times helps the affected person feel understood, while mapping out the times when he was better; this indirectly reminds him that he was not always depressed. It brings back positive feelings and the realization that he could begin to feel happier again. This opens the door to memories of better times, rekindling hope and eventually the possibility of not being depressed at all. By charting out the detailed difference of behaviours between good times and low periods, the person gets a clear picture of the behaviours that reinforce depression as well as other behaviours that could help them come out of the lows.
While Marbling does not cure depression, it is a useful tool to rekindle hope and motivation. As in the case of Arun, who, in addition to restarting his medication, got motivated enough to start doing vigorous aerobic exercises to help fight his depression.
Dr Dayal Mirchandani, MD, is a Mumbai-based consulting psychiatrist and author.