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Introduction
Anxiety and depression are
both symptoms and diagnoses. As symptoms, they
occur in various psychiatric disorders and in
other diagnosed illnesses and injuries. The
feelings of nervousness (anxiety) and apathetic
mood (depression) can occur in the course of
everyday life in persons with no specifically
diagnosed medical or mental illness.
Anxiety and Depression are
diagnostic entities listed in the Diagnostic
and Statistical Manual of Mental Disorders -
Fourth Edition (DSM-IV) with a multitude of
subtypes listed. From a more dynamic and neuro-physiological
viewpoint, anxiety and depression can be seen
as a disturbance of body energy. If we represent
human energy flow on a continuum from low (depression)
to high (anxiety), they are at opposing ends,
although as symptoms, they can exist simultaneously
in the same person.
In disease-focused medicine,
more emphasis is placed on pinning down the
specific diagnostic category and finding the
particular neurotropic chemical intervention
that will give most relief. That is, the search
for the most effective anti-anxiety and anti-depressive
medications becomes the standard of practice,
thought by some to be more "scientific."
This plan may promote many patients to feel
inadequate and deficient in some way with minimal
participation in their treatment plan. They
must have laboratory tests of blood levels to
monitor medication to, perhaps, "speak"
for the patient. This style of practice has
no rationale for looking more carefully into
the cause of the energy disturbance
so the patient may not be understood in the
context of their experience, environment, or
life style.
The Holistic medical approach
gives priority to relating to the whole person
- body, mind, and spirit in a particular time,
space and context. Each of these dimensions
contribute to the present energy state being
experienced.
The Holistic medicine evaluation
begins the treatment process as well as promotes
the development of insight. The Holistic physician's
awareness of his own feelings and the patient's
emotional responses in addition to the more
objective details of medical history and physical
examination, are the building blocks of a healthy
human relationship with the patient. This professional
association is marked by cooperation, consideration
and mutual interest which will promote growth
and maturation for both doctor and patient.
Roles are defined and clarified for each and
the treatment plan is outlined and explained.
The importance of patient participation and
feedback is acknowledged and the support of
other family members and friends is encouraged
when needed.
From this comprehensive exploration
and assessment, recommendation for nutrition,
exercise, life style and behavioral changes
may be indicated to facilitate a change of energy
flow - the goal of treatment.
Neuro-psychosocial Formulation
and Etiological Considerations
Anxiety
The basic problem involves
stimulation that produces an intense fight or
flight response; this response activates more
energy than can be used effectively. The person
typically feels discomfort. This discomfort
can be manifested as fear and trembling (unused
energy) sickness unto death, as described by
Kierkegard.
Finding and utilizing an acceptable
and potentially satisfying outlet and expression
of overstimulation of this energy can help initially
(e.g., jogging, swimming, music). The often
unknown source of the anxiety must be discovered
and reduced (it may be unconscious). For example,
this excessive energy may be produced through
misperception of someone's actions or words
which aroused fear, anger, guilt and can be
resolved by awareness, expression and clarification.
Dreams and fantasies can allow
more accurate reality orientation and it places
everyday experience in a more balanced perspective.
If sleep disturbance is a problem, sedative
herbs, relaxation, and abdominal breathing exercises
with the goal of self-mastery can be helpful.
Reductions in the use of caffeine, consumption
of regular meals, a structured schedule with
balance of work, rest, and aerobic exercise
as well as pleasurable activity are all important
factors to monitor. Relationship issues in work,
family or social areas should be assessed with
the need for psychotherapeutic assistance determined.
When anxiety including phobia,
panic, or posttraumatic stress is present, EMDR
or other desensitization techniques can be used.
The Holistic physician promotes the opportunity
for verbal and behavioral expression to occur
with identification (when possible) and clarification
about the overstimulating energy source as part
of the intervention.
Depression
The basic core of' depression
typically involves loss. This includes the loss
of a meaningful relationship, activity, function,
or possession. This produces a gap or block
in the flow of energy
through our system. When energy
flow bogs down or is not available, depression
may be experienced. Metaphorically, it is similar
to our national economy where money equals condensed
energy. When money flow is bogged down or blocked,
the economy slumps into depression. There is
disequilibrium.
When a person experiences a
loss, his/her depression typically lifts in
one to six weeks if a satisfactory adjustment
and adaptation can be made. If not, he/she may
enter a state of clinical depression. The associated
changes in neurotransmitter balance serve to
perpetuate the stalemate of low energy flow
to conserve energy. However, if the patient
has the opportunity and support for fully expressing
feelings and ideas about the loss (as mentioned
with regard to anxiety), the same healing
and recovery process can be mobilized in the
depressed person.
Through the careful exploration
and treatment that is encouraged by the Holistic
physician, the patient obtains an optimally
balanced view of his/her life situation. The
ultimate outcome involves the patient becoming
more empowered and feeling more confidence.
Steps toward satisfaction and pleasure with
self promotes subjective well-being and gloom
may be displaced. Regular physical activity
such as jogging, yoga, and breathing exercises
can be healthy ways to gradually augment energy
flow.
In the course of this approach,
as mentioned earlier with anxiety symptoms,
a more balanced and structured everyday life
routine is needed. Exploration and processing
the meaning of the loss can lead to insight
and gradual acceptance. Such a process may help
prevent relapse which otherwise is common in
many forms of depression.
The Holistic physician will
be alert to signs of guilt, low self-esteem,
and self-blame which are often part of a depression.
These can be dealt with psychotherapeutically
and spiritually in this paradigm of treatment.
Nutrition, Exercise and continued
regular activity are essential to promote continued
recovery. The use of St. John's wort should
be considered as an adjunct to treatment. If
sleep deprivation is a problem, herbal sedation
and Camomile tea can be used. These approaches
may be used as viable alternatives for mild
to moderate depressions which may not require
antidepressant medications.
If suicidal ideation is present
or if there is a history of previous suicidal
attempts, then careful supervision and antidepressant
medication should be utilized in addition to
the aforementioned methods. The patient should
be encouraged to continue to actively participate
in the treatment plan rather than become passively
dependent on medication alone to relieve depressive
symptoms. This also helps to prevent social
withdrawal and potentially slipping into a chronic
state of depression.
If bipolar disorder is present,
it may be necessary to use a mood stabilizing
medication such as Lithium Carbonate or Depakote
to lessen life endangering behavior. In more
extreme cases (e.g., if psychotic symptoms emerge),
a neuroleptic such as Haldol or Zyprexa may
be necessary. Other medications to consider
include Zoloft, Paxil, and Effexor.
©1998 by
The American Academy of Experts in Traumatic
Stress, Inc. |
