The Couch Effect: Why do we need to talk?

The importance of Therapy in tackling depression in our day-to-day lives

Dr. Gaurav Deka

It was during the end of the first year at medical school that I found myself falling into this indecipherable and profound depression, from which I thought I would not be able to get out. I was diagnosed with chronic clinical depression and obsessive compulsive disorder. Depression though heard of as a common problem amongst the youth, and particularly with students studying medical science, felt experientially different from whatever I had heard and read. To the extent that I had frequent episodes of numbness and blankness.

The kind of thoughtlessness that one experiences in meditation can be equated with the state of the mind in depression as well. The only difference being, in depression, this state of thoughtlessness felt increasingly dark and negative and there was no structure by which I could rationalize what I was feeling. This feeling had no voice of its own and it would not articulate itself.

When I went to one of the psychiatrists in my city, he asked me to continue with my daily dose of SSRI (Selective Serotonin Receptor Uptake Inhibitors) and watch more TV and Chitrahar. That would make me cheerful, not talking about my problems. It was only a chemical imbalance and it could be corrected by stimulating a few cells in the brain. That's what my books also told me.

Much later in my life, when I began working with people suffering from depression, and more so with people who suffered from the kind of depression like mine, where I could not articulate, express or put it into a structure, I would device ways of building a structure around it. It could begin with simple open ended questions like: How does it make you feel? Say the answer is sadness, or say, anger then, where in the body do you feel this sadness? Or where in the body would you like to feel this anger? If this 'negative emotion' had a color what would it be? If it had a shape what would it look like? If this 'feeling' had a voice and it could speak, what would it say?

Why are such questions important? Questions are important because they help the client (or the patient) to begin talking about it. Most times, people may dismiss mental health issues as something imaginary, or say something intangible. Just because you can't see depression or palpate or examine depression like any other physical ailment, doesn't mean that it doesn't exist or is imaginary. When as a therapist I use open ended questions to address the issue, there is an automatic and immediate understanding between me and my client that we both consider the problem very much real. Questions help us establish the reality of the issue. It helps the client to build his or her trust on the therapist, and the fact that both are on the same page.

Emotions and feelings do not have a body. They don't have any structure or form. Therefore patients may find it really hard to articulate mental and emotional health crisis. We are so used to the physical world outside of us, that we don't even know how to address something that is not physical, and yet so overpowering. In order to resolve anything, we must first acknowledge its presence and secondly, we must give it some kind of structure. Anything that does not have a structure is difficult to deal with - be it a spirit or a thought. Therefore in therapeutic space, it becomes very important to talk about the various aspects of these negative emotions. Sometimes, when the client is unable to express these emotions, we have to use our imagination: for example, if this sadness had a color, what would it be? If it had a shape how would it look like? If this feeling could speak, what would it say?

The purpose of all these questions is to eventually make the client talk about their feelings. For the more they will talk, the more the issue will begin to form a structure. That's purely because when you begin to talk about something, you also begin to acknowledge that it exists for real. Our job as therapists is to help the client come out of their confusion regarding the negative feelings, and make them accept that their feelings are not ghosts floating in the air. They are very much real.

So, contrary to what my psychiatrist had said, that I must not spend time talking about my problems, rather watch Chitrahar and pop my pills, questions like these by a therapist help us get in touch with our emotions and make us wonder where do these emotions originate from? And what happens when we trace its origin? I shall come back in my next column to talk about how we can trace the origin of our problems when we begin to talk. And what can be done when we reach there. But first, let's start with talking!

(This is a new column where we try to highlight the importance of therapy in mental well-being. The author, Dr. Gaurav Deka, is a Delhi-based medical doctor and psychotherapist. His work is based mostly on the transpersonal model of the mind which includes ideas and processes like Past Life Regression, Inner Child Integration and Holistic Healing. He can be reached at gauravdeka.89@gmail.com)