Monday, November 09, 2009

Will Van Derveer, M.D. - Depression is Not a Disease: Anxiety & Depression Workable via Meditation? (My Response)

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Over at Elephant Journal, Dr. Will Van Derveer, a Buddhist psychiatrist, posted Depression is Not a Disease: Anxiety & Depression Workable via Meditation?, an interesting look at mental illness through his particular perspective.

Here is a little of the article:

An important distinction here is between what we might call necessary suffering and unnecessary suffering. Necessary suffering is the facts of life that none of us can avoid: we all experience losses, illness, aging and death. We often experience disappointment. Unnecessary suffering includes the very real illnesses we inflict unwittingly on ourselves by repeating habitual patterns of judging, pushing away, managing or otherwise dominating our lived experiences (including our experiences of necessary suffering).

Why would anyone want to relate with pain directly, instead of avoiding it? Suffering is, after all, a nuisance obstructing our plans. But avoidance of pain, more often than not, seems to lead to more of the same. We have a choice: pay now or pay more later. One example that occurs frequently in my psychiatric clinic is insomnia. Many of my patients are hard-driving, successful overachievers whose ambition and success can not make room for addressing their insomnia. They are denying one of the facts of life: that their bodies are far from the efficient productivity machines they want them to be. Many of these patients have not slept well for decades before appearing in my office. They’ve used various strategies (caffeine, exercise, fixating on personal goals or peak experiences) to avoid fatigue and other obstacles, forcing their bodies to perform day in and out, without taking the rest we all require. Eventually this master/servant relationship with our body manifests as full-blown psychological disorders. At that point, significant treatment including medication may be necessary. But is it possible to live productive lives without accumulating stress in the body, and resultant unnecessary illness?

In my professional experience working with my patients as a psychiatrist, and in my personal experience as a meditator, I find that the self is much more expansive that what I was taught in my medical training. In fact, it seems the self is without any limit other than those we presuppose to exist. These limits mark the boundary we draw between what we regard as self and what we define as other. When we label any aspect of our experience as “other,” we are effectively saying, “I deny the limitless quality of reality.” The inherent tension between self and other accumulates as stress in the body, eventually leading to unnecessary illness. Take for example feeling anxious in a social setting. People in this situation have only two options: feel it and go toward it, or recoil from it and isolate from social situations. Thus life either expands or contracts depending on how one relates with social anxiety or any other painful experience. Put another way, uncomfortable experiences invite us to step through a door into our wholeness and our inherent wellness.

While I think he makes some good points, I also had some issues with the article, so here is my response, left at the blog.
Interesting article, and partially true.

Unfortunately, it is much more complicated than Dr. Van Derveer makes it seem.

All mental illness, from anxiety to schizophrenia is integral in nature, meaning that there is a body/brain component (brain chemicals, genetics, etc), a psyche component (the subjective experience of the illness, as well as the role it plays in shaping our consciousness, etc), a cultural component (attachment issues, intersubjective issues such as "secondary gain," meaning the perks that come with being ill, like attention and care from loved ones, etc), and a social component (generally this will be a stigma, like in-patient treatment or criminality, etc). Neglecting to account for any of these issues leaves only a partial accounting of the illness.

Without doubt, some of what Dr. Van Derveer says about spiritual materialism is true, especially in the medical model in which he was trained. However, I would prefer to see a therapist follow a different lead in this area. A good therapist might ask us to look at what the illness needs from us, what role is it trying to play in our spiritual lives, our evolution as individuals?

If we take our depression or anxiety (and I am diagnosed with social anxiety disorder) as a teacher, what can we learn about our lives? Even this approach is not fully integral as outlined above, but it is a far more productive way in to the parts of ourselves that are not yet whole and healthy.

If we take our "suffering" as a teacher, we can get that indestructible wholeness Dr. Van Derveer mentions in his article. But that wellness will come because we no longer resist the pain that depression or anxiety brings, not because we have overcome what for many is a biological illness. Pain x Resistance = Suffering. Remove the resistance, and the suffering goes down to zero.
Regular readers of this blog will know that I have written about this in the past, at least as far as my own anxiety, in terms of parts work. I've even worked with depression as possession by a part. So my comments above are pretty mild and minimal.


3 comments:

Diane D'Angelo said...

The problem with defining depression and anxiety as "diseases" is the abnegation of outside circumstances and/or personal responses to these circumstances in favor of taking a pill. While the tone of this article was a bit flip (which is what I found myself reacting to), we must keep in mind how little we actually know about brain chemistry and mental illness. Many psychotropic drugs were found accidentally -- a psychiatric application was determined while treating another illness with the drug.

raw by default said...

In my view, things like depression and anxiety are symptoms... not diseases in and of themselves. But where those symptoms come from is the question. There could be all sorts of causes, from biological to spiritual. It's not always something we have conscious control over, either; to say that we can "choose" whether or not to have depression or anxiety is about as far-fetched (in some cases, anyway) as saying we can "choose" to change our hair colour on the genetic level with our thoughts alone.

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