| 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. |
