050: Live Therapy with Marilyn, Part 2, Is Depression a “Mental Disorder?”

The Hidden Side of Depression, Anxiety, Defectiveness, Hopelessness and Rage

We nearly always think about negative feelings, such as  severe depression or anxiety, as problems that an expert must try to fix, using drugs and / or psychotherapy. And there are a multitude of theories about why humans become depressed, including, but not limited to:

  • Reality. We think we get depressed because reality sucks. We believe our mood slumps result from the negative circumstances in our lives, such as being alone following a rejection, experiencing the loss of a loved one, not having enough money, education or resources, social prejudice, or (as in Marilyn’s case) facing some catastrophic circumstance, such as severe illness.
  • Upbringing. We think we get depressed because of insufficient love and nurturing in childhood, or because of traumatic childhood experiences.
  • Biological factors. We believe that feelings of depression and anxiety result from problems with our genes, or diets, or because of a chemical imbalance in our brains.

Certainly, there can be some truth in all of these theories. Reality does kick us all in the stomach from time to time, and the pain we feel is understandable. My wife and I lost her father to Parkinson’s Disease a few years ago. We loved him tremendously, and his loss was extremely painful for everyone in our family.

Most of us have experienced less than ideal circumstances when growing up as well, and many have been victimized by horrific experiences, such as child abuse or bullying. And clearly, some psychiatric illnesses, such as schizophrenia, do result from some kind of biological abnormality in the brain.

But the problem with all of these theories is that they put us at the mercy of forces that are largely beyond our control—since we often cannot do much to change reality, rewrite our childhoods, or modify our brains short of taking this or that medication. And, in addition, these theories all suggest that negative feelings like depression and anxiety show that there is something wrong with us.

In this podcast, Matt and David take a radically different approach, and argue that Marilyn’s intense feelings of depression and anxiety are not “mental disorders” that reflect some defect in Marilyn, but rather the expression of what is most beautiful and awesome about her. They also argue that there are large numbers of advantages, or benefits, of feeling the way she does. They use several Paradoxical Agenda Setting Techniques, including the Invitation, the Miracle Cure Question, the Magic Dial, Positive Reframing, and the Magic Dial. The results are stunning and unexpected.

At the end of this segment, David and Matt argue that it might be desirable for Marilyn to continue to feel some of her negative feelings, and ask her how depressed she would like to feel at the end of the session, using the “% Goal” column on her Daily Mood Log. She also indicates how anxious, ashamed, defective, alone, hopeless, frustrated, and angry she would like to feel.

The third and final podcast next week will include the M = Methods phase of the session along with the end-of-session T = Testing and wrap-up, including Relapse Prevention Training.


14 thoughts on “050: Live Therapy with Marilyn, Part 2, Is Depression a “Mental Disorder?”

  1. Hi David and Matt
    Thanks for a wonderful podcast again, I really enjoyed and hope that there future podcasts of this nature. I am psychologist in Johannesburg, South Africa, so I am not able to have this kind of treatment firsthand or the training but it is lovely to listen to two seasoned practioners such as yourself working with Marilyn. I have learned a lot and I hope, that you would come to South Africa one day. Regards

  2. Hi David, Matt and Marilyn,
    Thank you for sharing this wonderful therapy session. It is a joy to see the magic as it unfolds amidst a heartbreaking situation. 3 talented therapists doing what they do best on important authentic work. You are changing my previous skepticism about CBT. Best wishes,
    Robyn Fowler

  3. I am sorry about being impulsive. That comment about skepticism needs to be moderated. I was referring to the old fashioned CBT which generally did not show the compassion, the motivational elements, the spiritual awareness or the empathy of the modern TEAM-CBT. I love the TEAM approach and am excited about getting more training here in NY so I can better help my own clients. Robyn

  4. Hi Everyone,
    I echo the above sentiments. Even though I’ve read your books (many times over), attended your 4 day workshop and worked through your ebook, this session helped bring it all together for me. I hope there are more to come. I also really appreciated listening to Marilyn share her experience and was humbled by her honesty. That said, I was absolutely stopped in my tracks when you mentioned that Marilyn has 6 university degrees! whoa. Marilyn has worked hard. Very impressed with this session and everyone’s efforts to help each other – as therapists, client and producer.

  5. The positives about hopelessness were difficult for me to believe, but I’m continuing to think on it. I just think that the literal definition of the word leaves little room for reinterpretation. The idea that it is a relief seemed off to me. I see hopelessness as letting the depression take you. That being said it was a beautiful reframe to say that is was deeply spiritual to be sad without cognitive distortions. I can sort of see where that’s acceptance, but it seems like dangerous acceptance and possibly not true (I’m thinking of Logo therapy now where there is always meaning to be found). I was questioning whether Marilyn was really hopeless, because so much of the rest of the session was in my opinion showing the strength and courage she has; and I believe that that comes from a place of hope. I mean here she is on the podcast, not drunk in the gutter. Still working on herself and trying to do and be her best. Sending much love to Marilyn.

    • Hi Don, your comment is really good in my opinion. Thanks!

      Yes, one has to be careful with all of these techniques, as they are very powerful, and can be misused. If a patient is hopeless and suicidal, the only agenda item is to evaluate the suicidal urges to make sure the patient is safe. In addition, if you would have suggested to me 15 or so years ago that hopelessness has a positive awesome side, I would have thought you crazy!

      This insight came to me on one of the Sunday hikes, and I can remember the exact moment, and which trail we were on. The Positive Reframing, if done skillfully, can have a mind-blowing (and positive) impact on the patient. I have observed this phenomenon on at least 50 to 100 occasions, and it always amazes me! david

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