A New Way To Understand and Treat Depression and Suicidal Thoughts: Part 1 - The Story of Alex
Suicide rates and rates of depression are high in our society, despite antidepressant medications and Cognitive Behavior Psychotherapy (CBT), two mainstream treatments. How do we understand this?
We have been taught that depression is a flaw in brain chemistry or as a result of negative thinking. But another important—and hopeful—way to understand depression is through an understanding of how emotions function in the mind and most especially the body.
Experiences may ignite big emotions. And, depression is a response to those emotions when they overwhelm our capacity to manage them.
Life experiences, especially adverse ones, ignite many emotions in the brain. Research has shown that burying emotions, instead of naming them, validating, and actively processing them, leads to depression, anxiety and many other symptoms of mental and physical illness.
The Connection Between Traumatic Events and Emotions
Alexander, who had escaped a war-torn country, was depressed and suicidal when I first met him. He had thoughts of ending his life because of the seemingly inescapable pain he felt. We can understand Alex's pain by understanding two facts:
core emotions—like fear, anger, and sadness—are natural, unavoidable, biological responses to stressful life events, including the invisible traumas of childhood.
when core emotions aren't safe to fully experience and process, they get stuck inside the mind and body causing incredible pain and a sense of being disconnected from one's authentic self and others.
Traumas, by definition, are events so intense that the emotions they produce overwhelm us. Without support from a caregiver who can validate our emotional distress, and without knowledge to understand our emotional experience, or without tools, techniques, and healthcare professionals to help us metabolize the emotional energy surging through our bodies, we have no other coping mechanisms but to shut down emotions using a variety of defense mechanisms. As a result, emotions remain stuck, causing pain and eventually deadening us. We sit in a literal psychological darkness alone, numb, and frightened. That is until one day, when our emotions are finally validated and released.
Safely Releasing Emotions
“Alex,” I guided during one of our therapy sessions, “Can you tune inside and name the emotion you sense inside as you share the memory with me?" He had witnessed the murder of a civilian.
“It is terror!” Alex said.
To help him safely remember the traumatic moment without being re-traumatized, we established two pre-conditions: 1) that he had one foot firmly planted in the present moment; and 2) that he felt connected to me.
Then I asked him, “What physical sensations are you experiencing right now that tell you the feeling is terror?”
“I am trembling all over but especially in my legs,” he said.
Fear, of which terror is an extreme form, is one of the seven core emotions on the Change Triangle. It originates in a part of the brain called the limbic system where there is no conscious control to stop emotions from happening. Emotions evolved that way to help ensure our survival. Before our thinking brain knows we have an emotion, the middle part of the brain, where the emotion originates, sends signals throughout the body creating a host of physiological changes.
Why do emotions effect the body so pervasively? To swiftly mobilize us to move. Emotions, in essence, are survival programs that evoke survival actions, like running from danger. It is only after an emotion is triggered that we become consciously aware of the feeling. For example, if I see a dark shadow in my periphery or hear footsteps running towards me from behind, my ears prick up and my heart begins to race. Those physical changes are precisely what tells me that I am afraid. Trembling is another physical hallmark associated with fear.
“Alex," I asked, "Can you drop the storyline in your head, drop the emotions, and just stay with the trembling sensations with a stance of curiosity and compassion towards yourself?” I gently added, “Keep breathing deeply into your belly to help you move through it. The trembling will stop when all that pent-up energy is released. Stay with it.”
We sat together as Alex focused inward on the trembling sensations in his limbs. After several minutes, his body calmed and the trembling quieted. The energy from the terror that had been trapped in his body, and which caused him unimaginable distress, had released.
When emotions aren’t processed, it can throw the mind and body into a state of imbalance called dysregulation. In our society, symptoms of dysregulation are frequently given various labels and diagnoses like depression, chronic anxiety, personality disorders and more. At the root, these diagnoses share a common component: blocked and buried emotions that ultimately give way to the unbearable sense of being disconnected from one’s self.
I helped Alexander recover by teaching him about emotions, and then helping him safely release the terror, anger, and sadness that had been trapped inside his body for many years. Releasing buried emotions helped his nervous system to re-regulate.
Alex’s depression lifted because we liberated the underlying emotions. While the emotions from that time were too much for Alex to bear alone, now with my help, he could safely process them. With his nervous system regulated, the suicidal thoughts stopped.
Learning to Sense Emotions Physically
Sensing one’s emotions on a physical level is at first challenging. But with practice, it soon gets easier, like learning a new language or starting a new exercise regimen. There are also skills and techniques anyone can learn that help emotions flow up and out, like breathing, grounding, and connecting to someone else who understands. For people who have suffered traumas like Alex's, it's important to find a psychotherapist who is well-informed about trauma and emotions. Modalities like AEDP, IFS, SE, and EMDR, are some of the ones that I recommend. One day, emotion education will be taught in schools. But until then, we must take it upon ourselves to learn. Additionally, we must find help from people who understand emotions and who know how to transform suffering at its roots.
(Patient details have been changed for confidentiality)
Here is a short video to inspire hope for healing: https://www.youtube.com/watch?v=K4h8QWh1ogs&t=252s
For immediate help, call the National Suicide Prevention Hotline at 800-273-8255 (TALK) or click here.
Fosha, D. (2000). The Transforming Power of Affect: A Model for Accelerated Change. New York: Basic Books
Hendel, H.J. (2018). It’s Not Always Depression: Working the Change Triangle to Listen to the Body, Discover Core Emotions, and Connect to Your Authentic Self. New York: Random House
Levine, P. (1997). Waking the Tiger: Healing Trauma. Berkeley: North Atlantic Books
Siegel, D., Fosha, D., & Solomon, M. (2009). The Healing Power of Emotion: Affective Neuroscience, Development & Clinical Practice (Norton Series on Interpersonal Neurobiology). New York: Norton
Van Der Kolk, B. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York: Viking