Depression is said to affect more than 20 million people in the United States, but psychiatrist James Gordon argues that it's not disease.
Gordon discusses his new book, Unstuck: Your Guide to the Seven Stage Journey out of Depression, in which he makes the case that most people who are depressed don't need drugs to feel better.
Psychiatrist Peter Kramer, author of Listening to Prozac also weighs in on depression and its treatment — and when drugs might be needed.
by James S. Gordon
Depression is not a disease, the end point of a pathological process. It is a sign that our lives are out of balance, that we're stuck. It's a wake-up call and the start of a journey that can help us become whole and happy, a journey that can change and transform our lives.
This book is the story of that journey and a detailed map of its challenges and rewards. I'll be your guide. I'll show those of you who've been suffering with "clinical depression" how to move, step by step, through and beyond its dense darkness. And I'll walk with all of you who are simply unhappy, anxious, or confused, and help you to discover ways to help and heal yourself.
This journey, which is as old as recorded history, has seven stages. In Unstuck, I'll give you the tools and the compass you need to successfully navigate each one of them. And I'll share with you the stories of people — the ordinary, and yet remarkable, men, women, and children — who've taken this journey with me. Like them, you too can move through and beyond depression and distress, learn from and be healed by your experience, and find fulfillment, even delight.
I've been preparing to write this book for more than forty years, since I myself had an experience of clinical depression that lasted many months.
One late-winter morning in 1965 in New York, six months into a pathology research fellowship, between my second and third years at Harvard Medical School, I awoke in a sweat. The sheets were twisted around my body, and I was clutching the blankets to my chin. My mouth was dry, and my head ached. My chest hurt when I breathed, as if a hand had pushed my sternum up against my spine. I felt feverish, but didn't seem to have an infection. I didn't know if I could heave my body out of bed, but I knew I didn't want to.
Several weeks before, my girlfriend and I had broken up. Now the irritable unhappiness of our last months together, the loss of our love, seemed to be breaking open in my body, weighing me down. The doubts and frustrations of my first years in medical school—of long days in dry lectures and tedious labs—rushed back. My mind was filled with anxious, accusatory questions. What had I done wrong? Why hadn't I been able to love better? How could I ever find fulfillment in medicine? What was the matter with me?
I told myself to get over it. I was young, privileged, healthy. Perhaps my girlfriend and I would get back together. In any case, there would certainly be other women I could love, wouldn't there? I knew I should be able to sort out my confusion and pain about medical school, to embrace my upcoming years of work with patients, and find a way to become the kind of doctor I wanted to be. I said these things to myself, but none of them seemed to make any difference. I felt worthless and hopeless, ashamed of my weakness, horribly lonely, without strength or will or direction. It felt like the end.
It was actually the beginning.
In the months that followed, I was wrapped up in and constrained by the damp heaviness of my depression. It looked to my frantic parents and bewildered friends as if my easy, confident, forward progress had come to a crushing halt. It felt that way too. I resigned my fellowship, left New York, moved back to Cambridge, Massachusetts, and began to see a psychiatrist. Before, I'd always been sociable, often laughing. Now I spent many of my days alone, crying for lost opportunities, relentlessly examining and judging my faults, missing my girlfriend. I plodded slowly, head often down, through Cambridge's lovely spring and summer. And yet I felt something new, something very necessary and overdue, was growing in me.
When I returned to medical school a half year later, I was still unsettled in many ways, but I felt different, more solid, as if my center of gravity had begun to drop from my head to my heart. My own suffering, and the early days of my own journey of self-discovery, had opened me to people who were dealing with situations far worse than mine. On the Beth Israel Hospital surgical ward, I sat with ancient Jewish men and women, some of them Holocaust survivors, as they moaned through late-night pain and early-morning loneliness. On my medical rotation, I held a giant, bewildered black man who, believing he had to "fl y or die," was trying to pry open the windows at Boston City Hospital. While sitting with and caring for these people, and many others, and sometimes helping them find strengths they'd forgotten they had, I began to discover my own strength and purpose and meaning.
In the fifteen years afterward, as a student at Harvard, a psychiatry resident at the Albert Einstein College of Medicine, and a researcher and clinician at the National Institute of Mental Health (NIMH), I continued to be impressed by the strength and resiliency, as well as the vulnerability, of troubled and suffering people. I respected the people I was helping as full partners in our therapeutic work, and I began to think of them as fellow travelers on a healing journey. I developed programs that actively engaged deeply depressed and psychotic adults and adolescents in their own care and, later, a national program for runaway and homeless youth.
During those years and since then, I've worked closely with and learned deeply from some of the great physicians and researchers of our time. I've also studied with remarkable traditional healers from India, Tibet, Africa, China, and the Americas, exploring ways of understanding and treating depression that have been used successfully by cultures around the world for thousands of years. With the help and guidance of these men and women, I developed and refined the comprehensive, practical, individualized, non-drug approach to depression that I'll teach you in this book.
This "Unstuck approach" will equip you with the perspectives and attitudes and the mental, emotional, and physical techniques you need to sustain yourself as you make the journey through and beyond depression. It includes:
Simple, effective meditations that can enhance the biology of your brain and body, and make it far easier for you to deal with and transform the beliefs and fears that have inhibited and overwhelmed you.
Clinically tested experiments with words, images, drawings, movement, yoga, and dance that can help you mobilize your intuition—and your body—to move surely and often swiftly through each of depression's seven stages.
Detailed, practical plans for using food and supplements, and the ancient, powerful methods of Chinese medicine to balance your physical and mental functioning.
Ways to make the world's spiritual wisdom and spiritual practices a sustaining part of your healing journey.
Strategies for tailoring all of these approaches and techniques to your unique, individual situation, to your life.
In the years since I left NIMH, I've used this model in my own private practice, with many hundreds of depressed people of every age, class, and race. The results, as you'll see, have been deeply satisfying for my patients and for me, and often quite miraculous. Since 1991, as the founder and director of The Center for Mind-Body Medicine (CMBM), I've brought the
approaches and techniques I describe in Unstuck to tens of thousands of troubled and stressed-out people around the world. Together with my CMBM colleagues, I've created groundbreaking programs for health professionals and medical students who are hoping to live lives of greater professional fulfillment and personal satisfaction. We've helped people with cancer and other chronic illnesses, as well as those who are anxious and depressed, to feel far healthier, vastly more optimistic and energetic, far more in control of their lives. And we've made it possible for many thousands of people who've been depressed and traumatized by war and disaster, in Kosovo, Israel, and Gaza, and in post-9/11 New York City and post-Katrina New Orleans, to find new hope as well as emotional healing.
Now, for the first time, I'm offering this program, this Unstuck approach, to you, in a form you can use on your own at home. This Unstuck program is not a substitute for consultation with a physician or sessions with a skilled psychotherapist. It is a powerful, user-friendly way for you to help and heal yourself, as well as a practical plan for enhancing your experience with the professionals with whom you work.
As you read Unstuck, I'll be by your side, explaining and guiding you through every stage of your healing journey, leading you in exercises and experiments that you can use to explore and resolve the difficulties that trouble you. At the end of each chapter, I'll give you simple, practical Prescriptions for Self-Care, methods you can use every day to transform yourself mentally, physically, and spiritually; methods that will help you lift the weight of depression and soar beyond it.
This book will challenge the prevailing "medical model" of depression and the widespread, even epidemic, use of chemical antidepressants. This narrow model of diagnosis and treatment insists that those who feel helpless and hopeless, unhappy and uncertain, have a disease, like insulin-dependent diabetes, that requires a pharmacologic treatment. I'll offer you evidence that strongly suggests that this model is poorly justified, largely inappropriate, limited and limiting, and, often enough, dangerous to your physical, emotional, and spiritual health. The antidepressants that it dictates should be used seldom, as a last resort — and generally briefly — not as a form of primary care.
What I'm sharing with you here is a newer, more hopeful and far more comprehensive and effective model for healing depression — both the clinical depression that is diagnosed in sixteen to eighteen million Americans each year and the chronic, low-grade dissatisfaction, unhappiness, and anxiety that affect so many more of us. It's a model you can start to use right now, one that will meet your unique individual needs and give you positive results that you can begin to experience immediately.
This Unstuck approach marries modern science with the perennial wisdom of the world's great psychological and spiritual traditions. It makes use of the remarkable capacity each of us has to recover — physically, emotionally, and spiritually — from the hurts and trauma we have experienced, to transform our fears into teachers, and to restore and renew our brain, body, mind, and spirit.
The path is realistic, hopeful, well traveled. The people I've worked with have learned to reduce their stress and improve their moods. They've changed their attitudes, their biology, their relationships, and their lives in profound, and sometimes immeasurably enriching, ways. In the midst of loneliness, confusion, and despair, they've found meaning, purpose, and peace, as well as love and delight. They feel better, not only better than before they became depressed — but often better, more fulfilled — than they ever have. And so can you.
Excerpted from Unstuck by James S. Gordon, MD. Reprinted by arrangement with The Penguin Press, a member of Penguin Group (USA), Inc. Copyright (c) James S. Gordon, 2008.