Author Archives: mpincus2013

The critical element of social community in treating depression and preventing suicide

In class this week, Professor Nadine Kaslow spoke with us about the Grady Nia Project she started. African american women who have been in abusive relationships and attempted suicide in the past year are eligible for treatment in the Nia Project. In this psycho-educational program, women receive education and training about depression, suicide, and effective ways of coping, and regularly engage with the other women in the program. The program particularly emphasizes strengthening one’s social support networks throughout the treatment process. As Professor Kaslow explained, social support has been shown to be one of the strongest moderators of suicide attempts. In a video interview with a Nia Project participant, the participant talked about how meaningful her experience in the project had been and underscored the centrality of her fellow Nia community to her healing process. I really appreciate the Nia Project’s emphasis on embedding participants within a larger supportive community, and believe that mainstream psychotherapy should incorporate this element of treatment to a greater extent.

In a typical treatment session for depressed individuals experiencing suicidal ideation in Western society, a patient meets with a psychotherapist in an indoor space–a setting that is separate from the rest of the patient’s life. Although the therapist and patient may discuss ways that the patient can expand their social support network outside of the sessions, other individuals do not play an integral role in the psychotherapy process. Contrast this with the approaches taken by other cultures in treating depression. The online podcast The Moth, featuring true stories told to a live audience, presented an incredible monologue by Andrew Solomon in which he discusses his experience as a recipient of the Senegalese ritual ‘ndeup.’ This ritual is intended to treat depression and is an elaborate affair which begins with Solomon wearing a loin cloth, having his chest and arms rubbed with millet, holding various Shamanistic objects, and then making his way towards the village’s central square. In the central square, all the village people have gathered–having taken the day off from work–and drum and dance around Solomon as he gets into a wedding bed with a ram. Solomon is stripped of his loin cloth, the ram’s neck is slit and Solomon buries butchered pieces of the ram into the ground while repeating the mantra, “Spirits, leave me alone to complete the business of my life and know that I will never forget you.” The ritual concludes with a big feast and more dancing and drumming. Solomon does experience a significant lift in his mood, but isn’t able to entirely articulate which essential elements of the ritual contributed to raising his spirits.

In discussing his experience with a Rwandan man years later, Solomon is eventually able to understand why the ritual had felt so therapeutic. The Rwandan man explains that there is a Rwandan ritual similar to the ndeup and, in comparing these rituals with those of standard western psychotherapy treatment, makes it clear why and how the African rituals are effective in mollifying depression. The man explains, “You know, we had a lot of trouble with Western mental health workers who came here immediately after the genocide, and we had to ask some of them to leave…They came and their practice did not involve being outside in the sun like what you’re describing – which is, after all, where you begin to feel better. There was no music or drumming to get your blood flowing again when you’re depressed and you’re low and you need to have your blood flowing. There was no sense that everyone had taken the day off so that the entire community could come together to try to lift you up and bring you back to joy. There was no acknowledgement of the depression as something invasive and external that could actually be cast out of you again. Instead, they would take people one at a time into these dingy little rooms and have them sit around for an hour or so and talk about bad things that had happened to them. We had to get them to leave the country.” One of the key elements that the Rwandan man underscores is the involvement of the entire community in the treatment process. Feeling the love, support, and compassion of an entire community appears to be an amazing and effective way to address depression. Unfortunately, the centrality of this component to the healing process is sadly overlooked in our overly individualistic society.

Kaslow, N. J., Thompson, M. P., Meadows, L. A., Jacobs, D., Chance, S., Gibb, B., … & Phillips, K. (1998). Factors that mediate and moderate the link between partner abuse and suicidal behavior in African American women. Journal of Consulting and Clinical Psychology, 66(3), 533.

 

The Benefits of Posttraumatic growth

An article we read in class this week–”Loss, Trauma, and Human Resilience”–brings attention to our commonly held conceptualization of grief as the appropriate response to trauma. In so doing, we as a society fail to appreciate the fact that the majority of people exposed to trauma respond with resilience.

More alarming, though, is that psychologists have tended to pathologize resilience as an unhealthy reaction to trauma (Bonnano, 2004). According to the grief work approach that has prevailed in the psychotherapy world, it is deemed necessary and appropriate to ‘work through’ the negative emotions and thoughts associated with grief if one wants to resume a healthy life again. It has been posited that failing to display grief and ‘work through it’ within close proximity to the traumatic event will ultimately result in a delayed grief reaction. In reality, empirical research has not supported these contentions. In fact, research shows that most people respond to trauma in a resilient fashion, and that grief work is not always effective and may even be maladaptive (Kato & Mann, 1999; Neimeyer, 2000). Hence, ‘absent grief’ isn’t problematic–as the grief work theorists would have us believe; instead ‘resilience’ is likely a healthy coping mechanism in the face of trauma.

In outlining the factors that contribute towards resilience, George Bonanno mentions research on the trait of ‘hardiness’ (Bonanno, 2004). According to X, “hardiness consists of three dimensions: being committed to finding meaningful purpose in life, the belief that one can influence one’s surroundings and the outcome of events, and the belief that one can learn and grow from both positive and negative life experiences.” I think this personality dimension is extremely critical in helping people deal with traumatic and difficult experiences in life and is very much neglected as a virtuous trait in our modern society. We live in an era when individuals seek to maximize immediate gratification and minimize exposure to pain and suffering through distractions like television and pharmaceutical interventions. For most people, the prospect of enduring a difficult, trying circumstance with the idea that it could make you better off is probably quite foreign and counterintuitive.

However, the concept of posttraumatic growth–in which people experience a meaningful improvement in their life after a traumatic or difficult situation, above and beyond a return to baseline–has been discussed since ancient times. The notion that suffering can yield powerful transformations and spiritual growth appears in ancient texts from many of the world’s religions. Victor Frankl’s A Man’s Search for Meaning and his theory of logotherapy have been an incredible contribution to this literature. In even the worst of possible situations as a prisoner in a holocaust camp, Frankl was able to find meaning in his suffering and difficult everyday experiences, and in so doing make his plight more manageable.

The opportunity that trauma offers us for a spiritually enriching or transformative experience is an incredible offer. To cultivate and ensure resilience, we should acknowledge the opportunity trauma is offering us to grow spiritually so that we can be most receptive to it when the chance presents itself.

 

Bonanno, G. A. (2004). Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events?.American psychologist59(1), 20.

Kato, P. M., & Mann, T. (1999). A synthesis of psychological interventions for the bereaved. Clinical Psychology Review, 19, 275–296.

Neimeyer, R. A. (2000). Searching for the meaning of meaning: Grief therapy and the process of reconstruction. Death Studies, 24, 541–558.