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Sources of Depression  

Sources of Depression
By
Bruce L. Andrews, MS, LPC, LMFT


Many people have heard the different names for specific types of depression such as:  Major Depressive Disorder, Bipolar Disorder, Dysthymic Disorder, and many others.  This article will briefly discuss the sources of depression leading to those diagnoses.

Exogenous Depression - This is a depression that develops from without, or originates externally from the person.  It is due to events or situations that normally would lead one to feel depressed.  These events may be significant losses such as a death or illness in the family, or the loss of a job.  Many other stressors that occur outside of the individual may lead to depressive symptoms. 

Endogenous Depression - This is depression that develops from within, or originates internally.  Thus, an individual’s life may be going well financially, or in terms of relationships, or employment, and despite those positive life circumstances, the individual develops a significant and sometimes debilitating depression that requires treatment.  An interesting point is that when MRI’s and Cat-Scans are made of the brains of people experiencing either exogenous or endogenous depression, the readings are very similar.  That is, the brain activity is very similar.  Often people who experience endogenous depression will have a family history of depression, with nuclear or extended family members for generations all experiencing depression of this nature to some degree.  Most people are aware of family histories of cancer or other diseases that lead family members to be more likely to have those diseases.  Similarly with Endogenous Depression, family members may be more likely to experience the chemical imbalances in the brain that result in the symptoms of depression if there is a family history of depression. 

Exogenous and Endogenous – Of course, one may experience depression caused by Exogenous and Endogenous source events occurring at the same time. 

Treatment - Effective treatment is available through a combination of counseling and appropriately prescribed medications.   The most effective treatment occurs when there is a collaborative and cooperative treatment team including the client, the therapist, the family physician, and, in some cases, trusted family members or significant others.

  Click here for a printable version of SOURCES OF DEPRESSION (pdf)

South Sheridan Medical Center (SSMC) Counseling Services
1842 Sugarland Drive, Suite 103
Sheridan, WY 82801
Phone: (307) 673-4960
Located in the Urgent Care Clinic (across from the Holiday Inn)

EMOTIONAL FIRST AID
By
Bruce L. Andrews, MS, LPC, LMFT

Most people are familiar with the term “First Aid”.  Many people are trained in “Basic First Aid”, or have at least learned how to provide some first aid just through life experiences.  People know that for example:  When one receives a cut on the arm, an immediate response may be to say, “Ouch!” because it hurts.  This most likely will be followed by an attempt to stop the bleeding through an application of pressure to the wound. Then there will be an assessment of how serious the wound is, and whether it can be taken care of with a band aide or other home dressings or if there is need for the attention of a physician and possibly even stitches.  Either of those responses then are followed by appropriate measures to provide cleanliness and other infection prevention measures to see that the wound does not become worse and to follow its progress until complete healing has occurred.  Most people expect that if stitches have been required that there will be at least slight scarring, and in the case of more serious wounds perhaps more noticeable scarring.

All of the process described above is within most peoples experience, set of expectations, and personal competence to respond and deal with regarding a physical trauma.  They can approach it and deal with relatively calmly on their own, and if assistance is needed there is generally no hesitation to seek the assistance of friends or even medical professionals should that be necessary.  Certainly there is little, if any, cultural stigma attached to requesting medical assistance when significant physical trauma has occurred.  People tend to know what the normal reactions are to physical trauma.  They tend to know what the usual ways to respond are.  They have a set of expectations as to how much or how long they will be inconvenienced by a particular physical trauma.  The anxiety or concern regarding that trauma is tempered by their knowledge and the sense of competence or confidence that that knowledge brings.
 
On the other hand, few people are trained in how to cope with emotional trauma.  How many people have ever heard of “Basic Emotional First Aid Course”?  What does an emotional “Ouch” feel like, or sound like, or look like?  How does one assess the seriousness of an emotional wound?  How does one determine when “home remedies” are not sufficient, and there is a need to request the assistance of a mental health professional?  What are the normal responses to emotional trauma?  In regard to physical trauma we know it is normal to bleed if you are cut badly enough.  It’s normal for it to hurt in certain ways, thus we expect it.  In regard to emotional trauma we are not sure what to expect.  We don’t know what “emotional bleeding” is.  We don’t know, as well, how emotional pain presents itself.  Thus we don’t know how to differentiate between that which is normal and that which is abnormal.  This can lead to responding to emotional trauma with greater anxiety and fear than one might have if one had greater knowledge about normal responses of normal people to abnormal circumstances.

The cultural stigma regarding asking for the assistance of mental health professionals tends to be maintained, to some degree, by this lack of understanding.  The counseling or psychotherapy process provides an opportunity to gain the knowledge, understanding, competence, and confidence to deal effectively with emotional trauma starting with emotional first aid and following through to emotional healing. 

Bruce L. Andrews, MS, LPC
Master of Science – Psychology

Click here for a printable version of EMOTIONAL FIRST AID (pdf)

South Sheridan Medical Center (SSMC) Counseling Services
1842 Sugarland Drive, Suite 103
Sheridan, WY 82801
Phone: (307) 673-4960
Located in the Urgent Care Clinic (across from the Holiday Inn)

EMOTIONAL TEMPERATURE
By
Bruce L. Andrews, MS, LPC, LMFT

In regard to physical health, most of you have experienced a high temperature of 102 or 103 degrees, or maybe even higher.  You may remember lying in bed alternately having the chills and then sweating with your body hurting all over.  About all you can do is take fluids because you don’t feel like eating.  At times like these your body and your brain are working hard to overcome the effects of an infection in your system.  You cannot think or act nearly as effectively until your brain and your body are free of having to put energy into coping with the fever. 

A similar process occurs in regard to emotional/mental health.  It has been my experience, with clients and personally, that the following is an accurate observation:  “When emotional temperature goes up, thinking goes down and problem solving goes out the window.”  This appears to apply for both positive and negative feelings.  Here are three examples to consider.

 First, picture two people so angry at each other that they are nose to nose and toes to toes, red in the face, and hollering at each other.  What they see are bulging eyeballs, open mouths, clenched fists, and red faces.  What they hear are angry, hostile, and even threatening noises.  Most of the words get lost in the noise and the intensity.  The words that do get through are ones for which the parties need to apologize when they have cooled down.  It may sound backwards, but once the emotional temperature is down and the people are calmer, they are more able to speak quietly enough to be heard and to hear more effectively.  The yelling was heard only in hurtful ways.  Once calm is restored, thought can be applied to effective problem solving.  I do not mean to suggest that anger or any feeling should not be expressed.  I am suggesting that feelings need to be expressed with the assistance of a clear brain, in order that they can be expressed effectively rather than destructively.

A second example is of panic.  Think of a hunter lost in the woods.  If he or she panics they may began to run without particular direction.  At some point they may notice footprints on the forest floor in front of them.  They may then begin to realize that those are their own footprints.  They have been running in circles.  If they stop and catch their physical breath, then their heart will stop pounding in their ears and they can calm down.  In other words, they can also catch their emotional breath.  They may be able to hear a car on a road a mile or so away, and thus identify a direction to find their way back from being lost.  The point is that one needs to catch one’s emotional breath and reduce one’s emotional temperature in order to think clearly and act effectively.

A final example is not of a negative emotion, but of a positive emotion.  Have any of you ever seen two people in love?  Two people like this tend to have a very narrow focus.  That focus is each one for the other and nothing else exists.  They forget things, they walk into walls, their friends laugh at them and say things like “When they come back down to Earth they’ll be able to think again. Right now they are useless.”  No wonder there is that old saying “Love is Blind.”

 In conclusion, it is important to remember that both thought and feeling are important ingredients in dealing with any situation.  Feelings tend to be the fuel that generates active thought.  Thoughts or brainpower regulate the effective expression of the feelings.  Here is another way to look at these ideas.  Think of a relationship as a car.  Think of feelings as the fuel for the car and one’s brain as controller for the accelerator, steering and brakes.  The further one pushes down on the accelerator the more difficult it is to effectively and safely control the speed and direction in which one travels.  The more one uses all of one’s control devices to adjust to the conditions of the road, the more likely a person is to reach their intended goal with their car (relationship) in a single effectively- functioning piece.

Click here for a printable version of EMOTIONAL TEMPERATURE (pdf)

South Sheridan Medical Center (SSMC) Counseling Services
1842 Sugarland Drive, Suite 103
Sheridan, WY 82801
Phone: (307) 673-4960
Located in the Urgent Care Clinic (across from the Holiday Inn)

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