Part 2 The Breakthrough and the Science Behind It.

We have named this disorder the:
Financial Deficit Disorder or FDD.*
(We have used the internationally accepted criteria for psychiatric disorder as outlined in the DSM. Distress in the patient or family together with loss of function in the culture to which the patient belongs.)
Diagnosis:-
The cardinal feature of this disorder is characterised by a fundamental deficiency (ie lack), of money. (This explains why it is so prevalent amongst the poor and its female gender bias). What we have found, and what most people don’t really realise, is that poverty is a psychiatric disorder, in actual fact. DSM criteria)

Criteria:-
The financial deficit should be present for at least one day or more (this could be on the overgenerous side). Milder episodes of shorter duration have been known to occur. (Forgetting to bring money to pay for concerts, or movies, or restaurants).
Patients suspected should be carefully questioned about all aspects of their financial condition.

History:-
Look for a history of :-
Income Deficiency Disorder (or IDD); from which it needs to be distinguished. It is often triggered by Job Deficiency Disorder (or JDD), [Beware of the existence of dual or possible triple diagnoses.]
Redundancy Disorder (or RD) or Multiple Redundancy Disorder (or MRD) is commonly associated.
No job or source of legitimate income for 1 month. FDD symptoms can be masked by the concurrent presence of Illegitimate Income Disorder (or I.I.D.). This is generally known as crime, stealing, thievery etc.
Here, an astute clinician will detect the presence of a Dole Dependency Disorder or DDD. This disorder manifests as a co-dependent coalition between the Department of Labour or Work and Income (WINZ) and the patient. The WINZ is now named Income Support (which incidentally reveals the true nature of this patho-financial relationship). If the patient is a single female living alone with a dependent child the diagnosis is DPB/DD or Domestic Purposes Benefit Dependency Disorder.
These co-dependant relationships should be present for 3 months before a diagnosis of true Financial Deficit Disorder can be made.

Presentation and Clinical Features.
Stage 1
The main complaints are those of not being able to afford things. In other words it could be said that there is the presence of a ‘Deficiency of Affordance’ or D.A. As the disorder progresses, this deficiency becomes more generalised. Affected patients speak of not being able to afford practically anything. All suggestions, advice, given by any well meaning clinician are countered by the patient stating they are not able to afford to carry them out. This resistance or negative transference should on no account be interpreted or confronted, unless you want a black eye. One’s counter transference must always be recognised and held in check.
One will frequently find unpaid bills, letters from impatient bank managers and landlords, bank overdrafts, and letters threatening to sue to recover payment. Look especially for summonses for unpaid traffic fines. (a bad prognostic sign)
The mood is often dysthymic or depressed with all the characteristic signs of a major clinical depression (beware; this is not depression!), early morning waking, and lack of motivation. The future looks grim or even absent. As the presence of deficiency of affordance deepens, the complaints spread, and it is as if the patient cannot afford anything. The afflicted patient cannot afford to be happy, and in severe cases cannot afford to live. This tells the alert clinician to look for either the presence of suicidal ideation or the absence of the presence of living ideation. (ie wanting to live). Such ideations will be obscured by the lack of absence of the presence of financial ideation.
Alternatively, the symptoms of stress predominate, and disorders of anxiety become manifest, with panic attacks, and phobic anxiety.
Relationships with partners are fraught with frequent arguments about money and spending.
An absolute diagnostic sign is always the presence of bankruptcy which should always be looked for but its absence does not rule out the diagnosis. If a single bankruptcy is present, look for the presence of more than one, because you may be dealing with a Bipolar Financial Disorder where the patient swings wildly from wealth to penury. FDD itself could be a Unipolar expression of this disorder. A unipolar expression of its other extreme is where a patient will abruptly “go wealthic or hypo-wealthic (a less intense expression) ” and exhibit all the signs of an acute money overdose. (see later). A close relationship with the affective disorders is obvious.

Stage 2
Here the lack of affordance shows itself in an obvious deficiency of possessions. The car is sold, the house is sold for a smaller one, the swimming pool downsized, and any servants asked to leave. Flats get smaller, downsized to bed sitter, or even dormitory accommodation, and, in the extreme, under motorway residing.
Power, gas, and phone get cut off and clothing is second-hand and shoes are worn.
Because afflicted patients have either sold the car, or cannot afford to run one and cannot afford public transport, they are unable to get about and are said to posses Locomotional Inertia or LA. Thus they have a tendency to stay put.
The mood may turn to anger and desperation as the lack of affordance spreads. In this phase one might find theft, petty larceny, extortion, or prostitution as endeavours to boost falling financial levels. The low mood may lift but is replaced by secretiveness cunning and cynicism.

Stage 3
This is the chronic and most severe stage of this disorder.
Patients begin to cut down on food and sustenance. There is under-nutrition, or malnutrition. Here it becomes infectious and spreads to other members of the family affecting especially the children. There is lack of affordance of basic medical attention, prescriptions are given but cannot be paid for. Children and adults remain sick in spite of ‘free’ medical attention. Skin sores become obvious, and in children, otitis media goes untreated leading to glue ear and a condition known as Financially Induced Auditory Educational Deficit or FIAED develops, because they cannot hear at school. Children with FIAED may present with Job Deficiency or Dole Dependency Disorder as adults.
In this the final stages of this disorder sufferers often aggregate together in FDDG’s or Financial Dependency Disorder Ghettos. Such ghettos colloquially known as “slums” are extremely difficult to shift due to the concurrent presence of Locomotional Inertia which, like the individual patients, has them stay where they are. One of the authors (Tboni) actually visited several of these in Calcutta and saw the devastating effects of this stage first hand.
FDDG’s are prone to secondary bacterial epidemics such as plague, cholera, AIDS and, typhoid which sweep through them sometimes with appalling loss of life.. TB and Hepatitis A is endemic.
In this, its terminal stage, the disorder is known as Extreme Poverty.
Curiously enough, the mood disorder, which was manifest in the early stages is replaced by stark realism. There is more than enough life but for the day only. This can easily mislead the trained psychiatric observer into believing the sufferers are well. Diagnostic acumen is lost and the true extent of the disorder remains hidden.

Laboratory Findings.
In many cases the diagnosis will be fairly clear using the strict criteria above. In more doubtful cases the Financial Level or FL’s need to be checked by a recognised Financial Laboratory such as a chartered accountant, financial adviser, or money manager, or the next door neighbour. Special training is being set up to train FL analysts specifically for the purposes of diagnosis and treatment of FDD. FLs always need to be monitored during treatment.
In NZ the normal range of FL is quite wide and consultant advice is indispensable in managing treatment. (FL units = income minus outgoings divided by net worth)

Treatment
We have found here in Auckland that of the treatments available to us, the medication of choice is New Zealand money in dollars. At the moment we have not had the funds to research alternative formulations such as gold, silver, gemstones, stocks, shares, or investment notes.
NZ dollars have an advantage in that they are easily administered by gift, and seem to be readily accepted by our patients. To increase the dose one just increases the value of the notes given. So far non-compliance has not been a problem. However, as yet this treatment is in its infancy.

Dosage and Administration.
We prefer to administer the medication in notes, by hand, but coinage or cheque could be an option. A newer method in the pipeline is “EFTPOS for FDD” where the medication dosage is computer controlled, monitored, and recorded. ( We have a hardware manufacturer currently researching a handheld, computerised Financial Level device for our patients to do their own FLs and control their own dose. This is highly experimental)
It is usually advisable to start with a lowish dose* and work up until a response is achieved. In severe cases however, a high parental dose may be injected directly into the bank account.
A reasonable starting dose might be (according to the FL) say $50 tds and work up incrementally from there. Alternatively a once daily dose of $150 is usually better given mane, when it can be spent during the day.
However a nocte dose can allay anxiety preventing early onset insomnia. There is a danger it could provoke early morning wakening and morbid excitement about the spending to come.

Response
A steady decline in signs and symptoms, together with a compensatory rise in Financial Levels, should be looked for.
Affective signs improve first, followed by improvements in self esteem and motivation . Dysphoria shifts quite quickly. This shift is often abrupt, swinging into euphoria, (which can mimic a manic response and its associated spending sprees) as the possibility of spending up big begins to dawn.
Later this subsides, as the patient becomes eufinancial.
Physical signs such as a return of power, phone and gas are next followed by improvements in clothing and a gradual increase in possessions. Often but not always nutrition takes longer as there is a tendency to pig out on alcohol and junk food.
A rapid reduction in the job deficiency level could indicate that the patient has found a job. This is always favourable prognostic sign and suggests monetary treatment could even be discontinued.
Financial levels should be performed weekly and the dosage titrated.
Other parameters should also be used to adjust dosage. For example a drop in the Locomotional Inertia level suggests the patient is now getting out and about.

Treatment Duration:-
Treatment should continue till all signs and symptoms have resolved. The average case will probably need to stay on money indefinitely. If treatment is stopped too soon there will be a rapid return of symptoms usually worse than before and a great distrust of the clinician. A negative transference is common in such cases and this can only be resolved with high doses of the medication.

Adverse Affects:-
Tolerance and addiction can be problematic with financial treatment and the trained clinician should always be wary of the first signs.

Tolerance:-
Symptoms resolve at first but higher and higher doses are necessary to maintain financial levels.
Signs:- Look for concealed bank accounts, TAB slips, or sponging relatives.
Addiction:-
Higher and higher doses are demanded in spite of resolution of symptoms.
Signs:- Look for rapaciousness, and grandiose ideation. There is embezzlement or gambling. Grand larceny instead of petty theft,


Overdose
Overdose also can be a real problem.
Acute overdose:-
Sudden departure on world trips
Sudden appearance of a BMW
Porche
Mercedes
Ferrari
Rolls Royce in the garage.
Large new residences in sought after suburbs
Throwing of large parties with free booze at expensive hotels.
Sudden regular appearance at large international Casino’s.

Chronic overdose.
Ideas/delusions of grandeur. Harbouring notions of wanting to control the world. It is said that these patients have a tendency to get together and attempt to put together develop world control strategies.
Several large estates in international cities eg South of France.
Very Large bank accounts in overseas countries eg Switzerland, Cayman Islands.
Being given massive bonuses for financial failures in order to bribe politicians to continue treatment.


Other forms of treatment.
Psychotherapy or Counselling
This can also be used to successfully treat FDD.
More often it is used to treat the associated anxiety and depression. Here the aim should be to have the patient “accept” their poverty. Their negative feelings about this can be construed as resistance that they have not done so yet, therefore counselling or therapy is necessary. Any resistance to this notion obviously indicates severe psychopathology, and this should be pointed out to the patient.
If there is any difficulty in getting the patient to swallow this, one should always interpret the unconscious. It is clearly a sign of the patients’ “unconscious drive” to be poor. This drive can never be denied by the patient, since the facts will speak for themselves, and by definition one can never be conscious of what one is unconscious of.
Once this (load of codswallop) is accepted by the patient, one is free to indulge ones theory of choice. The FDD can be the result of oedipal issues, castration anxiety, birth trauma, faulty parental attachment and poor breast feeding. Role inadequacy, poor self esteem, wounded child within, childhood abuse or even faulty notions that one has a right to have money. The new cognitive behavioural therapies ideally lend themselves to this.
As a competent therapist, one can wax eloquently about the rewards of “getting well” or “getting better” of “coming to terms” with ones poverty. One could well exhort the patient of the benefits of Being free from the addiction to money. Poverty can be construed as a “blessed state” as the bible says, “Blessed are the poor”. (it is the result of one’s karma) New age Zen Buddhism is fraught with begging bowls and the like. Reincarnation ideally lends itself to the acceptance of one’s poverty. It could be pointed out that whilst one might be poor in this life in the next one could be wealthy.
The point could be made, as one writes out the bill, that the less money one has in this life, the richer one will be in the next.
The competent therapist, at the same time as indulging in their favourite therapy, can successfully delete money from the patient with the confidence that at least one of them is being treated for FDD. Perhaps even two are benefiting. Certainly, at least the therapist is benefiting and supervisor as well if the therapist is paying for their supervision.
If all counselling methods fail one is obviously dealing with a Financial Deficiency Personality Disorder or FDPD. These disorders are in actual fact, a subset of borderline patients, exhibiting as they do the whole range of affective and cognitive fiscal psychopathology. Since by definition, a personality disorder cannot be cured, the therapist can go on treating the patient for life, ensuring that the therapist at least, is getting the correct medication for their FDD in this life. (The ‘financially wounded healer’ as it were.)


Homoeopathic Treatment of FDD.
Homoeopathy is the treatment of a disorder with microscopic doses with the notion that it stimulates the natural response by the body.
We have not yet tried the homoeopathic approach but it has immense and cheap possibilities. Since homoeopathic doses are more powerful the less you give, a starting homeopathic dose might be say five cents three times daily working up to a stronger dose of one cent three times a day or even less. This would of course be a lot less expensive.
The dole tends to work in this way as does the DPB. The New Zealand Governments bumbling attempts to use homeopathic treatments such as the dole to treat FDD are in our view futile and reveal their ignorance of both homeopathy and FDD.

Jungian Analytic Psychotherapy
Here we might point out the emergence of a new archetype.
This is The Poverty or Indigent Archetype. This archetype has both the patient and the therapist in its grip.
It is an archetype that has been around for thousands of years and is very powerful in its expression. Coming to terms with this archetype could obviously take a lifetime of individuation; meanwhile payments for therapy can be transferred into the therapist’s bank account. In this case it is best for the patient to treat the therapist by arranging for automatic payments to be paid into the therapist’s bank account. This enables the therapist to go on treating the patient so he or she might become individuated. There is a co-dependency that is beneficial to both parties. The therapist gets medication for their FDD and the patient gets to be individuated.
Theory has it that this process only becomes complete a few minutes before death, so there is plenty of scope.


Differential Diagnosis
We believe that FDD is not only misdiagnosed but also mistreated. It can present in many forms. There is a strong association we believe with the affective disorders especially the Bipolar Affective Disorders (see later) and the anxiety disorders.

Financial Deficit disorder; Depression and the Anxiety Disorders

We believe that many diagnosed with depression or anxiety are misdiagnosed and have in actual fact, an underlying FDD. Furthermore the FDD actually triggers the depression or anxiety. These patients are misdiagnosed, and this misdiagnosis masks the underlying FDD.
Basically, these patients are just heartily pissed off with not having enough money to make ends meet, and the trial and effort of having to get people to give them some, is enough to make anyone ropable, anxious, depressed, or drive them to drink for that matter.
Giving antidepressants or anxiolytics is an attempt to bribe them into not noticing exactly how pissed off they actually are.
This is why our treatment works and is so successful. We treat the actual cause, not the symptoms.
If the depression is treated with antidepressants, the FDD goes unnoticed, financial levels remain low, Job Deficiency remains high and Locomotional Inertia will persist. This happens because they don’t have two cents to rub together.

We maintain that all cases in which depression or anxiety occur should be treated as FDD in the first instance and treated with money. In other words treated with gold-dust instead of bull-dust!

If in fact FDD is not present the money will be harmless spent or saved and no permanent damage is done. The disorder can then be treated appropriately.
A bold experimental regimen (the M or M regimen) currently under trial is to administer a dosage of dough equivalent to the cost of the therapist’s or psychiatrist’s assessment fee (in private currently round about $450/hour) together with the amount of money that would be spent on medication (56 prozac caps was $98.81). The patient could then have the choice to medicate herself or himself with the money or the medication. (M or M)
This two phase process recruits self caring and self responsibility in treatment and enhances a positive therapeutic outcome. Needless to say this needs to be overseen by a competent consultant clinician who has been fully trained in the recognition and treatment of FDD and is the holder of a current practising certificate, and has ongoing and verified supervision to cope with the transference issues that arise.
We believe that such misdiagnosis is disastrous for the patient and result in vast amounts of public money being squandered in mistreatment. These funds inevitably end up in the coffers of pharmaceutical corporations instead of being given to the hapless victims of this terrible and under-diagnosed condition in order to treat them for their disorder.
Alternatively, the funds are channelled into buying computers for Mental Health Management Systems in order to manage the patients. Here there is a complete misunderstanding of the whole issue because it is not the Mental Health Management who needs the computers; it is the patients. We believe either the money or the computers should be given to the patients, who could either treat themselves or use a computer to keep track of their respective failing financial disorders, a boost for their own morale and autonomy. Either way, it is obvious the patients would then not require managing, Mental Health Management then wouldn’t need to buy the computers, and we could all get on with treatment.

Financial Deficiency Disorder and Post Traumatic Stress Disorder.
or FDD & PTSD
The onset of FDD we believe may also trigger those who have abusive histories and therefore precipitate the onset of PTSD. Once again the PTSD gets the treatment whilst the underlying FDD goes undiagnosed and untreated.
The ACC has the right idea, but we think that once approved, the ACC could give the patient the money and the patient could have the option of self medicating with the money or spending it on counselling.
A hitherto un-researched area is that of childhood financial abuse. The unsuspecting victim is given either too much or too little and there is wilful exploitation of the primitive financial ego to cope with $$s. The perpetrators are often well known to the families, devoted uncles, aunts grandparents or even parents themselves. Personalities can become devastated, with splitting, dissociation, and possibly even the development of multiple alters to cope with swings in capital.


Aetiology, Treatment and Prevention.
Lines for future research.
So far, anthropological evidence suggests that Financial Deficit Disorder affects those cultures that use money as legal tender. (money, as in dough, funds or funding, cash, spondulicks, jimmy o goblins, finances, stuff, wherewithal, proceeds, filthy lucre, shekels, brass, lac, coin, mint, zillions, pile etc..). The expression of FAD in a barter cultures is at present unknown but could be related to the ‘potlatch’ of Indigenous North Americans where possessions are given away in a huge squander, leaving the potlatches in a condition now know as Possession Deficit.
A far more important but closely related condition affecting predominantly indigenous peoples and cultures is the Land Deficit Disorder, as exemplified in New Zealand.
The steps involved in the development of this disorder are as follows.
The first step is the colonising of “newly discovered” land by an overseas foreign power. (Namely Britain)
Secondly is the negotiating of “treaties about land” with much fanfare with these same indigenous peoples. (The Maori)
The next step is crucial in the pathogenesis of the disorder.
For full clinical manifestations to take place, the visitors (in NZ the Manuhiri mostly the “pakeha”) are then required to connive and swindle the indigenous peoples (the Tangatawhenua) out of the treaty previously negotiated. This can take many years. This policy of deliberate fleecing has the effect of causing gross inflammation of both cultures. Transference and counter transference are flagrantly acted out with protests, “brown eyes” the release of copious quantities of both parliamentary and media hot air and other offensive fumes. This accounts for the racial bias indicated at the beginning of the paper.
Both sides usually attempt supervision by their appropriate deities. Competition between the two deities for supervision is common. Personally we think the visitors supervisors with their Christian crosses, haven’t made a very good fist of it so far, and we consider it is about time the indigenous deities had a larrup. Maui is reputed to have caught the whole shebang from the bottom of the sea so we don’t see why he shouldn’t have a say.
Once again we see inappropriate diagnosis and mistreatment. Since the cause is a deficiency of land it is easy to see that fiscal envelopes, even fiscal parcels for that matter, just won’t wash.
The treatment medication proper, for Land Deficiency Disorder is land, earth, ground, geography, terra-firma, dirt, acres, property, & real estate; preferably flowing with the indigenous equivalent of milk & honey. This is not the time to treat with the occasional acre on a PRN basis.
No.
What is required is a large dose of property properly administered. We advocate a combination therapy. That is, a balanced combination of coastline, mainland, isthmuses, delta’s, bush, mountain & highland, promontories, and cliffs. Needless to say absolute politically correct protocols, should be strictly observed, to minimise inflammation.

Historical issues.
Historically, Financial Deficit Disorder has been with us for at least two thousand years. Biblical records reveal it was even present at the time of Christ; who Himself was probably the first clinician not only to recognise the disorder but also to prescribe the correct treatment. He was fully aware of the spiritual benefits that accrued to both the giver and receiver of treatment. He stated (and this is on biblical record) that of the three virtues the greatest was charity,(ie treatment or giving money away). He was Known for His Efforts in health promotion in advocating the giving of Alms to the Poor (treating the financially disordered). Buddhist monks as early as 2500 years ago were known to voluntarily take on FDD and beg for treatment with a bowl in order to obtain spiritual enlightenment.
In our technologically elite society however we do not have to use such primitive and archaic methodology. With current advances in psycho neuro pharmacology and cognitive neurobiology we can look for a definitive treatment and even a permanent cure for this old world disorder.
We do know that centauries of treatment with social, political and economical remedies are simply futile because they do not address the root cause.
We believe that the use of money as described above as a specific treatment is a real breakthrough. Yet we also believe that the use of legal tender is in the long run liable to be just too expensive. In other words, the cost of money could be just too high.

Future lines of Research:-
We think that a breakthrough lies in the new area we have distinguished as Neuro-Psycho-Financial-Pharmacology. (or NEPSYFIP) We do know that spending sprees occur in the manic phase of bipolar disorder. [Most authorities now accept that this is a neuropsychological disorder.] We also know that spending sprees (like the potlatch) not only result in possession deficit, but are one of the signs of an acute money overdose.
Magnetic Resonance Imaging [MRI] together with Positron Emission Tomography [PET} scans could examine the living brain to determine the metabolism of glucose while patients are in the act of actually spending their money. What happens to their oxygen uptake and their cerebral microcirculation as they acquire, or are deprived of money? PET and MRI scan equipment should be set up in banks, casinos, Racing Clubs, Stock Exchanges & DSW offices as well as Lottery outlets.
All patients on the dole could have mandatory MRI scans. This could locate the existence of a cerebral nucleus deep within the limbic system, which we have named the nucleus fiscalus or financial centre of the brain. This centre we believe controls all aspects of our financial management behaviour. It is obviously very close to the affective control centre that is responsible for affective disorders but has never before been distinguished as such. If MRI scans were done on indigenous peoples we might even find the location of not only the Poverty and Wealth nucleii but the elusive Cerebral Ownership Nucleus or CON.
At this stage we could ask ‘what are the neurotransmitters involved?’ Is there a specific financial neurotransmitter? Is there a CON susceptibility neuro-transmitter? Is this related to serotonin? Or is there a monoamine neuro- transmitter unique to the synaptic transmission of financial behaviour? Are there financial receptor sites and could they be blocked or facilitated?
Here is the domain of the neuro-psycho-financial pharmacologist. Such an individual should posses degrees in both Medicine, and Science, with Double Majors in Pharmacology and Neurophysiology, be Financial Members (in good standing) of both the Royal N.Z College of Psychiatrists and the New Zealand Association of Psychotherapists, have degrees in Philosophy Law, and Commerce, as well as Accountancy and Masters in Business Studies and Economics, together with Women’s Studies; be fluent in Maori, as well as be knowledgeable in Alternative Theologies. A Major in Quantum Physics and Genetics would also be an advantage. Practical experience in all these subjects would be, of course, essential and mandatory.
Is FDD the result of a disordered fiscal centre? These questions open up the possibility of a medication that could treat those already affected by intervention in the synaptic cleft either by blocking financial receptors or promoting the synthesis of financial transmitter molecules.
Alternatively stereotactic surgery might be utilised to remove or destroy a faulty financial centre in those financially deficit. Once removed it might even be possible to transplant it or even synthesise a computer chip to duplicate its functions.
Another line of inquiry is genetic. Is the financial centre genetically controlled?. If these genes were removed what would be the gender of the jewels exposed? We also postulate the existence of a financial gene or ‘fincogene’ responsible for the operation of the financial centre. This operation is probably sex linked. Such a gene or combination of genes could be triggered in childhood by the over prescription of birthday presents or gifts from the tooth fairy or Easter Bunny.
The determination of the structure of this molecule could herald the possibility of a final cure of FDD.
Brain and bone marrow samples could be taken from leading financiers and the exceptionally wealthy in order to isolate this ‘fincogene’. The bone marrow and cerebrum from such financial luminaries as Warren Buffett Donald Trump Rupert Murdoch, Bill Gates, The Queen, and former president Mobutu of Zaire should be harvested in an all out search for the gene. This gene could then be synthesised and injected directly into the brains of the poverty stricken, the resultant wealth would liberate our economy from the financial strictures of Financial Deficiency Disorder forever.
Like smallpox, lack of money might just become a memory and the poor a fading memory.

Important notice:-
We in Auckland have mild attacks of FDD from time to time. We willingly volunteer our services as subjects for experiments in money overdose and will not hold experimenters liable for any adverse effects provided the dose is sufficiently large..
Tboni

Breakthrough in Mental Health. Part One

Newsflash Newsflash Newsflash

Important Announcement

Breakthrough in Mental Health
A First for Community Mental Health in Auckland
(a Community Mental Health Centre in Auckland New Zealand)

By Tboni

After extensive research amongst our colleagues, we in Auckland believe we have discovered a hitherto unrecognised disorder that could be widespread in our community and even infectious.
A disorder that could be responsible for the emotional, psychological, mental and physical suffering of thousands possibly millions of its innocent victims worldwide.
It occurs we believe most frequently amongst the disadvantaged and underprivileged, the poor and poverty stricken, the unhappy, the depressed and stressed; those particularly at the lower levels of our society. It has a racial as well as a female gender bias.
We claim that the recognition of this disorder, its diagnostic criteria, and its treatment regimens have never before been distinguished.
Up till this historic time, the disorder appears nowhere in psychiatric literature or in the DSM (fourth edition, to the best of our knowledge) and we claim it could be a “world first”, for Henderson House, reflecting credit on the Community Mental Health Centres of the Waitemata CHE, and glory on its Mental Health Management. We believe that, because the prevalence of this disorder, (present evidence suggests we have seen just the tip of the iceberg), its severity, and the degree of suffering it gives rise to, urgent attention should be given to making this knowledge public. Millions could be affected by this disorder worldwide, as compared to a mere ten or so with mad cow disease.
Furthermore, a research group should be set up immediately, to investigate the severity and prevalence of this disorder, its long term effects and demographic boundaries.
This paper, for the first time, distinguishes the disorder, outlines the important diagnostic criteria, the differential diagnosis, the treatment of choice, and outlines treatment protocols, adverse effects, and suggests important avenues for future research. We do not claim this is at all comprehensive, and some of our findings may eventually be found to be mistaken, but it is a start, and much more work needs to be done.
Because this disorder has never before been distinguished as such, we are unsure where it should lie in current psychiatric nosology. We would appreciate suggestions.

Do you need an anaesthetic?

I went to a professional meeting the other week.
I had not been for some considerable time and was interested in what others were doing in their practices.

An attractive woman gave a presentation on ‘Dissociation’ that she had diagnosed in a man in his 70‘s. ‘Dissociation’ is a process in which, according to the professional cognoscenti, fragments become ‘split off’ from access to ‘normal ‘ consciousness’ which is seen as an integrated whole.

I find myself often being affronted by such notions because the notions are lifted holus bolus from the background and the people whose lives they were originally formulated to explain, and treated as if they had an existence of their own applicable to humankind as a whole, peasants, university professors childcare workers, and army generals. Such processes and notions become to be treated as if they were universal processes of the human condition which, clearly, is not necessarily so.

Now, a force such as gravity might be common to all bodies that posses mass but to imply that dissociation is a process that can be applied to all folk, saviours and sinners alike is stretching reason to breaking point.

In all such discussions I have found there is much excitement and chatter that goes in to distinguishing the ‘dissociative process’ (whatever that is supposed to be) and not much about the persons life as a whole, which to my mind should be the nexus of the whole operation.
Indeed there are a lot of such concepts.
Notions of ‘transference’ and ‘the unconscious’ are a couple I find particularly obnoxious, not because there is anything the matter with them per se, but because they are riveted in place as absolutes, like stations of the cross in the church of psychotherapy and can be used by a devout believer to explain just about anything at all about anyone however problematic or repugnant that might be.
I am reminded of a client who had given up on her mother who was a devout Christian because her mothers answer to anything problematic was prayer, and, if there is anything at all in the church of psychotherapy with the same explanatory power as the Christian Holy Trinity it is Dissociation, Transference, and The Unconscious.

Anyway!

She gave a sensitive presentation for the most part. But then, all of a sudden she began to break into cognitive neuro-speak.

“He looked this way and I knew the left hemisphere had kicked in, and there had been a blockage, an emotional dysregulation of the prefrontal limbic hypothalamic axis that had probably occurred as a child. I realized his fear was the outcome of a damaged attachment that had occurred as the result of a distant capricious, non available mother. “

She went on in this way for some time, interweaving her own observations and thoughts of her clients conduct with observations about his neurophysiology and even her own neurophysiology as it was occurring in the present.

It seems she thought that she had similar access to her own brain as she did his.


I was aghast.

I thought:-

"Don’t bother to examine the nervous system.

Don’t bother with xrays or MRI or fMRI scans of the cerebrum.
We can tell what’s wrong just by talking and watching your eyes!
It’s your brain that‘s been injured!

Your mother gave you a brain injury as a child by damaging your attachment.
But wait!

There is even more!

We can help.

And we don’t even have to study or even conduct an examination of your nervous system.
Nor do we even have to bother with an anaesthetic, an operating theatre, or surgical instruments.

With the latest cutting edge science we can tell what is wrong just by looking and talking about your past.

We can do neurosurgery right here on the couch. We can link brains and my brain can do neurosurgery on yours as we speak."


What I found horrifying was that she absolutely believed every word. Everybody afterwards nodded sagely and gave her a round of applause.

I gave a weak smile but just could not bring myself to ask whether or not she had given him an anaesthetic.

The Psychotic Brain

The Psychotic Brain.

Each of the following scenarios is factually plausible. The are placed together to demonstrate the conundrum psychiatry continually faces in pursuing its idiosyncratic and idiotic model.

1 Eric is a middle manager in a drug company who lives alone in his bachelor apartment. He is usually well disposed towards his peers and friends, well liked and enjoys his job.
One day when answering the phone he hears a series of clicks he has not heard before. He pays no attention but then he hears the same clicks when answering the phone at work. Sometimes when he answers the phone there is no one there. “Funny thing that’ he says to himself and pays no attention. “Anyone else hear funny noises?” he asks at work. “Nope” they say, “You must have a faulty phone”.
Eric calls security and they check out the phone. Nothing wrong. Then he notices that a particular green car seems to be following him. He happens to look out the apartment window and notices that same green car parked a little way off outside his apartment. Just for the hell of it he walks outside along the path and notices a man in it he doesn’t know reading a newspaper. “Coincidence!” he says to himself.
A few weeks pass and he notices another car parked unusually outside his apartment. He again goes down to look. This time he sees the same man as before still reading a newspaper. The unusual clicks on the phone persist.
Then he notices that when he comes home at night his papers and things on his desk seems to have been rearranged. Nothing has been taken but he becomes suspicious. He says to himself that he must be getting paranoid and tried to put it out of his mind. He asks his workmates about it but they reassure him and say not to worry and say that he is just getting a bit paranoid. He tries to put it out of his mind but it just won’t go away. Finally although he knows he is being silly he places fine threads over his desk and hairs in strategic places on the doors in his house.
Astoundingly when he come home they have been displaced. Not only once but on many different occasions but nothing has been taken. His friends do not believe him and attempt to reassure him. This being the case and not wanting to be seen as stupid or paranoid he stops talking about it to anyone. Inside himself however he becomes more and more suspicious and more and more paranoid. He finds himself scared to go to work, wanting to stay home to see if he can catch them red handed.
Finally after he fails to go to work his friends knock on his door to see what has happened. Eventually the Police are called and when they gain entry they find him cowering under the bed in terror of unnamed people who are after him.

The Police take him to the local Mental Health services where he has a psychiatric assessment and he is given a diagnosis of Paranoid Psychosis (Not otherwise specified) and he is commenced on antipsychotic treatment.


Dr. Oakshott is a research biological psychiatrist specializing in the brain alterations in psychosis. Currently his project is in the particular lesions he avows, that mark the paranoid brain and is very keen to get some case material. Someone suggests he might wish to interview Eric who could be a good candidate for his research. Dr Oakshott is very keen and interviews Eric who’s ‘uncontaminated’ paranoid ideation would, Dr Oakshott considers, make him an ideal subject to include in his project. Eric agrees to be a subject, having been convinced that he is in fact ‘mentally ill’ by his key workers.
Eric consents to having an MRI scan of his brain as well as an fMRI scan, having little else to occupy his time.
Dr Oakshott is pleased when he view’s Erics scan because he can identify specific lesions and alterations that he is convinced distinguish the paranoid brain (namely Eric’s) from the normal brain.
In his study of the paranoid brain versus the normal brain Dr Oakshott has taken the liberty of including his own brain scan as being one of the normal controls.
Finally Dr Oakshott’s study of the normal versus the paranoid brain is completed and published to great acclaim.
He is sought after for seminars and lectures.
Dr Oakshott publishes a textbook entitled “Neurobiological Psychiatry” complete with visual scans of the lesions that distinguish the paranoid brain from the normal brain. The textbook is a resounding success in the psychiatric literature.
The years pass and a Nobel prize is mentioned.

3 Some twenty years pass, and Dr Oakshott now in a position of authority in psychiatry happens to be reading his newspaper.
The newspaper carries the headlines that the FBI is now able to release files that had hitherto been classified.
These files related to the surveillance of individuals that had been considered threats to national security because of their drug business affiliations or suspicions about them that had prompted ‘red flags’ for intensive surveillance.

Horror struck, Dr Oakshott realized that Eric, one of the subjects on whom his whole thesis rested, was in fact on of those whose life had been under intensive surveillance. Furthermore, he realized that Eric must not have been psychotic or deluded at all, but simply reacting as anyone might to such intense surveillance.
His whole theory, in fact his whole reputation and his textbook became at stake for him as he realized that he did not really know whose brain was the psychotic brain.
His own brain.
Or Eric’s.

The Executive

Diane was an intelligent petite neatly dressed woman in her early thirties with an air of no nonsense efficiency about her. Apart from some redness around her eyes there was little to indicate any emotional distress. She announced that she had been suffering from depression that had developed four months previously and she required a repeat of her antidepressant medication.
A quick scribble would have sent her on her way. I asked her if she was sure she had depression.
Yes she said she had looked it up and had been to see her GP. She had all the signs and symptoms. I thought I might just sound her out a bit more just to get some more information for myself.
This was the first time in her life she had experienced depression but she had finally she realized she was ill and needed treatment.
I asked her to tell me how it began and the following extraordinary tale unfolded.

Diane was from the UK of a middle class family. Her mother taught at University and her father was a respected businessman of renown. She had gotten good marks at School and had gone on to get a degree in Business with 1st Class Honors. She had been sought after to help in the reorganization of the British Health System in London and had acquitted herself well.

So well in fact, that she had attracted the attention of the NZ Ministry of Health. She had been head hunted by the Ministry to advise in the transformation of a Hospital Board to a Crown Health Enterprise. This was a big step but she thought overseas experience could only assist her career, especially if she acquitted herself well.

She was recruited to advise a team of managers, all male, in the setting up of the CHE (Crown Health Enterprise), a job that was to take two years and her salary was commensurate with theirs.

Right from the start she had some misgivings about the rather simplistic ideas she thought her male colleagues had. But she gave them the benefit of the doubt.
Her unease grew as the months passed as she began to realize they were serious about their ideas.
She voiced her doubts in one of their meetings. She was respectfully and politely listened to and then ignored. They went on as if she had said nothing. As she listened to the terms of reference, and the magnitude of the job ahead, she realized would take a lot longer than two years, way beyond the expected end of her's (and their) contracts.

She took the floor and outlined her case. Again they listened but pointed out that her version would take a lot longer than the two years they had at their disposal. Once again she was ignored and they went on with their own solutions.
Again she sat back listening. This time she began to realize that their management plans were not only simplistic but had no possibility of working. She commanded the floor in one of their meetings, and spoke her mind. There was some embarrassed smiling around the table. She flushed, aware all eyes were upon her.
Her statements that their solutions were completely unworkable, fell on deaf ears. She had at least expected that they might argue with her her and enter into some dialogue but they did not. She felt embarrassed, not used to being ignored in such a flagrant manner. They simply heard her out with faint condescending smiles on their faces.
Afterward they asked if she was OK. They thought she was upset.

She thought to herself that maybe she had got it wrong so she took some work home re re work her own solutions. But no. She could find nothing the matter with her plan. Even putting the best frame around their plans they were still unworkable.
She went back into the meetings determined once again to have her say. Again they ignored her and this time she lost her temper. Through angry tears she told them their plans would not work in two years if then, that she had been hired as a consultant and was determined to have her say.

There had been an uncomfortable silence, she recalled. They had all stared at her. One apologized for his indifference to her plight muttering that he hadn’t realized how upset she was. They asked that perhaps it might be a good idea for her to have some time off and again apologized for not noticing how upset she was earlier. Someone wondered about her fitness for the job.

With a sinking feeling she rose and left the meeting. Nothing in her past had trained her to deal with such condescending patronizing circumstances. She began to doubt herself. Perhaps she had got it all wrong. She again went over her work waking in the night thinking about the problems. No, there were no mistakes. Surely they must know they were wrong she thought. No one could be that stupid. But she was completely outnumbered and outvoted by her all male counterparts. She decided to just listen in subsequent meetings.

As she did so she began to realize that the were fully aware of what they were doing. The occasional sly smile, the odd conspiratorial look between them. And slowly the penny dropped.
They were all on contract and the payment bonus for finishing the job on time in two years was substantial. They were not interested in their plans being actually workable. They were interested in finishing in 2 years, by which time they would have all fulfilled the contract, collected their bonuses and someone else would have to clean up the mess they left behind! Anything that even hinted that what they were doing would not work would be disastrous.

Nothing had prepared Diane for this assault on her integrity. If she confronted them she would be ignored and her mental health and emotional capability questioned. It had already been alluded to in the meeting. If she went along with them she would have to live with herself afterward and her reputation as a consultant would be in tatters.

Being new to NZ she had few friends here and she had thought of returning to the UK but that would have meant leaving the job half done admitting failure on her previous unblemished career, returning with her tail between her legs. She felt she was in a blind alley with nowhere to go. She began to wake up at night worrying, and she began to lose some weight. Maybe they were all right about her after al she thought. She was not emotionally up to the job. She was becoming depressed. She looked up depression and found she had many of the symptoms. She saw a GP who started her off on antidepressants.

Being an executive manager she had managed to hold herself together. She had convinced herself that she would just have to resign herself to the fact that she was a depressive and would probably not be able to cope with the future she had planned in business.

It was in these resigned circumstances that I saw her.

To say I was appalled was an understatement. I had heard about the managers she was working with. Several were brash young executives with their new MBA’s under their belt newcomers to health, out to make big money. I had seen others who had been intimidated by their power hungry disenfranchising maneuvers and arbitrary methods. They thought that ‘adequate consultation with all staff’ meant giving orders.

What to do?
Because I had dealt with similar cases in the past said, “I don’t think you actually do suffer from depression. I think you have been deliberately shafted. You have been taken down, and deliberately ignored.”
She let out an explosive breath of relief. “You mean I don’t really have depression?” she asked.

“Well all I can say is that I have seen other folk exactly like you who have been treated in the same contemptuous way by similar managers and they couldn’t sleep, lost weight and thought that they were depressed. I think this has got to stop.”

“Really!” She said. And then she talked of all the slights she had received, their patronizing offhand comments about women in business, what she had done, and how her indignation seemingly had been translated into her having an ‘emotional problem’.
Her story happened to coincide with the histories of others who had come to see me with similar stories about the same individuals.

I asked her if she had some documentation of what had happened in the meetings. She said yes she had. She had written notes of times dates and meeting agenda’s to re scrutinize where she had possibly gone wrong and what she might learn. However no matter what she did she had realized she was outnumbered, and out voted and no matter what she said or did they would continue with their unworkable agenda.

She explained that her immediate Bosses were the Ministry of Health. Complaining to them would almost surely result in their canvassing the rest of the team and the outcome would almost certainly be a vote from the others that she was mentally unstable.

I suggested she write out a full summary of times, dates, and plans, what she had said, what they had said, the outcome of votes cast up until the present leaving out emotional reactions any interpretations as far as possible. Could she do that?
Then I said we would meet again to go over the details and see what might be done.
Yes of course she said. (She was after all an accomplished manager.)

A couple of meetings later we discussed the issues.

She seemed to be transformed.
She had been very busy. She said that after our meetings she thought of what she might do. She had decided to return to the UK. She had then written a comprehensive report of everything that had happened to her with the times, dates and the minutes including who had said what, of all the meetings she had attended. To this report she attached her resignation stating exactly what had happened and her reasons for her abrupt departure. She had sent it by registered mail to the Ministry that had employed her.

She booked a flight back to the UK and thought that her experience in NZ would form the basis for a thesis for a doctorate.
I asked her what about the antidepressants?

“Oh those,” she said. “I don’t need them. I don’t think I really needed them in the first place.”

Some months later I heard via the grapevine that the management project had been disbanded by the Ministry and its members made redundant.

Saved from Burnout

An all too familiar story.
Joe came to see me. He looked tired. He told me he had been off work for 18 months because of mental illness.
“ It was a good thing my doctor spotted it.” He said. “He got it right first time.”
“He told me I was suffering from work stress and depression, and I was getting burnout. He said I needed time off. I got time off but every time I tried to go back to work I got worse. He said I was getting a clinical depression and had to give me medication. That helped a bit but then I got panic attacks whenever I tried to go back to work and he had to give me something to sleep and he had to up the medication. Now I can’t go out without getting panic attacks. My doctor also thinks I have got phobic anxiety. They’re not going to keep my job open anymore, I’ve run out of sick pay and had to make do on the benefit. “
I asked him what went wrong with his job.
“It was my boss.” He said. “He just had it in for me.”

The story gradually unfolded in our talking together.
I found that two years ago Joe had been a middle manager in a fairly large firm. He had done pretty well. He was married with two children on a good salary. No history of mental illness.
“What had happened” I wondered so that he was now jobless, on a sickness benefit, because of multiple mental illnesses. Ie Stress, depression, phobic anxiety.
Two years ago nothing had seemed to alter this tranquil existence. He liked his work seemed to get on well with his staff, and met all his deadlines. Then his line manager was replaced.
This man had a completely different agenda from his previous manager. He was very officious in his manner and had a completely different way of doing things. He wanted a lean mean machine. Joe went out of his way to please him and show him he was up to the job.
None of his efforts seemed to satisfy this man who seemed to continually find fault with his work. The new manager kept laying blame with Joe’s attitude but Joe could never find out what he meant. He made repeated efforts to find what this meant but this only reinforced his manager’s opinion that his attitude was at fault.

He began to get worried that his job might be at stake and wondered it the new manager had an agenda to restructure and get rid of him. He knew that if he shared these misgivings with his boss it would only reinforce the adverse opinion he had about his ‘attitude’.
He discussed it with Rosie his wife. She was sympathetic and very supportive.
However as the situation at work continued Joe began to worry more about his predicament. He was not used to being continually the subject of criticism especially when he was doing his best to take them on board.
He began to worry at night and wake early in the morning dreading the day before him.
He took a vacation for a couple of weeks. He and the family had a great time but as the time approached to return to work the worry began once again.
Rosie was concerned about his health and suggested that he see his GP.
Joe was couldn’t see what the GP might do but decided it wouldn’t do any harm.
His GP checked him out physically and then began to ask Joe a lot of questions.
‘How long had he been worrying? On a scale of 0 to 10 how bad was the anxiety. Did he wake early in the morning? Had he lost any weight?
What were his energy levels? How was his concentration?
Did he think life was worth living? Had he ever thought of taking his own life?
His GP seemed to concentrate on Joe and said little about the situation at work with his manager even when he explained it.
Finally his GP announced
“ I think you have an early clinical depression triggered by work stress. It is just as well you came to see me otherwise you could have gotten burnout’.
“Hang on said Joe. You mean I am mentally ill?”
“ Yes you might say that” said his doctor.
“How do you know?”
Well because you have many of the symptoms of depression.”
This came as a revelation to Joe. He had never thought he had a mental illness.
“What do you think I should do? He asked.
“Well I think you should start medication and take at least a month off work to allow the medication to take effect. If you don’t you run the risk of burnout.”

This was a revelation to him. He was getting depression all along. Maybe it was that his new manager had seen in him, right at the start. Of course!

He went home buoyed up by the fact that the medication would soon get him back on board.

He had enough sick leave and took the time off. He began to feel better anticipating the effect of the medication. The weeks went by. Yes he did feel better but as the deadline approached for returning to work he started to become more anxious. His Boss said he was not to return until he was completely well. Yet Joe knew he would be coming back into the same environment. He began to worry and pace anxiously about the house in anticipation of returning to work. Maybe this meant he was not quite better. Because he knew he had a mental illness he began to doubt his own thinking and his own feelings. He would frequently have to check things out with Rosie to make sure he had got it right. She became exasperated with his ruminations and he in turn began to get panic stricken.

Finally she took him back to their GP.

He listened to all their concerns and to the tales of anxiety and finally said that Joe was suffering from phobic anxiety, and that he would have to change the medication.
Joe was aghast. I have phobic anxiety as well as depression? He asked now completely demoralized.
Yes unfortunately they can go together but they are well recognized.

“When can I go back to work?

“Well I wouldn’t recommend it. It would only exacerbate the illness and you could end up with burnout he said.

Once again the medication was changed and Joe returned home. He wrote a letter to work saying he would return as soon as he was able. He decided he could stay home until he had used off all his sick leave. This extra time off helped but once again whenever the deadline approached he became anxious. By now he was also angry about had had happened to him but was persuaded by the GP that this anger was just a symptom of stress.

By now he had used all his sick leave and was on a benefit. He got a letter from his boss saying that they could only hold his job open for six months on leave without pay after which they would have to replace him.

So there he was sitting across from me asking for advice.

I thought to myself
“How to turn someone from a well off productive business man to a hard up sickness beneficiary in only eighteen months.”

As I was thinking he remarked “Just as well my Doctor caught me just in time. I could've got burnout!”

I felt sick and sighed. Maybe I should have been a lawyer.

The Writer

James was depressed. He had been depressed for over four years.

He had been around the world, lived in the UK as a fitter and turner, earning enough money to finance periodic tours of Europe, and Asia. He seemed pretty accomplished and articulate, and had, on one job, even taken over as resident engineer, on account of his troubleshooting skills.
After some years he returned to New Zealand as he said, to settle down. He continued to work as a fitter and turner, but life began to lose its glamour and lose its gloss. He would wake in the morning before going to work and contemplate the day. As he did so he would be filled with a nameless dread. He would ask himself “Is this all there is to life?” And, “ Am I going to spend the rest of my life like this?”.

He did not want to go to work and had to force himself to get up.
It was OK once he got there but sometimes in those mornings he would wake early, anxious and begin pacing the floor. He became increasingly apprehensive at work and would worry over minor matters. He felt he was stuck, his life had somehow stuck . He was stuck in a dead end job with no where to go. He felt his life stretching out into the future, every day the same.

At first he thought is was just a reaction to settling down, that he would get over it. People told him that all jobs were boring at times and he was expecting too much. They said he had a very successful job and would eventually get over it, but he did not. The situation became worse. He tried drinking but that made him feel even worse in the mornings. He had a hangover in the mornings as well as the dread. He would snap angrily at his workmates and friends over minor matters. They told him he “had a problem” and should see someone about it. By this time the penny dropped. He really did have a problem. He asked his GP about it and he arranged a visit to a psychiatrist.

The psychiatrist was very sympathetic and understanding. He was very professional and seemed to know what he was doing. He asked a lot of questions about his habits his sleeping his concentration his energy level and his early history and childhood.
James parents were ‘lower class’. His mother did house cleaning to make ends meet and his father worked on the wharf. His father was a somber unhappy man who worked hard every day of his life. James could not recall a time he had seen his father happy.
His father repeatedly said to his son “Just you be thankful you’ve got a job you’re good at. You don’t have to like it.” The psychiatrist seemed to think this was quite important and suggested that his father had suffered from depression. He said that there was frequently an “hereditary component” to depression intimating that this somehow explained James current complaints.
He asked a lot more questions about his moods. Had there been times when he had felt really happy that ‘he could do almost anything’? Had he at these times gone without sleep? James racked his brains. Yes there had been one or two times. Were these times interspersed with not so happy or even depressed times. James had to admit they were interspersed.
The psychiatrist’s interest was aroused and James noticed that the conversation had shifted somehow. He would describe the details of his happy and unhappy life situations, whilst the psychiatrists would respond by referring to them as “episodes” and “mood swings”. Describing them in this way seemed to give them some special significance.
He was asked if there were there recent times when he was happy. Yes there were responded James. It didn’t have anything to do with being depressed or his job. He felt better when he wrote.
He had over the past year or so written three novels one of which was on the verge of being published. When was writing he forgot about his horrible life at work but whenever he returned to work he felt worse. The psychiatrist suggested to him him that this was in fact an escape mechanism to keep him from dealing with his real problems. It was a way James had developed to compensate for, or escape from, his depression. He was escaping into fantasy as it were. James had to agree.
At the end of the interview the psychiatrist said that the indications were that James had a Major Depressive Illness. He was informed that there was a hereditary ‘component’ but it was an illness like any other. In addition he said that it was highly likely that overall, he had a Bipolar Disorder of which his current depression was a manifestation. He thought that this was partly genetic and probably reflected a chemical imbalance in the brain that was triggered by the environment. The appropriate treatment was medication which he would probably have to take for an extended length of time. At last James thought, someone knows what is wrong.
The psychiatrist carefully explained that he would be taking lithium which was a mood stabilizer to minimize the ‘mood swings’, and an antidepressant to treat the depression.
The medication worked for a while. Each day James awoke hopeful that he would feel differently. This hope made him feel better just in and of itself.
However as the months rolled by, nothing much changed. His life kept bumping along and he became resigned to the fact that this was all life had to offer. He kept returning for repeat prescriptions but there was little respite from the unremitting gloom except when he was doing his writing or watching a screenplay or reading existential philosophy in which he had recently developed an interest. Because of his lack of response to treatment he was referred for Cognitive Behavioral Therapy.

He was quite interested in this but like the medication before it didn’t last. He got sick of writing down his thoughts and although he got to know about his core beliefs and his self image improved it made no difference to his feeling of dread in the mornings as he contemplated his future, and he eventually abandoned the practices altogether.

Finally someone thought that he might benefit from talking to someone else.

I have learned from long experience over the years to take nothing for granted so I asked him in this first session what he wanted and how I might be of some help.
He told me he had been suffering from depression for around 4 years and had been told that it might help to talk to someone about it.
I asked him what he would like to talk about, and he told me he had written a novel ready for publication and had two others on the go.
So for the next three quarters of an hour we talked about writing. We talked about fiction and non-fiction. We talked about science fiction, poetry and prose. We talked about thrillers and romances, and novels. How he wrote, on a computer with a pen or in pencil where he got his ideas from; did he write in the morning or in the evening. Writers he liked writers he disliked and why. We talked about the difficulties in publishing, artists and the artistic temperament. We even talked about mental illness and writing, including and Ernest Hemmingway and why he might have killed himself. We had odd sorties into film video and screenplays and ended up in his interest in existential philosophy. At the end of the session it was apparent that we had barely started on his interest so eager was he to talk. During all this time in the conversations we had, it was clearly apparent that he was not depressed at all.
I commented that that there was a lot more to talk about and wondered where the depression fitted in all this. He replied that that was just the problem. He was a fitter and turner, a good one at that. He earned a good living. This was just the problem. He couldn’t see a way out.
As a throwaway line as he left I commented that I was not surprised he was depressed trying to be a fitter and turner when all the time he wanted to be a writer. I said I’d be pretty depressed too trying to do something my heart and soul wasn’t really in to.
Next time we again talked about writing. We talked about books and writers, he might touch base with. Movies, screenplays, and education. Life and the artistic temperament, and what life might actually be about. The world of the artist and how hard it was to get ideas across. University courses, writing groups, the world of ideas.
In the third session he said he had applied to Otago University to do a course in creative writing with film video and screenplay thrown in. he had also applied to do a course in existential philosophy, to fulfill the requirements of a Masters degree. He had been visited by an old friend from California, a woman who had just finished a PhD he said proudly, who was wholly supportive of his endeavors.
I asked him about the depression. Funny thing you should ask me he said. After 4 years of anxiety and dread it had suddenly vanished. It had left him. I just feel quite different in the mornings. That’s interesting I said. When did it leave?
After the first session he said.
What was it I asked?

Something you said at the end stuck with me, he responded. What was that?
You said something like “I’m not surprised you are depressed trying to be a fitter and turner when all along you are a writer.”

“No one had ever said that to me before.”