Monthly Archives: July 2013

Depression (blog 3) – Getting help, by Lindie White

lindie white

Lindie White

In the last of our blog series on depression, psychotherapist, Lindie White, writes:

Most people need help when they are depressed or have prevailing sadness and low mood. If we can’t acknowledge this when we’re suffering, then that’s part of the problem! The essential first step is to name your depression to yourself and someone else. When it is acknowledged, then what?

If you go to a GP you will be offered medication and/or some kind of talking therapy.
Medication can help some people, sometimes, although some find that anti-depressants don’t help at all or are not enough on their own.

Therapy really does help tackle depression and there are many different kinds of talking therapies on offer. Most commonly available through the GP is Cognitive Behavioural Therapy (CBT), often delivered by an in-house counsellor. This aims to address negative, self-destructive and ‘untrue’/unrealistic thinking patterns. Other therapies include psychodynamic or psychoanalytic – stemming from Freud and Jung’s thinking about the unconscious – and humanistic or person-centred – focusing on helping the client find their own answers. All therapies have different emphases and have been developed as people discovered that no one method serves all people or meets all needs.

Research has consistently found that what makes the real difference is the therapist rather than the therapy. So, do some research, see what appeals to you, and trust your instinct as to how you ‘fit’ with a particular therapist and how the first one or two sessions feel. A good therapist will facilitate this sort of discussion.

The following are important factors in successful counselling and psychotherapy:
• a good working alliance between therapist and client
• a therapist who listens well and is responsive and flexible within reason
• a therapist who displays qualities of empathy, warmth and care
• an agreement between the client and the therapist on the goals of the work
• a client who is highly motivated for change and relief of suffering
• a therapist who can enable the client to experience calm if the client is highly aroused with anxiety or other emotion

A key point in dealing with depression and its recurrence is that it is our emotional reaction to our emotions that keeps them going and complicates them. We can exercise choice about our reactions when we have greater awareness and can fully engage our will to heal ourselves.

As practitioners and clients, we need to keep exploring better ways to find this healing and bring a natural, organic quality of enjoyment and engagement to our lives. A recent development has been to integrate insights and practices of Buddhist-based mindfulness, yoga and meditation with more traditional talking therapies. (See The Mindful Way through Depression, Freeing Yourself from Chronic Unhappiness by Mark Williams, John Teasdale, Zindel Segao and Jon Kabat-Zinn, Guilford Press, 2007.)

Many people are also helped by complementary therapies, an approach we promote at Wendy Bramham Associates. Acupuncture, homeopathy, massage, nutrition and chiropractic are all useful for different issues, so explore what appeals to you.

Whatever path of therapy you pursue, do your research and follow your own instincts, hints and leads. Each of us makes our own path by walking it, connecting and disconnecting with others as we do so. And if you feel so low that you don’t know where to go, ask yourself what might appeal if you weren’t feeling so depressed and follow that, maybe with the support of someone you trust. Therapy is a powerful tool for combating depression, so have courage to take the first step and seek help.

See previous posts on this blog for more information about types of therapy, the effect of life choices, how therapy helps and book recommendations.

We particularly recommend the following books on depression and how to live with and through it:
Depression – the way out of your prison, by Dorothy Rowe, Routledge 2003
Living with a Black Dog, by Matthew and Ainsley Johnstone, Pan Macmillan Australia, 2008
First Steps out of Depression, by Sue Atkinson, Lion Hudson, 2010
The Endorphin Effect, by William Bloom, Piatkus, 2011

Plus, on spirituality:
The Power of Now, by Eckhartt Tolle, New World Library, 2004
The Power of The New Spirituality, by William Bloom, Piatkus, 2012

And an audio CD for guided meditation:
A Meditation to help you relieve Depression, by Belleruth Naperstek, Health Journeys, 1993

Myths and Stigma around Mental Health

There can sometimes be a chasm between the medical and the psychotherapeutic models of health. In the former, external interventions, such as drugs, are used to relieve and/or cure symptoms. In the latter, the human condition is accepted as fallible, and it is considered normal for the complexities of life to become overwhelming at times.

In psychotherapy the patient has to play a central and active role in their recovery, but within the context of a working and trusting partnership over time. The work involves addressing the whole person, and certain physical symptoms can be seen as clues to begin to understand what might be troubling that person at a deeper level.

In some cases the neuro-chemical levels (eg serotonin) in the brain may need re-adjusting with medication. Drugs can help a person to gain enough mental strength to get to therapy in the first instance and begin to talk about their feelings.

Breaking down some mental health myths

With psychological health issues, the patient has to be able to admit that there is a problem in their life or circumstances, and have a willingness to allow for change. The acceptance that one is vulnerable requires courage. Paradoxically, it is a sign of strength and health.

It is not always helpful to label a person, as if they have taken on a new identity (“the anorexic” or “the alcoholic”); this can also obscure that person’s abilities, strengths and wider interests or ambitions. In some severe cases, it is helpful to say that a person has a mental illness. However, quite often it can be more constructive to view psychological difficulties as a phase during which any of one of us can find the complexities of life overwhelming. Such phases are often vital in helping us learn new and valuable information about ourselves and our lives.

 Almost everyone has been in a bad place at some time
 Vulnerability is not a weakness but a strength, because it is an important and healthy facet of the human condition
 Asking for help is a sign of strength and health
 Talking gets you support and treatment

Stigma around mental health

People with mental health conditions are often discriminated against and the stigma will often impede people from asking for help and getting the treatment they need.

Sometimes people are afraid that those with a mental health disorder will be violent or dangerous, but they are far more likely to hurt themselves than others. Stereotypes are often developed in the media by linking violence and criminality with mental illness.

Our society can often portray very limited definitions of health, normality and success, all of which create psychological pressures that can be difficult to navigate. For example:
 Material wealth is more valuable than wellbeing and happiness
 Women should be thin
 Boys shouldn’t cry
 Vulnerability is a weakness
 Reflection and contemplation is less valuable than productivity
 We are encouraged to make more money, spend more and consume more
 It is not commonplace to discuss our inner lives

Ignorance, lack of information and lack of understanding all lead to fear and prejudice. It is natural to be afraid of what we don’t know. When we have a psychological difficulty, it would seem that we can easily feel at fault, as if somehow we have caused it to happen willingly; whereas if we get cancer or break a leg we do not feel to blame – it’s something that happens to us.

Very few people ever consciously choose to have a mental health problem, and most people would prefer to overcome it if they could. But the stigma, and some of the values in our culture, make it difficult for people to admit there is a problem, which only makes it worse. It can also be a shock to begin to understand that our unconscious mind (eg. the feelings that we may have had to repress; or the patterns of coping or relating to others which we learned as a child) can have such a powerful affect on our life and behaviour. We are not responsible for what is in our unconscious but finding the courage to be open and really learn about ourselves is the ultimate act of responsibility.

Definition of mental health and illness (taken from the World Health Organisation website)

The WHO defines mental health as “a state of well-being in which the individual realizes his/her abilities, can cope with the normal stresses of life, can work productively and can contribute to their community”. (I would add “can maintain relationships”). It’s about being good enough, rather than being perfect!
Mental disorders are defined in a social and historical context, so perception of them changes over time and across cultures. Over a third of people across the globe report problems at some time in their life that will meet the criteria for a common mental disorder.

Wendy Bramham
July 2013, for BBC Wilshire series on mental health

The following information is taken from the Mind website –

Common diagnoses of mental health issues
Depression lowers your mood, and can make you feel hopeless, worthless, unmotivated and exhausted. It can affect sleep, appetite, libido and self-esteem. It can also interfere with daily activities and, sometimes, your physical health. This may set off a vicious cycle, because the worse you feel, the more depressed you are likely to get. Depression can be experienced at different levels e.g. mild or severe, and can be related to certain experiences; for example, postnatal depression occurs after childbirth. Depression is often associated with anxiety.

Anxiety can mean constant and unrealistic worry about any aspect of daily life. It may cause restlessness, sleeping problems and possibly physical symptoms; for example, an increased heart beat, stomach upset, muscle tension or feeling shaky. If you are highly anxious you may also develop related problems, such as panic attacks, a phobia or obsessive compulsive disorder.

Obsessive-compulsive disorder
Obsessive-compulsive disorder (OCD) has two main parts: obsessions and compulsions. Obsessions are unwelcome thoughts, ideas or urges that repeatedly appear in your mind; for example, thinking that you have been contaminated by dirt and germs, or worrying that you haven’t turned off the oven. Compulsions are repetitive activities that you feel you have to do. This could be something like repeatedly checking a door to make sure it is locked or washing your hands a set number of times.

A fear becomes a phobia when you have an exaggerated or unrealistic sense of danger about a situation or object. You will often begin to organise your life around avoiding the thing that you fear. The symptoms of phobias are similar to anxiety, and in severe forms you might experience panic attacks.

Bipolar disorder (formerly known as manic depression)
If you have bipolar disorder you will experience swings in mood. During ‘manic’ episodes, you are likely to display overactive excited behaviour. At other times, you may go through long periods of being very depressed. There are different types of bipolar disorder which depend on how often these swings in mood occur and how severe they are.

Schizophrenia is a controversial diagnosis. Symptoms may include confused or jumbled thoughts, hearing voices and seeing and believing things that other people don’t share. If you have these symptoms you might also become confused and withdrawn. There is debate about whether schizophrenia is actually one condition or more a collection of symptoms that are not clearly related.

Personality disorders
Generally speaking, personality doesn’t change very much. Yet it does develop as people go through different experiences in life, and as their circumstances change. If you have a personality disorder, you are likely to find it more difficult to change your patterns of thinking, feeling and behaving, and will have a more limited range of emotions, attitudes and behaviours with which to cope with everyday life.

Eating disorders
Eating disorders can be characterised by eating too much, or by eating too little. If you have an eating disorder you may deny yourself anything to eat, even when you are very hungry, or you may eat constantly, or binge. The subject of food, and how much you weigh, is likely to be on your mind all the time. Your eating disorder is likely to develop as a result of deeper issues in your life and is possibly a way of disguising emotional pain. Anorexia, bulimia, bingeing and compulsive eating are some of the most common eating disorders.

In addition to the more formal diagnoses above, there are some behaviours and feelings which are strongly associated with mental health problems.

Self-harm is a way of expressing very deep distress. You may not know why you self-harm, but it can be a means of communicating what you can’t put into words, or even into thoughts, and has been described as an ‘inner scream’. After self-harming, you may feel better able to cope with life again, for a while, but the cause of your distress is unlikely to have gone away.

Suicidal thoughts
It is common to have suicidal thoughts if you are experiencing mental health problems – especially if you have a diagnosis of depression, borderline personality disorder or schizophrenia. The deeper your depression, the more likely it is that you will consider killing yourself. However, you can help yourself and you can get help from other people. A great many people think about suicide, but the majority do not go on to kill themselves.

Panic attacks
These are sudden, unexpected bouts of intense terror. If you experience an attack you may find it hard to breathe, and feel your heart beating hard. You may have a choking sensation, chest pain, begin to tremble or feel faint. It’s easy to mistake these for the signs of a heart attack or other serious medical problem. Panic attacks can occur at any time, and this is what distinguishes them from a natural response to real danger.

Self-harm – BBC Wilts, by Wendy Bramham


What a leads a person to self-harm?

Self-harming behaviours, such as cutting, scratching and hitting oneself, are often a physical way to deal with very painful psychological experiences and feelings of distress and isolation. Self harm can arise for all sorts of reasons such as grief, abuse, trauma, fear, loss and other feelings that are overwhelming. These may be from early childhood or in the present, or they may follow an incident that makes a person angry, frustrated or disappointed.

There is usually mounting tension followed by a compulsion or an impulsive need to self-harm. Some people dissociate (separate themselves so that they are not fully aware of their behaviour) from their mental and physical pain during the act of self-harm. Because others may see acts of self-harm as “deliberate”, unsympathetic responses can be a consequence. However, quite often a person is not very conscious of their reasons for self-harming and does not feel in control when they do it.

There are various forms of self harm, including cutting with a razor or knife, burning, hitting or banging your head, or over-dosing when it’s not life-threatening. It is often done in secret.

Self-harm has hidden short-term benefits for the person harming. These can include:

  • Release of emotions – getting them “out” can bring relief and decrease in tension
  • Making the mental pain feel real (akin to crying without tears, when the person can’t externalise their feelings)
  • Giving a distraction from, or a sense of pause, from the mental pain
  • Providing a way of telling others how bad you feel
  • Punishing the self for self-hatred and guilt

How does therapy help?

  • learning to manage feelings and difficulties in healthier ways, such as talking
  • exploring and understanding the circumstances in which the self-harm arises
  • understanding the unconscious conflicts and buried emotions underneath the acts of self harm
  • developing a capacity to contain, tolerate and think about distress

By: Wendy Bramham, July 2013
for BBC Radio Wiltshire

Seek immediate help for any serious injury or overdose – with your GP, ambulance or A&E.


Domestic violence 0808 2000247
Bullying 020 8554 9004
Chidline 0800 1111
Homeless: Shelter 0808 800 4444
Samaritans 08457 909090
Drugs: Frank 0800 776600
B-eat (eating) 0845 6341414
Consumer Credit counselling services 0800 1381111
Mind 0300 123 3393

BBC Wilts – Eating disorders, by Wendy Bramham


An eating disorder is when an eating pattern starts to have a serious impact on your emotional or physical health, and on your day-to-day feelings. Typical categories include anorexia, bulimia and binge eating; many people will swing between all three, or not fit into any of these. Eating disorders are a form of addiction, and can be extremely difficult to relinquish. You can suffer from an eating disorder at any weight, i.e. you don’t have to be thin (only 10% of sufferers are anorexic; 40% suffer from bulimia; the remainder fall into binge-eating or non-specified categories).

Why does a person develop an eating disorder?
It is difficult to answer this question simply, and it is dangerous to generalise. Mental health issues involve a mixture of mind, body and emotions, and so are complex. Many psychological difficulties occur due to a mixture of genetics, early childhood experiences, personal and family history, and current life circumstances. Each individual will have their own different reasons and different avenues that lead to recovery.

  • Often an eating disorder begins in adolescent or teenage years, but not always
  • We are vulnerable if we are preoccupied with studies at school; are desperately trying to hold things together; are afraid of letting people down; feel that we must keep going; want to be high achievers; or feel deep down we must be perfect to be lovable
  • Onset may follow a stressful life event, such as trauma, neglect, a difficult relationship or a bereavement
  • Eating disorders are sometimes linked to anxiety about bodily changes during and after puberty and the onset of sexual maturity
  • Conflicting fears and wishes for independence and autonomy can be a factor. For example teenagers and  young adults naturally  need their parents’ support and affection and yet equally need to be separate and have their own relationships
  • Underlying issues may include low self-esteem, depression and anxiety, and these have a great impact on someone who is, for example, vulnerable to societal and media pressure to be thin. Such a person may not be able to find enough of an identity for themselves beyond such false/unrealistic comparisons
  • People who do not develop eating problems may be concerned about their weight but there are other domains in life that influence their self-esteem; these act as a protective buffer

The National Centre for Eating Disorder lists the following typical personality traits in eating disorder sufferers (
• Feelings of powerlessness, or worthlessness
• Sensitivity to imagined rejection or abandonment
• Poor assertion skills and difficulty managing relationships healthfully
• Perfectionist attitudes, and applying high standards to themselves whcih they would not necessarily apply to other people
• Poor emotional problem-solvers, tending to avoid life’s difficult situations
• Difficulty saying “no” or asking for what they want in life; tendancy to be “people pleasers” or go out of their way to be nice, but may have moments of aggression when things get on top of them
• Lack of confidence in managing relationships in a way that serves their needs rather than those of other people

An eating disorder can seem like a logical way of coping with some of the issues listed above. It is an attempt to regain a sense of control and safety when life or our feelings are overwhelming and chaotic, and because weight can be controlled it becomes an important source of power for the sufferer. Controlling food intake is often an attempt to manage feelings of anxiety, fear, helplessness, hopelessness and sadness, and additionally the disorder can become a useful scapegoat for all that is wrong with a person or their life.

Hidden Benefits of an eating disorder
 offers something that the sufferer cannot achieve elsewhere (eg control)
 a way of communicating something that can’t be done in other ways
 a way out of commitments or pressure
 due to the pressure to be slim (endorsed by fashion media) we falsely believe that if we have the “perfect” body we will feel more confident and life will be good
 helps us to feel we can cope when life feels overwhelming
 a way to rebel against parents, and assert autonomy

 Most eating disorders start from dieting
 A person begins to set very strict rules about “good” and “bad” food, which must be followed
 Meals with family and friends will be avoided, leading to withdrawal/isolation
 Strange rituals with food may occur
 Weight loss happens, and this may also be due to over-exercising and/or making oneself sick and/or taking laxatives
 People make themselves sick (bulimia) because they can’t keep up the strict controls over eating, and then resort to binge eating on the so-called bad foods. This leads to guilt, self-hatred and shame. Due to these feelings the problem can remain hidden from others for years.

How can you tell if you have an eating disorder? (see
 Do you ever make yourself sick because you feel uncomfortably full?
 Do you worry you have lost control over how much you eat?
 Have you recently lost more than one stone in a three month period?
 Do you believe yourself to be fat when others say you are too thin?
 Would you say that food dominates your life?

Serious health side-effects
Due to loss of muscle and electrolytes (important chemicals in our bodily fluids), the vital organs can be seriously damaged, including the heart which can become weak. This can lead to cardio-vascular disease and heart attack. Other problems include loss of periods in females, lanugo hair on face and upper back, hypothermia, infertility and osteoporosis. Tragically, whether intentional or not, people can and do die from eating disorders.

First Steps to Recovery
Shame, guilt and fear can stop someone from getting the help that is so vital to recovery. Admitting things have gone wrong is not at all easy but is the crucial first step to getting better.
Don’t try to manage this on your own. It takes determination, motivation and insight – as well as time and patience – to begin to recover. Get support from family, friends and professionals. See your GP and join a local support group or contact a charity such as B-eat – 0845 6341414 or ABC – 01934 710679. Alongside daily practical support, try to find a therapist who will meet with you for as long as you think you need.

How to find a therapist
Ask your GP for what is available in your area on the NHS. Alternatively look for a private therapist. It’s always good to get a personal recommendation if you can. Otherwise I recommend searching for a local therapist by going onto the British Association for Counselling & Psychotherapy (BACP) website – Its Good To Talk –‎ – look for “accredited” therapists. Or try the UK Council for Psychotherapy (UKCP)‎ Then look for someone with whom you feel comfortable and understood, where your strengths as well as difficulties can be validated. It is common practice for the first session to be utilised to work out whether it is right for you. Try to gauge if you feel safe enough with this particular therapist to be open, honest and vulnerable. Trust your instincts.

Don’t just measure eating and weight as a sign of getting better. It is crucial to try to address the emotional turmoil beneath the eating disorder.

 Take a realistic look at how your eating disorder affects you in a negative way. Also be honest about the hidden benefits (as mentioned above) you might be subconsciously gaining from your attitude to food and eating. What is your eating disorder giving you? What need is it meeting in you? Then learn more positive ways to meet that need. This endeavour should probably be undertaken in regular therapy sessions with a therapist who is supportive and who also can see you as a whole person beyond your eating disorder, i.e. so that you can discuss your passions, abilities and begin to address your future hopes and ambitions.
 Get support from friends and family
 Join a local support group see B-eat or ABC as mentioned above
 Consider family therapy
 Read up on it and learn – become an expert
 Be honest with yourself and others; don’t put on a false façade and pretend that all is OK

Words from a recoverer: “Developing a sense of self after years of being detached from life was very exciting!”.

How does Therapy help?
 Provides a safe container for the dialogue that can begin to explore the underlying and sometimes hidden feelings, thoughts and circumstances behind the disorder
 Such an exploration is done in the context of a trusting, reliable, boundaried, non-judgemental working partnership over time
 Can increase a person’s ability to tolerate difficult feelings and also uncertainty
 Can increase a person’s capacity for self-awareness, self-acceptance and self-compassion
 Negative thinking is often rooted in disordered relationships. Therapy can offer a different experience of relating
 Can illuminate self-destructive thinking and core beliefs such as “I am not good enough”. Such thinking patterns can form a person’s identity and gives reasons for bodily attack

It is extremely hard to have to watch your child suffer and to be confronted with strong emotions such as anger and despair. Parents have a tough job because they are trying to be both supportive but are also expected to “supervise” mealtimes etc.

 Try to see the person beyond the eating disorder. Try to view the eating disorder as separate from your child.
 Because your child feels safest with you, it is likely they will vent their anger and other scary feelings onto you. Remember that intense feelings are triggered by the eating disorder and are often not personal. Try not to get into confrontations, get angry or use emotional blackmail
 Get support for yourself – this also teaches your child that it’s healthy to ask for help; it will also make you more able to cope with your child
 Draw limits for unacceptable behaviour – when things are calm make a plan with your child how you will both cope when times are fraught
 Encourage your child to get professional help and be part of the process
 Learn and understand about eating disorders
 Don’t ignore warning signs – encourage your child to talk, and listen to them
 Try to keep doing normal things together – without the eating disorder being the main focus
 Firmness needs to be combined with explanation and encouragement rather than threats or punishment

Statistics the from USA (Association for Anorexia Nervosa & Associated Disorders)

 More people die from eating disorders than any other mental health condition
 For women aged 15-24 the death rate from anorexia is 12 times higher than all other causes of death (American Journal of Psychiatry Vol. 152 (7), July 1995, p. 1073-1074, Sullivan, Patrick F.y)
 20% of those with chronic eating disorders will die prematurely from associated symptoms (
 On a more positive note – just under half of patients who get treatment will recover fully (


Wendy Bramham, July 2013, for BBC Wiltshire