USING THE ENNEAGRAM IN HEALING DEPRESSION

Belinda Gore © 2004

While there is a strong biological component to depression that is best treated with medication, there is a psychological aspect that can be approached through cognitive techniques that address how we talk with ourselves about who we are and how we can interpret our experiences. Good therapy for depression includes a well-balanced approach; research clearly indicates that medication plus psychotherapy and changing environmental factors is significantly better than any of these treatment options alone.

JILL WAKES UP TO THE STRESS IN HER LIFE

Jill is a professional singer who came to see me when she was diagnosed with a nodule on her vocal chords. She was understandably frightened that surgery might destroy her singing voice and thus her career. As a Type Six, she experienced herself as anxious and wanted help in managing the rising feelings of panic. However, as she told me about her life circumstances, it soon became clear that her medical condition was only one of several major stressors that together were weighing down on her and that underlying her accustomed anxiety as a Six was the beginning of depression.

Not only was Jill facing a frightening surgery, she also had been alerted to the possibility that she might lose her primary job due to cuts in funding. In addition, she and her husband were having relationship problems and their financial situation was precarious. In the face of all these problems, she had begun to neglect herself, eating at fast food restaurants and vending machines, choosing high fat foods to soothe herself and carbohydrates to give her quick energy because she was so often tired. She had little time for exercise and was operating on minimal sleep. As a result she had gained weight and was feeling even worse about herself. It was not hard to see that she was headed down a slippery slope toward a major depression.

Characteristic of a Type Six personality, Jill consulted outside resources—usually in the form of self-help books—to provide guidance regarding her various problems. The problem with self-help books is that they usually reflect the personal perspective of the writer without an accompanying clause, “The writer of this book has a type Seven personality and tends to support taking an energetic and positive outlook on problems,” or “This writer has a Type One personality and tends to believe that self-discipline in the service of high ideals is always the best solution.” Therefore, Jill was lost in a mass of conflicting advice and the more she read, the more confused she got.

Our first decision together was for her to take a one-month medical leave of absence to find out exactly what non-surgical treatments might be available for her condition and to begin voice therapy without the constant strain of singing and teaching. This leave was also designed to give her an opportunity to re-establish a regular sleep cycle and to integrate a healthy eating plan and a daily exercise program into her life. She was afraid that requesting a leave would jeopardize her job, and hence her security, even more; however, she realized that her current path was leading to a breakdown. Her employer was supportive and she found substitutes to fill in for her during her time off.

Jill’s family doctor was willing to prescribe an anti-depressant with minimal side effects and she began to feel the first positive effects within a week. Once her physical body was receiving better care, she found herself less tense and irritable and was ready to deal with her relationship issues. Her husband agreed to resume treatment for his depression and could be more available to her. He has a Type Four personality and Jill had believed that she was not depressed because she did not have the same symptoms as he did. We talked about the difference in personality orientation: he was more likely to neglect his work and be to more withdrawn, while she was more agitated and pushed herself to compensate for the depression.

Jill’s depression was situational, triggered by an overload of stressors. She responded well to both the medication and the psychotherapy, and is back to her normal level of personality functioning.

EXERCISE: Sometimes we are all so immersed in our lives that we cannot see the issues that are weighing us down. If you suspect this may be true for you, try this exercise:

1. Draw a large circle on one half of a blank sheet of paper. Within that circle, identify your life as you currently see it. You may want to focus on one aspect, like your primary relationship or your career, or you may prefer to get an overall picture. Write as many items as you can think of to describe your life as it is today.
2. Draw a second circle on the other half of the page. Within that circle, identify the characteristics of your life as you would like it to be. Be as specific as you can be.
3. Now draw a long rectangle in the middle of the page, separating the two circles. Within the rectangle identify all the factors that seem to be interfering with the circle #1 becoming circle #2. What stands in the way of having your life, or some specific aspect of your life, becoming what you would like it to be? Write everything you can think of and then organize these impediments or barriers into categories. These are the issues that need to be addressed to promote psychological health.
4. Share your exercise with a friend or therapist. Get their feedback and ask for their help in working on the barriers.

ALISON LEARNS TO LIVE WITH CHRONIC DEPRESSION

Alison’s story is different from Jill’s. While Alison also has a Type Six personality, she inherited a pre-disposition to chronic depression from her father. Since the Six personality structure is built around an attachment relationship with the father (or whoever provides for the safety, security and guidance for the child), Alison also modeled herself on her father’s behavior, further establishing a tendency toward negative self-talk and a limiting view of the world. She remembers having a poor self-image as a child, believing at an early age that she was fat, that she was not as smart as her siblings or the other children at school, and that everyone looked down on her because her family had little money and could not afford nice clothes for her. It is no surprise that she tried to find ways to soothe herself, first medicating her feelings with food and later with alcohol.

Alison had been in and out of therapy for years when she came to see me. She had taken a variety of medications, with mixed success. Because she was actively alcoholic and bulimic, it was important to address these issues so that she could be emotionally available to do the rest of her psychological work. It took a crisis at work and an emotional breakdown before she was ready to accept the teaching and fellowship available through Alcoholics Anonymous. She had been using drinking to soothe her anxiety and in order to stay sober she needed medication to help with her mood swings. Recently her psychiatrist has been using a different category of medication that has been found helpful with Bipolar Disorder, formerly known as Manic-Depressive Disorder. While Alison’s behavior is not typically bipolar, she is responding well, helping us understand that her depression is biochemically different from average depression caused by imbalance in neurotransmitters.

Alcoholics Anonymous gave Alison several important tools. Because her Social instinct is strong, she has received great benefit from the experience of a support group. She has identified a series of self-defeating statements that are woven into her daily self-talk, things like “I’m too fat, no one could really like me,” “If I tell people no, they will reject me and I will be alone in the world,” “Life isn’t fair, why should I even try.” Being in a community of fellow alcoholics who recognize similar “stinking thinking” has helped her to see that she is not alone in the world and that there are people who understand and accept her as she is. AA is an alternative culture in which a group of people shares a similar worldview that is different from the prevailing attitudes of the dominant culture. She can belong in this alternative culture. In addition, the tools she has learned in AA are useful to her in managing her bulimia as well.

An important part of our work together has been to identify the self-defeating statements that are part of her internal world and to find more positive and self-enhancing statements to replace them. I have asked her to list her negative beliefs so we can attend to them one by one. For instance, she has often said, “Life isn’t fair.” Now she is learning to remind herself, “Everyone suffers, even though I may not see it and even though others may have what I think I want. Resenting other people does not help me have the life I want and distracts me from the positive things I can do for myself.”

EXERCISE: You might try making a list of the negative attitudes or self-defeating statements you make about yourself and about life in general. Spend some time making the list as thorough as you can. Then try to think of an alternative statement that takes a more positive view of yourself and the situation. Ask a good friend or a therapist to help you.

Another tool from AA is to make a Gratitude List. At the end of the day, or when you are beset by resentment or regrets, make a list of everything in your life for which you are grateful. Focusing on the positives often gives you a different perspective on any situation. If you are a Positive Outlook type—that is, Two, Seven, and Nine—you have to be careful that you do not just put a positive spin on your problems. The point here is to find true gratitude in your heart for whatever you may identify.

Alison is learning to accept that she will always need to be aware of her tendency toward behavior that leads back into depression. We can usually identify a pattern of neglect for self-care leading to resentment leading to depression. While we can trace this pattern to unhealthy levels of development in her Type Six personality, her story nevertheless gives us all an example of tools for dealing with the various manifestations of depression that might show up in any of the types.