Depression: An Introduction

by Barbara Dowds

Published by Phoenix Publishing House ISBN:-13: 978-1-912691-79-1 reviewed by Eleanor Dunn

Depression: An Introduction is a new book authored by Barbara Dowds and published this year. Depression is one of the quintessential issues that brings people to psychotherapy and practitioners are more than familiar with it, so the question that the author poses in her preface to the book; “Do we really need another book on depression?” seems very pertinent. However, as Dowds points out, depression is increasing in its prevalence and also can be very difficult to treat, and our understanding of it, and its complexities, are constantly developing and evolving. Bringing the reader up to date with that developing understanding is where Dowds’ book is particularly strong and answers her query about the need for another book on the topic. In the first half of the book she gives a comprehensive summary and explanation of the most up-to-date research on the topic. Her own background as a scientist in molecular biology is probably to her favour here as she clearly has an excellent grasp of the latest research in the field as she outlines the biological, psychological and social contributors to depression. The subject matter can be dense at times and requires a degree of concentration from the reader, and perhaps even a re-read of certain sections in order to fully grasp the information being communicated. Of particular note for this reviewer was to learn that in terms of genetic susceptibility there is 100% overlap between the genes that predispose for depression and those that predispose for anxiety. Thus, in genetic terms, anxiety and depression are the same phenomenon, it is the environment that determines which a person will develop. In addition, Dowds summarises the latest research on the connection between the immune system and also the gut microbiome and depression. As practitioners we are frequently reminding clients about the importance of managing stress, having a good diet and getting exercise as a means of supporting good mental health and depression symptoms, but to be reminded of the background evidence that supports this advice is motivating and supportive. Throughout Dowds emphasises the humane view of depression as an adaptive response as opposed to an illness or weakness in the person. Triggered by things such as loss or stress, depression is evolution’s answer to help the person survive such events as its symptoms can lead to avoidance of danger and prevent a waste of time and energy on unnecessary tasks or pursuits. And Dowds reiterates the therapist’s role in finding the message hidden within the low mood, stating “If a first episode of depression is seen as a wake-up call rather than a disease, the individual can learn and profit from it” (21). Dowds also reminds the reader that depression is a condition prone to relapse. Adolescents who develop depression are very likely to go on to have depressive episodes in adulthood, and also be subject to the kindling effect whereby less and less stress is needed to trigger a depression. A reminder for the reader of the importance of treating depression early in adolescents and young adults.

The second half of the book is written in a different style and perhaps one that most therapists would be more familiar and comfortable with. Here Dowds writes about psychotherapeutic approaches to depression, the challenges that may be faced in the work and ways of overcoming such challenges.

Dowds takes a distinctly integrative approach to working with depression and while not averse to use of CBT interventions, she is clear in her belief that as an approach it can never go far enough and does not have the ingredients required. A summary of her thoughts is reflected in this quote:

 The problem with CBT is that it is resolutely anchored in the present and in the conscious mind and conceives of clients as broken machines within which rational cognition needs to be reasserted. As such it lacks the psychic depth, emotional awareness, inspiration, imagination, embodiment, and focus on relationship that depressed clients desperately need. 

Here again, Dowds writes emphatically about the importance of listening to and learning the message that the depressive symptoms of the client may be trying to communicate and without which the whole venture may be undermined. In particular listening to what needs have been unmet and also supporting the emergence of the authentic self that may have been wounded by earlier experience. Dowds stresses the importance of the relational aspects of therapy and how they can be key to support the client who may be stuck in low mood. Building on the integrative theme, examples of integrative and experiential approaches that can be used to support the client to build up and restore the wounded self are provided.

Dowds has done well to fit so much information into a relatively short publication, and at times it leaves the reader wanting more. They may do well in such situations to follow up on the extensive references or pointers that Dowds gives to her other writings. Part 2 of the book finishes with a case study that brings together the information of the previous chapters in a relatable and reflective manner. There is real sense of the depth and humanity of the work involved and the appreciation for the wholeness of the person.

 Overall, this is a book well worth reading for anyone who wants to reacquaint themselves with the theory and practice in relation to depression and also those who may want pointers as to how to keep up to date with the latest thinking in the field. Finally, and fittingly for a world that seems to be facing challenges on multiple fronts, Dowds finishes the book with a message of hope; that difficult as depression can be, people can and do transform its suffering, learn from it and move into new life.

Eleanor Dunn is an IAHIP accredited therapist working in private practice in Dublin city centre. She previously worked for 15 years with people experiencing homelessness. See eleanordunncounselling.com

IAHIP 2021 - INSIDE OUT 95 - Autumn 2021