Despite the title, this is not an anti-medication book. In fact, Bill O’Hanlon, a much-published psychotherapist and author, writes in Out of the Blue: Six Non-Medication Ways to Relieve Depression that medication can help, and that he respects each individual’s choice. This respect, along with his creativity and understanding that we must seek out what works for each person, is palpable throughout the book.
As a young man, O’Hanlon was depressed to the point of considering suicide. A friend talked him out of it, and gave him hope and an alternative — all of which led to O’Hanlon’s remarkable forty-year career as a therapist and teacher. I have been following his work and ideas for a long time. He draws from his life experiences, from clinical research, from what his clients have taught him, and from his time with the renowned hypnotherapist Milton Erikson.
I have worked with many depressed clients, and have had times when I struggled with those feelings as well. O’Hanlon uses writings from Abraham Lincoln, William Styron, William James, and others to both describe feelings and to give ideas of ways out. He does take some time to discuss just what depression is, and to explore and debunk myths about it. In the end, the DSM diagnosis is a list of symptoms voted on by committee, and that list changes from time to time. Its definition is further complicated by how grief fits in and other factors. What matters is how you are feeling, how you define it, and how you want to change.
O’Hanlon has a no-fault model of depression, and focuses on six methods to relieve it. The six methods are, as he describes them, marbling depression with non-depression; undoing depression; shifting the relationship with depression; challenging isolation and restoring and strengthening connections; envisioning a future with possibilities; and restarting brain growth.
If you’re wondering what marbling is, it has its basis in state dependent learning. O’Hanlon gets the metaphor of marbling from his childhood and his dad’s meat packing plants. Marbling — i.e., fat — in the beef gives it more flavor. Taking behaviors from times when you weren’t depressed and mixing them in now, or marbling them, can help you move out from the state of depression, O’Hanlon writes.
“I’m interested in discovering and detailing non-depressed experiences, actions, thoughts, and experiences,” he explains. “That way, I learn about the person’s abilities, competence, and good feelings as well as get a sense of the suffering she has experienced.”
For each of the six ways, O’Hanlon goes into detail on how to implement the method. I like that he goes beyond just verbal means of working and includes movement and exercise, even something as simple as going for a walk, perhaps even during therapy. He also suggests ways to connect to the wisdom and experience of your future self. He shows that having that connection to “the you who has yet to be” can be powerful in changing your present relationship with yourself.
The book also looks at methods and research areas that are still developing — including nutrition, vagal nerve and deep brain stimulation, and inflammation. Not every method works for everyone, O’Hanlon acknowledges: Getting better is an individual path.
To that end, O’Hanlon explores the use of video games, which I found particularly intriguing as I have teenaged clients who are big gamers. Parents typically are not particularly supportive of gaming, but I have worked with clients to see if there was a way to develop their recovery into a game they could buy into. O’Hanlon gives an overview of two therapeutic games already out there: SuperBetter and SPARX. (The TED talk by SuperBetter developer Jane McGonigal is remarkable.)
At the end of the book O’Hanlon even looks at research as to how medication might work — this, again, despite what the title may imply. This was particularly interesting to me since “mental illness is a chemical imbalance of the brain” is a false myth. How could medication work other than as a placebo if the chemical imbalance notion is wrong? It may work the same way that many of O’Hanlon’s six methods work: by helping new brain cells grow. The nice thing about the six alternatives, of course, is the lack of side effects.
O’Hanlon does an excellent job of aggregating extensive research with stories from his own life, his teachers and clients, and those well-known figures who have been depressed and survived and thrived. He somehow manages to take all that data, both qualitative and quantitative, and put it together in an easy-to-understand and engaging read that gives clinicians very useful tools.
I have had clients tell me that there are times during their depression when the world ceases to have color. O’Hanlon has given us ideas and methods that anyone can use to see those hues again. I am grateful that he has put together this valuable, well-researched resource.
Out of the Blue: Six Non-Medication Ways to Relieve Depression
W. W. Norton & Company: April, 2014
Hardcover, 272 pages