Ask not what’s inside your head; ask what your head’s inside of: Psychodynamic Counselling and the task of re-connecting

Mental health meltdown
One of the most significant social developments in recent years has been the rise witnessed in people presenting with mental health issues. Not a week goes by without news surrounding either a celebrity or high-profile case of someone coming out with a story of how they have been struggling to live with some kind of mental health issue. This modern trend is mirrored in the multiplication of classifiable mental disorders over the decades. The two most widely recognised toolkits for assessing and classifying psychiatric conditions are the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association (currently in its fifth edition) and the International Classification of Diseases produced by the World Health Organisation (currently in its tenth edition). Both have seen an increasing number of categories being listed and described across the decades. For example, the original DSM-1 had 106 mental disorders whilst the current 2013 DSM-5 has increased that number by 50% to 157. The DSM-4 had 297!!

What are we to make of this? It is difficult to know sometimes whether this is just because we are better informed than previous generations who repressed so much, confined one thing or other to the proverbial closet; or whether this does reflect a genuinely objective crisis in global mental health. I am tempted to say that both, in fact, are true.

It is undoubtedly the case that we are better informed and more aware around lots of different issues connected to mental health than in previous generations. Take the royal family, for example. Generations ago, they embodied the stiff-upper lip that was so synonymous with British social mores. Nowadays, they have (to their credit) been increasingly outspoken about issues affecting them and have encouraged others that it’s good to talk about things like depression and low mood.

However, it is probably also the case that the statistics pointing to massive increases in the numbers of people presenting with mental health problems does not simply reflect the fact that we are better as a society at recognising and reporting problem issues. Even before the shadow of coronavirus-lockdown was cast upon our daily lives, the evidence for a crisis in mental well-being was being repeatedly evidenced. And the challenges presented by the COVID-19 pandemic will surely aggravate many of these problems for people.

One of the most reported has been depression which has seen a sharp increase in reported cases over the decades. One recent study suggests that young people were 6–8 times more likely to be diagnosed with a depressive disorder in 2007 compared to their peers in 1938. Depression has been described as a disease of modernity by some commentators which manifests itself in different ways. In the US of today, for example, teenagers are 38 percent more likely to report problems with memory compared with their 1980s counterparts. They are also 74 percent more likely to have trouble sleeping and twice as likely to have seen a specialist for mental health issues. In one study, contemporary college students were 50 percent more likely to admit that they felt overwhelmed, while adults were more likely to say that they were restless sleepers, had a poor appetite and that, on top of that, everything else was an effort. All these issues are often manifestations of depression (Blaszczak-Boxe 2014).

Depression and biology
The leading contemporary treatments for depressive disorders reflect the idea that the problems originate in something known as the serotonin deficit. Serotonin is a neurotransmitter which is the key to regulating our mood, feelings of well-being and general levels of happiness. People living with low mood and depression have been found to have lower levels of serotonin in their brains. This finding has reinforced the current medical view that depression and other related conditions are due to this biological factor.

There is something seductive about accepting this as an explanation for your problems. Rather than feel that you or your upbringing or your parents are to blame, the fact that your depression is down to the reduced levels of a particular neurotransmitter in your brain, give you the comforting implication: “It’s not my fault: it’s a serotonin deficit.” And the current solution for people living with depression is to seek a prescription for anti-depressants such as citalopram and fluoxetine from your general practitioner. The central task of these and comparable pharmaceutical products is to combat these serotonin deficiencies in the hope that this should restore a greater sense of balance to your mood and outlook.

However, before long, it is only a matter of time before a more uncomfortable set of inferences around powerlessness and dependency on medico-pharmaceutical expertise are drawn. Among other things, this attempt to solve the problem of depression foists the power to provide solutions onto the medical establishment, leaving people disempowered. This disempowerment, ironically but perhaps predictably, deepens many conditions, not only depression.

Depression and lost connections
In his 2018 book, Lost Connections, Johann Hari argues passionately that the route to a more hopeful and effective response to depression (and by extension) many other mental disorders is to enable human reconnection with the different dimensions of human life and existence. For Hari, depression is very much a disease of modernity brought on by constellation of factors which undermine our capacity for happiness. For Hari, depression and anxiety are caused by the following factors (or disconnections as he would call it):

  • meaningful work
  • opportunities to make real connections with other people
  • the absence of meaningful values to live by
  • unprocessed childhood trauma
  • anxiety around status and self-esteem
  • sufficient contact with the natural world
  • the promise of a more hopeful and secure future

For him, serotonin deficiency operates as an intermediate warning system which alerts the mind to the reality of a deeper and more profound breakdown, or in Hari’s words, disconnection.

Psychodynamic counselling and re-connecting
Psychodynamic therapy and counselling represent a powerful way to help to facilitate precisely that re-connection Hari calls for. In therapy, client and counsellor work through many of the core issues of life which underpin our sense of self-worth and value. Ultimately, the possibility for re-connection can become real. The hope is that working through these can result in us looking afresh at the reality of and attitudes towards aspects of our lives which Hari argues are contributing towards low mood, depression and other related conditions.

When we have meaningful work, relate to people in a authentic way, ditch junk values, process childhood trauma and memory, embrace ideas and ways of being that enjoy a sense of durable meaning, enjoy a status-anxiety-free life, possess self-respect, reconnect with the natural world and look forward to the prospect of more secure lives; then we are more connected to ourselves and enjoy the prospect of a happier existence.

This might sound easy but of course it isn’t. And the coronavirus pandemic has only multiplied the challenges for many of us. But the engagement with psychodynamic work, which explores many of these issues, is still worthwhile and possible. And it can transform lives. Some of the work extends beyond the counselling room. For example, therapists cannot magic away the zero-hours employment status of some nor rescue those caught in the insecurity of the gig economy, both of which can be argued are anxiety and depression-inducing.

Therapy as hope-borrowing
The attempt at recovery which counselling promises has been likened to the borrowing of someone else’s hope whilst waiting for your own to return. Therapy can contribute towards a personal transformation which rebuilds the inner resources to deal with the issues of life as well as the strength to collaborate with others in working for greater transformation of society in all its aspects. Through re-connecting to the most important aspects of our lives and sorting out what your head is in then; identifying what isn’t helping and what might, represents a pathway to a better life: more connected, hopeful and healthier.

 Further reading & viewing
Uncovering the real causes of unhappiness and depression. Johann Hari explores

Blaszczak-Boxe, A. (2014) Americans more depressed now than decades ago. Available at

Hari, J. (2018) Lost connections: why you’re depressed and how to find hope. London: Bloomsbury.

Twenge JM, Gentile B, DeWall CN, Ma D, Lacefield K, Schurtz DR. (2010) Birth cohort increases in psychopathology among young Americans, 1938-2007: A cross-temporal meta-analysis of the MMPI. Clin Psychol Rev. Mar; 30(2):145-54.