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‘Voice and Choice’

How teenage depression is treated today.

I am deeply moved by Len Vander Zee’s article “Grace in a Locked Ward” and so grateful for his courage in sharing the story. The more we can share stories like this, the more we reduce the stigma associated with mental health, and the more we can act as Christ-followers with one another. Len is leading the way and I commend him for it.

I have at least a couple of responses to Len’s story. The first is a sense of wonder and joy that the treatment appears to have been effective – or, at least, that his depression and anxiety symptoms disappeared and have not returned. I am struck by what he regards as crucial in his recovery: the belief in him and mentorship by Mr. Apol, the building and grounds supervisor, and the powerful moment of grace he experienced – the presence of God in the midst of his deep desolation. This confirms what we know today from brain science: it is especially the power of relationship that brings about recovery and healing. Note that the crucial relationships were not with “professionals.” For Len, Dr. Mulder had so little impact that he has no real memory of their interactions.

Better outcomes
The second is that mental health service delivery in response to depression is very, very different today. Treatment for depression for a 14-year-old today is co-determined by the 14-year-old, a psychotherapist, and ideally his or her parents. The client exercises “voice and choice” (which in and of itself supports recovery). Except in rare circumstances, treatment is not “residential,” and only under extremely rare circumstances – involving imminent danger to self or others – is someone placed in a locked facility against their will (though too often jail has become today’s default residential “treatment” facility). While every situation is unique, treatment outcomes with depression today are often excellent, usually involving a combination of psychotherapy, some medication and connection with others.

“Electroconvulsive Therapy” (ECT) is still used today but only in rare circumstances, and much differently than it was in the 1950s. ECT is used only for situations of severe, treatment-resistant depression. Much lower and targeted doses are used under a general but light, brief anesthetic. If memory loss occurs at all, it is very temporary. Our brains are full of electronic impulses; ECT attempts to reconfigure those impulses. Here too, the outcomes are now often successful.

Humility still needed
I find Len’s story sobering and disturbing as a mental health professional. The methods used in the 1950’s seem so archaic and harmful, even inhumane. The mental health system today can also cause harm. What attitudes and methods might we be employing today that others will look back on years from now with disbelief and disgust? I hope that we in the mental health field learn from past mistakes, and that those mistakes inject much-needed humility into the professional world.

At least with respect to depression, we can point to significant improvements in understanding, treatment and outcomes today – even as depression remains a stubborn, elusive mystery that ultimately we still do not understand.

  • Mark is the Executive Director of the Shalem Mental Health Network (shalemnetwork.org).

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