11 February 2006
on ABC Radio National
All In The Mind
The prison of depression - a conversation with Dorothy Rowe
Dorothy Rowe has always seen herself as an outsider, yet this psychologist and prolific author is considered one of the 50 wisest people in the UK and her many books continue to sell like hot cakes. Depression, she says, is an intolerable prison we build for ourselves, but we can escape by choosing to change the way we interpret our lives. Hear her controversial yet heartfelt views on the 'prison of depression' in this frank conversation with Lynne Malcolm.
Lynne Malcolm: Hi there, Lynne Malcolm here with All in the Mind on ABC Radio National. Today an unorthodox yet rather practical exploration of the debilitating condition of depression. Depression is now recognised as one of the biggest health issues we face, and with public figures like the former Western Australian premier Geoff Gallop bringing their struggle with the 'black dog' out into the open - our awareness is higher than it's ever been. And the number of anti-depressants prescribed in Australia has more than doubled in the last 15 years. But my guest today is sceptical about the idea that drugs are the only answer and her views on the causes and treatment of depression have made her quite a controversial figure in the world of psychiatry. Yet at the age of 75 psychologist and author Dorothy Rowe still draws crowds to her talks and her many books on human behaviour still sell like hot cakes. Dorothy Rowe aims to help people understand their crippling condition in order to take charge of their lives and free themselves from what she calls the 'prison of depression' - and her advice, which we'll hear about today, is based on decades of work with children and families, first as a school counsellor and then as a psychologist working with mentally ill adults. But first, what drives Dorothy Rowe? Here she's telling me that depression was in her family and she's always seen herself as an outsider.
Dorothy Rowe: I always knew in my family that I wasn't wanted. I don't think my mother wanted another child and my father – he told me this himself when I was about 20 – that he'd wanted a boy and he was very disappointed, and he was a very loving father but no, he was terrified of my mother anyhow. He wouldn't stand up to her and I was born on my sister's sixth birthday and I don't think she's forgiven me yet. So I was an outsider and then all sorts of incidental things happened, and also I was always questioning what we were being taught at school because it was a very rigid sort of syllabus that we had. But of course the outsider sees things more clearly, when you're on the inside there's a lot you don't see. So I don't mind being an outsider.
Lynne Malcolm: So your mother was depressed. Have you been depressed? How have you worked through it?
Dorothy Rowe: Well fortunately what happens in families is that we learn our parents' ideas and then we go along with some of them and we do the opposite in the others. So my mother was a pessimist. I became an optimist. My son is a pessimist. And it's just, I know he does it just to annoy me. So I knew that I must not think like my mother or I would be in trouble. I remember two occasions when looking back I think I was depressed – one was when I was doing my leaving certificate at Newcastle Girls High School and the other was when my marriage was breaking up. But I got extremely good results in my leaving certificate and won an exhibition at Sydney University. You don't do that when you're deeply depressed. And when my marriage was breaking up, I was working all the time and when you're deeply depressed you can't work. So I am always very careful not say 'oh yes, I know just how you feel, I've been depressed' because I really don't. But of course I'd started off my life with a question, 'Why does my mother behave as she does?'. And I generalised it to 'Why do we all behave as we do?' and that's what my work's been about.
Lynne Malcolm: So what were some of those behaviours that you remember from your mother as a child?
Dorothy Rowe: Well she must have been depressed when I was born but in those days in 1930 the word depression wasn't mentioned, in the same way the word cancer wasn't mentioned. So the whole family would say 'oh look, that's Ella', that's my mother's name you know, but nobody ever explained anything to me. She could be very charming, extremely charming, and then she could suddenly change and go to her bedroom and not emerge for days, months on two occasions I remember. And then she would fly into a tremendous rage and as I was the young child at home I was often the object of her rage and that was utterly terrifying.
Lynne Malcolm: And that's what's driven you to do so much work in this area?
Dorothy Rowe: Well if you work as a clinical psychologist in the health service most of your clients are depressed, that's the biggest problem. I was seeing people who were too terrified to get out of bed in the morning, who would simply sit immobile, and it's a dreadful, dreadful state. You know, when you've got a physical illness, even though you're in a lot of pain, you can have minutes where you can separate yourself from your body and be close to other people, you know, have a joke with someone, have a cuddle, feel loved. But when you're depressed you're inside a prison. That's what depressed people talk about, being in that prison and you can't get out of it. You treat yourself horribly so that you're the prisoner in isolation and the cruel jailor. And of course being in complete isolation is the worst torture that any human being could have. And when I'd be talking with, or sometimes just sitting with people in that state I'd long for a magic pill they could just take and be happy again. But what I saw right from the beginning was that the pills, the tricyclate anti-depressants and ECT – we use that – people would get a bit better and then they'd be back again. Six months, or it might be six weeks later. And what I was also seeing was the psychiatrists were not interested in these people as people and they were not interested in the person's life. And time and time again I'd see the patient say something which I knew was significant and the psychiatrist ignored it. I always remember one woman, and Jenner said to her, 'How long have you been depressed?'. And she said, 'I've been depressed ever since my father died.' And he said, 'How long ago was that?'. She said three years. So, you've been depressed for three years – and that bit of information 'since my father died' was just forgotten. And that was happening all the time, not just with depression.
Lynne Malcolm: So you're talking about the sorts of information that we don't focus on to help us with understanding people with these issues?
Dorothy Rowe: Well I'm talking about what the psychiatrist did, because they would say that you didn't need to know that. And we each tell our story in our own individual way. I kept meeting patients who had been diagnosed as endogenously depressed, that is there's no external reason – for 20 or 30 years – and they must have been interviewed by hundreds of doctors and nurses and yet not one of them had ever just told their story. And of course when they told their story there were so many things in the life of that person that were tragic, often not huge things, but the private disasters we all suffer when we know that we're not loved or our hopes can never be fulfilled.
Lynne Malcolm: You talk about the sorts of mechanisms that go towards creating a depressed person in terms of emotions, in terms of sadness or anger or loss, and that gets turned in. Can you just talk a little bit about that mechanism.
Dorothy Rowe: Well, we as human beings we are meaning, creating creatures. It's not what happens to us that determines our behaviour but how we interpret what happens to us. You know one person can win the lottery and interpret it as 'great, I'm going to spend, spend, spend'. Another person interprets as 'oh, I don't deserve this, this is terrible, I feel guilty'. Now when you speak of emotions, emotions are meanings, you know fear is the meaning 'something terrible is happening that is a threat to me'. Anxiety is the meaning 'something terrible is about to happen'. Anger is a wonderful emotion because it brings out our personal pride, anger is 'how dare this happen to me' and we fight back. Or we should, but nicely though.
Lynne Malcolm: But how do those emotions get turned into depression and why?
Dorothy Rowe: Well whenever we suffer a disaster the natural response to a loss is sadness. Now you can turn that sadness into depression by blaming yourself for what's happened instead of saying 'I feel very sad because my mother's died and that's a loss that I will never really get over'. But if you say to yourself, 'It's my fault my mother died because I didn't look after her properly,' you're blaming yourself, hating yourself. You know the more you hate yourself the more frightened you are of other people. Because if they see how bad you are they will punish you. In that way you cut yourself off from every aspect of your life and that's the prison of depression.
Lynne Malcolm: So it's a prison that people actually build for themselves?
Dorothy Rowe: Well, when you say it like that it sounds as if somebody sits down and thinks 'Oh well I'm going to get myself depressed.' But the pattern of thought that leads people to be depressed is so well practised, the steps in it, they don't have to think it consciously. Because first of all the only people who get depressed are good people.
Lynne Malcolm: Oh.
Dorothy Rowe: Yes, good people are people who believe that they are not good enough. You can feel guilty about anything. You're always blaming yourself before you blame other people. Now if you're a good person and if you believe in the inevitability of punishment for wickedness and rewards for being good, that's the belief, we call it belief in the just world, that we live in a just world where goodness is always rewarded and badness is always punished. Because if you're good sooner or later you'll get those rewards that you've been working so hard for.
Lynne Malcolm: It's quite a consoling thought isn't it, that we live in a just world?
Dorothy Rowe: Yes, because to think it's an unjust world it's hard to face life sometimes. So you know these are ideas that are prevalent in our society, they're not crazy, they are ideas which keep our society running quite well. And so there're a whole lot of us who can move very quickly from suffering a disaster, feeling sad, blaming themselves for the disaster, and finding themselves in that prison of depression.
Lynne Malcolm: So how do you get out of that prison?
Dorothy Rowe: Oh I can tell you very easily, it's very simple for me to say but it's hard to do because you have to change ideas that go right back to when you were a very small child. And the first thing is that you come to realise that it isn't a matter of struggling to be good all the time, that, you know, you set yourself some reasonable standards, if you've got a job then you want to do a reasonable job, you don't have to do a perfect job. If you're looking after your family, you do it to the best of your ability but you recognise you can't make life perfect, you just, you know, do as much as you can without punishing yourself for failing and actually physically wearing yourself out. So it's kind of getting away from the idea of good/bad and thinking along the lines of behaving reasonably. Now the other idea you have to change is the idea of the just world. No amount of goodness prevents disaster and I've seen so many people who are shocked when something terrible happens to them and they say 'but I've been good, why has this happened to me'. Well what made you think you were an exception? Anything can happen to anybody and it takes a lot of courage to recognise that.
Lynne Malcolm: So you were saying it's easy to say how to get it out of the prison. It is easy to say but depression is a shocking thing and people struggle for years and years and years and get stuck.
Dorothy Rowe: Yes. What gets people stuck is they don't want to change their ideas and the reason they don't want to do that is this tricky business of personal pride. The day after Geoff...
Lynne Malcolm: Geoff Gallop.
Dorothy Rowe: Geoff Gallop made his announcement I heard an interview with Nick Sherry on the ABC and he was the Tasmanian politician, MP, who some years ago attempted suicide. And what he said was that he was living solely for politics. He wasn't married. He didn't have a partner. He just worked and worked and worked, and no doubt took great pride in being such a single-minded, focused member of parliament. And then there was some kind of question about his expenses and that really threw him because he'd always prided himself on being a good person, doing the right thing. And suddenly the ground beneath his feet had disappeared and he found himself falling apart and then he blamed himself for the disaster. And his blame was so strong that he felt that he didn't deserve to live anymore. Fortunately he didn't act in haste and he actually sought some help. He did the two sensible things – one is to get some medication. The anti-depressants won't solve the problem but what they can do is just steady you a bit so that you can think. And then he found someone to talk to and out of the conversations he had with a counsellor – and he probably talked to lots of other people – he realised he had to have a balanced life. He took time off, he did things for himself just for pleasure. Well now he's married, he's got small children and he understands where the depression came from and he's making sure it won't ever happen again.
Lynne Malcolm: You're listening to all in the mind on ABC Radio National, I'm Lynne Malcolm and I'm speaking with psychologist and author Dorothy Rowe. She's sometimes regarded as unorthodox in her approach to the explanation and treatment of depression. But like much of the medical profession she sees a place for both medication and talking therapy.
Dorothy Rowe: My experience is that it's best if people make up their own minds whether they want anti-depressants, they shouldn't be automatically prescribed and patients made to feel guilty if they don't take them. Do you know 50% of anti-depressant prescriptions, they might be filled but the drugs aren't taken, people just don't take them. But you know we differ in the amount of pain we can bear. For some people it helps them to have the edge taken off their pain, which is what the anti-depressants do. And for others – and I've had lots of people say this to me – they would say I don't want a drug that's just a crutch, I want to feel I've done this on my own. So I know it needs to be a personal decision and you need someone to talk to.
Lynne Malcolm: So there are a number of different styles of talking therapy, and cognitive behavioural therapy is becoming very popular. It's a type of positive psychology, isn't it?
Dorothy Rowe: Cognitive behavioural therapy, we'll only talk in letters now, CBT, is very useful first of all in that it makes you pay attention to the way you're always putting yourself down, being negative, never positive. You know, you're being your own worse enemy. And it gives you a program that you can follow. But that does not work with the kind of people who are deeply depressed because it's not a simple solution. And there are people who've got major issues that go way, way back in their life. What do you do if as a child your father belted you, was harsh to you, treated your mother badly, was a drunk, you know, that kind of pattern? And then now he's an old man and part of you wants to punish him for what he did to you and the other part says 'no, he's old, you can't do that'. That's a dilemma that needs to be talked through and thought about and working out ways, practical ways of dealing with it. Yes, go and see him but not every day, that sort of thing.
Lynne Malcolm: So addressing those very deep issues that have developed over a whole lifetime can often take years and years and years of working through, can't it?
Dorothy Rowe: Oh it doesn't have to take that long but I do know that it's not just Woody Allen who just went and wanted to have somebody listen to him talk about himself. And you know a lot of therapists in private practice know quite well that their client isn't going to change because the client just loves having an hour a week of having somebody listen to them. Which is fair enough, if you're living in a family where nobody listens to you, your kids have switched off, your husband's bored, asleep or dead and there you are, you feel so lonely. So it's a lifesaving thing to have somebody take an interest in you. So I wouldn't decry that at all. What we all need to do is to think about ourselves, think about the way we live our life. And I know lots and lots of people have worked these things out for themselves through their reading. I mean that's why my books go on and on selling. It's not that I come up with slick answers, but people say to me, 'You wrote that book about me,' and I've never met them up to that minute. Or they say, 'You really set me thinking and then I remembered and then I thought about that...' and that's when I'm really pleased, when that happens.
Lynne Malcolm: You're with All in the Mind on ABC Radio National, I'm Lynne Malcolm and I'm talking with Dorothy Rowe whose book Depression – the way out of your prison gives practical guidance to people and their families.
Dorothy Rowe: The first thing you have to do is to decide that you want to get out. A lot of people in the depths of depression find being depressed safe. It's horrible, but while they're depressed they don't have to deal with the chaos outside their prison. And so the first step is to decide that they're going to leave the prison. And then, all they need to do is just start to do little things for themselves, it might only be deciding to go for a walk every day, or perhaps just go and have a swim, or take up yoga, just something you do for yourself that is nice, and you don't punish yourself about it. And then because you've changed your behaviour your ideas change. One of my clients gave me a wonderful clue. Her name's Margaret, she leads a very adventurous life but when I first met her she did very little. But what she would do was, she started it just to tease me, she said 'I look in the mirror and I say to myself Margaret, you're all right.' She started to act as if she was all right, and she started to do more things, extraordinary things. And she changed because she was doing these things. So the trick is, act as if you are your own best friend and one day you'll realise that you really are.
Lynne Malcolm: Also it must be...it's a very difficult thing to live with somebody who's depressed.
Dorothy Rowe: The first thing is to make sure you have time for yourself because you have to keep yourself well, otherwise you're not going to be of any use to anybody else. And secondly, it's very difficult but try not to take personally the way the depressed person behaves. They can be very rude. They can shut you out. They can do dreadful things like not be speaking to you, then a visitor arrives and they put on this happy face to face the visitor. And, you know, is all chatty and then the minute the visitor leaves they'll slump back into the depression. Try not to take that personally. And don't keep telling the person you ought to do this or you ought to do that. And when the person does do something don't say 'well why didn't you do that last week'? Just be supportive and don't get in the way. But often it's very difficult because people don't emerge from depression and go back to the person they were. If they emerge from the prison of depression never to be depressed again, they've changed. And that means you have to change too and you mightn't want that. So be prepared.
Lynne Malcolm: What drives you? You're so prolific.
Dorothy Rowe: I'm not as prolific as I would like to be but I enjoy doing it. Why not? I'm 75, I look at my contemporaries and the ones who are doing well are the ones who haven't changed except, you know, bits of them don't work as well as they used to. But they are still involved, still interested and still thinking. And the ones who are falling down, they're the ones who gave up and decided to be old. One of the things I've observed from people who I've known for a very, very long time is that if you're not truthful with yourself you're mucking around with your memory and if you do that, as you get older your memory won't work so well. It only stands to reason. You know when something happens, you know it happens and that is stored in your brain. And then if you say to yourself that it didn't happen then another bit of your brain is denying the first bit of your brain. No wonder your brain doesn't operate so well in old age. So you know you often have to lie to other people to get by, but never lie to yourself.
Lynne Malcolm: That's very good, a good way to finish I think, thank you very much Dorothy Rowe.
Dorothy Rowe: Thank you.
Lynne Malcolm: Author and psychologist Dorothy Rowe, and she tells me that her next book is on siblings. I'm sure that will make fascinating reading.