Major Depression: Treating Depression in the Context of Marital Discord

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Table of Contents

Introduction
Main text
References

Introduction

Major depression is a condition that lasts for two or more than two weeks, during which the patient feels extreme sorrow, anxiety and lack of interest in the regular activities of life. This may consequently result in loss of appetite, and negative emotions also resulting in loss of sleep in most cases. In some cases, if left untreated, major depression may cause feelings of suicide in patients.

Main text

Major depression has today been recognized as one of the devastating diseases of the modern world, and research has indicated that it is likely to evolve as the secondary factor causing mental diseases to numerous persons, worldwide (Murray & Lopez, 1996). Endorsing the fact, Olfson et. Al. (2002), have pointed that in the past decade, the statistics of patients receiving psychiatric help and treatment for depression has risen substantially. According to the American Psychiatric Association (1994), nearly twenty percent of the total population of the United States has reported some kind of depression and the percentage of women reporting depression is double that of men.

Depression is a psychological disorder which may result due to many factors. Distress in relationships, either between married couples or any other family members, is also one of the reasons for depression. Numerous researches have established significant associations between major depression and misery in family relations, whether between couples or other family members (Beach, Smith & Fincham, 1994; Fincham, Beach, Harold & Osborne, 1997).

Major depression could also be a result of family problems and difficulties leading to an aggravation of the patient’s mental state, which in turn could lead to further intensification of the depression in the person (Keitner et. al., 2003). Thus, depression is a vicious or “virtuous cycle” (Fisch et. Al. 1982) and could manifest itself in the worst possible scenario, if it is not taken care of appropriately using the correct therapies or treatments (Keitner et. al., 2003).

Depression in children and youth

Depression can manifest in adults, children and teenagers, irrespective of gender and age. The major symptoms of depression include anxiety, grief, hopelessness, irritability, complete lack of interest in regular school activities and the difficulty concentrating in school or academics. When students and youth become experience severe depression, their performance, peer relationships, friendships and their ability to yield, suffer tremendously.

If depression is not treated using the appropriate therapy at the correct time it can result in addictive behaviors such as smoking, drinking and drug abuse and sometimes risk-taking such as suicidal tendencies. Depression is a mental disorder which can be treated using appropriate medication and therapy programs. If left untreated, it can lead to several academic and social problems resulting in failure of the individual.

Depression in the Interpersonal milieu

Research has indicated that a majority of patients with major depression are unable to effectively undertake and fulfill family responsibilities. Keitner at. al. (2003) have noted that families of patients with major depression also tend to display inability ineffective functioning due to the existence of partners with acute depression. It has also indicated that prior to the occurrence of major depression, marital difficulties surface between the partners in the form of arguments and other events including lack of communication and support. Exchanges with families with a patient of major depression have highlighted the occurrence of negativity, detachment and mistrust as common attributes of the partners with chronic depression ((Kahn et al., 1985).

Segrin (2000) has also pointed the occurrence of reduced social skills in patients with major depression as compared with those who are not depressed. These skills may manifest as a result of lack of communication, withdrawal symptoms and reduced closeness with other co-relatives, as a result of which here is anger, irritability and strain in inter-personal relationships involving married partners or family members and the quality of the relationship among children, marital partners and other family members also suffers considerably.

Several researchers have studied that depression in one of the partners or spouses in a relationship often leads to heated interchanges (Davila, 2001; Goldman and Haaga, 1995) and as such is significantly related to misery and disturbances in marital relationships, thereby increasing the rate of divorce among such partners (Wade & Cairney, 2000). Gotlib and Goodman (1999) have found this to be the cause of augmented psychopathology among the offspring of such couples.

For instance, couples or either partners, who are patients of major depression are likely to exhibit reduced effectiveness in disciplining their children. The prospects of the children of such parents experiencing anger and violence are also very high. There is a higher possibility that these children experience withdrawal feelings and feelings of not being loved, which may result in an augmentation of the misbehavior (Gotlib and Goodman, 1999).

Depressed parents may sometimes tend to rely too heavily on their children for emotional support when they are unable to find the same in their marital relationships and may in the process, share emotions and thoughts with the children displaying an affinity towards suicide and despondency, which they are not able to emotionally handle. Thus the occurrence of depressed patients within the family increases the likelihood of depression among their children (Gotlib and Goodman, 1999).

The need for therapy in patients of Major Depression

Adults with major depression are known to experience substantial problems in their family functions and responsibilities and the use of therapy, for instance, family and couple therapy may be essential in the treatment of such individuals (Keitner et. al., 2003). Kung (2000), has also pointed the treatment of depression using family and couple therapies, as these have been recognized as an effective therapy for married persons or adults who undergo distress in their relationships (Kung, 2000).

Several other researchers have stated that couple therapy aims to treat depressed patients by changing the behavioral and cognitive patterns affecting the relationships of the couples (Halford, Bourma, Kelly & Young, 1999). They have noted that the use of family therapy for treating depression is known to aid the improvement in the patient by a considerable reduction in the symptoms of depression, thereby enhancing the potential of the family relatives to deal successfully with major depression and its numerous problems (Keitner et. al., 2003).

Major depression is a mental condition which can be effectively treated using several therapies with the help of couple and family therapies by extensively assessing and analyzing the family members and focusing on the familial accountability to change and hence initiate changes in the behavior of the patient family member (Keitner et. al., 2003). The therapies are categorized as the cognitive therapy, the behavior therapy or the social skills training therapy.

Family problems and depression-the association

Major depression is often associated with family and relationship distress (Beach, Smith & Fincham, 1994; Fincham, Beach, Harold & Osborne, 1997). Whisman (2001) has studied the negative effects of depression on marital relations between couples and has pointed the substantial occurrence of depression among both men and women due to marital dissatisfaction. When partners experience discontent in their relationships, there is sorrow and anguish which often leads to severe mood swings. This has been proved by several researchers who have studied that the occurrence of distress in relations is known to augment the risk of depression (Beach & O’Leary, 1992).

The distress may be due to several factors, including incompatibility, arguments, failure to reach a conclusive decision or even trivial day-to-day matters. Sometimes, the distress may be due to severe matters such as exposure of an extramarital affair in the relationship, occurrence of domestic violence and severe exchanges of verbal communication between the two partners (Brown & Harris, 1978; Beach & O’Leary, 1992).

Depression may be caused by or maybe a cause of distress in an interpersonal relationship. As such depression may precede or be preceded by familial distress of any kind (Beach & O’Leary, 1993). Several couple therapies have shown to reduce depression substantially among patients, including the CBT, interpersonal psychotherapy (IPT) (Klerman et. al, 1984) and the behavior therapy (Lewinsohn et. al., 1980).

Conjoint Interpersonal family Psychotherapy

The conjoint IPT is an extension of the individual IPT to treat patients with major depression (Klerman et. al., 1984). The therapy lays emphasis on solving the conjoint problems occurring in relationships and consequently augments the level of intimacy and communication in relationships. Lack of intimacy and communication in relationships often leads to presumptions which may result in conflicts (Klerman et. al., 1984).

The result is doubt and lack of clarity due to which the soreness in relationships augments considerably. The couple may tend to drift further owing to mood swings and depression which in turn could lead to increased depressive behavioral patterns. The cycle is a vicious one and finally leads the partners to a point of no return. The therapy also aims to explain and solve the role-related disputes including the definition of responsibilities, financial obligations, social and domestic activities and role-playing (Klerman et. al., 1984).

Behavioral family therapy

Family therapy has several popular terms including behavioral family therapy, couple and family therapy and the family systems therapy. It was also commonly referred to as marriage therapy and is one of the branches psychotherapy. This therapy when compared to individual therapy has shown substantial improvements in the depressive functions of the affected patients. Beach (2003) and Kung (2000) have researched several cases of the family therapy approach and found it particularly helpful among patients suffering from family distress.

The family and couple therapy basically focus on the importance of family behavior in treating the depressed patients. An emphasis is laid on the intimate relationships between the partners in the relationship, and the alteration of their behavioral patterns to initiate positive changes in the attitudes of the couple which ultimately result in reduction of depression and distress in interpersonal relationships. The highlight is on the communication between the family members abs as such, family relationships are given utmost importance in the maintenance and development of psychological health.

This therapy has an interpersonal approach where the either one couple partner or the family members of the patient are comprehensively informed about the symptoms and the potential outcome of major depression in the patient (Beck, 1976). All the concerned members have explained the basic concepts of communication skills and are elucidated on the importance of compromise, anger management and the display of empathy in listening to the patient (Beck, 1976). The therapist may also provide the family several training lessons in skills to solve problems of the patient or resulting due to the patient’s behaviors (Beck, 1976).

The cognitive model of behavioral family therapy has been found to be effective in treating patients of major depression. Not only does this model offer training in the necessary communicative skills and solving of problems, but additionally involves the modeling of appropriate and the pointing of inappropriate behavior by the therapist. There are many similarities between behavioral therapy and cognitive behavioral therapy in the stress on the behavior and the skill training given by therapists. The therapists emphasize greatly on the notions or ideas in the minds of the people, and make sincere attempts to change or alter them (Beck, 1976)..

The therapist also plays a substantial role in the identification of the irrational beliefs they hold and modify them so that there can be a noted change in the behavior of the family as an entire unit. Thus, the cognitive-behavioral therapy attempts to alter the inbuilt beliefs and attitudes of the people and this cognitive reformation results in a positive change in the behavior of the individual or individuals (Beck, 1976).

Couple and Family therapy approach

Couple therapy usually occurs when intimately connected partners, married or otherwise, agree to take the therapy together. Family therapy occurs when a complete family comes together for therapy and is collectively involved in the treatment of their closely related member. The member may be a blood relation or may be a spouse or even an in-law. In case of family therapy it is essential that there is a familial bond between the patient and the other members of the group, involved in the therapy.

Couple therapy as well as family therapy, are components of the Family Systems therapy approach, since the member or members working together are related to or are constituents of the same member or patient. For instance, in couple therapy, if one of the spouses has major depression, the therapy will consider the causes of depression from the point of view of the relationship and not simply the patient alone.

In the family therapy approach, the families are required to carry out specific tasks. These tasks are classified as the ‘basic tasks’, the ‘developmental tasks’ and the ‘hazardous tasks’.

Basic tasks are the normal functions or tasks which are carried out together by the families including providing food and shelter.

Development tasks are classified further as individual development tasks and familial development tasks. The individual development is the progress and growth of the individual member of the family while the familial development task stresses on the collective development of the family as a unit.

Hazardous tasks are those tasks which arise due to certain crises or mishaps in the family including incidents of severe illnesses, deaths, losses, accidents, changes in jobs or residences or even loss or reduction of income.

Behavioral Couple Therapy (BCT)

Behavioral therapy is widely and extensively used for treating couples and family-related cases of major depression. The BCT enjoys maximum experimental support in addition to the maximum history of study and research (Beach, 2001). According to Hahlweg and Markman (1988), the scope of BCT is in it universal application across a range of cross-cultural patients with major depression. BCT also has it base in the social models of learning and exchange theories and similarly lays emphasis on the environmental factors and the behavioral and emotive results (Christensen and Heavey, 1999).

The BCT is based on the theory that the manner in which the marital partners communicate and connect with each other is very highly responsible for the degree of their marital satisfaction or dissatisfaction. According to Epstein, Baucom, and Daiuto (1997), behavioral interventions and techniques of the BCT are highly effective when a particular problem or area of concern is addressed by the therapist. For instance, if a couple is engaged in a conflict related to the academic duties of the children, the therapist can encourage the partners to distribute the roles based upon the proficiency each partner has in the subject.

The BCT also lays emphasis on the enhancement of the basic skills of communication and the teaching of strategies to solve problems. The therapist plays a crucial role in teaching the couples several communication and behavioral skills which will enable them to convey their feelings and emotions without actually blaming each other and to engender potential solutions to the problems which they encounter rather than simply debating over the issue (Christensen and Heavey 1999).

Beach, Fincham and Katz (1998) have studied the importance and significance of the BCT in reducing not only marital distress but also major depression among the affected patients. The BCT has thus been found to be not only equally effective to the individual cognitive therapy approach in reducing symptoms of major depression but also more effective in improving conflicting marital relationships between partners (Beach and O’Leary, 1992). As such, the BCT has proved to be effective when marital discord was teamed with major depression and failed to prove helpful otherwise (Beach, Fincham, and Katz 1998).

Depression, Therapy and the role of culture

In today’s global scenario, it would be useless to talk of therapies and treatments without the mention of culture. Culture play a crucial role in determining the type of treatment and therapy that can be used effectively for the patient as the cultural backgrounds of the patients may be different from one another. Cultural sensitivity is an important dimension in the field of medicine and must be included in this study as well.

Cultures determine the values and traditions prevalent in a particular society, and also to a great extent define the background of the problem faced by the patients. Cultures of different communities may vary and sometimes even differ. For instance, the emphasis on gender roles on the basis of culture is more prevalent in Caucasian families and not in families of African-American descent. Researchers have pointed that whereas employment has proved to be a useful strategy for women and their families of the African-American culture, the results showed little or very few benefits to the Caucasian women and their families (Cochran, Brown, and MacGregor, 1999).

Similarly, in most Asian cultures, the society and interdependence on family members plays a major role in the lives of the people. Therefore, a symptom of depression to a potential patient of the Western culture would merely seem to be as a normal difficulty in regular life to the Asian. The difference in the cultural attitudes will entail different methods of treatment to the patients of both the cultures.

Further, there is a greater mingling and interaction between family members and society in the Asian cultures of India, Japan, China and Taiwan, as a result of which the rates of depression in these countries are substantially lower than their western counterparts. In the several types of research of major depression, there is increasing evidence of the importance of family and couple therapy to treat patients, as such the role and functions of the family and its members must be acknowledged and greater awareness must be created on the development of these roles within the family structures in order to prevent the occurrence of psychological disorders.

References

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