Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states ...Read More
My wife trains dogs for people with depression, phobias and other psychiatric problems. These dogs, mostly Labrador Retrievers and Golden Retrievers, have been very successful in helping those with mental illnesses to get out of the house and function. By the way, they are referred to as Psychiatric Service (Assistance) Dogs. It seems the mere presence of the dog has a calming effect on those people who, previous to having a dog, could not function at all. In addition, the dogs are trained to respond to the changing moods of the client and provide the necessary attention and reassurance. But, for some people can there be too much of a good thing? Here is an interesting piece of a case that has been totally disguised so as to protect privacy and identity:
"A middle aged man who is now a widow and living alone in some place USA has been extremely depressed since the loss of his wife. He has no children, no friends and no life. His mental illness has been so severe that he is on permanent disability and lives in public housing. His medical doctor referred him for psychiatric and psychotherapeutic services and these have been only moderately successful in relieving his depression. He heard about the use of psychiatric service dogs acting as companions and assistants for those with a variety of disabilities, from physical to emotional. When he mentioned the possibility of such a dog helping this patient, the man became enthusiastic, something unusual for him. A company that trains and provides such dogs (my wife’s company) was contacted and the appointment was set up. Lest there be any doubt, the man’s psychiatrist and psychotherapist fully endorsed this patient getting such a dog.
To jump ahead to the main issue, after a good deal of training for the dog and for the patient in learning how to handle and care for such a dog, and after he and the dog passed the necessary licensing tests, the patient and his dog settled down into a much improved life for this man. Now, with a dog, there was no way for him to stay in the house alone. Besides being a wonderful companion for the patient, he also had to frequently walk the dog and this caused him to meet people who regularly stopped to speak to him and the dog.
Also, with the dog he could shop in supermarkets, shopping centers, eat in restaurants, fly in air planes and even use buses with the dog. Fully licensed, both man and dog wore ID which entitled them to go anywhere they wished.
Then, one day, my wife got a complaint from the man. His complaint was that the dog did not allow him to wallow in depression and self pity! Alert to his master’s moods, the dog was quick to respond by jumping on the man’s lap and encouraging petting and hugging. On this particular day, the man became frustrated because ‘he did no want to feel better!’ "
Why would someone not want to feel better? Is such a thing possible? How can it be explained?
There are multiple explanations for depression and its causes that range from a chemical imbalance in the brain to learned helplessness and learned hopelessness. None of the explanations are mutually exclusive so that there can be a combination of factors causing depression. These overlapping causes can be a chemical imbalance in the brain along with learning to be and feel hopeless and helpless.
How can depression be learned? There were a number of fascinating experiments years ago that included the use of electric shocks delivered to a variety of animals from dogs to rats. When the shocked dogs had a place in the cage they could escape to in order to end and avoid the electric shock they made normal adjustments. However, those animals that had no escape route from the electric shocks became hopeless and depressed even if there cage was later changed and there was room to escape shocks. These latter dogs remained in the electrified part of the cage because they had learned that escape was hopeless.
There was a time when psychoanalysts referred to this phenomenon in people as "secondary gain." A secondary gain is defined as wanting to remain neurotic, depressed and anxious because it was rewarding to remain sick.
Many years ago when I was interning at a psychiatric day hospital for acutely ill psychotic patients we learned that people are often fearful of giving up their mental illness, even if it is psychosis, because it is all they have ever known. In other words, for some people sickness feels so comfortable that it is threatening to learn to be normal or healthy. One ADHD adult man who refuses medication but is successful at work, refuses medication because it frightened him to think of being any other way than they way he is now.
With this explanation in mind, it is not so surprising to learn that the depressed patient in the case above became annoyed with his dog. On that particular day he preferred to continue to feel hopeless and helpless. He had felt this way for so many years that the new and healthy way of being, without depression was not quite normal for this man.
It is nice to report that this patient was able to gain new learnings and function in the world as a much happier and content individual.
It is normal to believe that people want to feel better. However, like most things about human nature, the truth is complicated.
Your comments are welcome and encouraged.