Uncomfortable emotions and depression: a non-pathologising, homeostatic paradigm and therapeutic approach

Dr George Burkitt has had an exceptionally diverse career, the past 25 years as a special-interest GP devoted to counselling and psychotherapy for men, teenage boys and their families.

Uncomfortable emotions are, and have always been, a reality of human life. At times, they may be sufficiently prolonged and distressing for individuals to seek professional advice and treatments, with ever increasing encouragement from an expanding army of medical and other mental health professionals and organisations. The dominant public discourse is of a mental health “crisis” manifest by a growing incidence of mental illness and demands for yet more money and services to be deployed to deal with the problem. Yet few new strategies are on offer.

I submit that the insidious pathologising and medicalisation of emotional discomfiture over the past 150 years of development of psychiatry is the fundamental cause of the problem, as people become less and less resilient and more dependent on others to help them make sense of their distress.

A fundamental reassessment of the nature-given purpose of uncomfortable emotions is necessary.

All living creatures constantly monitor their internal and external environments for favourable and unfavourable phenomena, evoking responses to maximise their health and minimise adverse impacts. Maintenance of this dynamic state of integrity is known as homeostasis. The capacity to experience discomfort is an essential feature of all homeostatic processes.

Uncomfortable emotions represent part of this system, having evolved to serve the maintenance of dynamic, emotional wellbeing. Like physical discomforts, their purpose is to instigate change. Because an emotion is perceived as unpleasant does not mean that it is inherently dysfunctional or pathological. Indeed, if it were not uncomfortable, it would not evoke a response.

Emotional discomforts may be extremely unpleasant – so too are severe thirst, hunger, physical pain, heat and cold, which are an indispensable part of physiological homeostasis of hydration, nutrition, tissue integrity and thermoregulation respectively. The more intense the discomfort, the greater the motivation to relieve the discomfort.

There is no scientific basis for the idea that emotional pain is pathological, nor for the medical syndromes of “depression”, “anxiety” and other “mood disorders” being construed as diseases. Insidiously, such notions appear to have become accepted wisdom in the context of the highly questionable evidence that “antidepressants” and “mood stabilisers” (rebadged “antipsychotics/major tranquilisers”) and other medications are effective treatments, often propagated in spurious explanations to patients that emotional distress is caused by ill-defined “chemical imbalances in the brain”.

There is also no evidence that “depression” is a discrete pathological entity. Rather, for each individual, the symptom complex is a unique soup of uncomfortable emotions, with each person’s dis-ease being as different as tomato soup, minestrone and fish chowder. All that these have in common is that they are liquid foods and, if presented in a bowl covered in chopped parsley, they all look the same!

Four realms of experience essential for emotional wellbeing

For each individual, emotional health involves a dynamic, integrated sense of life-enhancing connection, control, safety and feeling valued/worthy. These four realms are described in more detail below.

During normal daily life, all humans frequently experience these realms being challenged or compromised. Most of these experiences and their associated emotional discomforts are trivial, as are the measures required to alleviate the discomfiture. Most often, there is a diminution of an individual’s sense of connection, control, safety or worthiness/value; but less often, there is an uncomfortable excess of one of these realms. Examples are frustration associated with having mislaid one’s reading glasses, apprehension associated with crossing a busy street, embarrassment at being unable to recall someone’s name, and a sense of unease when crammed together with others in a crowded space. Relief of the discomfort is often so simple and quick that the discomfort is barely registered cognitively.

Less frequently, the discomfiture is more intense and prolonged, clearly identifiable and defined. When more than one realm is compromised concurrently, the “soup of discomforts” may significantly impact wellbeing, resulting in “depression”. However intense, the integrative purpose of major discomforts is functional and biologically purposeful. Often, the intensity of discomfort results from failure to act appropriately earlier in an evolving situation, such as the distress of debt resulting from a failure to curb previous spending.

In this context, I have developed a self-empowering psychotherapeutic alternative to the often indiscriminate use of medication and pathologising talking therapies that presently dominate mental health treatments. The approach recognises that many patients have unresolved complex childhood or later-acquired trauma and poorly developed or damaged self-esteem, often unrecognised and/or not addressed.

This approach focuses on building patients’ emotional intelligence skills to value, engage with and understand the homeostatic meaning of their discomfitures as the basis from which they can identify and create whatever is required to restore or enhance their individual wellbeing.

The four essential realms of wellbeing and their associated homeostatic emotions are:

• a sense of connection to self, others, community, things, place and expectations
  • loss of connection is experienced as sadness and its variants, including grief, disappointment, loneliness, rejection and displacement
  • excess connection is experienced as overwhelm and feeling smothered
• a sense of being in control of one’s life
  • perceived loss of control is experienced as anger and its variants including frustration, irritation, irritability, annoyance and rage
  • boredom and restlessness represent the other side of the ledger
• a sense of feeling safe, both physically and emotionally
  • fear is the emotion evoked by the perception of being unsafe; variants include anxiety, apprehension, trepidation, wariness, confusion, uncertainty, panic and terror
  • complacency and inattention represent an excessive sense of safety
• a sense of self-worth or value as an individual
  • shame results when one’s sense of self-worth is challenged, and includes the feelings of embarrassment, unworthiness and humiliation; such feelings are embodied in poor self-esteem
  • false pride (being “up yourself”) represents the opposite discordant state

Employing the homeostatic model, talking therapy for mood disorders focusses upon gentle interrogation of uncomfortable emotions for their embodied meaning allowing patients to identify and then create their desired forms of connection, control, safety and feeling worthy, rather than on eliminating uncomfortable feelings which is generally the primary aim of conventional talking and drug therapies. Creative actions might involve reconceptualising/reframing that which is desired, or acting in a manner that was not previously contemplated.

This personal growth paradigm promotes continuous enhancement of emotional intelligence skills building lifelong resilience. It radically rejects the notion that the patients are “sick” or “broken” and thus needing to be “healed” or “fixed”.

About the author:

In a career spanning 50 years, George Burkitt has developed an exceptionally diverse range of skills and experience including Indigenous health care, disability and palliative care, military service, extensive international travel and co-authorship of three highly successful medical textbooks. All have informed the evolution of his understanding of the nature of mood disorders and their management, though much is also a product of his own personal growth journey. Details can be found at his website www.georgeburkitt.com.au

Practicing in isolated regional settings with a poorly prioritised patient demographic, and with minimal academic connections and status, has provided George limited opportunities for the sharing of these ideas and no opportunities for publication in mainstream journals, especially given that his work radically challenges the paradigm upon which mood disorders are conceptualised and treated. A detailed explanation of the homeostatic model is provided on George’s website via a hyperlink to a presentation to the 2021 Queensland Men’s Health and Wellbeing Association gathering, “Manshine” (second paragraph of the home page).