Overcoming Depression & Female Learned Helplessness
through Hypnotherapy

By Dr Tracie O'Keefe DCH, keynote speaker, Women and Depression Conference, 6-9 April, 2006, Sydney, Australia

Abstract

This is a discursive paper and workshop illustrated by four women's cases where they were able to overcome their sense of depression by learning a greater sense of self-efficacy during hypnotherapy. In Australia, as in every other country in the world, girls and women are of less social, work, economic, religious and political importance than males. Women learn from a very early age not only to acquiesce to perceived male superiority but also to generally not pursue power over their own lives. Because Australia comprises such a wide mix of people of varying ethnic derivations, women's liberation is at times is years behind North America and Europe.

Many women in Australia have been raised in family structures that value males over females. This can profoundly undermine girls' and women's sense of ego, self-differentiation and efficacy. Such learned helplessness is supported by a society where few women are industry, religious or political leaders, not through choice but exclusion.

In this paper I look at four women who were helped in relation to a sense of depression through hypnotherapeutic intervention and personality alteration. Hypnotherapy has proved to be an accelerated form of personality re-invention and supplementation that can help women find their voices and strengths in a very short period of time. As a goal-focused therapy, hypnotherapy has shown itself to be one of the quickest forms of personality change methods without resulting to what are often over-prescribed medications that frequently oppress women, rather than support them.

Introduction

When a person is depressed they can have a sense of unhappiness, helplessness, despair, sullenness, impending doom, tiredness, exhaustion, lack of energy and lack of self-efficacy. They are unable to focus on the positive aspects of life and become obsessed with the negative aspects of their existence. Along with those psychological difficulties a physical malaise also takes over the body and people have a sense of not being in the best of health, wellbeing or spirits (Beck, 1973).

There are two kinds of basic depression identified in medicine and psychology. The first is endogenous depression that is the result of illness or profound chemical changes in the body due to an upset of homeostasis, which is the balancing of the body's systems, causing secondary psychological effects. The second kind of depression is called exogenous or reactive depression which is the result of a person experiencing primarily psychological reactions to a situation which then activates physical symptoms (DSM IV 1994).

In some cases people are diagnosed as manic depressives in that they continually swing from one extreme of heightened manic happiness to very low states of morbid depression (Fuller, Torrey & Knable, 2002). The allopathic medical model considers this a mental illness and generally medicates in the first instance and very rarely offers psychological help.

Depression is also graded as minor or major in accordance with its severity, debilitating effects and length of duration. In grading and looking at depressive behaviors a clinician needs to also remember cultural influences and ideations that may have a major effect on how they see a patient and how the patient sees themselves and their own experiences. Breggin (1993), the American psychiatrist, observed that depression is recorded more in cultures where there is great profit from treating the concept of depressive illnesses, particularly through hospitalisation, electric convulsive therapy (ECT), and psychopharmacology.

Laing (1985), the Scottish psychiatrist, talked about how, after many years of practice, he came to believe that the institution of medicine often becomes just that - an institution. His work was largely responsible for the decommissioning of many mental health hospitals internationally in that he saw medicine as often being devoid of human understanding. He was particularly horrified by the way women were treated by the medical profession when they had psychological difficulties, seeing standard prescriptions as not being the way forward for women experiencing psychological and emotional difficulties.

Pope (2001) talked about how what is often forgotten in our culture, in the English- speaking world, is that depression is part of the menstrual cycle that has a function. Women experience many kinds of depressive states at differing times of their lives including times when they are premenstrual, ovulating, menopausal, post-partum, dealing with empty nest syndrome, ageing or during illness. Natural depressive states for women are constantly being misdiagnosed as illness and not natural functions. Instead of telling the women to find a space, be alone to rest and recover, physicians are all too often unnecessarily administering drugs. Our society, it seems, considers lack of productivity the real illness in women that it seeks to fix with pharmacology and sometimes electric shock treatment in order to create corporate profit.

Many women presenting themselves to their doctors complaining of depression are primarily offered poor and unproven drug therapy. Moore (1998), a senior fellow in health policy at George Washington University Medical Centre writes: "Nearly every one of the most popular prescription drugs has potential side effects, yet doctors seldom discuss them for fear that patients will be too frightened to take their medicine. For example Mortin, Advil, and Aleve may cause life-threatening perforated ulcers: Prozac is linked to 242 different adverse effects: Xanax can be highly addictive. Tranquilizers, sleep aids, painkillers reduce blood pressure - all have documented risks".

Jensvold, Halbreich, & Hamilton (eds, 1996) said: "Until recently, women were excluded as research subjects from much pharmacological research, including the early phases of drug testing and numbers of prominent large studies, as well as many smaller studies. Also commonly, when women have been included in drug research, data have not been analyzed with regard to sex and have not been reported in a manner that allows such analyses to be performed. Factors unique to women have often been used as justification for excluding women from drug research."

This means many of the medications currently being prescribed to women for depression have not been tested on women. There is no knowledge of how those medications affect the hormonal cycles of women or how the hormonal cycles affect the medications' reactions on the body.

Since Australia was a British colony, much of European-type immigrant Australian culture over the past 200 years has been based on Judeo-Christian theology. Within the past 30 years a large influx of Asian and Muslim communities have been added, but mainly in the cities. There is also the native Aboriginal cultures that are now a smaller part of the population who do use the services of Western allopathic medicine but also rely on traditional community support and medicine (Census of Population and Housing - 2001, internet).
In Christianity and Judaism, Adam and Eve were not made equal but woman was made as a companion and servant for man as an afterthought. Eve got Adam thrown out of the Garden of Eden due to her initiating the act of original sin. She is still seen as the temptress to be resisted and excluded from power in the churches and the temple. In these religions people's sexual and political power is purposely kept out of the hands of women by men (Holy Bible, 2000).

In the Encyclopedia of Feminism, Tuttle (1986)) writes: "Traditionally Jewish women have been subordinate to men and forced to lead restricted lives". She further goes on to talk about how many Jewish women have been liberated in the 20th century. In truth, however, in Jewish communities men are still the ones who hold the major power at work, and financially.

Chang (1993) tells us about three generations of women brought up in China: "The story of his wife, my great-grandmother, was typical of millions of Chinese women of her time. She came from a family of tanners called Wu. Because her family was not an intellectual one and did not hold any official post, and because she was a girl, she was not given a name at all."

Mosteshar (1995), who was born in Iran and educated in Britain, and then returned to Iran, describes the choices of oppressed Muslim women in Iran and many other countries: "Then they were shown various methods of contraception and advised to use them 'until you are sure that the man you are married to will be the man you want to stay with'. Few of these girls had ever spoken a dozen words to the boys who were downstairs preparing to turn them into women. Most of the brides told me that their grooms had been chosen by their parents or that they were their cousins."

Roddick (2000), the world famous entrepreneur who started her own chain of cosmetic stores The Body Shop, wrote: "Is it far harder for a woman to be an entrepreneur? Certainly the enterprise culture is full of contradictions for women. On the one hand you are encouraged to get out there and conduct your own destiny, but on the other hand there is the very strong moral authority of home and hearth - the idea that we should be with our kids. It is still far easier for any women to go to the bank and secure a loan for a new kitchen or fitted wardrobes than one for starting a business. There is still the prevailing notion that women don't have the necessary business skills."

There are still far less women in Parliament in Australia percentage-wise than many other countries, even though it has been 120 years since the formation of the Women's Suffragette League that was formed to get women the vote. (www.parliament.ns\v.gov.au/prod/web/common.nsf/key/ResourcesFactswomenmp3)

In a lot of ways Australia is many years behind many English-speaking countries such as Britain and North America and even some parts of Europe concerning the way in which women are not integrated into controlling society and their own lives. Australia is still very much a macho culture with very few women at the top of industry or politics. Many women were brought up and are still being brought up with little concept that they are able to do and be anything they want in life, instead being seen as second-class citizens. Many first, second and third generation Australians come from cultures where women still have much less value or importance and power than men:

"The inferior social and economic position of women, gender bias in the law, lack of access to legal services and lack of concerted government action continue to underpin women's legal inequality in Australia. Those suffering special disadvantage include Aboriginal and Torres Strait Islander women, women of non-English speaking background, women living in rural and remote areas, older women, women with a disability and women who are multiply disadvantaged." (National Women's Justice Coalition contribution on Articles 15 and 16 of CEDAW to the Australian Non-Government Organisations' report to the UN Commission on the Status of Women particularly in response to the Australian country report, prepared July 1997).

There are also groups of people who I wish to mention in my discussion who damage the central egos of many female children and women. They can include women themselves who are part of certain groups of separatist feminists, as well as female religious fantasists. They are elite idealists who preach to women about what they should and should not be and are extremely judgmental.

Women with overbearing religious or philosophical ideations can foist doctrine so oppressively upon their daughters that they are left with feelings of insecurity and inadequacy in that the daughters can never live up to the mothers' standards. They are women who sometimes teach their daughters to give up their own power to their husbands out of religious duty in a male-dominated religion. This child becomes a woman who becomes a professional victim with a sense of powerlessness about being able to create her own life course, happiness and wellbeing.

Gauld (1995) describes how hypnosis in varying forms has been used considerably over thousands of years in the healing process of all human beings from the Egyptians to modern times). Crasilneck & Hall (1985) write about how many different kinds of practitioners practise hypnosis including hypnotherapists, psychotherapists, counsellors, psychiatrists, anaesthesiologists, oncologists, dentists, social workers, nurses and sometimes educators. Erickson (Vol. I-IV, 1980) the 20th century's premiere medical hypnotist, believed that in treating depression with hypnotic techniques the practitioner generally needs to have had training in the psychological and maybe physiological disciplines as well as hypnosis.

The use of hypnotherapy in the treatment of depression has been greatly explored by the psychologist and hypnotherapist Yapko (1992). He contests the validity of many psychopharmacological studies and their choice as a primary treatment in many cases of depression. He also talks about how there has been great fear around the use of hypnosis and ameliorating depressive states that he sees as being unfounded. His work clearly shows that the use of hypnosis can accelerate self-evolution, psychodynamic and cognitive therapy through brief hypnotic therapy.

The use of hypnotic techniques and considerations in treating women needs at times to be different than those used with men (Hornyak, 2000). Women's bodies are different from men and their life issues and illnesses are often different to those of men. While some universal hypnotic techniques can be used with men and women alike, some hypnotic therapeutics need to be specifically designed for women.

Aim

In this paper I will look at four cases of women who have improved and moved away from overly depressive states by the use of modern eclectic hypnotherapy which is a combination of hypnosis and psychotherapy. All cases experienced a combination of endogenous and exogenous depression. In reporting and reviewing these cases I seek to show that such women can seek help from hypnotherapy that is other than a psychopharmacologically-based remedy.

Results

Case 1: Sharon

Sharon telephoned on the recommendation of her friend who had seen an article about me in a newspaper. Initially the friend telephoned me because she was concerned about how depressed Sharon had become since the friend had last visited Australia.

When she telephoned me herself, Sharon told me she was of Middle Eastern derivation, her family were strict Muslims and she beseeched me that her husband must not know about her treatment. Since she was unused to the centre of Sydney, the friend dropped her off at the clinic and picked her up afterwards.
It was easy to see the extent of her involvement in her religious system, because Sharon wore a head scarf, which covered all of her face, with only her eyes showing when she was in public. At 23 she had already had four children but all of them, she explained, are girls so she was depressed because her husband was not happy without a son.

The last birth had been nine months ago. She was still breast feeding and her husband was angry because she was not getting pregnant again so she could try for a son. It was quite easy to see from her description of her life, body language and her mood of deep solomnness that she was suffering from both post-natal and reactive depression. She was also overwhelmed by her isolated domestic life. If it were not for her friend she would not have had the money to come for treatment.

During four sessions of hypnotherapy and teaching her self-hypnosis she was able to reorganise her daily schedule, installing sharing the childcare with a cousin, visiting a family planning clinic without her husband knowing for oral contraception, and joining a women-only gym. Her self-esteem strengthened and Sharon enlisted the help of her mother-in-law to persuade her husband to give her a few years before they tried for another baby.

The hypnotherapy was expediently useful in helping her take back control of her life and the self-hypnosis she was taught was something she could do every day in the privacy of her own home, without anyone else knowing that she had ever had help.

As Sharon's life became more under her own control she became fitter, more confident, and happier and the post-natal depression lifted. The friend eventually went back to the Middle East but by that time Sharon had built a new network of helpers and she felt she was better able to cope with her life.

Case 2: Larna

Aged 35, Larna had been involved with drugs since she was 13, regularly taking amphetamine, ecstasy and smoking marijuana on a daily bias. She was a single working mother, with a son of four, making her living in the sex industry in a brothel.

In recounting her history to me Larna had talked about how she had always felt she was intellectually inferior and did not have the mental abilities to succeed in life. Due to her involvement at school with drugs she had become estranged from mainstream education and gravitated towards other out-of-control drug abusers during the whole of her adult life.

The women in her family had not become ambitious professionals but been mothers and simply worked to survive as an additional income to the males' role as primary breadwinner. Added to this was the fact that the father of her child was articulate with deep religious convictions and not involved with her lifestyle in anyway. When she saw him to give access to the child she constantly felt intimidated by him.

What was plain for me to deduce at the first interview was that she had very low self-esteem, poor self-image and a lack of positive self-belief. What immediately contrasted to that observation was that she had a good command of the English language, used quite complex sentence construction and very articulate use of adjectives. The disparity indicated that she was in fact a very intelligent woman who was not aware of her own intellectual abilities and that no one from her background had ever emphasised to her how capable intellectually she probably was.

She sought therapy because she was depressed about her circumstances and wished to stop drugs, get an education and live a different way of life. Over several hypnotherapy sessions, and the work she was set to do at home, she was able to become free of drugs, and stopped smoking. She learned to future-pace her own success, change her belief system and plan how she was going to start a degree programme to take her towards the profession in which she wanted to work. And in saying this, I make no judgement on the sex industry as I see many clients who work in this area. As opposed to being depressed Larna learnt to be involved in creating her own reality, cut herself some slack, and realised that she was much more capable than she had believed during her life.

Case 3: Diane

This patient was a 35-year-old long-term psychiatrist patient with a 20-year history of admittance and discharge from mental hospitals for bouts of Bipolar II disorder. She had had more then 80 electric shock treatments (ECT). At the time of consultation Diane was in a depressive stage, on Lithium Carbonate, and trying to progressively come off tranquilisers that she had been taking for 18 months. She also had a history of complex multiple drug abuse usually with partners who were also drug abusers.

Previously to attending my clinic she had been seeing the same psychiatrist once a week for several years when she was not hospitalised. The psychiatrist was currently on a six-month sabbatical and she had not been offered an alternative. Diane sought help with her depression because she was living alone and trying to get over the break-up with her boyfriend, who had been a fellow psychiatric patient in a hospital and had been violent towards her.

Certain things struck me about this patient right from the outset. Firstly she was an absolutely compliant person who seemed to expect people to tell her what to do, including her family, the psychiatrist, and her ex-boyfriend. Secondly she seemed very comfortable in the roles of someone's daughter, victim, member of the family that was mentally ill, patient, and her ex-boyfriend's ex-girlfriend.

Thirdly she had only ever worked a couple of years up until she was 20, after which her family had supplied her with a stipendiary from their large business interests but they had little contact with her. During hypnotherapy Diane was asked to construct a new kind of image of herself that was different from any she had ever had before. Through interactive psychotherapy and hypnotic suggestion she was taught to be the kind of independent person that she had never associated with herself before.

Since she was very afraid of people thinking she was weird and an outcast I insisted that she became much weirder and told her that I totally objected to her becoming normal in any way whatsoever (paradoxical intention). This was very shocking to her at first and then we designed a way of hypnotic dreaming for her to use at home for her unconscious mind to come up with new ways of becoming out of the ordinary.

I saw Diane for five hypnotherapy sessions, after which she was using daily self-hypnosis, had a belief in her own efficacy, had devised a regular daily schedule so that she could exercise, shop for fresh food, study and do some volunteer work at a local charity. One of the most useful things she said she acquired in therapy was an ability to define the boundaries in her relationships so that she let people into her world on her own terms. Her depression lifted and for the first time in her life she found that she was quite comfortable being an individual pursuing her own interests.

Case 4: Martha

Martha presented with two main complaints which had led her to become very depressed and to consider suicide, even though she was a devout Catholic and said she believed it was a sin. She had just had a bilateral mastectomy due to cancer of the breasts. At the time she had been undergoing chemotherapy and radiotherapy. She had also suffered long-term from Irritable Bowel Syndrome (IBS) with alternate constipation and loose motions and was struggling to even keep food down after meals. All this plus the fact that her niece was coping very well with her own bilateral mastectomy made her feel she was a loser and had lost all her attractiveness to her husband.

Martha also told me that she had very caring husband and three teenage sons who were doing the best they could to help her through her cancer treatment. Although she loved her niece she felt overwhelmed by the fact that the niece seemed to be sailing though her treatment remaining cheerful.

Initially I told Martha I could not help her because I was not qualified enough to do the job she had asked of me. Annoyed that she had travelled two hours to see me she demanded I explained because I had said on the telephone that I did help people in her situation. I told her that I believed she had already given up on herself and what she was seeking was a magician and I was not a magician. I could, however, teach her to be a magician herself, but only if she was prepared to treat herself with the things that I taught her.

Intrigued, she decided that she had nothing to lose and agreed to learn self-hypnosis and use it four times a day. I also got her to promise on the Bible that she would keep her word. We then started hypnotherapy to change her eating patterns, types of food consumed and reprioritise her daily schedule so that the three sons and her husband would be looking after themselves over the next six months.

She was taught psychoneuroimmunology to help combat the cancer, the ability to change her mental state, the differentiation of herself as a person apart from her family; and she was asked to teach those things to her niece. After a few hypnotherapy sessions Martha became more philosophical and decided to take one day at time and get as much out of that day as she was able to while taking care of herself first.

I saw her for six sessions and the depression quickly lifted as she learnt how to control her eating and bowel movements. She also made plans to have breast reconstruction but then cancelled the surgery because her husband pleaded with her not to go through with the operation. Her self-esteem increased and she learnt the cancer had been a great physical blow to her, but if she took her time, she was able to cope and continually try to get better. What was new to her was that she began to see herself as a separate person, an individual and not just an appendage to her family, which was what she had been raised to think she should become.

Discussion

Each of these four cases were women who sought hypnotherapy from a private clinical hypnotherapist (me) to alleviate depression and become motivated toward resolutions. They all paid for their own treatments, bar one, who was funded by her friend, and none were funded by government heath funds. Some, however, did get partial rebates back from their private medical insurance companies. During treatment it became clear that they all suffered from low self-esteem and a lack of self-efficacy in their abilities to move beyond the depressive state. What became clear as well is that as women they did not believe they were capable enough to cope with whatever came their way. Either they had not learnt significant coping mechanisms in the first place for self-integrity; or the vagaries of life had led them to a place of dependency on the patriarchal all-powerful medical system; or they had been ill and felt that their self-reliant resources were depleted.

Three of the four patients reported that they had been prescribed antidepressants by their GP and not gained any relief from them. The GPs had consulted with those patients for around five minutes each. None of those GPs referred the patients on for any form of counselling or arranged any kind of follow-up with regard to the effects the antidepressants were having. The one patient who had been previously identified as long-term Bipolar II seemed not to be supervised by anyone at the time. Breggin (1992) criticised at length the culture of allopathic medicine - GPs and psychiatrists prescribing unsubstantiated antidepressants at the drop of a hat without even finding out what was bothering the patient.

One of the major problems with the way allopathic Western medicine sees depression is that it always sees it as an illness. In trying to fix this pathology it administers chemical cocktails to change the body's levels of serotonin without dealing with the cause of the depression. This is rather like hitting the foot with a hammer to make it fit the larger shoe.

Australian women within the medical system who defy the patriarchal rule books are cited as being upstarts and proletariats. Kerryn Phelps, the first female doctor to be the president of the Australian Medical Association had to employ lawyers to defend her against defamation when the press over-profiled her because of her lesbian relationship (Mitchell 2002).

Women's way through and out of depressive states needs to be different and needs different strategies from men by nature of our unique social positions of having had such a long history of social oppression. This is the kind of oppression that has often been shared by gay, lesbian, bisexual, transgender and intersex (GLBTI) cultures or people of ethnic derivation (Paglia 1994). Just as Paglia demands that GLBTI people need to take charge of their own future, so do therapists dealing with women and depression need to charge their patients with responsibility for their own recovery.

Many Australian and international women have been made to feel subservient to the men in their families and have lowered career, social, personal, and economic expectations. The mental health system in Australia also has not yet grasped the concept of helping a client heal themselves and doctors are still revered as omnipotent. So when medics tell women they have an illness called 'depression' and they should take medication, that is what the client does, joining in what is often a folie a deux.

Women today in Australia still live mainly in a patriarchal culture and are taught a degree of helplessness and dependency from an early age. They perceive themselves as done to rather than doers. They are further disempowered when, experiencing natural depression, they are told that they have some kind of dreadful illness, which can only be cured by drugs. This is often further exacerbated when even female medics join in the deception and prescribe unnecessary medical treatments when what is needed is caring and talking, not unproven pharmacological prescriptions.

It would be better to see being in a depressive state as a gift in that the mind and/or body is seeking to draw attention to a particular problem or situation. As human beings we are meant to experience sadness as it is part of the whole repertoire of experiences like happiness, anger, delight, jealousy or fear. It only becomes pathology in Western medicine because there are trillions of dollars to be made out of it by drug companies.
With the four women in this study, they were required to change their exercise schedule, eating, prioritising and organisation of their lives. In treating depression, or as it used to be known 'melancholia', there is a need to consider all aspects of the person including physical, mental, spiritual, and social. What is also important, and can be found out quickly through hypnotic regression, is the onset and possible causes of the melancholia.

What purpose does it serve?
To what does the person need to pay attention?
What needs changing?
What does the person need to do to move to the normal state of bodily homeostasis which is happiness?
How can the person once again, or even sometimes for the first time, lead a fulfilling life?

All four patients were predisposed to the idea that they could get help from hypnotherapeutic treatment and that help could be effective. With each of the patients I spent time in the first session suggesting expectation for change to them. They were also told that change at times could be dramatic and they were asked if they were ready for those kinds of changes to happen in their lives. This is what Erickson (Rossi ed, 1980) called a double bind. First the client was told that there would be change (expectation of change); then they were told that change may be dramatic (compounding the first suggestion); and then they were asked for assurances that they would be prepared for that kind of change when it came (double bind).

Patients were also made aware that they would have tasking (homework) that needed to done between sessions and that part of the therapy needed to be completed. My experience over the years has been that patients who task well always stand a better chance of therapy being expedient. This also makes therapy interactive and commits clients to being largely responsible for their own recovery, improving their egos, self-esteem and self-efficacy.

Repetitive homework with self-hypnosis on a daily basis is also a form of cognitive behaviour therapy in that it installs new behaviour programmes and cognitions through repetition. Depressed people need to break out of old ways of thinking and move onto new, more constructive automatic mindsets. What was of note from these four cases was that the women did not have a sense of their own personal power. These women did not experience an ego state that was sufficiently developed to support a belief that they could create what they wanted. Each woman had low self-esteem and lack of self-efficacy due to the way they were raised. They were not taught that they could not only meet life on their own terms but also create life on their own terms.
The hypnotherapy helped the four women in the study to experience and create fast cognitive, behavioural and experiential change. They learnt to change their moods and personal experiences at will, take charge of their lives and to be able cope with life regardless of what happens. In short, the four women matured into the kind of adult personalities that are self-dependent and self-servicing.

It is important to note that no matter how depressed a patient is, if they are motivated towards change, the placebo effect generally kicks in and magnifies any change so the placebo effect becomes compounded. Some women, however, get caught up in vicious circles of depressive states, lack of ability to work and economic and social decline.

Feeling depressed arises from a sometimes simple or sometimes complex set of circumstances, psychological ideations and/or physical concomitants that are always different for every individual. No two patients are ever alike even though they can experience similar physical aspects or psychological themes. For women there are issues in therapy that are generally different from those of men such as child-raising, access to education and economics, and legal rights. All of these issues in a woman's life contribute towards feelings of self-worth, ability to believe in herself, and ability to overcome life issues, and recover from depressive states and illness.

Women have special needs in therapy for depression because they carry with them their social history of oppression. Germaine Greer (Greer, 1973) was born in Melbourne in 1939, went to England and published her famous book The Female Eunuch in the early 1970s which dealt with the call for women to further emancipate themselves from what is essentially a male-dominated world culture. She wrote: "This book is part of the feminist second wave. The old suffragettes, who served their prison terms and lived on through the years of gradual admission of women into professions which they declined to follow, into parliamentary freedoms which they used more and more as shops where they could take out degrees while waiting to get married have seen the spirit revive in younger women with new and vital cast."

Greer was right in some ways in that many middle-class women do waste their opportunities for independence to differentiate themselves as individuals rather being a male appendage. However, Australia today is such a mixture of cultures and many of the women are from cultures where religion and social order dictate that women's needs are second to men's. Those women, of whatever class or derivation, have not been brought up with the belief that they can do and achieve anything they want. Part of their indoctrination has also been that they often see the medical establishment as the answer to all their ills and are easily led into the illusion that a pill can fix their woes during depression, but it seldom does.

The nature of women is that they are generally seen as the carers in our societies and that they do tend to operate on a micro-social level as opposed to a global macro level as men do. Men derive much of their power bases through associations and mutual support known as the 'boys club'. Knight (1983) in describing the Freemasons taps into the very mechanism that gives men their power through politics, religion, brotherhoods and lifelong associations. Women, because they are often tethered to their families, do not have such strong support mechanisms and are left with a sense that they are without great self-power.

This idea becomes very clear when we look at women like Nicola Horlick (1997) an English woman who has been one of the leading directors of British pension funds, earning millions of pounds a year and also having several children at the same time. Horlick put her success down to the fact that she had attended a boys' school as a small child and, unlike many of her peers, grew up with the idea that she could achieve anything her male counterparts did. Even when dealing with a child who was diagnosed with leukaemia, she simply says that she took everything in her stride.

Need, however, is the mother of invention and women do have an inbuilt natural aptitude to regenerate themselves. The singer Marianne Faithfull (1991) tells us how after international fame in the 1960s she developed a heroin dependency, lost everything and lived on the streets of London's Soho during the 1970s. In the 1980s she totally reinvented herself again, shooting back to international acclaim for her work. Debbie Harry (2002), who fronted the rock band Blondie, was the one of the famous American female rock singers of the 1970s who broke through to international fame but gave everything up to care for her boyfriend who had a life-threatening disease for several years. As he recovered she had to build her career again virtually from the bottom upwards and it took her 20 years to establish herself as a music legend.

Through the emergence of monotheism - the idea of one all-powerful male god, from around 2000 years ago - women lost their sense of power which was further decimated by the industrial revolution and the separation of women from nature. The reintroduction of matriarchy and pagan principles of the 'mother the giver of life' (Straffon, 1997) and political liberation means that women are slowly regaining their personal power in some areas of the world. For many women, however, even in the depths of the most sophisticated societies, they are still bonded to the role of subservient second-class citizens. To overcome a depressive state a person needs a sense of personal power; and part of the redress for the four women in this study was that they left therapy with a sense that they were the ones in control of their own lives.

Perhaps Western allopathic medicine models can learn from the Aborigines of Australia about Wuriupranili, a solar goddess who carries a torch that is the sun. At the ocean to the West, she douses the torch in water and uses the glowing embers to find her way beneath the earth back to the East again. The colours of dawn and dusk come from the ochre body paints she wears.

General practitioners and psychiatrists are generally the frontline for many patients who present themselves as suffering from depression or are in what is perceived as a depressed state. Those doctors fail in nearly all cases to distinguish between exogenous and endogenous depression but use a sticking plaster approach of prescribing dubiously tested antidepressant drugs to alleviate and remedy depression.

Those doctors adopt this approach for several reasons. They hope that for some patients the depressive state is transient and that it will pass shortly; and by giving the patient what they believe to be a cure, it will help the patient wait for change. Doctors also prescribe those medications in the hope that the very act of prescribing something will act as a psychological catalyst to commence a healing state in the patient. Such medications are also prescribed as a sugar pill depending on the placebo effect of the patients believing in the medication. Some doctors actually do believe in the efficacy of antidepressants.

Doctors also often prescribe such medications because they fear the consequences should they not prescribe those pills. Their medical associations give them strict guidelines to prescribe such medications and should the doctors stray from those guidelines they run the risk of being in breach of their insurance policies.
We can see from the four cases that women suffering from what they believed was depression were actually often dealing with life issues. Whether those issues arose as psychological reactions to circumstances or due to physical depletion of the body's wellness is immaterial. Each person suffering from depressive states was able to benefit from interpersonal reactions with me, the therapist trained to guide people through those states by hypnotherapeutic treatment.

Critique

This study only deals with four women who have presented themselves to a private health clinic for help with their self-identified states of depression. It does not deal with extremely economically disadvantaged women who are unable to afford the services of a private hypnotherapist.

The four cases reviewed were also women who were motivated towards change but felt they were unable to make it happen without help. This study does not deal with depressive women who are unmotivated towards change who have become chronically morbid, may be in the depths of mental illness or be of a paranoid or schizoid nature.

Conclusion

The four women in this study suffered from a self-identified state of depression and were successfully helped though hypnotherapeutic intervention. Each of them in their own way suffered from low self-esteem and poor self-image. This is a common theme found among women due to patriarchal cultural ideations, who suffer from depressive states for extended periods of time beyond the norm.

Three of the women had previously failed to get any help through allopathic antidepressant prescriptions. One of the major keys in their fast successful treatment was that through hypnosis and psychotherapy they were helped to mature their personalities and evolve a greater sense of self-efficacy. In this case the hypnotherapy was goal-focused, encouraged and fostered cognitive awareness and used both direct and indirect suggestion for behavioural change.

Recommendations

In order to help women in any kind of therapy it is necessary to afford them the time to deal with their concerns. GPs would be more effective if they referred patients complaining of depression to professionals specifically trained to deal with depression exploring its emotional and biological causes, rather than automatically administering unproven antidepressant pills. Hypnotherapy is the use of hypnosis with psychotherapy and the manipulation of the body's systems by suggestion for psychobiological change, particularly the endocrine system.

Hypnotherapy has proved itself time and time again to be one of the fastest and most cost-effective ways to address depression. With treating women hypnotherapeutically, who present with depression, it is essential for the clinician to consider the women holistically to help change physical, psychological, spiritual, social, intellectual, sexual and economic concomitants of the whole woman.

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