Discussed in this article:
The Quiet Crisis Within Diabetes
Depression is a 'quiet crisis' facing diabetics, their families and their health care providers. Financially and emotionally this crisis is exacting a terrible cost.
The purpose of this and following articles is to share important information about depression and how a hypnotist can responsibly and effectively help a diabetic with depression. This assistance will help to improve a diabetic's life by (a) reducing the suffering from this painful state of mind and being and (b) thus enhance their diabetes management skills which will therefore result in a state of enhanced health.
Bear in mind the importance of your contribution as a hypnotist. You can make an incredible difference because even a small reduction in a diabetic's long term blood sugar levels can result in a marked decrease in the likelihood of diabetic complications.
A largely unknown hence, hidden danger of diabetes is that diabetics have twice the risk of non-diabetics for becoming depressed. Dr. Richard Surwit of Duke University states that: "Diabetes more than doubles the odds of suffering from depression at some point. One third of people with diabetes have been diagnosed with significant depression and 11 percent with major depression--twice the rate in the non-diabetic population (1)."
What is obvious and yet, not really obvious about the preceding statement is that being diagnosed with a major disease is traumatic. This, in and of itself, can lead to depression--never mind all the other contributing factors that are related to diabetes and depression.
For example, a contributing factor to depression in a diabetic can be their physiological state. As noted by Dr. Surwit, there is research indicating that high blood sugars cause biochemical changes in the brain that can lead to depression. (2)
Physicians by and large, are extremely busy and the demands on them are greater than most can imagine. It is no wonder that many of them are simply not aware that their diabetic clients are two times more likely to suffer from depression. If they knew this, they would probably be more likely to refer their diabetic clients with poor blood sugar control to someone who could help.
When appropriate, a hypnotist can help in key ways because a hypnotist is trained to be a motivational coach and stress management consultant. One way a trained hypnotist can help a depressed person with diabetes will be explained later in this article. But first, let's look at an important question.
This is an important question for many reasons. Probably one of the more compelling reasons to deeply consider this idea is because, if true to some degree, then it begs this question: Wouldn't the validity of this concept make the majority of treatment efforts inappropriate and/or ineffective to some degree? Consider the plight of many frustrated nurses and doctors who will attest that no matter what they do for their patients, nothing seems to work.
This statement is not meant to denigrate in any way the efforts of so many. It is meant to highlight the importance of timely consideration of the depression-diabetes connection before the cost for all concerned becomes not only debilitating, but also tragically unnecessary.
Consider this: Evidence, that will be discussed shortly, shows there is a strong connection between depression and diabetes. This is important because, unless diabetes treatment programs are sculpted to target a largely unaddressed cause and exacerbating feature of diabetes, many of those at risk will only become worse. Those at risk include person's with pre-diabetes as well as those with diabetes.
This pragmatic approach also prompts one to think about the idea that perhaps with re-targeted treatment methods, many of those with diabetes may actually experience a remission of symptoms. And, dwell on the idea of how many may be able to avoid developing diabetes.
Bear with me a moment while I explain. Untreated depression in those with diabetes is a personal tragedy for all family members but most especially children. I state this because children have no coping skills to handle the emotional burden of a depressed and diabetic parent.
Imagine being a child helplessly watching your mother (as in my case) being slowly, inexorably, taken apart emotionally and physically by the deadly combination of poorly controlled diabetes and untreated depression.
It is because of this searing pain that I am driven to reach whomever I can with my Diabetes Motivational Coaching TM training so that perhaps some little boy somewhere doesn't have to watch his mother go blind emotionally and physically.
I realize this may sound disingenuous or dramatic to some and I understand but I make no apologies because it is true. In fact, my feelings go far deeper than what I have communicated here. You see, the apple doesn't fall far from the tree and now that hypnosis has helped me to put my life on a previously undreamed of healthy course, my motivation is intensified because I think so many times: "What if my mother had been able to have access to these methods? How much better would her life be now?"
Now, to tie all this in to my point that perhaps an innovative approach can actually prevent diabetes: The challenge with current diabetic treatments is that no amount of chemical management (including anti-depressants as well as insulin, etc.) will ever ameliorate this significant cause of diabetes. (Depression) This is because these treatments do not address the root of the problem. Furthermore, no amount of medication given to one individual will ever prevent another from developing diabetes.
The last point seems odd until you consider a landmark Swedish study (3) in which it was discovered that there is a disturbingly high correlation between traumatic childhood life events (4) and diabetes-related auto-immune activity. This study involved 17,000 children born between 1997 and 1999. One of many conclusions in this study is that: "Experiences of serious life events (e.g., parental separation, serious illness, or death in the family) has been suggested to trigger type 1 diabetes(5) or the auto-immune process behind the disease.(6)"
An additional interesting point to take away from the preceding considerations is that current treatment programs treat one person. Limited efficacy and high cost. However, if a patient were to receive Diabetes Motivational Coaching TM then more than one person can receive the positive benefits because a healthier, non-depressed diabetic parent is less likely to have a precipitating influence on their child. Two for the price of one. A win-win situation from so many angles. Obviously more study is required but the premise is intriguing and the evidence it is based on is reasonably sound.
Another win-win benefit of appropriate, innovative treatment is that the exacerbating (and ultimately very costly) effects of depression on those with diabetes can likely be reduced or eliminated.
So, what can a properly trained hypnotist do? One key way a properly trained hypnotist can help is to reduce or eliminate depression in an individual (diabetic or not) by helping them to eliminate depression activating post-hypnotic suggestions.
A post-hypnotic response is a cause-effect belief program that powerfully dictates behavior. Another way to look at this is that when a specific stimulus becomes uniquely associated with a strong internal state, you have a post-hypnotic suggestion and effect. (stimulus/response)
For example, the physical lethargy and mental apathy that accompanies very high (or low) blood sugars can be a contributing factor to inappropriate cause-effect belief formation. To illustrate, let me share with this case: Shortly before I was diagnosed with diabetes, my cognitive functions were significantly reduced and my affect was severely depressed.
In layman's terms this means I felt like garbage due primarily to out of control blood sugar levels that were causing me to lose my vision as well as feel awful. (What is interesting to note is that diabetes and its attendant emotional/physical affects can go undiagnosed or misdiagnosed for years.)
Now, when a person has a strong emotional feeling, that affect state can then become associated with whatever situation and/or thoughts they are currently experiencing. I.E., uncontrolled diabetic consequences coupling with a relationship break-up, a job loss or any other stressful situation. These are common events but note that even a small, insignificant incident can also be implicated. This confluence of events is called an I.S.E. or Initial Sensitizing Event. (Please note that, as in the case of many phobias, some initial sensitizing events can have a profound post-hypnotic impact after only one learning event.)
The next stage in deepening the power of this erroneous belief programming occurs when a person is next exposed to the same stimuli that were initially associated with a powerful, negative state of mind.
The result? Generally, with enough repetition and enough time, feelings can become facts cognitively and physically. And then, a pseudo-depression cycle is perpetuated.
As a quick illustration imagine a large spider near your foot. Now, if you are a person who becomes upset when big, hairy spiders with lots of eyes and big fangs are near you, then your body will respond to some degree.
Now, imagine being unconsciously reminded (triggered or post-hypnotically influenced) to thinking and therefore feeling, many times a day that there is a nasty spider about to crawl up your leg. Ultimately, this could become a panic disorder that can even attach itself to unrelated objects and/or events. In fact, this is not uncommon.
Hopefully, this example will help to illustrate why I call it pseudo-depression. I do this because the belief syllogism is: "I feel depressed (like garbage) therefore there must be reasons."
And, when feelings happen, a person must make sense out of their world. So, they justify this unconscious, powerful, emotional experience with a conscious understanding that usually takes the form of inappropriate cause-effect associations. I.E., "I am feeling depressed because of my job--spouse--life--" or whatever seemingly reasonable explanation is available.
In other words, one's feelings of depression can be in part or whole, built on erroneous beliefs or, post-hypnotic suggestions. Therefore, all a depressed person may need are the tools and coaching in order to be able to disable erroneous cause-effect belief programs.
To finalize this point, please consider a quote from Breaking The Patterns of Depression, by Michael D. Yapko, Ph.D.:
"For most people, depression is the product of a hurtful way of interpreting and responding to life experiences."
In this article I have attempted to share information that will raise awareness on a number of different levels. If you are a person with diabetes and you are hitting a 'wall', consult with your physician to discover whether or not you have depression.
If you are a nurse or physician and you have patients who don't seem to want to take care of themselves, then perhaps there are hidden forces at work. And, there are alternatives that you may not have been aware of before now.
If you are a hypnotist and you wish to help those with diabetes, please remember four things:
1) You must always obtain a fully informed referral from your client's doctor. If you suspect your client is depressed, never diagnose. In fact, if you think they are depressed, it is incumbent upon you that you suggest they see their physician for an official assessment before you can help them further. Be sure to obtain an additional referral so that you can help them appropriately with their depression if your help is suitable. If you feel you cannot help, don't.
2) Should a physician or nurse, have time to chat with you, please remind them that if you are only allowed one approach to helping their patient, stress management alone can produce incredible blood sugar lowering benefits over time. This is attested to by an article in a January, 2002 issue of Diabetes Care in which a study done by Dr. Surwit shows that: "stress management techniques, when added to standard care, helped reduce glucose levels". Surwit notes also that: "The change is nearly as large as you would expect to see from some diabetes-control drugs".
3) By acting in a responsible manner as part of your client's health care team, you can in your way, make a big difference, even if only by reducing stress. Please note that stress is a contributing factor to depression. Therefore, as your client is reducing their stress levels they may also experience a reduction in depression. This will in turn create a need for your client to reduce their diabetic medication needs . This is because there is evidence that a reduction in depressive symptoms correlates with a reduction in blood sugar. This was demonstrated in a study conducted by Patrick Lustman, a psychologist at Washington State University School of Medicine in St. Louis.
4) Finally, before helping a person with diabetes or depression, you really need to know a great deal about both subjects.
1) More Ways A Hypnotist Can Responsibly Help.
2) When A Hypnotist Should Never Help.
3) The Depression-Diabetes-Pain Connection.
4) Additional Interesting Ideas and Studies.
Finally, for your information, I (DH) have created a nascent organization called the Diabetes Research Association of America. It is filed as a Minnesota non-profit but it is not yet a true 501c 3 organization though I intend to soon make it so.
The mission of DRAA (www.draa.Net) is two-fold: (1) To research how mind/body methods can help diabetics to safely help themselves and (2) To teach these methods to others so that they can help diabetics to help themselves.
Thank you for reading this article. It is greatly appreciated and I welcome comments.
1. The Mind/Body Diabetes Revolution, Richard S. Surwit, Ph.D. Page 43
2. Ibid. Page 44
3. Psychological Stress May Induce Diabetes-Related Autoimmunity in Infancy --Anneli Sepa, PhD; Jeanette Wahlberg, MD; Outi Vaarala, MD, PHD; Ann Frodi, PhD; Johnny Ludvigsson, MD, PHD
4. Ed. Note: It is fascinating to note that in 1684, English physician and anatomist, Thomas Willis wrote that diabetes was the result of "sadness, or long sorrow." Apparently like DaVinci, he was ahead of his time.
5. Hägglöf B, Blom L, Dahlquist G, Lönnberg G, Sahlin B: The Swedish childhood diabetes study: indications of severe psychological stress as a risk factor for type 1 (insulin-dependent) diabetes mellitus in childhood. Diabetologia 34:579-583, 1991
6. Thernlund GM, Dahlquist G, Hansson K, Ivarsson SA, Ludvigsson J, Sjöblad S, Hägglöf B: Psychological stress and the onset of IDDM in children. Diabetes Care 18:1323-1329, 1995