Is anyone surprised that many old people are anxious and depressed? Losing friends, function, independence and familiar surroundings would make anyone depressed. Mary Pipher, in her excellent book about old people, Another Country, describes the condition of seniors who have been forced to leave their home, who have watched their friends die and their own capacities decline, as identical to post-traumatic stress disorder (PTSD).
Neither is it surprising that the response of the health care establishment is anti-depressants and anti-anxiety medications. While these drugs can be helpful, they fail to address the causes of anxiety and depression: isolation, ill-health, lack of anything pleasant to look forward to.
Medicare-Covered Services
Prior to 2014, Medicare treated mental health differently than other ailments. Beginning in 2014, Original Medicare will cover 80% of outpatient mental health services, as it does for other outpatient services. Medicare Advantage policies will treat mental health visits as specialist visits.
Medicare-covered services fall into two categories: the pharmacological and the psychological. In our profit-driven system, they’re considered complementary and we’re advised to pursue both simultaneously.
I have mixed feelings about both of them, based on personal experience. There’s no doubt both have been helpful at times. Yet I have reservations about both.
Pharmaceuticals can be prescribed by your regular doctor and are probably worth trying. If you don’t like the way one makes you feel, you can try something else. The psychological approach — “talk therapy” with a counselor — relies on finding the right counselor. This can be a difficult, especially for a person in psychological distress. In my opinion, peer counseling (discussed below) is a better solution for the mildly depressed.
Non-Medical Remedies for Emotional Problems
Of course, the best remedy for depression is falling in love, closely followed by having a lot to look forward to, experiencing radiant health, and having a sense of purpose in life. Alas, such remedies can’t be bottled or channeled through group therapy.
Still, two non-medical approaches have proven track records: 1) physical activity and 2) helping others. Since depression can make it hard to follow through on these solutions, pharmaceuticals and talk therapy can reboot our sense of possibility. Then we can turn to these everyday approaches.
A final tried-and-true non-medical remedy is — a pet! Studies consistently show that people with pets live longer and are more satisfied with their lives than people without them. Petting dogs and cats (and bunnies and gerbils) increases endorphins associated with well-being in both humans and animals. (Check out Pets Release Love Hormone, How Owning A Dog Extends Your Life, and numerous other links found by googling “pets and health.”)
I personally regard my cats as oxytocin providers and think Medicare should cover pet food (just kidding).
Peer Counseling
With standard “talk therapies,” both indivdual and group, the skill of the therapist is critical to the effectiveness of the therapy. Unfortunately, mental health professionals are poorly monitored and their strategies are rarely based on credible research. Practitioners have enormous latitude to do as they please. Finding a good counselor can be a challenge.
Even with a good counselor, in my opinion, standard talk-therapy is a flawed approach. Its effectiveness is limited by a fundamental, irreconcilable opposition: Psychological well-being requires a sense of power but the patient/counselor relationship has a built-in victim/savior dynamic.
In contrast, the format of peer counseling incorporates two key activities that foster mental health: helping another person and exercising self-control. Both of these flow from the fact that peer counseling is reciprocal.
Re-Evaluation Co-Counseling
Peer counseling involves non-professionals counseling each other. One framework for this is Re-Evaluation Co-Counseling or RC. RC has international reach and offers guidelines, workshops, videos and print materials aimed at helping people become effective counselors AND “clients.” Though based in Seattle and 100 percent American, it’s little-known in the U.S. because it has a tradition of shunning publicity.
RC has both the quirks and the virtues of an organization that’s the ongoing vision of one person. (That person, founder Harvey Jackins, died in 1999, passing the reins to his son, Tim Jackins). I haven’t been involved with RC for a long time, but I still use what I learned from it.
Here’s how RC works:
At every session, two participants exchange the roles of counselor and client. Sessions are divided in half; roles change midway when a timer beeps. This means that at every session, every participant both receives and provides help. Roles are switched at midpoint, after a brief transition. That this can happen confirms to both participants that they can control their emotions.
The core of a session will vary, but the idea is that the “client” receives the full caring attention of the “counselor.” Good listening skills are the counselor’s most important asset. Sometimes a whole session may involve nothing more than reflective listening. Other times, counselors may intervene with questions or suggestions.
RC teaches a range of techniques aimed at helping the client bring to the surface and release negative emotions. Its rhetoric is similar to other post-Freudian approaches such as cognitive therapy and gestalt therapy. As with paid counseling, the skill of the counselor makes a difference. But even with an unskilled co-counselor, the “client” benefits from the structure of the session. And because the victim-savior dynamic is not a factor, a counselor’s ability to do harm is more limited.
RC offers a training program for would-be co-counselors and a framework for establishing a local “co-counseling community.” Such communities exist in many U.S. cities and can be found through the RC website, which also offers numerous publications if you decide to try it on your own.
Dialectical Behavior Therapy (DBT)
Through an unusual article, No Longer Wanting to Die, I recently learned of another approach to mental health that seems worth exploring: DBT or Dialectical Behavior Therapy. The Wikipedia link is below.
For More information:
- Overview of mental health among the elderly
- Wikipedia on Re-Evaluation Co-Counseling
- Wikipedia on Dialectical Behavior Therapy
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