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The Kusnacht Practice Podcast #013 Interview with Melissa Nobile, psychologist at The Kusnacht Practice on depression and suicidal thoughts in young people

24.11.2020 - Interviews, Mental health, Podcasts

“We sometimes have this tendency to think, as human beings, that it’s going to be one big solution that’s going to get us out of our current struggle with mental health. But it’s actually a lot of little things put together that are going to create the solution.” – Melissa Nobile, psychologist MSc.

In the thirteenth episode of The Kusnacht Practice’s podcast series, Global Sales and Marketing Director Philippe Rovere talks with Melissa Nobile, psychologist MSc, about depression and its association with suicidal ideation in young people.

Melissa examines the rise in young people requesting mental health assistance and the increased severity of symptoms.

She highlights the importance of reaching out to others, the limitless value of hobbies in providing a positive mental distraction. And the encouraging influence that celebrities coming forward will have on shaping the ideals of our youth.

Philippe Rovere: Hello, this is Philippe Rovere, I’m the Global Sales and Marketing Director here at The Kusnacht Practice. We are reinventing the experience of care. I am here this morning with Melissa Nobile, she’s the psychologist, Operation Coordinator and Project Manager here at The Kusnacht Practice. Good morning.

Melissa Nobile: Good morning, Philippe.

PR: So with Melissa this morning, we are going to talk about depression and suicidal thoughts in young people after Justin Bieber spoke of his mental health problems. Young people are suffering from depression more than ever during the pandemic with 59% of the 17 to 20 year olds and 54% of the 11 to 16 year olds telling an NHS survey that their lives have become worse in 2020.

And singer Justin Bieber is the latest in a series of young entertainers to open up about his own loneliness and suicidal thoughts. In a revealing new documentary titled “Justin Bieber: Next Chapter,” the singer admitted: “I think that there were times where I was really, really suicidal, like really like, ‘man, is this pain ever going to go away?’ It was so consistent, the pain was so consistent,” he says. And have you seen Melissa, an increase in young people with suicidal thoughts and depression? Likewise, through your work at the clinic?

MN: If we’re talking in general, since the pandemic, it’s still quite early to conclude with any numbers. And I think we’ll have to wait a few years before we have more perspective on what’s going on.

But what I can talk to you about is the general tendency that’s being reported in different clinical settings, inpatient, outpatient, hospitalisations, etc. And what I’m hearing from co-workers in the field. And that is that during the first wave of the pandemic, so when it pretty much began, in March, April, May, June, there was actually a decrease in young people seeking mental health services; which doesn’t mean that they weren’t suffering, but that simply the access was less there.

And then, as the summer began, in Europe at least, in August, and then September; and since then it’s been definitely quite an important increase in young people under 25, seeking mental health services. What clinicians are reporting is that not only are there a lot more young people seeking these services, they’re also coming with more severe symptoms than we usually see in these settings.

So we kind of have, as clinicians, this average of what we see on a day to day basis in our clinic, wherever that may be. And there’s this tendency now, where pathologies are becoming a little bit more severe at the moment. But again, I’m really reporting what I’m hearing, what I’m observing in this field of work. And time will tell and give us more perspective on exact data to clarify what may have been going on.

PR: Reading the article about Justin Bieber, where he credits the prayer, the meditation, and particularly the music in helping him recover. He states, for instance, “I pray and meditate, things like that, I write music and I listen to music and music is so powerful; It can really help you when you’re feeling low.”Melissa how important can an interest like music be as a coping strategy for those struggling with their mental health?

MN: You really have a point there when you say an interest like music. Because what I’m hearing in this sentence, with Justin Bieber talking about how music helped him is, generally speaking, he’s talking about the role of having a hobby, an interest or a passion in life. It happens that for him, it’s music, but for other people, it’s going to be different things. And yes, engaging with a passion, or a hobby or an interest is going to be a component that’s going to help, at least some people, who are struggling with their mental health, cope with the situation. And that’s going to happen through different means. I can give you an example of a few.

The first one is that engaging with something, with a hobby or a passion of yours, from a neuroscientific standpoint, it’s going to release dopamine in your brain and that’s going to help you feel good. You’re going to feel more pleasure, which again, if you’re going through a difficult time, you’re going to be glad for that hour a day where you might be feeling a little bit more pleasure.

It’s also going to help you get out of your mind, almost as a form of distraction. And if you think of difficulties or struggles with mental health, whatever it is that people are going through, the common denominator between their struggles, whether it’s anxiety or an eating disorder, or feeling depressed, the common denominator is that you’re a prisoner of your own mind.

With anxiety, you’re a prisoner of thoughts, of worrying thoughts, of thoughts that things are going to go bad. We call these catastrophising thoughts.
If you’re struggling with feeling depressed, your mind is going to be a prisoner of thoughts that, maybe, you’re not worth much, or that it’s never going to get better, hopelessness.

If you’re struggling with an eating disorder, you’re going to have obsessive thoughts around food or your body image. So regardless of your challenge, usually there’s this common factor that you’re a prisoner of your own mind. And through a hobby and interest, you’re going to have these moments in the day, where you’re going to set yourself free from these, from this prison of your mind. So this is how hobbies and interests can be beneficial for you.

And then it’s also going to help with creating a routine, which we know for some difficulties, having a routine can be part of a solution. And it’s going to help you, to maybe have something to look forward to, if you’re going through a phase in your life where it’s dark and things feel meaningless.

We sometimes have this tendency to think, as human beings, that it’s going to be one big solution that’s going to get us out of our current struggle with mental health. But it’s actually a lot of little things put together that are going to create the solution. And what goes with this statement is, what’s important to know is, that while having a hobby or an interest is going to help a lot of people, it’s not always going to be, obviously the only solution. And it’s not going to be a sufficient solution for a lot of difficulties.

If you’ve been, or if you are experiencing trauma. Or if you’re really stuck in the midst of an eating disorder, or you’re clinically depressed, it’s not going to be sufficient, but it’s going to be one of those little things that are going to be part of the solution, by having a hobby.

PR: Fascinating the strategy you’re using to overcome this. Could you explain a little more? Because I understand that you’re already using the music therapy here in The Kusnacht Practice. Could you explain a little more how it’s used in your clinical environment? And what kind of results have you seen from it?

MN: Yes, so we do use music therapy at The Kusnacht Practice. And music therapy, there are so many different forms of it, that’s the first thing to know, what they all have in common. And this is probably going to sound quite obvious, for people listening, is that they use music as the therapeutic tool to help people heal or recover. Which is different from other forms of psychotherapy, such as talk therapy, where you’re using language.

So that would be the first point. And then it might be easier for me to illustrate a few different ways how music therapy can be used, more than going to the theory of it.

One example could be, the music therapist could be sitting with the person who’s experiencing difficulties. And instead of having them talk about a certain situation, for example, a difficult relationship with a parent, they could tell them okay, play a few notes that would represent what it feels like for you. And then maybe a few notes of what hope feels like for you. And they can enter a dialogue like that where something is being expressed without using words.

So that would be one situation. I’ve also seen it being used with more, almost on a cognitive level. If you have, for example, someone with an eating disorder.

What you usually see in eating disorders is personality traits of high perfectionism. They go hand in hand quite often, and with an instrument again, for example, the piano because it’s quite accessible to everybody, you can start working on that perfectionism and challenge this belief that you always have to be perfect, by having the person improvise a melody. Because when you’re improvising, there’s no right or wrong, and there’s no way of doing it perfectly. You just need to do it your own way.

And the good music therapists will help the person understand that process. And then it can be carried out in other areas of their life, and really challenge the idea of having to be perfect all the time. And then there’re other ways of using music therapy, especially in the US, but we use it at The Kusnacht Practice too. It’s more by incorporating ancient instruments, for example, the gong, which is an instrument that’s about 4000 years old, or singing bowls.

In those sessions, the client is a lot more passive than the ones I’ve described before. They’ll usually be lying down, or they can be sitting down with their eyes closed, and pretty relaxed, and just, for maybe 60 minutes, listening to these sounds. And because these sounds are so ancient, they’ve been there for so many different civilisations, it’s going to create this really, sometimes, not always, powerful experience for someone; almost like they’re reconnecting to who they really are, or to ancestors.

If you’ve never experienced it, it may sound a little strange, and I’d really encourage you to experience it once. I’ve had a client that once said it felt like they ‘were going back home’. Whatever that meant to them, it’s what it felt like for them. And we know also, for example, these types of sessions with ancient healing instruments, that it provides, and this has been measured scientifically, it sometimes brings people into a deep state of relaxation. And with relaxation, it’s a lot more than just feeling good during the session and feeling the state of being relaxed, it’s indispensable to healing the nervous system.

And a lot of difficulties, mental health difficulties, pathologies, the root source of it, or at least something that goes with having a difficulty is that the nervous system is either under-functioning, shut down, depressed, or over-functioning. So through these sessions, you’re learning to relax, you’re relaxing that nervous system, and that’s going to be very important in recovering as well.

PR: Those forms of expressions you’re relating to are very interesting for our audience to understand how we can unlock, basically that personal expression; and particularly the emotions you can actually put on. This is difficult to put in words and putting it into your music notes is probably easier for the patient. In that respect, what kinds of signs can friends and family look for if someone is believed to have those types of suicidal thoughts and depression and mental challenges, in your opinion?

MN: Let’s briefly start by maybe defining the word depression, because I’m sure that five different people listening to the podcast, this podcast, are going to have five different ways of picturing depression, and it’s a term that’s so used in our society. As humans, you’d have to picture us all being on a continuum. On one end of the continuum, there’s bliss, super happy, life is amazing. On the other end, there would be, what I would call, clinical depression, or major depressive episode.

All humans, we’re somewhere along that continuum. It’s not that we’re one day on one end the next day on the other end. And we’re all going to fluctuate on that continuum throughout life. It’s completely normal. And it’s part of being human. We go through day to day life and have loads of interaction and events happen to us. And this is going to be dictated by biology, psychology, social factors, loads of different things.

And so people sometimes use the word depressed, and rightly so when they’re feeling somewhere on that continuum, close to one end, that’s more the depressed end. And then when we get to that extreme of clinical depression, that’s what I, as a clinician, would call depression, not invalidate wherever you are on that continuum. So for some people in their lives, they’re feeling depressed in the sense of the quality, the intensity, the duration of the feeling is becoming problematic, and it’s getting hard to function.

So on that continuum, on that end, for these people, what you would usually see is a combination of lots of different symptoms. It could be that they’re either sleeping a lot more than usual, or sleeping a lot less than usual. It can be that they’re gaining a lot of weight, or they’re losing weight suddenly. So they’re not very clear symptoms, and they’re very subjective.

It can be that they’re feeling hopeless and they’re expressing it, or they’re quite irritable and that they’re having a hard time concentrating. But again, because these symptoms are usually experienced quite subjectively, it’s not always that easy to see it from the outside. And sometimes the person can hide it really well and it would go unnoticed, and we see that in the media sometimes. We hear someone, unfortunately, died by suicide, and people say ‘Oh, I had no idea he was having a hard time’. So it’s not always easy to see these signs.

And for the suicidal thoughts that you mentioned, we would call, as clinicians, ‘suicidal ideation’. There again, it’s not obvious because it’s going on inside the person’s head. What I can tell you though, and we know that from research and practice, is the majority of people who are having suicidal ideation, if you ask them the question, they will answer you very honestly. And people are surprised by that fact. But the vast majority of people would tell you ‘Yes and I have a plan’ or ‘No,’ if you actually asked the question.

PR: So for people that basically focus on those signals and see that somebody is not behaving like their own self. How is it then important to encourage those with hobbies and interests like sport and music and reading to embrace them further? And use them as coping strategies when they are struggling with their mental health, or their mental challenge? How do you see that being helpful in that respect?

MN: It can definitely be helpful, as I explained before, it’s going to be lots of little things put together. I mean, I’m generalising, but for the majority of difficulties, they are going to help the person get out of this challenge. So it’s going to help if they feel able to. And if they don’t, to not beat themselves up, and to know that’s also okay, and it’s a process.

PR: So you mean that these strategies are being used in a holistic way. We say holistic way when they are used in conjunction with improvements in diet and sleep. Would that actually reduce the need for the prescription drugs? Or would you see that as being just a side strategy or core strategy for you?

MN: They can reduce the need for prescription drugs. The answer is that it will so depend on the person; on their very individual situation; on what exactly they’re struggling with. I mean, if you’re experiencing panic attacks, which is quite common, it’s going to help to have a hobby. We know physiologically, it’s going to help eliminate some stress in the body, so your threshold for the next panic attack is lower.

If your hobbies are sports, it’s going to, again, give you that distraction for a while. It’s going to have loads of benefits, but it might not be sufficient to get to the root cause of the problem and actually heal it. But that doesn’t mean it’s not helpful. It’s just going to be one of many contributing factors. So I’m aware I’m not exactly answering the question because it’s just going to depend so much on the problem of the person.

PR: And then Justin Bieber’s admission came after similar comments from other entertainers, such as Lady Gaga and Kanye West and Selena Gomez about the mental health challenges that they’re going through. How significant is it that these figures have come forward? And can this help other young people deal with their own issues, in your opinion?

MN: It’s significant, and it’s not easy to understand from an adult mind. Because as adults, we have, usually, less of a tendency to look up to celebrities or idols. I mean, we usually don’t have posters in our bedroom anymore etc. But adolescent teenagers, part of the developmental process is going to be to look up to these people.

I’ll give you a very brief theoretical background on it. What happens is that when you’re a child, you can picture the child’s sense of identity as a sponge, and then water is going to come into that sponge. Those are going to build the belief and the values and the thought, belief and values mostly, that the child has that are going to constitute their identity. And this water coming in is coming mainly from parents, because as children you’re going to believe everything your parents tell you. So if your parents don’t believe in climate change, you won’t believe in climate change. If your parents believe that talking about sadness is not okay, you’re going to believe talking about sadness is not okay.

And then part of the adolescent process is going to be building your own identity and separating from your family and becoming an adult of your own a little later. So this sponge, you’re going to have teenagers, they’re going to ring it out, get some of that water out. So all these beliefs and values, that they believed to be true as children, because their parents told them, and decide, okay, what am I keeping? What am I adding from somewhere else? What is going to be me? What’s going to be my identity? What am I going to believe in? Which adult do I want to become?

And in that process, they’re going to detach quite a bit from parents. Which is why you’ll see lots of crises usually happening in the teenager, where they’ll leave and slam the door and be angry at their parents. And they’ll be relying a little bit more on their peer group, and on celebrities, usually on idols to constitute the new sense of identity and put that water in their sponge. So if you put yourself in that, where you’re thinking in that developmental process, a celebrity that someone looks up to, whoever it may be, it’s going to be huge for a teenager because it’s going to add that water to their sponge. It’s going to constitute a new way of the teenager wanting to be.

So there may be, in this situation you described of Lady Gaga or Justin Bieber saying, ‘Okay, it’s okay to have mental health problems, and it’s okay to talk about them.’ Well, in the sponge you’re going to start becoming someone who believes ‘Well, it’s okay to have mental health problems, and it’s okay to talk about them’. And it’s going to, over time, reduce stigmatisation, which is going to allow more people to talk about it, and people to get better more easily too.

So it’s, to answer your question: Yes, it’s quite significant that these people are speaking up. And I think over time, the more it’s done, the more this younger generation, who’ll one day become adults and leaders, will create a new society where it’s okay to talk about all of this.

PR: Well, thank you. I think the analogy of the sponge is very visible for the audience to understand how this critical stage is for a child to become an adolescent and then an adult. So this is really casting some important light on this. Talking about this importance, how important is it for those with these kinds of issues to speak up and to be open about them? And how can that help them on the road to recovery?

MN: There’s no one rule. But it can be valuable for the person, and that in different ways. The first way I can think of is that it’s going to able the person, again, depending on who they talk to, etc, which belongs to each person to decide. It’s going to allow them to access support. Because if people know where you are having a difficult time, they’re going to be able to reach out to you and offer support. And that can take so many different forms.

If you’re having, again, more of an anxiety disorder, and you’re just someone very anxious, let’s say, and you’ve talked about this with one of your best friends, they can then notice what’s going on for you more easily. And they might be able to be part of the solution by telling you, ‘Okay, I think right now, that you’re being very anxious, and I’m not experiencing reality in the same way as you are.’ And that can help you realise what’s going on, and it can be part of the solution.

In regard to this continuum of depression, if you’re someone that’s feeling quite depressed, at one stage in your life, and your loved ones know about it. Well, part of the symptoms of depression is that you’re going to feel quite guilty about asking for help. You’re going to feel you’re quite worthless, so if you talk about it, people are going to be able to reach out to you and prove to you that no, they actually do care.

So it’s going to have a role and a lot of healing can be found in just having a community of people who know what’s going on for you. Because we are social animals, and social animals, they like to have each other, and there’s comfort to be found. And I can tell you an example, quite recently, I was working with a young woman. And this is not the first time it happened, that she had experienced a miscarriage in the first few months of her pregnancy. She was experiencing a lot of, well, she was going through a grieving process, and a lot of pain around it.

And in our society, in the first few months of pregnancy, women usually, or couples, excuse me, they decide not to tell friends and family. They wait for a few months, so that if there’s a miscarriage, nobody knows. And she decided, following a handful of sessions, that she was going to ask for support and be open about it and talk to friends. She was amazed. And this happens often by how many people who’ve said ‘Oh, me too’.

PR: So unlocking this situation and allowing other people to talk right?

MN: Exactly, and people to relate. And you realise that it’s actually quite part of the human experience, to go through hard times, and you’re not the only one. So opening up about it allows you to witness that with your own eyes.

The last thing I’ll say though, for that question, is that not everybody is able, or feels able to be open about their struggles, and that’s also okay. You do not have to do anything you’re not comfortable with. Again, if you’ve experienced some forms of trauma, you might physically be feeling that you can’t trust anybody again. I was saying before, if you’re in the midst of feeling pretty depressed, you might feel so worthless and that you’re a burden to everybody, so you won’t manage to talk to people, that’s also okay. So there’s no, there’s no one way of doing it, but there’s support available if you need it.

PR: Right. So we were here this morning discussing the depression and suicidal thoughts in young people. This is Philippe Rovere. I was this morning with Melissa. Thank you, Melissa for this.

MN: Thank you very much.

PR: Melissa is our psychologist, Operation Coordinator and Project Manager here at The Kusnacht Practice. Thank you again.

MN: Have a good day.