Casebook: When depression diagnosis is secondary gain

In all my time as a Human Givens practitioner, I can only think of three clients who came to me, who were unequivocally not seeking relief but as part of their strategy for living a life that worked for them.  That in therapy speak, there was a clear secondary gain for these three for having a mentally ill diagnosis. 
None was in fact depressed in the way I would normally understand it.  So that is three out of many hundreds and therefore exceptional.  But I am a private therapist who charges for my services.  So I cannot help but wonder if there might be more, surviving and even prospering “in the system”.


The curious case of Karen – was she really depressed?

Karen and I spoke at a MIND organised conference many years ago now. She was one of the organisers and she told me that she had been depressed for years and years – she had seen ‘everyone’ and no-one could ‘cure’ her. Being a cocky young therapist (though not young in years) I offered to see her – I could sort her out in a few sessions I thought. She had no money so I offered to see her for free.

At our first session she told me she had been depressed for at least twenty years and she now lives on her own. I found it tricky to elicit any specific depressive symptoms or behaviours, but she assured me she had regular appointments with ‘Mental health professionals’ and her diagnosis was why she was unable to work. We agreed some goals – look into some volunteering at a cat rescue centre, a little exercise.  She enjoyed her relaxation where I did some guided imagery with her.  We arranged a follow-up appointment for the following week.

The second session became yet more baffling for me. Yes, Karen had enjoyed her first meeting and thought that what I had to say was ‘interesting’. However, she wasn’t able to complete or even start the tasks and she felt no different – still depressed. I was puzzled.

Again it was difficult to pin down any specific depressive behaviours with her, merely a vague non-specific ‘feeling depressed’. ” I can’t work, or do anything really because of this depression and it’s been like this for years and years” she stated. “Well how do you fill your day? Give me an example of a typical day for you” I asked.

And then the penny started to drop.

” Well there isn’t a typical day” she told me. “but I start by feeding my cats. I have quite a few; usually from the rescue centre I said I might help out at. Then I have my breakfast. If it’s a week day then I may have a MIND meeting to attend – I’m co-chairperson. Or a taxi might arrive to take me to the PCT Service Users Group, or maybe the Mental Health Services Users Forum, or other committees and groups that I am involved with. These can take up most of the day sometimes and I am exhausted so after I’ve eaten I may put my feet up, play with the cats and watch some TV before going to bed”.

” I think you’re right,” I said to Karen after listening to her. ” I don’t think I can help you lift your depression. Just as many ‘experts’ before me, your case has beaten me. I suggest you continue to live your life as you are. Maybe one of the many people you meet in the mental health field will eventually help you find the answer.”

And that was the last time I saw Karen with the depression of many years standing. Perhaps she is still filling her day with the quest of finding someone that may rid her of depression.  And in the meantime many professionals value her input and wisdom on the many working groups, committees, service users panels and the like that she continues to be a member of!