Insights – 6 min read

Christmas with the Terrible Twins and Their Many Horrible Relatives

October 31, 2023
By Dr. Mark Whittington and Gaby Bush

How to deal with Psychological Problems that Occur in Combination

Life is a very untidy business. And therapy is a gritty, often very messy process to boot. Psychological problems very seldom occur in isolation. Far more often mental health issues manifest themselves in a combination of complex, interconnected and interdependent ways. And never more so than in the context of anxiety and depression. These two increasingly prevalent psychological problems are so metaphorically and literally joined at the hip that they are often referred to as “the terrible twins”. However, twins though they might be, this dreadful twosome are far from identical. They need to be treated in very specific and dramatically different ways. For example, no matter how much it feels like you might, you can’t actually die from anxiety. On the other hand, in stark contrast, depression can be deadly. An estimated 121 million people suffer from depression world-wide. Severe depression is responsible for some 850,000 deaths by suicide every year. While the path descending into depression is different for everybody, there are many broad overarching similarities.  (I except those for whose depression is primarily attributable to biochemistry.) For most of us, the journey begins with a crisis. Crisis causes anxiety. Anxiety leads to depression. Depression leads to self-medication.  Self-medication leads to addiction. Addiction leads to more mood disorders, interpersonal problems and once again to anxiety. Anxiety leads to eating disorders and thence once again to depression. And so, the potentially deadly circle dance goes around ever downward and deeper into the dark and dangerous realm of serious mental illness.

The professional practitioner’s go-to reference for accurate diagnosis is the venerable The Diagnostic And Statistical Manual of Mental Disorders, a variant of which was first published in 1952. DSM has long attempted to organise subjects like personality disorders into convenient clusters.

I accept that this attempt to simplify things is both necessary and laudable, but I can tell you first hand drawing from my 30 years of personal hands-on experience in the clinical trenches that life is never quite as clear cut, simple or tidy. Not in the case of personality disorders nor in that of many more common psychological disorders. The propensity for issues to occur together makes them harder to diagnose and to treat. The medical term for all this is comorbidity. I promise not to descend into “Doctor Speak” or medico mumbo jumbo. That won’t be necessary because my point is a profoundly simple one. It’s what we call a “no-brainer”:

 Anxiety and depression are closely interrelated. It follows therefore, that the depressed person can learn from the experience and treatment of the anxious person and vice versa. What’s more, both can learn by thinking critically about the crisis that may have led both of them there in the first place. And so on and so on.

I am not a theatre buff or a Shakespeare tragic by any stretch of the imagination but I have been known to quote Claudius when he laments, “When sorrows come, they come not single spies, but in battalions.” Hamlet Act IV, Scene V (And yes I had to look that up. The act and scene I mean. Claudius’ words are forever etched on my temporal lobe if you trust the most recent evidence of where the functions of memory are carried out by the brain.)

Comorbidity, the co-occurrence of two or more psychological disorders within an individual, is a complex and common phenomenon in the field of mental health. However, it is one with which Metaphorical Therapy can offer significant help not least because the System focusses on a wide array of common problems through the same revealing lens; that of the Keystone Principles of Mental Health.

The legendary golfer Gary Player said, “The harder I practice the luckier I get.” It is a universal truth that the more you practice the better you get. Another no-brainer. However don’t let yourself fall into the trap of repetitively practicing just one thing. It’s better than nothing. But only just. Witness boxers and martial artists endlessly practicing combinations that can be applied to a multiplicity of different combat scenarios. In short: If one move is all you have, you are at a significantly greater risk of receiving an ass-kicking in the ring or on the street.

In summary then: The propensity of problems to occur together is not the exception but the norm in the realm of mental health. Research demonstrates that people diagnosed with one psychological disorder are at a significantly increased risk of developing additional conditions. This phenomenon poses unique challenges for both individuals and mental health professionals. Many psychological disorders share common risk factors, such as genetic predisposition, childhood adversity, or environmental stressors. But it is important to note that coping strategies can also often span more than one just one problem. For example; knowing when to ask for help is important in the context of all, and very nearly almost every mental health issue you care to imagine. In a nutshell then: The co-occurrence of psychological problems has profound implications for affected individuals, treatment providers and society as a whole.

So knowing all this what can you do?

The best way to answer this question by using the specific MindMovie treatment modules in the Metaphorical Therapy smartphone app and tracing the bones of a simplified journey through the various immersive modules.

Imagine this:

You are experiencing problems with Anxiety and panic attacks so you listen to the Storm of Anxiety and Dr Whittington’s accompanying tracks a couple of times and you find yourself feeling better and coping more effectively than you were.

You think, “Excellent! Job done!”

And you are quite wrong. (Or at best only partially right.)

 As a paid subscriber by listening to only the one module that you think applies your problem you are denying yourself many more valuable benefits and survival skills that are there ripe for the taking. For example:

The best thing about all this is just how easy Metaphorical Therapy makes things for you. It’s not work. Not even close. It’s more like sitting back to watch your favourite movie or listening to a few of your favourite songs. You will be hard-pressed to come up with a reason not to do it.

Remember the more you practice the better you get. This is nothing more than a profoundly simple human truth. The Metaphorical Therapy app is much like moisturiser. The more you put it on, the deeper it sinks in.


About the author

Dr. Mark Whittington and Gaby Bush

Dr. Mark Whittington is a graduate of the distinguished Otago Medical School, and has more than 30 years’ experience working at the clinical coalface as a Consultant Psychiatrist.

Gaby Bush is a creative director, writer ,ex-patient, corporate refugee, and survivor of severe PTSD. Gaby is living proof of how well the Metaphorical Therapy System works in the real world.

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