In this post I want to look at how Chinese Medicine, and particularly the 5 Element Tradition, might understand and treat what’s now called depression. I want to do this because I believe that acupuncture can provide treatment that’s effective, empowering and lacks the side effects associated with conventional approaches. I’m going to explain a little of the underlying theory as simply as I can and then try and show a little of how that might look in practice. This isn’t going to be definitive but I hope it’ll illustrate why acupuncture can be so effective for things like depression.
In part.1 I looked at how, over the course of the 20th century, the way depression was understood had changed from a psychoanalytical to a biochemical model. These changes dramatically increased the number of people diagnosed with depression and at the same time made the condition a target for, and increased the use of, anti-depressant medication. In this new understanding the subjective experience of the patient is understood simply as a pattern of symptoms from which of a chemical imbalance can be diagnosed. I finished part 1 with the critique Charles Eisenstein provides of this model, and, while I don’t agree with all he says, his insistence on the centrality of the patient’s experience is crucial.
It’s become a cliché to say that Chinese Medicine treats people not diseases but it’s also sort of true. For a practitioner of Chinese Medicine diagnosis always starts with the patient’s experience of disease, which is always personal to them. From this perspective there’s not really a thing to which one can attach the label ‘depression’ and for which one can provide a standardized, one size fits all treatment. According to Giovanni Maciocia what is called depression in the West corresponds to at least five broad categories of mental-emotional disturbance mentioned in the Classical texts of Chinese Medicine (1).
These include Yu or stagnation, Agitation and Palpitations & Anxiety, but none of these alone provide a simple diagnosis with an associated treatment because each can develop in multiple ways. Maciocia goes on to list a number of factors that may lead to the development of these patterns of which the two most important are constitutional factors and emotional stress. This is really quite logical, after all no two people will respond to the loss of a loved one in quite the same way. So understanding the patient and how they’re interacting with their experience is the starting point for Chinese Medicine.
I’ve written a little about the 5 Element model elsewhere. I don’t like the term Element and prefer to talk about 5 Phases with its implication of a dynamic process rather than a static object. In such a model illness can be understood as an imbalance, disruption or interruption within that process of becoming that the 5 Phase model describes. According to 5 Element theory each of us has a tendency toward a particular imbalance and that tendency could be thought of as the constitutional factor (CF) in the development of a disease. Although such tendencies might sit within a relatively small number of very broad categories (the 5 Phases) there is of course infinite variation within that because one can always discern ever finer gradations of the balance of Yin and Yang.
In classical thought each of these five broad categories was associated with a ‘spirit’ and these five spirits, acting in concert, were the basis of our ‘self’. I don’t like trying to map classical ideas and concepts onto modern conceptions but one could think of these ‘spirits’ as aspects of the psyche, to use Western psychoanalytical language. And the harmonious interaction of these five Spirits was the basis of a stable and healthy ‘self’.
I’m using the word ‘self’ here to point to the psycho-spiritual aspects of our being but in a holistic system there really is no clear distinction between our physical and mental aspects. And of course, even though it’s classified as mental health issue, there are a whole range of physical symptoms associated with depression. So one might say that mental and emotional issues are rooted in a disturbance in one of these five Spirits and that, because of the dynamic relationships between them, that disturbance affects the whole system. For me the aim of diagnosis is to identify the original disturbance in order to treat that rather than its effects.
Perhaps the Spirit most often associated with depression is the Hun or ‘ethereal soul’. This is the aspect of ourselves that is responsible for planning & organisation, for movement & direction, hope & inspiration, and with just that little list it’s easy to see why an imbalance in this aspect of ourselves may lead to a diagnosis of depression. The Hun is said to reside in the Liver and in Traditional Chinese Medicine (TCM) which was developed under the materialist paradigm of Mao’s China, Liver Qi stagnation is often diagnosed in cases of depression (1). So this sort of imbalance may leave a person feeling frustrated, forgetful and agitated, while on a physical level they may become clumsy and accident prone.
An imbalance with the Hun may affect the Shen which might be understood as our consciousness. So while an imbalance of the Hun may generate frustration and anger it’s the Shen, the Spirit associated with our Heart, that recognises or knows the emotion and the resulting disturbance may present as anxiety. Indeed in conventional medicine diagnoses of ‘depression and anxiety’ are much more common than diagnoses of ‘depression’ alone. There’s also a 5 Phase relationship here, with the Hun being associated with Wood and the Shen with Fire; so stagnation and/or deficiency in the former leads to distress in the latter. But it’s also possible that depression could have its genesis in the Shen.
The Shen is associated with the Fire phase. This is the aspect of ourselves that seeks relationships and intimacy and so disturbance in this aspect of ourselves can lead to anxiety, angst, sadness and even despair. Intimacy is always associated with vulnerability so when this aspect of ourself is out of balance the Shen may, in order to avoid those feelings, become overly social, seeking safety in the approval and love of others. This is the comic who everyone loves but who, to everyone’s surprise, commits suicide because of the terrible loneliness they feel but hide behind their outgoing persona. And again there may also be associated physical symptoms that might include heart palpitations and excessive sweating for instance.
I’m not going to try and elucidate all the ways depression could manifest within the 5 Element model. Like a game of Go the model has a few simple rules from which almost infinite complexity can be generated. This means there are some very subtle distinctions to be made. For instance one might need to distinguish between what I’m calling anxiety (associated with the Shen) and worry or pensiveness (associated with the Yi, or intention). For myself I might see the former as being more concerned with how a person feels they are perceived while the latter may be more obsessive and might be characterised by a sense of lack on some level. But they could appear very similar. The key to making these subtle distinctions lies in listening with great care to a patient’s subjective experience of their depression, as well as a keen focus on what the 5 Element tradition terms a person’s CF.
This sort of diagnosis allows treatment to be tailored to the individual and to address the aspect of them that is generating the wider pattern of symptoms that would conventionally be given the label ‘depression’. It’s this ability to meet the patient where they are, to listen without preconception and to treat accordingly that makes acupuncture such a powerful and empowering way of treating depression.
(1) Maciocia, Giovani, The Psyche in Chinese Medicine, London, Elsevier, 2009.
Bruce Bell is a 5 Element acupuncturist working from clinics on the edge of Midsomer Norton and Bath. He has a particular interest in mental health issues.