CHAPTER FOUR

Therapeutic Model
 

    Now as we find, in considering the particular disturbances which exist with this body - and these with the view of bringing normalcy and a revivifying of purposes, desires or ambitions - the body WHOLE must be taken into consideration; that is, the physical, the mental, and the spiritual attributes of the body.
    For while each of the phases of the body-development is met within its own environ or phase, there are experiences which arise within a body - as we find within this body - when all of these must be considered as they coordinate or cooperate one with another.  And as is then to be understood, these MUST coordinate and cooperate - body, mind, soul - if there is to be the best reaction in the physical, mental or spiritual.  (1189-2)
 

    This excerpt exemplifies the holistic therapeutic model advocated in the Cayce readings on depression.  [1189] was experiencing depression as a result of an "exceeding upset in the ideals of the body-mind".  Even though the etiology in this case was primarily of a  mental/spiritual nature, the readings for this woman insisted that the physical disturbances produced by these "disappointments" must also be addressed (see the treatment plan in Chapter 3).

    The holistic approach advocated in the readings sought to treat depression by establishing health.  The last sentence from the introductory quote provides a definition of health which is the goal of the therapeutic process - the coordination and cooperation of body, mind and soul.

    As an illustration of what holism is about, imagine that a person is feeling depressed and seeks professional help.  If this person were to see a family physician or psychiatrist, there is a very high probability that a somatic therapy such as anti-depressant medication would be prescribed.  Generally speaking, the physical dimension of the condition would be emphasized.  Physical disorders such as thyroid and adrenal disease would be ruled out.

    On the other hand, if this depressed person seeks help through psychotherapy, it is very likely that the mental (or cognitive) aspect of the condition will be emphasized.  Obviously, this is a generalization since there are many forms of psychotherapy currently available.  However, based upon the documented prevalence of cognitive and cognitive-behavioral approaches in the treatment of depression, and for the purposes of the present discussion, this is a reasonable assumption.  The role of dysfunctional attitudes and irrational beliefs might be discussed and cognitive and/or behavioral interventions recommended to change these mental patterns.

    Finally, if the depressed person was religiously oriented and sought help through pastoral counseling, the spiritual aspects of the depression might be explored.  For example, the need for a closer relationship with God (by whatever name) might be discussed.  Selections from the Bible or other inspirational materials might be recommended.  Prayer and/or meditation might be suggested.  Altruism might be stressed in terms of service to mankind, or simply being more loving in daily encounters with others.  The purpose and meaning of life, the role of values, etc. would likely enter into the counseling process.

    Now, to extend the illustration one step further, imagine that the professionals in each of the disciplines just cited were good friends and respected the expertise of each other.  Further imagine that each were to see the hypothetical client, make their assessments, and then come together and discuss the case with the intention of providing the best possible care for that individual.  In a spirit of cooperation, a treatment plan addressing each aspect of the condition - body, mind and spirit - would be produced.  This approach would be an excellent example of holism.  Presumably, Edgar Cayce performed this service each time he provided a reading for a person experiencing depression.

    The good news is that there appears to be a recognition of the need for an integrated approach to the problem of depression.  This realization is being manifested in the trend for combined modalities and the increasing frequency of cross discipline referrals.  In this context of progressive therapeutic applications, the Cayce approach is offered as an extremely comprehensive perspective on the treatment of depression.
 

A Therapeutic Model

    There are two distinct approaches for the application of the Cayce material.  Since the death of Edgar Cayce in 1945, the case study approach has been used extensively for numerous disorders which the readings addressed.  The basic idea of this approach is to try to match one's condition (as nearly as possible) with a reading given by Cayce for a similar problem.  Persons utilizing the case study approach may use the Circulating Files on a given topic (which contain a few exemplary readings) or visit the A.R.E. Library in Virginia Beach, Virginia for a more extensive study of all the readings on their particular condition.  The sample of case studies in Chapter 3 and a more extensive collection (McMillin, 1991b) are provided to make the readings more accessible for anyone wishing to apply the case study approach to the treatment of depression.

    An alternative approach is to seek a general understanding of the problem by studying all the cases on a given topic (statistics are helpful here).  The idea is to find the basic patterns of pathology and treatment which can be condensed into a therapeutic model.  The Research Bulletins produced by the Edgar Cayce Foundation are an excellent example of this empirical approach to the readings.  These bulletins cover a spectrum of disorders and can be particularly helpful to the health care professional desiring an in-depth view of the readings on a given subject.

    Obviously, these two approaches are not mutually exclusive.  One may develop a basic treatment plan, based on a consideration of all the readings on a subject, and then "fine tune" it with information from a specific case.  This hybrid approach serves as the basis for the therapeutic model developed in this chapter and is based upon the need for a flexible, yet comprehensive approach to the treatment of depression.

    Since depression is diverse in its etiology, clinical presentation, and response to treatment, an effective therapeutic model must address variations in type (e.g., unipolar, bipolar, secondary) and severity (i.e., mild, moderate and severe).  The model presented in this chapter is structured enough to guide the therapeutic process yet pliable so that the clinician can make adaptions for each particular case.
 

Dis-ease and Disease

    In order to address the varying levels of severity found in disorders such as depression, the readings make a distinction between dis-ease and disease.  Dis-ease refers to relatively mild distress, usually brought on by systemic imbalance.  If the condition is not addressed and balance restored, disease may result.

    For, in each physical organism there are those conditions that enable the organ to reproduce itself - if it has the cooperation of every other portion of the body.  When these suffer from mental or physical disorders which make for repressions in any portion of the system, then dis-ease and distress first arise.  If heed is not taken as to the warnings sent forth along the nervous system ... that certain organs or portions of the system are in distress - or the S.O.S. that goes out is not heeded - then disease sets in ...   (531-1)

    In regards to depression, dis-ease may be manifest as mild symptoms, such as feeling "down" or "blue" for no apparent reason.  A person may experience periods of gloomy thinking and feeling, occasional insomnia, tendencies for listlessness or restlessness, etc.  The relatively mild expression of these symptoms may not interfere with one's lifestyle to the point of being debilitating, and yet life is not as full as it should be.  Body, mind and spirit are not quite in coordination.  At a physical level, perhaps there is a tendency for toxemia due to poor eliminations.  Possibly negative attitudes and cognitions are having a depressive effect upon the nervous systems resulting in mild physical symptoms or somatic complaints.  These descriptions fall within the domain of dis-ease.

    On the other hand, disease is full blown clinical pathology.  There is so much incoordination in the systems that symptoms are no longer an inconvenience - they are debilitating and they hurt badly.  The pathology may be functional or organic.  Regardless of the etiological pattern involved (i.e., whether it is produced by mental or spiritual factors), disease necessarily involves major physical pathology.

    From a treatment standpoint, the readings provide variations in therapies which address these varying levels of severity.  Preventative treatments address the mild systemic dysfunctions associated with dis-ease and provide a health maintenance program to prevent relapse.  The hallmark of the preventative treatments is their universality - the readings state they would be good for everyone on a regular basis.  Preventative recommendations include: balanced diet, daily exercise, hydrotherapy, osteopathic treatments, massage, use of the Radio-Active Appliance, working with ideals, and service to others.  The emphasis at this level is personal involvement in balanced living.  Professional services are required for certain therapies, however the bulk of the application is simply a matter of lifestyle.  It is important to note that these preventative therapies are also the most frequently recommended treatments for depression.  Hence, the basic treatment plan for depression consists of these preventative measures which are essentially health maintenance recommendations.

    The importance of preventative measures is emphasized in the following excerpt which also stresses the mental and spiritual ramifications of maintaining a healthy body.

    Much may be said as respecting that of preventative conditions for a body such as this, rather than neglecting seemingly minor conditions [dis-ease] until curative forces are necessary [disease].  An ounce of prevention is worth many pounds of cure.  Then, so adjust the conditions in the physical forces that, that of the mental and spiritual may have that channel to manifest through.   (1731-1)

    In contrast to preventative measures, curative treatments are needed to correct the major pathology associated with disease.  Here the emphasis shifts to more professional involvement, sometimes to the point of hospitalization.  The physical dimension is accentuated and the nature of the interventions reflect this shift.

    For example, the Radio-Active Appliance may be used in either mode; however, in the curative mode certain modifications are required (such as changing the type of metal attachments and the addition of a solution jar).  For more severe cases, a Wet Cell Battery may be required (the readings state that it works on the same principle as the Radio-Active Appliance except that it is more powerful).  Thus, there are gradations in the potency of the interventions to meet the requirements of varying degrees of pathology.

    The variations between preventative and curative applications will be dealt with in more detail in Chapter 6 which explains the various treatments which the readings recommended in cases of depression.  For now, it is only necessary to point out that the readings do provide a comprehensive approach to treating the various manifestations of depression.

    In summary, the proposed therapeutic model is a hybrid approach which utilizes a basic treatment plan composed of therapies commonly suggested for the treatment of depression.  These treatments may be viewed as preventative since they promote systemic coordination through balanced living.  The preventative application of the model addresses mild depression in its manifold forms.  The therapeutic model also incorporates specific curative treatments to address more severe cases of depression.  The curative applications require increasing professional involvement and allow clinicians to customize the treatment plan for each individual.  The actual treatments involved in the model will now be discussed briefly and some specific applications noted.
 

The Basic Treatment Plan

    The basic treatment plan forms the foundation of the holistic therapeutic model.  It is suitable for most cases of depression and may entirely suffice for low level depression.  It is also appropriate as a maintenance plan to reduce the likelihood of relapse, hence it is inherently preventative in nature.  Since it is basically a health maintenance program, it has the added benefit of being relatively safe producing few, if any, harmful side-effects.

    The components of the basic treatment plan are listed in TABLE 4.1 and will be briefly described here.  A more thorough explanation of these therapies will be provided in Chapter 6.

*  Improving eliminations is a high priority since the readings cite toxemia as one of the most common etiological factors associated with depression.  Hydrotherapy, manual medicine (osteopathy and chiropractic), massage, and diet are the main therapies in this regard.

*  Manual medicine and massage also assist in establishing better coordination between the central and peripheral nervous systems.  This is important since the readings consistently portrayed the pathophysiology of depression as a "lapse in nerve impulse".

*  The Radio-Active Appliance may prove helpful in cases where restlessness, fatigue or insomnia are significant symptoms.

*  The readings also consistently stressed the importance of moderate outdoor exercise for relaxation, improving eliminations, and in certain cases, as a form of phototherapy.

 *  The ideals exercise is an important intervention for establishing priorities, not only within the therapeutic regimen, but also for long-term health maintenance.  This cognitive-behavioral intervention is also an excellent means of recognizing and correcting dysfunctional attitudes and beliefs.

*  Finally, the spiritual phase of the basic model encourages persons to take a broader perspective on their immediate situation.  Altruistic service provides a sense of interpersonal connectedness which can be extremely therapeutic in the treatment of depression.
 

Additional Therapies for Specific Cases

    While the basic treatment plan provides a foundation from which to approach the treatment of depression, supplemental or adjunct therapies of a curative nature may be helpful in specific cases.  In these instances, the basic treatment plan is modified to address the needs of the individual.  Some examples are provided here; keep in mind that these are merely suggestions which clinicians may wish to utilize at their discretion:

*  The readings noted sensory system involvement (i.e., disturbed hearing, taste, sight or smell) in many cases of depression.  This was linked to conjoint innervation of the sensory organs and certain visceral organs.  Thus assessment and treatment should focus on the possibility of cervical and upper dorsal pathology.  The pneumogastric and hypogastric plexus were also frequently cited in these cases and may require manipulative therapy.

*  When depression is severe, therapeutic milieu is a necessity - the environment must be conducive to healing.  If the home situation is not appropriate, hospitalization may be required.

*  Companion therapy may be helpful for cases where the individual is unable to follow the treatment suggestions and requires supervision.

*  In cases presenting with oppositional or noncompliant behaviors, suggestive therapeutics may be utilized to increase cooperation.

*  A blood and nerve building diet may be helpful for individuals suffering from general debilitation.

*  The wet cell battery with gold may be useful for persons who exhibit cognitive impairment (or other deficit symptoms).

 *  Glandular dysfunction may present as disrupted biological cycles and/or abnormal results on endocrine tests (e.g., nonsuppression of dexamethasone, blunted or exaggerated TSH response to TRH).  In such cases, Atomidine may be useful to normalize glandular functions.  The addition of Jerusalem artichoke to the diet was also recommended in several cases involving glandular imbalance.

*  Somatic complaints should be taken seriously for they can provide valuable clues to the systemic dysfunctions associated with depression.  In particular, back pain can be extremely helpful in locating and treating somatic dysfunction in relation to the spine.

*  Extreme toxemia may present as constipation, skin blemishes, and/or foul breath.  Improvement of eliminations would probably be helpful via hydrotherapy and eliminative diet.

These suggestions are presented merely as possibilities to assist the clinician in forming hypotheses.  They should not be used in a "cookbook" fashion.  To the contrary, it is important that clinicians interested in applying this material become intimately familiar with the case studies and therapeutic modalities recommended in the readings.  This depth of inquiry is necessary to become sensitive to the subtleties of this information and provide customized treatment plans for the more severe cases.  Chapters 5 and 6 provide further discussions of these principles and techniques to assist clinicians in becoming knowledgeable in their application.
 

Bipolar Disorder

    In order to apply the Cayce material to the treatment of bipolar disorder, one must be intimately familiar with the cases in the readings.  The section on bipolar disorder in Chapter 2 is essential in this respect.  The cases carrying a medical diagnosis of manic-depression (the old term for bipolar disorder) and additional cases with bipolar features are listed there for further study.  All these cases are included in Chapter 3.

    The basic treatment plan is appropriate for most cases of bipolar.  Additionally, many of the suggestions for adjunct curative therapies presented in the previous section are also applicable.  From this foundation, a few further suggestions may be considered:

*  Be alert for a "cold spot" or discomfort in the lacteal region (a couple of inches above and to the right of the navel).  This indication is particularly significant in cases diagnosed as bipolar which respond to anti-convulsants but not to lithium carbonate.  Castor oil packs and deep manipulations in the lacteal area were frequently recommended by Cayce in such cases.

 *  Extreme lability of mood during manic phase (especially excessive irritability and/or bursts of anger) may respond to violet ray therapy in conjunction with massage or manual medicine.  Treatment should focus on the solar plexus region and along the entire length of the spine.

*  Gold therapy (via the wet cell battery) may be appropriate for chronic cases and especially when there is an indication of genetic factors and/or enduring cognitive deficits.

*  Cases presenting with manic psychosis may involve injury to the lower spine or pelvic organs.  Manipulative therapy may be required to adjust the coccyx, sacral or lumbar regions of the spine.  Be particularly sensitive to somatic complaints or history of injury in this portion of the anatomy.

*  Suggestive therapeutics was often suggested in these cases.  The spiritual aspect of the suggestions was emphasized.

    Again, these suggestions are provided for clinicians wishing to utilize the Cayce material in more severe forms of pathology.  The material should be viewed as hypotheses which clinicians may wish to consider as possibilities in any given case.  This information is not intended for self-diagnosis or self-treatment.  It should be used in cooperation with a qualified health care professional.
 

Secondary Depression

    It should be apparent from the preceding discussion and the case summaries provided in Chapter 3 that the treatment of "secondary" depression does not differ radically from "primary" depression.  The same nonspecific modalities which address "physical" illness are appropriate for "mental" or "emotional" illness.  This is a natural outcome a holistic perspective - everything is connected and interactive.  Therefore, primary health care providers wishing to use the Cayce approach should become familiar with the readings on any particular condition from which a client may suffer and apply the principles and techniques appropriate for that patient.  In most cases, the treatments will be congruent with the model presented in this chapter and the depression will be addressed from a holistic framework.

    As an example, consider case [4196] (McMillin,  1991b).  The reading for this adult male is directed at his depression as indicated by the question which initiated the reading ("What causes depressed mental condition?").  In describing the pathophysiology of the condition, the reading notes disturbances in the circulatory system and states: "Hence the nausea as produced in the organ and the reflex from this through the cardiac plexus gives palpitation, or heavy quick breathing, gasping in the diaphragm and lungs ..." The reading explicitly describes the systemic interactions which are producing these symptoms and trace them all back to "congestions" in the nerve centers of the 6th, 7th, 9th and 10th dorsals.

    In view of the research that has been done in the area of secondary depression and primary care service, it is quite likely that if this man were alive today and sought help through his family physician his depression would be ignored.

    A number of studies have demonstrated that the most commonly encountered psychiatric disorders in the primary care practice are depressive disorders.  In addition, these studies have also shown that depression is under recognized or misdiagnosed in the primary care practice.  Clearly, any strategy that will improve this problem will benefit the patient, the physician, and the problem of cost containment.   (Zung, 1990, p. 72)

    Thus, in today's medical system, Mr. [4196] would likely leave his doctor's office with a handful of prescriptions to suppress the cardiovascular symptoms and nausea.  If the depression were addressed, it would likely be considered a psychological reaction to his "physical" disorders and he might be given an additional prescription or an anti-depressant.

    If the depression in this case were severe enough to warrant a referral to a psychiatrist, the anti-depressant would come first and the somatic complaints might be regarded as somatization (hypochondria).  He might receive psychotherapy for his "psychological" problems.  If his physical symptoms were severe enough, he might also exit this doctor's office with a handful of prescriptions for his somatic complaints.

    Cayce's recommendation for this man was to relieve the pressures in the nervous system and viscera through manual medicine ("massage and manipulation of the cervical and dorsal region, with the diaphragm and gastric region manipulated to empty and to equalize circulation and assimilation in the body").  Small quantities of lime water and elm water were also suggested to "equalize and neutralize conditions in the body."

    The philosophy is "cure by removal of cause" (an old osteopathic dictum echoed in the readings).  The body is assisted in healing itself and the depression, nausea and cardiovascular symptoms are addressed from a systems perspective.  If the therapies are successful in helping the body to achieve equilibrium, this fortunate man might never have to be concerned about relapse to his diseased condition.  On the other hand, a failure to deal with the underlying cause could result in chronic debilitation and a dependence on increasingly powerful drugs to relieve the wide range of symptoms.  Obviously, if one accepts the Cayce readings as valid glimpses into the human body and its pathologies, some changes in the health care system are in order.

    The major problem with applying the therapeutic model to primary health care as it currently exists in this country is the heavy reliance which the model places on manual medicine.  While many osteopaths and chiropractors may feel comfortable with this approach, most M.D.s will not.  So realistically, unless the widely acknowledged economic crisis in allopathic medicine changes the current health care system, the therapeutic model proposed in this chapter will have limited application to secondary depression.

    For those M.D.s who are interested in this model and wish to make contact with practitioners with the expertise to provide manipulative therapy, the North American Academy of Musculoskeletal Medicine may be of assistance.  (2875 Northwind Drive, Suite 207, East Lansing, Michigan 48823).  This organization is composed of osteopaths, physical therapists and M.D.s who recognize the need for incorporating manual medicine into mainstream health care.

    There are also a couple of excellent books available which explain Cayce's perspective on a wide range of illnesses which are common in primary health care.  The Physician's Reference Notebook by William A. McGarey, M.D. (1983) and Keys to Health: The Promise and Challenge of Holism by Eric Mein, M.D. (1989) provide an introduction  to the Cayce readings which most M.D.s will find helpful.  These books are available through the A.R.E. bookstore in Virginia Beach, Virginia.

    Depression need not be "underrecognized or misdiagnosed in the primary care practice".  Neither is it necessary to devalue it with the label of "secondary" depression.  The readings provide an integrated approach for understanding and treating depression in the primary setting.  However, to apply this model, clinicians must have a working knowledge of the Cayce readings on the various diseases and syndromes which present in the physician's office.  Furthermore, client's must be willing to cooperate in the therapeutic process by making lifestyle choices compatible with this approach.
 

The Importance of Cooperation

    Just as body, mind and soul must coordinate to maintain health, the therapeutic process is an exercise in cooperation.  Even in mild cases of depression, the readings did not expect the afflicted individual to simply "pick themselves up by the bootstraps."  The participation of sympathetic health care professionals were required to provide certain treatments.  Quite often, copies of the readings were provided directly to the health care provider in each case.  Interestingly, Cayce often had no conscious knowledge of the professional to whom the referral was made.

    In the most severe cases of depression, the patient might be referred to an institution such as the Still-Hildreth Osteopathic Sanitarium.  Even in these extreme cases, the readings encouraged the depressed person to participate in the treatment plan to whatever degree possible.  Thus, therapy was viewed as a cooperative venture between a suffering individual and one or more professionals open to the readings' holistic perspective on healing.
 

Summary

    The therapeutic model proposed in this chapter emphasizes health maintenance as a prerequisite for the treatment of depression.  Therefore, it inherently addresses both treatment and the prevention of relapse.  A basic treatment plan has been presented which forms the foundation of the model.  This plan consists of the most frequently recommended interventions in the Cayce readings on depression.  Generally speaking, these recommendations fall within the designation of preventative measures which address mild systemic imbalances (dis-ease).  The elements of the basic treatment plan were briefly listed and the purpose of each stated.  Lifestyle choices play a major role in the basic treatment plan.  While professional assistance is necessary for certain therapies, emphasis is placed on personal involvement.

    The basic treatment plan may be adapted for particular cases requiring specialized attention.  For example, bipolar disorder or psychotic depression may require more powerful interventions involving therapeutic milieu and more intense somatic therapies.  Obviously, the emphasis in these cases shifts toward increased professional involvement with the clinician augmenting the basic plan with supplemental (curative) interventions.  A thorough knowledge of the case studies of depression and the therapeutic modalities involved is necessary to customize the treatment plan in these cases.

    The importance of cooperation between the various health care professionals and the individual suffering from depression cannot be emphasized too strongly.  This is especially true in cases of "secondary" depression.  If the primary care physician is unsympathetic and uncooperative to the Cayce perspective on the linkage of depressive symptoms to underlying systemic pathology, the application of the therapeutic model is seriously compromised.  On the other hand, if the physician is in sympathy with the Cayce approach, both the "physical" disorder and depression can often be addressed with the same treatments.

    The therapeutic model proposed in this chapter is of necessity only an outline.  Just as the readings were hesitant to discuss diseases as a class (with a rigid treatment plan for each illness), the approach of this chapter has been to provide guidelines and direction rather than specific recommendations.  The reason for this is simple.  The lifestyle choices which are inherent in the basic treatment plan are best left to each individual.  Likewise, when the assistance of a health care professional is required, the specifics of treatment are usually determined by that professional.  However, the professional needs to be an informed practitioner.  It is the purpose of the next two chapters to provide detailed information to assist the professional and layperson in their cooperative contributions to the healing process.