I don’t feel that I’m good with Depression. Though my colleagues, supervisors and patients with depression have disagreed, I still can’t shake the feeling that depression is one heart malady which I could be better at helping my patients confront. Statistically speaking, that’s a big deal since, according to a recent article, 1 in 6 people are, or have been, suffering from depression.
As an ethical psychotherapist I must ask myself why. I think it’s because depression, more than any other issue, erodes motivation. Anxiety issues? People generally are eager to try new coping skills or get to the issues which prompt the constant feeling of nervousness and worry. Anger problems? Just get the patient angry enough at their own life story or condition and suddenly all that anger becomes rocket fuel. Oh, and because tears are behind nearly 102% (my figure) of anger issues. Hot tears that are trying to escape. But that’s another article. Depression. Depression is the swamp in the Never Ending Story. Once you’re in, you’re in. Once you stop seeing daylight, you begin to forget about daylight. You become like that turtle.
When I work with depression I try to keep three key things in mind. You can keep these things in mind if you think you are depressed. Please, though, if you think you are depressed, see the Helplinks page for more resources and find a therapist. Depression loves to cut you off and make you feel alone and helpless. Depression kills. The CDC reported that suicide is on the rise and depression increases the risk of suicide exponentially. Get help. Read this article first if you want, but get help. I’d suggest not reading further, getting help, then coming back.
Responding to the Response Problem
There are many flavors of depression. We have a problem-focused Situational Depression; fix the situation and the depression lifts. There’s a Dysthemic Disorder, which is essentially being “down in the dumps” and nothing brings pleasure. There’s the Depressive Disorder which is hard core, debilitating and brings a whole host of behavioral issues. However, for the sake of these three keys, those flavors don’t matter. What matters is that all of those flavors come under two categories—like sneeze guards at a buffet—organic problems or response problems. Honestly, organic is easier to fix. Find the right meds and you’re a great deal better.
Response problems, or Reactive Depressions, are best described by Welsh counselor and minister Selwyn Hughes as “…the depression that comes from the way we interpret the knocks and hardships that crowd into our lives.” A response problem is when all the little beat-downs of life, or one giant slam knock you down and you stay down. Maybe you get up physically, but you stay down emotionally. Just like there are many flavors of depression in our buffet, these flavors may also mingle. Sometimes medication is not forever if you work with a therapist to change your responses. Sometimes, if you only see a general practitioner to proscribe your anti-depressant, you may never look at your responses and end up feeling like you have a life-long disorder when you may not. In short, know what flavor you’re dealing with and what issue cooked it up, then chow down.
Absolutes Depress You Absolutely
Should, Must and Always are your enemies. Rigid thinking causes all manner of response problems and depression. Examples:
“I should get what I want.”
“I should be perfect.”
“Things must go my way or [I am a bad person] [God hates me] [I give up].”
“I must feel happy all the time.”
“This always happens to me.”
“It will always be this way.”
Depression is a tricky beast. Every one of these statements steals your ability to hope or your ability to cope. They set an impossible standard, seek an impossible result or leave you with an unchangeable situation. Changing “should” and “must” to “want to” and “like to” decrease stress and anxiety immensely. Changing “always” to “could” can bring freedom and hope sure as opening a window in a stuffy room. Go ahead and try it on the sentences above. Go ahead. We’ll wait.
Small Changes, Big results
I think what I hate most about depression is that it can befall a patient of mine so swiftly amid positive progress. Suddenly they’re back in the dark room and they can’t see their growth, their hopeful changes or their great accomplishments. They sit in darkness again and all those things seem impossible, fallible and hopeless. Their memory becomes quite selective of only their mistakes and failures, their future becomes the insurmountable mountain. In those moments I have to wrench tight my urge to dispute the negative perspective and slam on the light switch. Instead I have to remember to gently light a candle. Go back to the rigid thinking. Discuss the absolute. Taste the flavor of the malaise and judge if it is a response problem, a medication problem or a mélange of both.
Most of all, I have to remind myself, moment to moment, that even though it’s only a small candle, it’s already a big change. That is the secret which depression tries to hide under its bulk; small changes mean big results with depression. Any positive change in behavior, attitude, even meal time, can disrupt the cycle of negative thought or dispute the rigidity to the point that hope begins to wax and the depression wane. Think of the smallest change you can handle and start there.
F You Depression
I may do more “Three Keys to X Issue” posts. They won’t have a dedication at the end. This one does. I’ve worked with all manner of abuse, anger, anxiety, addiction and loss. I’ve never (to my knowledge) lost a kid to any of those, or any other issue. I lost a kid to depression. He had stopped being a patient of mine for almost two years when something he couldn’t respond to finally brought him to take his own life. I don’t hold any thoughts that I was in any way responsible. In fact, I still carry a note he left me on his discharge day about how much help I had been. What I do hold on to is the certainty that depression is a killer, and that it doesn’t have to be. This is why I try to be better at treating depression. This is why I say again to you, the one who read all this and thought “maybe I am depressed” but pushed the thought away or thought it too hard to solve, or too embarrassing, get help now. Light your candle. F the darkness.