The Upside of Depression and the Downside of Medication

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Are there advantages to being depressed? Something good about something we think of as so bad? A recent New York Times Magazine article by Jonah Lehrer makes just that case: Depression’s Upside.

The essence of the argument is that some episodes of depression allow for and encourage a kind of analytic rumination that is productive. Put another way, the tendency in depression to focus on a problem, mulling it over to the exclusion of other thoughts, permits the sad person to find a solution to his difficulty and change his life in a positive way.

The counter-argument, however, is that the ruminative process is both painful and unproductive — that it often creates a kind of self-flagellating preoccupation with one’s trouble rather than a process that leads to something good; that unhappiness and focusing on pain and its concomitants simply feed on themselves to no helpful end.

In my clinical experience, therapy with people who are depressed over loss or injury often breaks down into two phases. The first of these is a grieving process, where the person expresses and processes (or sometimes purges) the feelings of anger, sadness, emptiness, desolation, and hopelessness that come with the loss of something of value — a love, a job, high social status, a capability, a fortune, etc.

The second phase involves learning from one’s painful experience about how to live differently, make different decisions, associate with different people, become more assertive, overcome fear; value things differently in life such as money, material things, status, accomplishment, friendship, and love.

Naturally, neither of these two phases is absolutely discrete — they blend into each other and overlap each other. As a practical example, someone who has had a series of bad relationships will typically need to grieve the unhappy end of the most recent one and, in the process, learn how he happened to choose a person or persons who made him so miserable; then changing whatever needs to be changed internally and externally so that different and more satisfying choices occur in the future.

People who are like the hypothetical individual just cited usually come into therapy in emotional pain and seek relief of that pain as promptly as possible. This desire is entirely reasonable — who wouldn’t want this? Some of them request medication, which is often the fastest way to “feel better.”

But many are leery of psychotropic drugs and see them as artificial, hoping that therapy will produce a more lasting fix without dependency upon a foreign substance. Indeed, while a good therapist will strongly encourage the use of medication for someone who is seriously depressed, i.e. suicidal, unable to work, sleeping away the day away (or almost unable to sleep); that same therapist will also know that medication sometimes serves to “de-motivate” the patient, giving him or her a relatively quick solution that allows that person to tolerate an intolerable situation. In the New York Times Magazine article mentioned above, Dr. Andy Thomson describes this problem eloquently:

I remember one patient who came in and said she needed to reduce her dosage. I asked her if the antidepressants were working, and she said something I’ll never forget. ‘Yes, they’re working great. I feel so much better. But I’m still married to the same alcoholic son of a bitch. It’s just now he’s tolerable.’

Clearly, this woman was aware that she needed to be in some amount of discomfort in her relationship with her husband in order to be motivated to get out of it. The drug made her feel better, but, it also reduced her incentive to change herself and her life. It was, in effect, a kind of band-aid, rather than a real cure. It anesthetized her and, in so doing, robbed her of something that was essential for new learning and behavior change to occur.

Unfortunately, most people who come to therapy are neither as courageous or insightful as the woman just described. Once they feel significantly better, whether due to therapy or medication, it is common for them to be less interested in continuing treatment. They have recovered from the event that precipitated their entry into therapy, but they might not yet have learned enough to avoid making the same mistakes that contributed to the problem in the first place.

Such a person can reason that the cost of therapy (both financially and in terms of time, effort, and the difficulty that comes with changing one self) is now greater than emotional pain from which they might still be suffering. Put another way, at this point, doing therapy “causes” more difficulty and pain than not doing therapy, just the reverse of what seemed true when they started the treatment process.

At this stage, those who continue in therapy have something that an old mentor of mine, Truman Esau, used to call “therapeutic integrity.” What he saw in some of his patients was an almost heroic desire to make themselves better regardless of how much the actual process of doing so was difficult, uncomfortable, or painful.

These patients didn’t shy away from problematic truths about themselves or others. They worked hard to stretch and challenge themselves, knowing that it was crucial to improve. They didn’t simply want a quick fix. Like the woman in Dr. Thomson’s example, they recognized that some pain was essential to being motivated. They knew that there was no such thing as “a free lunch,” and were willing to do whatever it took to repair and better their lives.

If you are in therapy now, it will be important for you to be sensitive to this shift from the often intense distress that brought you into therapy, to the point when the therapy itself might seem distressful. This can mean that the therapist is not skillful or that he is pushing you too much, but it just might also signal that some of the most difficult life changes you need to make are still ahead of you, even if the cost of making those changes seems greater than when you started treatment.

If you leave therapy because it is hard and unpleasant work, the problems you have won’t care. They will simply continue to reside in you, work on you, and trip you up. It is not enough to get over your last disappointment or unhappiness, but to change yourself enough to avoid future problems.

Few things that are worthwhile come to us for free.

The above image titled Depression is the work of Hendrike, sourced from Wikimedia Commons.

Fifty Positive Steps to Change Your Life

Australian State Route Shield

You might think it an odd place to begin changing your life, but consider this: write your own obituary. What is it that you’d like someone to say about you after you are gone?

One of the tricks to changing your life is to widen your imagination, break your routine, and see and think about things differently. Here are 49 more small steps that you might consider in the process of reconfiguring yourself:

If you are a city dweller, drive far enough away from the city to see the stars on a clear night. There are lots more than you think.

Think of someone you dislike and make a list of all of their positive qualities.

Volunteer to do something that might be described as “community service.”

Start to write your autobiography.

Write a short story.

Eat a raisin slowly, as if you’d never tasted one before.

Go to a fancy restaurant and eat a meal alone; or go to a concert, play, or movie alone.

Make a list of all the things you are grateful for.

Apologize to someone who deserves your apology, including a “no excuses” statement of regret and some method of attempting to make-it-up to them.

Re-contact an old elementary school friend.

If your physician allows it, begin a weight-lifting program.

Wake up early to see the sun rise.

Make two lists, one of your strengths and another of your faults.

Create a “bucket list:” all the things you’d like to do before you “kick the bucket.” Make plans to do one of them within the next year.

Tell someone how much you appreciate him and why.

Write a letter. Hand write it.

Do some routine task (eating for example) with your non-dominant hand.

Build something, even if it is only a model airplane.

Grow something.

With adequate supervision so that you don’t get hurt, spend some time blindfolded.

Take an academic course.

Meditate.

Take a yoga class.

If you aren’t a dancer, learn to dance.

Remember all of the difficult life challenges that you’ve overcome and identify the qualities in you (strengths) that allowed you to overcome them.

Imagine a different and more rewarding life than the one you currently lead. What do you need to do to create it?

Create a five-minute comedy monologue and deliver it to a group of friends.

Learn to sing or play a musical instrument.

Play chess.

Give up something for a month (for example, TV, a favorite food, alcohol, caffeine, or listening to music).

If you have no children, consider becoming a “Big Brother” or a “Big Sister.”

Learn a foreign language.

Participate in a team sport.

Start a philanthropic project with some friends, no matter how small it might have to be.

Visit a public high school in the inner-city and think about the future of this country and what you can do to make it better.

Clean out your closet.

Imagine that you are to be stranded on a desert island and can only take five non-essential items with you. What would they be?

If your memory was going to be erased, what would be the single memory that you would ask to be spared? Why that one?

Go on a retreat.

Teach someone something. Show them “how it is done.”

Give some money (even if its only a dollar) to some needy person you know; and do it anonymously!

Buy a hard copy of one of the few remaining great newspapers in the USA (for example, the New York Times, Washington Post, or Wall Street Journal) and read every word. Then think about the fact that a Bell Labs study reportedly estimated that the average sixteenth century man had less information to process in a lifetime than can be found in a single daily edition of the New York Times.

If you wear a tie, tie the knot in a new way (most men tie a Four-in-Hand knot, but there are some others that actually look better).

Paint, draw, sketch, or sculpt something.

If you haven’t done so already, read Becker’s The Denial of Death.

Walk to some destination that you usually reach by car or pubic transportation.

Make a list of all that you have learned about life since finishing your formal education.

If you don’t have a tatoo, get a temporary tatoo (if there are no health risks to you) and observe how people look at you differently; if you have a prominent tatoo and can cover it up, walk around and notice the way that people look at you now.

Send me a suggestion on one more step to change your life.

The image of the Australian State Route Shield is sourced from Wikimedia Common.

Making the Same Mistakes Over and Over: How to Learn From Childhood

There are few perfect childhoods out there. Indeed, it’s the nature of childhood to have some tough times. You are small, you don’t know anything, everything has to be learned for the first time. No wonder its a challenge! The adults tower over you and the big kids can belittle you, push you around, and trip you up. Literally.

So what do we do to survive childhood? Well, we figure out some strategies to deal with the problems that we face. For example, if you have an angry parent, you might learn to be sensitive to signs of upset in someone else, know when to keep your head down, try not to ruffle feathers. On the other hand, if you had a parent who only gave you attention when you were helpful and solicitous, doing things like looking after your younger siblings, you could have learned how to take care of others and seen that quality as, perhaps, one of your only virtues.

Often, the solutions that were necessary early in your life don’t work very well in the “older” (which is to say “current”) version of you. Being sensitive to possible anger in friends, lovers, and coworkers could well find you cowering unnecessarily, accepting half-a-loaf because your are afraid that if you speak up, you will get none. Being a care-taker as an adult might get you some initial approval, but it can prove unsatisfying when the person you are with expects that you will do all the caring and give all the help in the relationship, but doesn’t think to give much back to you.

It’s a little bit like this: Imagine that you were born in Alaska, learned to wear heavy clothes and multiple layers. It was a solution that was necessary and one that worked. If you continue to live in Alaska, you will find success if you use the same solution forever. But, should you move to South Florida and operate by the same set of internalized rules, now you will have quite a problem!

Childhood solutions only are useful to adults if you continue to live in circumstances similar to your childhood. But, by definition, most of us live in different circumstances. We are not any longer so small and defenseless, so unworldly and innocent. We now have much more capability to change the world around us. Unfortunately, some of us don’t know it.

Are you doing the same things that you did as a kid, using solutions that haven’t solved anything for a while? Are you suppressing emotions because that¬† was a good strategy in an uncaring childhood home? Are you still afraid of situations that resemble your early life challenges? Do you still avoid difficulties, never having figured out how to face them?

It’s worth taking an inventory of your early life and, even more importantly, your current life.¬† Look frankly at what did or didn’t work as a kid (and what does or doesn’t work now), asking yourself whether youthful difficulties produced a way of being that isn’t helpful. If you keep using failed solutions, you will likely continue to experience failure. Most of our problems are patient. They wait for us to recognize them and then to solve them. They can wait a lifetime.

Is that how you want to spend the rest of your life, making the same mistakes, accepting less than what might be possible and good for you? If you are willing to wait in that way, don’t call a therapist; you are too patient and not sufficiently motivated to change. But if you are beginning to be aware of how unsatisfying your way of living is and have the courage to face that fact, do call. That’s what therapists are there for.