Our Relationship With Our Therapist

 

 

 

 

 

 

 

 

 

If you have ever suffered from clinical depression, chances are that you have undergone psychotherapy.  Today, my musings will focus on the mysterious, intimate relationship between therapists and their clients in dealing with depression.

I guess you could say that I’m a veteran of therapy.  I first started going during my last year of law school.  This fledging attempt at “getting better” didn’t go so well.  At the time, my therapist was focused on helping me to recover from being raised by an alcoholic father.  Depression wasn’t even part of the conversation.  I was high achieving, but broken in some fundamental sense.  I really didn’t know who I was or how to be myself in the real world.  So, I pretended a lot. 

I pretended by learning how to please others.  Certainly, getting good grades was part of this basic formula. My mother and professors were certainly pleased.  I loved learning, but getting good grades was more than that.  I began to envision myself as a “success” and needed high grades to build on that identity.  Good grades would take me places, I thought. They eventually took me to law school and my new identity, after passing the Bar Exam, as a member of the legal profession.  I wasn’t just Dan, I was a “LAWYER”; an Esq. par excellence.

After becoming an attorney, I saw a therapist off and on.  They helped, but not in any enduring way. Years went by and I still felt that same sense of brokenness that I had when I first began therapy over twenty years ago.  I would bash myself with these critical questions:  ”Why can’t I get myself together after all these years of therapy?  Why can’t I figure all this out?”  These questions would haunt me for a long time. Little did I know that most people with depression struggled with the same misguided ruminations.

Psychologist James Hollis once said that the quality of our lives is driven by the quality of questions we ask ourselves.  Depression warps this questioning process.  The questions our melancholy ask of us are dead ends even though we don’t see them as such while we are engaged in such self-assessments.  A common lament: “What’s wrong with me?”  What good comes of this question for someone with depression?   Its focus is actually part of the illness and not a legitimate route out of it. It often compels us to make up a list of “Things to Do to Fix Myself” never realizing that we don’t need to fix ourselves so much as compassionately face ourselves.

I’ve had the same psychologist for the past three years.  His name is Jerry and he bears some resemblance to Freud with his grey beard, don’t you think? 

 He’s an Italian guy from the Bronx and a professor of psychology at one of our local universities.  I often waffle about how much can be accomplished from seeing a psychologist once every week or two.  But I am often surprised by the sustenance that I draw from Jerry, often in unexpected ways.

In my own depression, I found that I would often try to run away from the suffering of it all.  Alternatively, I would perpetuate it with negative thinking and unskillful behavior; I would literally step on the melancholy gas pedal. 

The famous psychoanalyst Carl Jung once wrote:  “The principle aim of psychotherapy is not to transport one to an impossible state of happiness, but to help the client acquire steadfastness and patience in the face of suffering.” We need to face our depression and perhaps learn that it won’t destroy us; we need to learn (yes, it is a skill you can learn) not to run from it or keep feeding it.  Jung’s wisdom was echoed by another renowned analyst, Helen Luke:  “The only valid cure for depression is the acceptance of real suffering.  To climb out of it any other way is simply laying the foundation for the next depression.”

Recently, I went through a painful episode in my life.  I was telling Jerry about my best friend, Steve, and said, “He told me that he will always be by my side 24-7.”  Jerry sat across from me with his wise eyes and paused.  He then said, with a sense of weighted authenticity, “Dan, I too will stand beside you and be with you at all times.”  The intimacy between us during that 10 second exchange was profound and stayed with me for a long time.  Can someone you see for 1 hour truly care about you in such an intimate way?  Yes. 

It can’t be faked, however. Maybe that’s part of the chemistry of having the right therapist and it’s a different equation for everyone.  I believe that it’s critical to have a therapist as our ally in our recovery from and management of depression on a consistent basis.  I believe consistency is important because people with depression often come from families where consistency was sorely lacking; they may not even have much it in their present lives.  Even if they do, it most likely needs shoring up.

In a loving way, let go of the questions that only lead you down depression’s dead ends.  Therapy is not only a questioning of negative habits that fuel depression, but a replacement with questions worthy of you.  In short, they are nothing short of the Great Questions:  “How can I bring more meaning in my life?  What are my greatest passions in life?”  It is only by facing and being present to the pain of our depression that we can learn to let it go and live out the great questions of our lives.

Chipping Away at The Iceberg of Depression

    

 

 

 

 

 

 

     James Hollis, Ph.D., the noted psychologist, once said that we spend the first half of our lives accumulating accolades for our resumes.  These same achievements, he opines, then become the biggest impediments to our making real and healthy changes in our lives.  It’s as if we are at an existential crossroad:  we look back –north for the sake of this analogy – and see what we have accomplished. We then look forward – south – and see an unknown and scary future as yet undefined.   “The past is who I am”, we think.  It offers us a sense of stability, a history and a comfortable life.  Nothing bad in and of itself.  Yet, we may be deeply unhappy and unhealthy.  We may even be suffering from depression because of the stress involved in accumulating these accomplishments.

     The prospect of real change is frightening.  We worry: “What if I make these changes in my life and things don’t get better.  Maybe they’ll even make my depression worse!” Yet, depression is a terrible liar; its voice drips with a corrosive inner directed sarcasm that seeks to undermine any meaningful recovery from it.  It disempowers us from seeking a way out of its meaningless labyrinth.  Its sole agenda is to keep perpetuating itself.

     In some real sense, we must stand up to our depression.  We must disassemble it piece by piece and try to understand what we are dealing with.  We must know its ways and how it manifests in our daily lives.  There are things that we do that propagate it; other things that let it wither on the vine.  

     I used to unwittingly feed my depression with my pensive nature.  In some dreamy sense, I thought I had some dramatic and sad existential take on the human condition.  Sort of like a modern day Tolstoy.  The problem, as I see it now, is that this propensity was not constructive and helpful.  It could, when fueled by the various conniptions of life, be overly dramatic.

     As I’ve previously blogged, pessimistic or distorted thinking is a hallmark of depression.  While I don’t think existential musings make one depressed, I do believe that when we take such thoughts too far or too seriously, we fuel depression. 

     I often think of depression as an iceberg.  We envision these monoliths as permanent, imposing and unshakable.  Yet, we know that they really aren’t.  An increase in temperature (e.g. think global warming) causes chunks of ice to start falling away from the iceberg’s hefty girth.  By standing up to depression, parts of it too begin to fall away.

     We don’t have to take our depression on all at one time, but take it on we must. I like to think of it as a kind of vow we make to ourselves .  Mahatma Gandhi once wrote:  “A vow is fixed and unalterable determination to do a thing, when such a determination is related to something noble which can only uplift the person who makes the resolve.” 

     Standing up to our depression is ennobling and courageous.  Rather than being a victim of depression – and there are sure to be times we feel that way – we can take a vow to stand up to it.

     Please try to be one of the thousands of people who stand up to depression everyday. I have been privledged to know some of these everyday heroes and it always reaffirms my faith in humanity.

Missing The Point

I recently read a tragic article about a young man at New York University who jumped to his death at the school’s library the other day.  One of the school’s spokesman said, “It’s a very competitive school that stresses people out. This sort of stuff happens at places like this”.  Sort of like a variation of “shit happens,” don’t you think?  I think this misses the point.

Some months ago, I wrote a blog article called, “The Death of a Law Student.” A brilliant young man – I’m sure much like the man who killed himself this past week – from Fordham Law School, David Nee, killed himself shortly before graduation.  While there may be no concrete answers to these tragedies, I feel that there are lessons to be learned.

First, when reporting these stories, there is usually no mention of the victim’s psychological history.  Neither is there in most news accounts of the 30,000 people who kill themselves every year in this country. 

That’s okay, because everyone has a right, as does their surviving family, to privacy.  Yet, I am sure if we were to know the whole story about these victims, we’d find that the majority of them had been suffering from depression for some time.  It wasn’t just “stress” or a “competitive academic environment” or a job loss which caused these deaths.  Perhaps, it was the latest in a series of emotional struggles; inner battles which that person fought valiantly but ultimately lost.

Second, I think these suicides underscore just how painful depression really is. Dr. Kay Redfield Jamison (click here to read an interview with her), author of the recent and definitive book, Night Falls Fast, captures this sense of pain:

“Depression paralyzes all the otherwise vital forces that make us human, leaving instead a bleak, despairing, and deadened state.  It is barren, fatiguing, and agitated condition:  one without hope or capacity.  All bearings are lost; all things dark and drained of feeling.  The slippage into futility is first gradual, then utter. Thought, which is pervasively affected by depression as mood, is morbid and confused.  The body is bone-weary; there is no will; nothing that is not an effort, and nothing that at all seems worth it.  Sleep is fragmented, elusive, or all-consuming.  Like an unstable gas, an irritable exhaustion seeps into every crevice of thought and action.”

It is so painful, in fact, that some sufferers would prefer death to the ongoing agony of dealing with depression for the rest of their lives.  They often conclude that the noonday demon will be with them forever because of their inner battle and many failures to overcome or contain it which have been going on for some time.  Seeing no progress or hope on the horizon, people take their lives.  They experience a sort of “combat fatigue.”  They just can’t get out of their foxholes.  It feels like a dead end.

It’s very difficult for suicidal people to think about anything but the pain they’re in.  It is hard for them to connect to the very real pain – emotional devastation really – that loved ones would feel were they to take their life.  It’s as if they’ve become unmoored from all those who care about them and can only hear the siren of depression’s screaming wail.

I have been encouraged by others who have never experienced depression not to blog about the “grim topic” of suicide.  To me, that’s like saying let’s not talk about cigarette smoking and cancer. Untreated depression – like smoking packs of cigarettes everyday- can and often does lead to death.

In a real sense, I don’t give a damn what others think.  I want to reach those people out there who are suffering with depression and need someone, for Christ’s sake, to tell them that they understand and they’re not crazy to feel this way – even when it comes to having suicidal thoughts.

People who have suicidal thoughts should seek help right away.  Click here for immediate help, a toll free number and additional resources. There were plenty of times during my deepest depressions that I felt like I couldn’t take it anymore.  And there was no hiding place; nowhere that I could go to escape the clutches of depression. It covered me like a wet wool jacket as I stumbled through my days.  I always reached out for help and it saved me.

I think that people who experience depression are very brave people.  They must cope with something very painful.  Often, they don’t feel supported. Often, even when they are really supported, they don’t think so because their depression tells them otherwise.  It’s the voice of depression giving them the old screw job every which way they turn. 

Had we broken arms or legs, it would be so simple.  Loved ones would respond – maybe with flowers and chocolates and a puffing up of our favorite pillow – with love and care.

Sometime ago, I was trying to tell my mother and older sister about my depression.  They weren’t terribly moved and I got angry.  I said, “Maybe, if my head were falling off and I was spouting blood, you would believe me then.  You would give me a damn ounce of compassion.”  Looking back on it, I really don’t think they were being selfish bastards.  I think that they just didn’t know.  They didn’t have any frame of reference for what depression is or just how painful it can get.

This really doesn’t make it any easier for the depressed person.  They feel misunderstood at a time when they feel broken.  They’re reaching out to people beyond their therapist and psychiatrists and hoping to find friendly souls to assuage some of their anguish.  “Surely, people will understand me and care about this,” they often think.  But others are often frightened and minimize the problem:  “Just get the hell over it” they preach from the pulpit.  All the while, we stand there, crying inside and feel all alone in a veritable wasteland. 

A few times, in the worst of times, I even thought that maybe if I really did kill myself, then others would take my pain seriously.  But what a supreme tragedy such an act would be; it doesn’t solve anything and would only leaves a cosmic trail of pain in its wake forever.  I am so grateful that I never acted on any of these impulses.

We all want so much to connect at a time when depression has disconnected us.  We feel ourselves falling with no parachute.  Yesterday, I give a presentation to thirty undergraduate students on the topic of depression.  After my talk, I fielded many questions.  One young woman asked, “what do you think helped you most in getting over your depression?”  First, I said that I hadn’t gotten over it; I would have it – in some form- probably for the rest of my life.  I told her that it was contained and manageable, not cured.  I also said: “Probably, what helped me the most was time.” My depression and who I am has changed over time.  It didn’t kill me.  I survived and continue to work at it like a miner digging for coal.  I have learned creative and effective ways to cope with it.  It doesn’t rule my days – most of the time.

After hearing my answer, she exclaimed, “How brave you are.”  I responded: “I really don’t feel brave at all.  What I do feel is determined”.  I feel determined to fight my depression in all of its manifestations.  I feel determined to not let it define me and my life.

It is such determination, over time, that helps us recover from depression.  It gives us hope because we can actually witness ourselves not giving into our melancholy.   We don’t need to keep being victimized by it.  Sure, there will be days when it might get the better of us.  But, as the old Zen saying goes, “fall down seven times, get up eight.”  Keep getting up.

The CEO of Depression

 

 

 

 

 

 

 

 

 

I’ve read lots of books and articles about depression. What’s strikes me about most of them is how redundant they are. It’s as if there is a place called “Depression Town” where a lot of these authors live and reach consensus about what should be in these books

Most of the books I’ve read didn’t particularly help, some did.  Yet, I felt compelled to keep buying them.  I would show up on a regular basis at my neighborhood Barnes & Noble looking for new self-help titles or troll Amazon hoping –just hoping – that there would be a depression book written especially for me.  During the worst of my depressions, I didn’t read the books so much as use them as emotional tourniquets.

The titles would usually be great – “10 Was to Stamp out Depression for Good”; the content not so much.  Many of the books were boring.  How could this be true, I thought?  How could they be writing about depression – one of the most God-awful experiences you can imagine – and bore me? Most of the authors seemed never to have suffered from depression. If they had, they didn’t say.  If they had, I wished that they had told me so.  Maybe I would have felt a greater connection to what they were trying to say.

I think it’s easy to get lost in so much advice. And we’re all seeking pearls of wisdom; nuggets of truth that we can take back to our nest and ponder.  I think the best wisdom not only deals with the particulars of depression, but also connects us to the larger human condition and all humans search for meaning within suffering.

Sister Kathryn James Hermes, author of the book, “A Contemplative Approach to Depression”, writes that prayer and contemplation help us to deal with depression in a larger spiritual context:

“Both of these practices lead to vulnerability – the learned powerlessness of the truly powerful who can simply be: simply wait, simply be present, simply wonder, simply trust that much larger hands are holding us and knows for whom we work in view of a much larger plan that we cannot as yet understand.”

Absent this, I think many of our efforts to get better may fall flat.  Without such nurturance, advice becomes just another self-improvement project.  Not much really changes.  Oh, it might for a short while.  We feel better, and then one of the wheels of our lives starts to wobble as we try to traverse our days.  We feel like that is something about ourselves that needs fixing, and we get to it. Yet, there’s something very isolating and lonely about these Oprah-like projects to remake ourselves.  Often, it involves rejection of some important element of who we really are. 

That being said, we may come to the conclusion that depression is bigger than us, but it’s not bigger than God. A God –however you define Him/Her, who “holds us in His/Her much larger hands.”

When the turbines of depression were really churning in my life, dealing with it felt like a full time job.  I had two jobs really – working as a lawyer and trying to get better.  This often, in retrospect, would take on a grim earnestness that wasn’t very constructive.  Sometimes, or so it seemed, God would drop these moments into my life to remind me not to take myself or my depression too seriously.

My then 5 year daughter would say, “Daddy works for the Depression Company.”  As I tucked her into bed at night, and looked into those magical eyes that all small children possess, I said, “That’s right honey.  And I’m the CEO.”

 

The Remains of the Day

 

 

 

 

 

 

 

 

“Then summer fades and passes and Fall comes.  We’ll smell smoke then, and feel the unexpected sharpness, a thrill of nervousness, swift elation, a sense of sadness and departure.”  -  Thomas Wolfe

I felt like a tortilla a few days ago; you know, flat and doughy.  There’s a realization that summer’s really gone, and that the chilling zaps of winter are on the horizon.

When I wake up now, it’s dark.  While driving to get my coffee, the whole murkinessof the morning is compounded by the cold rain hitting my windshield.  Long gone are the summer showers that can feel so refreshing.  These drops are brooding; they cover everything like oatmeal coming out of the sky.

I’m looking out the window at my regular coffee haunt – Starbucks.  I like the regularity of it as the seasons change in front of me.  Everybody there knows my name – sort of like Norm from Cheers.  I like this easy familiarity; especially the witty banter about the work day about to begin.

I start to read a book, but throw it back in my brief case.  The shortening of our days and sunlight, in my experience, seems to make depression a bit worse.  The dark dank seems to reflect our inner landscape.  I know winter’s coming – sort of like I felt when I knew the Bar Exam was coming.  Emily Dickinson captures the sense of the melancholic days of winter:

“There’s a certain Slant of light, Winter Afternoons – That oppresses, like the weight – Of cathedral tunes.  Heavenly hurt, it gives us; we can find no scar – But internal difference – Where the meanings are.”

For those of you who don’t know – but I’m sure most of you do – science has chimed in and concluded that the lack of sunshine makes some of us feel pretty crummy.  It’s called Seasonal Affective Disorder (“SAD”).  The reduced level of sunlight seems to cause a disruption in our biological clock which let’s you know when you should sleep or be awake.  It also can lower the levels of serotonin (a known culprit in depression) and melotonin which affects our sleep patterns.  Click here to see a list of symptoms compiled by The Mayo Clinic to see if you suffer from SAD. 

According to expert, Norman Rosenthal, author of the book, Winter Blues, there’s an estimated fourteen million Americans who suffer from SAD and another fourteen percent of the adult U.S. population estimated to suffer from the winter blues.  Dr. Rosenthal states: “Though these people are not usually affected severely enough to seek medical attention they nevertheless feel less cheerful, energetic, creative, and productive during the dark winter days than at other times of the year.”

The Mayo Clinic lists a number of remedies to treat SAD including medication, lifestyle and home remedies and alternative medicine.  Things that I’ve felt helpful are as follows:

The first is the purchase and use of a bright light.  It’s a box that throws off a high concentration of light.  You sit in front of it for thirty minutes to a hour and let these simulated sun rays soak into your brain.  For more information about how these devices work and places to buy them, check out the companies Sun Box, Inc. and Full Spectrum Solutions, Inc.

Second, I’ve found that it’s very important to schedule my vacations in the winter.  My family and I go to sunny locales and bask in the sun like tortoises.

Third, get warm anyway you can.  I do this in two ways.  I make regular trips to the sauna at my gym. There’s nothing like sitting around with a bunch of naked guys that you don’t know –some of them are pretty hairy – to work up a rejuvenating sweat. The only thing missing are feathered head dresses and peyote.  This can also be accomplished with using the old hot tub.  I also change to a “warming diet” when the cold winds blow.  Click here to check out a series of great articles (just click again on the “Healthy Tips” button located on left side tool bar) from Dr Elson Hass, author of the best-selling book, Staying Healthy with the Seasons.