Our Struggle with Depression

 

Everyone has had a taste of what depression feels like. Everyone feels the blues at times. Sadness, disappointment, fatigue are normal parts of life. There is a connection between the blues and clinical depression, but the difference is like the difference between the sniffles and pneumonia – Richard O’Connor, Ph.D.

Years ago:  I am walking down a Manhattan street on a grey day.  I am feeling so sad; beyond somber and without any external point of reference. I looked up at the grey buildings. I suddenly have the sense that I am a building; a tower with a cracked foundation slowly falling to the pavement below.

I step into a church I don’t know.  I try to pull myself together. “Please God. I need your help.” I have to be in Court shortly. I look at my watch. My suit feels tight against my skin. I struggle to make the sadness more manageable, more contained.  I leave because I must, not because I feel any better; but because I am an adult and have to move through my day, no matter the volume of pain ringing in my ears.

The sadness from that day would end.  I would feel better.    But a pattern was developing, even then.  A pattern of how I would respond to sadness in my life, both past and present.

The Struggle to Break Free   

Some folks have given up hope that depression will ever leave them alone. They’re just hoping for more good days than bad.  When it’s a relatively good day, when life is in flow and not stuck in the muck of melancholy, there is happiness, or perhaps, relief.  The depression gods’ hurtiling thunderbolts have missed them this day. But when they’re in the thick of it, they fight their sadness.  It’s as if they’re pressing on the gas trying to escape their pain while depression has its foot on the brake.

Sadness is not Depression – though they are cousins

First, let’s be clear: sadness is not depression, but it may manifest as persistent sadness that can be a symptom of clinical depression. When I developed depression ten years ago, my sadness was accompanied by lots of crying for no particular reason.

Paradoxically, Dr. O’Connor, in his book, Undoing Depression , wrote that depression is often the absence of despondency:

“We confuse depression, sadness, and grief.  However, the opposite of depression is not happiness, but vitality – the ability to experience the full range of emotions, including happiness, excitement, sadness, and grief.  It’s not sadness or grief, it’s an illness.”

Maybe this is why we don’t see – we don’t see how we react to our own sadness because we’re stuck in the vortex of depression where everything, like the perimeter of a tornado, is thrown together.

This relationship between sadness is troublesome for a depressive.  This is so not because there is anything wrong with sadness – it’s a normal part of the human experience and gives our lives depth and pitch.  It’s the bass tone you hear when B.B. King plays the Blues. In my experience, sadness has a bittersweet quality to it. As the great novelist Herman Hesse once penned, “It was if all of the happiness, all of magic of this blissful hour had flowed together into these stirring, bittersweet tones and flown away, becoming temporary and temporary once more.”

The Brain Knows How we React to Sadness

A recent study revealed that the brain’s response to sadness can predict a relapse into depression.  Faced with sadness, the relapsing patients showed more activity in a frontal region of the brain, known as the medial prefrontal gyrus.  These responses were linked to higher rumination: the tendency to think obsessively about negative events.  Patients who didn’t relapse showed more activity in the rear part of the brain, which is responsible for processing visual information and is linked to greater feelings of self-acceptance and non-judgment of experience. 

According to Norman Farb, Ph.D., who did the study:  “For a person with a history of depression, using the frontal brain’s ability to analyze and interpret sadness may actually be an unhealthy reaction that can perpetuate the chronic cycle of depression.  These at-risk individuals might be better served by trying to accept and notice their feelings rather than explain and analyze them.”

We keep trying to find the source of our sadness like squinting to find the bucket that has fallen in the deep well.  We circumambulate the hole, peering into the darkness, but don’t see the flashlight nearby that can help.  We can’t see that our attempt to break down and explain our sadness to ourselves isn’t helping – it’s hurting us.

A New Relationship to Our Sadness

In his book The Mindful Path to Self-Compassion, Christopher Germer, Ph.D., writes:

“This is an opportunity to move from mental work to heart work.  Self-compassion has a distinctly nonintellectual and non-effortful feel to it. If we can find ourselves in the midst of suffering and acknowledge the depth of our struggle, the heart begins to soften automatically. We stop trying to feel better and instead discover sympathy for ourselves. We stop trying to feel better and instead discover sympathy for ourselves. We start caring for ourselves because we’re suffering.”

Don’t always try to figure out your depression. Give yourself a breather from solving it, this boulder of sorrow. Instead, see that you – yes, you – are worthy of compassion from yourself because you suffer. If you don’t know how to feel this compassion for yourself, isn’t it about time to try?

 

 

The Storm Rolls In

There are many myths and misconceptions about clinical depression.  One of the most tiresome is that depression is just being down in the dumps – in my experience, it’s more like being down in the abyss.  Or, that depression is just everyday sadness. Who doesn’t get sad, after all, in today’s crazy world?

But depression isn’t normal sadness – not by a long shot. Everyday sadness – which is part of the human experience for everyone bar none — is usually a reaction to some sort of loss whether in real-time (you just lost your job) or in your mind (you have a sad memory).  After some period of time, our ability to adapt kicks in and our emotional world levels off; we regain a sense of emotional balance and are ready to face life challenges.

In contrast, clinical depression is persistent sadness (according to experts, something that last two weeks or more – see a list of other symptoms from the DSM- IV as laid by clicking the link above).  This sadness does not go away.  We do not adapt. We do not return to an emotional balance without some sort of treatment — whether it’s therapy, medication, life style changes (e.g. a committed exercise regimen) or some combination of all three.

Many folks with depression may also have an absence of the normal range of emotion – particularly the ability to experience joy. There is a flat affect – an emotionally deadening; tears are replaced by simply torment. Our emotional range, if you will, our palette of colorful emotions, is reduced to variations of grey or black.  Purples, greens and yellows are simply unable to bloom in depression’s arid soil.

The predominant feeling that all depression sufferers endure, if you could call it a feeling, is unadulterated pain; a sense of darkness that sets up residence in the core of our humanity like a burned out sun that has lost its sense of heat and light.

Some people recover from depression and go into complete remission. For many that fall into this group, their depression is contained by medication, therapy, life style changes and/or some combination of all of these.  Depression does not return, thank God.

Others – in my experience many – do not per se recover.  They have periods of recovery and episodes of relapse. Or, their depression goes from being Major depression (a truly crippling condition where daily functioning is all but impossible) to Dysthymia (a milder, but more chronic form of depression). The biggest difference between the two is that Dysthymia does not usually incapacitate someone and thoughts of suicide are absent.

Stress can trigger the mercenaries of depression to return during a relapse and assault our mind’s garrisons – – a big problems if you’re a lawyer.  Too much stress, too many triggers and a lawyer who had been doing pretty well finds herself or himself falling into the basement of despair.  This underscores the importance of learning about the patterns of depression in our lives so as to head it off at the pass.

It’s as if each person’s depression (while sharing some common features – hence the DSM IV) has its own personality, like the classic children’s book Where the Wild Things Are.  We must learn read the habits of our depressions because we will then be able to recognize the signs of the trouble brewing inside our heads.

Like a storm seen in the distance from the shore, those who’ve been through a depression can sense the barometric pressure dropping and see the threatening clouds approaching. We may not tell others of this sense of foreboding because we don’t want to concern others, feel that they wouldn’t understand or conclude that they can’t do anything to help anyway.

Other signs begin to appear as the storm moves closer to shore: we don’t have the energy to return calls at the office (our voicemail box becomes digital chunks of impatient clients or opposing counsel calling back for the third time), a fragmentation of our ability to think and concentrate and a strong desire to isolate ourselves and wait – for God knows how long – for the storm to pass.

Just as storms form because of a combination of climatic condition, so too does depression.

For law students, their personality types (often neurotic, perfectionist and overachieving), run head on into the pessimistic thinking style they learn in law school – the buzz saw of learning to “think like a lawyer.”  This pessimistic style, finds trouble everywhere it looks.  It may make us good lawyers, but often unhappy – and depressed – human beings.

For practicing lawyers, the qualities they took into and learned from law school meet head on with the extraordinary demands of a modern law practice.  We’ve come to name those who grew up and fought in World War II “The Greatest Generation.” Perhaps today’s lawyers might be thought of as “The Driven Generation.” Law has become less of a profession and more of a business. 

For a lawyer who has goes through a relapse of depression, it’s often befuddling to them why they’re they are going through all this shit again. But regardless of the reason, there you are in the thick of it; the vaporous stink of depression has fallen on you like used up coffee grounds.  It seems, most assuredly, unfair.  Yet, there it is.

Here are some thoughts about preventing relapse and how to keep you feeling well:

  • Learn about how your depression expresses itself.  When you start to experience the early warning signs of a depression, talk about with a professional.  Read  5 Depression Relapse Triggers to Watch For which should give you some further signs to watch for.
  • Watch your thoughts.  In myself, I can see a shift from a relatively optimistic outlook to a pessimistic one.  I am quicker to judge others and assume the worst about them and their behavior – as well as myself.  When not in this space, I am likely to be more forgiving and – I am sure my wife would agree – easier to hang out with! Read, Therapy Better Than Antidepressants at Heading Off New Bout Triggered by Sadness.
  • People who relapse are often people who stop taking their medication.  They do so because they’ve been taking it for awhile, feel better and decide they just don’t want to take it anymore.  This can often have disastrous consequences: a return of depression or even suicide.  Beware of this and carefully plan out with a professional how to taper off medication if that’s where you would like to go.  Read, What is Depression Relapse and Can It Happen to Me?

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