Why So Many Lawyers Suffer From So Much Depression

As to being happy, I fear that happiness isn’t in my line. Perhaps the happy days that Roosevelt promises will come to me along with others, but I fear that all trouble is in the disposition that was given to me at birth, and so far as I know, there is no necromancy in an act of Congress that can work a resolution there.” – Benjamin N. Cardozo, February 15, 1933

Law is a prestigious and remunerative profession, and law school classrooms are full of fresh candidates. In a recent poll, however, 52% of practicing lawyers describe themselves as dissatisfied. Certainly, the problem is not financial. Associates at top firms could earn up to $200,000 per year just starting out, and lawyers long ago surpassed doctors as the highest-paid professionals. In addition to being disenchanted, lawyers are in remarkably poor mental health. They are at much greater risk than the general population for depression. Researchers at John Hopkins University found statistically significant elevations of major depressive disorder in only 3 of 104 occupations surveyed. When adjusted for sociodemographics, lawyers topped the list, suffering from depression at a rate of 3.6 times higher than employed persons generally. ( A more recent study from 2016 found that lawyer suffered from depression at a rate nearly three times that of the general public). Lawyers also suffer from alcoholism and illegal drug use at rates far higher than nonlawyers. The divorce rate among lawyers, especially women, also appears to be higher than the divorce rate among other professionals. Thus, by any measure, lawyers embody the paradox of money losing its hold. They are the best-paid professionals, and yet they are disproportionately unhappy and unhealthy. And lawyers know it; many are retiring early or leaving the profession altogether.

Positive Psychology sees three principal causes of the demoralization among lawyers.

Pessimism

pessimism

First is pessimism, defined not in the colloquial sense (seeing the glass as half empty) but rather as the pessimistic explanatory style. These pessimists tend to attribute the causes of negative events as stable and global factors (“It’s going to last forever, and it’s going to undermine everything.”). The pessimist views bad events as pervasive, permanent, and uncontrollable, while the optimist sees them as local, temporary and changeable. Pessimism is maladaptive in most endeavors: Pessimistic life insurance agents sell less and drop out sooner than optimistic agents. Pessimistic undergraduates get lower grades, relative to their SAT scores and past academic record, than optimistic students. Pessimistic swimmers have more substandard times and bounce back from poor efforts worse than do optimistic swimmers. Pessimistic pitchers and hitters do worse in close games than optimistic pitchers and hitters. Pessimistic NBA teams lose to the point spread more often than optimistic teams.

Thus, pessimists are losers on many fronts. But there is one glaring exception: Pessimists do better at law. We tested the entire entering class of the Virginia Law School in 1990 with a variant of the optimism-pessimism test. These students were then followed throughout the three years of law school. In sharp contrast with the results of prior studies in other realms of life, the pessimistic law students on average fared better than their optimistic peers. Specifically, the pessimist outperformed more optimistic students on the traditional measures of achievement, such as grade point averages and law journal success.

Pessimism is seen as a plus among lawyers because seeing troubles as pervasive and permanent is a component of what the law profession deems prudence. A prudent perspective enables a good lawyer to see every conceivable snare and catastrophe that might occur in any transaction. The ability to anticipate the whole range of problems and betrayals that non-lawyers are blind to is highly adaptive for the practicing lawyer who can, by so doing, help his clients defend against these far-fetched eventualities. If you don’t have this prudence to begin with, law school will seek to teach it to you. Unfortunately, though, a trait that makes you good at your profession does not always make you a happy human being.

Sandra is a well-known East Coast psychotherapist who is, I think, a white witch. She has one skill that I have never seen in any other diagnostician: She can predict schizophrenia in preschoolers. Schizophrenia is a disorder that does not become manifest until after puberty, but since it is partly genetic, families who have experienced schizophrenia are very concerned about which of their children will come down with it. It would be enormously useful to know which children are particularly vulnerable because all manner of protective, social and cognitive skills might be tried to immunize the vulnerable child. Families from all over the eastern United States send Sandra their 4-year-olds; she spends an hour with each of them and makes an assessment of the child’s future likelihood of schizophrenia, an assessment that is widely thought of as uncannily accurate.

This skill of seeing the underside of innocent behavior is super for Sandra’s work, but not for the rest of her life. Going out to dinner with her is an ordeal. The only thing she can usually see is the underside of the meal – people chewing. Whatever witchy skill enables Sandra to see so acutely the underside of the innocent-looking behavior of a 4-year-old does not get turned off during dinner, and it prevents her from thoroughly enjoying normal adults in normal society. Lawyers, likewise, can not easily turn off their character trait of prudence (or pessimism) when they leave the office. Lawyers who can see clearly how badly things might turn out for their clients can also see clearly how badly things might turn out for themselves. Pessimistic lawyers are more likely to believe they will not make partner, that their profession is a racket, that their spouse is unfaithful, or that the economy is headed for disaster much more readily than will optimistic persons. In this manner, pessimism that is adaptive in the profession brings in its wake a very high risk of depression in personal life. The challenge, often unmet, is to remain prudent and yet contain this tendency outside the practice of law.

Low Decision Latitude

stressed

A second psychological factor that demoralizes lawyers, particularly junior ones, is low decision latitude in high-stress situations. Decision latitude refers to the number of choices one has – or, as it turns out, the choices one believes one has – on the job. An important study of the relationship of job conditions with depression and coronary disease measures both job demands and decision latitude. There is one combination particularly inimical to health and moral: high job demands coupled with low decision latitude. Individuals with these jobs have much more coronary disease and depression than individuals in other three quadrants.

Nurses and secretaries are the usual occupations consigned to that unhealthy category, but in recent years, junior associates in major firms can be added to the list. These young lawyers often fall into this cusp of high pressure accompanied by low choice. Along with the shared load of law practice (“this firm is founded on broken marriages”), associates often have little voice about their work, only limited contact with their superiors, and virtually no client contact. Instead, for at least their first few years of practice, many remain isolated in a library, researching and drafting memos on topics of the partners’ choosing.

A Win-loss Game

winloss

The deepest of all the psychological factors making lawyers unhappy is that American law is becoming increasingly a win-loss game. Barry Schwartz distinguishes practices that have their own internal “goods” as a goal from free-market enterprises focused on profits. Amateur athletics, for instance, is a practice that has virtuosity as its good. Teaching is a practice that has learning as its good. Medicine is a practice that has healing as its good. Friendship is a practice that has intimacy as its good. When these practices brush up against the free market, their internal goods become subordinated to the bottom line. Night baseball sells more tickets, even though you cannot really see the ball at night. Teaching gives way to the academic star system, medicine to managed care, and friendship to what-have-you-done-for-me-lately. American law has similarly migrated from being a practice in which good counsel about justice and fairness was the primary good to being a big business in which billable hours, take-no-prisoners victories, and the bottom line are now the principle ends.

Practices and their internal goods are almost always win-win-games: both teacher and student grow together, and successful healing benefits everyone. Bottom-line businesses are often, but not always, closer to win-loss games: managed care cuts mental health benefits to save dollars; star academics get giant raises from a fixed pool, keeping junior teachers at below-cost-of-living raises; and multi-billion dollar lawsuits for silicon implants put Dow-Corning out of business. There is an emotional cost to being part of a win-loss endeavor. In Chapter 3 of my book, I argue that positive emotions are the fuel of win-win (positive-sum) games, while negative emotions like anger, anxiety, and sadness have evolved to switch in during win-loss games. To the extent that the job of lawyering now consists of more win-loss games, there is more negative emotion in the daily life of lawyers.

Win-loss games cannot simply be wished away in the legal profession, however, for the sake of more pleasant emotional life among its practitioners. The adversarial process lies at the heart of the American system of law because it is thought to be the royal road to truth, but it does embody a classic win-loss game: one side’s win equals exactly the other side’s loss. Competition is at its zenith. Lawyers are trained to be aggressive, judgmental, intellectual, analytical and emotionally detached. This produces predictable emotional consequences for the legal practitioner: he or she will be depressed, anxious and angry a lot of the time.

Countering Lawyer and Unhappiness

new-lawyers

As Positive Psychology diagnoses the problem of demoralization among lawyers, three factors emerge.Pessimism, low decision latitude, and being part of a giant win-loss enterprise. The first two each have an antidote. I discussed part of the antidote for depression in Chapter 6, in my book

Pessimism, low decision latitude, and being part of a giant win-loss enterprise. The first two each have an antidote. Chapter 6 of my book details a program for lastingly and effectively countering catastrophic thoughts. More important for lawyers is the pervasive dimension-generalizing pessimism beyond the law – and there are exercises in Chapter 12 of my book, Learned Optimism that can help lawyers who see the worst in every setting to be more discriminating in the other corners of their lives. The key move is credible disputation: treating the catastrophic thoughts (“I’ll never make partner,” “My husband is probably unfaithful”) as if they were uttered by an external person whose mission is to make your life miserable, and then marshaling evidence against the thoughts. These techniques can teach lawyers to use optimism in their personal lives, yet maintain the adaptable pessimism in their professional lives. It is well documented that flexible optimism can be taught in a group setting, such as a law firm or class. If firms and schools are willing to experiment, I believe the positive effects on the performance and moral of the young lawyers will be significant.

As to the high pressure-low decision latitude problem, there is a remedy as well. I recognize that grueling pressure is an inescapable aspect of law practice. Working under expanded decision latitude, however, will make young lawyers both more satisfied and more productive. One way to do this is to tailor the lawyer’s day so there is considerably more personal control over work. Volvo solved a similar problem on the assembly lines in the 1960’s by giving its workers the choice of building a whole car in a group, rather than repeatedly building the same part. Similarly, a junior associate can be given a better sense of the whole picture, introduced to clients, mentored by partners, and involved in transactional discussions. Many law firms have begun this process as they confront the unprecedented resignations of young associates.

The zero-sum nature of law has no easy antidote. For better or for worse, the adversarial process, confrontation, maximizing billable hours, and the “ethic” of getting as much as you possibly can for your clients are much too deeply entrenched. More pro bono activity, more mediation, more out-of-court settlements, and “therapeutic jurisprudence” are all in the spirit of countering the zero-sum mentality, but I expect these recommendations are not cures, but Band-Aids. I believe the idea of signature strengths, however, may allow law to have its cake and eat it too – both to retain the virtues of the adversarial system and to create happier lawyers.

When a young lawyer enters a firm, he or she comes equipped not only with the trait of prudence in lawyerly talents like high verbal intelligence, but with an additional set of unused signature strengths (for example, leadership, originality, fairness, enthusiasm, perseverance, or social intelligence). As lawyers’ jobs are crafted now, these strengths do not get much play. Even when situations do call for them, since the strengths are unmeasured, handling these situations does not necessarily fall to those who have the applicable strengths.

Every law firm should discover what the particular signature strengths of their associates are. Exploiting these strengths will make the difference between a demoralized colleague and an energized, productive one. Reserve five hours of the work week for “signature strength time,” a non-routine assignment that uses individual strengths in the service of the firm’s goals.

There is nothing particular to the field of law in the re-crafting of jobs. Rather, there are two basic points to keep in mind as you think about these examples and try to apply them to your work setting. The first is that the exercise of signature strengths is almost always a win-win game. When Stacy gathers the complaints and feelings of her peers, they feel increased respect for her. When she presents them to the partners, even if they don’t act, the partners learn more about the morale of their employees – and of course, Stacy herself derives authentic positive emotion from the exercise of her strengths. This leads to the second basic point: There is a clear relation between positive emotion at work, high productivity, low turnover and high loyalty. The exercise of a strength releases positive emotion. Most importantly, Stacy and her colleagues will likely stay longer with the firm if their strengths are recognized and used. Even though they spend five hours each week on non-billable activity, they will, in the long run, generate more billable hours.

Law is intended as but one rich illustration of how an institution (such as a law firm) can encourage its employees to re-craft the work they do, and how individuals within any setting can reshape their jobs to make them more gratifying. To know that a job is a win-loss in its ultimate goal – the bottom line of a quarterly report, or a favorable jury verdict – does not mean the job cannot be win-win in its means to obtaining that goal. Competitive sports and war are both eminently win-loss games, but both sides have many win-win options. Business and athletic competitions, or even war itself, can be won by individual heroics or by team building. There are clear benefits of choosing the win-win option by using signature strengths to better advantage. This approach makes work more fun, transforms the job or the career into a calling, increases flow, builds loyalty, and it its decidedly more profitable. Moreover, by filling work with gratification, it is a long stride on the road to the good life.

Martin E. P. Seligman, Ph.D., is the Fox Leadership Professor of Psychology at the University of Pennsylvania, the Director of the Positive Psychology Network, and former President of the American Psychological Association. Among his 20 books are Learned Optimism and The Optimistic Child. Here, from his book Authentic Happiness: Using the New Positive Psychology to Realize Your Potential for Lasting Fulfillment, is his chapter entitled “Why Are Lawyers So Unhappy?”

© by Martin Seligman. Reprinted with permission from the author.

Are you a law student or lawyer struggling with depression? Do you need help developing a practical, constructive game plan to help you cope and recover from depression?  If so, I can help.  I created my life coaching practice specifically devoted to helping law students and lawyers who struggle with this condition. Visit my website at www.yourdepression.com to learn more.Share this:

The Blues Is Depression. Should You Treat It With Pills?

What people refer to as the blues is usually depression.  Depression, or the blues, is an unpleasant emotional state characterized by what therapists refer to as “the negative cognitive triad.”  That’s 1) negative thoughts about oneself, which are the voices of your inner critic harping on you for what you supposedly have done wrong, should have done differently, and on and on 2) negative thoughts about others that lead you to see what you don’t like in them instead of heeding their virtues and enjoying them, creating relationship problems and 3) negative thoughts about the future.

Some people describe the blues, and also depression, as feeling like there’s a dark cloud over you.  Others refer to depression as seeing the world through dark glasses.  Feelings of hopelessness and helplessness are another indicator.

How can you get rid of your blues and your inner critic by treating the underlying depression?

There are four main strategies:

  1. Change your feelings.Take pills or use one of the newer treatment methods that change your bluesy mood by changing your inner body chemistry and brain functioning.
  2. Change your thoughts.  Eliminating the inner critic may get rid of the depressed, bluesy feelings.
  3. Change your actions. Get exercise.  Go out and be with people.  Express more gratitude.  Do acts of kindness.
  4. Identify and address the problem that initially triggered your depressed feelings and thoughts.  Find a new solution and both the negative feelings and the negative thoughts will evaporate.

Why do people take antidepressant medications?

There are four main reasons why people who may be distressed by something in their lives end up defining their depression as an illness and taking medication.

First and foremost, depression is a terrible feeling that sufferers sorely want to get rid of.

Second, most folks have not been fully informed of the medications’ downsides. I’ll elaborate on drug dependency below.  In addition, these medications can cause serious weight gain, a significant drop in libido (ability to enjoy sex), hazy thinking, and a general emotional numbness that blocks feelings of joy in addition to feelings of depression.

Third, people who take the medications may not have been informed of their relatively low rate of effectiveness.  They can be effective if they work, but they only work for something like about 60% of people who use them.

Fourth, most people who take anti-depressant medications have not been informed by their doctor about alternative treatment options.  To a man with a hammer, the world is a nail.  Physicians know about illness and prescribe medications.  As psychologist Martin Seligman has explained, depression is a relatively normal, if quite unpleasant and often self-defeating, response of giving up in response to a challenging life circumstance.

What are the downsides of assuming that depression is an illness and therefore needs pills? 

As mentioned above, two particularly negative side effects of medication that doctors do not sufficiently explain include potential weight gain and decreases inability to experience sexual arousal. Doctors may mention them but often do not clarify that both extra pounds and decreased interest in sex can have strongly negative impacts on personal self-esteem, on attracting a mate and on sustaining a marriage.

The other significant risk that doctors may or not fully explain is that users may have a hard time getting off these medications.  When a drug company says that their anti-depressant medication is not addictive, strictly speaking, they are telling the truth.  A strict clinical definition of an addictive substance or activity is one that induces both dependency and craving.  Antidepressants do not induce craving.  Over time they do, however, make users drug dependent.

Craving is a familiar feeling to anyone who has fallen in love.  The intense sexual desire that drives someone in love to find every way possible to be near the object of their desire is a craving.  Someone who craves alcohol similarly may wake up in the morning already urgently wanting a drink.

What does “drug dependent” mean?   Drug dependency is the state a body goes into when it has adapted to the presence of a chemical to the point that the body requires steady doses of the substance to maintain normal functioning. We are all, for instance, chemically dependent on water.

Our society is highway-dependent.  Many of us have become accustomed to having highways that enable us to drive to work from the suburbs.  Having bought a house in the suburbs on the assumption that we can take the highway to work, we have become highway dependent.  It’s unlikely that anyone has a craving for highways.  Many of us though have become highway dependent.

If you for some time have been taking an antidepressant medication, the odds are that your body has become drug dependent.  That means that if you should decide today that as of tomorrow you will no longer take the medication, starting tomorrow, you are likely to discover that without the pills that you normally take your body will plunge into a serious depressive state.

Does this depression mean that you need after all to stay on your meds because the pills are all that have stood between you and the depths of despair?   Not at all.  To the contrary, this depression means that your body has become dependent on the antidepressant pills.  Is this addiction?  No, but it is drug dependency.

I am not saying that no one should ever take antidepressant medication.  They do help some people.  Some people experience relatively few to zero negative side effects.  My point is just that if you are considering taking these medications, or have for some time been using them, you deserve accurate information about the factors to take into account in your decision, including information about other treatment options.

Here are six vital points to consider.

1) There now are multiple excellent alternatives to medication for working your way out of depression, including various kinds of talk therapies such as CBT, energy therapies such as Bradley Nelson’s Emotion Code and Body Code, acupuncture, exercise, electrical stimulation of the brain, the visualization you can download for free from my website, or read about how to do on one of my other blogposts, couples therapy, and more.

2) Depression is induced by a situation in which you have experienced insufficient power. If you close your eyes and picture whom or what you may feel angry at, you will see an image of the trigger person or situation. Fix that situation, and your depression will be likely to go away.

3) If your doctor is recommending medication as a short-term fix, use the pills until you feel better. Use your renewed energy to address the power-loss situation. Then begin the medication-weaning process asap.

4) Wean slowly. Consult your prescribing doctor for an appropriate weaning schedule for the particular medication that you are taking.

5) Be aware that research has shown that the most powerful way to overcome depression and keep it far from you, in the long run, is the combination of therapy and medication. Medication alone and psychotherapy alone have very similar effectiveness rates, but medication has an impact more quickly, and psychotherapy tends to have more longer-lasting impacts.

6) There is a visualization exercise that you can do with a therapist, a friend, or on your own that may help you conquer the depression in just a few minutes.  See my posting on A New Treatment for Depression.

6) In my clinical experience, I find that most depression is a response to relationship problems. Look into marriage educationcouples counseling, or a combination of both to upgrade your relationship. These treatment routes can make you a double winner.  You can both end the depression and simultaneously gain a vastly more gratifying marriage or romantic partnership.

Susan Heitler, Ph.D., a Denver Clinical psychologist, is an author of multiple publications including From Conflict to Resolution for therapists, The Power of Two and poweroftwomarriage.com for couples who want to strengthen their relationship. Dr. Heitler’s most recent book is Prescriptions Without Pills, with a free companion website at prescriptionswithoutpills.com.

 

How Exercise Reduces Depression, Anxiety, Cynicism, & Anger

Exercise is good for you. If you’re procrastinating a run or putting off a walk, then we recommend that you close your computer and get outside, content in the knowledge that you have fully grasped the thesis of our article. If you are still here, then we assume that you would like to know more.

First, let’s review exercise’s benefits for the body.

Individuals who exercise a total of 7 hours per week have a premature mortality rate 40 percent less than those who exercise less than 30 minutes per week. Physical activity also appears to reduce your risk for colon and breast cancers. Furthermore, there is evolving evidence that physical activity may also reduce your risk for endometrial and lung cancers.1–3

Research also suggests that health benefits may be appreciated from even modest exercise programs. As little as 2.5 hours of exercise per week significantly reduces your risk of type 2 diabetes and cardiovascular disease. When it comes to exercise, half a loaf really is better than none. In fact, physical inactivity is estimated to cause one in 25 deaths worldwide each year.1–3

And yet despite all that is known about the health benefits of exercise, a little more than 50 percent of Americans do not meet the current CDC recommendations of 2.5 hours of moderate-intensity (50-70 percent maximal heart rate) or 1.25 hours of vigorous intensity (70-85 percent maximal heart rate) exercise per week.1

For reference, maximal heart rate can be calculated by taking 208 – 0.7 x age (an older, unvalidated version of this equation used 220 as the base).4 As an example, a 30-year old’s maximal heart rate is calculated to be 187 beats per minute (“bpm”). This means that in our 30-year old example, a moderate-intensity activity should achieve a heart rate of at least 94 bpm while a vigorous-intensity exercise should aim for a target of at least 131 bpm.

We will return to these parameters in a moment, but for now, let’s turn to the benefits of exercise for the brain.

Before diving in, it is necessary to review the concept of effect sizes. An effect size expresses the difference between two groups; usually between a treatment group and a control group. Effect sizes are calculated as numbers but can be represented categorically as “small,” “medium,” “large,” and “very large.”5–7

Very generally, a medium effect size should be able to be “seen” by the naked eye. For example, in Professor Jacob Cohen’s pioneering work on the subject, he cited the difference in average height between 14-year-old and 18-year-old females to be an example of a medium effect. As an example of a large effect, Professor Cohen cited the difference in IQ between a “typical” college freshman and a “typical” Ph.D. holder.5 For the purposes of our discussion, the larger the effect size, the more likely it is that the treatment (e.g. exercise) is better at treating depression than the control condition (e.g. no exercise).

With our introduction to effect sizes out of the way, let’s study the effects of exercise on the brain.

Studies have demonstrated a strong antidepressant effect for exercise. For example, one meta-analysis that examined well-controlled studies of exercise as an intervention for clinical depression found a very large effect size when compared to nonactive control groups. Notably, previous work had demonstrated a large effect size for study populations of undifferentiated clinical and non-clinical subjects with depressed mood.8

We wish to pause at this point to put these antidepressant effect sizes for exercise in perspective. Let’s turn briefly to effect sizes associated with various psychiatric and general medical pharmaceuticals and treatments. We will use the most optimistic estimates of efficacy for the various classes of interventions so as to level the playing field as much as possible. We fully acknowledge that we will not be comparing apples to apples. The following discussion is not meant to be a definitive statement regarding the efficacy of various treatments. Instead, we hope that the comparisons will help place the magnitude of exercise’s effect size in context.

To begin, let’s compare exercise’s large or very large effect size with antidepressant medication’s small effect size in acute depressive episodes.9 Psychotherapeutic interventions have similar effect sizes to psychopharmacologic medication in the treatment of depressive episodes. However, the combination of psychotherapy and psychopharmacologic medication yields a medium effect size; a value notable for its superiority to either intervention offered in isolation.10 Electroconvulsive therapy for an acute depressive episode has a large effect size.11

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There are numerous potential confounding variables in this very brief comparative overview. Despite every effort to control for the various confounds, it is likely that depressed cohorts who were able to exercise were qualitatively different in some ways from some of the populations included in electroconvulsive trials for example. Researchers have employed various techniques to try to eliminate these confounds, and there are reasons to treat much of the data as valid, but caution is certainly warranted.

Antipsychotics for acute psychosis, antihypertensives for high blood pressure, and corticosteroids for the prevention of asthma exacerbations all have similar medium effect size. Whereas, antibiotics for ear infections and metformin for diabetic mortality have small effect sizes. To find a general medicine medication with an effect size on par with exercise we have to turn to proton pump inhibitors and their large effect size in the treatment of esophagitis.9 In fact, the mean effect size for all general medical medications corresponds to a small effect.10

Research has revealed benefits for exercise in other domains of mental health as well. Meta-analytic reviews have found a small effect size for exercise on state or trait anxiety.8 However, upon closer examination research reveals that exercise has a stronger effect on state anxiety than on trait anxiety.12

Evidence also suggests a broader application of exercise beyond strictly pathological states.13–15 One large non-clinical population-based study demonstrated that individuals who exercised more than two times per week experienced reductions not only in depressive symptomatology, but also in cynical distrust, anger, and stress when compared to individuals who exercised less often.15

There is also significant evidence for a dose-response relationship between exercise and mental health. Exercise regimens with higher intensities, greater frequencies, and longer durations tend to lead to greater response rates in depressed populations. Interestingly, depression remission rates seem to peak at moderate levels of intensity, frequency, and duration suggesting that sustainability of a regimen is an important ingredient to consider when developing a program.8

The setting that one exercises in also appears to play a role. Research has demonstrated that exposure to nature and so-called “green space” exerts powerful effects on mood and self-esteem. Exercising outdoors in a natural setting with trees and plants appears to be superior to exercising in an environment devoid of such “green” qualities. The positive effects rapidly develop with even just five minutes of outdoor time offering a very achievable goal even for busy individuals.3

Interestingly, natural settings with bodies of water present (e.g. streams, rivers, lakes, etc.) appear to offer enhanced benefits over and above those seen in other natural settings.3 Natural settings seem to exert their positive effects on health through a variety of mechanisms; however, it should be noted that the effects are not fully explained by the association of green space and exercise.16 In fact, greater exposure to nature, in general, has been associated with as much as a 12 percent reduction in all-cause non-accidental mortality!17

How does exercise exert these far-ranging effects?

There are many gaps in our understanding of the mechanisms by which exercise exerts its anxiolytic and antidepressant effects. There is some evidence that exercise may increase turnover of serotonin, leading to an adaptive downregulation of the serotonergic 5-HT2C receptor. Activation of the 5-HT2C receptor seems to inhibit dopamine and norepinephrine release. Thus, a downregulation at the 5-HT2C receptor leads to an increase in availability of dopamine and norepinephrine. This effect is thought to be particularly important in the prefrontal cortex and is hypothesized to contribute to the anxiolytic and antidepressant effects associated with exercise.8

In addition to increasing serotonin turnover exercise seems to trigger a release of beta-endorphins. Endorphins are part of the brain’s endogenous opioid system and also tend to produce anxiolytic and antidepressant effects when released.8

From a more macroscopic scale exercise, like antidepressant medication, helps restore sleep patterns frequently disrupted in the setting of depression. Furthermore, evidence suggests that activity in the prefrontal cortex is reduced during exercise and that this modification of cognitive processing may correlate with the subjective anxiolytic and antidepressant effect of exercise.8

Finally, exercise engages an individual in an activation and approach set of behaviors that are diametrically opposed to passive and avoidant cognitive strategies classically found in depression and many other psychopathological states. In this way exercise seems to operate on a similar theoretical framework as the psychotherapeutic technique known as behavioral activation. Behavioral activation targets behavior first rather than cognition as many other forms of psychotherapy do.18 It must be noted that although exercise may be a component of a behavioral activation treatment regimen, the psychotherapeutic technique utilizes many other activation strategies to catalyze change.8

Let’s be optimistic and imagine that the preceding discussion helped you move from the contemplative to the preparatory stage of change and that you are preparing to make a change in your exercise habits.19 How much exercise do you need to get before you can appreciate the mental health benefits?

Evidence suggests that an optimal exercise program is about 30 minutes in duration, has a frequency of 2-4 times per week, and is of such an intensity level that an individual achieves 70-80 percent estimated max heart rate.8

Recall that our maximal heart rate from our 30-year old example was calculated to be 187 bpm. This means that the targeted intensity level of exercise for mental health should achieve a heart rate between 130-150 bpm.

Finally, the individual should commit to at least four weeks of the new exercise program to optimize the chances for long-term habit formation. Evidence suggests that while 70 percent of individuals maintain a short-term exercise program, only 50 percent maintain the program for six months.8

We have covered a lot of ground in our exploration of the varied health benefits associated with exercise.

We began by discussing the significant benefits of exercise for our general medical health. We learned that exercise reduces rates of mortality, some cancers, type 2 diabetes, and cardiovascular disease. For more on the mortality benefits of exercise visit our website Neuraptitude.org.

We next turned to exercise and mental health, studying depression as our archetype condition. We found that exercise can be considered a valid “antidepressant” or augmentation strategy in the treatment of depression and that its effects are comparable to antidepressant medication and psychotherapy.

As we discussed before, we are not comparing apples to apples, and direct comparisons between techniques are not fair outside of a given trial. Our point is not to assert the unrivaled superiority of exercise to psychopharmacologic agents, psychotherapeutic techniques, or other therapeutics. Rather, we wish to elevate exercise from a healthy lifestyle habit to an adjunct treatment.

And finally, let’s recall that exercising in natural outdoor settings, ideally in close proximity to a body of water, may enhance the health benefits associated with exercise.

The most effective treatment for a given mental illness is almost certainly to be pluralistic rather than singular. A holistic treatment strategy that targets biological, psychological, and sociological substrates of disease offers a significant synergistic advantage over a singular approach.

By Matthew Mackinnon, M.D.

Dr. MacKinnon is a psychiatric resident physician at the University of Washington who researches and writes about the neuroscientific intersection of mental health and mental illness. Dr. MacKinnon runs Neuraptitude.org, an online scientific publication dedicated to uncovering the natural capacities of the human mind by exploring topics that reveal, bit by bit, the intrinsic enormity latent within the brain.

 References

  1. Centers for Disease Control and Prevention (CDC). Physical activity and health. CDC.gov.https://www.cdc.gov/physicalactivity/basics/pa-health/. Accessed November 12, 2016.
  2. Penedo FJ, Dahn JR. Exercise and well-being: a review of mental and physical health benefits associated with physical activity. Curr Opin Psychiatry. 2005;18(2):189-193.
  3. Barton J, Pretty J. What is the Best Dose of Nature and Green Exercise for Improving Mental Health? A Multi-Study Analysis. Environ Sci Technol. 2010;44(10):3947-3955. doi:10.1021/es903183r.
  4. Tanaka H, Monahan KD, Seals DR. Age-predicted maximal heart rate revisited. J Am Coll Cardiol. 2001;37(1):153-156. doi:10.1016/S0735-1097(00)01054-8.
  5. Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, N.J: L. Erlbaum Associates; 1988.
  6. Fritz CO, Morris PE, Richler JJ. Effect size estimates: Current use, calculations, and interpretation. J Exp Psychol Gen. 2012;141(1):2-18. doi:10.1037/a0024338.
  7. Sawilowsky S. New Effect Size Rules of Thumb. Theor Behav Found Educ Fac Publ. November 2009.http://digitalcommons.wayne.edu/coe_tbf/4.
  8. Stathopoulou G, Powers MB, Berry AC, Smits JAJ, Otto MW. Exercise Interventions for Mental Health: A Quantitative and Qualitative Review. Clin Psychol Sci Pract. 2006;13(2):179-193. doi:10.1111/j.1468-2850.2006.00021.x.
  9. Leucht S, Hierl S, Kissling W, Dold M, Davis JM. Putting the efficacy of psychiatric and general medicine medication into perspective: review of meta-analyses. Br J Psychiatry. 2012;200(2):97-106. doi:10.1192/bjp.bp.111.096594.
  10. Huhn M, Tardy M, Spineli LM, et al. Efficacy of Pharmacotherapy and Psychotherapy for Adult Psychiatric Disorders: A Systematic Overview of Meta-analyses. JAMA Psychiatry. 2014;71(6):706. doi:10.1001/jamapsychiatry.2014.112.
  11. Lisanby SH. Electroconvulsive Therapy for Depression. N Engl J Med. 2007;357(19):1939-1945. doi:10.1056/NEJMct075234.
  12. Paluska SA, Schwenk TL. Physical Activity and Mental Health.Sports 2000;29(3):167-180. doi:10.2165/00007256-200029030-00003.
  13. Stephens T. Physical activity and mental health in the United States and Canada: Evidence from four population surveys. Prev Med. 1988;17(1):35-47. doi:10.1016/0091-7435(88)90070-9.
  14. Taylor CB, Sallis JF, Needle R. The relation of physical activity and exercise to mental health. Public Health Rep. 1985;100(2):195-202.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1424736/. Accessed November 8, 2016.
  15. Hassmén P, Koivula N, Uutela A. Physical Exercise and Psychological Well-Being: A Population Study in Finland. Prev Med. 2000;30(1):17-25. doi:10.1006/pmed.1999.0597.
  16. Bowler DE, Buyung-Ali LM, Knight TM, Pullin AS. A systematic review of evidence for the added benefits to health of exposure to natural environments. BMC Public Health. 2010;10:456. doi:10.1186/1471-2458-10-456.
  17. James P, Hart JE, Banay RF, Laden F. Exposure to Greenness and Mortality in a Nationwide Prospective Cohort Study of Women. Environ Health Perspect. 2016;124(9). doi:10.1289/ehp.1510363.
  18. Cuijpers P, van Straten A, Warmerdam L. Behavioral activation treatments of depression: A meta-analysis. Clin Psychol Rev. 2007;27(3):318-326. doi:10.1016/j.cpr.2006.11.001.
  19. DiClemente CC, Prochaska JO, Fairhurst SK, Velicer WF, Velasquez MM, Rossi JS. The process of smoking cessation: An analysis of precontemplation, contemplation, and preparation stages of change. J Consult Clin Psychol. 1991;59(2):295-304. doi:10.1037/0022-006X.59.2.295.

 

Stress and Depression

Survival depends on the speed of noticing and responding to threats to our safety. In a depressed brain, the parts of the brain that are scanning for danger and responding to it are overly active. Perceiving threat comes too easily. There are several factors about this necessary and natural biological response that may contribute to depression.

  • The response time is one such factor. Humans are biologically geared to respond to threat with a physical response to it. Without thought or decision, the brain/body makes possible necessary, immediate action when a threat, or stressor, occurs. Regardless of the level of overt danger, when a person feels a threat, the body responds immediately with arousal in the nervous system, intensifying heart rate, respiration rate, and blood pressure to allow for rapid physical activity. This response is proportional to the threat and ends when the threat is gone. A person also gets a release of energy, the activity of the stress response system, needed to fuel the rapid physical activity. These responses are lifesaving when threats to safety occur – but they are also an underlying factor in developing depression when they are overly active. Some people are born with brain structure that commits too many brain cells to scanning for danger, making the threat response too active.
  • The intensity of the sympathetic response may be too great, meaning that the level of arousal and the way it triggers stress response is excessive proportional to the threat. This too can be genetic, or it may be an outcome of early childhood adversity causing high arousal to even smaller threats. It is also important to note that traumatic experience often results in hypervigilant attention to the environment and also a biological tendency to overreact to reminders of the trauma.
  • Another aspect of how the threat response system can contribute to depression is how hard it may be to calm the stress response or the nervous system arousal. When these two systems that govern response to stressors are insufficiently supplied with the neurochemicals that bring them back to homeostasis or that buffer brain structures from the impact of the arousal, a person may be negatively affected by the very systems that should otherwise be protective. Unable to calm down quickly enough, the strong and persistent arousal of the nervous system and the stress response system is damaging in several ways. One theory of depression is that the inflammation throughout the body will ultimately cause many kinds of physical and emotional outcomes, not the least of which is depression.

The threat in a modern world may not be the overt danger that human systems developed to cope with stress but rather any situation that calls for a response, even when the demand for physical energy is unnecessary. For example, the stressor may be a situation that is not unexpected or dangerous. It could be a boss who makes a demand for overtime hours when you want to be home with your family or a child who is sick and keeping you awake at night. Those may be temporary and insignificant in general, but when they are ongoing or when they are too frequent then the stress system becomes antagonistic to health.

Over-activation of the nervous and stress response systems ultimately exhaust the brain/body. You can help yourself be less affected by stress. A person may, by genetic predisposition, respond too intensely to a normal level of threat or ongoing life stress may exhaust the supply of energy and create distress. Since so many of us live lives that are filled with stressors that are not the life-death-get-up-and-run variety, we would be well advised to learn the means to diminish stress. While each person must apply these guidelines to his or her own situation, the outline is simple:

  1. If at all possible, eliminate your stressor. Deciding to change is often the hardest thing people do: Can you stop trying to do something that is just too difficult, that you do not have the capacity for? Can you walk away from things that you cannot control and then manage your guilt for not trying? You might need the perspective of an outside observer to help you figure this out.
  2. Manage your time or manage your environment. Learn to make good use of lists to create job tasks by prioritizing or stop saying yes to demands for your help when you have too much to do. And learn the skills to organize the environment. Trying up may be life-changing indeed for some, but the diminished stress of an orderly environment can be life-saving, especially when you combine it with using calendars, reminders, and lists to manage time.
  3. Manage your attitude. Lightening up and finding your sense of humor can go a long way toward lowering your stress level. So, can becoming more sanguine about life experience. Learn to tell the difference between what is urgent is important and then learn that urgent may sometimes just be ignored.
  4. Learn to relax. This is not just about ‘vegging out in front of a program or video game. It is about loosening those muscles and calming the mind. Whether you do best with brief and frequent breaks every day or relax with longer periods of muscle relaxation, either way, it is a relief to your brain/body to relax. People who develop apps know this, so, it turns out there are countless options to use technology to guide your relaxation practice. You may be one of those who relaxes via vigorous exercise. But relax. Daily.

When you have addressed these four means to diminish the intensity of your response to ordinary life stress, then you will be on your way to eliminating depression too.

By Margaret Wehrenberg, Psy.D.

Dr. Wehnrenberg is a coach and therapist, an author, and an international trainer and speaker on topics related to psychotherapy for anxiety and depression, stress management and optimizing anxiety for achievement. She is a practicing psychologist, coaching for anxiety management and providing psychotherapy for anxiety and depression disorders. She has been a trainer of therapists for 25 years, and she is a sought-after speaker for continuing education seminars, consistently getting the highest ratings from participants for her dynamic style and high-quality content. Her individualized coaching for panic, worry and social anxiety has helped professionals from entrepreneurs to corporate executives, from sales personnel to IT specialists.

Margaret is a frequent contributor to the award-winning Psychotherapy Networker magazine and has produced Relaxation for Tension and Worry, an audio file for breathing, muscle relaxation, and imagery to relax. Audio and DVD versions of her training are available for obtaining CEU’s. She has seven books on topics of anxiety and depression published by W.W. Norton, a and a workbook, Stress Solutions, published by PESI. Check out her website MargaretWehrenberg.com.

 

 

 

On Depression, Hope, Hopelessness, and Freedom

Hope is a desire for something combined with an anticipation of it happening, it is the anticipation of something desired. To hope for something is to make a claim about something’s significance to us, and so to make a claim about ourselves.

One opposite of hope is fear, which is the desire for something not to happen combined with an anticipation of it happening. Inherent in every hope is a fear, and in every fear a hope. Other opposites of hope are hopelessness and despair, which is an agitated form of hopelessness.

Hope is often symbolized by harbingers of spring such as the swallow, and there is a saying that ‘there is no life without hope’. Hope is an expression of confidence in life, and the basis for more practical dispositions such as patience, determination, and courage. It provides us not only with aims but also with the motivation to attain those aims. As the theologian, Martin Luther said, ‘Everything that is done in the world is done by hope.’ Hope not only looks to the future but also makes present hardship easier to bear, sustaining us through our winters.

At a deeper level, hope links our present to our past and future, providing us with an overarching narrative that lends shape and meaning to our life. Our hopes are the strands that run through our life, defining our struggles, our successes and setbacks, our strengths and shortcomings, and in some sense ennobling them. Running with this idea, our hopes, though profoundly human—because only humans can project themselves into the distant future—also connect us with something much greater than ourselves, a cosmic life force that moves in us as it does in all of nature. Conversely, hopelessness is both a cause and a symptom of depression, and, in the context of depression, a strong predictor of suicide. “What do you hope for out of life?” is one of my most important questions as a psychiatrist, and if my patient replies “nothing” I have to take that very seriously.

Hope is pleasant in so far as the anticipation of a desire is pleasant. But hope is also painful, because the desired circumstance is not yet at hand, and, moreover, may never be at hand. Whereas realistic or reasonable hopes are more likely to lift us up and move us on, false hopes are more likely to prolong our torment, leading to inevitable frustration, disappointment, and resentment. The pain of harboring hopes, and the greater pain of having them dashed explains why most people tend to be modest in their hoping.

In his essay of 1942, The Myth of Sisyphus, the philosopher Albert Camus compares the human condition to the plight of Sisyphus, a mythological king of Ephyra who was punished for his chronic deceitfulness by being made to repeat forever the same meaningless task of pushing a boulder up a mountain, only to see it roll back down again. Camus concludes, ‘The struggle to the top is itself enough to fill a man’s heart. One must imagine Sisyphus happy.’

Even in a state of utter hopelessness, Sisyphus can still be happy. Indeed, he is happy precisely because he is in a state of utter hopelessness, because in recognizing and accepting the hopelessness of his condition, he at the same time transcends it.

Neel Burton, M.D., is a psychiatrist, philosopher, writer, and wine lover who lives and teaches in Oxford, England. He is a Fellow of Green-Templeton College, Oxford, and the recipient of the Society of Authors’ Richard Asher Prize, the British Medical Association’s Young Authors’ Award, the Medical Journalists’ Association Open Book Award, and a Best in the World Gourmand Award.He is author of Heaven and Hell: The Psychology of the EmotionsHide and Seek: The Psychology of Self-Deception, and other books.

 

 

 

The Ups and Downs of a Bipolar Life: An Interview with Tom Roberts

Hi, I’m Dan Lukasik from LawyersWithDepression.com.

Today’s guest is Tom Roberts. Tom is a mental health speaker and writer living in Huntington Beach, California.  He’s the author of “Escape from Myself: A Manic-Depressive’s Escape to Nowhere” Tom earned his Master’s Degree in Radio, Television, and Film from the University of Kansas. He worked for several years as a broadcast journalist for local stations and freelanced for National Public Radio’s popular newscast “All Things Considered,” “The Voice of America,” and “ABC Radio News.” Tom has been a professional actor on stage, screen, and television and currently does voice-over work in the L.A. area. He is the creator of the website Tom Speaks Out!

Decoding Depression

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When I talk about medicine and mental health to large audiences, I often start with the following imagery and facts: think of a woman you know who is radiantly healthy. I bet your intuition tells you she sleeps and eats well, finds purpose in her life, is active and fit, and finds time to relax and enjoy the company of others. I doubt you envision her waking up to prescription bottles, buoying her way through the day with caffeine and sugar, feeling anxious and isolated, and drinking herself to sleep at night. All of us have an intuitive sense of what health is, but many of us have lost the roadmap to optimal health, especially the kind of health that springs forth when we simply clear a path for it. The fact that one in four American women in the prime of their life are dispensed medication for a mental health condition represents a national crisis.

Humans have used mind-altering substances to try to dull and deaden pain, misery, sorrow, and suffering since time immemorial, but only in the last few decades have people been persuaded that depression is a disease and that chemical antidepressants are the remedy. This is far from the truth. Many of my patients have been to multiple doctors, bumping up against the hard ceiling of what conventional medicine has to offer. Some have even tried integrative medicine, which aims to combine both traditional medicines (i.e. prescriptions) with alternative treatments (e.g. acupuncture). After all, they are told that there are great natural complements to all the wonders pharmaceutical products have to offer. But the reason they can’t find a solution is because nobody has asked why.  Why are they unwell? Why are their bodies creating symptoms that manifest as depression? Why didn’t they stop to ask this important and obvious question the first time they experienced a flat mood, anxiety, insomnia, and chronic exhaustion?

Before I even get to the answers, let me be the first to tell you that the only path to a real solution is to leave the medical world you know behind. This, the journey I will take you on, is not just about symptom suppression, it’s about health freedom. First let me tell you that I was once a typical doctor, not to mention a typical American who loved pizza, soda, birth control, and ibuprofen. My message is from a personal journey and thousands of hours of research that has compelled me to share the truth about prescription-based care: we’ve been duped.

Yes, my entire training was based on a model of disease care that offers patients only one tool – a drug – and never a shot at true wellness. We’ve handed over our health to those who seek to profit from it, and we’ve been buying into a paradigm based on the following notions:

  • We are broken.
  • Fear is an appropriate response to symptoms.
  • We need chemicals to feel better.
  • Doctors know what they are doing.
  • The body is a machine requiring calibration (via drugs). A little too much of this, too little of that.

I call this collective set of notions the Western Medical Illusion. It sets up a vicious system that ushers you into lifelong customer status, dependent and disempowered.

As you can likely guess by now, I love to rant. But I do so with the best evidence science can offer, and there’s a lot we know today about the real root cause of depression – and how to treat the condition safely and successfully – without a prescription pad. If there’s one lesson I will drive home, it’s this: shed the fear, take back your inner compass, and embrace a commitment to your best self, medication free. Even if you don’t already take a prescription drug, I bet you still doubt living the rest of your life prescription free and reliant on your own inner intuition to know what’s best for you. The idea of supporting your body’s innate wisdom may sound quaint at best or like dangerous hippie woo-woo at worst.  From now on, I want you to embrace these new ideas:

  • Prevention is possible.
  • Medication treatment comes at a steep cost.
  • Optimal health is not possible through medication.
  • Your health is under your control.
  • Working with lifestyle medicine – simple everyday habits that don’t entail drugs – is a safe and effective way to send the body a signal of safety.

How can I make these statements, and what do I mean by life-style medicine? I’ll be presenting scientific proof.  When I first meet with a woman and her family, I speak about how to reverse her anxiety, depression, mania, and even psychosis. We map out the timeline that brought her where she is and identify triggers that often fall under one or more of the following categories: food intolerances or sensitivities, blood sugar imbalances, chemical exposures, and thyroid dysfunction, and nutrient deficiency. I forge a partnership with my patient and witness dramatic relief within thirty days. I do this by teaching my patients how they can make simple shifts in their daily habits, starting with the diet. They increase nutrient density, eliminate inflammatory foods, balance blood sugar, and bring themselves closer to food in its ancestral state. It’s the most powerful way to move the needle because food is not just fuel. It is information (literally: “it puts the form into your body”), and its potential for healing is a wonder to me every single day.

Achieving radical wellness takes sending the body the right information and protecting it from aggressive assault. This isn’t just about mental health; it’s about how mental health is a manifestation of all that your body is experiencing and your mind’s interpretation of its own safety and power. It’s also about how symptoms are only the visible rough edges of a gigantic submerged iceberg.

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Not that none of these concepts connects with substances in the brain that might be “low.” If you had to define depression right now, before reading further, chances are you’d say something about it being a “mood disorder” or “mental illness” triggered by a chemical imbalance in the brain that probably needs to be fixed through medications like Prozac or Zoloft that will lift levels of brain chemicals associated with a good mood. But you would be mistaken.

So many patients today who are being shepherded into the psychiatric medication mill are overdiagnosed, misdiagnosed, or mistreated. Indeed, they have “brain fog,” changes in metabolism, insomnia, agitation, and anxiety, but for reasons only loosely related to their brain chemicals. They have all the symptoms that are mentioned in a Cymbalta advertisement that tells them to talk to their doctor to see if Cymbalta is right for them. But it’s like putting a bandage over a splinter in the skin that continues to stir inflammation and pain. It’s absolutely missing an opportunity to remove the splinter and resolves the problem from the sources. And it’s an iconic example of how conventional medicine can make grave mistakes, something the pharmaceutical industry is more than happy to encourage.

In holistic medicine, there are no specialties. It’s all connected. Here’s a classic case in point: Eva had been taking antidepressants for two years but wanted to get off it because she was planning to get pregnant. Her doctor advised her not to stop taking the drug, which motivated her to see me. Eva explained that her saga had begun with PMS, featuring a week each month was she was irritable and prone to crying fits. Her doctor prescribed a birth control pill (a common treatment) and soon Eva was feeling even worse, with insomnia, fatigue, low libido, and generally flat mood dogging her all month long.  That’s when the doctor added the Wellbutrin to “pick her up,” as he said, and handle her presumed depression. From Eva’s perspective, she felt that the antidepressant helped her energy level, but it had limited benefits in terms of her mood and libido. And if she took it after midnight, her insomnia was exacerbated. She soon became accustomed to feeling stable but suboptimal, and she was convinced that the medication was keeping her afloat.

depressed-middle-aged-woman

The good news for Eva was that with careful preparation, she could leave medication behind – and restore her energy, her equilibrium, and her sense of control over her emotions. Step one consisted of some basic diet and exercise changes along with better stress response strategies. Step two involved stopping birth control pills and then checking her hormone levels. Just before her period, she had low cortisol and progesterone, which were likely the cause of the PMS that had started her whole problem. Further testing revealed borderline low thyroid function, which may well have been the result of the contraceptives – and the cause of her increased depressive symptoms.

When Eva was ready to begin tapering off the medication, she did so following my protocol. Even as her brain and body adjusted to not have the antidepressant surging through her system anymore, her energy levels improved, her sleep problems resolved, and her anxiety lifted. Within a year she was healthy, no longer taking any prescriptions, feeling good – and pregnant.

I require my patients, and I implore you to think differently about health-care decisions and consumerism. Part of my motivation in writing about depression was to help you develop a new watching, questioning eye that you can bring to every experience. For my patients to be well, I know that they will need to approach their health to an extreme commitment to the integrity of their mind and body. Personally, I have no intention of ever returning to a lifestyle that involves pharmaceutical products of any kind, under any circumstances.

Why?

Because we are looking at the body as an intricately woven spider web – when you yank out one area of it, the whole thing moves. And because there is a more powerful way to heal.

It’s so simple that it can be considered an act of revolution.

You might think of yourself as adverse to conflict – someone who wants to keep the peace, keep your head low, and do what’s recommended. To be healthy in today’s world. However, you need to access and cultivate a reliance on yourself. And you’re going to do that by first shifting your perspective forever. Look behind the curtain and understand that medicine is not what you think it is.  Drug-based medicine makes you sick. I will go so far as to say that hospital care makes you sick; though estimates vary, it’s reasonable to say that hospital care claims tens if not hundreds of thousands of lives annually due to preventable medical mistakes such as wrong diagnoses and medications or surgical errors, infections, and simply screwing up an IV.

The Cochrane Collaboration, a London-based network of more than 31,000 researchers from more than 130,000 countries, conducts the world’s most thorough independent analysis of health-care research. Based on the data from the British Medical Journal, the Journal of the American Medical Association, and the Centers for Disease Control, it has found that prescription drugs are the third leading cause of death after heart disease and cancer. And when it comes to psychotropic drugs, the Cochrane Collaboration’s conclusions are compellingly uncomfortable. In the words of the Collaboration’s founder, Dr. Peter Gotzsche, “Our citizens would be far better off if we removed all the psychotropic drugs from the market, as doctors are unable to handle them. It is inescapable that their availability creates more harm than good.

By and large, doctors are not bad people. They are smart individuals who work heard, investing money, blood, sweat, and tears into their training. But where do doctors get their information? Whom are they told to trust? Have you ever wondered who’s pulling the strings? Some of us in the medical community are beginning to speak up and to exposed the fact that our training and education is, for the most part, bought.

“Unfortunately in the balance between benefits and risks, it is an uncomfortable truth that most drugs do not work in most patients.” Before I read this quote in the prestigious British Medical Journal in 2013, I had already begun to explore the evidence that there really isn’t much evidence to support the efficacy of most medications and medical interventions, particularly in psychiatry, where suppressed data and industry-funded and ghostwritten papers hide the truth. Another 2013 study published in the equally respected Mayo Clinic Proceedings confirmed that a whopping 40 percent of current medical practice should be thrown out.  Unfortunately, it takes an average of seventeen years for the data that exposes inefficacy and/or a signal to harm to trickle down into your doctor’s daily routine, a time lag problem that makes medicine’s standard of care evidence-based only in theory and not in practice. Dr. Richard Horton, the editor in chief of the much-revered Lancet at this writing, has broken rank and come forward about what he really thinks of the published research – that it’s unreliable at best, if not completely false. In a 2015 published statement, he wrote: “The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness.”

In 2011 the British Medical Journal performed a general analysis of some 2,500 common medical treatments. The goal was to determine which ones are supported by sufficient reliable evidence. The results:

  • 13 percent were found to be beneficial
  • 23 percent were likely to be beneficial
  • 8 percent were as likely to be harmful as beneficial
  • 6 percent were unlikely to be beneficial
  • 4 percent were likely to be harmful or ineffective

The treatments in the remaining 46 percent, the largest category, were found to be unknown in their effectiveness. Put simply, when you visit a doctor or a hospital, you have only a 36 percent chance that you’ll receive a treatment that has been scientifically proven to be either beneficial or likely to be beneficial. Such results are strikingly similar to those of Dr. Brian Berman, who analyzed completed Cochrane reviews of conventional medical practices, finding that 38 percent of treatments were positive and 62 percent were negative or showed “no evidence of effect.”

Are these exceptions? I would like to argue that they aren’t. This is because the whole pharmaceutical approach is predicated on wrong-headed information. Pharmaceutical products as we know them have not been developed or studied with modern science’s most relevant principals in mind, such as the complexity and power of the human microbiome, the impact of low-dose toxic exposures, autoimmune disorders as a sign of environmental biochemistry. Because medicine operates under the now antiquated one gene, one illness, one pill rubric, efficacy will be measured through a skewed lens, and safety cannot be accurately assessed or discussed with individual patients.

Many of us move through life with a sneaking fear that the other health shoe could drop at any moment. We can easily fall prey to the belief that our breasts are ticking time bombs that infections are just a cough or handshake away and that life is a process of adding more medications and drugs to put out small fires as we age. Before I stopped prescribing, I had never once cured a patient. Now people are cured every week in my practice. As I mentioned, my patients are my partners. We collaborate, and they work hard. They work hard at a time when they can’t lift a finger – when the prospect of walking to the corner drugstore with a slip of paper twinkles like the North Star in their dark sky. They follow my lead because they feel inspired by my conviction and hope in this new model – one that asks the question “Why?” and has the goal of not only symptom relief but an incredible boost in their vitality.

Excerpted with permission from the book, “A Mind of My Own,” by Kelley Brogan, M.D.

All rights reserved. 

KELLY BROGAN studied cognitive neuroscience at MIT before receiving her MD from Weill Cornell Medical College. Board certified in psychiatry, psychosomatic medicine, and integrative medicine, she is one of the only doctors in the nation with these qualifications. She is the author of the best-selling book, A Mind of Your Own: What Women Can Do About Depression That Medication Can’t. She practices in Manhattan and is the mother of two young daughters. Check out her website.

 

 

 

 

 

 

How Standing Up For Yourself Helps You Fight Depression

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Depression the most common mental health disorder in the United States with nearly one in 10 U.S. adults experiencing some form of it. Depression is affecting younger and younger generations, and sadly, it is on the rise. According to the World Health Organization, by the year 2020, depression will be the second most common health problem in the world. With October being Depression Awareness Month, I’m probably not the first to bring this subject to your attention, but what if we took pause to think about what these numbers really mean?

Once we recognize the real impact of depression, not just on a broader world health level, but on the individual lives that it affects every day, we must abolish whatever remains of the stigma that depression is something to be ashamed about, or that it’s just a bad mood, so “snap out of it.” And we must start thinking about what works in terms of treatment, a subject I’ll talk more about in a free Webinar “Empowering Strategies to Fight Depression.” How can each of us take up arms against this painful condition and offer ourselves, our children, and our loved ones their best chance at overcoming depression?

When it comes to finding ways to empower ourselves against depression, I believe that one of the most important things to consider is the effect of the “critical inner voice.” The critical inner voice represents a damaging internal thought process, a form of destructive self-talk that perpetuates feelings of shame, self-hatred, negative rumination, and low self-esteem. Studies have shown that low self-esteem predicts depression. Even in toddlers, a negative self-concept has been found to be associated with depression.

Although, most of us experience low self-esteem and are familiar with the commentary of a critical inner voice, for those who are depressed, this critical inner voice can have a powerful, debilitating influence on their state of mind. The critical inner voice can cause people to dwell on perceived problems or sorrows. It can also make it even more difficult to take actions that would help individuals emerge from a depressive state. This voice is often critical and highly distorted. In a blink of an eye, it can fill our heads with thoughts like: “You’re so pathetic. You’re just a drain on everyone. You’re worthless/ stupid/ ugly. Why can’t you just be normal? You don’t really have anything to look forward to. There’s nothing to feel good about.”

The critical inner voice is also tricky, as it can seem both self-soothing and self-punishing. It lures us into engaging in actions or situations that then perpetuate our anxiety and depression. “Just go home and be by yourself,” it suggests.  “You should just have a drink and relax. There’s no point in trying to be active. Why go through all the trouble of going out and seeing those people?” When we give in to these “voices,” our inner critic is then there to punish us. “What’s the matter with you? All alone again. What a loser. You never succeed at anything. No one wants you around anyway.”  This type of cyclical thinking turns us completely against ourselves and leaves us at the mercy of a mean and ruminating inner enemy. To combat depression means taking on this inner voice or “anti-self.”

My father, Dr. Robert Firestone, created Voice Therapy as a therapeutic approach to conquer your critical inner voice, and in our book of that tile, which I co-authored with my father, we discuss specific ways people can start to challenge this inner enemy. Here are some of the valuable steps that can help people to start to recognize and counter these destructive thought processes.

  1. Identify the negative thoughts and beliefs you experience. Notice the events and circumstances that trigger these “voices” and the feelings that arise.
  2. Write the thoughts down in the second person as if someone is talking to you. So, instead of writing “I don’t have anything to offer,” write “You don’t have anything to offer.” This allows you to shift perspective and see the voice as an external enemy instead of your own point of view.

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  1. Respond rationally and compassionately to these “voices,” as you would to a friend, except this time, write your responses in the first person, as “I” statements. “I have a lot to offer. I have many qualities that people appreciate, and I care about others. I am fine the way I am.”
  2. Talk to a close friend who tends to have a more optimistic outlook. This can help you align with your real self and counter the negativity of your anti-self.
  3. Make yourself engage in activities that you have enjoyed in the past. Even if you don’t feel like it right now, taking these actions will help reinvigorate you and interrupt the destructive thought process that’s taking place.

One of the most important principles you can adopt in facing off against this inner critic that fuels depression is to practice self-compassionResearch findings have consistently shown that greater self-compassion is linked to less anxiety and depression. Despite the fact that people who suffer from depression may have lower levels of self-compassion, studies also show that practicing self-compassion can reduce symptoms of depression, in large part because it helps us not get stuck in our negative thoughts.

Dr. Kristin Neff describes three key elements of self-compassion: 1) self-kindness over self-judgment, 2) mindfulness over over-identification with thoughts and feelings, 3) common humanity versus isolation. Self-compassion asks us to value ourselves as human beings without judgment or evaluation. It allows us to notice our suffering and to feel compassion for ourselves without getting caught up in the rumination that comes with assessing ourselves or our state of being. Dr. Neff’s research has confirmed the benefits of this practice when fighting depression. One of the rewards of self-compassion is that it’s proven to better help us to achieve change in our lives.

Depression is a real disorder, but there are real ways to fight it. And when we do, no matter what treatment approach we take, we must be on our own team. We must see our critical inner voice as the enemy it is and reconnect with our real selves, the part of us that embraces our basic human right to live our lives on our terms.

By Linda Firestone, Ph.D.

Dr. Firestone is the Director of Research and Education at The Glendon Association. An accomplished and much requested lecturer, Dr. Firestone speaks at national and international conferences in the areas of couple relations, parenting, and suicide and violence prevention. Dr. Firestone has published numerous professional articles, and most recently was the co-author of Sex and Love in Intimate Relationships(APA Books, 2006), Conquer Your Critical Inner Voice (New Harbinger, 2002), Creating a Life of Meaning and Compassion: The Wisdom of Psychotherapy (APA Books, 2003) and The Self Under Siege (Routledge, 2012).

Follow Dr. Firestone on Twitter or Google.

 

The Ten Best-Ever Depression Management Techniques: An Interview with Dr. Margaret Wehrenberg

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I’m Dan Lukasik from Lawyerswithdepression.com. Today’s guest is Dr. Margaret Wehrenberg. Dr. Wehrenberg is a clinical psychologist in Naperville, Illinois. She is the author of six books on the treatment of anxiety and depression published by W.W. Norton, including, “The Ten Best-Ever Depression Management Techniques: Understanding How Your Brain Makes You Depressed and What You Can Do to Change It” and “Anxiety + Depression: Effective Treatment of the Big Two Co-Occurring Disorders.” An international trainer of mental health professionals, Dr. Wehrenberg coaches people with anxiety via the internet and phone. She’s a frequent contributor to the award-winning magazine, Psychotherapy Networker and she blogs on depression for the magazine Psychology Today.

Dan:

What is the difference between sadness and depression and why do people confuse the two so often?

Dr. Wehrenberg:

Because depression comprises sadness. Sadness is a response to a specific situation in which we usually have some kind of loss. The loss of a self-esteem, a loss of a loved one, the loss of a desired goal. Depression is really more about the energy – whether it’s mental energy or physical energy – to make an effective response. So, sadness is an appropriate and transient emotion, but depression sticks around and affects all of our daily behaviors and interactions.

Dan:

What causes depression? Sadness, as you say, is an appropriate response to loss.  What is depression a response to?  What are the causes of depression?

 Dr. Wehrenberg:

Over the course of my career, I’ve developed the idea that there are four potential causes to depression.  This comes from working with people for forty years; it comes from reading a lot of research.

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The first part is genetics. You are born with a brain that is going to tend toward depression because of the function of neurotransmitters in your brain. It’s a genetic predisposition towards depression. With poor self-care, poor nutrition, you may end up stimulating or starting that feeling of low energy, of low interest in the world around you. Then if you pull back from the world around you, now you start to have fewer experiences that keep you interested in the world.

Another possible and probable cause is with people who are experiencing situational stress that goes on, and on, and on. That could be the stress of not being able to earn enough money, and you’ve got two jobs, and kids, and a life filled with stress. It could be the stress that comes on while caring for someone in your family circle who’s got a disability, or a chronic illness; that increases with severity over time. So, you’re stuck in stress, and you deplete yourself. And you can become depressed.

The state of the depression is a lot like the state of being sick. If you had the flu, you wouldn’t feel like sitting around eating and drinking; you wouldn’t feel like playing a round of tennis. If somebody says, “Let’s watch a really interesting T.V. show” and you say, “No, I want to go to sleep instead,” that’s pulling back from the world is healing.  People have the same feeling when they’re depressed, but those feelings don’t lead toward healing because they’re persistent.

Two other causes that people would certainly be aware of are trauma or coming from early childhood adversity where early in your childhood you were not treated well, you were neglected, had some other abusive situation, and those two very difficult situations can lead people to function in a depressed way.

Dan:

Let’s talk about the issue of stigma. As a person who’s had depression for the past 15 years, it’s something that I’ve had to deal with. Why is there so much stigma surrounding depression?

Dr. Wehrenberg:

Part of it is because we have this mentality in this country that you should be able to pull yourself up by your bootstraps. And we look at people who are low energy, who aren’t completing tasks, and we judge them as doing it on purpose. People who aren’t depressed are of the impression that you could just decide to do it differently.

I was speaking with a 21-year old client of mine the other day who said, “I can’t make myself do the work, and I hate it that I am that lazy.” So, he judges himself as lazy, even though it’s the depression that’s robbing him of energy and mental tenacity. So, even depression sufferers judge themselves to be wrong, lazy, and bad and believe they should do better. So, I think the cultural expectation that you should be more productive. Also, people don’t see it as the medical problem it is. It’s just that it’s not a very “visible” medical problem.

Dan:

In the past 40 years or so that you’ve been a therapist and have treated people with depression, what have you observed about the rate of depression in our country and our understanding of it?

Dr. Wehrenberg:

I think the rate of depression, everybody would agree, is growing. More and more people are suffering depression.

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There are different reasons why when we look at this.

Culturally, one of them is that American culture is a highly stressed culture.  But it’s stress not over life and death, but that’s certainly the case for many living in poverty who have to worry where their next meal is coming from, but usually, what we look at is the stress of always needing to be more, to do more, to get more status and money. That’s not a very good way to feel good about yourself because there’s a limit, a human limit of time, a limit of money, a limit of talent or ability, a limit to resources or access to achievement.

Dan:

Following up on what you just said earlier, you talked about some possible causes of depression including genetics and family of origin issues. Now you’re talking about American culture and its connection to depression. What is the connection?

Dr. Wehrenberg:

We have a culture that values productivity, money, and status, and not everybody can achieve goals of status or financial success and it gets depressing to see how valuable those seem to be in our country.

We don’t value something everybody can do. Like, be a person of good character. We value how much status you’ve got, which is very different.

Dr. Andrew Weil, who is a real guru of physical health and mental health, says he thinks that stress equals inflammation in your whole body and that inflammation is a trigger for depression.

Dan:

Why did you write the book, “The Ten Best-Ever Depression Management Techniques?” It’s a great read. I recommend all my listeners and readers at lawyerswithdepression.com to pick it up.

Dr. Wehrenberg:

I wrote it because I believe both consumers and therapists need ideas for what to do right now other than to investigate, in some more general way, a life history, what do you do today that will make you feel somewhat better, to start you moving out of the depression. I wanted to present as many practical ideas as I could that would help people start to lift out of depression with the help and advice of a therapist and also for the general public that could read this book and say, “Oh, there are things I can do that would make me feel better.” And they’re simple; they’re not complicated.

Dan:

Can you share with our listeners some of the techniques you recommend in your book?

Dr. Wehrenberg:

Let’s start with somebody with low energy. Almost everybody who is depressed is doing something even while they are depressed. Playing a game on their phone, watching T.V. or watching Netflix.  They are doing something. Unless, they are sleeping, of course.  But I want to use what you’re already doing to help motivate you to do something you think you should do. So, for example, I often see people with depression that aren’t doing good health care, they’re not doing good care of their environment, they are not doing dishes, they are not doing laundry, stuff like that. So if you just think about household stuff for a second, what I want my clients to do is to break down the task into its parts.

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If you’re going to do laundry, the first thing you have to do is pick it up off the floor. So, I don’t want you to think, “Oh, I’ve got to get all the laundry done.”  If you’re depressed, that won’t work. What I want you to do is think is, “All I have to do is pick up the dirty clothes in the family room and then I’m going to sit down for 15 minutes and do what I’m willing to do anyway – play a game on the phone, turn on Netflix. Set a timer for 15 minutes of enjoyment of your show and then when the timer goes off, you just get up and pick up the clothes off the floor of your bedroom. Little pieces, okay.

What we know about depression is those small accomplishments are perceived in the brain as positive and encouraging, and you start to feel, “Oh, I can do something for myself.” You begin to have just a little rise in your overall energy. If you can do that consistently, then pretty soon, you get the task of doing the laundry over with. It may take a few days, but it’s done. Then you have a positive self-appraisal. That’s what I’m going for, for example, with a very simple way to think about raising your energy through small increments.

Dan:

So the small steps and small behaviors affect neurochemistry?

Dr. Wehrenberg:

They do, indeed. Because when you take action and it has a positive outcome, you have just changed the level of the neurochemical called dopamine, which I call the “James Brown” of the brain.  It’s the “I feel good,” when dopamine is released in your brain you feel better. We know that people who decide, “I am going to do this,” and do it, they get a rise in dopamine and change your neurochemistry.

Dan:

I want to discuss your second book, “Anxiety + Depression: Effective Treatment of the Two Co-Occurring Disorders.” I struggle with both anxiety and depression with depression being the primary diagnosis. Many people I meet struggle with both.  Why do the two co-occur together and sometimes not?

Dr. Wehrenberg:

Very often, if you are looking at brain function and structure, what you see in people who have both anxiety and depression, which, by the way, is about fifty-percent of the time, is that people who have one, have the other. Often, the anxiety comes first, and it’s not treated well. There’s a neurochemical called serotonin which is related to something called rumination or you might think of it as “brooding.” When people brood, when they go over and over a failure or fear, they get stuck mentally. It raises anxiety because it’s hard to solve a problem that you’re just brooding about and it raises depression because you don’t feel like you’re moving very much in your behavior or your thinking. That’s a pretty simplistic statement. And people will say, yes, but there are far more theories about the underlying neurochemistry.  That’s true, but the chemistry that relates to brooding is related to both anxiety and depression, the repetitive, negative thinking.

Dan:

Regarding your history as a therapist treating people with anxiety and depression, are there some techniques that work better with anxiety versus depression? Or, do all these techniques work equally well with both conditions?

 Dr. Wehrenberg:

I think you have to look at the energy level. Some people with anxiety and also depression have a fair amount of energy to cope with the depressive quality of repetitive, negative thinking. And you use the energy of that anxious person to be more assertive with yourself to say, “I’m going to take charge of this.”

But what I also find that works very well with anxiety and depression together is to work on mindful awareness, to try to stay in the moment, not to try to predict a negative outcome, but rather to pull yourself into the moment. And mindfulness, which can be done by meditating to stay in the present moment, but you can also just keep pulling yourself back to this moment by saying to yourself, “What’s happening now?” This pulls you back from predicting negative outcomes and then getting upset about what might happen. If you stay in the now, you can say I can do this activity now, this action now, and all I have to worry about is now. And then you tend to get better outcomes. So, that’s good for both for anxiety and depression.

Anxiety is “I worry about the future; I fret about the past.” And depression includes, “I think the future will be grim.” So if you stay in the moment, you’re addressing both of them.

Dan:

As a psychologist and therapist who’s worked with people with anxiety and depression for decades, tell us a little bit why a person struggling with depression and anxiety should see a psychologist, a therapist? What benefit could be obtained from seeing someone such as yourself and how does that work?

Dr. Wehrenberg:

We know that medication, which is often people’s first choice, can be extremely helpful. But what I say to my clients is that medication can help you feel somewhat better, but it doesn’t teach you anything about managing your life. Psychotherapy, when it’s practical, when I’m looking at it through the “The Ten Best-Ever Depression Management Techniques,” what it’s teaching you is how to handle your negative mood, what to do when you don’t have energy. It’s teaching you behavior that will rewire your brain. It talks about how and why exercise and nutrition are important.

But also why taking even a small action on your behalf changes your neurochemistry.  So, psychotherapy immediately affects brain function. But, you usually need a psychotherapist to give you ideas, help you find ideas of how you stop yourself, how you block yourself, and to help you find the most effective tools for you in your specific situation. A psychotherapist can be very helpful in teaching you how to get rid of these negative symptoms and feel better for life.

Dan:

Dr. Wehrenberg, what’s the best way for our listeners and readers to get in contact with you?

Dr. Wehrenberg:

Well, if you’re able to spell my name, you can look me up on Margaretwehrenberg.com.  I work in Naperville, Illinois. But my website has my telephone contact and a link. And if you went to the Psychology Today magazine website, you can look at my blog on depression, and you would be able to contact me through there as well. I have a really good “Contact me” on my website.

Dan:

On behalf of your listeners at Lawyerswithdepression.com., I want to take the time to thank you for this insightful interview. I think it’s going to help many people.

Dr. Wehrenberg:

Thank you for having me. I appreciate it.

 

 

Depression and Faith: An Interview with Rabbi Mark Gellman

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Today’s guest on our show is Rabbi Mark Gellman.

Rabbi Gellman is the Rabbi Emeritus at Temple Beth Torah in Melville, New York where he has served since 1981.  He earned his Ph.D. in Philosophy from Northwestern University in 1981 where he also completed doctoral work in the History and Literature of Religions specializing in Buddhism and Judaism. He is the recipient of many honorary degrees.

Rabbi Gellman writes a weekly column, “The Spiritual State,” for Newsweek magazine and the syndicated column,“The God Squad,” read by readers around the world.

Welcome to our show Rabbi Gellman.

Dan: 

Rabbi, during your time that you’ve been a Rabbi, and I understand that’s been decades now, have you counseled people with depression?

Rabbi Gellman:

Yes, I have.  Although my general orientation, and I hope it’s the orientation of most clergy, is to refer people to professional psychiatrist or psychologists who specialize in this. It’s not something that clergy should enter, in general, because they’re not trained for it.

Dan:    

Once you’ve referred those people and they are treating with a psychologist, psychiatrist, or both, do the clergy have some role in comforting the people with spiritual support with this kind of condition?

Rabbi Gellman:

Yes, I think we serve two roles.

One is what I would call “psychiatric first responders.”

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We’re the ones who first alert people to the fact that they are depressed and that they need some kind of professional treatment in order to get back to some level of functioning life. The second purpose which we serve as clergy, if we are doing our jobs well, and our calling well is to provide to the community a message of hope. The antidote to depression, of course, is hope. And in a communal sense, Rabbis can provide that hope. In fact, it is my view that the search for hope that is the primary motivator for people to affiliate with religious denominations and to seek personally their own way to God.  It is the search for hope, ultimately.

Dan:    

Many people who I speak to around the country, and myself included, I am a practicing Catholic, and so often in the throes of depression, or maybe even at the beginning, I would often ask God, “Why me?” I think that so many people, and maybe it’s true for any kind of suffering that afflicts people, ask that seminal question.  In your faith, and in your experiences, how do you respond to that?

Rabbi Gellman:

Well, I have a rather unconventional view of many things. And I have an unconventional view of that question. First of all, I don’t think it’s a common question. People say it is, but I don’t believe it. I’ve never heard it. Most people are not really consumed by the question of why this has happened to them.

There’s two reasons for that. First, they can think of a lot of reasons it’s happened to them. So, they know the reasons it’s happened to them. Second, the question, “why me,” presumes a kind of spiritual and ethical arrogance that most people are mature enough not to have.  By that, I mean the question, “Why me?” if you sort of unpack it a little, means, “I am so righteous, I am so good, I’ve done so much for the world, and for my family, and for my community, that my virtue is so enormous, that it should protect me against all evil.

Now, no one really believes that.

No one believes, in their right mind, in the list of the greatest human beings that have ever lived, Gandhi and Mother Teresa, that they should be No. 3.  I honestly don’t think people ask the question, “Why me?”

My approach has always been on two levels. One on a level of personal counseling to try to get people to find some resources to find some reasons to hope and I have some techniques that are very effective in that way.

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Second, in my teaching, to explain to people that there are two reasons why bad things happen to them.  The first is that they caused them to happen. People who have lung cancer after a lifetime of smoking really have no right to say, “Why me?” They did it to themselves. People who have neglected their physical fitness and have developed different pathologies that come from obesity or inactivity have done it to themselves.  So, much of what happens to us, that is evil, is self-produced.

The second reason why bad things happen is because of what Aristotle called, “natural evil”. That is just the way the world works. A Rabbi said a phrase, “Olam K’minhago nohgge,” which means the world goes according to its own order. It means if you’re walking along the street and a brick falls from a scaffolding and you’re underneath, it’s bad luck on you. But, that’s just the way the world works. If you happen to be in a place where a tornado hits, or a hurricane hits, it’s the way the world works and this natural order of the world is not evil.  It’s just the natural working of the laws of the world. A Tsunami is not evil. If a wave crashes over an uninhabited island it’s not evil. It’s only if people are there. Well, people choose to be there.  The point is there are things we do to ourselves and there are things that happen to us because the world is the way it is.

Dan:

With respect to “the way the world is, would that include our bodies, our brains, and our genetics? There are now studies which show that many, many people, especially with the more severe forms of depression, have a strong genetic vulnerability to depression. Or, other people grow up in neglectful homes where they are neglected or physically abused.  Those people have high rates of adult-onset depression.  Can you follow-up on this?

Rabbi Gellman:

Sure, I mean, sometimes you draw some bad cards. You draw environmental bad cards, you grow up in an abusive, deprived upbringing, and, in some cases, you draw a bad genetic card. But, I would say to both those things that there are ways that people overcome those inheritances.

For example, there are people who grow up in very, very difficult circumstances.  And for some reason, they are disciplined and hopeful, and they are able to move out into better circumstances for the rest of their life.   Other people surrender to the difficulties of their environment.  How do you distinguish between one and the other? Why is someone able to pull themselves up by their bootstraps and someone else isn’t from the same deprived neighborhood? So, something else is at work here.

As far as the genetic inheritance, it may be true, it probably, certainly is true, studies in schizophrenia certainly seem to indicate it is true, that there’s a strong genetic component to depression.  However, there’s a problem with focusing on that medical fact and the problem is that it gives people an excuse to wallow in their depression, to surrender to their depression.  Hey, look, I’ve known people who are obese, who say, “Look, I can’t lose weight because I’m genetically fat.”

You know, that’s ridiculous.

You may have a genetic predilection to obesity, you my have a genetic predilection to depression, but that doesn’t mean you can’t fight it.  And if you believe that this was your inheritance, it’s just another reason to surrender. And depression requires vigilance, and it requires very strong emotional dedication to becoming well again.

Dan:

Can you give us some insights into how the Jewish faith, the Jewish religion, views depression, and, specifically, do you give examples from the Old Testament that you believe are insightful into how people can see their depression and overcome their depression?  You minister and you preach. Can you give us a little insight on that?

Rabbi Gellman:

The first is a personal understanding. I think it comes out of scripture, but not directly.

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It’s a technique that I developed which I call, “spiritual balancing.” The history of this is that my wife and I, Betty, were living in Evanston near Northwestern University. We were remodeling an old house and the fellow that was helping us do some spakling was carrying two big containers of this spakle up the stairs and I said to him, “Why don’t you just carry one bucket up? Why carry two at once?” And he said, “Well, if I carry one it throws me off and it hurts my back.  If I carry two, it keeps me in balance and I can carry twice as much.”

For some reason, it was an epiphany for me.  It was a life-changing moment, just watching this guy carry spakle up the stairs. What I realized at that moment, and developed it as a counseling technique, and have spoken to psychiatric associations about it, is this technique of spiritual balancing.

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So it works this way. Someone comes to me and they’re depressed, they’re in grief, they’re in a bad place.  So I say, “Here’s what we’re going to do. We’re going to do five minutes of you telling me, in as much excruciating detail as you can, why your life is miserable. Five minutes.

And then, for the next five minutes, I want you to tell me why your life is wonderful. What are the wonderful things in your life. But it has to be for the same amount of time.

I do this often with people in grief.  “Give me five minutes of how sad you are, and how broken you are that you’re loved one died and how unfair it is and how awful it is, and how it’s breaking you, and then five minutes what you loved about the person.  And what was great about the person.”

What I discovered quickly, using this technique, is that in the end, people felt much better, at the end of the counseling session. The reason they felt better was not that anything had changed, but that they had balanced the miserable, depressive thinking that they had, that had imbedded itself in their brain because of their trauma, with positive, endorphin producing, hopeful thoughts that were also in their brain, but they weren’t accessing them because they weren’t thinking about it.  They were obsessed with the loss.  That’s the purpose of the Psalms, of many different passages in the Bible which is to get you at the moment you are most depressed to thing about the goodness that is still in your life and to overcome that natural tendency to focus on your burdens by turning in a conscious way to a meditation on your blessings.

Then you will discover when you do this that there is not a single day in which you wake up where your blessings do not exceed your burdens – not one single day.

 

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