John McManamy writes, “The chemical imbalance myth creates the false impression that our brains are some sort of neurotransmitter porridge that can be rendered just right with squirts of serotonin and dopamine.” Read the Blog
In his book “What Happy People Know,” Dan Baker argues that you can’t be in a state of appreciation and fear, or anxiety, at the same time. “During active appreciation,” Baker writes, “the threatening messages from your amygdala [fear center of the brain] and the anxious instincts of your brainstem are cut off, suddenly and surely, from access to your brain’s neocortex, where they can fester, replicate themselves, and turn your stream of thoughts into a cold river of dread. It is a fact of neurology that the brain cannot be in a state of appreciation and a state of fear at the same time. The two states may alternate, but are mutually exclusive.” Other studies have also highlighted how gratitude can buffer you from the blues, promote optimism, and, in general, make you feel peachy.
However, I do hereby swear that it is possible to be grateful and depressed.
For example, I’ve articulated on several posts that I have been in a depressed cycle for about nine months. I have good days, and I’m able to write my blogs, do a little publicity, arrange play dates for the kids, and help with their homework. But I have, for three seasons now, woken up with that nausea in my stomach and the familiar dread that most depressives feel in the morning, of wondering how I’ll make it through the day with what I call “dark vision.”
Today I woke up incredibly grateful for my husband. By the time I got downstairs, he was brewing Godiva chocolate coffee and had the table set for breakfast. He was making the kids’ lunches and making sure our son had his lacrosse stick for practice afterward. I was grateful for my kids: for the creative and sarcastic one who left a poster for me last night that read “I love Daddy more than you,” and for the other one who has a beautiful, sensitive soul and the discipline and determination to–in my opinion anyway–succeed at whatever he wants to do in life. For my family I am incredibly grateful.
However, if learned this afternoon that tomorrow would be my last day on earth, I would be immensely relieved.
I know that seems wrong … that I could be grateful and want to die at the same time. But I guess it’s the difference between a physiological pain–a quiet desperation, or a plea for relief–and the virtues of love, commitment, and appreciation. Professor of Psychiatry Peter Kramer explains this quandary best when he says, “Depression is not a perspective. It is a disease.”
A Beyond Blue reader caused me to think about this. On the combox of my post, “Never Place a Period Where God Has Placed a Comma,” she wrote:
I know how hard it is to fight for sanity when your brain chemistry is askew. However, I sometimes feel you don’t realize how lucky you are. Perhaps I’ve missed posts regarding the blessings in your life, but you have a husband who loves you and supports you and two children, a boy and a girl even. The people you’ve loved, the people who’ve loved you, the joy and heartaches you’ve shared … relationships are where it’s at.
She’s absolutely right. I have so much to be grateful for. And if I haven’t articulated that enough in my blogs, I’m remiss. However, expressing the anguish of depression doesn’t mean I’m not grateful. The love I have for my husband and my kids can’t and won’t stop the pain of depression. And considering that 30,000 Americans kill themselves every year, I would imagine that I’m not alone in saying that. Good and healthy relationships are certainly buffers against depression and anxiety and can aid us in our recovery. But gratitude and appreciation can’t interrupt my mood disorder any more than they can relieve the pain of arthritis.
If I sound defensive, I guess it’s because I used to beat myself up over and over again for not being grateful enough to stop a depressive cycle. And based on my mail from readers, I know that is the case with lots of folks. So, while I continue to record all my blessings in my mood journal each day and say them aloud right before dinner and at bedtime with the kids, I now know that gratitude is a separate animal to my depression, and that sometimes confusing the two, especially while in a depressive cycle, can do more harm than good.
So I take note of my blessings. I thank God many times throughout the day. But if, at the end of my prayer, I’m still depressed … well, that’s okay. Because, as Kramer says, depression isn’t a perspective. It’s a disease.
Therese Borchard is the author of Beyond Blue: Surviving Depression & Anxiety and Making the Most of Bad Genes and The Pocket Therapist: An Emotional Survival Kit. Subscribe to Beyond Blue, visit her website, or follow her on Twitter @thereseborchard.
One study found that as many as eighty-percent of all people in this country that suffer from depression don’t get any treatment.
Given that depression is the leading cause of disability in the U.S. and that over 20 million people are afflicted with it, that’s a lot of people – about 16 million.
However, many of the law students, lawyers and judges with depression that I’ve met tell me that they don’t need to be told to get help because there are already getting it. They’re already in therapy, taking medication or both. They get it. They know that depression is an illness and they have to deal with it.
Some of them have been coping with it for a very long time. I call these people “depression veterans”. I have met many such veterans and their courage and determination to recover and stay well inspires me. As I wrote in a prior blog, these people are really my “heroes”.
I also have met many in the legal biz who say they’re at the end of their rope. They’ve been in and out of therapy over the years with little or negligible improvement in their depression. Others have started and stopped a number of antidepressant and/or other mood stabilizing medications tired of to little impact on the mood and too many side effects. But the depression always returns for them.
For most of them, it’s not a relapse into major depression. Rather, a mild or moderate depression interspersed with fatigue, a lack of pleasure and a glum outlook on life. What they are experiencing is a fact about depression and its course. That it often a chronic and life-long illness for those so afflicted.
Then there are many who go through long stretches of feeling pretty well most of the time, but still have pockets of depression.
I put myself in this camp.
Most days, my depression, on a scale of “1” through “10” is a 1 or 2, if it’s present at all. If it gets worse, it’s less often, not as strong and has a much shorter duration is much shorter – maybe a 3 or 4. This seems to be especially so during the dark days of winter.
What worked for me to reign in the beast of depression was a change in life style, which included regular therapy, medication, a support group, prayer and exercise. While there is no one thing that is a panacea for depression sufferers, I am convinced that such the positive changes have a direct, lasting an significant alleviation of depression’s worst symptoms.
To make a lifestyle change, I develop a depression “toolkit”. A game plan that I’ve pretty much stuck to for a number of years. The value of such a toolkit is that it provides a map for us to stay on course. It gives us a sense of structure and a sense of hope.
If you thinking about how to really recover from depression stay healthy, it’s important to come up with your own depression toolkit. There are lots of ways to go about it. The two best examples of depression toolkits I’ve found come from the University at Michigan’s Depression Center and the Depression and Bipolar Support Alliance.
So pick up your pen and start building your own toolbox today.
Copyright 2014 by Daniel T. Lukasik
I made a new friend this week.
A lawyer from down south emailed me. He had found me through my website. He told me about some terrible and unexpected turns his life had taken recently which had plummeted him into a major depression.
I e-mailed him back and said that I would like to speak with him by phone.
I learned that his drop into the well of depression wasn’t his first experience with this terrible illness. He had gone through a bad episode twenty-five years ago, but since then nothing until his most recent crash.
During our thirty-minute talk, I felt the rawness of his pain in his voice. I recognized this sound all too well. It was the pain of depression.
He told me that the only respite he felt was when he fell asleep because it was only in this state of unconscious that he had some relief from the grinding wheels of depression.
I also learned that he was married, a father of four and had worked very hard for over twenty-five years as a lawyer. He was a Catholic who prayed often. He felt horrible about the pain and anxiety his depression had caused his wife and children. He told me that he felt comfortable talking with me because I was a lawyer and someone who had been through depression. As we talked, his voice became a little lighter and his tone a bit more optimistic.
I don’t attribute to anything I did.
Instead, I see it more as a testament to this central truth about life on earth: It is in sharing with one another our stories that we heal.
And I believe that we’re all called to be healers of one another.
And in listening to one another’s stories, we learn that suffering doesn’t have the final say.
And in this truth, we find hope.
There’s some interesting research to suggest that happy people view the world through certain comforting illusions, while depressed people see things more realistically. [i] For instance, the illusion of control. You can take a random sample of people and sit them in front of a video monitor with a joystick, and tell them their joystick is controlling the action of the game on the screen. (But the point of experiment is that it actually doesn’t). Depressed people will soon turn to the lab assistant and complain that their joystick isn’t hooked up correctly. Normal people, on the other hand, will go on happily playing the game for quite some time.
I think this explains a lot about why lawyers are so prone to depression. Because of their experience with the law, most attorneys have lost their rose-colored glasses some time ago. (Or else they never had them and chose the law as a career because it suited their personality). Attorneys know that life is hard, and doesn’t play fair. They’re trained to look for every conceivable thing that could go wrong in any scenario, and they rarely are able to leave that attitude at the office. They see the worst in people (sometimes they see the best, but that’s rare). They tend to be strivers and individualists, not wanting to rely on others for support. They have high expectations of success, but they often find that when they’ve attained success, they have no one to play with, and have forgotten how to enjoy themselves anyway.
All this makes it hard for attorneys to get help with their depression. They tend not to recognize it as such; they just think it’s stress, or burn out, or life. They don’t expect that anyone is going to be able to help. Most of my attorney-patients have contacted me because their relationships are falling apart, but they don’t see that it’s depression that makes them such a lousy partner – tense, irritable, critical, joyless, tired all of the time, relying on alcohol or other drugs. If they’d gotten help for the depression a couple of years previously, their spouse wouldn’t be moving out now. The truth about depression is that it not only makes you feel horrible, it wrecks your life. And that’s why I wrote the book, Undoing Depression, in the first place. I was running an outpatient clinic, and grew exasperated with seeing the people whose lives wouldn’t have been so ruined if they had got some help when they first needed it – before they alienated their children and spouse, got fired, went into debt, developed a substance abuse problem, etc. I thought there was a need for an intelligent self-help book, one that points out all the bad habits that depression engenders and which, in a vicious circle, keeps reinforcing the disease. But the truth is that self-help isn’t nearly enough for most depression sufferers. It’s as if you stepped over an invisible cliff, and you can’t find your way back doing what you normally do, because that’s what led you over the cliff in the first place. Depression is the original mind/body disease; your physical brain is damaged because of the stress in your mind, and you’re unlikely to undo that damage without help.
Depression is highly treatable, but if you want a lasting recovery you have to change your life. The ugly fact is that depression is very likely to reoccur. If you had one episode of major depression, chances are 50:50 that you’ll have another; if you have three episodes, it’s 10:1 you’ll have more. But you can improve those odds if you get good professional help, with medication and with talk therapy. We won’t put your rose-colored glasses back on, but we can help you see how negative thinking and the negative acting is contributing to your disease.
[i] See for example, Shelly Taylor: Positive Illusions; and Julie Noren: The Positive Power of Negative Thinking.
Richard O’Connor, Ph.D., is the author of two noteworthy books, Undoing Perpetual Stress: The Missing Connection Between Depression, Anxiety, and 21st Century Illness and Undoing Depression: What Therapy Doesn’t Teach You and Medication Can’t Give You. He is a practicing psychotherapist with offices in New York City and Canaan, Connecticut. He has suffered from clinical depression and is a member of a depression support group.
The lack of hope is one of the most powerful features of clinical depression.
Why this is so is a complicated question to answer. For lawyers struggling with depression, perhaps even more so.
A lot of people, including lawyers themselves, find it hard to understand why such powerful professionals, superheroes and heroines in blue suits, would be afflicted with depression in the first place.
Yet, the numbers don’t lie.
Studies show that lawyers have twice the rate of depression of the general population. When put in context, that means 240,000 of this country’s 1.2 million lawyers are struggling with depression right now.
Why, some think, would lawyers, armed with intelligence, perceived wealth (whether true or not) and a take-no-prisoners fighters’ edge succumb to such a dire condition?
The Answer: Because depression simply doesn’t work that way.
The truth is that smarts might not matter much; wealth, while helpful to provide resources otherwise not available, does not guarantee recovery. And adversarial toughness? This trait might be more of a cause of depression than a shield because many lawyers’ believe that the remedy is to just “suck it up” or think their way out of their pain. But these strategies don’t work. They simply fall on depression’s deaf ears.
Because most folks don’t expect lawyers to suffer from depression, they tend to search for different explanations for a lawyer’s downcast affect. They often believe they’re suffering from “the blues”; or, worse yet, a failure of will to push themselves out of it. One survey found that over forty-percent of Americans see depression as a failure of such will. One can only imagine how much higher that figure would be for lawyers who people feel should be able to fight themselves out of just about anything.
Depression Isn’t the Blues
It’s normal to feel the blues: a bittersweet type of sadness that colors our lives from time to time. Blues music is popular given the universal nature of this experience. But while sadness and the blues are inevitable parts of life, clinical depression is not. The most significant difference between sadness and depression is that someone that’s sad goes about their daily business without much trouble. Depression, however, involves significant impairment in one’s ability to carry out daily task at work and home. Other differences between the blues and depression include the length of time the sadness endures and whether or not there are other symptoms associated with depression, which are tagging along with the perpetual sadness.
Dr. Richard O’Connor, in his deeply insightful book Undoing Depression, captures some of the difference between the two:
Everyone has had a taste of what depression feels like. Everyone feels the blues at times. Sadness, disappointment, fatigue are normal parts of life. There is a connection between the blues and depression, but the difference is like the difference between the sniffles and pneumonia.
“Why Don’t You Take a Vacation?”
When I was diagnosed with major depression over twelve years ago, I needed to take some time off from my hectic job to allow the antidepressants my psychiatrist had prescribed to take effect. I called a meeting to tell my three partners about my diagnosis and need to take a break. Until such time, they hadn’t known I was suffering from depression. Yes, my production was down and I closed my office door a lot more often. Maybe a little tired or burnt out, but what lawyer didn’t sometimes feel that way?
After hearing me lay it all out on the table, one of my law partners at that time said, “What the hell do you have to be depressed about? You’re the managing partner of a successful firm with a beautiful family. Why the hell don’t you just go on vacation?” The subtext on his stinging judgment and solution to my situation was that if only I were more “grateful” for the good things in my life, including my success in the law, I wouldn’t be feeling so “depressed”.
Little did he know how grateful I was for all the good things that life had bestowed on me. But no matter how many times I knelt on my church’s pews thanking God for my blessings or made a list of things to feel happy about, the specter of depression just wouldn’t leave me. It was my constant companion.
Like most people who have never gone through major depression, my partner simply had no reference point for what I was going through. He thought of depression as sadness: a series of bad days that would benefit from an all-inclusive vacation to Jamaica sipping Margaritas by the pool.
However, I was depressed even on vacations. The sun and surf weren’t pleasurable; they were painful. They reminded me of what I had lost: the ability to enjoy life, to appreciate the beauty of nature and the capacity to connect with my family who I loved so dearly.
The response of my partner, I was to find, was typical. It made me feel more hopeless and alone. I felt that apart from my psychologist and psychiatrist, few could understand. When really in the dirty trough of depression, I would think, “Nobody really understands.” I was adrift in a sea of melancholy with little hope of reaching dry land. Andrew Solomon, author of the best-selling book The Noonday Demon: An Atlas of Depression writes:
“When you are depressed, the past and future are absorbed entirely by the present moment, as in the world of a three-year-old. You cannot remember a time when you felt better, at least not clearly; and you certainly cannot imagine a future time when you will feel better.”
In the beginning of my illness, I didn’t recover from depression so much as survive it. I found myself crawling towards what hope I had left in me. At that point, the only thing that seemed to keep me going was the deep love for my wife and precious daughter.
That was it.
This beacon of love kept me trudging through depression, hoping that the heavy cloud of melancholy would someday dissipate so that that I could walk in the sun again.
While the antidepressants I was put on were no panacea, they became an important part of the solution for me. They didn’t obliterate the depression, but they kept me stable and prevented me from falling into the basement where I couldn’t function.
But medication wasn’t enough. And it isn’t for most depression suffers.
I needed to start thinking about how to live a better life and treat myself differently. My psychologist once called depression “crooked thinking”. I tended to catatrophize everything by more often seeing problems as unsolvable and conflicts a matter of life and death. When I lost a case, I would take it personally, I was a bad lawyer, and even a worse, a person who didn’t measure up. A loser. I didn’t realize that I was punishing myself. I didn’t realize that this was a choice and I could stop.
I began to feel like I didn’t have to go on this way anymore. I came to believe that problems could be solved and that outcomes weren’t always in my control.
I began to hope.
Copyright, Daniel T. Lukasik, 2014
Over the years, I’ve read too many books to count about stress, anxiety, and depression. Like most people, I’m always looking for tips and clues about how to handle things better.
Some of these books have turned out to be real stinkers. Others, retreads of books and articles that have said the same things over and over again.
I have found some gems, though. Books that have something original to say, or are well-written.
I’ve found that the most useful ones make me want to read them further after the first 25-pages, or so. Good rule of thumb.
I hope you find help, hope, and insight between their pages.
The title of this book grabbed my attention because it seemed to capture so much more than just stress management. Stress management is truly about managing being overworked, overscheduled, and overwhelmed.
According to the author, the key is not time management but “stuff management — taking control of all those tasks to do, people to see, commitments and obligations to fulfill. Mismanagement of all that “to-do” stuff is what leads to stress. Emmett combines quick, easy-to-digest tips and infectious good humor to give readers positive ways to handle stress and their overly busy lives.
You can also check out her website for other helpful tips and ideas.
Monkey Mind: A Memoir on Anxiety — Daniel Smith
I first read about Smith’s book in a New York Times article called “Panic Buttons“. This memoir on stress and anxiety is not only informative and insightful, it’s well-written and funny.
The long list of things that, over the years, have made Daniel Smith nervous includes sex, death, work, water, food, air travel, disease, amateur theater, people he’s related to and people he’s not related to, so the prospect of a book review probably wouldn’t seem like a very big deal to him. Or would it?
This fleet, exhausting memoir, is an attempt to grapple with a lifetime of anxiety: to locate its causes, describe its effects and possibly identify a cure. Or, if not a cure, at least a temporary cessation of the worry that’s been plaguing him since his youth.
Check out his website, The Monkey Mind Chronicles, for more interesting stuff.
Rick Hanson, Ph.D. is a neuropsychologist and best-selling New York Times author.
Hardwiring Happiness lays out a simple method that uses the hidden power of everyday experiences to build new neural structures full of happiness, love, confidence, and peace.
In an interview discussing the book, he states:
“So, how do you get good things—such as resilience, self-worth, or love—into your brain? These inner strengths are grown mainly from positive experiences. Unfortunately, to help our ancestors survive, the brain evolved a negativity bias that makes it less adept at learning from positive experiences but efficient at learning from negative ones. In effect, it’s like Velcro for the bad but Teflon for the good.
This built-in negativity bias makes us extra stressed, worried, irritated, and blue. Plus it creates a kind of bottleneck in the brain that makes it hard to gain any lasting value from our experiences, which is disheartening and the central weakness in personal development, mindfulness training, and psychotherapy”.
Check out his website for more information about the book and his suggestions.
Why Zebras Don’t Get Ulcers: An Updated Guide to Stress, Stress-Related Diseases and Coping – Robert Sapolsky, Ph.D.
Why don’t zebras get ulcers–or heart disease, clinical anxiety, diabetes and other chronic diseases–when people do?
In a fascinating that looks at the science of stress, Stanford biologist Robert Sapolsky presents an intriguing case, that people develop such diseases partly because our bodies aren’t designed for the constant stresses of a modern-day life – – like sitting in daily traffic jams or racing through e-mails, texting and running to pick up our kids after a tough day at work. Rather, humans seem more built for the kind of short-term stress faced by a zebra–like outrunning a lion.
This book is a primer about stress, stress-related disease, and the mechanisms of coping with stress. How is it that our bodies can adapt to some stressful emergencies, while other ones make us sick? Why are some of us especially vulnerable to stress-related diseases and what does that have to do with our personalities?”
Sapolsky, a neuroscientist, concludes with a hopeful chapter, titled “Managing Stress.” Although he doesn’t subscribe to the school of thought that hope cures all disease, Sapolsky highlights the studies that suggest we do have some control over stress-related ailments, based on how we perceive the stress and the kinds of social support we have.
As a busy lawyer, I was immediately attracted to the title Full Catastrophe Living. It literally leapt of the bookshelf and cracked me on the head. Who doesn’t live a life so jammed with stuff to do that it feels like a catastrophe?
Chronic stress saps our energy, undermining our health, and making us more vulnerable to anxiety, depression, and disease. The heart of the book is based on Kabat-Zinn’s renowned mindfulness-based stress reduction program at the University at Massachusetts Medical Center.
The author takes the phrase “full catastrophe living” from book and movie “Zorba the Greek”. If you’ve never seen it, an Englishman Basil – – who is half-Greek – – inherits a run down mine in a small Greek town. To help him restore it, he hires a local character named Zorba to be the foreman of the local laborers. Zorba, full of the zest of a life truly lived, is asked by Basil, “Do you have a family?” Zorba responds “Wife, children, house – – the full catastrophe!!!”
Undoing Perpetual Stress: The Missing Connection Between Depression, Anxiety and 21st Century Illness – Richard O’Connor, Ph.D.
Author of my favorite book on depression, “Undoing Depression”, Richard O’Connor, Ph.D., has written another simply brilliant book on the consequences of “perpetual” stress in our lives – the alarming and escalating rates of clinical anxiety and depression. This was the first book I read that made clear to me the connection between stress, anxiety, and depression. It formed the basis for my blog on the topic How Stress and Anxiety Become Depression. The human nervous system was never meant to handle this many stressors. It’s as if the circuit breakers in our brains are blown by too much stress running through our brain’s circuitry. This book is a perfect fit if you want to learn a lot about the brain and physiology of stress – I found it fascinating. If you’re looking for a quick read and pick-me-up, this isn’t it. Check out his website.
A Mindfulness-Based Stress Reduction Workbook — Bob Stahl
The author writes that the key to maintaining balance is responding to stress not with frustration and self-criticism, but with mindful, nonjudgemental awareness of our bodies and minds.
This book employs some of the same mindfulness strategies discussed in Full Catastrophe Living but does it in the format of a workbook. I find this format very helpful because it’s practical and gives me exercises to do to put into practice mindfulness to reduce my daily stress load.
The 10 Best-Ever Anxiety Management Techniques – Margaret Wehrenberg, Ph.D.
Medication, once considered the treatment of choice, is losing favor as more and more sufferers complain of unpleasant side effects and its temporary, quick-fix nature. Now, thanks to a flood of fresh neurobiology research and insights into the anatomy of the anxious brain, effective, practical strategies have emerged allowing us to manage day-to-day anxiety on our own without medication. Addressing physical, emotional, and behavioral symptoms, Margaret Wehrenberg, Ph.D., a leading mental health clinician, draws on basic brain science to highlight the top ten anxiety-defeating tips. Everything from breathing techniques to cognitive control and self-talk are included. I really like that the 10 chapters are highly readable and short. Dr. Wehrenberg is also a frequent blogger at the Psychology Today website. Here’s one of her blogs, The One-Two Punch of Negativity and Fear.
This book approaches the problem of anxiety a little differently than most. Instead of trying to help you overcome or reduce feelings of anxiety, it will help you climb inside these feelings, sit in that place, and see what it would be like to have anxiety and still make room in your life to breathe and rest and live, really and truly live, in a way that matters to you. This approach is based upon a research-supported form of psychotherapy called Acceptance and Commitment Therapy, also known as ACT which starts with the assumption that the normal condition of human existence is suffering and struggle, ACT works by first encouraging individuals to accept their lives as they are in the here and now. This acceptance is an antidote to the problem of avoidance, which ACT views as among the greatest risk factors for unnecessary suffering and poor mental health
The Worry Cure – Robert L. Leahy
For “highly worried people,” or those who suffer from the “what-if disease,” this book presents a systematic, accessible self-help guide to gaining control over debilitating anxiety. Leahy is an expert in changing thought processes, and he walks worriers step-by-step through problems in the way they think, with pointers on how to change these biases. The author then outlines a seven-step worry-reduction plan (remember, I love plans!) beginning with identifying productive and unproductive worry, progressing to improving skills for accepting reality, challenging worried thinking and learning to harness unpleasant emotions such as fear or anger.
Self-Coaching: The Powerful Guide to Beat Anxiety – Joseph J. Luciani, Ph.D.
This is a good book for those who don’t want to see a therapist or, if they do, need extra doses of encouragement and practice to overcome their stress and anxiety. The author advises readers to identify themselves as specific personality types (e.g., “Worrywarts,” “Hedgehogs,” “Perfectionists”) and then gives specific instructions on how to change the particular thought patterns associated with this type of personality. So many people who struggle with anxiety never got what they needed while growing up – – enough love, encouragement, and affirmation. Lacking these core experiences, we develop can develop particular maladaptive strategies to cope with people and situations that push our buttons. This is the only book that I’ve read that pairs specific coping recommendations with particular personality types.
What books would you recommend? Hit the comment button and submit your favorites.
If you are interested in talking to Dan about CLE eligible trainings he offers law firms, call him at (716) 913-6309 or via our contact form. One-on-one coaching is also available for lawyers who need individualized attention. Go to Dan’s website Yourdepressioncoach.com to download his free book and schedule a consultation.