The Suicide of a Law Student Hits Home

When people are suicidal, their thinking is paralyzed, their options appear spare or nonexistent, their mood is despairing, and hopelessness permeates their entire mental domain. The future cannot be separated from the present, and the present is painful beyond solace. ‘This is my last experiment,’ wrote a young chemist in his suicide note. ‘If there is any eternal torment worse than mine I’ll have to be shown.’ – Kay Redfield Jamison, M.D., “Night Falls Fast: Understanding Suicide”

A second-year law student at the University at Buffalo School of Law, Matthew Benedict, died by suicide earlier this week by leaping from the Liberty Building he had been clerking at according to the Buffalo News. Another account of Matt’s life and suicide was reported in The New York Law Journal.

Matt’s funeral is tomorrow. By all account’s he was a tremendous, loving, talented, bright young man.Matt was kind-hearted, passionate and driven.

One of Matt’s friend’s wrote this sympathy section of the funeral notice:

“He was brilliant, authentic and loyal. Matt encompassed qualities that undeniably made him stand out from the crowd, and loved by many. But what I admired most about Matt was his unconditional love for his family. He had immense respect for his parents, and a strong bond with his three siblings. Matt spent a lot of time with his family, and whenever I was with the Benedict family, I felt a great amount of love, appreciation, and support for one another.”

Matt reportedly suffered with depression.

Shocking. Sad beyond words. But I will try to offer a few.

Earlier in my legal career, I occupied an office on the 16th floor of the Liberty Building for five years. Hearing about Matt’s death, brought back images from those days.

This suicide hits home for me.

As a lawyer who has suffered from major depression for almost 20 years, I never had suicidal ideations. However, I could see how someone going through depression could think about suicide. The pain of depression can be that horrible.

There is a stigma attached to disclosing to anyone you have depression. But to say that you have suicidal thoughts would be, for must with depression, unheard of.  I feared others would think me “crazy” or ready for a stay in a mental institution.  The reality is, as most who have gone through major depression understand, that this happens.  That’s why it is listed as one of the nine symptoms of major depression. One study reports that approximately 10% of those with depression have had suicidal thoughts and/or plans.

Fortunately for me, my thoughts never went beyond that. I never planned or attempted suicide. But I know others who have. Most survived; a few did not.

A few years, I recall sitting at my desk at my law office.  It was around noon.  I had too much work to grab lunch.  I got a text from a fellow lawyer and friend.  He was a highly successful insurance defense trial lawyer. And also, a member of the depression support group I started for lawyers ten years ago.

I sometimes ignore texts.

Thank God, I didn’t brush off this one.

Dear Dan,

By the time you read this, I will be dead. You can find my body in my law office.  My car is parked in the City lot on the 5th floor.  Thanks, Steve.

I immediately called 911. The police found my friend unconscious in his office following a drug overdose. His stomach was pumped, and he survived.

Talking to my friend later, he said that he had convinced himself that the pain of living another day with depression was worse than the pain of killing himself.

It’s tough to understand this – if you’ve never been through major depression.

David Foster Wallace, the author of the best-selling book “Infinite Jest,” who later committed himself after suffering from depression for years, writes:

“The so-called ‘psychotically depressed’ person who tries to kill herself doesn’t do so out of quote ‘hopelessness’ or any abstract conviction that life’s assets and debits do not square. And surely not because death seems suddenly appealing. The person in whom its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise. The variable here is the other terror, the fire’s flames: when the flames get close enough, falling to death becomes the slightly less terrible of two terrors.”

The Depression-Suicide Connection

Approximately 25 million Americans suffer from depression each year. It is the leading cause of disability in the U.S. and globally, where some 350 million people are afflicted.

Although the vast majority of people who have depression do not die by suicide, having major depression does increase suicide risk compared to people without depression.

According to a 2018 Center for Disease Control report, suicides are on the rise in this country.

The Washington Post, reporting on the release of the study, noted that 54% of those who died by suicide had no diagnosed mental health condition.

But Joshua Gordon, director of the National Institute of Mental Health, said that statistic must be viewed in context.

“When you do a psychological autopsy and go and look carefully at medical records and talk to family members of the victims,” he said, “90 percent will have evidence of a mental health condition.” That indicates a large portion weren’t diagnosed, “which suggests to me that they’re not getting the help they need.”

Depression is among the most treatable of psychiatric illnesses. Between 80 percent and 90 percent of people with depression respond positively to treatment, and almost all patients gain some relief from their symptoms. But first, depression has to be recognized.

But according to the organization Mental Health America, 30% to 70% of suicide victims suffer from major depression or bipolar (manic-depressive) disorder.

Some facts on suicide in this country from 2017 (the latest data available):

  • Suicide was the 10th leading cause of death in the U.S.
  • More people died by suicide (47,173) than homicide.
  • There we approximately 1,400,000 suicide attempts.
  • White males accounted for 69.7% of suicide deaths.
  • On average, there are 129 suicides per day in this country.
  • 40% of persons who complete suicide have made a previous attempt
  • Nine of out ten people who attempt suicide and survive, do not go on to complete suicide at a later date.
  • Each suicide intimately affects at least six other people (estimated). In 2013, it was estimated that one in every 63 Americans became a suicide-loss survivor.

High Rates of Depression in Law School Contribute to Suicides

The specific details of what led this bright, talented young man to jump are unknown.

But what we do know is that his suicide is far from an isolated incident in the legal profession.

A 2016 survey of 3000 law students revealed that 17% had screened positive for depression, and 21% reported they had seriously thought about suicide in their lifetimes. 6% said, they had seriously thought of suicide within the past twelve months.

A few years, I was contacted by the Dave Nee Foundation to give a speech at its annual fundraiser in New York City. The foundation was founded by friends of Dave following his suicide during his third-year of law school at Fordham. It was an amazing event with over 150 people there to support the foundation’s mission to educate others about depression and suicide in law schools and the legal profession.  I met Dave’s friends and family. They were all gracious, welcoming, and smiling.

It came time for my short time.  The room darkened and I stepped up to the dais.  A spot light shone on me and it was difficult to make out the faces of people in the audience as I spoke – except one.  Near the stage was Dave’s mother. I looked at her. Here face crumbled into grief.  It was a powerful moment I will never forget. Though I never met Dave, he is a big reason why I continue to give speeches on depression.

The High Rate of Lawyer Depression

High rates of depression rise following graduation from law school.

A 2016 survey of almost 13,000 practicing lawyers and judges, found the following:

  • 28 % of lawyers reported experiencing depression within the past 12 months, compared 1% for the general population.
  • 46% reported they had encountered a problem with depression over the course of their legal careers.
  • 5% reported having had suicidal thoughts at some point in their legal career.
  • 19% experienced anxiety.
  • In terms of career prevalence, 61% reported concerns with anxiety at some point in their career, and 46% reported concerns with depression.
  • Mental health concerns often co-occur with alcohol use disorders and our study reveals significantly higher levels of depression, anxiety, and stress among those screening positive for problematic alcohol use.

Lawyers rank 5th in incidence of suicide by occupation.

Patrick Krill, a lawyer and mental health consultant, wrote Why Are Lawyers Prone to Suicide? for CNN:

“Despite whatever preconceptions or judgments, many people may have of lawyers and the work they do, there are facts about the practice of law that can’t be denied: It’s tougher than most people think and frequently less fulfilling than they would ever believe.

The psychologist Rollo May famously defined depression as “the inability to construct a future.” And, unfortunately for many attorneys who define their existence by a hard-earned membership in the legal profession, the powerful despair they experience when that profession overwhelms and demoralizes them doesn’t leave them much psychological real estate for constructing a future they can believe in.

Not a future where the practice of law will be what they hoped for, not a future where their lives will have balance and joy, and not a future where their relationships will bring fulfillment and their stresses will seem manageable. They just can’t see it. Unable or unwilling to extract themselves from the psychological, financial and personal mire they never would have expected years of hard work and discipline to bring them, many lawyers then find themselves sinking into a funk, a bottle or a grave.”

A few years ago, I spoke at a conference put on by the Cincinnati Bar Association on depression in the legal profession.  There were about 60 lawyers in attendance.  A few days after the event, I was contacted by another speaker who informed me that one of the attendees had died by suicide.  It took my breath away.  His name was Ken Jamison, a highly successful lawyer and beloved member of his legal community.  His friend and then law partner, Tabitha Hochscheid, Esq., wrote a deeply personal blog about Ken for my website. Here, in part, is her moving tribute:

“I’ll always miss Ken Jameson. The courage and commitment he showed to his clients, his family and those of us in business with him is something I admire. However, his suffering in silence has left me and his other colleagues with regrets as to what we could have done to help. In the end, however, Ken could not give himself permission to be less than perfect and eventually, felt those in his life were better off without him. It is truly a sad ending to a beautiful life that could have been prevented. My hope in sharing Ken’s story is that there will be greater recognition of depression and the despair that can accompany and that it will help someone struggling with these issues. As for Ken, I hope he has found the peace that life did not provide.”

What can we do?

Learn about the symptoms of depression and possible warning signs for suicide.

Depression is a significant risk factor for suicide. The deep despair and hopelessness that goes along with depression can make suicide feel like the only way to escape the pain. If you have a loved one with depression, take any suicidal talk or behavior seriously and watch for the warning signs:

  1. Talking about killing or harming one’s self
  2. Expressing strong feelings of hopelessness or being trapped
  3. An unusual preoccupation with death or dying
  4. Acting recklessly, as if they have a death wish (e.g., speeding through red lights)
  5. Calling or visiting people to say goodbye
  6. Getting affairs in order (giving away prized possessions, tying up loose ends)
  7. Saying things like “Everyone would be better off without me” or “I want out”
  8. A sudden switch from being extremely depressed to acting calm and happy

According to the Mayo Clinic, the first step is to find out whether the person is in danger of acting on suicidal feelings. Be sensitive, but ask direct questions, such as:

  • How are you coping with what’s been happening in your life?
  • Do you ever feel like just giving up?
  • Are you thinking about dying?
  • Are you thinking about hurting yourself?
  • Are you thinking about suicide?
  • Have you ever thought about suicide before, or tried to harm yourself before?
  • Have you thought about how or when you’d do it?
  • Do you have access to weapons or things that can be used as weapons to harm yourself?

Asking about suicidal thoughts or feelings won’t push someone into doing something self-destructive. In fact, offering an opportunity to talk about feelings may reduce the risk of acting on suicidal feelings.

If a friend or loved one is thinking about suicide, he or she needs professional help, even if suicide isn’t an immediate danger. Here’s what you can do.

Encourage the person to call a suicide hotline number. In the U.S., call the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) to reach a trained counselor. There is also a confidential online chat available.

Encourage the person to seek treatment. A suicidal or severely depressed person may not have the energy or motivation to find help. If the person doesn’t want to consult a doctor or mental health provider, suggest finding help from a support group, crisis center, faith community, teacher or another trusted person. You can offer support and advice — but remember that it’s not your job to substitute for a mental health provider.

Offer to help the person take steps to get assistance and support. For example, you can research treatment options, make phone calls and review insurance benefit information, or even offer to go with the person to an appointment.

Encourage the person to communicate with you. Someone who’s suicidal may be tempted to bottle up feelings because he or she feels ashamed, guilty, or embarrassed. Be supportive and understanding, and express your opinions without placing blame. Listen attentively and avoid interrupting.

Be respectful and acknowledge the person’s feelings. Don’t try to talk the person out of his or her feelings or express shock. Remember, even though someone who’s suicidal isn’t thinking logically, the emotions are real. Not respecting how the person feels can shut down communication.

Don’t be patronizing or judgmental. For example, don’t tell someone, “Things could be worse” or “You have everything to live for.” Instead, ask questions such as, “What’s causing you to feel so bad?” “What would make you feel better?” or “How can I help?”

Never promise to keep someone’s suicidal feelings a secret. Be understanding, but explain that you may not be able to keep such a promise if you think the person’s life is in danger. At that point, you have to get help.

Offer reassurance that things can get better. When someone is suicidal, it seems as if nothing will make things better. Reassure the person that with appropriate treatment, he or she can develop other ways to cope and can feel better about life again.

Encourage the person to avoid alcohol and drug use. Using drugs or alcohol may seem to ease the painful feelings, but ultimately, it makes things worse — it can lead to reckless behavior, or feeling more depressed. If the person can’t quit on his or her own, offer to help find treatment.

Remove potentially dangerous items from the person’s home, if possible. If you can, make sure the person doesn’t have items around that could be used for suicide — such as knives, razors, guns, or drugs. If the person takes a medication that could be used for overdose, encourage him or her to have someone safeguard it and give it as prescribed.

Take all signs of suicidal behavior seriously

If someone says he or she is thinking of suicide or behaves in a way that makes you think the person may be suicidal, don’t play it down or ignore the situation. Many people who kill themselves have expressed the intention at some point. You may worry that you’re overreacting, but the safety of your friend or loved one is most important. Don’t worry about straining your relationship when someone’s life is at stake.

You’re not responsible for preventing someone from taking his or her own life — but your intervention may help the person see that other options are available to stay safe and get treatment.

If someone is in immediate danger of committing suicide, call 911 immediately.

Other Resources

Each state has a Lawyers Assistance Program to provide law students and lawyers with confidential help regarding a mental health or addiction programs.  Here is a list of state LAP’s.

If you happen to live in the Buffalo, New York area, you can contact Crisis Service’s 24-Hour Crisis Hotline at (716) 834-3131. If you would like to become actively involved in the Western New York Community on this issue, contact Dr. Celia Spacone, Director of the Suicide Prevention Coalition of Erie County, at the same number.

Matt’s family has set up a fund where you can donate to their cause to “improve the lives of athletes that battle mental health issues.” This was a cause dear to Matt’s heart.  He was a star football player at Middlebury College. Go to their website, “Matthew Benedict’s One Last Goal,” to contribute.

By Daniel T. Lukasik, Esq.

Uplift: How Pushing Weights Lifts My Depression

“Human beings are designed for regular physical activity. The sedentary nature of modern life probably plays a significant role in the epidemic incidence of depression today.”  Andrew Weil, M.D.

After a long winter and dreadful May of rain and cold temperatures, beautiful June is finally here. The sunlight is filtering through the green tree leaves and warm air blowing across my hair.

Summer’s a great time to start investing in your health again after winter’s hibernation.  People are out walking or working in their gardens.  This whole time of year screams “move!”  I have added weight training as part of my moving routine.  Maybe you can, too.

You Can Recover From Depression

I am 57 years old. I am a lawyer. And I struggle with depression.

I was diagnosed when I turned forty.  I didn’t know what was happening to me. But I knew something was wrong. I was crying quite a bit.  My sleep became disrupted. It became difficult to concentrate.  I felt no joy in my life.

Ultimately, my family doctor diagnosed me with major depression and provided me with the help I needed. I started going to therapy and was put on anti-depressants. This saved my life.

Since being diagnosed all those years ago, I have learned to live with depression as have many of the 20 million people who are living with this illness right now in this country.

“Aren’t Your Meds Working?”

A friend I hadn’t seen in months bumped into me at Starbucks.

I’d been standing in line waiting for coffee.  There was a tap-tap on my shoulder. Turning around, I saw my friend, Brian, who, like me, had been a lawyer for over twenty-five years. 

Accomplished and well-connected, Brian had a quiet composure that appeared to follow him wherever he went. I liked him. You could look into his eyes.  And he would look attentively back.  He knew I had struggled with depression.

“How are you?” he said.

“Not so great,” I slumped.

Recovery from Depression: The Power of Expectation

Recovery from depression depends in part on what you believe is possible for the future. If you are to recover at all, you have to take action at some point. It could be a series of small steps about your daily routine – eating breakfast, walking out the door to get fresh air and natural light, making a point of talking to someone each day.

Or it could be much larger, like going to a psychiatrist and starting treatment, regularly meditating, exercising frequently, taking long walks. Whatever it is, you need to feel motivated to overcome the inertia, to stop the loss of warming energy to the cold stillness of depression.

To feel motivation, you need to believe, however tentatively, that you can change for the better, to expect recovery from the worst symptoms. You’re likely to hit a lot of barriers, though, that make it hard to keep up positive expectations.

When you expect to fail, it often happens that you stop taking action to help yourself recover. The deeply ingrained habits of depressive thinking and belief can quickly take over. You might start making rules and setting goals.

If recovery is not total and permanent, it’s not recovery. Treatments can’t fail, depression relapse can’t happen. You can’t be recovered if you’re still on medication. You have to get better in six months or a year, or some fixed period of time.

Of course, the rules and goals are entirely your invention, but they’re part of the expectations you feel in your gut. If you can’t meet them, the disappointment confirms your deepest conviction that you can never succeed.

Finding Meaning in the Legal Profession:An Interview with Dr James Hollis

This is my interview with psychoanalyst, James Hollis, Ph.D., author of the best-selling books, “What Matters Most: Living a More Considered Life,” and “Finding Meaning in the Second Half of Life: How to Finally, Really Grow Up

Dan:  What is depression?

Jim:   I think first of all we have to differentiate between depressions because it‘s a blanket term which is used to describe many different experiences, different contexts and different internalized experiences of people.  First of all, there is the kind of depression that is driven by biological sources and it is still a mystery as to how that works.  We know it affects a certain number of people in profound ways.   Second, there is reactive depression which is the experience of a person who has suffered loss and as we invest energy in a relationship or a situation and for whatever reason, that other is taken away from us, that energy that was attached to him will invert as depression.  Reactive depression is actually normal.

We would have to figure out where that fine line is and where it might cross over into something that was more than normal.  When we say that a person is grieving too long or it is affecting their lives so profoundly, that’s a judgment call, of course, but we do know people that have been sort of destroyed by reactive depression because they had attached so much of their identity to the other, whatever it might be: a position in life that they lost or a relationship that was important.

But I think none of us can avoid occasional reactive depressions because life is a series of attachments and losses.  Most commonly, when we think about depression, however,

Seasonal Affective Disorder: What You Need to Know

We set our clocks back an hour in early November, resulting in shorter days, and darker skies before most of us leave work each afternoon.

It is important to understand the effect that light has on us. If you find yourself falling into the doldrums at this time of year as the number of daylight hours dwindle, seasonal affective disorder (SAD), sometimes called seasonal depression, may be to blame. Most SAD sufferers experience symptoms during the winter months, causing researchers to conclude that inadequate sunlight may play a role. But you don’t have to spend the winter months feeling depressed and unmotivated. Here’s what you need to know about SAD and how to alleviate it.

What Causes Seasonal Affective Disorder?

Most researchers believe decreased access to sunlight plays a role in seasonal affective disorder. Light affects our circadian rhythms, and UV rays can also change how the body processes vital minerals and other nutrients. For example, inadequate sunlight exposure is linked to low Vitamin D, which, in turn, has been linked to depression and other physical and mental health woes. So, the effects of darkness on the body—not just darkness itself—might be partially to blame.

A recent study, published in the Journal of Affective Disorders, bolstered the connection between SAD and inadequate sunlight. It found that weather and climate—including rain and pollution levels—don’t appear to alter mood. But access to sunlight is a major predictor of mental health. In the study, people who lived in regions with shorter, darker days were more likely to experience poor mental health.

While light almost certainly plays a role, not all cases of SAD occur during the short, dark days of winter. A small fraction of cases occur on a seasonal basis during the spring or summer, which suggests that no single factor can fully explain SAD. Other potential risk factors include:

  • Seasonal lifestyle changes. If you only work during a portion of the year, have less to do during a specific time period, or face annual stress, you may experience seasonal depression.
  • Seasonal associations with previous trauma and grief. Our minds form strong connections between the sights and sounds of seasonal shifts and memories of the past. You may find yourself growing depressed each year around the time you suffered a trauma or loss.
  • Cultural norms and traditions. The high of the holiday season followed by the low of the new year can spur depression in some people.
  • Certain health issues are more likely to manifest at specific times of the year. For example, if you have severe allergies, you may get depressed in the spring, while chronic bronchitis can make the winter months depressing.

Each of these factors alone is unlikely to trigger depression, but in conjunction with other risk factors—including a family history of any form of mental illness—they can lead to SAD.

Symptoms of Seasonal Affective Disorder

Cyclical depression that occurs around the same time each year or that relents when the season changes, is the hallmark of SAD. If symptoms are not cyclical, you might be diagnosed with another disorder, such as major depressive disorder or dysthymia.

People with SAD often experience depressive symptoms which are less severe than those associated with major depressive disorders. Though suicidal thoughts can and do occur—particularly if SAD is left untreated—these thoughts are less common. Some common symptoms include:

  1. Low energy, feelings of grogginess, or excessive sleep. People with summer SAD may experience insomnia.
  2. Changes in appetite. People with SAD are vulnerable to weight gain. SAD sometimes causes carbohydrate cravings, because carbs offer a temporary energy boost.
  3. Irritability and anger.
  4. Changes in your relationships with others: People with SAD often feel lonely and rejected.
  5. Loss of interest in previously enjoyed activities.
  6. Feelings of guilt.
  7. Dread or uncertainty about the future.
  8. Loss of motivation.
  9. Feelings of sadness.

Treatment for Seasonal Affective Disorder

People with winter SAD often respond well to light therapy, which involves sitting under a UV lamp for a short period of time each day. If you have access to daylight and can spend time outdoors, you might also find your symptoms improving if you receive 20-40 minutes of daily direct sun each day.

Treatment for major depression can also prove effective at treating SAD. Those treatment options include:

  • Psychotherapy to help you talk through your feelings, identify problematic thought patterns, and more effectively cope with your depression. If causes relationship problems, therapy may also help improve your relationships. Your therapist can also talk to you about lifestyle changes—diet, exercise, activities—that may complement your treatment and help to alleviate your depression.
  • Antidepressants: Depression alters chemicals in your brain. Sometimes lifestyle remedies are inadequate to get things back on track. Antidepressants can be effective and often need only to be taken for a short period.

Is It Possible to Prevent Seasonal Affective Disorder?

Research on the prevention of SAD is mixed. However, there is some evidence that light therapy can help prevent SAD in people with a previous history of the condition. If you’re worried that you might develop SAD this winter, talk to your doctor about preventative strategies. Also, maintain a healthy lifestyle—overeating during the holidays, excessive spending, and low motivation can all make SAD worse.

If you experience SAD, you don’t have to suffer through months of misery. SAD is one of the most treatable forms of depression, and with the right care, you can feel better in weeks, or even days.

This article originally appeared in Psychology Today magazine

Joel L. Young, M.D., is the Medical Director of the Rochester Center for Behavioral Medicine outside of Detroit and teaches Psychiatry at Wayne State University School of Medicine. Trained at the University of Michigan, Dr. Young is certified by the American Board of Psychiatry and Neurology and holds added qualifications in geriatric and forensic psychiatry. In addition, he is a diplomate of the American Board of Adolescent Psychiatry.

Dr. Young and his clinic have been primary investigators in a number of clinical trials involving antidepressant, AD/HD, and bipolar medications. He has authored three books and more than 70 textbooks and articles. His most recent book, When Your Adult Child Breaks Your Heart: Coping with Mental Illness, Substance Abuse, and the Problems That Tear Families Apart, was published by Lyons Press in December 2013.

 

References

 

Good is Not Enough: You Need More Than Getting Rid of Your Depression Symptoms

If you asked any one of us, we would say that top on our list of what we want is to feel better.  But what is “better”?  To most, it means that the symptoms of depression have gone away.  However, just the absence of symptoms is not enough to feel well.  Being well is not only freedom from the episodes of a mood disorder or depression symptoms.  It’s an ongoing process that includes participating in the world around you, being in control of your life, having a sense of personal growth and relationships that matter.  It means that you have a sense of competence and mastery in the things you do in your life and that you feel good about who you are.  How do you get there?

There is an interesting professional article by C.D. Ryff from the University of Wisconsin-Madison (2014) that discusses psychological well-being.  In the past psychologists thought of well-being as happiness, satisfaction with life, and a positive affect (similar to mood).  Thinking about well-being in deeper terms, Ryff describes the essential features of well-being which I will summarize for you here.

What are the components of well-being?  First is having a purpose in life, where you feel your life has meaning, purpose, and direction.  You might find this as a working or volunteer person, student, parent, or whatever it is that guides you.  It’s something that’s easy to forget when we are depressed, so you do have to work on it.  Next is whether you are living a life based on your own personal convictions, beliefs, opinions, and principles.  You are free to make decisions for yourself (that is called autonomy).  For example, if you are an adult, do you feel controlled by another person?   The third feature of well-being is making use of your personal talents and potential, called personal growth.  This could be in your work, school, volunteering, or family life.  Another feature is how well you are managing your life situations, the ups, and downs of daily life called mastering your environment.  We all have fluctuations: the key is how we learn to deal with them.

The fifth feature of well-being is in having positive relationships, with deep ties to others.  It could be with friends or family members, just as long as you have close personal connections.  That is very important to maintaining your mental health balance and definitely helps with depression, a time when isolation can occur.  The last is self-acceptance, which means having knowledge and acceptance of who you are, including your own personal limitations.  Nobody’s perfect – we all have our strengths and weaknesses and do better when we learn to accept and work with them.

This list must seem daunting!  How in the world can I be well if I have to achieve all of these things that are difficult for anyone to do, let alone someone with a mood disorder?  Good question!   It’s not the kind of thing that happens overnight; it takes a lot of time and effort on your part.  And you don’t have to master them all, certainly not all at once.  Begin by having a conversation with your therapist about this and try to identify one or two areas in your life from this list that you want to work on.  Then put those two areas into a clearly stated goal.  Having a goal set in this way helps you to achieve the kind of life you want.  Understand what you have going for you that will help you, such as your strengths, and what you might have to change about yourself and your world to reach this goal.  Try to identify how you personally impact the situation and potentially get in the way of reaching your goal.  Is it negative thoughts you may have?  Are there barriers that exist to achieve your goal?  Find a way to work around them.  Make a list of the first 3-5 steps to reach your goal.  Stay focused on the goal and not how difficult it is.  Care for yourself as you work to achieve it.

For example, your goal might be a purpose in life and personal growth as a musician. You might state it as “I want to improve my skills as a musician and get more professional gigs.  That will make me feel good about myself, bring people pleasure, and earn some money to support myself.”  You might then identify that you are not always consistent with practice time, and feel shy about going out and promoting your musical performance.  Neighbors might complain about hearing you practice. Thinking about it, you may identify one or two negative thoughts you have about your skills (I’m not very good” or “Nobody will hire me”) that are behind these behaviors.  Use CBT to challenge those negative thoughts and behaviors and replace them with more realistic thoughts.  Then think of your strengths, of past successes you have had in this area, and use these to boost your confidence.

Next make a to-do list of what steps you might take to make this happen, and who can help support you in this. That might include: set aside a specific practice time and place each day; take a music lesson(s); make a CD of your performance and bring it around to a few places where you want to perform; put a small sample of your music on social media to attract audience members , such as YouTube, Facebook, LinkedIn, Twitter; make attractive posters to promote your skills and performance dates; put the posters on social media and hang them up in a few select areas around your town announcing your performances and availability.  It’s a lot to do when depressed; have a friend help you.  Do these one-at-a-time, so you don’t get overwhelmed. It is possible and realistic for those of us who have depression to expect wellness.

By Susan J. Noonan, MD, MPH.

Susan is a graduate of Mount Holyoke College, Tufts University School of Medicine, and the Harvard School of Public Health. She is a long-term patient and the author of two books on managing depressionManaging Your Depression; What You Can Do To Feel Better, and When Someone You Know Has Depression: Words to Say and Things to Do, with a companion website and blog. She is also a mental health Certified Peer Specialist, counseling fellow persons with mental illness. In these ways, she bridges that space between recipient and provider of healthcare services. This blog was previously posted, in modified form, on website www.susannoonanmd.com.

 

The Return: Slipping Back Into Depression

I’ve slipped a bit, lately.

After months of relative peace, a return.

First, it was the sadness.  I feel it when I wake up, eat my lunch, drive home from work, and hit the hay at night.  While its intensity varies, it’s always there coloring my days.

My good sense of humor caught the last bus. A bone-wearying fatigue settles in as I withdraw from activities involving people.

I go into hibernation.  I reserve my limited supply of energy for the essential things: work, a limited amount of outside commitments that can’t be avoided or rescheduled, my wife and daughter, a few clients, and filling up my truck with gas.

Life becomes pared down. It loses its sense of richness.  This as a painful, the absence

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