psychologist Archives - Lawyers With Depression

Unpacking Depression: An Interview with Psychologist Dr. Margaret Wehrenberg

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.

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The Depression Journey: Walking the Rocky Trail With a Therapist

Diagnosed with major depression by a psychiatrist when I was forty years old, I had to find a therapist who could help me. The physical side of the illness pounded me: sleeplessness, fatigue, and the inability to concentrate and be productive at my job as a lawyer. But also the psychological dimension: feelings of low self-worth, chronic sadness, and negative thoughts about my ability to recover and be happy again.

A friend recommended me to the man who would become my therapist for the next twenty years. Jerry was a psychology professor at a local university. From the Bronx, he has a wonderful, salty sense of humor. Not only was he brilliant, but he was also warm and engaging. I felt at home, and we quickly bonded.

During this dark time in my life, I felt isolated. More often than not, I felt lonely and didn’t know anyone with depression that could understand what I was going through. Jerry did. He became my closest ally, who was with me every step of the way as I dug my way out of the dark cellar of depression. It took time. And patience that was tough to come by as I slogged through depression for years. But his strong and kind presence saw me through. He gave me insight into what depression was and the ruminative, distorted thinking that the disease would churn out. Jerry called this “crooked thinking.” I learned to recognize such thoughts as not part of who I truly was but as part of the illness. It gave me a distance from them and made it easier not to identify with them. This opened up the possibility – and hope – that I could let go of these destructive thoughts and embrace more realistic, positive ones.

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Dan’s Tips for Weaving Together A Recovery Plan to Heal Your Depression

What will make the pain of depression stop?

Sometimes the ache is dull, other times sharp. It can last a few hours, days, or weeks.

This is ground zero for depression sufferers. What can I do to feel better?

The answer is often elusive. Many don’t know where to get help, let alone walk the path of healing. Recovery starts and sputters for others: they feel better on a med, then it stops working. Or, they start a bold new exercise regimen, only to see it fizzle.

What to do?

There is no one-size-fits-all cure for depression. That what makes it so exasperating. It isn’t like having a bad cold where Nyquil will do the trick for most. Rather, depression is an illness of the body, mind, and soul that doesn’t lend itself to simple fixes. Because we’re all humans with bodies and brains, some things will generally work for everyone; exercise comes to mind. But because we’re also unique, we need a tailored recovery plan to get and stay better.

We need a quilt of healing.

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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.”

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.

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.

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.

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.

The Connection between Depression and Trauma and Neglect

Why do people become depressed? A popular theory is that it is the brain chemistry that is in disarray. But this way of thinking often obscures the issue.

Depression rarely comes out of nowhere. It almost always has an explanation, even if it is not apparent to us. Also, read “What is Your Depression Telling You?”

A better explanation for why many people become depressed is, in my opinion, that we develop vulnerabilities earlier on in our life that predispose us to live a life that is lacking in zest, enjoyment, and meaning.

Oftentimes these earlier vulnerabilities point us to experiences of trauma, neglect, or interpersonal disappointments that may or may not be fully apparent to us.

We almost all undergo some kind of trauma, neglect, or serious interpersonal disappointments at some point in our life, and how we deal with these events can prepare the ground for a later depressive episode. To understand why this is is to understand how humans function.

Responding to Trauma by Losing Ourselves:

When we go through difficult events that we don’t know how to deal with, our psyche responds just like a lizard that loses its tail because it is afraid of a predator. It helps us make an adaptation out of fear, but always at the cost of making us a little less human, or little less ourselves.

Overwhelming shame, for example, might make us abandon a piece of who we are, or in the worst case, our entire person.

How Sexual Abuse Can Lead to Depression:

If I was sexually abused, for example, and didn’t know how to deal with my conflicted emotions and loyalties, it might make me feel bad about wanting and desiring. I might be confused about whether I myself sent out the wrong signals, and might question if the sensation of pleasure I felt, really meant that I desired the abuse, or that my desires are bad.

The psychological compromise I can make to rid myself of my shame is to begin to live a passive life where my awareness of my desires and wants is dimmed, or totally banished. This might mean that I get involved in relationships that are not particularly good for me, that I put up with mistreatment or one-sided relationships because I am reluctant to say “no”, or that I unconsciously seek out bad relationships because I at some level believe I should not get what I really want, or deserve to be punished in some way to atone for my badness.

This compromise I have made to deal with the unbearable experience of sexual abuse has now prepared me for life of lackluster results and lack of enjoyment.

If I become depressed, this is therefore not because there is something wrong with my brain. It is because some part of me doesn’t want the life that I have. My depression is like the last call to me deep from within that indicates that I need to make changes to my life situation because the status quo is antithetical to life. My adaptations to a difficult situation, have now become destructive to what life is really about. Life has turned against life, and my depression is thankfully alerting me to this fact.

Trauma Comes in Many Forms:

Trauma does not have to imply a big dramatic calamitous event, but can refer to any moment when we felt overwhelmed with painful or distressing emotions we did not get the help to deal with. Sexual abuse, physical violence, or growing up with alcoholic parents are some of the more apparent reasons why a person might get exposed to emotional overwhelm, but there are many others.

One of the more frequent causes of adaptations out of fear is the fear of losing love from the people we depend on. In Alice Miller’s book “The Gifted Child”, she describes how this can happen due to growing up with narcissistic parents.

A child, she says, has the need to look into their parent’s eyes and see themselves reflected. If I cry, I need my parent to validate that I am feeling sad, and if I am happy, I need my parents to be happy for me. Unfortunately, some of us look into our parents eyes, and see our parents feelings, not our own. When we are sad, they feel inadequate and get annoyed with us. When we are excited, they are too busy watching TV, and tell us to shush.

These kinds of experiences when they accumulate over time can create serious distortions to our self-image, and can make us abandon ourselves in a pursuit to become more acceptable to our parents.

Research has shown that threats to our sense of safe connection with a caregiver register in our brain as panic, and that losing our connection completely registers as pain. To avoid feeling these unbearable emotions, we will do a lot, even if it means ridding ourselves of our natural spontaneous desires and feelings.

Other ways to deal with the threat of loss is to become numb, or to become what the psychiatrist Karl Jaspers has described as a “dead person with wakeful eyes”.

What Does Depression Have to Do with It?

When we pay too big of a price to stay safe early on in life, we enter into adulthood ill prepared to deal with life’s challenges.

If we have gotten used to numbing ourselves to unpleasant emotions, we will likely also find it difficult to feel joy and excitement.

If we have learned to live our life in an effort to please our parents, our accomplishments won’t really mean much to us, and we will pursue goals that are not aligned with what we really want.

If we had to abandon ourselves because of shame about our needs or our feelings, we will forever have a sense of emptiness inside because we aren’t fully honoring and accepting who we are.

In many cases, when we really look at the reasons why people become depressed, we find a childhood history of trauma, abandonment, or neglect that has resulted in adaptations that are currently getting in the way of living a meaningful life.

Depression is often simply telling us that we are not really living our lives as ourselves.

To resolve this situation is to confront the underlying reasons why we make the choices we do, and to see to what extent we are really living a life based on avoiding shame, anxiety, guilt, and pain, and not a life based on our genuine feelings, needs, and aspirations.

Rune Moelbak, Ph.D., is a psychologist and depression specialist in Houston, Texas. He is the owner of Better Therapy, a therapy practice for people who want to discover the underlying roots of their current psychological problems.

One Woman Lawyer’s Journey Through Depression

Acknowledging my depression for the first time during my third year of law school was as terrifying a realization as it was liberating. Between finishing up final classes, getting ready for the bar exam, and preparing for the first semester of my LL.M degree program, I fought every day to simply get out of my own way, and I fought even harder to hide it. I would wake up in the morning in tears, yet by the afternoon I was at school, going through the motions, and relieved to just make it to the end of the day.

This contradiction of being in law school and living with depression was an unbearable secret. At my core, I was beyond ashamed and embarrassed. I would beat myself up over and over again with the same though: how did I mange get myself to law school only to end up feeling this way? I was so lost, and I was experiencing a pain that was as indescribable and unfamiliar as it was pervasive and present. I convinced myself this that feeling this way was the price I had to pay to become a lawyer, to live up to this expectation I had created about myself. So just get through it, I told myself. This is the way it’s to be done. Suck it up. Survive.

In the months to come, however, my depression worsened. Despite having passed the bar exam, started course work toward my LL.M degree, and a relationship with a man who said he cared for me, I crashed. I spent entire days in bed, with no one to the wiser. I stopped answering my phone and emails, and I wasn’t going to classes. Getting out of bed felt like stepping off the edge of a cliff. Life having any sense of forward momentum and progress was something that seemed to happening for other people, and I was left struggling, trying to figure out how to keep up.

Something inside me managed to articulate clearly and loudly that something was wrong with me that went beyond telling myself to suck it up. One morning, moved by forces that to this day are still a mystery to me, I found my way to the university’s student counseling services. A social worker took me in a back room for an intake interview. Directly and clearly, I was honest for the first time about what was happening to me. The next thing I knew I had a calendar filled with multiple weekly appointments with a psychiatrist who immediately put me on an anti-depressant and talk therapy.

Believe me when I say that those talk therapy sessions in the student counseling center changed my life. My therapist saw through me with kindness and compassion in a way I didn’t think was possible for another person to do, and she understood the how and why of what was happening to me. She helped me put words to emotions and thoughts that existed only in my head. I learned that I could say I was dealing with depression, and that with work it was something I could learn to manage.

But my therapist also told me this was only the beginning for me with understanding and successfully managing my depression. She said we had only scratched the surface. Her words were profound and prescient. As my experience with law evolved from getting through the competitive and pressure filled environment of law school to the demands of practice, so did my experience with depression and its affect on my ability to know and to listen to love myself. For a while, I felt good, and depression felt like memory. I found I was more comfortable with and better at being a working lawyer than I was a law student. Practice requires you to touch more upon your true nature more, I think, than law school. There was less posturing and more action, and I am more suited for that reality. I still, however, had a lot to learn about asserting myself and holding my own in intense environments. As the red flags of my depressive behaviors and thoughts would pop up, I realized that no matter what anti-depressant I was on, or what words of wisdom I tried desperately to recall from a therapy session, I was still out of sync with myself emotionally and my surroundings. This was a powerful insight, but I still could not in the moment handle the stresses I experienced on a daily basis successfully or in a way that felt true to myself. Sexism, cutthroat competitive colleagues, long hours, bitter partners who saw heaping insult upon you as affective training and as lawyerly karmic right. The romantic ideal of the practice of law as noble and worthwhile was elusive and false. The reality was all too much.

Even as I become more successful in advancing my career, obtaining a Federal clerkship and a Big Law job, my depression didn’t dissipate and disappear, as I had naively hoped it would (because as all lawyers know, the right job and status fix things, right?). Instead, its presence became more insidious, because when I felt it, I immediately knew it meant that something was dreadfully wrong, and the fear of where it could take me became all-consuming. The energy it took for me to hold my own with colleagues and clients and still at the end of the day deliver good work took over, and any healthy sense of self-care I had learned when I first acknowledged depression in my life was pushed aside. I now felt like a failure at the most fundamental level because I couldn’t control my depression. Even as my experiences with depressive tendencies became more insightful and clearer to me in their meaning, I was still at a loss as to what to do, and I brutally beat myself up for not being able to fix it.

After completion of a project I was on in 2009, I left my job, and I left life as a working lawyer. And again, I crashed. For a time, I swung too far in the other direction, internalizing depression to the point where it became my identity. I didn’t know where depression ended and my sense of self began, and concluded that the entirety of my life would be determined by its presence. Therapy and medication again were options, but this time, I knew in my gut what I needed was beyond the relief they would provide.

Only with time and by stepping back from thinking of myself as both a lawyer and as someone with depression have I have learned that ultimately I am neither one of those things. I have learned that when I fight and ignore my intuition is when I get into trouble. That is what depression at its worst takes from me. It takes away my voice. When outside noise and pressure and people are too loud, and are in turn amplified in my mind by my depressive thinking, I, in the most glorious sense of the word, am gone. The “I” whose evidence of worth is proved by mere existence; the “I” that only has to live and breathe to be worthy, is nothing to me. All I can see is worry and striving and other people’s judgments, and my own judgments, and angst and pain.

I don’t know that I will work in law again, but I entertain the thought now and then. This thought isn’t without a realistic notion of what it will take to get back into the profession, so, equally, I honor the thought that I may never find a fit for myself in law. I’ve also accepted depression in my life as a siren meant to warn me I’m headed for trouble. This clarity isn’t without fear. I’ve had hard times since I left my last job as a lawyer, but I can honestly say that what I’ve learned about myself and life since has so far been worth it all.

By Anonymous