Too Much Stress Can Lead to Depression

 

I listened to a National Public Radio segment about the connection between playing NFL football and brain trauma.

One retired running back said that each time he was hit when carrying the ball it was “like being in a high-impact car accident”. What a tremendous cost to pay, I thought.

For many of us, daily life is so demanding and stressful that it’s like being in a series of high-impact “stress collisions”. The word “stress” doesn’t even seem to do justice the corrosive experience of so much stress. “Trauma” is more like it.

This trauma isn’t the type inflicted by bone-jarring hits during a football game — it’s psychological, though no less real.

Psychiatrist Mark Epstein, M.D., author of the book The Everyday Trauma of Life, writes in a recent New York Times article,

“Trauma is not just the result of major disasters. It does not happen to only some people.

Dan’s Top 10 Video Picks on Depression

Films can teach us a lot about depression.  Not only can they provide information.  They can also move us emotionally by drawing us into the subject with interviews, animations, and other techniques that aren’t amenable to books.  Here are my favorite videos that address the topic of depression.

Living with Depression

I came across this short video recently.  And was very moved.  It captures, with sublime music and moving images of a young woman, her struggles with clinical depression and the loneliness she endures. Powerful. Over four million people have viewed it. Running time is 3 minutes and 22 seconds

The Trauma of Stress in the U.S. and its Connection to Depression

The NFL football draft just happened. I followed it because I’m a lover of the game.

I played as a kid. I now watch the games on TV with my other brother, Wally over pizza, hot chicken wings and lots of libations.  It’s almost a religious experience, full of pageantry, mystery and a sense of belonging that we feel as fans.

football collision

But as I grow older, my passion is tempered by news of the devastating toll playing such a violent game has on players.

I read a news piece a few days ago about former NFL player Brian Schaefering who played pro ball for five years.  He started a Gofundme page to raise $3000 to buy a service dog to assist him with stability issues resulting from the traumatic brain injury he sustained playing football.  Wow.

Jerome Bettis, a retired running back from the Pittsburgh Steelers, said that each collision he suffered during a game “was like being in a car accident.” What a tremendous cost to pay, I thought.

For many of us, daily life is so demanding and stressful, that, like a football player, it’s like being in a series of car accidents. The word “stress” doesn’t even seem to do justice the corrosive experience of so much stress– “trauma” is more like it.

The trauma isn’t the type inflicted by bone jarring hits during a football game, but it’s no less real – and can be disastrous for our physical and mental health.

trauma

In his book, The Everyday Trauma of Life, psychiatrist Mark Epstein writes in a recent New York Times article,

“Trauma is not just the result of major disasters. It does not happen to only some people. An undercurrent of trauma runs through ordinary life, shot through as it is with the poignancy of impermanence. I like to say that if we are not suffering from post-traumatic stress disorder, we are suffering from pre-traumatic stress disorder. There is no way to be alive without being conscious of the potential for disaster. One way or another, death (and its cousins: old age, illness, accidents, separation and loss) hangs over all of us. Nobody is immune. Our world is unstable and unpredictable, and operates, to a great degree and despite incredible scientific advancement, outside our ability to control it.”

Such trauma not only impacts our psychological/emotional and spiritual selves, but our physical brains.

brain

In a brilliant article in the Wall Street Journal, Stress Starts Up The Machinery of Major Depression, Robert Sapolsky, Ph.D., points out that there are many factors that increase our risk of major depression including genes, childhood trauma, and endocrine and immunological abnormalities.

But stress is a frequent trigger.

Sapolsky writes, “The stress angle concerns ‘anhedonia,’ psychiatric jargon for ‘the inability to feel pleasure.’ Anhedonia is at the core of the classic definition of major depression as ‘malignant sadness’”.

As a person who has a genetic history of depression in his family and childhood trauma, I was drawn into Sapolsky’s article. What was the connection between stress and the malignant sadness I’ve experienced off and on since being diagnosed with depression twelve years ago?

Who would have thought that rat brain research would help me understand the link?

Sapolsky gives us a little background about our brain structure by letting us know that our abilities to anticipate, pursue and feel pleasure revolve around a neurotransmitter called dopamine in a region of the brain called the nucleus accumbens. Then he turns to the rats for further illumination:

“Put a novel object – say, a ball – in a mouse’s cage. When the mouse encounters the ball and explores it, the arousing mystery, puzzle and challenge cause the release of a molecule in the nucleus accumbens called CRF, which boost dopamine release. If an unexpected novel object was a cat, that mouse’s brain would work vey differently. But getting the optimal amount of challenge, what we’d call ‘stimulation,’ feels good.”

We humans need just enough challenge and stress to make life interesting.

“CRF mediates this reaction: Block the molecule’s actions with a drug, and you eliminate the dopamine surge and the exploration,” writes Sapolsky. “But exposing a mouse to major, sustained stress for a few days changes everything. CRF no longer enhances dopamine release, and the mouse avoids the novel object. Moreover, the CRF is now aversive: Spritz it into the nucleus accumbens, and the mouse now avoids the place in the cage where that happened. The researchers showed that this is due to the effects of stress hormones called glucocorticoids. A switch has been flipped; stimuli that would normally evoke motivated exploration and a sense of reward now evoke the opposite. Strikingly, those few days of stress caused that anhedonic state to last in those mice for at least three months.”

Sapolsky concludes:

“But meanwhile, these findings have an important implication. Life throws lousy things at us; at times, we all get depressed, with a small letter “d.” And most people—as the clichés say—get back in the saddle; prove that when the going gets tough, the tough get going. What then to make of people who are incapacitated by major depression in the clinical sense? Unfortunately, for many, an easy explanation is that the illness is a problem of insufficient gumption: ‘Come on, pull yourself together.’ There is a vague moral taint.”

The trauma of everyday stress is an important player in major depression. When combined with genetic history and childhood neglect or trauma, it can tip the applecart and result in what Andrew Solomon calls “The Noonday Demon”.   The takeaway is that the better we get at managing the “trauma of everyday life”, the better chance we have at preventing depression.

My worry is that the society we’ve created and the hectic lives we lead make the management of stress very difficult, indeed.

 

 

 

Depression Screening for All?

From National Public Radio‘s program, “On Point with Tom Ashbrook,” a great conversation with experts about a new national task force’s recommendation that says everyone should be screened for depression.  Listen to the Podcast

Can Creativity Help Depression? An Interview with Carrie Barron, M.D.

Dan: Why did you write The Creativity Cure?

Carrie: I felt that the solutions out there for people with anxiety and depression were partial solutions, incomplete remedies. The way we live now causes stress for many people – the pace, the lack of rest or leisure, the relentless striving. Our technological, cerebrally focused culture has taken us out of our bodies and ourselves. Addiction to devices causes an imbalance and a malaise. When you are tied to a device 24-7 you may not be experiencing the fullness of all 5 senses, the things that make you feel energized. The primal satisfaction of making things and using the hands are slowly slipping away from us. For wellbeing, we have to make a conscious effort to maintain them. When my patients make and fix things, they feel better. Research shows that manual effort and creativity are antidotes for malaise. The Creativity Cure was written to help people find another way.

Dan: I deal with lawyers with depression and other professionals that are on their phones and computers a lot. What kinds of things would you recommend that they do with their hands for physical?

Carrie: It’s about getting out of your head. There are many cerebrally oriented people, but “ I think therefore I am” (Descartes) may not be the answer in the current culture. It is really becoming I think therefore I’m not. Too much thinking at the exclusion of physical and manual activity can make us depressed. Physicality, creativity and using your hands – – cooking or washing cars or crafting, painting walls or using watercolors — honor anatomical intent. Long ago manual action in everyday life was necessary for physical survival. Now we need these actions for psychological survival.

The need to create is primal. Paint a wooden board or do Legos with your child. Do that thing you were always drawn and do it clumsily, imperfectly. You don’t have to have any experience as an artist or a maker of things. You don’t have to have a fine result. You can just explore, begin and build. The beauty is in the inner experience. Research has shown that meaningful hand use decreases depression.

Dan: In your book, write about the unconscious mind. What do you mean by that?

Carrie: The unconscious mind, the deepest most hidden layer of our mind houses our , primal self, our instincts, our intuitions and our truth. The unconscious is a treasure trove of clues about our natural self, our unique self.  We can get in touch with the deepest layer of our mind via dreams and seemingly random thoughts. Noting where our minds naturally drift helps us learn about where we need to be and what we need to do. The unconscious is a very powerful resource.

Dan: What is our unconscious trying to tell us for people who suffer with anxiety and depression?

Carrie: Depression can have many different causes: biological, situational, genetic or hormonal. It can also be the result of trauma. Self-knowledge and insight – knowing what resides in your unconscious mind – helps with depression because as the saying goes, the truth sets us free. Talking to a pastor or a mental health professional can elucidate information that moves you forward. Understanding yourself: who you really are, what your instincts are or what you are actually upset about is key for positive change. Sometimes you think your concern is one thing and your deeper self tells you that it is another. Following unconscious clues helps you live more truthfully and happily.

Dan: You mentioned “clues” from the unconscious. Can people that are dealing with anxiety and depression unearth these clues themselves? If a person did receive such clues, how would a person know, without talking to a therapist, know what to make of these clues?

Carrie: Writing is helpful. Keep a journal. Take walks, try yoga, breathe, self-reflect, fiddle with paint, doodle, just let. Important material bubbles up when your mind slows down. Be curious and wonder, “Who am I that I love that, what does this leaning say about me, how can I this passion be part of my regular life?” Paying attention to the feeling that accompanies certain thoughts can help you. Certain involvements can make you unhappy but they are habitual so you just keep on. Acknowledging your true inner responses enables you to change. Breaking through denial is key.

Dan: In my work helping lawyers with burnout, anxiety and depression, many of them that seem to contact me are middle-aged. Do you find that a lot of the people, the clients you see are coming to you in midlife?

Carrie: Yes, and midlife can be the best time of life. Loss and disruption, while initially causing depression or anxiety, can lead to positive inner transformation. If we learn to seek pleasure, solace or a feeling of elevation from friendships, family, creativity, and tending to those we love, we are empowered. If you are dependent on an outside institution for your self-esteem, you are less in control of your life and more vulnerable. Define yourself; don’t let it come from the outside.

Dan: I’d like to follow up on a point you make in your book when you talk about people not being in contact with their physical bodies and a visceral since of being alive. I spoke recently with Richard O’Connor, a psychologist in New York City who wrote the book Undoing Depression. He said that depression really wasn’t really about the emotion of sadness – – but about the absence of all emotion. Is that something that you see with the depressed patients you treat?

Carrie: I think it was Andrew Solomon, author of The Noonday Demon: An Atlas of Depression, who offered that beautiful juxtaposition: the opposite of depression is vitality – – not happiness. That really captures it.

Dan: In your book you make a distinction. You indicated that The Creativity Cure is a good fit for people with mild to moderate depression anxiety, but maybe not major depression. Why?

Carrie: For those who suffer from major depression and feel that their depression is well managed, The Creativity Cure is a great option for finding more vitality. Those who at baseline have mild to moderate depression and find that meds do not help enough can discover ways to unleash creativity and happiness in the book. It takes some motivation, but once you get going, you will have more energy and a greater number of happy moments.

Dan: What percentage of your patients would you say depression plays a role in their maladies for which they’re seeing you?

Carrie: Eighty percent.

Dan: Wow – -that many. And to actually put The Creativity Cure into effect, how long do you generally work with somebody to get to the point where they can do it on their own?

Carrie: We start right away by finding out as much as we can about who that person is and what makes him or her feel alive. We think about what is working and what is not, why certain choices were made and ways to redirect the self. Through the Five Part Prescription: Insight, Movement, Mind Rest, Using Your Own Two Hands and Mind Shift people can uncover their true leanings and find more vigor, inspiration, passion. For positive change, integrate the methods into your lifestyle over several weeks. Little steps! True change is all about a little at a time and building.

Dan: In your career as therapist, have you treated lawyers with depression?

Carrie: Yes, yes.

Dan: Have you found anything about their life style that contributes to their depression?

Carrie: I think its three things for lawyers, especially those in high-pressure positions. My client Marnie comes to mind. She is a 28 year-old lawyer who has to give up her personal life at the drop of a hat when she is needed. It is tough. Number one, she is often exhausted because 17 -hour days are not uncommon. Number two, there is a lack of autonomy because this 17 -hour day can be thrust upon her at anytime and continue for weeks. Marnie, professional, committed and with good attitude, has to be available in the moment, late nights, on weekends.

But, compliance takes a toll. It makes her depressed to be in the office and not see sunlight. Not being in control of her time is hard. Even if the work is interesting, she has to give up other important involvements. Marnie feels lonely and isolated because she has little opportunity to be with old friends or to develop new ones. We are working on ways she can maintain friendships, even in text message or email shoot-outs if an in- the- flesh visit must be delayed.

Number three is that living in your head all the time, no matter how brilliant you are, is not healthy. Smart as a whip with facts and numbers, Marnie garners much more pleasure from aesthetics. She likes design but has not felt free enough to develop this interest. Colors, shapes, proportions – thinking about these things makes her happy. It is a sensual, visual way of moving through the world. A big part of the treatment is making her interest in design part of her ongoing life.

I think lawyers in general are really smart people who are great at using their minds. They have been reinforced for this all their lives, but for a richer, higher, happier state, many of these cerebral people need to get out of their heads and start using their hands. Go into a creative world. Balance mind, hands and body.

Dan: I have given many talks around the country on the topic of lawyer and one of the things I like to say is that lawyers have the most active fantasy lives of most professionals I’ve ever spoke to, where they dream of doing something else than lawyering. Can those be clues that would fit in with The Creativity Cure?

Carrie: Fantasizing is a sign of mental health. It’s a good thing. Learning about your inclinations through daydreams might lead you to change your life in a big way or make it better in small ways. Tiny steps allow for big changes because they foster consistency and this builds a new self in a solid way. If you’re interested in learning how to make beautiful cupcakes you can do that for an hour on the weekend. Play guitar, write poems, tend tomatoes in a vegetable garden and do it for a few minutes a day. Start small and make it part of you. Keep dreaming and keep doing. Contentment is about maintaining an identity that integrates your creative

How Lawyers Can Get Things Done When Depressed

Getting things done at work is a top priority for any lawyer. This is all the more so when a lawyer is suffering from clinical depression because it becomes harder and harder to be productive: stacks of paperwork become bigger stacks of paperwork, deadlines begin to feel like death sentences when not completed and time is running out, and the e-mail box is overflowing like a sink onto a cold, tiled floor.

BN-EN874_depres_G_20140915175608

The failure to fix a lack of productivity spirals folks out of control. Not accomplishing things makes their work problems seem, essentially, unsolvable. Depressed lawyer can’t seem to remember a time before their depression when they were on top of their game. Author Andrew Solomon writes:

“When you are depressed, the past and future are absorbed entirely in 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’re certainly cannot imagine a future time when you will feel better”.

A Tsunami of Self-Condemnation

When you combine lack of productivity and disorganization, you have a recipe for toxic self-condemnation: “I got nothing done this morning.” “I feel useless and out of control”. They feel incompetent in a profession that prizes competence because they blame themselves for not having the motivation to check things off their list of things they need to  get done. What they fail to see, is not they’re inept or lazy. They’re sick.

Depression creates a ‘brain fog” that prevents anyone within its gravitational pull from getting much done; a psychic disorientation that feels like you’ve been kicked in the head by a horse. The reason is that there is actually decreased metabolic functioning in the frontal lobes of the brain, which are responsible for initiating behavior. So even though there’s a desire to press on the gas to get things done, our brains are running on vapors.

Well Done

Lawyers feel desperate to become unstuck – to get traction and get back on the path of productivity. In the insightful book Get It Done When You’re Depressed, the authors are dead-on about the types of things depressives tell themselves when trying to get things done – and how this actually leads to things not getting done: (1) You have decided that there’s no use in starting if you don’t have the desire for the project, (2) you search for the feeling of wanting to get something done even when you know that lack of motivation is a normal symptom of depression and (3) you wait so long to get a good feeling about what you need to do that you never even get started.

Given this, how can we possibly get things done when depressed? Is it even possible? The three points I took away from the book are:

1.   Keep working until you do feel even a small sense of accomplishment, and hold on to that as you finish a project.

2.   Work no matter what so you can go to bed with a sense of accomplishment.

3.   As you start to implement these ideas, remember to take it slow and have realistic expectations.

Remember, depression doesn’t want you to do anything and never will. It’s an inert illness, not an active illness. If you wait until you ‘feel like it’ to start something, you’ll wait forever.

Lawyers are perfectionists and set high expectations on themselves. But that doesn’t work with depression; it only serves to fuel the illness because you cannot get everything done that you customarily had gotten done when not depressed. So, be kind to yourself.

In a past blog, My Desk, My Enemy: 6 Helpful Ways to Get Organized, I wrote further about the nuts-and-bolt of how to get things done when depressed. Check out the blog for practical things you can put to use in your law practice and life.

Copyright by Daniel T. Lukasik

Best Depression Quotes

Others imply that they know what it is like to be depressed because they have gone through a divorce, lost a job, or broken up with someone. But these experiences carry with them feelings. Depression, instead, is flat, hollow, and unendurable. It is also tiresome. People cannot abide being around you when you are depressed. They might think that they ought to, and they might even try, but you know and they know that you are tedious beyond belief: you are irritable and paranoid and humorless and lifeless and critical and demanding and no reassurance is ever enough. You’re frightened, and you’re frightening, and you’re “not at all like yourself but will be soon,” but you know you won’t.  Kay Redfield Jamison, Night Falls Fast

That’s the thing about depression: A human being can survive almost anything, as long as she sees the end in sight. But depression is so insidious, and it compounds daily, that it’s impossible to ever see the end.  Elizabeth Wurtzel, Prozac Nation

In depression . . . faith in deliverance, in ultimate restoration, is absent. The pain is unrelenting, and what makes the condition intolerable is the foreknowledge that no remedy will come – – not in a day, an hour, a month, or a minute . . . It is hopelessness even more than pain that crushes the soul.  William Styron, Darkness Visible

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. Make no mistake about people who leap from burning windows. Their terror of falling from a great height is still just as great as it would be for you or me standing speculatively at the same window just checking out the view; i.e. the fear of falling remains a constant. 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. It’s not desiring the fall; it’s terror of the flames. And yet nobody down on the sidewalk, looking up and yelling ‘Don’t!’ and ‘Hang on!’ can understand the jump. Not really. You’d have to have personally been trapped and felt flames to really understand a terror way beyond falling.  David Foster Wallace

The term clinical depression finds its way into too many conversations these days.  One has the sense that a catastrophe has occurred in the psychic landscape. Leonard Cohen

They flank me-Depression on my left, loneliness on my right. They don’t need to show their badges. I know these guys very well. …then they frisk me. They empty my pockets of any joy I had been carrying there. Depression even confiscates my identity; but he always does that. Elizabeth Gilbert, Eat, Pray, Love

Depression is nourished by a lifetime of ungrieved and unforgiven hurts. Penelope Sweet

Depression presents itself as a realism regarding the rottenness of the world in general and the rottenness of your life in particular. But the realism is merely a mask for depression’s actual essence, which is an overwhelming estrangement from humanity. The more persuaded you are of your unique access to the rottenness, the more afraid you become of engaging with the world; and the less you engage with the world, the more perfidiously happy-faced the rest of humanity seems for continuing to engage with it.  Jonathan Franzen, How to Be Alone

I’m here. I love you. I don’t care if you need to stay up crying all night long, I will stay with you. There’s nothing you can ever do to lose my love. I will protect you until you die, and after your death I will still protect you. I am stronger than Depression and I am braver than Loneliness and nothing will ever exhaust me.  Elizabeth Gilbert, Eat, Pray, Love

Choking with dry tears and raging, raging, raging at the absolute indifference of nature and the world to the death of love, the death of hope and the death of beauty, I remember sitting on the end of my bed, collecting these pills and capsules together and wondering why, why when I felt I had so much to offer, so much love, such outpourings of love and energy to spend on the world, I was incapable of being offered love, giving it or summoning the energy with which I knew I could transform myself and everything around me.  Stephen Fry, Moab Is My Washpot

I didn’t want to wake up. I was having a much better time asleep. And that’s really sad. It was almost like a reverse nightmare, like when you wake up from a nightmare you’re so relieved. I woke up into a nightmare.  Ned Vizzini, It’s Kind of a Funny Story

I thought the most beautiful thing in the world must be shadow, the million moving shapes and cul-de-sacs of shadow. There was shadow in bureau drawers and closets and suitcases, and shadow under houses and trees and stones, and shadow at the back of people’s eyes and smiles, and shadow, miles and miles and miles of it, on the night side of the earth.  Sylvia Plath, The Bell Jar

No amount of love can cure madness or unblacken one’s dark moods. Love can help, it can make the pain more tolerable, but, always, one is beholden to medication that may or may not always work and may or may not be bearable.  Kay Redfield Jamison, Night Falls Fast

Depression is melancholy minus its charm.  Susan Sontag

You are constantly told in depression that your judgment is compromised, but a part of depression is that it touches cognition. That you are having a breakdown does not mean that your life isn’t a mess. If there are issues you have successfully skirted or avoided for years, they come cropping back up and stare you full in the face, and one aspect of depression is a deep knowledge that the comforting doctors who assure you that your judgment is bad are wrong. You are in touch with the real terribleness of your life. You can accept rationally that later, after the medication sets in, you will be better able to deal with the terribleness, but you will not be free of it. 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.  Andrew Solomon, The Noonday Demon

Depression is the most unpleasant thing I have ever experienced. . . . It is that absence of being able to envisage that you will ever be cheerful again. The absence of hope. That very deadened feeling, which is so very different from feeling sad. Sad hurts but it’s a healthy feeling. It is a necessary thing to feel. Depression is very different.   J.K. Rowling

Do not abandon yourselves to despair. We are the Easter people and hallelujah is our song.  Pope John Paul II

The absolute worst part of being depressed is the food. A person’s relationship with food is one of their most important relationships. I don’t think your relationship with your parents is that important. Some people never know their parents. I don’t think your relationship with your friends are important. But your relationship with air-that’s key. You can’t break up with air. You’re kind of stuck together. Only slightly less crucial is water. And then food. You can’t be dropping food to hang with someone else. You need to strike up an agreement with it.  Ned Vizzini, It’s Kind of a Funny Story

Depression is the flaw in love. To be creatures who love, we must be creatures who can despair at what we lose, and depression is the mechanism of that despair.  Andrew Solomon, The Noonday Demon: An Atlas of Depression

And an inky-colored despair of rejection enveloped me like the black tortilla of depression around a pain burrito.  Christopher Moore, Bite Me

Others imply that they know what it is like to be depressed because they have gone through a divorce, lost a job, or broken up with someone. But these experiences carry with them feelings. Depression, instead, is flat, hollow, and unendurable. It is also tiresome. People cannot abide being around you when you are depressed. They might think that they ought to, and they might even try, but you know and they know that you are tedious beyond belief: you are irritable and paranoid and humorless and lifeless and critical and demanding and no reassurance is ever enough. You’re frightened, and you’re frightening, and you’re “not at all like yourself but will be soon,” but you know you won’t.  Kay Redfield Jamison, An Unquiet Mind: A Memoir of Moods and Madness

So why am I depressed? That’s the million-dollar question, baby, the Tootsie Roll question; not even the owl knows the answer to that one. I don’t know either. All I know is the chronology. Ned Vizzini, It’s Kind of a Funny Story

Music can lift us out of depression or move us to tears – it is a remedy, a tonic, orange juice for the ear. But for many of my neurological patients, music is even more – it can provide access, even when no medication can, to movement, to speech, to life. For them, music is not a luxury, but a necessity.  Oliver Sacks

Grief is depression in proportion to circumstance; depression is grief out of proportion to circumstance.  Andrew Solomon, The Noonday Demon

We don’t have a great war in our generation, or a great depression, but we do, we have a great war of the spirit. We have a great revolution against the culture. The great depression is our lives. We have a spiritual depression.   Chuck Palahniuk, Fight Club

I didn’t want to wake up. I was having a much better time asleep. And that’s really sad. It was almost like a reverse nightmare, like when you wake up from a nightmare you’re so relieved. I woke up into a nightmare.  Ned Vizzini, It’s Kind of a Funny Story

Killing oneself is, anyway, a misnomer. We don’t kill ourselves. We are simply defeated by the long, hard struggle to stay alive. When somebody dies after a long illness, people are apt to say, with a note of approval, “He fought so hard.” And they are inclined to think, about a suicide, that no fight was involved, that somebody simply gave up. This is quite wrong.  Sally Brampton, Shoot the Damn Dog: A Memoir Of Depression

It’s so hard to talk when you want to kill yourself. That’s above and beyond everything else, and it’s not a mental complaint-it’s a physical thing, like it’s physically hard to open your mouth and make the words come out. They don’t come out smooth and in conjunction with your brain the way normal people’s words do; they come out in chunks as if from a crushed-ice dispenser; you stumble on them as they gather behind your lower lip. So you just keep quiet.”  Ned Vizzini, It’s Kind of a Funny Story

A loss of focus can be the most debilitating of depressive symptoms, rendering a person unable to work effectively or plan for the future, which seems desolate, devoid of the possibility of redemption.  John Nelson, M.D.

The depressed person is constantly chewing on himself.  He needs to find something else to chew on. The form of diversion is not important, but the act of diversion is.  Penelope Russianoff, When Am I Going to Be Happy?

Depression is not only an experience in the mind; it is also an affliction of the body.  There is a lack of energy, a painful heaviness; sadness and a grief that permeate to our marrow. Philip Martin, The Zen Way through Depression

In an age of hope men looked up at the night sky and saw “the heavens.” In an age of hopelessness they call it simply “space”.   Peter Kreeft

The opposite of depression is not happiness, but vitality – the ability to experience a full range of emotions, including happiness, excitement, sadness, and grief. Depression is not an emotion itself; it’s the loss of feelings, a big heavy blanket that insulates you from the world yet hurts at the same time. It’s not sadness or grief, it’s an illness.  Richard O’Connor, Ph.D., Undoing Depression

Depression can be set off by a variety of stressors: sexual abuse, housing problems, illness in one’s child, and the other common problems you might imagine. To suggest that depression arises from loss is to skew the argument in the direction of the metaphor . . . , the one that likens apparent depression to ordinary bereavement. Likewise, “sadness” does not capture the essence of depression, which is a marked disruption of brain and mind characterized by painful apathy. Not only in degree but also in quality, sadness and depression are different.  Peter Kramer, M.D., Against Depression

One of the features of depression is pessimistic thinking. The negative thinking is actually the depression speaking. It’s what depression sounds like. Depression in fact manifests in negative thinking before it creates negative affect. Most depressed people are not aware that the despair and hopelessness they feel are flowing from their negative thoughts. Thoughts are mistakenly seen as privileged, occupying a rarefied territory, immune to being affected by mood and feelings, and therefore representing some immutable truth.  Hara Estroff Marano

I am now the most miserable man living. If what I feel were felt by the whole human race, there would not be one cheerful face left on earth.  Abraham Lincoln

My hunch is that the disease/defect model of depression, is unwittingly contributing to the ongoing stigma of depression. Through the lens of the disease model, the legions of the formerly depressed are a “broken” people who need lifelong assistance. I would like to see a more revolutionary public education approach, with campaigns that emphasize the unique strengths that are required to endure depression. Even if a person is helped by drugs or therapy, grappling with a severe depression requires enormous courage. In many ways, a person who has emerged from the grip of depression has just passed the most severe of trials in the human experience. If we acknowledge that surviving depression requires a special toughness, we will not see formerly depressed people as a broken legion, but as a resource who can teach us all something about overcoming adversity.  Jonathan Rottenberg, Ph.D.

Where’s the big national foundation leading the battle against depression? Where is the Jerry Lewis Telethon and the Annual Run for Depression? Little black ribbons for everyone to wear? The obvious answer is the stigma associated with the disease. Too much of the public still views depression as a weakness or character flaw, and thinks we should pull ourselves up by our bootstraps. And all the hype about new antidepressant medications has only made things worse by suggesting that recovery is simply a matter of taking a pill. Too many people with depression take the same attitude; we are ashamed of and embarrassed by having depression. This is the cruelest part of the disease: we blame ourselves for being weak or lacking character instead of accepting that we have an illness, instead of realizing that our self-blame is a symptom of the disease. And feeling that way, we don’t step forward and challenge unthinking people who reinforce those negative stereotypes. So we stay hidden away, feeling miserable and yourselves for ourselves for our own misery.   Richard O’Connor, Ph.D., Undoing Depression

Depression is not a disease, the end point of a pathological process. It is a sign that our lives are out of balance, that we’re stuck. It’s a wake-up call and the start of a journey that can help us become whole and happy, a journey that can change and transform our lives. Healing depression and overcoming unhappiness mean dealing more effectively with stress; recovering physical and psychological balance; reclaiming parts of ourselves that we’ve ignored or suppressed: and appreciating the wholeness that has somehow slipped away from us, or that we have never really known.  James Gordon, M.D., Unstuck

Scientists know that traumatic experiences such as child abuse and neglect change the chemistry and even the structure of the brain. They sensitize the stress response system so that those who are abused become overly responsive to environmental pressures. They shape wiring patterns in the brain and reset the sensitivity level of the machinery. Eventually, even small degrees of stress provoke an outpouring of stress hormones, and these hormones in turn act directly on multiple sites to produce the behavioral symptoms of depression. They push the brain’s fear center into overdrive, churning out negative emotions that steer the depression’s severity and add a twist of anxiety.  Ellen McGrath, Ph.D.

Depression can be seen as a break-down in the service of offering the person an opportunity for a break-through. In this way, depression can be a corrective feedback to a life with little reflection. We only reflect on those things that break down in life. For example, if life is going along smoothly you won’t spend time thinking about the meaning of life. We tend to think deeply about life when something is not working. When we identify a problem, we begin to reflect on what caused the problem and how to fix the problem. If you are disconnected from your deepest feelings and impulses you may still manage to get through life without realizing it.  Lara Honos-Webb, Listening to Depression

The opposite of depression is not happiness, but vitality – the ability to experience a full range of emotions, including happiness, excitement, sadness, and grief. Depression is not an emotion itself; it’s the loss of feelings, a big heaving blanket that insulates you from the world yet hurts at the same time. It’s not sadness or grief, it’s an illness. Richard O’Connor, Ph.D., Undoing Depression

When we ruminate, we become fruitlessly preoccupied with the fact that we are unhappy and with the causes, meanings, and consequences of our unhappiness. Research has repeatedly shown that if we have tended to react to our sadness or depressed moods in these ways in the past, then we are likely to find the same strategy volunteering to ‘help’ again and again when our moods start to slide. And it will have the same effect: we’ll get stuck in the very mood from which we are trying to escape. As a consequence, we are at even higher risk of experiencing repeated bouts of unhappinessMark Williams, The Mindful Way through Depression

Perhaps all the dragons of our lives we fear are princes and princesses who are only waiting to see us once beautiful and brave. Perhaps everything terrible is in its deepest being something helpless that wants us to help.  Rainer Maria Rilke

We only reflect on those things that break down in our life. For example, if life is going along smoothly you won’t spend time thinking about the meaning of your life. We tend to think deeply about life when something is not working. When we identify a problem, we begin to reflect on what caused the problem and how to fix the problem. If you are disconnected from your deepest feelings and impulses you may still manage to get through life without realizing it.But if you begin to open to the possibility that there was something fundamentally wrong with your level of functioning before your depression, only then does the idea of depression as a gift begin to make sense. A breakdown can become a gift when it is in the service of increasing reflection on your life which will lead you to ask the fundamentally important questions: What is wrong with my life? What can I do to correct the problem? When you listen to your depression, you can heal your life.  Lara Honos-Webb, Ph.D., Listening to Depression

Depression has a mind of its own. When you are depressed, you think in generalizations (nothing works out), you don’t give yourself credit (I can’t do anything right), and you label yourself in the most negative terms (loser, ashamed, humiliated). You set demanding standards that you will never live up to. You may think you need to get everyone’s approval, or excel at everything you do, or know for sure something will work out before you try it. Your thinking keeps you trapped in self-criticism, indecisiveness, and inertia. Robert Leahy, Ph.D., How to Beat the Blues

Depression is the inability to construct a future.  Rollo May, Ph.D.

Every time a person gets depressed, the connections in the brain between mood, thoughts, the body, and behavior get stronger, making it easier for depression to be triggered again. At the earliest stages in which mood starts spiraling downward, it is not the mood that does the damage, but how we react to it. Mark Williams, The Mindful Way through Depression

The Failure of Will theory is popular with people who are not depressed.  Get out and take your mind off yourself, they say. You’re too self-absorbed.  This is just the stupidest thing you can say to a depressed person, and it is said every day to depressed people all over this country.  And if it isn’t that, it’s, ‘Shut up and take your Prozac.’ These attitudes are contradictory. Conquer Your Depression and Everything Can Be Fixed by the Miracle of Science presuppose opposite explanations of the problem. One blames character, the other neurotransmitters.  They are often thrown at the sufferer in sequence: ‘Get out and do something, and if that doesn’t work, take pills.’ Sometimes they’re used simultaneously: ‘You won’t take those pills because you don’t WANT to do anything about your depression, i.e. Failure of Will. Susanna Kaysen, Unholy Ghosts: Writers on Depression

Perhaps, the answer is that my ravaged mind rails against the idea of God, but something deeper in me calls out as if God might answer. ‘There are not foxholes,’ I guess, and depression is the deepest and deadliest foxhole I’ve been in. It may be the ‘dark night of the soul’ that the mystics talk about but in depression it is not so much that one becomes lost in the dark as one becomes the dark.  Parker Palmer

Depression can seem worse than terminal cancer, because most cancer patients feel loved and they have hope and self-esteem.  David D. Burns, Ph.D.

That terrible mood of depression of whether it’s any good or not is what is known as The Artist’s Reward.  Ernest Hemmingway

One description of depression is that it is like the shapeless sagging of a rubber band that has been kept too taunt for too long. When feelings have been strong, stressed, unprocessed, or held captive over a period of time, we just stop feeling altogether. Persons and events no longer have the power to enliven us; we operate on a low level cruise control.  Usually we keep functioning, but there is no positive or creative affect toward persons and things, and even less toward ourselves.  We basically stop living our only life.  Ron Rohr

All of us feel shamed by life.  All of us consider ourselves failures of some kind, screw ups in something really important to us. Notice how shame, consciously or unconsciously pulls us away from risk, ratifies our negative sense of worth through self-sabotage or compels us into frenetic efforts of overcompensation or yearning for the validation from others that never comes; how much each of us needs to remember one definition of grace as accepting the fact that we are accepted despite the fact that we are unacceptable   James Hollis, Ph.D., What Matters Most

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

While direct-to-consumer advertising has likely fostered an easier acceptance of these pills, most of the people I interviewed who suffer from major depression embark on a psychiatric career with great reluctance.  Typically my respondents turn to medications only when desperation leaves them without alternatives.  This is understandable in terms of the identity line that one crosses by seeing a doctor, or seeing a diagnosis of depression and filling the prescription for anti-depressants.  One person poignantly expressed her identity dilemma by saying that, ‘When I swallowed that first pill I swallowed my will.’ Beginning a regimen of psychiatric medications is part of the traumatic transformation from person to patient; from being merely a troubled person to someone who has mental illness.   Daniel Karp, Speaking of Sadness

Mysteriously and in ways that are totally remote from natural experience, the grey drizzle of horror induced by depression takes on the quality of physical pain.  William Styron, Darkness Visible

 

 

 

 

Dan’s Top Ten Depression Books

Undoing Depression – Richard O’Connor, Ph.D.

This is the best book I’ve read on depression.  Perhaps it’s more compelling than most books on this subject because Richard O’Connor, a therapist in New York City, has gone through major bouts of depression himself.  Depression has often been compared to heart disease; an illness fueled by complex and interrelated factors: genetic, biochemical, environmental.  In this book, O’Connor focuses on an additional factor often overlooked: our own habits. Unwittingly, we get good at depression.  This book teaches us how to replace depressive patterns with a new and more effective set of skills. We already know how to “do” depression. And we can learn how to “undo” it. With a truly holistic approach that synthesizes the best of the many schools of thought about this painful condition, this book offers new hope, and new life, for sufferers of depression.  Go to Dr. O’Connor’s website  

The Noonday Demon – Andrew Solomon

Winner of The National Book Award following its release a decade ago, this is a beautifully written book by depression sufferer, Andrew Solomon.  Drawing on his own struggles with the illness and interviews with fellow sufferers, doctors and scientists, policy makers and politicians, drug designers and philosophers, Solomon reveals the subtle complexities and sheer agony of the disease. With uncommon humanity, candor, wit, and erudition, he not only helps us understand depression, but also the human condition. Go to Andrew Solomon’s website to read a chapter

The Mindful Way through Depression – J. Mark Williams, Ph.D.

Mindfulness, a simple yet powerful way of paying attention to your most difficult emotions and life experiences, can help you break the cycle of chronic unhappiness once and for all.  It seems like every few days, there is a new book or article out on the power of mindfulness. Here, four uniquely qualified experts explain why our usual attempts to “think” our way out of a bad mood or just “snap out of it” lead us deeper into the downward spiral. Through insightful lessons drawn from both Eastern meditative traditions and cognitive therapy, they demonstrate how to sidestep the mental habits that lead to despair, including rumination and self-blame, so you can face life’s challenges with greater resilience. Jon Kabat-Zinn gently and encouragingly narrates the accompanying CD of guided meditations, making this a complete package for anyone seeking to regain a sense of hope and well-being.  Go to a review and summary of this book

Listening to Depression – Lara Honos-Webb, Ph.D.

I first read this book five years ago and was struck by its originality:  depression isn’t just a disease to be fixed with medication and therapy, but a warning signal that our lives are off track and needs to be healed.  In this sense, depression and its painful symptoms is a sort of unwelcome wisdom. Dr. Honos-Webb argues that we too often try to cut off or numb our feelings of depression instead of listening carefully to what they are telling us about our lives. Listening to Depression offers insightful ways to reframe depression as a gift that can help you transform your life for the better.  Go to an interview with Dr. Honos-Webb

Lincoln’s Melancholy – Joshua Wolf Shenk 

I am a little biased here.  I am a lawyer and Lincoln is my hero.  He not only was a great trial lawyer, but also struggled with depression his entire life. Giving shape to the deep depression that pervaded Lincoln’s adult life, Joshua Wolf Shenk’s Lincoln’s Melancholy reveals how this illness influenced both the president’s character and his leadership. Lincoln forged a hard path toward mental health from the time he was a young man. Shenk draws from historical record, interviews with Lincoln scholars, and contemporary research on depression to understand the nature of his unhappiness. In the process, he discovers that the President’s coping strategies—among them, a rich sense of humor and a tendency toward quiet reflection—ultimately helped him to lead the nation through its greatest turmoil.  Go to the author’s excellent website about the book

Unstuck: Your Guide to the Seven-Stage Journey Out of Depression – James S. Gordon, M.D.

One of our country’s most distinguished psychiatrists and a pioneer in integrative medicine, Dr. Gordon believes that depression is not an end point, a disease over which we have no control. It is a sign that our lives are out of balance, that we’re stuck. It’s a wake-up call and the start of a journey that can help us become whole and happy, one that can change and transform our lives. Unstuck is a practical, easy to use guide explaining the seven stages of Dr. Gordon’s approach and the steps we can take to exert control over our own lives and find hope and happiness. Unstuck is designed for anyone who is suffering from depression, from mild subclinical depression (“the blues”) to its severest forms. Go to this PBS television intereview with Dr. Gordon

Unholy Ghosts: Writers on Depression – Nell Casey

The only book of its kind, Unholy Ghost is a unique collection of essays about depression that, in the spirit of noveliest William Styron’s Darkness Visible. Unlike any other memoir of depression, however, Unholy Ghost includes many voices and depicts the most complete portrait of the illness.  With an introduction by Dr. Kay Redfield Jamison, Unholy Ghost allows the bewildering experience of depression to be adequately and beautifully rendered. The twenty-two stories that make up this book will offer solace and enlightenment to all readers.  Go to an excerpt of the book

Depression is Contagious – Michael Yapko, Ph.D.

Dr. Yapko has identified the types of relationship patterns that lead to negative ways of thinking, feeling, and relating to others and culls from the latest findings in neuroscience, social psychology, epidemiology, and genetics to provide a practical, proven plan for developing the skills and insights you need to forge stronger, healthier social connections and enjoy an enriching, interconnected life. While commonly prescribed drugs address some of depression’s symptoms, they cannot change the social factors that cause and perpetuate the disorder. By treating a social condition as though it’s a disease, the problems compound rather than diminish. The foundation for recovery is to build a healthy social life based on understanding what to expect from our relationships, what we should give, and how to relate to and accept others — skills that have been neglected by modern society. Dr. Yapko’s groundbreaking plan of action — filled with skill-building emotional and mental exercises, anecdotes, and illuminating explanations.  Go to an article written by Dr. Yapko about his approach to treating depression

I Don’t Want to Talk About It – Terrence Real

Depression is a silent epidemic in men who hide their condition from family, friends, and themselves to avoid the stigma of depression’s “un-manliness.” Problems that we think of as typically male — difficulty with intimacy, workaholism, alcoholism, abusive behavior, and rage-are really attempts to escape depression. And these escape attempts only hurt the people men love and pass their condition on to their children. Real reveals how men can unearth their pain, heal themselves, restore relationships, and break the legacy of abuse. He mixes penetrating analysis with compelling tales of his patients and even his own experiences with depression as the son of a violent, depressed father and the father of two young sons. Go to a video of Terry talking about men and depression

What to Do When Someone You Love is Depressed – Mitch Golant and Susan Golant

There are few circumstances in life as hard and at the same time as important as being a friend to a person who is suffering from depression. What to Do When Someone You Love Is Depressed offers guidance to the friends and family of a depressed person on how to keep one’s own spirits up and at the same time do what is best to help a loved one get through a difficult time.  Read an excerpt here

HONORABLE MENTION

 The Zen Path through Depression – Philip Martin

Extremely accessible to people with little or no Zen experience as well as to longtime students of Buddhism, The Zen Path through Depression shows how the insights and exercises of Zen offer relief for those suffering from depression.  Read an excerpt here

Beyond Blue – Therese Borchard

In this part memoir/part self-help, Therese Borchard, who blogs about depression at her site, Beyond Blue, endears herself to the reader and then reduces even the most depressed to laughter as she provides a companion on the journey to recovery and the knowledge that the reader is not alone.  Go to her popular depression blog now

Get it Done When You’re Depressed –Julie A. Fast and John Preston, M.D.

When a depressed person can’t meet the expectations of society, the depression becomes worse and a vicious cycle begins. The goal of Getting Things Done When You’re Depressed is to break this cycle. Readers will learn how to prepare themselves mentally for working while depressed, how to structure their environment so they can work more easily, how to work with others and how to prevent depression. Go to an interview with the author

The 10 Best-Ever Depression Management Techniques – Margaret Wehrenberg, Ph.D.

What I like about this book is that it provides an overview of the some of the best techniques out there that scientists and therapist are using to help and heal people from depression. As Margaret Wehrenberg explains, you must first understand your brain. Drawing on cutting-edge neuroscience research presented in a reader-friendly way, Wehrenberg skillfully describes what happens in the brain of a depression sufferer and what specific techniques can be used to alter brain activity and control its range of disabling symptoms. Containing practical, take-charge tips from a seasoned clinician, this book presents the ten most effective strategies for moving from lethargy into action, taking charge of your brain, and breaking free from depression to find hope and happiness. Read an excerpt here

 

 

Built by Staple Creative