Depression Takes the Fun Out of Life: How to Bounce Back!

You probably take life very seriously if you’re depressed. It’s probably the result of neurochemistry gone awry and a particularly dark and pessimistic take on reality that makes you feel helpless and hopeless.

Getting pleasure out of life, playing and fun are often lost in depression’s onslaught.

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When not depressed, I have a goofy sense of humor that bursts forth without warning: just ask my family! I also love to laugh at unabashedly juvenile movies – – Blazing Saddles and Anchorman, come to mind. But when depressed? I can’t muster a simple smile, my face locked in a type of grim sadness. In fact, it seems at such times as if everyone else is effortlessly enjoying life – – except me. And that feels pretty lonely.

I can also get pretty angry. I feel that depression is cheating me out of the sweetness of life that everyone has a right to: the ability to enjoy myself.

Richard O’Connor, Ph.D. writes that the cause of our loss of joy and laughter when depressed emanates from a damaged sense of self:

“Depression is a loss of parts of the self. Instead of experiencing our inner selves as strong, vital, and joyful, we see ourselves as weak, damaged, or blameworthy. We wish that others could make us feel better, but we can’t usually express such wishes directly; instead we use various self-defeating defense mechanisms to keep our wishes out of consciousness. Play is essential to nurturing the self. The depressive, trying to hide from his own punitive ego like Adam from a wrathful Jehovah, feels that he’d better never let his guard down, always be busy, and always be productive. But play changes moods. Play can lift depression.”

But just how do we go about starting to play? Here’s Dr. O’Connor’s take on what play is and how to partake in it:

1.  Play is usually physical. Our bodies are engaged. We move, we use our large muscles, we can sweat.

2.  Play often involves a conscious abandonment of dignity, sometimes by putting us into roles or positions that are outside our usual behavior.

3.  Play usually involves others. Solitary play is okay if there is no one available, but it’s more fun with other people.

4.  Play involves being spontaneous, doing what our impulses tell us. This may require planning. Games have rules to keep our spontaneity in safe limits. Spontaneity helps us lose self-consciousness, which seems to be a major point of play.”

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Grownups like you and I all too often dismiss having fun as a remedy for depression. In my experience, this is a big mistake. It should be part of everyone’s depression toolkit. It dismissive attitude is rooted in the negative, ruminative thinking that goes in our heads before even trying to participate in play. Dr. Hara Estroff Marano talks writes about the value of play:

“As welcome and wonderful as those feelings generated by play are, it’s value among adults is too often vastly underrated. We would all agree that play lifts stress from us. It refreshes us and recharges us. It restores our optimism. It changes our perspective, stimulating creativity. It renews our ability to accomplish the work of the world. By anyone’s reckoning, those are remarkably worthy achievements.”

Once you’ve jumped in feet first, the flow of pleasurable experiences takes over and the benefits sink in.

Is play missing from your daily round?

Don’t let your depression squash all the joy out of your life. Go play and have fun!

Copyright, Daniel T. Lukasik, 2015

 

 

 

Breaking Bad Habits: You Can Do It

From The Washington Post, a story about Richard O’Connor, Ph.D.’s latest book, Rewire: Change Your Brain to Break Bad Habits, Overcome Addictions, Conquer Self-Destructive Behavior.  Read the News

10 Ways For Lawyers to Deal With Their Depression

A lawyer with depression used to call me once a month. He’d sometimes weep as he told me about the myriad of ways that his depression was disrupting his work and personal life.

I’d listen each time, for about fifteen minutes or so.  I thought I was helping him by offering a compassionate ear.

The conversation would always end with, “catch you later.” 

This went on for six months. 

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During our talks I’d make suggestions about things he could do to help himself.  It seemed to go in one ear and out the other. Despite all the pain in his life, absolutely nothing changed for him.

I finally got to the point where I said, “Bob, what are you willing to do to change your life?”  He seemed surprised by the question.  There was a long pause on the other end of the phone. 

He then said, “Catch you later.”  And he never called again.

Making a Choice to Change Things in Your Life

A hallmark of depression is that those afflicted feel that they have no choice: they victims of their depression and powerless to change it.  In the final analysis, that’s what happened with Bob and why things never changed for him.

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In her book, Listening to Depression:  How Understanding Your Pain Can Heal Your Life , psychologist, Lara Honos-Webb, takes a somewhat unique view.

She maintains that depression isn’t just as an “illness”, but as a wakeup call; a powerful warning that we have been traveling down paths in our lives that have been untrue to who we really and, as a result, have gotten sick because it.  She encourages us not to see depression as just a disease, but as an opportunity to change our lives.  There is something in us, she writes, if we would only listen, that is telling us that we are killing ourselves. 

But depressives, like my friend Bob, often don’t listen to the early warning signs.  So that inner voice just turns up the volume until we get sick with anxiety and depression – or heart disease, hypertension and cancer. 

I would like YOU to challenge a conclusion that you might have reached about yourself: that you can’t change.

I believe if you’re going to heal and grow, however, you’ll need to come to see life as a series of choices rather than inertia.  Richard O’Connor, Ph.D. once said, “While you’re not to blame for your depression, you are responsible for getting better.”

What old behaviors are you willing to change or what new behaviors are you willing to try to help you get better?

1.   Get help

You can’t handle this by yourself.  It’s not your fault.  It is a problem bigger than any individual person.  There are Lawyer Assistance Programs in most states that can get you started in the right direction, provide resources and help you with referrals.  Click here to search by state for a program nearest you.  While this advice sounds self-evident, believe me, it is not.  Recent statistics reveal that eighty percent of Americans don’t get any help for their depression.

2.   Maybe you have to take medication

That’s okay.  You may have a chemical imbalance that you need to address.  For many, psychotherapy won’t help until they quiet down their somatic complaints (e.g. extreme fatigue, sleep problems) so that they can have the energy and insight to work on their problems. However, “one size doesn’t fit all.”  Medication can – and is – over-proscribed.  I also have a problem with family physician diagnosing depression and recommending antidepressants.  In fact, such doctors write eighty percent of the scripts for antidepressants in this country.  Better idea:  go to be evaluated by a well-regarded psychiatrist who specializes in mental health. Check out HELPGUIDE.org, a not-for-profit organization, for a balanced overview of the pros and cons of medication.

3.   Negative Thinking

Whether you will need medication or not, you will need to confront your negative thinking with a therapist.  You really can’t do this effectively with friends or family alone.  A lot of research suggests that cognitive behavioral therapy is a particularly effective form of treatment for depression.  It teaches us that a large part of depression is made up of cognitive distortions.  One example is the all-or-nothing thinking approach.  Lawyers often think to themselves that they’re either “winners” or “losers” in the law. This is a distortion because the reality is that most lawyers both win and lose in their careers. Check out this excellent website article for a list of other cognitive distortions.  I recommend interviewing a couple of therapists before you settle on one.

4.   Exercise

The value of exercise is widely known:  It’s is simply good for everybody.  For a person with depression, it becomes not just about a healthy habit, but a critical choice.  In his book, Spark: The Revolutionary New Science of Exercise and the Brain, Harvard psychiatrist, Dr. John Ratey devotes a whole chapter to the importance of exercise in treating depression.  Please check this book out.  Also check out this short article from the Mayo Clinic about how exercise can help with the symptoms of anxiety and depression.

5.   Spirituality

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If you have a spiritual practice, do it.  If you don’t, think about starting one. This could include anything from a formal meditation practice, going to Mass or just taking a walk in the woods.  A lot of research suggests that people who do have a spiritual practice do better with depression.  If you believe in God or a higher power, you can avail yourself of help and support from Someone who is bigger than your depression.  If you do not believe in God, maybe you believe in some other form of spirituality you can tap into.  Spiritual growth and development, in my opinion, is an important pillar of recovery.

6.   Join a support group 

I started a lawyer support group in my community and it has been going strong for seven years.  Such groups can be invaluable in helping you to see that you are not alone and that others share in the very same struggle.  Contact a Lawyers Assistance Program in your state.  If you don’t feel comfortable being in a support group made up of lawyers, there are plenty of other routes to go.  Check out the website run by The Depression and Bipolar Support Alliance.  They run depression support groups meetings in all fifty states.

7.   Get educated

Read some good books on the topic of depression.  As part of your education, learn about the powerful connection between stress, anxiety and depression.  I recommend you read Dr. Richard O’Connor’s, Undoing Perpetual Stress:  The Missing Connection between Depression, Anxiety and 21st Century Illness.  Dr. O’Connor opines that depression is really about stress that has gone on too long.  The constant hammering away of stress hormones on the brain changes its neurochemistry.    This can and often does result in anxiety disorders and clinical depression.  I list a number of other great books on my website at Lawyers With Depression.  The site also offers guest articles, news, podcasts and helpful links for lawyers.

8.   Build pleasure into your schedule 

As busy lawyers, we have the “I will get to it later” mentality – especially when it comes to things that are healthy for us.   We have to jettison that approach.  We must begin to take time – NOW – to enjoy pleasurable things.  A hallmark of depression is the failure to feel happiness or joy.  We need to create the space where we experience and savor such feelings. 

 9.   Restructure your law practice

Nobody likes changes.  Lord knows, I don’t.  Yet this pointer falls into the category of “what are you willing to do?”  Maybe you will have to leave your job.  Is this stressful?  Yes.  Is it the end of the world?  No.  Maybe you will have to change careers.  I have spoken to many lawyers who haven’t been particularly happy with being a lawyer since day one.  But they kept doing it because they didn’t know what else to do, the legal profession paid a good buck, they didn’t want to seem like a failure, they were in debt, etc.  I am not trying to minimize these very real concerns.  However, your good health (as I learned the hard way) has got to reestablish itself as a top priority in your life.  I changed the nature and variety of my practice and am the better for it.  I do less litigation.  As a consequence, I have less stress, which has been long known to be a powerful trigger for depression.  It can be done.

10.   Practice mindfulness in your daily life

A lot of attention has been focused on the use of mindfulness lately as a way to help depression.  In mindfulness meditation, we sit quietly, pay attention to our breath and watch our thoughts float by in a stream of our consciousness.   We habitually react to our thoughts (e.g. “I will never get this brief done”).  In mindfulness meditation, we learn – slowly – to let the thoughts and feelings float by without reacting to them.  If such an approach to depression seems far-fetched, read the compelling book, The Mindful Way through Depression: Freeing Yourself from Chronic Unhappiness, for an excellent primer on how you can incorporate mindfulness into your day. Check out this article written for my website by one of the book’s authors.

In closing, I often tell lawyers to remember, to “be kind to yourself.”  When I say this they usually look puzzled – like many a judge who has listened to my oral arguments. They’ve rarely, if ever, thought about it and don’t know how to be kind to themselves.  I believe that it first begins with a conscious intention – “I am not going to treat myself poorly anymore.” 

Depression is often built upon poor mental/emotional and physical habits.  Such inner pain can bring people to the point where we they’ve had enough.  As one friend of mine said, “You get sick and tired of being sick and tired.”

 

Undoing Depression in Lawyers

There’s some interesting research to suggest that happy people view the world through certain comforting illusions, while depressed people see things more realistically. [i] For instance, the illusion of control. You can take a random sample of people and sit them in front of a video monitor with a joystick, and tell them their joystick is controlling the action of the game on the screen. (But the point of experiment is that it actually doesn’t). Depressed people will soon turn to the lab assistant and complain that their joystick isn’t hooked up correctly. Normal people, on the other hand, will go on happily playing the game for quite some time.

I think this explains a lot about why lawyers are so prone to depression. Because of their experience with the law, most attorneys have lost their rose-colored glasses some time ago. (Or else they never had them and chose the law as a career because it suited their personality). Attorneys know that life is hard, and doesn’t play fair. They’re trained to look for every conceivable thing that could go wrong in any scenario, and they rarely are able to leave that attitude at the office.  They see the worst in people (sometimes they see the best, but that’s rare). They tend to be strivers and individualists, not wanting to rely on others for support. They have high expectations of success, but they often find that when they’ve attained success, they have no one to play with, and have forgotten how to enjoy themselves anyway.

All this makes it hard for attorneys to get help with their depression. They tend not to recognize it as such; they just think it’s stress, or burn out, or life. They don’t expect that anyone is going to be able to help. Most of my attorney-patients have contacted me because their relationships are falling apart, but they don’t see that it’s depression that makes them such a lousy partner – tense, irritable, critical, joyless, tired all of the time, relying on alcohol or other drugs. If they’d gotten help for the depression a couple of years previously, their spouse wouldn’t be moving out now. The truth about depression is that it not only makes you feel horrible, it wrecks your life. And that’s why I wrote the book, Undoing Depression, in the first place. I was running an outpatient clinic, and grew exasperated with seeing the people whose lives wouldn’t have been so ruined if they had got some help when they first needed it – before they alienated their children and spouse, got fired, went into debt, developed a substance abuse problem, etc. I thought there was a need for an intelligent self-help book, one that points out all the bad habits that depression engenders and which, in a vicious circle, keeps reinforcing the disease. But the truth is that self-help isn’t nearly enough for most depression sufferers. It’s as if you stepped over an invisible cliff, and you can’t find your way back doing what you normally do, because that’s what led you over the cliff in the first place. Depression is the original mind/body disease; your physical brain is damaged because of the stress in your mind, and you’re unlikely to undo that damage without help.

Depression is highly treatable, but if you want a lasting recovery you have to change your life. The ugly fact is that depression is very likely to reoccur. If you had one episode of major depression, chances are 50:50 that you’ll have another; if you have three episodes, it’s 10:1 you’ll have more. But you can improve those odds if you get good professional help, with medication and with talk therapy. We won’t put your rose-colored glasses back on, but we can help you see how negative thinking and the negative acting is contributing to your disease.

[i] See for example, Shelly Taylor: Positive Illusions; and Julie Noren: The Positive Power of Negative Thinking.

Richard O’Connor, Ph.D., is the author of two noteworthy books, Undoing Perpetual Stress: The Missing Connection Between Depression, Anxiety, and 21st Century Illness and Undoing Depression: What Therapy Doesn’t Teach You and Medication Can’t Give You. He is a practicing psychotherapist with offices in New York City and Canaan, Connecticut.  He has suffered from clinical depression and is a member of a depression support group.

 

Lawyers With Depression: Crawling Towards Hope

The lack of hope is one of the most powerful features of clinical depression.

Why this is so is a complicated question to answer.  For lawyers struggling with depression, perhaps even more so.

A lot of people, including lawyers themselves, find it hard to understand why such powerful professionals, superheroes and heroines in blue suits, would be afflicted with depression in the first place.

Yet, the numbers don’t lie.

Studies show that lawyers have twice the rate of depression of the general population.  When put in context, that means 240,000 of this country’s 1.2 million lawyers are struggling with depression right now.

Why, some think, would lawyers, armed with intelligence, perceived wealth (whether true or not) and a take-no-prisoners fighters’ edge succumb to such a dire condition?  

The Answer: Because depression simply doesn’t work that way.

The truth is that smarts might not matter much; wealth, while helpful to provide resources otherwise not available, does not guarantee recovery. And adversarial toughness? This trait might be more of a cause of depression than a shield because many lawyers’ believe that the remedy is to just “suck it up” or think their way out of their pain.  But these strategies don’t work.  They simply fall on depression’s deaf ears.

Because most folks don’t expect lawyers to suffer from depression, they tend to search for different explanations for a lawyer’s downcast affect.  They often believe they’re suffering from “the blues”; or, worse yet, a failure of will to push themselves out of it.  One survey found that over forty-percent of Americans see depression as a failure of such will.  One can only imagine how much higher that figure would be for lawyers who people feel should be able to fight themselves out of just about anything.

Depression Isn’t the Blues

It’s normal to feel the blues: a bittersweet type of sadness that colors our lives from time to time. Blues music is popular given the universal nature of this experience.  But while sadness and the blues are inevitable parts of life, clinical depression is not.  The most significant difference between sadness and depression is that someone that’s sad goes about their daily business without much trouble.  Depression, however, involves significant impairment in one’s ability to carry out daily task at work and home. Other differences between the blues and depression include the length of time the sadness endures and whether or not there are other symptoms associated with depression, which are tagging along with the perpetual sadness.

Dr. Richard O’Connor, in his deeply insightful book Undoing Depression, captures some of the difference between the two:

Everyone has had a taste of what depression feels like.  Everyone feels the blues at times.  Sadness, disappointment, fatigue are normal parts of life.  There is a connection between the blues and depression, but the difference is like the difference between the sniffles and pneumonia.

 “Why Don’t You Take a Vacation?”

When I was diagnosed with major depression over twelve years ago, I needed to take some time off from my hectic job to allow the antidepressants my psychiatrist had prescribed to take effect.  I called a meeting to tell my three partners about my diagnosis and need to take a break.  Until such time, they hadn’t known I was suffering from depression.  Yes, my production was down and I closed my office door a lot more often.  Maybe a little tired or burnt out, but what lawyer didn’t sometimes feel that way?

After hearing me lay it all out on the table, one of my law partners at that time said, “What the hell do you have to be depressed about? You’re the managing partner of a successful firm with a beautiful family.  Why the hell don’t you just go on vacation?”  The subtext on his stinging judgment and solution to my situation was that if only I were more “grateful” for the good things in my life, including my success in the law, I wouldn’t be feeling so “depressed”.

Little did he know how grateful I was for all the good things that life had bestowed on me.  But no matter how many times I knelt on my church’s pews thanking God for my blessings or made a list of things to feel happy about, the specter of depression just wouldn’t leave me.  It was my constant companion.

Like most people who have never gone through major depression, my partner simply had no reference point for what I was going through.  He thought of depression as sadness: a series of bad days that would benefit from an all-inclusive vacation to Jamaica sipping Margaritas by the pool.

However, I was depressed even on vacations.  The sun and surf weren’t pleasurable; they were painful. They reminded me of what I had lost: the ability to enjoy life, to appreciate the beauty of nature and the capacity to connect with my family who I loved so dearly.

The response of my partner, I was to find, was typical.  It made me feel more hopeless and alone.  I felt that apart from my psychologist and psychiatrist, few could understand.  When really in the dirty trough of depression, I would think, “Nobody really understands.”  I was adrift in a sea of melancholy with little hope of reaching dry land.  Andrew Solomon, author of the best-selling book The Noonday Demon: An Atlas of Depression writes:

“When you are depressed, the past and future are absorbed entirely by the present moment, as in the world of a three-year-old. You cannot remember a time when you felt better, at least not clearly; and you certainly cannot imagine a future time when you will feel better.”

In the beginning of my illness, I didn’t recover from depression so much as survive it.  I found myself crawling towards what hope I had left in me.  At that point, the only thing that seemed to keep me going was the deep love for my wife and precious daughter.

That was it. 

This beacon of love kept me trudging through depression, hoping that the heavy cloud of melancholy would someday dissipate so that that I could walk in the sun again.

While the antidepressants I was put on were no panacea, they became an important part of the solution for me.  They didn’t obliterate the depression, but they kept me stable and prevented me from falling into the basement where I couldn’t function.

But medication wasn’t enough.  And it isn’t for most depression suffers.

I needed to start thinking about how to live a better life and treat myself differently.  My psychologist once called depression “crooked thinking”.  I tended to catatrophize everything by more often seeing problems as unsolvable and conflicts a matter of life and death.  When I lost a case, I would take it personally, I was a bad lawyer, and even a worse, a person who didn’t measure up. A loser. I didn’t realize that I was punishing myself.  I didn’t realize that this was a choice and I could stop.

I began to feel like I didn’t have to go on this way anymore.  I came to believe that problems could be solved and that outcomes weren’t always in my control.

I began to hope.

Copyright, Daniel T. Lukasik, 2014

 

 

Is it Lawyer Sadness or Lawyer Depression?

I can spot sadness on a lawyer’s face like a good poker player can read dog-eared cards in a smoky, backroom bar.  To others, his or her expression may seem like a seasoned lawyer’s humorless and steely resolve. But, I know better.  There is something tragic in his or her gaze, his or her face a subtler shade of grey.  The repartee, if any, is deeply cynical and sarcastic. It is a tough life for many in this boat, and many dream of a different life.  “Every man has his secret,” wrote Tennyson, “which the world knows not; and often times we call a man cold when he is only sad.”

sad woman

Such sadness, however, does not necessarily equate with clinical depression. Like all humans that walk this earth, sadness is woven into the life of every lawyer.  One of the tougher aspects of their lives is that their demanding careers often leave little time to be with and enjoy their families.  Because sadness is often about the loss of people we care about and/or the time we spend with them, this one seems to be particularly piercing for lawyers. Too much sadness is the price they pay for too much time at work.

For most of us, sadness seems to be short-lived before we bounce back up.  When sadness goes on for a day or two, we might say that we have “the blues.”

It’s normal to feel the blues; a bittersweet type of sadness that colors our lives from time to time. Blues music is very popular given the universal nature of this experience.

But while sadness and the blues are inevitable parts of life, clinical depression is not.  The most significant difference between sadness and the blues is that someone that’s sad goes about their daily business without much trouble.  But depression involves impairment in one’s ability to carry out daily task at work and home.

Dr.Richard  O’Connor, in his deeply insightful book Undoing Depression, captures some of the difference between the two:

“Everyone has had a taste of what depression feels like.  Everyone feels the blues at times.  Sadness, disappointment, fatigue are normal parts of life.  There is a connection between the blues and   depression, but the difference is like the difference between the sniffles and pneumonia.”

Other differences between the blues and depression include the length of time the sadness endures and whether or not there are other symptoms associated with depression which are tagging along with the perpetual sadness.

“I think the difference between just having the blues and depression lies in the symptoms,” writes Raymond Crowe, M.D., professor of psychiatry. “If the blues’ persist for more than a couple of weeks and are accompanied by trouble eating, difficulty sleeping, or suicidal thoughts, you should see a therapist or psychiatrist or your family doctor.”

depressed cave

Psychiatrist Peter Kramer, author of Against Depression, underscores the point that depression is a serious illness and not ordinary sadness:

For the psychiatrist, then, depression becomes an intimate.  It is poor company.  Depression destroys families. It ruins careers. It ages patients prematurely. It attacks their memories and their general health. For us – for me – the truth that depression is a disease is unqualified.  Depression is debilitating, progressive and relentless in its downhill course, as tough and worthy opponent as any doctor might choose to combat.”

It’s important to recognize the difference between lawyer sadness and depression because a suffering lawyer will not be able to resolve the depression by himself; talking it out with a group of workpals over some beers at lunch just won’t get to the heart of the problem.  This person will need a mental health professional to evaluate him or her and get him or her the serious help he or she needs.

Too frequently, the culture at large, and perhaps the legal profession in particular, mix up sadness, discontent, malaise, unhappiness and clinical depression.The titles of media and journal articles, while they may touch on depression, reflect this clumping together of unhappiness and depression.  I was interviewed for an article by The Wall Street Journal about depression in the legal profession.  While it was clear that the story was going to be about depression, the article’s title was Even Lawyers’ Get the Blues. A recent Law Journal article, which included a small section on depression, was titled How to Be a Happy, Healthy and Ethical Member of an Unhappy, Unhealthy and Unethical Profession.  Martin Seligman, the guru of the Positive Psychology movement, wrote a chapter in his book “Authentic Happiness” called, Why Are Lawyers So Unhappy? In the chapter, however, he wrote about both unhappiness and depression without attempting to differentiate the two.

This commingling of ordinary sadness, unhappiness and depression is confusing and misleading. And dangerous.  It is confusing because a sufferer and those around him may underestimate the gravity of the situation: “Bob is just sad, going through a tough patch at the law office.  He’ll get over it.”

But, Bob might not.  He may get worse.  The depression may deepen.  He may need medication that he’ll never get. He may need to talk to a therapist to address the distorted thinking that goes on during a depression. He may need medication to lift himself out of the darkness. Absent such help and hope, he may commit suicide.  As much as 80% of suicides are committed by those struggling with depression and lawyers have much higher suicide rates than the general population.

Others simply do not have a reference point for depression unless they have been through it before. Sadness? Yes. The deep psychic pain of depression? No. Misidentifying a person with depression as having the blues can have severe consequence because the more people do so in the life of the depressed person, the greater the isolation, the greater the pit of desolation the depressive falls into because no one understands. It causes them to queston themselves: “Why can’t I snap out of this?  What’s wrong with me?”

DSM

According to The Diagnostic Statistical Manual (DSM), the bible used by mental health workers, to be diagnosed with depression you need to have had a depressed mood or loss of interest or pleasure in daily activites for more than two weeks.  According to the National Institute of Mental Health, you also must have some, but not all, of the following symptoms:

  • Difficulty concentrating, remembering details, and making decisions
  • Fatigue and decreased energy
  • Feelings of guilt, worthlessness, and/or helplessness
  • Feelings of hopelessness and/or pessimism
  • Insomnia, early-morning wakefulness, or excessive sleeping
  • Irritability, restlessness
  • Loss of interest in activities or hobbies once pleasurable, including sex
  • Overeating or appetite loss
  • Persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment
  • Persistent sad, anxious, or “empty” feelings
  • Thoughts of suicide, suicide attempts

Do you think either you or someone you care about is suffering from depression?

Take this depression test to see if you or someone you care about might be suffering from depression.  If so, get help now.

 

 

 

Depression & Procrastination

Most people who are depressed have a hard time being productive. Work—and here I mean everything from paid employment to child-rearing and housekeeping to the kinds of “work” we assign ourselves, like reading a good book or planting a garden—is a chore to the depressed. It drains us, leaves us feeling as bad as before, physically worn out and emotionally depleted, instead of proud of ourselves and invigorated. Other people with depression seem to work very hard all the time, but there is little payoff for their efforts. As with so much of depression, there is a real chicken-or-egg question—is work so difficult because we’re depressed, or are we depressed in part because we can’t accomplish anything? And as with so many chicken-or-egg situations, we face a false dichotomy: the truth is, poor work habits and depression reinforce each other.

Depressed people tend to be great procrastinators. Procrastination means putting off for a later time what “should” be done now. The “should” may come from without, as with the teenager who dawdles over homework, or from within, as with me planting my garden. When it comes from without, it’s easy to see the rebelliousness that procrastination expresses. When it comes from within, it’s hard to see immediately what purpose procrastination serves—but it may serve many.

procrastination-meterProcrastinators have some big false assumptions about how work works. They assume that really productive people are always in a positive, energetic frame of mind that lets them jump right into piles of paper and quickly do what needs to be done, only emerging when the task is accomplished. On the contrary, motivation follows action instead of the other way around. When we make ourselves face the task ahead of us, it usually isn’t as bad as we think, and we begin to feel good about the progress we start making. Work comes first, and then comes the positive frame of mind. Closely allied to this misunderstanding about motivation is the idea that things should be easy. Depressed people assume that people who are good at work skills always feel confident and easily attain their goals; because they themselves don’t feel this way, they assume that they will never be successful. But again, most people who are really successful assume that there are going to be hard times, frustrations, and setbacks along the way. Knowing this in advance, they don’t get thrown for a loop and descend into self-blame whenever there’s a problem. If we wait until we feel completely prepared and feeling really motivated, we’ll spend a lot of our lives waiting. See my page on developing greater will power.

Procrastination can also help protect the depressed person’s precarious self-esteem. We can always tell ourselves we would have done it better if. . . . The paradigm is the college term paper rushed together in a furious all-nighter. The student protects himself from the risk of exposing his best work by never having the time to do it right. This allows him to protect his fantasied sense of himself as special and uniquely gifted. Procrastination is also a result of the depressed person’s tendency toward perfectionism, a crippling problem. Research has shown that the more perfectionistic a depressed person is, the worse his chances of recovery. Trying so hard to make every single little piece of a project perfect, we doom ourselves to disappointment and frustration.

broad_chain_closeup_c_wikimedia_org_There is a simple, useful process psychologists call chaining, or making one event depend on another event’s being accomplished first. You can make chains that help you get a lot of work done. I want to go play Tomb Raider on my computer, but I’m going to let that be my reward for first going through the outdated magazines. As I go through the pile, I find there’s one I really must renew my subscription to. Now I have to do that as well before I play Tomb Raider. Renewing that subscription reminds me that I have a stack of unpaid bills nagging at me. Maybe I can’t get the bills all paid, but I can take twenty minutes to get them organized and make a commitment to myself to pay them tomorrow. Now I can go play my computer game feeling a little less overwhelmed by events and a little more deserving of some time to goof off. As you get used to this practice, your chains can get longer and longer without getting burdensome.

Finally, there’s also the Irish way of overcoming procrastination. Confronted with a wall too high to climb, the Irishman throws his hat over it. Now he must find a way over the wall. If I have to paint a room, I’ll likely get the paint and start the first coat as soon as I can, disrupting the whole household in the process. That way I’m fully committed, and have to finish quickly.

Controlling procrastination is more like controlling eating or exercise than smoking or drinking; it’s impossible to never procrastinate. For one thing, often it’s not clear which of two is the most important activity. Study for the exam right now, or eat dinner and then study? Or eat dinner, take out the garbage, walk the dog, call a friend, check Facebook, and then study? But procrastination is a habit that can gradually be replaced by the habit of not putting things off.

Rita Emmett, in The Procrastinator’s Handbook, gives us Emmett’s Law: “The dread of doing a task uses up more time and energy than doing the task itself.” Here’s O’Connor’s corollary: “It’s amazing what you can accomplish when you finally get down to work.” So my first advice for overcoming procrastination is to glue your seat to the chair, ignore distractions, and work for five minutes. Then you can take a short break if you feel it’s necessary, but put in another five minutes after your break. The procrastinating impulse in your mindless self won’t respond to logical argument, but it may respond to a narrowing of focus. You’ll get in a groove, start feeling productive, and the impulse to procrastinate further will dwindle. If it doesn’t work today, try again tomorrow.

A second piece of advice: while you’re sitting glued to your chair, you’re not allowed to do anything other than the task you’re there for, no matter what attractive distraction might come to mind. You don’t have to work on your primary task, but you can’t do anything else. This can be torture, but it’s great mental discipline. You’ll quickly see how easily distracted you are, but you’re forced to develop the will power to withstand temptation. Eventually, you’ll get something constructive done.

Hold yourself to precommitments. No television (Internet, email) until I’ve worked for a half hour. If I get X done, I’ll reward myself with pizza tonight; otherwise it’s peanut butter. Be sure to keep these commitments reasonable and don’t set yourself up to fail. If you practice and get consistent at this, you can start to up the ante.

Business Finish LineProcrastinators don’t reward themselves for finishing. A drink with friends, a special dessert—things that normal people might do to celebrate an accomplishment—these things don’t occur to procrastinators (partly because they’re never satisfied with their results). But it’s important to practice these rituals because, in our minds, the pleasure that comes with the reward comes to be associated with doing a job well. In this way, work itself becomes more satisfying.

Clutter is highly associated with procrastination. Each of those extraneous items on your desk, workspace, or computer desktop is a distraction, a reminder of something else to do. Mental clutter works the same way; if you have a set of nagging chores, just making a list will help you focus on the present. The list will contain the nagging. Every time we are distracted, we lose efficiency. You can reduce your procrastination greatly by eliminating distracting cues.

Of course, personal computers and wireless communication have created many more temptations to procrastinate—games, Facebook updates, checking on the news. Tweets, cell phone calls, and instant messages constantly break our concentration. If we really want to focus on something, we have to remove temptation and prevent interruptions. If you work on your computer, turn off your Internet browser and make it difficult to get back on. Put the phone on silent. Multitasking is a myth.

By Richard O’Connor, Ph.D.

Dr. O’Connor is a therapist and best-selling author of the book Undoing Depression: What Therapy Can’t Teach You and Medication Can’t Give You.

 

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

 

 

 

 

Is Depression a Habit?

“Habit is habit, and not to be flung out the window by any man, but coaxed downstairs a step at a time,” wrote Mark Twain.

 

Bad habits are made up of repetitive behaviors done over and over again.  In part, this is how depression comes into being.  Richard O’Connor, Ph.D., in the documentary A Terrible Melancholy: Depression in the Legal Profession, says “Depression is, above all else, a vicious circle.  People keep depressing because they don’t know any other way.”  A vicious circle is nothing more than vicious behaviors and thoughts done over and over again.  Depression has a self-perpetuating momentum that’s difficult to stop, even when sufferers try and try again to not get caught in depression’s snare.

Those with depression do not often see the way out of the depression because that can’t imagine what not being depressed feels or looks like. 

Lara Honos-Webb, Ph.D., author of Listening to Depression, writes:

“If you have been depressed for a long time, you may encounter the obstacle that you forgot what it feels like to be not depressed. Paradoxically, healing from depression may be uncomfortable to you because it may represent new territory for you. In this way, depression becomes like a habit, and may be hard to break. One way to prepare for this obstacle is to remind yourself that you deserve to be free from this habit and that you would rather be afraid than depressed. As in the fear of losing control, even positive changes will bring with them fear and a sense of losing control. As you bring awareness to the threat of changing your life, the choice you would make between comfortable depression and the unknown will be obvious.”  

“Comfortable”?  How dare she call depression comfortable.  But the habit of depression is comfortable in the sense that some would rather stay stuck in their own pain than risk the stress and anxiety that comes from trying to change depressive thinking and behaviors.

You can also think of depression as not so much one big habit, like smoking or eating fat-laden foods, but as a series on small-habits that congeal into depression; a concrete-like state where a life formerly lived now feels lifeless. 

A lawyer I know said one of his small habits was to be well-groomed and dressed when he walked out the door in the morning.  Now, this might sound a little superficial.  After all, what does neurochemistry have to do with sartorial style? Moreover, there are lots of depressed folks in the world who dress impeccably.  But what he was trying to say was that, for him, letting himself go, not shaving and not caring what he wore, was a small a habit that made him feel worse about himself – a no-no for those who are prone to depression. It a way, it was one of many small triggers that help trigger his depression.

Well-known author Deepak Chopra writes:

“Once it turns into a habit, depressed people no longer need an outside trigger.  They are depressed about being depressed.  A gray film coats everything: optimism is impossible.  This defeated state tells us that the brain has formed fixed pathways.  A small incident like a flat tire or a bounced check leaves no room for deciding, ‘Is this going to bother me or not?’  Instead, the depressed response is already wired in.  Depressed people can even feel sad about good events (they are always waiting for the other shoe to drop) because they are trapped in the habit of depression at the brain level.

Depression also has its addictive side, in that sadness and hopelessness take charge. ‘I can’t be any other way’ is the common cry of the chronically depressed. In every case, there’s a ‘good me’ and a ‘bad me’ warring against each other. For the depressed person, the ‘bad me’ is sad and hopeless while the ‘good me’ is happy and optimistic. But, in truth, both sides are the ‘bad me’ because it casts its shadow over everything. The best moments are a prelude to a relapse. The ‘bad me’ is going to win in the end; the ‘good me’ is merely its pawn.”

Turning It Around

In a fascinating new book The Power of Habit, Charles Duhigg writes that the key to changing habits is to stop fighting them. Albeit Duhigg’s book does not specifically address depression, it is instructive.  “We all have habits,” says Duhigg.  “The key is to shift habits to the behaviors that I want.”  How in the world do we do that?  Duhigg elaborates:  

“Most people think of habit as a routine, but it’s actually a cue, a routine, and a reward.  Let’s say you want to create an exercise habit, like running.  Study after study has shown that the best way to do this is to choose a cue – a certain pattern of behavior, like putting on your running shoes next to your bed each night – and then to give yourself a reward.  So as so as you get home from running, eat a piece of chocolate.  The cue and the reward become interrelated, so when you see that cue, your brain begins expecting the reward.  In fact, it’s going to start enjoying that reward even before it’s delivered, and that’s what will push you into the behavior.”

But it isn’t quite that simple.  The book goes onto explain that this simple cue, routine and reward is only the beginning of a process of change. To take the example of running and chocolate above, as we keeping running over time, we exchange the reward of Ghirardelli dark chocolate squares for the more the deeper and more psychological reward of proving to yourself that you’re the type of person who habitually runs.

My routine to get me to exercise? I put my gym bag in my truck the night before.  I then get up the next morning, don’t shower or shave and drive off to the gym.  I can’t go directly to work looking like a slob so I now have to go to the gym.  Simple as this sounds, it really does work.  And I see myself as a person who takes care of himself and gets things done.  I’ve used the power of habit to build a good routine instead of a bad one.

Good habits make us feel empowered.  This is important for a person struggling with depression to learn or remember because they so often experience themselves as disempowered, lazy or incapable of doing something positive for themselves. 

Starting new, constructive routines and rewards is just one way to climb out of the well of depression.  But an important one. Get started today building your own positive habits and routines.

Need some ideas about good habits to help you heal from depression?

Check out Dr. Andrew Weil’s excellent webpage which addresses healthy habits to develop or his more comprehensive book Spontaneous Happiness in which he writes about his own struggles with depression.  Also pick up Get It Done When You’re Depressed by Julie Fast.

 

 

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

 

 

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