Dan's Blog Archives - Page 6 of 17 - Lawyers With Depression

Liz Swados’ Journey Through Depression

If you’ve ever suffered from depression, you know what a dark muck it can be. Helpless and hopeless, this deadened state leaves people at the bottom of a dank well with no ladder out.

I’ve gone through major depression. I count myself one of the 20 million in this country so afflicted. I’ve gotten to know so many fellow sufferers over the years. One I didn’t get the chance to meet, to my great chagrin, was author, composter and Tony-nominated playwright Liz Swados. We had a few things in common – we both grew up in Buffalo (she left for a theater career in NYC years ago and I’m still here), a lawyer connection (her dad was one and I’m currently one) and we both struggled with depression on and off during our lives.

Sadly, Liz died on January 5, 2016 of cancer at the age of 64 before I had the chance to meet her.

If you not aware of Liz’s work, you should be. She’s the author of the book, My Depression: A Picture Book.

The book is a memoir in words and pictures of Liz’s journey through depression that is by turns poignant and funny. Through her whimsical drawings, readers get a unique view of the experience of depression: from the struggle to keep her condition a secret, to the strange effects of ‘new’ drugs, to the small things that can trigger relapses. At its heart, it is a gentle reminder fellow sufferers are not alone and that they can lead a fulfilling and happy life.

She’s also the creator of the brilliant HBO animated film, “My Depression (The Up and Down of It)” that appeared last summer.

Here’s what Liz wrote about the film:

“It takes us through a journey from the beginning of a depression, through the darkest symptoms and searching a person can do to try to find a cure, to discovering small bits of light, be them from anything – chocolate, yoga, therapy, medications… We didn’t come to any brilliant conclusions; we just went by our instincts and experiences. We have been showing it to various audiences and have found that many people identify with it, which is a true pleasure because I wouldn’t want to represent something so sensitive in a wrong way. I’ve received emails and all kinds of communications from people telling me that they feel simpatico with me, and that’s the best: to give someone an identity and a way to be not alone in a very empty, difficult time of life. I think the most important part of the film is the humor. Depression may not be funny to live through, but if you look at it in a certain way, if you look at yourself and others as creatures under some silly dark spell, it can help lift the weight.”

It’s so hard to describe to others who have never been through depression what it’s really like. It’s tough, I think, because they really don’t have a reference point. They’ve been through sadness. But depression isn’t sadness – it’s an illness.

Liz’s book and film have done a lot of good to help others understand and, hopefully, offer more love and support.

But it’s also is a powerful visual journey for those who suffer. It gives voice to an experience that so often, in it’s most miserable manifestations, mutes that voice.

The voice of our truest and most vital selves.

And it does it all with a panache of humor.

Thanks for everything you’ve done Liz and rest in peace.

“Plop, Plop, Fizz, Fizz” – Oh, What a Relief it is? Our Relationship with Antidepressants

Most folks with depression have a complicated relationship with their antidepressant medications.

I certainly do.

While these pills saved my life years ago when major depression struck, years later, I often wonder if I still need to take them, or, if they’re still effective.

If I feel tired and flat on a particular afternoon, is it depression, the side effects of my meds or a jumble of both? Or maybe, it’s just my persistently pensive nature?

I think about this a lot these days – and maybe you do as well.

While the one-two punch of Cymbalta and Lamictal have kept me out of the dungeon of major depression for years, its comes with a cost. I have interludes of passivity, numbness, and fatigue. Maybe a low-grade depression at times, as well. If I ditch the drugs, maybe I will feel more “alive,” I think. I fantasize that cutting my ties with meds could lessen the days lost to the deadening grayness of a medically induced sense of normalcy I sometimes go through.

But I also feel anxiety. If I went cold turkey and lived medication-free, would it end, well, in disaster? A return to the swampland of depression? A deadman’s land if ever there was one. Can I take that chance? Should I?

There’s scary research that suggests once you stop antidepressants that work (or sort-of-work) for you and try to go back on the same ones because being off of them caused your depression to return (or you just couldn’t tolerate the horrible side effects that can come with discontinuation), there’s a good chance they won’t be as effective.

So, what’s a depressed person supposed to do? What should I do?

There are two camps that offer some guidance on this issue. Both have persuasive arguments about why those afflicted should or shouldn’t stay on meds.

The Stay on the Meds Camp

If depression is an “illness,” like diabetes or heart disease, I need these meds to balance out my of whacky neurochemistry. Given my risk factors: a family history of depression (genetics), a crazy childhood with a nutty, abusive and alcoholic father, and a high-pressure job with too much stress, I should stay on the pills.

In his insightful essay in the New York Times, In Defense of Antidepressants, psychiatrist, Peter Kramer, author of the best-selling books, Listening to Prozac and Against Depression, suggest that studies show this: for mild or moderate depression, talk-therapy is as or more effective that medication. But for the Moby Dick sized sucker called Major Depression? Medications are warranted, and, indeed, lifesavers. They help many to function and live productive lives, albeit with a range of mild to more severe side effects.

The Get off the Meds Camp

Some people (including psychiatrists) see meds as the devil’s handiwork: supposed chemical solutions to emotional problems that flat-out don’t work. Many psychiatrists’ (and family doctors who write the overwhelming majority of scripts for these drugs in the U.S.), they maintain, are “pill pushers” who do the bidding of “BigPharma”, a multi-billion dollar industry in this country. Antidepressants aren’t so much a cure as a curse.

Irving Kirsh, Ph.D., author of The Emperor’s New Drugs: Exploding the Antidepressant Myth, writes:

“Putting all [the research] together leads to the conclusion that the relatively small difference between drugs and placebos might not be a real drug effect at all. Instead, it might be an enhanced placebo effect, produced by the fact that some patients have broken [the] blind and have come to realize whether they were given drug or placebo. If this is the case, then there is no real antidepressant drug effect at all. Rather than comparing placebo to drug, we have been comparing ‘regular’ placebos to ‘extra-strength’ placebos.”

The remedy from this group? Psychotherapy. They see depression as the result of off-kiltered, negative thinking patterns. The way out of these ruminative, pessimistic thoughts involves working with a therapist who uses, most often, Cognitive Behavioral Therapy, to challenge and encourage patients to replace such thoughts with more realistic and positive ones.

In his book Undoing Depression: What Therapy Doesn’t Teach You and Medication Can’t Give You, Richard O’Connor, Ph.D. argues that both therapy and medication are effective, but limited in certain respects. He advocates an additional factor often overlooked in depression recovery: our own habits. Unwittingly we get good at depression. We learn how to hide it, how to work around it. We may even achieve great things, but with constant struggle rather than satisfaction. Relying on these methods to make it through each day, we deprive ourselves of true recovery, of deep joy and healthy emotion.

The 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.

Some Recent News on the Meds and Therapy Conundum

The New York Times reports that a large, multicenter study by Dr. Charles Nemeroff, then a professor of psychiatry at Emory and now at the University of Miami, found that for depressed adults without a history of abuse, there was a clear ranking order of treatment efficacy: Combined psychotherapy (using a form of cognitive behavior therapy) and an antidepressant (in this case, Serzone) was superior to either treatment alone. But for those who had a history of childhood trauma, the results were strikingly different: 48 percent of these patients achieved remission with psychotherapy alone, but only 33 percent of these patients responded to an antidepressant alone. The combination of psychotherapy and a drug was not significantly better than psychotherapy alone.

So what’s a depressed person supposed to do?

I don’t know, really.

We’re in a pickle, aren’t we?

Maybe there’ll be a soon-to-be discovered test that can guide us on precisely what to do. But for now, many of us will stay-the-course and, for better or worse, stick to the “plop, plop, fizz, fix”.

I see myself somewhere in the middle of all this. I’ve never been hospitalized or tried to commit suicide. But I have known depression’s scorching winds, gales that have torn the flesh from my body. I will never forget this pain. It’s scarred me. And I never want to return to it.

If you’re thinking of discontinuing your meds, here’s a great article on how to do it safely.

I welcome your comments about your depression journey with or without medicaton.

Copyright, 2017

by Daniel T. Lukasik

Pushing Back Against Depression

Depression will push our backs up against the wall. It often seems bigger than us: a bully. If we let it, it will pound us down. So, we’ve got to push back.

If we don’t fight back, together with the help of others, depression can consume our lives leaving only our pulse and some air in our lungs, but precious little else. The vitality, the passion and full array of emotions that make life worth living may be sucked up out of us as if by an alien ship from above.

There are many tools to fight depression. They can certainly help us regain our footing and make our lives functional and productive again. But isn’t life more than just about a return to “normal”? We all have dreams and aspire to live them. Theres’s something wild about dreams. So often, they are outside our “normal”. And regaining them is a big part of recovery for it is these passions that bring us most fully alive in the cosmos. And we have to fight for our dreams.

Just like fighting a bully, pushing back against depression takes courage. We have to reach deep down inside ourselves to listen to that part of our life force in us all that gives us the grit to say to depression,“no more”. We must say to ourselves, “I’m sick and tired of being ‘sick and tired’”.

When we’re ready to make some changes, we push the bully back. A small push in the beginning will do. We gain some space and separation from this goblin. We stop defining ourselves as a “depressed person,” as if our identity were wholly made up of our affliction. We are not our depression. It is a part, albeit a very painful part, of our lives. But it need not be all of it.

To fight back against depression, we need to empower ourselves to level the playing field. One of the best ways is learn mindfulness. With it, we gain detachment from our negative thoughts and emotions. Mindfulness teaches us that pessimistic thoughts and disturbing emotions are clouds passing in the sky, not reality. Check out the excellent book, The Mindful Way Through Depression to learn more.

If we don’t buy into the depressed stories our minds spin out, we can begin to see them for what they are: puffs of cerebral and neurochemical smoke. We don’t have to buy into them. We don’t have to live by that script.

This takes a lot of practice and we have to start slowing. This is, by no means, a quick “fix”. But in detaching ourselves from our mental jumble and the over reactive emotions that accompany my anxiety and depression, we gain freedom. We again have choices in life. We need not walk in the deep ruts of depression anymore.

And this is empowering.

Poet, Mary Oliver in her poem, “The Journey,”beautifully captures the sense of determination we need to recover from depression:

One day you finally knew
what you had to do, and began,
though the voices around you
kept shouting
their bad advice–
though the whole house
began to tremble
and you felt the old tug
at your ankles.
“Mend my life!”
each voice cried.
But you didn’t stop.
You knew what you had to do,
though the wind pried
with its stiff fingers
at the very foundations,
though their melancholy
was terrible.
It was already late
enough, and a wild night,
and the road full of fallen
branches and stones.
But little by little,
as you left their voices behind,
the stars began to burn
through the sheets of clouds,
and there was a new voice
which you slowly
recognized as your own,
that kept you company
as you strode deeper and deeper
into the world,
determined to do
the only thing you could do–
determined to save
the only life you could save.

Living Life at Midlife

“You know, we’re both in the autumn of our lives,” a friend said recently on his 52^nd birthday.

I nodded at this bittersweet truth.

I turned 54 this month – not old, but not so young anymore.

After my morning coffee, I took a detour on my way to work. There’s a beautiful forest with walking trails nearby. It was early and only a few other strollers were on the path. I walked most of it in peace and solitude with the sun shining through the still green leaves above me.

I thought more about what my friend had said. The story of my life has now come into greater focus at midlife. I am a bit wiser, and a bit bigger around the midsection, truth be told. I know in my bones that I’m mortal and the importance of making my days count.

We all look backwards at 50 through the rearview mirror. We take stock of our climb from diapers to degrees, backpacks to briefcases, and from youthful meanderings to mid-life muddling.

Called to Live Everything We Are

In his book, Living Your Unlived Life: Coping with Unrealized Dreams and Fulfilling Your Purpose in the Second Half of Life, Robert Johnson points out that the first half of our lives is spent addressing matters in the outside world – learning a trade, marrying and raising children and finding our way in this difficult world. Then, “in the second half of life, the hunger of our missing pieces often becomes acute. It dawns on us that time is running out. So we often set about rearranging things on the outside. Such changes distract us for a time, but what is really called for is a change of consciousness.”

Johnson extrapolates further on the unlived life:

“In the second half of life we are called to live everything that we truly are, to achieve greater wholeness. We initially respond to the call for change by rearranging outer circumstances, though our split is actually an inner problem. The transition from morning to afternoon that occurs at midlife calls for a revaluation of earlier values. During the first half of life we are so busy building up the structure of the personality that we forget that its footings are in shifting sands.”

James Hollis, Ph.D.,, frames the developmental task before us in his book, Finding Meaning in the Second Half of Life:

“The task implicit in this particular swampland is to become conscious enough to discern the difference between what has happened to us in the past and who we are in the present. No one can move forward, psychologically, who cannot say, “I am not what happened to me: I am what I choose to become.” Such a person can come to recognize that the early deficit was not inherent in the child, but the result of circumstances beyond the child’s control. One can then begin to tap the energy for life that was previously walled off.”

I have written before about my parents; an alcoholic father and long-suffering mother. Coming out of that traumatic mess, I learned that if I was going to survive in the world I had to become “successful”. For me, that took the form of a long legal career. I didn’t have a passion to become a lawyer as a young man. After earning a liberal arts degree in college, I sort of drifted into law school.

I wasn’t ever a money-grubbing attorney. I tried to work with honesty, integrity and compassion for my clients. And looking back, I did a lot of good for others. But there was always a nagging feeling inside of me that being a lawyer wasn’t “it”. Somehow, I felt, I had missed a turn further back on the road behind me.

And so, I’ve started to walk backwards to take a hard look at what “success” really means to me now at midlife. I have noticed this shift: I am not interested so much drawn in the question of “what makes a successful life?” as “what does it mean to lead a good life?”

To embrace our true self hat yearns for expression seems critical. While many parts of this authentic self have been expressed in our lives, other essential aspects were chopped off when we were younger by misguided or troubled parents and elders. And maybe that’s what depression is about for some of us: painful symptoms that leak out because of un-reconciled parts of us demanding to be heard and lived. These voices seem to demand our attention at midlife.

And we would be wise to listen to them.

While it’s true that we cannot change the past and the people that tamped down on our early life yearnings, we can view these people and experiences through different and wiser eyes. We can learn to leave the pain behind and learn from it.

Leaving Resumes Behind

If the central concern of the first half of our lives is building up our resumes of success, maybe the second half of life is a deeper search for meaning and purpose.

Therese Borchard writes:

“’It is when we begin to pay attention, and seek integrity precisely in the task within the task, that we begin to move from the first to the second half of our lives,’ writes Fr. Rohr. Yes, that usually coincides with gray wisps and colonoscopies and readers hanging on your neck. But that’s only because the older we get, the better perspective we have on what really matters. Ironically, as our eyes fail, we begin to see life with much better vision.”

Grace and Grit

There is a grace that comes after 50 that I didn’t have in my 30s and 40s; a sense of being at home in my own skin. My bones, like the roots of a mature tree in an old-growth forest, have sunk deep into the rich, brown soil of the earth I walk. Like all people, I’ve weathered many storms. While I know that there are sure to be more, I have faith that I’ll still be standing after they’ve passed and be walking in the sun again.

I think there’s some grit that comes when we pass the half-century mark. We have less tolerance of others’ bullshit and, hopefully, our own. Having lived long enough, we know the truth even if we can’t articulate it. I admire people who can speak truth with wit, irony, humility and a sense of decency. They don’t belittle others, nor are they arrogant or closed-minded about contrarian views. I always walk away from such people enlightened and marvel that in speaking their own truth they give permission for others to speak theirs as well.

Our lives, if they are to have true meaning, must be used to love and serve others for when we pass from this world, we won’t be remembered in others’ hearts so much for our accomplishments, but for the love we have given and shared.

And that is a good life to me.

God and Depression

“Does God care about me?”

“Why do I suffer so, Jesus?”

“Please help me, God”

“Where are you? Do you even exist?”

People suffering from depression ask these questions in the silence of their hearts. They cry out to God just as others have for millennia when faced with great sorrow:

“My tears have been my food day and night.” Psalm 42:3.

Beyond therapeutic and psychopharmacological bromides, we all seek loving comfort. Sometimes we get it from others – – sometimes we don’t.

We’ve reached our limit to cope, to keep it all together. We’re worn out by the battle.

We’re searching for answers: “Why me?”we ask. Even when we get answers (e.g. it’s “biochemical” or too much negative thinking) from others, the pain may not abate. And so we ask more existential questions about the nature of our suffering.

Barbara Crafton, an Episcopalian Minister and depression sufferer, writes in her book, When Jesus Wept: When Faith and Depression Meet, about this mystery:

“In several ways, above and beyond the genetics, family upbringing and “slings and arrows” of our existence that has brought us to this point in our lives, there is a real mystery to suffering. Why do some people suffer tremendously while others not so much? Why do some people with a certain makeup come down with depression while someone with a similar history do not? It’s a mystery. Often, while people who get treatment and help come to find out some of the reasons that they’re depressed, it often isn’t enough. The answers don’t always heal us.”

Abraham Lincoln, who struggled with depression his entire life, was quoted in the book Lincoln’s Melancholy: How Depression Challenged a President and Fueled his Greatness:

“I have been driven many times upon my knees by the overwhelming conviction that I had nowhere else to go. My own wisdom and that of all about me seemed insufficient for that day.”

Much like Lincoln, we can feel powerless to stop our depression. It is BIG and we are small. Anything other than the crushing experience of depression feels unreal. We’re not in the normal stream of life that everyone else is swimming in: we’re drowning.

I had never encountered any pain greater than depression. Other types of pain I could deal with and recover from: a burst appendix in college and blown out ligaments in my knee years ago. But depression? There wasn’t any surgery I could have, no caste that could be fitted. I felt like I was dying. In the book Unholy Ghosts: Writers on Depression, writer Susanna Kaysen captures this experience:

“The worst thing about depression – the thing that makes people phobic about it – is that it’s a foretaste of death. It’s a trip to the country of nothingness. Reality loses its substance and becomes ghostly, transparent, unbearable. This perception of what’s outside affects the perception of the self, which explains why depressed people feel they aren’t ‘there.’”

So in the face of so much pain, we look for power outside of ourselves. We place our hope in Someone bigger than our depression – – God.

It’s tough to pray when we’re depressed

Praying when in the throes of depression is a challenge. We might not be able to muster the energy, feel like it isn’t making a dent in our depression; or, worse yet, our faith falters and we stop believing.

We grow despondent.

We give up hope.

We give up on God.

We want salve on our wounds, but depression just keeps throwing salt in them. We yearn so badly for God’s direction (“Show me the way out of this darkness”), but it always doesn’t come.

Barbara Crafton writes:

“It makes every bit of sense for a person to whom faith is a matter of importance – even one who doesn’t think that all human sorrow can be magically prayed out the window – to hope that it will somehow illuminate the darkness of depression. We understand that nobody ever promised us a rose garden, but could we perhaps have a little light?”

Depression is a terrible liar

In a sense, depression is a temptation. It calls us. It whispers in our ear that all is lost and that we’ll never find our way back home. It’s a terrible liar, really. It spins the yarn that we’re worthless and there’s no point in living. And these messages repeat themselves over and over again in our minds and souls. And they all seem so true and unchangeable.

John Piper wrote in When Darkness Will Not Lift: Doing What We Can While We Wait for God – And Joy:

“…We should all fortify ourselves against the dark hours of depression by cultivating a deep distrust of the certainties of despair. Despair is relentless in the certainties of its pessimism. But we have seen again and again, from our own experience and others’, that absolute statements of hopelessness that we make in the dark are notoriously unreliable. Our dark certainties are not sureties.”

Who do You say I am?

One of the most powerful scenes in the Bible is when Jesus turns to Peter and says, “Who do you say I am?”

I like to imagine Jesus standing across from me. He’s looking directly into my eyes. I reach out to Him. and say, “Lord, who do You say I am?” It clearly isn’t what my depression judges me to be. Jesus is always affirming, always loving, always telling us just how precious we are. THAT is the voice we need to listen to and embrace.

A Light in the Darkness

Mother Teresa once wrote:

“If I ever become a saint—I will surely be one of ‘darkness,’” After her death, Many suggest that she suffered from clinical depression and long periods where she sought to understand God’s absence in the face of so much inner pain.

Therese Borchard writes:

“I spent a week with Mother Teresa and her Sisters the winter of 1994. I stood beside her for about two hours as we distributed Christmas gifts to orphaned children. I sensed sadness in her. But her light overshadowed it. Unlike a person wrapped in severe depression, wearing the expression of despair, she exuded light and hope. When she prayed, her deep love for God was visible, even contagious.

This saint of darkness has much to teach me about how to live with inner anguish.

First of all, I should stop referring to my depression and anxiety as the “Black Hole,” (singular and capitalized), and call it, as Mother Teresa described her difficult places, the “dark holes.” Because the darkness is never black, or without any light at all. Her legacy is proof that hope and faith and love prevail, even in the dark night.”

A few years ago, I composed this prayer.

Dear God,
I am on my knees, because I don’t have the strength to stand up.
My strength is gone. I can’t deal with my depression by myself any longer.
I am lonely.
I call on You.
I have faith that Your strength is bigger than my depression,
that Your mercy and healing white light will show me the path home.
I am not alone.
You’re rod and staff comfort me as I walk through the valley of the shadow of depression
and there is nothing I shall fear.

Amen

So don’t lose hope. Don’t lose God. He’s working somewhere in the pain to heal you.

As Pope John Paul, II wrote:

“Do not abandon yourselves to despair. We are the Easter people and hallelujah is our song.”

By Daniel T. Lukasik, Copyright 2015

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.

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.”

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

The Deadzone of Depression

There is a zone in a depressed person’s life where nothing seems to happen — except the pain of the absence of everything.

Kay Redfield Jamison, M.D., in her book, Night Falls Fast, writes:

I wish I could explain it so someone could understand it. I’m afraid it’s something I can’t put into words. There’s just this heavy, overwhelming despair – dreading everything. Dreading life. Empty inside, to the point of numbness. It’s like there’s something already dead inside.

Such anguish is so overwhelming that every other concern is squashed in its wake. Our capacity for willful actions seems to be gone; we can’t “figure it out.” We are stuck.

I have learned a lot about the zone over the years and how to handle it. It’s really like surfing a giant wave. To handle these waves, you study them and prepare yourself for when the next big one rolls in.

When I feel I’m entering a Dead Zone, I start a deliberate and kind conversation with myself that is practiced and rehearsed. I don’t let the toxic voice of depression drown me out. It’s important to empower ourselves in whatever ways we can during these times because depression will lead you to falsely conclude that you’re helpless to lift your dark mood. This conclusion is one of the central tenets of depression; one of its main “themes”. We need to create – and we can – different and healthier themes for our lives.

Start with a three-by-five index card. Use it to create your own deliberate and kind script of themes for yourself that day. Here’s is an example of what I had written on one of my cards:

— This depression isn’t forever. It will pass.

— I have handled it in the past. I will handle it now.

— Get out of my head – don’t sit around and ruminate.

I usually write a new card out every morning. When depression is absent (and there are long periods of time when it is), the theme of the card might be more celebratory or grateful:

— I appreciate all of the goodness in my life.

— Thank you God for all of the wonderful people you’ve put in my life.

— I am happy that I am not experiencing depression today.

According to psychologist, Deb Serani, Psy.D, there are both emotional and psychological reasons why this is so:

So, why do these gratitude experiences boost happiness and alleviate depression? Scientists say that these techniques shift our thinking from negative outcomes to positive ones, elicit a surge of feel good hormones like dopamine, serotonin and oxytocin, and build enduring personal connections.

The insight and reflection of counting these moments is what makes the practice of gratitude so powerful. But the key to combating depression is making these positive experiences part of the fabric of your life.

Try this for a while and see if it helps you. Don’t wait until you are in the zone of depression to construct the cards because your thinking during such times will be distorted.

Doing this is a healthy and self-empowering step that you can take today.

By Daniel T. Lukasik, Esq.

Perfectionism and Depression: Nobody’s Perfect

We often mix-up a drive to excel and perfectionism; they’re not the same thing. A drive to be your very best can leads to a sense of self-satisfaction and self-esteem. It feels good to give it all we got. Perfectionism? It’s a horse of a different color. People who feel driven in this direction tend to be more motivated by external forces – such as the desire to please others rather than themselves. Common and recurring thoughts of perfectionists include:

Anything short of excellent is terrible
I should be able to do/solve this quickly/easily
I am best handling this myself
I must find the one right answer
Errors, failure, and mistakes are unacceptable
I have to do it all at once

One depression/perfectionist suffer writes:

My name’s Paul and I am a recovering perfectionist.

I am also recovering from depression. The two are connected.

I’d been trying to do too much, too well, trying to please too many people, expecting too much of myself for too long, putting too much pressure on myself, creating too much stress. That’s a lot of ‘too muches’ for one person. My self-esteem took a battering, I stopped looking forward to anything and I felt like I was useless and hopeless.”

Psychologist Dr. Gordon Flett has studied perfectionists and found that they set excessively high personal standards for themselves and others then harshly evaluate their performance on these benchmarks. Often, perfectionists believe it’s their parents, bosses, or spouses who expect them to be perfect. They believe that such people will value them only if they’re perfect. The constant demand to appear as if they have it all tougher is draining.

Others tend to see them as harsh and unforgiving – rigid and unkind – though the truth on the inside is they are vulnerable people who lack resilience. Flett fund that physicians, lawyers, and architects, whose occupations demand precision, are at higher risk for perfectionism, depression and suicide.

Causes of perfectionism run from parenting to a genetic link, but whatever it’s origins, try these fixes:

Separate self-worth from the requirement to do things perfectly.

Dr. Nicholas Jenner writes: Perfectionism is addressable by using and applying cognitive tools. Positive change can be had when thinking is changed and self worth is separated from the requirement to do things perfectly. If you constantly hear your inner critic berating you for not getting or doing that extra 20%, you have noticed your perfectionist beliefs. Discrediting and disputing these values and finding realistic evidence to prove them wrong is a key part of recovery. As humans, we are inherently imperfect. We have the ability to fail without ever being a failure. We sometimes just need to think it and believe it.

Put people first.

Before tasks and “stuff,” put your heart into connecting with the people you love.

Come out as a human being.

Authenticity, although messy, is required for the pleasure of love, joy, fun and overall happiness.

Pay attention to your own signs of trouble.

Perfectionists get more anxious and rigid when they are hungry, angry, lonely or tired. Use prevention strategies to manage this tendency.

Let go of high expectations. Try to accept people as they are. We are all unique and flawed as human beings.

The great songwriter and poet Leonard Cohen once wrote and sang, “Ring the bells that still can ring. Forget your perfect offering. There is a crack, a crack in everything. That’s how the light get’s in.”

We’re cracked open when stress, anxiety and depression become just too painful and perhaps begin to see this eternal truth about others and ourselves:

Nobody is perfect.

Building Your Depression Toolkit

One study found that as many as eighty-percent of all people in this country that suffer from clinical depression don’t get any treatment.

Given that depression is the leading cause of disability in the U.S. and that over 20 million people are afflicted with it, that’s a lot of people – about 16 million.

However, many of the law students, lawyers and judges with depression that I’ve met tell me that they don’t need to be told to get help because there are already getting it. They’re already in therapy, taking medication or both. They get it. They know that depression is an illness and they have to deal with it.
Some of them have been coping with it for a very long time. I call these people “depression veterans”. I have met many such veterans and their courage and determination to recover and stay well inspires me.

As I wrote in a prior blog, these people are really my “heroes”.

I also have met many in the legal biz who say they’re at the end of their rope. They’ve been in and out of therapy over the years with little or negligible improvement in their depression. Others have started and stopped a number of antidepressant and/or other mood stabilizing medications tired of to little impact on the mood and too many side effects. But the depression always returns for them.

For most of them, it’s not a relapse into major depression. Rather, a mild or moderate depression interspersed with fatigue, a lack of pleasure and a glum outlook on life. What they are experiencing is a fact about depression and its course. That it often a chronic and life-long illness for those so afflicted.
Then there are many who go through long stretches of feeling pretty well most of the time, but still have pockets of depression.

I put myself in this camp.

Most days, my depression, on a scale of “1” through “10” is a 1 or 2, if it’s present at all. If it gets worse, it’s less often, not as strong and has a much shorter duration is much shorter – maybe a 3 or 4. This seems to be especially so during the dark days of winter.

What worked for me to reign in the beast of depression was a change in lifestyle, which included regular therapy, medication, a support group, prayer and exercise. While there is no one thing that is a panacea for depression sufferers, I am convinced that such the positive changes have a direct, lasting an significant alleviation of depression’s worst symptoms.

To make a lifestyle change, I develop a depression “toolkit”. A game plan that I’ve pretty much stuck to for a number of years. The value of such a toolkit is that it provides a map for us to stay on course. It gives us a sense of structure and a sense of hope.

If you thinking about how to really recover from depression stay healthy, it’s important to come up with your own depression toolkit. There are lots of ways to go about it. The two best examples of depression toolkits I’ve found come from the University at Michigan’s Depression Center and the Depression and Bipolar Support Alliance.

So pick up your pen and start building your own toolbox today.

18 Tips on How to Start a Depression Support Group

I started a depression support group seven years ago. It’s one of the most meaningful things I’ve ever done. We started out with ten people. It met once a month. Over time, it evolved into every-other week. We now gather once a week. I’ve been asked many times about how to start a depression support group. Here are a few pointers to help you get going. They’re in no particular order of importance.

1. Be clear about what a support group is

A support group is a regular gathering of folks suffering from depression who share their struggles with fellow sufferers to gain insight, strength and hope. These meetings are less structured and more open-ended and the content doesn’t come from a mental health professional. In constrast, group therapy is more structured, focused on teaching, and has a clear outcome that the group is trying to reach. They’re led by a therapist.

2. Picking a place

I suggest you seek out a place to meet at a school, college, church, community center, library or other free space in your community. I guess you could have it in your home. I have never done that. I don’t know anyone else who has. In my view, the problem with this spot is that you must be prepared to have it there every single time. It may put a lot of responsibility on you. What happens if you’re sick or on vacation and can’t host the gathering? I also don’t suggest rotating the location of the meetings to different members’ homes. This doesn’t work because it becomes just too complicated for people to remember where the meeting is being held. Pick one place and stick with it.

3. Determine a schedule

With the help of initial support-group members, decide how often to meet and for how long. For example, every two weeks for 60 to 90 minutes. My experience has been not to fiddle with the day and time you ultimately pick. Members in my group know, come hell or high water, meetings start at 12:30 sharp and end at 1:30 every single Friday. They need not think about it. If they miss some meetings, they’re not left hanging about when the next meeting is.

If others tend to come late to the meeting, always start it on time anyways. My experience is that people appreciate this. Everyone has busy schedules and other things to do. Meetings should be no less than once every two weeks because interest can wane if the group doesn’t meet often. If the meetings are too far apart, people forget each other’s stories.

4. Talk with your therapist

If you’re in therapy, talk with him or her about what you plan on doing and why. They know you well and can offer some suggestions. They’ve either run groups and/or been trained in how to do so. Get some ideas.

5. You don’t have to rebuild the wheel

Depression support groups happen everyday around the country. They’re run by various organizations such as the Depression and Bipolar Support Alliance. Check out their website to see where these groups meet in your community and go to a few to see how they function.

6. How Do I Find Support Group Members

You need to get the word out. Develop a flyer that briefly describes your group, where and when it meets, and contact information. You may also want to contact other support groups and ask if they can refer people to you or market your group on Facebook and other social networking sites. One thing I did was to write columns in my local paper about my own experiences with depression and the support group. This helped enormously. People connect with personal stories. It also helps people overcome the stigma of attending a meeting. If you’re comfortable with it, ask to speak at your local church or other social organizations you might be a part of. Another way to find members is to search for therapists who have offices within a 10-mile radius of where the meetings are going to be held. I’d send them flyers so that could refer people in need of support. Most therapists aren’t even aware of such groups. So educate them!

7. Have and opening and closing ritual

Early on, our group crafted an opening that we read before every meeting. I have typed out the opening we use at my group at the end of this blog. Towards the end of the meeting, I will say, “We’ve got about ten minutes left, is there anyone who hasn’t shared that would like to speak?” I’ll then conclude, “See you all next Friday at 1:30.” A consistent structure to the meetings helps a lot.

8. Arrange for refreshments.

Ask support-group members to take turns providing snacks and drinks if desired.

9. Create a confidential list-serve

It’s a good idea to get everyone’s email address to communicate with the group in the event of a meeting cancellation due to the weather or other problems. Sometimes, your usual location needs to be changed on a particular date because the building is closed for the holidays, etcetera. Send out an e-mail the day before the group meets to remind them there’s a gather the next day. People get busy and like these little pokes. I also forward onto members of group activities – sometimes we meet for dinner or breakfast. I also pass along depression blogs or news I’ve come across that might be interest. A confidential list-serve is easy to create. Check out this webpage about how to create a list-serve through Goggle. This is what I use. To make it confidential, I e-mail myself notices and blind copy the rest of the group. It works.

10. Leaders

A support group leader(s) is responsible for maintaining the structure of the group and keeping the group on topic. Leaders also set up meetings and clean up afterwards. They must be a bit assertive; if you are not comfortable being assertive, look for this quality in a co-leader.

11. Asking others to join the group – be sensitive to their concerns

Because of the stigma associated with depression, people are sometimes resistant to join a support group. They don’t know what to expect. “Will other people attending the group know me? Will this be embarrassing? Would this really help?” Then there are others who have attended other depression support group meetings and found them lacking. One of the most common things I hear is that many of the folks who attend these meeting aren’t working, are on disability and aren’t planning to go back into the work force. Let me be clear on this point: in no way am I criticizing people who are in this situation. In fact, I feel deep compassion for them. But for people who are in the workforce or those temporarily out of it who want to get back in, it isn’t always good fit. Be aware and sensitive to this issue. If I sense that people would like to come to the group, but are apprehensive, I meet them for coffee. Believe me, it helps to reassure them. Maybe a perspective member might not be a good fit for your group. If so, be honest with them and refer them to another.

12. Remember that it takes time to start and keep a group going

I have known other people who have felt the passion and courage to start groups only to see them fizzle out because of a lack of members or organization. That can be discouraging, no doubt. When I first started the group, I’d worry about how many people would come. For example, I’d be disappointed if 4 people came. I somehow felt like a failure (why can’t I get more people to come?) or a big success if 15 came (“Wow, this is great. People think this is important!”) But in the past seven years of running my group, I learned that numbers don’t count for much. It’s the quality and depth of sharing that counts. Some of the best meetings I’ve attended have been with small numbers of people. It allows more time for each person to share more details of their struggles that they otherwise may not been able to do in with a larger group setting because of time constraints. Commit to keep the group going for at least one year. It will have its ups and downs. You need to be persistent.

13. Remember to stay on topic.

You’ll notice some participants drift into other topics like buying a new car, gossip or recent things in the news. Help keep the group focused and on task. It’s a depression support group, plain and simple. The majority of people are there for that reason. It’s simply not fair to others who need the support to listen to others who want to talk about things other than their depression-related issues. If people want to talk about these issues, they can do so before or after the group.

14. Be careful not to let someone dominate the talk

This is a common and tricky problem I’ve had to deal with over the years. We address this in the opening ritual, but people need to be reminded of this for the benefit of the group. An individual member may sometimes need a bit more time to talk than usual. That’s okay. But if it becomes a chronic issue, take the person aside after the group and gently address it with them.

15. Share resources

Many people who come to groups have read books about depression that have “spoken” to them in a meaningful way. I’ve shared my own favorites in a blog, Dan’s Top Ten Depression Books. Group members can also create such a list and distribute it. From time to time, my group has also come up with a list of recommended therapists and psychiatrists in our area. Again, a very helpful thing for people who don’t have one or are thinking of switching (a very common issue).

16. Hire a therapist to attend the group

Our group has hired a therapist to facilitate our meetings during different times in our history. It’s absolutely not necessary to have successful group, but may be helpful. How to find one? Send out a letter to local counselors that you’re group is looking for one. How do you pay for it? Take up a collection from the group. For example, if you have 10 people (an ideal number of members for a support group, by the way, is 8 to 10 folks), ask that they each kick in $10 per group meeting to pay for the therapist. The psychologist in our group didn’t talk much during the meeting, except at the end. He would sum up some of the themes he heard and offer a few helpful tips and observations. I thought this worked well and was a real benefit to the group. You can also ask a local therapist to volunteer their time to this worthy effort.

17. Get trained as a peer support person.

There are different organizations that offer such training. Check out DBSA. Attend other depression support groups in your community to see how they run it.

18. Commit to confidentiality.

Make sure everyone in your group understands that what’s shared in the support group stays within the group. I can’t stress this issue strongly enough. People need to feel safe. Without that, the group just won’t succeed.

Ritual Opening for a depression support group

Welcome to the {insert group name] support group for people coping with depression.

Depression is a bio-psychosocial phenomenon meaning that it affects people in their biological, psychological, and social areas of daily function. Depression is a health problem that does not discriminate by gender, race, religion, occupation, or intellectual ability. It is not a moral weakness any more than asthma, diabetes, or hypertension are. But, similar to these other illnesses, depression is highly treatable and can be managed effectively. Interpersonal support is an important part of depression management.

This group is anonymous and confidential. Here is a forum to share your stresses and your experiences in coping with depression. We ask that group members suspend judgment of others, refrain from direct advice giving, and allow adequate time for all participants to share their respective stories.

We seek the serenity to accept the things we cannot change, the courage to change the things we can, and the wisdom to know the difference.

Have you ever taken part in a depression support group? What have your experiences been? Do you have any additions to this list that would help someone form a group? Please share.