Dan’s Blog

Good Ways To Treat Depression: And Why People Don’t Do Them or Give Up Trying

Depression sufferers are often told to embrace what I call the three “G”’ Trifecta: Get therapy, Get on antidepressants and Get some exercise.

Each of these tactics has empirical support. So there’s a lot to recommend about them. But as I will discuss later, lots of people have a hard time embracing these approaches or sticking with them. First, let’s take a peek at what’s good and promising about these three treatment routes.

Why these approaches are Effective

-Therapy

Many studies show that ‘talk therapy” helps folks with depression. In particular, cognitive behavioral therapy; a form of counseling in which a psychologist compassionately confronts a depressive’s pessimistic thinking and tries to teach him or her more optimistic an productive ways of thinking about their. Research has shown that there’s a powerful connection between pessimism and depression: the more negative your thoughts, the more likely you are to get sucked down into the well of depression. Other studies show that lawyers are much more pessimistic than the general population. As such, CBT is a very good treatment option for many in the legal profession.

-Medication

Antidepressant medications are often an effective way to treat depression for lots of people. It seems to alleviate the brutal physical symptoms – – loss of appetite, inability to sleep and chronic fatigue – – so that one can benefit from therapy. It’s tough to get much insight from therapy when you’re feeling so crappy.

However, recent research has discovered that it often takes two or three attempts before the right medication is found that will relieve a person’s particular depression.

-Exercise

Sweating it out has been proven to lift not only one’s general mood, but alleviate depression. Probably the best book I’ve read on the topic is Spark by Harvard physician, John Ratey, M.D. who writes:

“Antidepressants are curious because we think we’re changing brain chemistry when we take them. The science shows us that exercise does the same thing. By exercising, we’re improving the brain’s plasticity. And while it’s hard to get depressed people to get up and move because, well, they’re depressed, you have to sell them on the value of it. Once they get it, they go with it.”

Why People Don’t Do These Things, or Don’t Stick With Them

If these remedies are so effective for so many, why don’t more people who struggle with depression do them, do them more often or stick with them?

– I Don’t Want to Talk About It.

There are lots of reasons why educated and intelligent people don’t go to therapy.  Here are a few of them:

People (lots of them men) don’t go because they just don’t want to talk about what ails them. Culturally, men are often not given permission to be vulnerable and emotive. There’s a limited range of feelings that the culture says are okay for men to vent: anger, irritability and humor. –

Sufferers sometimes can’t find the right therapist and give up.

Those around them do not believe in therapy. I know a lawyer with depression whose wife thinks therapy is a bunch of hand-holding baloney and a rip-off at $125 per hour (Buffalo rates, mind you). As such, he feels discouraged, doesn’t want to hear his wife complain about the cost and doesn’t go.

People are just too fearful of what the consequences would be if they admitted they had depression: “Will I lose my job?” As such, they often deny to themselves or others that something is wrong. – Procrastination: “Maybe it will go away”.

Shame: people feel they will be labeled “defective”, “weak” or “mentally ill.”

Or, for many, they just don’t know any better. The misery they endure is their “normal”. They can’t see how their maladaptive, pessimistic thoughts about life could be anything other than reality – – “That’s just the way life is.” They may even feel bitter when they see others having fun or being happy. They feel cheated. Why can’t I have more happiness in my life? They may feel that happiness is something doled out by the unseen hand of God or lady luck. However it is dished out, they’ve feel they’ve been given a pittance. Not surprisingly, they have no confidence that they have the capacity to create happiness within themselves. “No”, they think when they imagine to themselves that they have good things to look forward to, “That’s not how my life seems to turn out’. This disempowered state is a vicious circle that can only lead to more depression.

 -Antidepressants: The Flip of the Coin?

There’s a billion dollar debate going on whether antidepressants work or not. On one side of the aisle are the folks in lab coats – the bespectacled researchers who look at brain tissue through microscopes; pharmaceutical executives in blue suits who smoke big-ass cigars; and the psychiatrists – the high priests of all that ails the depressed mind – – who advocate taking medication to treat clinical depression.

On the other side are patients who swear that the meds did nothing to help their depression and just screwed them up and made them feel like zombies. On the other are holistic practitioners who believe depression isn’t caused by a chemical imbalance in the brain, but by lack of proper nutrition, diet and balance (check out Dr. Andrew Weil) and my psychiatrists who believe that medications, while useful, are over-prescribed.

There currently are no tests, other than trial-and-error, to determine what type or types of medication will prove effective for a particular person. It’s really trial or error. Our family owns a big fat rodent. Did I say he was really fat? Anyway, he is black and white and lives in a large cage in a back room of our house. The colors make him look like a magician in a tuxedo. Hence, his majestic name – – Houdini. I felt like Houdini when my psychiatrist tried different medications on me in a quest to get the right one – a lab animal in which he tried this and then that. Some were real duds; some outright blunders. But I stuck with it. And I’m glad I did because the “right meds” were eventually found for me.

People won’t take medication because of the stigma attached to it. Or, they give up on it before the right medication, dosage or combination is found. Even when the right one is found, folks often stop talking it because of the side effects. I know depressed lawyers who would rather drink or drug rather than take antidepressants.

-Why We Won’t Get Moving

People find it hard to exercise because depression screws up their ability to sleep leaving them unmotivated and just too tired to get to the gym. Years ago, when I first was diagnosed with depression, I recall being bone-tired at the end of a work day and falling asleep a 9 p.m., sleeping on and off throughout the night, getting up at 3 or 4 a.m., shaving, getting dressed and driving to an all-night coffee shop to slurp coffee, get ready for work and wonder “Just what the hell is wrong with me?” But I didn’t have any answers back then. In retrospect, truthfully, the only thing that helped me survive it was to keep walking.

Three Quick Things to get you on the Right Track

1.    If you’ve never been to a competent psychiatrist, remind yourself that you can just go for a consultation and hear what they have to say. Whatever their recommendation, you don’t have to agree with it or follow it. But why not get an opinion from someone who has treated hundreds of people with depression and could tell you whether or not you have it and what your options are? You can also get a second opinion. There are “Depression Centers” around the country where you can go for such a consultation and then return to your treating psychiatrist who can prescribe the recommended medication and monitor you. Bring a friend or family member to the appointment. Sometimes, when we’re depressed, we might not truly hear when the psychiatrist has to say. What does your loved one or friend think the doctor said?

2.   If you don’t want to go to a therapist, you really have to ask yourself why not. I usually recommend that people call friends to ask for recommendations for a couple of therapists. Go visit a few for a 1 hour consultation to see if you click with that person. Remember, if you give into your depression, you will tend to isolate yourself and “suck it up.” What you really need to do is talk to a therapist who has treated hundreds of folks with depression who can give you some ideas about whether you can benefit from therapy. A good friend can listen and give you their love and compassion. But, they can’t do what a good therapist can do.

3.   Make it easier to exercise. Here are three quick ideas. First, always keep your gym bag in your car – EVERY DAY. I’ve found that I’m much more likely to exercise at the gym, if only for 20 minutes, if it’s in the car. Second, don’t shave or shower when you get out of bed. Get dressed like you normally do for work and go get a coffee if you like. I find that I have to work out because I now HAVE TO GO to the gym if I want to get a shower and shave – it’s too late to go home now!

Depression’s Negative Thinking

Years ago, when I had just been told I had something called “depression,” I was having a tough time accepting it – after all, I was a litigator, a good-slinger extraordinaire.  The only thing that I thought could bring me down was a lucky pistol shot at High Noon.

During a talk with my therapist in the beginning of my recovery a decade ago, I told him all the negative thoughts I was having about my life. My counselor, a large, white -bearded older man with an Obi Wan Kenobi-like aura, gently told me, “Dan that is depression talking.” Somehow that got through to me; somehow I knew it was true.

My counselor, pillar of Jedi knowledge that he was, had helped me look through a sort of psychic telescope into the constellation that was my patterns of depressive thinking.  All people who have struggled with depression must do combat with their negative thoughts.  They must – usually with a therapist’s help – begin to see that THEY are thinking these thoughts and they’re not just HAPPENING to them.

Negative Thoughts – and Lots of Them

It has been estimated that we have anywhere from 25,000 to 50,000 thoughts a day. If your ideas about life are predominantly downbeat, imagine how many negative thoughts you are generating daily—thousands upon thousands.

In the magazine Psychology Today, Hara Estroff Marano writes:

“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.  

Compounding the matter is that negative thinking slips into the brain under the radar of conscious awareness and becomes one of the strongest of habit patterns. People generate negative thoughts so automatically they are unaware that it is happening; that it is actually a choice they are making.”

Lawyers are particularly prone to this type of pessimistic thinking which helps explain why their rates of depression are about twice that – twenty percent – of the general population.

In recent article in The Wall Street Journal wrote about this very topic:

“Martin E. P. Seligman, a psychologist and proponent of ‘positive psychology,’ observes that lawyers experience depression at rates that are 3.6 times as high as that of other employed people. They also abuse alcohol and illegal drugs at rates above what’s seen in non-lawyers. Why is this? In part, he says, the law selects people with a glass-half-empty attitude. His research has found that people who score low on an optimism test do better in law school. ‘Pessimism, he writes, ‘is seen as a plus among lawyers, because seeing troubles as pervasive and permanent is a component of what the law profession deems prudence.

A prudent perspective enables a good lawyer to see every conceivable snare and catastrophe that might occur in any transaction. The ability to anticipate the whole range of problems and betrayals that non-lawyers are blind to is highly adaptive for the practicing lawyer who can, by so doing, help his clients defend against these far-fetched eventualities. If you don’t have this prudence to begin with, law school will seek to teach it to you. Unfortunately, though, a trait that makes you good at your profession does not always make you a happy human being’’.

The Big Ten

For us to start making different choices about what kind of thoughts we think, it’s important to see the patterns, the way these false thought patters take place over and over again.  Here are some examples of depressive thinking:

1.      False extremes – “the tendency to evaluate [one’s own] personal qualities in extreme, black-and-white categories; shades of gray do not exist.”

2.      False generalization – “after experiencing one unpleasant event, we conclude that the same thing will happen to us again and again.”

3.      False filter – “we tend to pick out the negative in every situation and think about it alone, to the exclusion of everything else.”

4.      False transformation – “we transform neutral or positive experiences into negative ones.”

5.      False mind-reading – “we may think we can tell what someone is thinking about us, that the person hates us or views us as stupid. But such negative conclusions usually are not supported by the facts.”

6.      False fortune-telling – “we expect catastrophe and the expectation itself produces hopelessness and helplessness.”

7.      False lens – “we view our fears, errors, or mistakes through a magnifying glass and deduce catastrophic consequences. Everything then is out of proportion.”

8.      False feelings-based reasoning – depressed persons “tend to take their emotions as the truth. They let their feelings determine the facts.”

9.      False “shoulds” – “Our lives may be dominated by ‘shoulds’ or ‘oughts,’ applied to ourselves or others. This heaps pressure on us and others to reach unattainable standards.”

10.  False responsibility – “when we assume responsibility and blame ourselves for a negative outcome, even when there is no basis for this.”

A common theme running through much of this type of thinking is a self-judgment of inadequacy and, as a result, the depressed person notices negative, misfortunate circumstances but ignores positive, fortunate circumstances.

Overachievers and perfectionist that they are, depressed lawyers may frequently receive positive feedback concerning his or her performance at work. For example, a depressed lawyer may have a caseload of one hundred cases.  He might have the upper hand on 90%, but struggles with the 10%.   This lawyer sees his struggle with the handful of cases as confirming what a loser he or she is, incompetent and unable to keep up “like everyone else.” The many positive comments made by colleagues or staff are not even remembered.

Because of the belief that he or she is inadequate, and his or her tendency to only notice negative experiences, the future is viewed as certain to be gloomy, dismal, and painful: “I’ll never make partner,” “I suck as a lawyer.”

Negative thinking sounds, to the outside observer, to be obviously false or negatively skewed. If so, just why do depressives repeatedly think like this over and over again?  Are they idiots?

No, it’s because depressive thinking is “automatic.” It is not the result of thinking the situation through objectively – ironically enough, something lawyers are trained to do.

It just happens rapidly without any reflection.

So it’s the event itself that is sad, not life in general. And even if this thought or feeling arises, it is only temporary.

Depressive thinking leads to depression, leads to depressive thinking, leads to. . .

As we explain these thinking styles you will see how each helps to maintain depression, by altering how we perceive reality.

It’s these thinking styles that make it so hard to see an end to the depression, as they limit our possibilities of thought. Once these patterns take hold, the emotional arousal they cause begins to affect us physically.

If you are thinking now “Yeah, but you don’t know my life” – remember: there is nothing so awful that you can imagine that someone somewhere hasn’t survived without becoming depressed.

It is not your fault if you are depressed, but there are concrete, effective things you can do about it.

How to Kick Negative Thinking’s Butt

Again, Estroff Marrano offers some ways to combat negative thoughts:

  • Distract yourself. Engaging, pleasant activities, such as exercise or hanging out with friends, are best. Once you are feeling more positive, you will be better able to solve problems.
  • Stop that train of thought. Think or even tell yourself “Stop!” or “No!” when you start to ruminate.
  • Write it down. Tracking your ruminative thoughts in a journal can help you overcome depression by organizing those thoughts and relieving yourself of their burden.
  • Solve a problem. Even taking a small step toward solving one problem that is weighing you down will help with overcoming depression. Data show a strong link between goals you cannot achieve and depression-inducing ruminative thinking, so start problem solving.
  • Identify triggers. Figure out which places, times, situations, or people are most likely to cause a bout of rumination, and find ways to avoid those triggers or manage them better. Mornings and evenings are the times when ruminative thinking is most likely.
  • Meditate. Mindfulness techniques can help you get some distance from the thoughts that trouble you, while at the same time reducing stress.
  • Stop linking small goals to big goals. For example, you may need to challenge a belief that achieving big goals (such as happiness) completely depends on succeeding at smaller goals (such as losing five pounds).
  • Get therapy. Seek cognitive therapy techniques to help you question your thoughts and find alternative ways of viewing your situation.

Try, day by day, to chip away at the conclusion that depression just happens to you, or that it’s just a disease.  Try to remember, that whatever it’s causes, negative thinking is a powerful fuel to help it arise and keep it going.  Think about it.

 

 

 

Christmas

A lovely thing about Christmas is that it’s compulsory, like a thunderstorm, and we all go through it together

A Christmas Curmudgeon  

Driving home yesterday, I spilled my large cup of Starbucks all over my lap causing me to swerve slightly, it seemed like inches, into the lane of a grouchy driver to my right: an eighty year old guy with a face like a overdone waffle wearing thick glasses who rolled down his window and let out a shrill scream, “Merry Christmas to you too, buddy!!”  Wow, I guess he had a tough day at the Mall!  I had a good laugh telling my friends about it later.

Mark Twain, who must have crashed into a few horse-drawn buggies in a dirt Yuletide parking lot, once wrote:

“The approach of Christmas brings harassment and dread to many excellent people. They have to buy a cart-load of presents, and they never know what to buy to hit the various tastes; they put in three weeks of hard and anxious work, and when Christmas morning comes they are so dissatisfied with the result, and so disappointed that they want to sit down and cry. Then they give thanks that Christmas comes but once a year.”

The Holidays are tough for many people.

While Christmas and the New Year come but once a year, it’s really a month long reverie of parties, music, eating and spending time with friends and family. During this stretch of time, Christmas isn’t so great for lots of people and there are good reasons for it.

Despondency is common during the holidays for many.  The most famous example of this is none other than George Bailey in the timeless classic, It’s a Wonderful Life.  I believe so many people relate to George because he’s the archetype of a good man who is befallen by undeserved tragedy – the prospect of financial ruin – and learns through an angel what his life would have been for others if he’d never been born.  George develops a new found appreciation for what’s really important, the love of family and friends.  He leaves his guardian angel, returns home only to find his family heartily welcoming his return and, because George has helped so many in his lifetime, they come through by helping him with enough money to solve his financial crisis.

Maybe most of us aren’t on a precipice of financial ruin, but there are many parties, celebrations and gatherings that require the spending for food and drink. This creates the need to put the hands deep in the pocket, both for gifts and to pay for the restaurants and bars. The temptations such as food, the cocktails, purchases and gifts is high and leads many people to feel stress for the consequences of their actions (gain more weight, headache, depression, overdrafts). These effects remain after the end of the holidays and cause even more stress and depression.

Everyone who struggles in today’s economy is George Bailey; stressed and wondering if they can support their families and provide a happy Christmas.  This can take a toll on many.

They may be lonely, whether surrounded by loved ones or not.  For those struggling with depression or just profound loneliness, Christmas can be so tough.  They’re expected by others to be Merry and when they’re not, they are prodded to “Cheer up.” That’s one of the confounding things for those who have never experienced depression:  that you could possibly feel so down when surrounded by circumstances that appear, to those with no reference point to understand, so great. But, there it is.  Even when not told by others to snap out of their funk, folks who are lonely and depressed feel this way because the holidays trigger some memory of loss, of loved ones not there that should be there or their inability to pull themselves out of a down mood.

There can also be family turmoil during the holidays. Usually people want to gather the whole family together for Christmas, but everyone has plans and sometimes there is conflict because people prefer to spend the holidays in their own home. There is also the possibility that people have high expectations these days from other people. People might expect perfect conditions with expensive gifts and positive response by all. This is not usually the case and this increases the chances to feel disappointed and the risk of sadness and depression are increased.

People are too pooped to party. One of the main reasons that the holidays bring with them intense stress is that suddenly there are many requirements and people have to do many things in a short period of time. Even when the activities are basically pleasant and enjoyable, they are a change from the daily routine that people are used to, and this situation is pushing the person to do more things than it can normally do. Shopping, the need for finding gifts, participation in various social events and obligations, the preparation of Christmas dishes and other sweets all create stress and fatigue.

The Spiritual Dimension of Christmas

While there are a lot of things that can bring us down this time a year, we all need to remember that, just like an elevator, there are plenty of things to bring us up: small kindnesses that fall on us like snow throughout a day: children with wool caps on running across the street with mittens while a volunteer crossing guard swooshes them along, someone says “Thanks” or “You’re welcome” and really meaning it, a Christmas song plays and takes you back to a sweet childhood memory of the holidays or you just plain old feel the ineffaceable lift of your spirits being part of the a time during the year where there’s some sort of fellowship, a sense that we all are part of God’s family, and wish each other well.

Because I am Catholic (a very liberal one, mind you), the holidays offer another gift to me – a sense of Joy.  I have always found the month leading up to Christmas enjoyable, what my church calls Advent, in some sense a salve on the short days and chapped skin from too much cold wind that hurdle through Buffalo salt covered streets.

I am never preachy about my faith (I don’t care for it when others do so about theirs’) because I feel there are many paths to God.  But I do feel it’s important to seep yourself in whatever your spiritual tradition leads you to be a better, more kind and decent human being.

In my faith, Christmas is a month of anticipation culminating in the birth of Jesus; the seminal event in human history where God intervenes in human time to send his only Son to save a broken and lost humanity from itself. This belief is expressed so beautifully in the Old Testament by the prophet Isaiah who writes:

 “The people walking in darkness have seen a great light; on those living in the land of the shadow of death a light has dawned. For to us a child is born, to us a son is given, and the government will be on his shoulders. And he will be called Wonderful Counselor Mighty God, Everlasting Father, and Prince of Peace.”

My parish priest, captured some of the mysterious dimension of Jesus’ birth when he wrote:

“Contemplate, with me, the mystery that is Christmas. Like all mysteries, it bears innumerable levels of meaning and of presence. The core truth is that God, in person of Jesus, takes a specific place, Mary’s womb, and time (c. 4 B.C.E.), and becomes one with humanity. It stretches the imagination to think that God would so choose to be identified with us that a transcendent/immanent communion issues forth through a simple woman, Mary, as “the Christ,” the anointed one. Nothing in the story of human creation before this event/birth, a recorded history of c. 6,000 years and an unrecorded history of probably 500,000 years, prepares us for this wonder.”

Thousands of years have passed since Isaiah’s psalm, we all still walk in darkness and all are in need of a “great light” to illuminate our steps as we walk through life.  There’s a yearning in all beings to be guided by something or Someone bigger than their limited self.

For me, the birth of Jesus, the Prince of Peace, brings a profound sense of hope into the world; hope that we all can grow as a people and know what it is like to feel the light of God’s love.

Coping with the Holidays

Be Generous and Mindful of those less fortunate to you.  It is funny how years later particular events stick in your mind.  One Christmas Season, a homeless man well-known to hang out in front of a coffee shop I used to go to, came inside.  He would do this on occasion and ask for money in tattered clothes and mangled hair. His name was Wesley.

I later learned that he was a Vietnam veteran who suffered from PTSD. I had given him change on occasion, but didn’t feel like it that morning. He asked, “Do you have any money?”  I said, somewhat brusquely, “No, I do not.” He then paused for a moment, a look of kind concern in his eyes, and said softly, “Do you need some.” This man with so little offered me what little he had and in doing so taught me the true heart of Christmas.

Remember the holiday season does not banish reasons for feeling sad or lonely.  There is room for these feelings to be present, even if the person chooses not to express them. But like all feelings, they pass. It might just be that the holidays, with all its high expectations of happiness, intensify these feelings.  Just hang in there.

Have a little faith in the goodness of life. We can all get weary from the drubbing we get at Christmas in our too materialistic, too focused on stuff society.  But let that not dampen your spirit too much because beneath it all, there’s simply too much goodness in this world to appreciate all around you.

The humorist Garrison Keillor wrote:

 “To know and to serve God, of course, is why we’re here, a clear truth, that, like the nose on your face, is near at hand and easily discernible but can make you dizzy if you try to focus on it hard. But a little faith will see you through. What else will do except faith in such a cynical, corrupt time? When the country goes temporarily to the dogs, cats must learn to be circumspect, walk on fences, sleep in trees, and have faith that all this woofing is not the last word. What is the last word, then? Gentleness is everywhere in daily life, a sign that faith rules through ordinary things: through cooking and small talk, through storytelling, making love, fishing, tending animals and sweet corn and flowers, through sports, music and books, raising kids — all the places where the gravy soaks in and grace shines through. Even in a time of elephantine vanity and greed, one never has to look far to see the campfires of gentle people.”

God bless you all and have a Merry Christmas.

Our Parents – Our Depression

If you look deeply into the palm of your hand, you will see your parents and all generations of your ancestors. All of them are alive in the moment. Each is present in your body. You are the continuation of each of these people – Thich Nhat Hanh, Buddhist monk

Like all parents, my mom and dad were flawed people – as I am.  Yet, they were something more than that.

I’ve struggled to understand them much of my adult life; maybe more so now that they’re both gone.  The nineteenth century German philosopher Arthur Schopenhauer once wrote: “The first forty years of life furnish the text, while the remaining thirty supply the commentary.”  Maybe it isn’t till midlife that we really work hard to interpret the stories of our past.  I believe there’s a strong urge in all of us to make a comprehensible story of one’s life at this juncture. And our parents are a large part of that tale.

The author of Slaughterhouse-Five, Kurt Vonnegut, a WWII veteran like my dad, wrote:

“The most important thing I learned was that when a person dies he only appears to die. He is still very much alive in the past, so it is very silly for people to cry at his funeral.  All moments, past, present, and future, always have existed, always will exist. It’s just an illusion we have here on earth that one moment follows another one, like beads on a string, and that once a moment is gone it is gone forever.”

Now that I’m 50, I still wonder what role mom and dad played in my depression.  Looking at the facts, I guess it’s all too obvious: drinking and mental health issues on both sides of the fence.  In my most self-absorbed moments, I blame them and feel justified in doing so.  In brighter moments of lucidity, I see that they, like me, were somebody’s children once.  They didn’t start out in life the way they ended up – nobody does.  They were, in a real sense, victims.  This fact doesn’t excuse what happened; the real pain they inflicted on their children. But it does help me to understand their plights in life.  And with that understanding comes some measure of peace, a peace of heart.

Turning the pages to our Past 

Jonathan Frazen, author of the best-selling book Freedom about a family that struggles with depression, writes:

“Depression, when it’s clinical, is not a metaphor. It runs in families, and it’s known to respond to medication and to counseling. However truly you believe there’s a sickness to existence that can never be cured, if you’re depressed, you will sooner or later surrender and say: I just don’t want to feel bad anymore.”

Here’s Jonathan Frazen talking about his novel on PBS:

How much of our life is determined by our familial past?  How much of it is spun by choices we make apart from that past?  Apart from what happened to us at the hands of parents, can we really change?  I believe that shifting through our past helps us to become “unstuck.” And after all, depression is about being stuck.  We can’t go forward, if we can’t go backwards and to see the truth of about past.

There are some things we can change and some we can’t.  We can’t change our genetics and scientists now know that the genes we inherit play a significant role in our vulnerability to depression. There is a gene that regulates how much of a chemical called serotonin is produced. Serotonin is a neurotransmitter.  The amount of serotonin that flows to your brain influences your mood, and emotional state.  Those whose serotonin transporters included a gene that was shorter than would be typically expected at a certain point had a harder time bouncing back after experiencing a stress event. Chronic stress and anxiety, as I’ve written about before, have a strong correlation to a vulnerability to clinical depression.

This bit of news makes me want to know my ancestors, these ghosts of my past.  These folks and I have something in common: irksome chromosomes that could flip off the happy switch in our brains from time to time.

I heard on National Public Radio that there have been 60 generations that have lived and died since the time of Jesus.  Since the extent of my knowledge about my family only goes back, at best, 100 years to the time of the birth of my grandparents, that leaves me about fifty-eight generations or 1900 years of emotional and genetic history unaccounted for.  I wish there was some kind of recorded history of their lives because I am a continuation of them even as my daughter is of me.

Dad’s Story

Dad was born in Buffalo in 1926, the oldest of five born to immigrants from Poland.  I never met my grandparents, but from family lore I’ve learned that they were tough people who lived even tougher lives: brute physical labor for their daily staple of meat and potatoes, playing pinochle while plumes of cigarette smoke wafted up to the ceiling and crates of cheap booze on the weekends. If you looked crossways at them, they’d likely belt you in the mouth.

Alcohol played a big role my family’s drama through the generations.  Sometimes they drank at home, but more often in what my grandma called “Gin mills.”  Men would cash their checks in these Polish joints, throw their money on long wooden bars sip draught beer as they talked about all the scraps they’d been in that week just trying to get along in life.

My dad grew up in this world.  At 17, he went off to fight in the Pacific theater against the Japanese.  War must have deeply affected him, as it does all young men.  Robert E. Lee, writing of his experiences in the Civil War, wrote his wife in 1864:

“What a cruel thing is war; to separate and destroy families and friends, and mar the purest joys and happiness God has granted us in this world; to fill our hearts with hatred instead of love for our neighbors and to devastate the fair face of the earth.”

Last year, I read a  New York Times review of a book out about J.D. Salinger, author of The Catcher in the Rye.  The article notes that Salinger, who served in the infantry during WWII in Europe, witnessed a lot of death and mayhem and struggled with depression his whole life:

“Salinger’s experiences during WWII heightened his sense of alienation.  The war left him with deep psychological scars, branding ‘every aspect’ of his personality and reverberating through his writings.  Salinger had suffered from depression for years, perhaps throughout his entire life, and was at times afflicted by episodes so intense that he could not relate to others.”

Ultimately, he stopped publishing, moved into a cabin in rural Connecticut and practiced Yoga and Zen meditation.

Dad clearly suffered from undiagnosed depression and PTSD, something that would, like Salinger, haunt him for the rest of his life.  But war can’t explain all misery, can’t explain the storms that would rage in his head.  His younger brother Roman, also a war veteran, became an alcoholic.  Dad’s younger sister suffered from depression and been treated for it with medication suggesting a possible genetic propensity in our family for the illness.

Mom’s Story

Mom, like dad, was also part of WWII generation. Her older brother Joe went off to war in the Pacific for three years.  As fate would have it, he met my future Dad aboard a ship in the Philippines and said, “If we ever get the hell out of this shithole, I’ve got this cute, blonde sister back in Buffalo.” They survived, my parents met, fell in love and married.

Mom had an alcoholic father, also an immigrant from Poland.  She recalled being asked by her mother to go find her dad on a regular basis when he didn’t return home after work.  Often, during the harsh Buffalo winters, she would find him passed out in a snow bank.  The only intimate moments she remembered sharing with him was when for her eighth birthday he took her to a Shirley Temple movie and bought her candy.

Mom and dad quickly had three kids.  Things went well the first ten years of their marriage, but the wheels began to fall off from there on out: dad drank too much, became a gambler, womanized and had unpredictable outbursts of high octane rage.  Mom collapsed back into herself and never really recovered.  She began to eat a lot, added lots of pounds to her slender frame and watched T.V. all the time.  Maybe the dopey sitcom narratives sliced through the quiet pain my mom carried – all the time – all of her life.

Dad died 32 years ago at the age of 56 (I was 19) from too much drinking and smoking. He died sort of unrepentant, never saying he was sorry for anything.  But, in my own mind at least, I think he was sorry.  I think he just couldn’t bring himself to say it because of the enormity of his sins.  But I have learned to forgive him, this enemy of my childhood who I had wished as a boy that he would just die.  The great poet Henry Wadsworth Longfellow once wrote:

“If we could read the secret history of our enemies we should find in each man’s life sorrow and suffering enough to disarm all hostility.”

As for my mom, well, she died almost two years ago at the age of 82 of brain cancer.  I devoted a  blog to her passing, but didn’t say just how difficult it was to really know mom. She was always somehow distant, like a star in the sky. She never had any friends, her family was her circle. She loved us, but often did not connect with her children; maybe because she had never been cherished as a child.  She did, after all was said and done, the best she could and, in this sense, was so much easier to forgive and let go of than dad.

Walter – Second Edition

Walter, my oldest brother at age 59 and dad’s namesake, and I were walking back the other night to the parking lot after our hometown hockey team, the Buffalo Sabres, had taken a real shellacking.  I asked him in the frosty, hidden darkness where men – – if they do at all – – share a sliver of their true inner lives: “Do you ever think of dad and what did he meant to you?” He replied, after a few huffing breaths: “Not really, just what a real asshole he was.”

My brother has never been in therapy, never taken antidepressants.  But he had heroically forged ahead “carving out a living” as he was prone to say.  Yet, I couldn’t help think about the profound effect dad’s abuse had had on him and my other three siblings.  I wonder if he sometimes thinks about it at night while lying in bed with the windows cracked open on a hot summer’s night.  Does he wonder why he can’t stop feeling bad about himself? Why he doesn’t feel more confidence?  And the toughest part of it all, the thing that keeps me up at night when I think of my burly, big-hearted brother, is that he probably blames himself for all of these feekings as adult children of alcoholics are prone to do.

My Coming Around

As for me, a real veteran of therapy and antidepressant medications, I know all too well that my parents are still tangled up with me long after their deaths.   My therapist once said that I had to work out the long buried grief of never having had the parents I needed.  Over the years, I have done a lot of grieving for the childhood I didn’t have. Yet, as I was to learn, it wasn’t only my grief about my childhood troubles that I was to deal with, but for my parents as well.  For the loss of their innocence, their difficult childhoods and all that they could have been.

Despite the pain in my family, there was love; fractured though it may have been. As he aged, I sensed that my dad knew that too much had gone wrong that he couldn’t fix.  But in small gestures here and there, he showed affection and love.  As my mom’s wake last May, I was privileged to give the eulogy.  What I said was my mom’s defining quality wasn’t success, intelligence or gardening, but kindness – that this is where she planted her flowers that continue to grow in the hearts of her children and grandchildren.  And what a gift that is.  One that’s always in bloom.

My parents were both hopeless in their own ways.  They were dealt a crummy hand in life.  They were born with certain genes, into a family and time in history that they didn’t choose.  The difference between them and me, the blessing that came out of my depression that didn’t for them, was that my pain forced me to finally confront my wounds and work hard to heal them – an ongoing project for us all.  It forced me to examine the long unexamined within me.  It gave me a choice: I could continue to live out my parents damaged views of life or embark on my own journey and discover what was real and true for me.

While it is true that none of us can avoid the pains and difficulties that come from living on this planet, what modulates the pain is love — pure and simple.  Andrew Solomon, who has suffered from depression for much of his adult life, captured this in his book The Noonday Demon: An Atlas of Depression:

“Depression is a 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 despair. When it comes, it degrades one’s self and ultimately eclipses the capacity to give or receive affection.  It is the aloneness within us made manifest, and it destroys not only connection to others but also the ability to be peacefully alone with oneself.  Love, though it is no prophylactic against depression, is what cushions the mind and protects it from itself.”

In the end, love really is the only thing that saves anybody.

The Ghosts of Depression

Pharmaceutical wonders are at work, but I believe only in this moment of well-being. Unholy ghosts your are certain to come again – Jane Kenyon, Having It Out with Depression.

Halloween has always been one of my favorite times of the year. A time for remnants of Snickers bars still stuck between your teeth the next morning, carved pumpkins of the edge of decomposition and a chill in the spooky night that reminds you Winter is to come all to soon. As a child growing up in the country, my hooligan friends and I relished the chance to go knocking on the doors of neighborhood mothers’ in aprons doling out nocturnal goodies.

When satisfied with our sugar-laden sacks of booty, we would scamper to our local graveyard full of old tombstones.  Once there, we would dare each other to run through as fast as we could, each privately fearing the claw of a bony hand that would pop out of a grave to drag us to some subterranean place where the dead lived and ate small children.

Walking home, we would walk by a neighbor’s house and swear that we’d seen Edgar Allen Poe looking out the window at the full moon.

A Paranormal Force

Ghosts don’t strike us as happy beings, unless it’s Casper The Friendly Ghost. They frighten us, haunt us. Depression has been referred to as a vile creature, an entity of sorts in our popular imagination. You have to look no further that the National Book Award winner, “The Noonday Demon: An Atlas of Depression” by Andrew Solomon. When I had depression years ago, I was told by a friend he understood that I had to “fight my demons.” As if I were the little girl possessed by Satan in The Exorcist. But he didn’t understand, really.

Depression is like a paranormal force, not something inside of our brains, but something outside of it. In a way, depression is a world inhabited by ghoulish ghosts that haunt us. They sporadically interrupt our lives and won’t leave us alone.

Ghosts are always people that have passed away. Often, these ghosts are haunting others because they’re not at peace. Maybe because they left something unsolved in this world. Or, maybe, because we have not let them go.

The Ghosts of Our Childhood

I think this is a crucial aspect of depression: the trouble letting go, the problem of forgiveness of those who have wronged us in the past.

Depression is a pressing down of sadness. A strategy doomed to failure if ever there was one. While many think of it as only as disease born solely of genetics, its archeological origins seem to have begun in the ghosts of our childhoods.

Researchers now know that many with adult-onset depression have had troubled childhoods of neglect or abuse. The nervous system is spooked by trauma and/or neglect which changes our neurochemistry and even the structure of the brain.  Ghosts take up residence in the attics of the brain where they lounge around sipping tea cups of neurochemicals that we all need to feel happy. But just as importantly, trauma creates a well of sadness, terrible loss and wounding of the spirit that lives on with us into our adult lives.

Children who come out of such childhoods often spend a lot of their adult lives feeling like a part of them is missing.  It’s a leak in their soul which can’t be plugged.

Elizabeth Wurztel, in her best-selling book, Prozac Diary, describes the difference between sadness and the zombie-like state major depression can create:

“That’s the thing I want to make clear about depression: It’s got nothing at all to do with life. In the course of life, there is sadness and pain and sorrow, all of which, in their right time and season, are normal—unpleasant, but normal. Depression is an altogether different zone because it involves a complete absence: absence of affect, absence of feeling, absence of response, absence of interest. The pain you feel in the course of a major clinical depression is an attempt on nature’s part (nature, after all, abhors a vacuum) to fill up the empty space. But for all intents and purposes, the deeply depressed are just the walking, waking dead.”

Psychologists can act as mediums at seances, seeking to welcome the dead into our presence so we can have it out with them and heal. We can finally let their voices go and live a life that is uniquely defined by the choices we make rather than the ones’ thrust upon us.

Psychiatrists strike me as more like Ghostbuster’s with ray guns of medication designed to blast the depression out of us.

In her book, Unholy Ghosts: Writers Write on Depression, Nell Casey has assembled various writers who write about their experiences with depression. The theme running through many of the writings is the dark, blank state of depression where the pain of it is actually the absence of feeling. One psychologist wrote that the opposite of depression isn’t happiness, it’s vitality. It’s the capacity to experience the full colorful palette of emotions that make up a normal human life.

For those who’ve experienced depression, they often run from it because they themselves fear becoming unholy ghosts.

But it’s ultimately in turning and facing the ghosts of depression that these phantoms lose the capacity to scare us, to truncate our emotional vibrancy. We can learn to see them for what they are: voices that aren’t true. Voices that can be left for dead.

Turning 50

Because time itself is like a spiral, something special happens on your birthday each year: The same energy that God invested in you at birth is present once again – Rabbi Menachem Mendel Schneerson

I just turned 50 a month ago.

My beautiful wife threw a birthday party for me at my in-laws beach house on the shores of Lake Erie, about fifteen miles from my fair city of Buffalo, New York, also known by locals as The City of No Illusions, the origins of which remain unknown to me.

You get a real sense of your age when all the tunes cranked out by the live band at your birthday gala are all from the sixties and seventies. No Lady GaGa tracks at this hoopla, but lots of gag gifts for the old geezer.

There’s Something About the Number

There is something momentous about turning 50. We all crunch numbers, don’t we. Those who have joined the 50 club seek a sort of mathematical revelation about its meaning: A half-century of 200 changes of the seasons, 600 full moons that have passed through the night skies from my boyhood until now.

It’s been two years since I’ve blogged about my 30th High School Return.  As I drove to that event, it was like a time tunnel back to my younger self as Bachman Turner Overdrive wailed “Taking Care of Business” as I barreled down Route 78, my thinning hair flying with the breeze kicking in through my car’s window.

My dad died at age fifty-six, about six year older than I am now.  That was over 30 years ago.  I wonder what he thought about turning 50.  I will never know.

Obama, George Clooney, Boy George and Eddie Murphy all heard the fifty gun salute this year.  Fame does not delay the passing of the years, though good makeup may.

The acclaimed poet, Billy Collins, on the occasion of his 50th Birthday, wrote:

But I keep picturing the number, round and daunting:

I drop a fifty-dollar bill on a crowed street,

I carry a fifty-pound bag of wet sand on my shoulders.

I see fifty yearlings leaping a fence in the field.

I fan the five decades before me like a poker hand.

Taking Stock

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

We all remember our parents at this ripe age. They seemed so old, didn’t they? We look at ourselves in the mirror and, seemingly overnight, we have become . . . well . . . old.

My hair recedes like the waves going back out to sea, my joints crack and my energy flags around 9:30 at night. Warm milk? Not necessary as my AARP (I just got my unsolicited card in the mail) brain softly whispers to me, “Goodnight Dan”.

Life has brought plenty of trouble, pain and suffering to all of us by 50; curve balls, losses and betrayals of all types. In the balance, it’s also graced us with unadulterated joy, irony, whimsy, mischief and love. We are all challenged to learn from the negative and practice gratitude for the many blessing that have been bestowed on us and those we care about it.

I savor the words of Dag Hammarskjold, former Secretary General of the United Nations, from his book Markings, “For all that has been – Thanks. For all that shall be – Yes.”

There is a grace that comes at 50 that I didn’t have at 30 or 40; 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. Like all people, I’ve weathered many storms. While I know that there are sure to be more to come, I have faith that I’ll still be standing after they’ve pass, that the barometric pressure will rise and that I’ll be walking in the sun again.

We hope by age 50 that we’ve becoming wiser. That in taking stock of our lives at the three-quarter turn of the track, we are able to distill something essential about how to live a good life.

True Grit

I think there’s some grit that comes at 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 tell the 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 by such people and marvel that in speaking their own truth they give permission for others to speak theirs as well.

Maybe few of us tell the truth all the time. So don’t be so hard on yourself. But bites and pieces of it well chewed, like my grandmother’s sweet potato pie, make for good digestion.

Garrision Keillor, of A Prairie Home Companion fame, wrote in Things to Do When You Turn 50:

“Start telling the truth. In small doses at first and then gradually build up to one out of three, a decent batting average. When you’re young, you’re scared, you’re trying to wend your way through the trees and not get shot at, you’re trying to stay on the warm side of the various big cheeses in your life, you’re wanting to be the good guy who everybody loves, not the jerk with the big mouth. But when you hit 50, you’re entering a new passage of life in which you can say what you really think.”

The Speed of Time

We all look forward to events on the horizons of our lives. For a guy like me that just turned 50, it’s retirement sometime in the not so distant future and a day when I won’t be father to a 12 year old daughter, but to a twenty-something woman walking down the aisle with her sixty-something dad.

As you head into the fifty-something territory, others of the same age spontaneously lament and wax that time is moving more quickly the older you get. This conversation can take place with perfect strangers at Starbucks.  I sense that it might be okay to have this middle-aged banter with someone because I can usually tell their approximate age by looking at them: thinning hair, a slightly craggy face and the look in their eyes that they’ve known just how tough life can be.

There is a recognition of our finitude, that time is precious, that we don’t have forever to take running leaps towards our dreams.

Steve Jobs, the founder of Apple Computers, spoke to a Stanford graduating class as their commencement speaker in 2005.

Shortly before then, he has been diagnosed, treated and recovered from pancreatic cancer, a cancer that would take his life some six years later. Not mincing words, he told the class that we will all die. This wasn’t meant to be morbid, he told them. But a recognition that time is precious and not to be squandered.  Our mortality gives us the motivation to find out what we love to do and do it.

Americans often associate this with finding a job they love. No doubt a noble endeavor. Yet most people do not find a job they love and often toil at average paying jobs that bring only a modicum of happiness, if any at all. But they labor on supporting themselves and their families seeking refuge in the solace of forests, a great book, a ball game and in making their spouse and children happy.

Much wisdom can be culled from our years of living to 50. We learn to see what’s really important and what is, by comparison, trivial at best. More than anything, I know this much is true: the decency and dignity with which we carry ourselves everyday trumps everything else that happens to us.

We All Have Choices

We all have choices and we need to be reminded of this over and over. Life will spare no one suffering. Some of us by mid-life will have suffered grievously: the loss of a spouse or loved one to cancer, the undeserved loss of a job and means to support oneself or, as I’ve written at some length before, episodes of depression.

But in my life time, I’ve learned that suffering does not have the final say. That we do have a large say about what suffering means to us and our relationship to it.

Brother David Steindl-Rast, writes in his book, Deeper than Words:

“Our human dignity hinges on the right use of freedom. The converse is the abuse of freedom. Fearing that, should we then want freedom to be eliminated so as to get rid of suffering? No freedom, no love; no love, no meaning; the worst possible suffering: meaningless. The only way off this dead-end road lies in the opposite direction love can give meaning even to suffering – and so overcome it.”

Yes, our life, if it is to have true meaning, is finally to be used to love and serve others. For when we pass, we will not be remembered in others’ hearts so much for our accomplishments, but for the love we have given and shared with others. You can bet on that.

The Triumph of the Human Spirit – Folks Dealing with Depression

A hero is an ordinary person who finds the strength to persevere and endure in spite of overwhelming obstacles – Christopher Reeve.

I want to tell others about all the remarkable people I’ve known who’ve struggled with depression.  While they’re not paladins that ride into medieval battle swinging swords atop snorting mares, they fight a different kind of battle.  And one no less heroic.

Many of the best people I’ve been privileged to know struggle with depression every day.  While they don’t have shiny medals pinned on their lapels, there is an unmistakable strength in them – even if they don’t see it.  I know it’s real because I see and feel it – just like when I am in a grove of giant and majestic pines during a walk in the forest that must withstand the fury of a winter’s storm in January.

A Hero Steps Forward

Take Bob Antonioni. Bob’s story appeared in Esperanza magazine’s regular column, “Everyday Heroes”.  He had a budding political career in the Massachusetts State Senate and a law practice. Despite holding such a public position, Bob took the courageous step to disclose that he suffered from clinical depression in the hope of letting others know it was okay – there wasn’t anything to be ashamed of:

“Telling his story has become another tool to chip away at stigma. Yet he remembers his trepidation when he disclosed the truth in a November 2003 interview with a local newspaper.
‘I had misgivings,’ he admits, ‘but I guess I didn’t give people enough credit. All I heard were thank yous —the complete opposite of what I expected.’ In fact, Antonioni was re-elected twice after that. He retired from public office in 2009 to have more time for himself and his family, but continues to practice law and pursue his advocacy work.”

To me, it says something wonderful about the human spirit that against such a formidable foe as depression, people keep fighting to get better. And many triumph. Just like Bob.

The Black Dog

A few weeks ago in Canada’s Globe and Mail newspaper, there was a great piece, Ill to Power.  The article was about Winston Churchill’s life-long battle with depression written by the author of the new book, A First-rate Madness.  Here, he describes Churchill’s struggles:

“There is no doubt that he had severe periods of depression; he was open about it – calling it, following Samuel Johnson, his ‘Black Dog.’ Apparently his most severe bout of depression came in 1910, when he was, at about age 35, Home Secretary. Later in his life, he told his doctor, ‘For two or three years the light faded from the picture. I sat in the House of Commons, but black depression settled on me.’ He had thoughts of killing himself. ‘I don’t like standing near the edge of the platform when an express train is passing through’.”

Like Churchill, Abraham Lincoln struggled with major bouts of depression.  In the book Lincoln’s Melancholy: How Depression Fueled a President to Greatness, Lincoln writes about a cloud over him that every bit matches Churchill’s darkness:

“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”.

Lincoln, who many say was one of this country’s greatest heroes, apparently did not feel like one all the time.

Hard to Feel Like a Hero

Most people depression — in some fundamental sense –feel broken.  This conclusion is fueled by the depression itself – both biological (sleep, appetite, energy levels) and psychological (e.g. “Nobody really cares about me”, “I stink at my job” or “My depression will never end”).  But this brokenness isn’t just an “inside job” – crummy stuff they tell themselves about themselves.  Other people or events in a depressive’s daily orbit serve-up damaging assessments and innuendos about a depressed person’s behavior or personhood.

Others may tell them that they are letting them down at the office or not contributing enough to family responsibilities – yes, loved ones can get fed up with the depressed person’s withdrawal from the family, the inability to do chores he/she used to do and the depressed person’s sourpuss.  Or, they deny the immensity of the suffering of the depressive by minimizing it:  “Don’t worry, things will get better.  You’re just in a slump.” 

We sense that their agenda isn’t so much about helping us get better, as it is about them their needs.  Why else would we feel so much crappier and lonely after such exchanges?  It isn’t as if their needs aren’t important, but shouldn’t our mental health be at least as important?

Then there is the cultural stigma – a cloud of ignorance, fear and misunderstanding – surrounding depression.  American culture tends to see depression as a moral or personal weakness; the “just-get-over-it” rants of a society that likes simplistic answers to complicated problems.  Dr. Richard O’Connor, in his book Undoing Depression, captures some the irony of how our society sees depression as different from – or maybe not as real as — other forms of illness:

“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”.

Renaming One’s Walk through Depression as Heroic

Why can’t we re-imagine our self-image in relationship to our depression in a more positive light?  Why can’t we think of our battles with depression as, in fact, heroic?  Instead of counting all of times that depression has gotten the better of us and knocked us to our knees, how about giving ourselves credit for all of the times that we have triumphed over depression (perhaps even in the simplest ways); the times that we have risen to the occasion in spite of our melancholy and the moments that we have looked depression in the eye and said, “no more.”  Make no mistake about it that takes gumption – lots of it!  And I’ve witnessed scores of people say “that’s enough.”  While talking back to depression isn’t a panacea, it may be a healtier way for us to cope rather than succumb to it.

Viewing yourself as a hero is a constructive and healing experience for people with depression.  It doesn’t deny that we struggle with it sometimes, but it more importantly doesn’t deny the power we actually do have over it and the courage it takes to deal with it to the best of our ability each day.

In his article “The Continuing Stigma of Depression” psychologist Jonathan Rottenberg writes about the stigma for those who have recovered from depression:

“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”. 

Things to Consider

 – Maybe we fall down 30 times a day, or maybe it’s just a stumble, but we have to regain our balance and get up.  As the old Zen saying goes, “fall down seven times — get up eight.”  That, my friends, is heroic. Just remember that when you fall and get up – YOU are that hero.

– We must remember that when we are in a depression, it isn’t easy to feel like a hero — just think of Honest Abe. But the depression will pass. So don’t be too hard on yourself if you don’t feel heroic all the time.

– We should not condemn ourselves when we are down, but pick ourselves up and remember that we are, truly, remarkable people. 

As writer Andrew Berstein once wrote:  “A hero has faced it all: he/she need not be undefeated, but he/she must be undaunted.”

 

The Suicide of a Lawyer with Depression — Ken’s Story

This is a guest blog by Cincinnati, Ohio attorney Tabitha M. Hochscheid, Esq., a partner at the law firm of Cohen, Todd, Kite & Stanford, LLC.  In this moving tribute, she writes about her law partner and dear friend Ken Jameson who committed suicide in May of 2011 after a battle with depression.

How well do we know those with whom we spend our work days with?  Is it possible to practice with someone and be there friend for years yet, not truly know that they are suffering from the depths of depression?  Being around other attorneys can give us the camaraderie and support we need to grow and build our practice.  But, often times, people keep their emotional health a secret and suffer from depression in silence.  By the time their colleagues realize what is going on, it can be too late to do anything about it. My partner and friend Ken Jameson was one of the people.  This is his story. 

Ken Jameson was, by outward appearances, successful, well liked, a loving husband and father, a friend to everyone and a dependable partner.  In fact, Ken was perhaps the epitome of the well liked, client centered and dedicated lawyer many of us envision when we think of how lawyers should behave. On the inside, however, Ken was struggling with the depression which eventually took his life.

I first met Ken in the summer of 2007 for breakfast to discuss my interest in joining Cohen, Todd, Kite and Stanford, LLC.  Ken was so easy to talk to and we instantly bonded because he too had left a small firm to find a place to grow and build his practice at Cohen, Todd, Kite & Stanford, LLC.   After I joined the firm in January 2008, Ken was always available to help and support me and we grew into friends, as well as, colleagues.

Like so many attorneys, Ken built a practice by creating a network of referrals, by giving his clients personal service and building long term relationships.  He was an attorney who facilitated resolutions and provided estate plans for people of all income levels.  Ken enjoyed his work.  After joining the firm himself in 2006, his practice thrived.  He became a trusted member of the firm and was on the management committee.   Ken shared is life outside of the office with his wife and best friend of 35 years, Betsy, and three adult children of whom he was most proud.

Ken was a universally well liked person.  He conducted himself professionally in such a way that he never seemed to have conflicts with others.  Ken cared about his firm family, he always checked in on people if they were sick or if he knew you were under stress.  He was active member in his Church.  Ken took care of his physical health by walking 5 miles a day, attending Pilates classes twice a week and maintaining a healthy diet.  By all outward appearances, Ken had success in his work, a happy home life and seemed content.

However, Ken had underlying mental health issues.  Like many attorneys he had trouble sleeping well.  Sleep is something that eludes most attorneys from time to time, but his type of sleep loss was chronic.   He would fall asleep and wake up in just a few hours and not be able to go back to sleep.  As long as I knew Ken, he had this issue.  He tried relaxation techniques to help him sleep better, he read books about stress management and attempted to delegate work to others.  Ultimately, Ken was a self confessed perfectionist and as such, had an inner critic who told him he had to be at work all the time.

Most lawyers struggle with the challenges of building a law practice, client demands and finding out how to have precious downtime.  Ken was doing all the right things, but he still wasn’t able to sleep.  In March of this year, he took time out of the office due to exhaustion.  He went to see his family doctor and was prescribed something for sleep.   He tried to come back to the office part time within a few weeks but was unable to sustain a schedule.   Ken represented to those of us at work that he was exhausted and initially did not tell others what was really going on.

In late April, he left the office again.  This time it was lack of sleep and a pinched a nerve in his back.   With this new medical issue, his depression worsened.  He spent sometime in the hospital to adjust to new medications and was scheduled for back surgery.  At this point, Ken began expressing worry about the office and felt as if he was letting the firm down.  Finally, Ken had back surgery for the pinched nerve in the middle of May.  After the surgery, Ken seemed to be doing better; everyone thought his return to the office was imminent.

Ken never returned to the office.  On Sunday, May 22, 2011, I received a call from our office manager.    She informed me that Ken’s depression had worsened and that he had taken his own life that morning.  As the next few days unfolded, details began to surface.  Ken underwent surgery on his back and in the days following the procedure, had checked in with people at the office and had seemed like his old self.  Ken also visited his mother and called his best friend.  All the while, Ken meticulously planned how to take his own life.

No one can answer the question of what was going through his head or why he was in such despair that he took his life.  The next five days were difficult at the office.  People were in a state of shock and disbelief.  His office door has remained open since Monday, May 23, 2011.   A memorial was held the Saturday following his death and it was standing room only.   Ken clearly touched the lives of thousands and his life was remembered in eulogies by his friends, his sister and his wife.  It was touching to see so many people who loved him, but the confusion as to what occurred actually increased for many.

Do you ever really know the people we practice law with?  Everyone at the office felt they had a personal relationship with Ken.  But, did anyone of us really know what was happening.  It is easy now to look back and see the signs of Ken’s illness (sleep deprivation, self criticism, feeling of letting others down, a search for answers and inability to allow others to help) and to wonder what if anything could have changed the outcome.  Time, however, does not give us this luxury and these questions will never be answered.  The best that can be done is to acknowledge that Ken’s illness, depression, can be deadly. 

It seems that our profession gives little in return for years of hard labor.  Learning a way to balance the demands of the business of being a lawyer with the need for downtime is essential to one’s mental and physical health.  Ken’s depression is an all too real downside of the practice of law.  His suicide is a tragedy to his family, our law firm and to the legal community.  He was one of the “good” guys and the profession needs more people like him.

For those of us left behind we struggle for understanding and to carry on in spite of the sadness we each feel.  Inevitably when speaking with others we are confronted with the questions of why?  Most people will ask the normal questions – were there money problems, did he have marital problems or health issues.  The answer to these questions is no and then people just cannot fathom why Ken chose to end his life.   I know in my heart that, as the minister said during his memorial, that Ken felt he was “fixing” the situation.  Ken was a fixer and this was his only choice left.

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

Editors note — If you or someone you know suffers from depression and may have thought about suicide, visit the website of the national organization The American Association of Suicidology which contains great information, resources and how to get help. Lawyers can also contact  Lawyer Assistance Programs in their legal community.  To locate a program near you, visit the ABA’s Commission on Lawyer Assistance Programs website.

Paying Attention to Our Depression

Depression isn’t just an illness.  It’s a messenger.

In his book, Unstuck, James Gordon, M.D., writes:

“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”.

If we would but listen, we might find that our depression is trying to tell us something; important insights about our lives and the ways we live it that might be keeping us mired in a soupy gloom.

We often don’t heed our inner wisdom, but keep going full-speed ahead in the wrong direction anyway. Richard O’Connor, Ph.D. observed, “Depression is a vicious circle and we keep doing these destructive patterns because “we don’t how to do anything else.”

When we think of depression only as an illness, we oversimplify its causes and remedies.  No doubt, it has profound effects on our brains and bodies.  Surely, it runs in families and likely has a genetic component. But if it were only that, a blue pill would solve the problem.  And it doesn’t.

The pain of depression may be an impetus for sufferers to live a more authentic life.  Often people who suffer from depression are living from a wounded place within themselves.  Along the way, they learned that they weren’t “good” enough or were “bad people”.  As a consequence, they learned to hide their true needs and wants and live an inauthentic life; a life that may not work, but they don’t know how to change.

In this vein, folks can come to think of depression as some sort of punishment:  a recompense of some unknown sins from an undefined past.  Or, maybe the very real wrongs they may have committed are magnified, as they are prone to be in the mind of a depressive, by the process of generalization: a known cognitive trick of depression where we take a negative incident (e.g. “I lost this case”) and turn it into “Why am I such a failure?”

Depression doesn’t just happen to anyone. Rather, it is the accumulation of a lifetime of varying degrees of psychic pain suffered during a lifetime, often starting in early childhood.  In our early years, many learned that it was dangerous to live from a space of our true selves because of a parent who was an alcoholic, abusive or in some way emotional abusive or absent.

Ellen McGrath, Ph.D., writes:

“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”.

Our parents, acting out of their own wounded souls, unconsciously played out their unresolved pain with us during our childhood.  They did so because of their distorted way of seeing the world; a place that they found threatening, its problems unsolvable and against them at every turn.  This hardened them and led them to fail in life’s most important vocation: the nurturance of their own children.

I recall my mom saying to me as a child, “Well, what are you going to do?”  While one could say this was the innocuous lament of a middle-aged mother of 5 kids, later in life I learned it was mom’s worldview that there weren’t really solutions to life’s fundamental problems, that we are, at our core, helpless in the face of life’s thorny challenges. 

My mom suffered from undiagnosed and untreated depression for most of her life.  I now see how this passive, victimized way of seeing the world took root in my psyche as a young man.  And how hard I had to work to overcome it over the years; how I had to struggle to listen less to the inner voice and critic of my parents and incline my ears toward my true self which was always there waiting to be heard.

In Listening to Depression, psychologist, Lara Honos-Webb writes that depression is trying to tell us something: that we are on the wrong track in life.  In this sense, depression can be a teacher if we would only listen to it.

How can we come to see depression as a teacher?  Honos-Webb writes:

“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.”

I admit that it’s hard to see depression’s value when in the thick of it, the swamp through which we slog with little relief.  But there’s much to be said for seeing depression not just as a disease, but as a messenger that our lives need to change for us to heal.

 

 

Our Struggle with Depression

 

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 clinical depression, but the difference is like the difference between the sniffles and pneumonia – Richard O’Connor, Ph.D.

Years ago:  I am walking down a Manhattan street on a grey day.  I am feeling so sad; beyond somber and without any external point of reference. I looked up at the grey buildings. I suddenly have the sense that I am a building; a tower with a cracked foundation slowly falling to the pavement below.

I step into a church I don’t know.  I try to pull myself together. “Please God. I need your help.” I have to be in Court shortly. I look at my watch. My suit feels tight against my skin. I struggle to make the sadness more manageable, more contained.  I leave because I must, not because I feel any better; but because I am an adult and have to move through my day, no matter the volume of pain ringing in my ears.

The sadness from that day would end.  I would feel better.    But a pattern was developing, even then.  A pattern of how I would respond to sadness in my life, both past and present.

The Struggle to Break Free   

Some folks have given up hope that depression will ever leave them alone. They’re just hoping for more good days than bad.  When it’s a relatively good day, when life is in flow and not stuck in the muck of melancholy, there is happiness, or perhaps, relief.  The depression gods’ hurtiling thunderbolts have missed them this day. But when they’re in the thick of it, they fight their sadness.  It’s as if they’re pressing on the gas trying to escape their pain while depression has its foot on the brake.

Sadness is not Depression – though they are cousins

First, let’s be clear: sadness is not depression, but it may manifest as persistent sadness that can be a symptom of clinical depression. When I developed depression ten years ago, my sadness was accompanied by lots of crying for no particular reason.

Paradoxically, Dr. O’Connor, in his book, Undoing Depression , wrote that depression is often the absence of despondency:

“We confuse depression, sadness, and grief.  However, the opposite of depression is not happiness, but vitality – the ability to experience the full range of emotions, including happiness, excitement, sadness, and grief.  It’s not sadness or grief, it’s an illness.”

Maybe this is why we don’t see – we don’t see how we react to our own sadness because we’re stuck in the vortex of depression where everything, like the perimeter of a tornado, is thrown together.

This relationship between sadness is troublesome for a depressive.  This is so not because there is anything wrong with sadness – it’s a normal part of the human experience and gives our lives depth and pitch.  It’s the bass tone you hear when B.B. King plays the Blues. In my experience, sadness has a bittersweet quality to it. As the great novelist Herman Hesse once penned, “It was if all of the happiness, all of magic of this blissful hour had flowed together into these stirring, bittersweet tones and flown away, becoming temporary and temporary once more.”

The Brain Knows How we React to Sadness

A recent study revealed that the brain’s response to sadness can predict a relapse into depression.  Faced with sadness, the relapsing patients showed more activity in a frontal region of the brain, known as the medial prefrontal gyrus.  These responses were linked to higher rumination: the tendency to think obsessively about negative events.  Patients who didn’t relapse showed more activity in the rear part of the brain, which is responsible for processing visual information and is linked to greater feelings of self-acceptance and non-judgment of experience. 

According to Norman Farb, Ph.D., who did the study:  “For a person with a history of depression, using the frontal brain’s ability to analyze and interpret sadness may actually be an unhealthy reaction that can perpetuate the chronic cycle of depression.  These at-risk individuals might be better served by trying to accept and notice their feelings rather than explain and analyze them.”

We keep trying to find the source of our sadness like squinting to find the bucket that has fallen in the deep well.  We circumambulate the hole, peering into the darkness, but don’t see the flashlight nearby that can help.  We can’t see that our attempt to break down and explain our sadness to ourselves isn’t helping – it’s hurting us.

A New Relationship to Our Sadness

In his book The Mindful Path to Self-Compassion, Christopher Germer, Ph.D., writes:

“This is an opportunity to move from mental work to heart work.  Self-compassion has a distinctly nonintellectual and non-effortful feel to it. If we can find ourselves in the midst of suffering and acknowledge the depth of our struggle, the heart begins to soften automatically. We stop trying to feel better and instead discover sympathy for ourselves. We stop trying to feel better and instead discover sympathy for ourselves. We start caring for ourselves because we’re suffering.”

Don’t always try to figure out your depression. Give yourself a breather from solving it, this boulder of sorrow. Instead, see that you – yes, you – are worthy of compassion from yourself because you suffer. If you don’t know how to feel this compassion for yourself, isn’t it about time to try?

 

 

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