Dr. Richard O'Connor Archives - Lawyers With Depression

Undoing Depression in Lawyers

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

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

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

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

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

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

The Dark Side of Antidepressants

As I’ve intimated, drug industry research on the newer antidepressants has been manipulated to maximize positive results and minimize the downside. Here’s one example: the original research that got FDA approval and set off the craze for these drugs had very low standards, which were not revealed to the public.

They were generally two- or three-month trials, very short over the lifetime course of depression, and the definition of cure was simply no longer meeting all the criteria for major depression. You might still be feeling suicidal and wracked with guilt, but if your sleeping had improved, as far as the FDA was concerned, the drug had demonstrated its effectiveness. Then there was the fact that in all these trials the drugs proved only slightly better than placebo—in most cases, about 40 percent of people got better with a sugar pill, and about 50-60 percent improved with an SSRI. Added to that is the fact that many of these studies stacked the deck by excluding people who were most responsive to placebo.

Subsequent studies, with larger groups over longer periods of time, have shown about the same disappointing results. The STAR*D study, with a large sample of real-world patients, without excluding placebo responders, found that about 50 percent of patients had a significant response to medication, but only about 30 percent met the researchers’ definition of remission. During follow-up, a significant number of patients relapsed. Overall, the recovery rate was only slightly better than chance alone. STAR*D was sponsored by the National Institute of Mental Health and should be considered relatively free of drug company influence.

The withdrawal problems with SSRIs have also been minimized. There can be significant withdrawal problems when you stop taking SSRIs—“SSRI Withdrawal Syndrome”—including extreme anxiety, skin crawling, confusion, GI distress, insomnia, and agitation. For some individuals these symptoms are excruciating. I had a patient who went through weeks of pure hell—fever, nausea, chills, extreme depression, and the certainty she was losing her mind—going off a pill I had encouraged her to take. The best advice is to discontinue any of these medications by tapering off slowly and under a physician’s care.

Last but not least, there are worries that antidepressants interfere with emotional vitality. One study of non-depressed volunteers found that taking an SSRI for only a week interfered with their ability to read facial expressions, especially of anger and fear. Another study of normal volunteers found that four weeks of Paxil significantly reduced their ability to feel sad or angry when appropriate. A group of patients who were experiencing sexual side effects also developed significantly less ability to cry or care about others’ feelings. They also lost erotic dreaming, surprise, creativity, anger, and ability to express their feelings.

Therapists who take SSRIs themselves were very disturbed by these findings, wondering if it meant they were losing their ability to be empathic; many of us have stopped medications as a result. I know a musician who tried Lexapro for his social anxiety and asthma. He noticed that he stopped getting chills and goose bumps when he was really moved by music. When he stopped Lexapro, he was able to get goose bumps again. He felt that he had also lost some of his ability to immerse himself in the music. Another male patient, who was prone to picking up girls for one-night stands, reported that with Paxil he stopped feeling guilty. At least he recognized this was a problem.

It seems quite possible that SSRIs (and other antidepressants, for all I know) get some of their effect from an overall emotional blunting, especially of negative feelings. Their use may make us temporarily a little shallow or insensitive. As far back as Listening to Prozac (1993), Peter Kramer was advancing the theory that people with depression may be especially sensitive to signs of rejection, and that SSRIs helped them cope better. This is one of the reasons why I’m so against the use of antidepressants by people without severe depression who simply want to feel better. They may worry less, but it can damage their relationships, reduce their enthusiasm, make them more shallow and unrealistically complacent. This may be why, in this age of stress, so many people are using antidepressants—the drugs can help people put up with things they should not put up with.

Bottom line on SSRIs? Depression is a serious illness, and these are serious medications. No one should ever take them lightly. They definitely can do harm, but the harm depression can do can be much worse. If you have a severe depression, you owe it to yourself to give medication a genuine try. But it needs to be part of a balanced plan that includes good psychotherapy and a lot of self-care. One thing medication can do is let you have the energy or hope to follow through.

By Richard O’Connor, Ph.D.

Dr. O’Connor is the author of the best-selling books, Undoing Depression and Undoing Perpectual Stress: The Missing Connection Between Anxiety, Depression and 21st Century illness.

Undoing Depression in Lawyers

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

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

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

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

Lawyers With Depression: Crawling Towards Hope

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

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

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

Yet, the numbers don’t lie.

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

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

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

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

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

Depression Isn’t the Blues

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

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

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

“Why Don’t You Take a Vacation?”

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

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

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

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

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

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

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

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

That was it.

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

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

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

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

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

I began to hope.

Copyright, Daniel T. Lukasik, 2014

Depression & Procrastination

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

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

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

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

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

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

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

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

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

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

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

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

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

By Richard O’Connor, Ph.D.

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

A Pep Talk for Those With Treatment-Resistant Depression

If you’re one of those struggling with chronic depression that isn’t responding to antidepressants and/or therapy, you need to read this piece. Read the Blog

Best Depression Quotes

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

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

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

The so-called ‘psychotically depressed’ person who tries to kill herself doesn’t do so out of quote ‘hopelessness’ or any abstract conviction that life’s assets and debits do not square. And surely not because death seems suddenly appealing. The person in whom Its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise. Make no mistake about people who leap from burning windows. Their terror of falling from a great height is still just as great as it would be for you or me standing speculatively at the same window just checking out the view; i.e. the fear of falling remains a constant. The variable here is the other terror, the fire’s flames: when the flames get close enough, falling to death becomes the slightly less terrible of two terrors. It’s not desiring the fall; it’s terror of the flames. And yet nobody down on the sidewalk, looking up and yelling ‘Don’t!’ and ‘Hang on!’ can understand the jump. Not really. You’d have to have personally been trapped and felt flames to really understand a terror way beyond falling. David Foster Wallace

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

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

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

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

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

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

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

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

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

Depression is melancholy minus its charm. Susan Sontag

You are constantly told in depression that your judgment is compromised, but a part of depression is that it touches cognition. That you are having a breakdown does not mean that your life isn’t a mess. If there are issues you have successfully skirted or avoided for years, they come cropping back up and stare you full in the face, and one aspect of depression is a deep knowledge that the comforting doctors who assure you that your judgment is bad are wrong. You are in touch with the real terribleness of your life. You can accept rationally that later, after the medication sets in, you will be better able to deal with the terribleness, but you will not be free of it. When you are depressed, the past and future are absorbed entirely by the present moment, as in the world of a three-year-old. You cannot remember a time when you felt better, at least not clearly; and you certainly cannot imagine a future time when you will feel better. Andrew Solomon, The Noonday Demon

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dan’s Top 10 Stress and Anxiety Book Picks

There’s a wonderful piece in todays New York Times Magazine, The Manic in Me: If I Couldn’t Conquer my Anxiety, the Least I Could do was Understand It by Daniel Smith. He writes:

“There are two types of anxiety sufferers: stiflers and chaotics. Stiflers are those who work on the principle that if they hold as still, silent and clenched as possible, they will be able to cut the anxiety off from its energy sources, the way you cinch off the valve from a radiator. Chaotics, by contrast, work on no principle whatsoever. Although chaotics are sometimes stiflers when alone, when they are around other people, and especially intense interpersonal situations, they are brought into a state of such high psychological pressure that all the valves pipes open of their own accord, everything is released in a geyser of physicality and verbiage, and what you get is a kind of shimmery, barely stable equilibrium between internal and external states, like in those rudimentary cartoons where the outlines of the characters continuously squiggle and undulate”.

Smith captures some of the panicked nature of anxiety sufferers. But he’s not describing the anxiety that’s a normal part of life. Anxiety can even be useful when it alerts us to danger. But for some people, anxiety is a persistent problem that interferes with daily activities – – just as depression does – – such as work, school or sleep. This type of anxiety can disrupt relationships and enjoyment of life, and over time it can lead to serious health concerns and other problems.

Scientists know there is a high degree of comorbidity (i.e. the presence of a disease in addition to the primary disease) with anxiety and depression: up to 60% of patients whose primary diagnosis is anxiety also suffer from depression and vice versa. Check out my earlier blog, How Stress and Anxiety Become Depression.

All this being said, and without further adieu, here are my top 10 picks. Feel free to suggest your own.

Why Zebras Don’t Get Ulcers: An Updated Guide to Stress, Stress-Related Diseases and Coping – Robert Sapolsky, Ph.D.

Why don’t zebras get ulcers–or heart disease, clinical anxiety, diabetes and other chronic diseases–when people do? In a fascinating that looks at the science of stress, Stanford biologist Robert Sapolsky presents an intriguing case, that people develop such diseases partly because our bodies aren’t designed for the constant stresses of a modern-day life – – like sitting in daily traffic jams or racing through e-mails, texting and running to pick up our kids after a tough day at work. Rather, humans seem more built for the kind of short-term stress faced by a zebra–like outrunning a lion.

This book is a primer about stress, stress-related disease, and the mechanisms of coping with stress. How is it that our bodies can adapt to some stressful emergencies, while other ones make us sick? Why are some of us especially vulnerable to stress-related diseases and what does that have to do with our personalities?”

Sapolsky, a neuroscientist, concludes with a hopeful chapter, titled “Managing Stress.” Although he doesn’t subscribe to the school of thought that hope cures all disease, Sapolsky highlights the studies that suggest we do have some control over stress-related ailments, based on how we perceive the stress and the kinds of social support we have. Watch this fantastic National Geographic Documentary featuring Dr.Sapolsky explaining Stress and Anxiety.

Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness – John Kabat-Zinn, M.D.

As a busy lawyer, I was immediately attracted to the title Full Catastrophe Living. It literally leapt of the bookshelf and cracked me on the head. Who doesn’t live a life so jammed with stuff to do that it feels like a catastrophe?

Chronic stress saps our energy, undermining our health, and making us more vulnerable to anxiety, depression, and disease. The heart of the book is based on Kabat-Zinn’s renowned mindfulness-based stress reduction program at the University at Massachusetts Medical Center. Check out this video clip of Dr. Kabat-Zinn. The author takes the phrase “full catastrophe living” from book and movie Zorba the Greek. If you’ve never seen it, an Englishman Basil – – who is half-Greek – – inherits a run down mine in a small Greek town. To help him restore it, he hires a local character named Zorba to be the foreman of the local laborers. Zorba, full of the zest of a life truly lived, is asked by Basil, “Do you have a family?” Zorba responds “Wife, children, house – – the full catastrophe!!!”

The Mindful Way through Anxiety: Break Free From Chronic Worry and Reclaim Your Life – Susan M. Orsillo, Ph.D.

Anxiety isn’t the same thing as stress. You can’t just “get over” anxiety. In fact, the very things most people do to try to feel better–avoiding feared situations, pushing worry out of mind–only make the problem worse. This book presents a powerful new alternative that can help you break free of anxiety by fundamentally changing how you relate to it. Mindfulness, a simple yet powerful way of paying attention to your most difficult emotions and life experiences, seems like it is everywhere these days and being offered as a solution to much of the mental distress that ails modern society. Yet, in my own limited experience, it is worthy of such attention because it works.

Undoing Perpetual Stress: The Missing Connection Between Depression, Anxiety and 21^st Century Illness – Richard O’Connor, Ph.D.

Author of my favorite book on depression, “Undoing Depression”, Richard O’Connor, Ph.D., has written another simply brilliant book on the consequences of “perpetual” stress in our lives – the alarming and escalating rates of clinical anxiety and depression. This was the first book I read that made clear to me the connection between stress, anxiety and depression. It formed the basis for my blog on the topic How Stress and Anxiety Become Depression. The human nervous system was never meant to handle this many stressors. It’s as if the circuit breakers in our brains are blown by too much stress running through our brain’s circuitry. This book is a perfect fit if you want to learn a lot about the brain and physiology of stress – I found it fascinating. If you’re looking for a quick read and pick-me-up, this isn’t it. Read the Book Review.

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

Medication, once considered the treatment of choice, is losing favor as more and more sufferers complain of unpleasant side effects and its temporary, quick-fix nature. Now, thanks to a flood of fresh neurobiology research and insights into the anatomy of the anxious brain, effective, practical strategies have emerged allowing us to manage day-to-day anxiety on our own without medication. Addressing physical, emotional, and behavioral symptoms, Margaret Wehrenberg, Ph.D., a leading mental health clinician, draws on basic brain science to highlight the top ten anxiety-defeating tips. Everything from breathing techniques to cognitive control and self-talk are included. I really like that the 10 chapters are highly readable and short. Dr. Wehrenberg is also a frequent blogger at the Psychology Today website. Here’s one of her blogs, The One-Two Punch of Negativity and Fear.

Things Might Go Terribly, Horribly Wrong: A Guide to Life Liberated from Anxiety – Troy DuFrene

This book approaches the problem of anxiety a little differently than most. Instead of trying to help you overcome or reduce feelings of anxiety, it will help you climb inside these feelings, sit in that place, and see what it would be like to have anxiety and still make room in your life to breathe and rest and live, really and truly live, in a way that matters to you. This approach is based upon a research-supported form of psychotherapy called Acceptance and Commitment Therapy, also known as ACT which starts with the assumption that the normal condition of human existence is suffering and struggle, ACT works by first encouraging individuals to accept their lives as they are in the here and now. This acceptance is an antidote to the problem of avoidance, which ACT views as among the greatest risk factors for unnecessary suffering and poor mental health

Get Out of Your Mind and Into Your Life – Steven C. Hayes

This is another book that uses the ACT approach. It’s different than the book above because it offers a five-step plan for coping with painful emotions such as anxiety and depression. How I love plans! I also liked the wisdom contained here: the recognition that painful feelings cannot be controlled will open you to the possibility of fully emotional living. When anxiety arises in our bodies and minds, we erroneously believe that we have the power to rein these in, stop them and thus effectively eliminate it. However, this approach only leads us further down into the well of panic. Anxiety is not the problem. It is our attempts to squash and control it that strengthen anxiety and prevent us from coping with it effectively. Learn what steps you can take to approach anxiety differently.

The Worry Cure – Robert L. Leahy

For “highly worried people,” or those who suffer from the “what-if disease,” this book presents a systematic, accessible self-help guide to gaining control over debilitating anxiety. Leahy is an expert in changing thought processes, and he walks worriers step-by-step through problems in the way they think, with pointers on how to change these biases. The author then outlines a seven-step worry-reduction plan (remember, I love plans!) beginning with identifying productive and unproductive worry, progressing to improving skills for accepting reality, challenging worried thinking and learning to harness unpleasant emotions such as fear or anger.

The Anxiety and Worry Workbook – David A. Clark, Ph.D.

Like many of the other books I’ve recommended, this one is also grounded in cognitive behavior therapy.

I like this book because included in it are carefully crafted worksheets, exercises, and examples that reflect the authors’ decades of experience helping people who really, really struggle with anxiety. Learn practical strategies for identifying your anxiety triggers, challenging the thoughts and beliefs that lead to distress, safely facing the situations you fear, and truly loosening anxiety’s grip–one manageable step at a time. Like depression, coping effectively with anxiety involves learning helpful new and constructive ways of thinking about the problems we all face. So often, it isn’t the reality of a situation that makes us anxious, but the stories we tell ourselves about the events that happen moment-to-moment.

Self-Coaching: The Powerful Guide to Beat Anxiety – Joseph J. Luciani, Ph.D.

This is a good book for those who don’t want to see a therapist or, if they do, need extra doses of encouragement and practice to overcome their anxiety. The author advises readers to identify themselves as specific personality types (e.g., “Worrywarts,” “Hedgehogs,” “Perfectionists”) and then gives specific instructions on how to change the particular thought patterns associated with this type of personality. So many people who struggle with anxiety never got what they needed while growing up – – enough love, encouragement and affirmation. Lacking these core experiences, we develop can develop particular maladaptive strategies to cope with people and situations that push our buttons. This is the only book that I’ve read that pairs specific coping recommendations with particular personality types.

Healing Anxiety and Depression — Daniel Amen, M.D.

Dr. Amen is a true pioneer in uncovering the connections between the brain and behavior. In this excellent book, he provides an overview of how the brain works and how medication, diet, supplements, exercise and social and therapeutic support can help anxiety. Check out this video clip of Dr. Amen talking about his comprehensive approach. As science’s understanding of how anxiety and depression work has grown, there is an emerging picture that both of these conditions are “whole body” problems that demand whole body solutions. Like depression, we can’t just take a pill. Rather, we need to look at every aspect of our lives so that we can address anxiety on multiple levels.

Is Depression a Habit?

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

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

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

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

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

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

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

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

Well-known author Deepak Chopra writes:

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

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

Turning It Around

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

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

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

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

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

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

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

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

Running on Empty

From the site Undoing Depression, Richard O’Connor, Ph.D. blogs that professionals frantically run from one success to another because they’re afraid some unnamed demon will catch up to them. Read the Blog.