Lesson 5: Coping with Depression
This lesson looks at living with depression day to day, with a focus on stigma, support groups, cognitive therapy, spirituality, and healing.
Stigma, Support, Therapy
Stigma is not just another form of discrimination. As Otto Wahl PhD of George Mason University explained to the 2001 NAMI conference, stigma impedes recovery, it takes away resources. When opportunities for work, housing, and things most people take for granted disappear, it makes it harder to become well and achieve restoration back into the community.
Fortunately, the popularity of Prozac has helped reduce the stigma of depression, and the Americans with Disabilities Act has given limited protection in the workplace for those whose depression impairs their major life activities. Nevertheless, the world can seem a very hostile place, and it helps to connect with people who have been through what we are going through.
Support
Jay Neugeboren in "Transforming Madness" describes what is now a rapidly-growing consumer-survivor movement, of people like us helping people like us. We are beginning to gather into a political force, complete with petty little rivalries and language strongly suggestive of the civil rights movement of an earlier era. We hear of Moe, mentally ill and proud, who helps run Boston's innovative Vinfen program. "There's no shame in having a psychiatric condition or caring for another person who has one," he tells the author. "Take away shame and anything's possible."
A National Depressive and Manic Depressive Association survey showed that treatment compliance and the doctor-patient relationship improves as a result of being in a support group. Similarly, support groups may help reduce hospitalization. Ninety-seven percent of those in a DMDA group say it helps them cope and 86 percent report they are more willing to take their meds and put up with side effects.
For this writer, my Wednesday night support group is a vital part of my treatment plan. On any given night there are anywhere from 12 to 25 people in attendance coming from all walks of life - a successful businessman, a Harvard law grad, a nun, a retired laborer, a downsized bookkeeper ... In any other setting, I might find them boring or intimidating or not my style. But here, they represent those rare few who share what I have, who know what I'm going through and where I'm coming from. I'm not expecting words of wisdom, nor do I need their sympathy. Simply sharing two hours with people who have walked in my shoes is all I require. I'm prepared to give back as much.
If live support groups are not for you, please avail yourself to the internet. Between the thousands of message boards, mailing lists, and chat rooms, you are bound to find a forum that is right for you.
Turning Your Thoughts Around
In the first line of the Dhammapada, the best known of the Buddhist scriptures, Buddha says: "Mind precedes its objects. They are mind-governed and mind-made. To speak or act with a defiled mind is to draw pain after oneself, like a wheel behind the feet of the animal drawing it."
Buddha also said: "Mind precedes its objects. They are mind-governed and mind-made. To speak or act with a peaceful mind is to draw happiness after oneself, like an inseparable shadow."
You might call the Dhammapada history's first self-help book and Buddha the first psychologist. Some 2,600 years later, Aaron Beck and David Burns built on the Enlightened One with the development of cognitive therapy, which helps you stop your brain from its own destructive thinking. The therapy is typically used in combination with drug therapy, once the patient is responding to medication, and generally involves from ten to twenty sessions. You should not feel you have to reveal private details of your life in cognitive therapy, but do expect to have your thinking challenged.
To begin:
Once our brains go down, the mind throws out all kinds of negative thoughts that can keep us trapped in a vicious cycle of depression. Even in more upbeat moods, we all too easily fall into the kind of thinking that can take us one-way down the elevator shaft, or very close to the edge: All-or-nothing thinking is one. Blowing negative events out of proportion is another, and blaming ourselves, no matter what, still another. Typically we filter out positive feedback and assume the worst based on little or no evidence.
We've all done it: We get stuck in traffic and our day is naturally ruined. We win some praise from the boss, but somehow it doesn't count. It rains on the family picnic and we're the ones who apologize instead of God. Sometimes it gets personal: We misplace our keys and assume we're jerks. We forget a person's name and automatically we're stupid.
And sometimes it can get very serious, especially when we don't see life going according to our expectations. Now, single incidents become part of an unending flow that stands for everything that is wrong with the world or ourselves. Here the mind is working overtime, indiscriminately processing outside information and stamping out negative thoughts on a production-line basis.
To give an extreme example:
Say you're a baby boomer and you're stuck in traffic. But now, instead of you thinking that your day is ruined, you see this as a situation that never should have happened in the first place had the bright promise of the sixties been fulfilled. It was all supposed to be love and light and peace, and what happens? Richard Nixon, oil crisis, Ronald Reagan, Republican Congress, and next thing you're midway between your cubicle at work and the soccer game you're supposed to be driving your kids to, and your husband doesn't give a shit, and, well, there's gotta more to life than this ...
Bring on the depression.
In cognitive therapy, your therapist is likely to ask you to recall what you were thinking as you plunged down into your last depression - all those stuck in traffic thoughts, if you like - and work with you in recognizing them and nipping them in the bud before they can cause future damage.
In essence, you are being asked to become a detached observer of your own nearly automatic worst thoughts. Once you've established breathing room, you can turn these thoughts around and substitute new ones. To stick with the stuck in traffic example, the car can become your peaceful inner sanctum rather than your personal torture chamber. And how does it FEEL being in your inner private sanctum? A hell of a lot better than your personal torture chamber, thank you very much, which is precisely the point of the whole cognitive therapy exercise.
But does it work? At ground zero in the teeth of a force nine depression - perhaps not. As a tool for long-term recovery, almost certainly, not to mention as an early warning system against future depressions. For more moderate forms of depression it may be a preferred option to drugs. And as a safety net for "Prozac poop-out" and other drug complications, it's a virtual necessity. Perhaps its greatest asset is an unintended one: the simple knowledge that we are not helpless bystanders, that in the unending battle for control of our own brains there is still an "I" that can put up a fight. And where there is "I" there is hope.
