Authors: Bill O'Hanlon
Out of the Blue: Six Non-Medication Ways to Relieve Depression (Norton Professional Books)
OUT OF
THE BLUE
Six Non-Medication Ways
to Relieve Depression
BILL O’HANLON
W. W. Norton & Company
New York • London
A Norton Professional Book
To Helen, who invites me into the blue of the sea,
and who showed up at another crucial time in my
life when I was discouraged and had lost some of
my faith in a future with possibilities. Now it’s blue
skies, nothing but blue skies, with you.
To anyone who reads this who is in the depths of
depression: Let me reassure your soul that there is
a way out. As the old saying goes, when you get to
the end of your rope, tie a knot in it and hang on
for dear life.
CONTENTS
1:
Out of the Blue: An Introduction to New Approaches to Relieving Depression
2:
Strategy #1: Marbling Depression With Non-Depression
3:
Strategy #2: Undoing Depression
4:
Strategy #3: Shifting Your Client’s (or Your Own) Relationship With Depression
5:
Strategy #4: Challenging Isolation and Restoring and Strengthening Connections
6:
Strategy #5: A Future With Possibilities
7:
Strategy #6: Restarting Brain Growth
8:
Send-Off and Future Directions for Non-Medication Approaches to Relieving Depression
OUT OF THE BLUE
Out of the Blue: An Introduction to New Approaches to Relieving Depression
This chapter makes the case that emerging understandings of the brain and new clinical developments have led to effective alternatives to standard drug treatments and cognitive approaches to treating depression. A brief listing and overview of the six strategies is included here.
WHY I WROTE THIS BOOK
I suffered a serious depression when I was a young man, in my late teens.
Before a friend found out and talked me out of it, I was considering suicide.
And I was far from alone. Depression is one of the most common issues psychotherapists and psychiatrists (and, I suspect, priests, ministers, family doctors, and internists) see in their work.
The past forty years have seen the development of medications that seem helpful to many, although there is some controversy about how well these drugs work and whether the growing belief that depression is primarily a biological/brain disease has increased the placebo effect of giving medications. Putting aside the issue of whether there is incontrovertible scientific evidence of the effectiveness of antidepressants, suffice it to say that many people are on them and find them beneficial.
But anyone in practice dealing with depression knows that the existing medications don’t work for everyone, and even for those for whom it does make a significant difference, there are all too often unwelcome side effects. This price is sometimes hard to pay, especially when the medications provide only partial relief or short-lived help.
Since coming out of my depression and working with others over the past forty years as a therapist, therapy teacher, and supervisor, I have discovered—through research and experience—methods for relieving depression that are not part of the mainstream of psychotherapy or psychiatric practice. By standard treatments, I mean mainly medication and cognitive behavioral treatment, a talk therapy method that helps people challenge unhelpful thoughts and beliefs and gets them to try new behaviors.
I thought this book would be a good place to spell out these innovative new approaches in order to make them more available to practitioners, to people suffering from depression, and to those who love and care for people suffering from depression. If your current approach to helping people is working, there is no need for these alternate approaches, but if even one person isn’t being fully helped by what you or others are providing, these strategies may be just the thing to make a difference.
When I was depressed, I never thought I would be happy again or find meaning in my life. All these years later, I live a happy, meaningful life, and this has made me optimistic that people can both come out of and prevent serious depression and find their way back to a meaningful life. I inadvertently used several of the strategies outlined in this book to recover from my own depression. I say “inadvertently” because I hadn’t yet articulated them and because I wasn’t yet a therapist and hadn’t gotten the chance to try them with others.
I don’t mean to minimize the severity of depression in offering these possibilities. Not only am I well aware of the depths of despair that can accompany depression from my own experience with it, but through the years I have treated many people who were struggling and consulted on countless other cases when supervising or teaching other therapists.
At the same time, I am convinced that there is help and hope, and I want this book to provide tools and hope to those who need it.
WHAT IS DEPRESSION?
I won’t spend much time on defining depression—this is a book about relieving depression, and I think almost everyone these days has some awareness of the contours of depression. But just to make sure we’re on the same page, let’s start with the official psychiatric diagnostic criteria for major depression, or major depressive disorder, from the last published diagnostic manual, the DSM-5 (American Psychiatric Association, 2013, pp. 94–95). Five of the following nine diagnostic signs must be present for two weeks for someone to receive this diagnosis.
•
Depressed mood most of the day, nearly every day
•
Diminished interest or pleasure in all, or almost all activities
•
Weight gain, or loss of or significant change in appetite
•
Insomnia or hypersomnia
•
Psychomotor agitation or retardation nearly every day, observable by others
•
Fatigue or loss of energy
•
Feelings of worthlessness or excessive or inappropriate guilt
•
Diminished ability to think or concentrate, or indecisiveness
•
Recurrent thoughts of death, or suicidal ideation or attempted suicide
In the latest revision of the DSM, the previously disputed criterion of a grief reaction lasting more than two months was removed from the list, since many grief specialists have observed that bereavement often lasts longer than two months. The main idea is for the clinician to distinguish grief responses from major depression triggered by a grief situation (Horwitz & Wakefield, 2007).
This list of symptoms, created by a committee, is not the definitive word on what depression is, and it will likely change in future editions and revisions of this manual. It is by no means scientific—it is a compromise voted on and approved by a group of psychiatrists, some of whom have been supported by pharmaceutical companies and biased by their training and the hands that feed them.
Depression can be devastating for those who experience it as well as costly for their loved ones and society. Economists estimate that, in the United States, depression costs us $43 billion every year. While we would do well to be skeptical of hard and fast numbers and percentages when it comes to depression, the World Health Organization (2011) estimates that depression affects 121 million people worldwide. In 2000, depression was the leading cause of disability and the fourth leading contributor to the global burden of disease. Depression is currently the second leading cause of disability for people between the ages of fifteen and forty-four, and it is estimated that fewer than 25 percent of those affected have access to effective treatments (World Health Organization, 2011). In the United States, an estimated 20.9 million adults (9.5 percent of the U.S. population aged eighteen or older) suffer from a mood disorder, and more than two-thirds of them (14.8 million U.S. adults) have major depression. Depressive disorders often co-occur with anxiety disorders (National Institute of Mental Health, 2011).
But beyond all those statistics, knowing the toll that depression exacts in personal suffering, and much too often in suicide, is what should move us to find anything that has the potential to assist even one more person who hasn’t yet been helped.
Abraham Lincoln, who suffered from what was called melancholy back in his day, described his depression thus in a letter to a friend:
I am now the most miserable man living. If what I feel were equally distributed to the whole human family, there would not be one cheerful face on the earth. Whether I shall ever be better I cannot tell; I awfully forbode I shall not. To remain as I am is impossible; I must die or be better, it appears to me. (Shenk, 2005, p. 62)
It is difficult for those who haven’t suffered a serious episode of depression to comprehend the soul-sucking force of it, but Lincoln’s statement comes pretty close to giving a sense of what it’s like:
If what I feel were equally distributed to the whole human family, there would not be one cheerful face on the earth.
Emily Dickinson called her depression “a funeral in my brain” (Dickinson, 1983, p. 317). William Styron mentioned “gloom crowding in on me, a sense of dread and alienation, and above all, stifling anxiety” (2008, pp. 25–26). William James, another famous sufferer of recurrent depressions, wrote, “It is a positive and active anguish, a sort of psychological neuralgia wholly unknown to normal life” (1961, p. 114).
Andrew Solomon, who after experiencing his own deep depression traveled around the world researching how different cultures thought about and dealt with depression, described it this way:
I began to feel increasingly sad and then I began to feel increasingly numb. Things began to become more effortful. I began to have this feeling of dread and anxiety. I would think “I have to get dressed. I have to put on clothes. I have to put on
both
socks . . . and both shoes.”
Until finally I felt I simply couldn’t do anything. I found myself lying in bed one day thinking: “I can’t put the toothpaste on my toothpaste. I can’t brush all of my teeth.”
I lay there in bed just shaking with fear and feeling no emotion of any kind except that fear and anxiety. I thought, “I have to call somebody,” but I simply couldn’t pick up the telephone and dial. (2001)
Despite these eloquent descriptions, it is difficult for those of us who aren’t so severely depressed to fully comprehend the depths of despair and paralysis that someone experiencing this kind of depression can feel.
I will add just a note here: I will not take up manic depression or bipolar disorder in this book. Although many of the strategies here might be helpful for someone dealing with that issue, it is beyond my expertise.
MYTHS ABOUT DEPRESSION
Myth #1: The Cause of Depression Is Known
Despite the commercials for medications you may see on TV, the cause of depression is not known, and it has not been established as genetic or biochemical. If you are a therapist, you probably know there is substantial uncertainty and debate in this area, even though many of your clients may come in believing the cause is definitely and scientifically known.
Here is what two prominent scientists say on the relationship between genetics and depression:
For most common diseases, specific genes are almost never associated with more than a 20–30% chance of getting sick.
—Bryan Welser CEO of gene discovery company
Perlegen Sciences as quoted in
Wired
,
November 2009, p. 121
The strongest predictor of major depression is still your life experience. There aren’t genes that make you depressed. There are genes that make you vulnerable to depression.
—Kenneth Kendler, MD Professor of Psychiatry
and Genetics at the Medical College of Virginia as
quoted in
Time
, March 2001
It is much the same with biochemistry: Although certain biochemical factors may be associated with depression, they have not clearly been established as the
cause
of depression.