Out of the Blue: Six Non-Medication Ways to Relieve Depression (Norton Professional Books) (20 page)

The first time I visited a country where the cars go on the left side of the road, instead of on the right side as they do in the United States (and where the turn signal is on the opposite side of the steering wheel), I had a great deal of trouble adjusting. We all tend to get grooved in our thinking and our ways of doing things—even our way of speaking. Comedian Steve Martin once joked, “I went to France. Did you know those French have a different word for everything?”

Our “grooves” are fine much of the time, since it makes us more efficient. We don’t have to work out how to open a door or tie our shoes or dial the phone each time we go to do it. But sometimes we get bored when we get too grooved. Or the groove we develop is unhelpful.

I once heard a saying: “The only difference between a rut and a grave is the dimensions.” People who are depressed often fall into pretty deep grooves—ruts. And it takes effort to change the brain. That effort feels unnatural or uncomfortable at first.

I eventually got used to driving on the opposite side of the road and taking different kinds of turns and reaching for the turn signal on the opposite side of the steering wheel, until it became effortless. And that leads us back to the good news: Our brains can change at any time in life.

But it takes new experiences—discomfort at times—and persistence to change the brain and forge new neural connections. And that is precisely what the depressed person needs: new brain cells, new brain connections, change. Getting them to exercise and stretch by seeking out novelty and new stimuli can be healing and give them purchase for climbing out of their depressions. But their brains have gotten into unhelpful ruts, and it will take some effort and discomfort for them to get to those new experiences and get moving. And because depression is often a problem of not just mood, but also motivation, getting your depressed client to both get moving and seek out novelty and new learning is challenging.

However, the research is becoming more and more compelling on this point, as I think this chapter has indicated. I will sometimes use the analogy of driving on the other side of the road with my depressed clients to help them understand that making the effort to exercise and to do something different will likely be difficult and uncomfortable at first, but that eventually it will likely get easier.

I hope you find this material on brain growth as exciting and hopeful as I do. In the next chapter, I will discuss other promising new developments for both healing depression and helping your clients thrive after their depression lifts.

CHAPTER EIGHT

Send-Off and Future Directions for Non-Medication Approaches to Relieving Depression

We’ve covered a lot of territory in the chapters that preceded this final chapter, and I want to both remind you where we’ve been and give you some ideas for what the future of depression treatment might be.

And I want to give you some ideas about post-depression thriving that go beyond mere recovery from depression to using the experience to forge a better, stronger self and future. In this regard, I’d like to take up with a famous depression sufferer, Abraham Lincoln, and show how depression wove itself into the fabric of his life and forged him into the extraordinary leader and complex human being he became.

LESSONS FROM LINCOLN

Lincoln suffered two great losses as a child and young man: the death of his kind and beloved mother from a fever, and the death of a woman he was romantically attracted to from an epidemic that swept through his town.

After the second loss, he became “melancholic,” the term used in Lincoln’s day for depression. He could hardly speak above a whisper, he lost weight, he spent a lot of time wandering in the woods with a gun (he wasn’t a hunter, so his friends feared the worst when he would disappear), and he was often bedridden with severe physical and psychological pain. Finally his friends became so concerned about his suicidal tendencies that they began to take turns keeping him company night and day, as well as removing any sharp knives from his surroundings.

Lincoln recovered from this bought of depression. But there are several things to note about it. One is that he had friends who cared for him and helped him through it. These social connections were crucial in Lincoln’s life. He readily made friends, and those friends were loyal and loved him a great deal.

Lincoln was kind of a contradiction in many ways. He was a loner and he was very social. He would brood and look as if he were the most unhappy man in the world while sitting on his own, but as soon as he interacted with others, he came alive with humor and stories and became the center of attention and the life of the party. After his eyes and laugh and warmth had lit up the room, he would wander off and sit by himself in a corner, and a friend reported that he would shift instantly to a deep gloom and rumination. He “contained multitudes,” to quote Walt Whitman, and some of those “multiple” aspects of him were gloom and light-heartedness and humor.

He could be self-deprecating. One time a heckler accused him of being two-faced. Lincoln, who was quite odd looking, retorted, “Sir, if I were two-faced, do you think I would be wearing this one?” and thus disarmed and won over his critic. At the same time, he was self-confident enough to run for president and to override inept generals under his command during the Civil War. He was fatalistic, often remarking that our lives are determined by fate, and at the same time he was quite optimistic about being able to better himself and do something to affect the course of events.

This dual aspect of his character became one of his strengths. Lincoln knew darkness and suffering well, since he lived with it almost all the time. And he knew happiness and love as well.

He developed a second deep depression and again was brought through it by friends. He told one of his friends that he would be quite willing and happy to die, but that he hadn’t really done anything to make the world a better place and to make his life worthwhile and memorable, so he wouldn’t let himself take that path of self-destruction.

This will to become significant ultimately led him into politics and to opposing the expansion of slavery in the United States. This and his ability to forge social connections and speak well led to his being elected president. The ability to survive terrible suffering made him exactly the right person to lead the nation when strength was needed. His inclusive, dual nature helped create the possibility for healing of the rift between the inflamed, passionate, opposing sides.

After reading a lot about Lincoln’s life, I have come to the conclusion that perhaps no other leader could have brought the United States through the Civil War and out the other side. Others would perhaps have not been strong enough to bear the weight of the terrible decisions that needed to be made, to stay the course through the terrible suffering and loss on both sides of the conflict, and to forgo the temptation to utterly destroy the losing side, as he was advised by many to do.

Lincoln’s depression, with which he ultimately somehow came to terms (he never again suffered a serious, debilitating depression after those first two) made him the man he was. It made him a great man, a man of compassion and kindness, a strong man, and a man who could see and appreciate both sides of any situation.

I mention this because, all too often, we only think about the devastating aspects of depression and don’t fully appreciate the possibilities of what I will call post-depression thriving.

POST-DEPRESSION THRIVING

What makes the difference between depression that merely wounds and leaves behind a fear of recurrence in its wake, and depression that leads to a better life after it goes?

I have done some thinking about this, since I have developed a better life post-depression and have worked with clients who have done the same. I have also read about or heard interviews with people who derived meaning and purpose in their lives as a direct result of having gone through depression. Abraham Lincoln’s life offers a few of these lessons, but is there a set of principles that can make it more likely that people will come through and beyond depression to a better life?

I have put my ideas about what helps people go beyond recovery to post-depression thriving into three categories that I call the Three Cs of Post-Depression Thriving. They are:

1.
Connection

2.
Compassion

3.
Contribution

Let me detail what I mean by each of these categories and how they make a difference in one direction or another.

Connection

If someone comes out of depression more connected to himself, to another, or to some bigger meaning and purpose beyond himself, then that connection is likely to lead to post-depression thriving. If, instead, he becomes more disconnected from himself, others, and the sense that life has a bigger purpose and meaning, he is more likely to suffer post-depression fear, stress, and trauma.

Here’s how Andrew Solomon, author of
The Noonday Demon
, put it in an interview:

There are . . . people who have got (depressive) symptoms that are unbelievably extreme and that are almost intolerably painful but who somehow in between episodes and around episodes manage to nonetheless have lives in which they really connect to other people and lives in which they themselves see considerable value.

I think it is very important for people who experience depression to spend the time when they’re in depression thinking [about] what complexity life has to offer, and when they begin to come out, to try to grab on to things that will offer some meaning in their lives. (Solomon, 2001)

Compassion

Another factor in determining whether or not depression ends up helping the person have a better life afterward is compassion. Does the sufferer develop more compassion for himself and others in the aftermath of his depression or not? If the depressive episode leads to more compassion, it will likely make the person’s post-depression life better; if not, it will lead to more pain and discomfort.

Remember what Andrew Solomon said when he was asked what had changed in him after his depressive episodes: “I feel like I became a kinder person because of the depression that I’d been through. I became more empathetic.”

If the depressed person can apply this compassion, this kindness, this softening to himself, all the better. Depressed people can be very hard on themselves, and if, in the wake of depression, they can be a little kinder to themselves, a little less harsh, and not so judgmental, their lives will probably improve as a result of the suffering they went through. Psychologist Ken Pargament found through his research that people who were unable to forgive themselves tended to be more callous toward others and were more likely to suffer depression and anxiety (McCullough, Pargament, & Thoresen, 2000).

I like to use the word
softening
for compassion. Sometimes we get hardened to the suffering of others or to our own human frailties. We judge others or ourselves unforgivingly. If we let it, depression can soften us up and free us from our self-righteous and punitive views.

Contribution

The last of the post-depression thriving elements is contribution. By this I mean taking one’s depressive experience, learnings, and compassion and applying them in the world to relieve or prevent the suffering of others.

It might be that the depressed client is moved to right some social injustice, such as racism, homophobia, poverty, hunger, or animal maltreatment. (I mentioned this in Chapter 5 under the rubric of Mitzvah Therapy.) Or his goal may be directly related to alleviating or preventing depression. He might decide to start a depression awareness and education effort. He might decide to work in brain science to discover more about preventing or successfully treating depression. The point is that if a person can make a meaningful contribution as a result of having gone through depression, he is likely to thrive in his post-depression life.

I mentioned Abraham Lincoln’s decision not to die until he had made a meaningful and memorable contribution. After he recovered from his depressive episodes, he took a trip to the South in which he saw how the slaves suffered under their owners and handlers. Perhaps something in him, remembering his own deep misery, identified with the slaves’ misery, and he resolved to do something to prevent more suffering in this area. This became his cause when he entered national politics, and he played a major role in eliminating legal slavery in the United States.

HOW TO USE THE THREE C
S
OF POST-DEPRESSION THRIVING IN TREATMENT

Obviously, we won’t usually focus on post-depression thriving until the client has come out of the worst of her depression. But there may be times when a therapist might seed these ideas earlier in treatment, weaving them together with some of the other methods discussed in earlier chapters. For example, you might say to a client, “After you come out of this depression, maybe we’ll talk about how this terrible experience might be mined for something that you can use to rebuild your life in a new way.” This uses the Future Pull techniques discussed in Chapter 5 and can also start to shift the client’s relationship to her depression.

Once the person does start to emerge from the depression, I usually begin this investigation by explicitly asking her about changes in the areas of connection to herself, others, and the bigger meanings in her life, as well as whether she has noticed any changes in the realm of self-compassion or compassion toward others. Later, when she has recovered more fully, I explore whether she is moved to do anything to contribute to others or the conditions in the world as a result of having passed through such a life-changing and tough experience.

More often than not, clients report experiences and intentions in all three of these areas (connection, compassion, and contribution), but if they don’t, there is no problem. They may simply prefer to forget the whole thing and move on, assigning the experience to history and not needing to carry any particular thing forward from it. I mention it here because most of us therapists haven’t been trained in how to mine therapy problems as sources of meaning and growth following recovery, and we may be able to make an important contribution to our clients’ lives if we help them make meaning and thrive in the wake of depression.