Out of the Blue: Six Non-Medication Ways to Relieve Depression (Norton Professional Books) (5 page)

A more expanded way of using oxymorons is to spread them apart in a sentence or phrase; this is called the apposition of opposites.

“It’s important to remember to forget certain things and not to forget to remember other things.”

“It seems that you’ve spent so much time in darkness that your eyes have adjusted and can see things in the dark that others can’t.”

“You are hoping against hope that this depression will lift.”

As you can see from the above examples, there can be a place for using oxymorons in therapy to emphasize that it’s okay and even beneficial to have conflicting perceptions and experience opposing ideas.

Including the No With the Yes

Carl Jung once wrote, “One does not become enlightened by imagining figures of light but by making the darkness conscious” (Jung, 1968, p. 265).

One last application of the inclusion of opposites technique is to include the negative with the positive by using tag questions. Tag questions are little questions added on to the end of a statement that seem to say the opposite.

One of my mentors, the late psychiatrist Milton Erickson, once told me, “If you can’t say the ‘no,’ the patient has to say it.” He regularly used these tag questions. Here are some examples:

“You don’t think you’ll get better, do you?”

“You’re not feeling better, are you?”

“You’re starting to feel better, aren’t you?”

If you think of the Asian symbol of the yin yang, you will get this technique. There is a yes in the no and a no in the yes, and they complete each other to make a whole.

The point of this method is to help people become more integrated, including all their aspects, so they feel less fragmented or troubled by the disparate aspects of their experience, feelings, or personalities. Without this integration, clients often feel ashamed or torn in two directions, which can increase their emotional distress and deepen their depression.

Practicing Inclusion of Opposites

Here’s another chance to practice. Cover up my suggested permissive responses below and come up with your own way of responding with permission to this depressed person’s statement.

Depressed person:
I feel like I’m falling through the floor and there’s no bottom. I just keep falling.

Your response:

[Possible responses: “You haven’t found the bottom of the bottom.” “You’re afraid things will get worse without stopping, and you are hoping we will find a way to stop your descent. Is that not right?”]

Exceptions

Very rarely is someone always depressed, or always empty, or always without energy, or always suicidal. If you (or the person you are helping) explores exceptions to the usual problem, feeling, or thought, you can usually find moments when it is not occurring. A lot can be learned from these exceptions that may be helpful in finding relief from the depression, and we’ll get into that more later in the chapter. Here we’re just trying to do some marbling by acknowledging that there are exceptions to the rule of whatever the person is complaining about or isn’t working for him.

For example, he has no energy (except when he does).

Or he can’t get out of bed (except when he does).

He feels bleak, except when he doesn’t.

He never laughs anymore, except when he does.

What I’m pointing out here is that life and people are more complex than we sometimes think or acknowledge. Remembering and recognizing that complexity helps us keep our perspective. Rarely is a situation all one way or all the other. Rarely is a person only one way.

Of course, we have to be very careful with this technique, as it can be invalidating or sound flippant or glib. For example, if the depressed person says, “I can’t get out of bed,” and you respond with, “Yet you got out of bed to get to my office,” it probably won’t have the validating and expanding effect that this technique intends. Rather, this technique mostly involves listening carefully and choosing the right moments and words to highlight the exceptions in a respectful way. I listen for reports of things that have been better or different from the usual problem in the recent past.

For example, if the person says, “I did better the first few days after I came in last week, and then everything just fell apart again,” I ask him what he felt or experienced during those first few days before I ask about what happened when he fell apart. If the depressed person has been adamant about giving up and killing himself and then starts talking about his plans for some future event, this indicates that there are moments when he is thinking about being alive in the future. Acknowledging this exception may merely involve asking more about those future plans.

Here is an example of a client-therapist interaction in which the client talks about his depression but indicates that there’s more to the story than just depression:

Client:
Sometimes I just feel so hopeless. I don’t know if I’ll ever come out of this hole I’m in. Maybe getting this new job will help. My old job just sucked.

Therapist:
When you’re afraid you won’t come out of it, it seems hopeless, but when you think about this new job, you get some sense of hope.

Discover Times of Non-Depression

One specific way to discover and highlight exceptions is to listen for and acknowledge moments of non-depression. Perhaps the person got absorbed in a movie and “forgot himself” for a few hours. Perhaps he spent time with a friend or family member and felt better for a time. Perhaps there was a time in the recent past when, inexplicably, his depression was better for a day, a week, or longer.

What Happens When the Depression Starts to Lift?

Still another way to find exceptions is to find out about what happens when the depression starts to lift that’s different from what happens during the depressive episode. Maybe the person starts to become more social, or listens to music more, or goes out of the house or eats different foods. Of course, one way to find out what happens when the depression starts to lift is to listen for reports of those times, but you can also elicit such reports by asking about them directly.

Here’s an example of such a direct elicitation:

Therapist:
I’m curious. You’ve been through these times of depression before and have come out of them. What happens when you start to emerge from that darkness and begin feeling better?

Why Isn’t It Worse?

One last way to discover exceptions is to investigate why the depression isn’t worse or the person isn’t less functional. This is sort of a backward way of discovering exceptions. For example, you might ask your client, “How have you been able to go to work or visit with friends when some people with depression haven’t been able to do those things?”

Or, “What has stopped you from acting on those suicidal thoughts?”

Or, “Why haven’t you given up on seeking help?”

The answers to these and similar questions can contribute to the marbling experience we’ve been discussing throughout this chapter. Obviously, one has to ask these questions and investigate this area with a great deal of sensitivity. You don’t want to imply that the person needs to be doing worse before he can convince you that he is really suffering or that he has to reach the depths of suffering that others do. Instead, you are trying to awaken in him an appreciation for the times and parts of his life that aren’t so dysfunctional.

Here is an example of the kind of inquiry you might make:

Therapist:
I was a little surprised to hear that you finished that big project at work even though I know you’ve been feeling like hell. If I were talking to someone else who was depressed and had a similar kind of project in front of them, what would I tell them about how you were able to pull that off even though you felt so impaired?

Inclusion Recapped

To recap, since we’ve covered a lot of territory in this section, the three techniques of inclusion are:

1.
Permission (To and Not To)

2.
Inclusion of opposites

3.
Exceptions

DEPRESSION AS A BAD TRANCE

Many years ago I learned hypnosis. Afterward I began to recognize some similarities between a hypnotic trance and what I began to think of as a “symptom trance” or “problem trance.” Both types of trances often involve a narrowing of the focus of attention. And the induction of both involves rhythmic repetition.

I read a book by Hans Eysenck a while ago, and in it he told a story. There was an English medical student, a surgeon just about through with his training, who was drafted into the army during one of the world wars and sent to fight on the fields of France. When a French soldier was severely wounded by a mortar shell, the medical student rushed to his aid. The French soldier was writhing in pain and doing further damage to himself, so much so that he was in imminent danger of dying unless the Englishman could get him to stay still until he could get him back to the surgical tent for treatment.

In desperation, the Englishman remembered a demonstration of hypnosis he had seen during his medical training and decided to try what he remembered of hypnotic induction. But he didn’t know much French, so the best he could do was repeat again and again to the writhing Frenchman the only French words he could conjure up: “Your eyes are closing. Your eyes are closing.”

To his amazement, the Frenchman stopped writhing and his breathing slowed. He appeared to be in a trance that lasted long enough to get him back to the medical tent, where the British surgeons operating there did indeed save his life.

After the operation, the medical student told the British surgeons the story of his hypnosis. They all began laughing and told the baffled student that what he had really said was “Your nostrils are closing. Your nostrils are closing” (Eysenck, 1957).

What I relish about this story is that it was the repetition, not necessarily the correct words, that had the hypnotic effect.

I later came to believe that, in a more sinister way, a similar process happens in depression. The depressed person repeats the same thoughts, activities, feelings, and experiences again and again and begins to become entranced. Only the trance is not a healing trance, a therapeutic trance, but a “depression trance,” which induces more and more depression as it is repeated.

Marbling may go some distance in breaking the depression trance, but in the next chapter, we’ll discuss many more ways to invite the depressed person out of his depression—or, to put it another way, how to wake him up from his bad trance.

CHAPTER THREE

Strategy #2: Undoing Depression

This chapter reconceptualizes depression as a process. With this new conception, we can help people find the parts of their depression over which they have influence.

This perspective draws on recent research showing that the brain gets “grooved” by repetition of experience and action, and that it can shift by changing one’s contexts, actions, thinking, and interactions.

Because people who are depressed tend to think and do the same kinds of things, stay in the same environments, and interact with the same people, this second strategy for relieving depression involves getting them to shake things up by doing things that are incompatible with their depression patterns. This invites them to wake up from their “depression trance.”

This strategy also draws on recent brain science that shows that our brains and nervous systems get “grooved” with repeated thoughts, experiences, and actions. Thus, our goal is to “undo” depression and the depressive brain grooving that gets deeper and deeper the longer the depression persists. Adding new stimulation and experiences can reawaken the numbed brain.

When I was studying with the late Milton Erickson, he told me of working with a patient, James, who was severely depressed and not responding to treatment.

James was spending his time alone at home, and Dr. Erickson suggested that James go to the local public library and be depressed there instead. I wondered what good such a suggestion would do. The patient would still be depressed, just in another location. But it turned out that Dr. Erickson was thinking about this strategy of undoing depression when he offered that intervention.

James dutifully went to the public library each day and was just as depressed as he had been at home, until one day he was a bit bored and asked the librarian where to find materials on exploring caves, an area in which he had some interest.

While James was in the stacks looking at spelunking books and magazines, another library patron asked him, “Do you know anything about cave exploring? I see you looking at those books, and I’ve always wanted to explore caves but have never done so.”

James admitted that he didn’t know anything but shared the man’s interest. After some conversation, they decided they would go together that weekend to explore caves after doing some more research.

James ended up making a new friend and developing a new hobby, and he discovered that his depression began to lift as he become more active and less isolated.

I was astonished after hearing this case example from Dr. Erickson. How had he known that James would meet someone at the library or develop a new hobby?

After studying Dr. Erickson’s thinking and approach to change for some time, I now realize that he didn’t need to know any of that. All he had to do was get James to go to a different location where something new could happen. James and Dr. Erickson already knew well what was likely to happen if James stayed depressed in his house, doing nothing. He would remain depressed. At least at the library, there was the possibility of something new happening, of new input and new interactions. (And, of course, Dr. Erickson never mentioned the other hundred people he must have sent to the library and for whom nothing changed.)

It’s like the twelve-step saying: “If you do the same thing you’ve always done, you’ll get what you’ve always gotten.”

Or the Dakota tribal saying I came across: “When you discover you are riding a dead horse, the best strategy is to dismount.”