Waging the Battle Against Depression

The loss of Robin Williams hit me harder than I could have imagined.  Maybe it was because I read that he suffered from depression and that the reports were stating suicide.  Maybe it was because he reminded me of my brother and the impossible loss of him that leaves a haunting remnant which may never quite disappear.  Maybe it was because as a little girl my first all time favorite television show was Mork and Mindy.  Our two Siamese cats were named after that show.  And of course Robin Williams is simply a legend who has been a constant companion for us on screen over decades.  His roles in Dead Poets Society and Good Will Hunting will forever move me.  A young teen who is waging their own battle against depression spoke about Mr. Williams and said simply to me, “If only he could have held on for 5 more minutes and made another choice, things might have changed by tomorrow”. 

I realize no one gets out of this life alive, and I realize that the loss of any life by any means can feel so utterly tragic.  Yet upon hearing this today, I feel the need to speak out to the tragedy of depression and suicide.  This is about more than the loss of a celebrity.  In my profession, I watch people wage a brave battle against mental illness everyday... old, young, rich, poor, known, unknown.  It is very real and still very stigmatized.   According to the World Health Organization, “depression is the leading cause of disability and the 4^th leading contributor to the global burden of disease in 2000.  By the year 2020, depression is projected to reach 2^nd place in the ranking of DALY’s (disability adjusted life years, which are measures of overall disease burden, defined as the years lost due to ill health, disability or early death)”.  Approximately 16% of the population is estimated to be affected by major depression, and an additional 1% is affected by bipolar disorder.  And those who suffer from depression live in a darkness that few who have not been there can possibly understand.   Symptoms of depression can include feelings of worthlessness and guilt, hopelessness, long periods of sadness, feelings of emptiness, irritability, changes in sleep or appetite, loss of energy, loss of interest in pleasurable activities, thoughts of suicide, difficulty concentrating, problems with memory, and unexplained physical problems such as back pain or head aches.   Depression symptoms have a major impact on life functioning and can also manifest on many different spectrums.  Certain specifiers for types of depression include: anxious distress, mixed features (simultaneous depression and mania), melancholic features, atypical features, psychotic features, catatonia, peripartum onset (related to pregnancy), and seasonal patterns.  Symptoms may also manifest differently in children and teens and in the geriatric population, and differently in men and women.  Depression can also co-occur with other mental health conditions.   And no matter what your background, your race, your SES, depression does not discriminate

In my work as a therapist and in my collaboration with To Write Love on Her Arms – a nonprofit movement dedicated to presenting hope and finding help for people struggling with depression, addiction, self-injury and suicide, we are dedicated to removing the stigma of mental illness and addiction.  I was recently revisiting a radio show I did in 2011.  The host questioned how people could lay in bed for 2 weeks, why can’t they just get up?  He was questioning the governance of our own lives and how we have become so resigned to handing our lives over to therapists and medications?   

Well, imagine this.  The feeling of weights on your chest, ropes around your limbs, restricted breath, heavy air, a bowling ball in your stomach, pain in your body and heart and breath, all smothering you to the point of an endless exhaustion.  Imagine walking out into the brightness of day and feeling blinded and blank and dead, unable to connect to the aliveness in the communities we share, feeling plastic and disconnected.  Your mind tells you to get up, to get happy, to get help, to get better.  But nothing in your body or mind can connect to it or activate.  Sometimes it is numbness.  Sometimes it is a pervasive feeling of dread and debilitating anxiety.  Sometimes it is an endless ocean of tears.  And sometimes all of the above.   You are not supposed to just get over it, and you are not supposed to travel this road alone.  You are not crazy.  It is ok to need help, and there is great courage in asking for help.

The helplessness and hopelessness that often accompany major depressive episodes are symptoms, and sometimes they are contributing factors in the case where someone may have experienced trauma or/and abuse in their lives to the point where they have internalized a sense of worthlessness or helplessness, as their experience likely dictated to them.  Sometimes these environmental experiences trigger genetic vulnerabilities.  Sometimes genetic vulnerabilities are expressed with no environmental trigger.  There are also extensive neurobiological explanations as to the etiology of depression that point to disruptions in the neurotransmitters serotonin, norepinephrine and dopamine. 

Individuals suffering with significant depression or mood disorders that can lead to suicidality are not crazy.  They are often all too sane and are resorting to the consideration of suicide in a desperate, last ditch effort to seek relief in order to deal with their immeasurable pain.   They need help.  They need understanding.  They need to know suicide is a permanent solution to a temporary problem and that there is hope and there are other solutions.   They need to know that if they can hold on just a beat longer, something can change.   Many of these individuals will benefit significantly from seeking out therapy and a medication consult with a psychiatrist.  In some cases medications may not be needed, but in many cases they are life saving in conjunction with talk therapy.   Along with this treatment, many life changes are recommended along a biological-psychological-social-spiritual-nutritional-fitness continuum.   And for many, this is a lifelong battle.  Even with therapy and medication or/and other holistic methods of mood management, depressive episodes can manifest periodically throughout one’s life.  The goal of therapy is often to assist the individual in mindfully observing themselves and being able to identify changes in their life and mood.  This then helps them to reach out for support and make the changes they need to get in front of and manage a depressive episode, and to know that it is temporary and that it does not define them.  Cognitive, behavioral and narrative coping methods are also often taught throughout the individual’s therapy, as well as assisting them in healing from any childhood trauma they may have experienced. 

In closing, here are some quotes that paint a powerful picture from individuals who have suffered from this debilitating illness.   (Names held for anonymity).

“I was a stripped electrical wire and my life was a raging ocean.   I think I died.  I think I am a shell of my old self.  I feel like a refugee.  I feel like a battlefield survivor that just doesn’t know how to make it in this society, in the everyday flow and hum and buzz.  The flow drowns me, the buzz floods me, the hum agitates me.  I am separate.  I am an observer.  I am broken.  I am meant to be more.” – Anonymous

“I’ve seen the line between sanity and madness, and it’s not a thin line.  It’s an invisible fault line.  I’ve seen it in others, and within myself.  I know the madness within me is only one or two choices away, for many of us.  My depression can try to take me to depths of darkness where the world feels like one of Sylvia Plath’s final poems.  Mechanical, emotional, raw, shameful, crude, distorted. It drives me down to the recesses of hell.  The pain is in my body; my head throbs, my heart aches, I want to scream, I want to cry, I shake.  But it’s just another day.  The sun is out, yet today it blinds me, my eyes never adjusting. The air is heavy on my skin, the oxygen thick, the air never cold enough, sleep never long or restful enough. But everyone else is going on with their day. It’s just a day…why have I changed?  I have to push through mud, pull the corners of my lips against gravity into a smile; I have to remind my heart to beat.    These feelings - I have to see them and name them.  And I have to ride them out.  And then I am aware I know so much, have seen so much, I sometimes feel so sane, that the sanity gets to be too much.  I yearn for the luxury of brokenness again, of losing myself into the false promise of suicide’s relief.  Then I remember the flip side.  And I remember that relief and freedom and bliss are in showing up and walking right through the pain and the fear.  I have to keep going.  And I do.  I keep going, and I am bigger than the depression, than the madness.  It speaks to me and I choose whether I listen and how I respond.  I fight to build the muscle of my happiness, and some days are easier than others.” - Anonymous

To all of you out there struggling with depression or suicidal thoughts, this is not the end of your story.  There is hope.  Your life can be beautiful.  You are needed and you are loved.  In many ways we are all weird, beautiful, broken, extraordinary human beings, no matter what our path.  You are not alone.  

Please reach out to a teacher, a pastor, a parent, a friend, a therapist.  Resources can be found in your area via the following links:

This link will take you to mental health and substance abuse treatment resources. It also provides a link to the suicide prevention lifeline. http://findtreatment.samhsa.gov/

You can also search www.psychologytoday.com to locate a therapist in your area.

 If you are in an immediate life-threatening crisis, please call 911.

REST IN PEACE ROBIN WILLIAMS

References

World Health Organization (www.who.int)

Mayo Clinic (www.mayoclinic.org)

To Write Love On Her Arms (www.twloha.com)

The Power of Validation: PART II: The Communication Ingredients

In relationships there are several key things you can do to maintain a sense of wholeness through healthy communication, self and other validation, and setting flexible boundaries. 

1.        Even when you disagree with your partner, consider, acknowledge and validate their experience, their point of view, their feelings.  Not only will this empower you, it can lead to more open communication.  When your partner feels heard, they will feel less defensive, and thereby likely more open to hearing your experience.   

2.       Respond versus react.  Reactivity is impulse and emotion fueled.  It is setting you up for a fight, a power struggle, a threat-based exchange of attack and defense.  If you are feeling angry or upset, take a moment, take a time out.  Pause, breathe, center.  Consider the exchange that just occurred and inform yourself of some things that may be going on for you and your partner.  When you are ready for a responsive versus reactive dialogue, come back and begin with ‘I statements’ of what you are feeling and what you are needing.  Allow the other person to respond without interrupting.  If you reach a stale mate, walk away with the agreement to revisit this later.

3.    Check your perception.  It’s easy to jump to wrong conclusions and make up your own accounts and narratives for which when you check you may just have no evidence.  Be willing to consider another point of view and tell yourself something new and different.  Be willing to let go of what you think you know.  There is strength in vulnerability and it may help you be more open and accessible to the other person.

4.       Consider your reactivity.  What are you reacting to?  Own your ‘stuff’.   When you react, are you being triggered by your fears and insecurities?  If so, you may end up projecting these onto situations where they do not belong.  In doing so, you will often create a self-fulfilling prophecy.  Be aware that you are not reacting based on old negative self-beliefs and self-schemas, or out of personal traumas, fear of rejection, losing control, self-doubt or unwillingness to be wrong. 

5.       It is not all about you, so don’t take it personally.  Remember that each of us has a history, a story, a framework through which we view our lives and others.  Imagine being in the other person’s shoes, consider their story, their intention, and then sometimes the content of what they are saying becomes less important and the emotion and need become more clear.  Be careful not to personalize their ‘stuff’. 

6.       Engage compassion.   This is important at any time, but especially in moments of anger or fear.  If you’re feeling stuck or paralyzed, be kind to yourself and to others.  Being of service to someone or something else may just get you out of your own way for a moment, and open up some new doors for you.

7.       Be willing to be wrong.  There is power in this.  If you’re one of those people who always need to have the last word, or who can’t be wrong, try a little contrary action.   Resist the urge to respond.  Resist the urge to prove a point.  Ask someone else more about their point of view.  Get interested in what they have to say, whether you agree with it or not.  The interest may just be reciprocated.

8.      It can be very empowering to let go of needing to control others’ perceptions of you – no matter what they are.  Own who you are and how you feel.  You can’t control anyone else, only yourself.  And even if you’re a super hero, not everyone’s gonna like you.  Let it go.

9.       Nurture yourself.  If you are only other-focused, you will be running on empty and symptoms of imbalance and ‘dis-ease’ are likely to come up sooner or later.  Fill yourself up and you will have more to give.  Empower yourself and you will empower others. 

10.   Don’t lose yourself to relationships.  You are not just your job, you are not just your hobbies, and you are not just the role you take on in your relationships.  You are a sum of your parts, embrace them all, nurture and value them all.  You cannot expect others to give you what you do not give yourself. 

      

11.    Address codependency.   Codependency is chronic self-neglect.   Do you need someone else to be ok with you in order for you to be ok with you?  Do you need to please, care take or receive validation and praise to feel good and to know who you are?  Can you say no?  Do you live, breathe and feel through other’s experiences and needs?  Do you give up too much for another person or try to control someone else’s feelings and choices?  Do you fear rejection, loss of control?   If any of these things are true, it is time to let go and start getting to know your authentic self, who you really are outside of your fears and what you have learned.  You will need to challenge each of your beliefs and begin telling yourself a new story.   It will be uncomfortable, but hey, that’s where the change happens.12.    In communications ~ Be honest.  Be clear.  Be consistent.  Clarify, don’t guess.  Be direct.  Ask for what you need. Be assertive (not aggressive).  Leave the past in the past.  Avoid aggressive arguing, defending, judging or blaming. 

13.    There is opportunity in crisis.  If a difficult person or situation enters your life, perhaps that is life saying I want you to learn how to deal with this.  We often repeat old patterns and they keep showing up over and over.  The next time an old pattern presents itself, recognize it and begin to engage contrary action.  Love yourself enough to do something different – you will grow through the discomfort.  There is a lesson to be gained, and in gaining it there can be relief from suffering.  Moving through what consumes us, versus avoiding or self-medicating or repressing, can bring liberation and enlightenment. 

14.    Learn to embrace the differences between you and others.  Celebrate your uniqueness.  Know that conflict is a part of life and trust that you can hold onto yourself and be ok. 

15.    And as I mentioned in my prior piece…  Get conscious.  Get intentional.  Shut off your auto pilot and be deliberate.  Listen to your inner voice, that inner dialogue.  Make sure it’s yours, make sure it’s accountable, and make sure it’s kind. 

The Power of Validation

On Oprah’s final show, she made the following statement: “I’ve talked to nearly 30,000 people on this show, and all 30,000 had one thing in common: They all wanted vali­dation. If I could reach through this tele­vision and sit on your sofa or sit on a stool in your kitchen right now, I would tell you that every single person you will ever meet shares that common desire. They want to know: ‘Do you see me? Do you hear me? Does what I say mean anything to you?’

Back in my graduate school days and a painstaking 215 page dissertation later, I lived and breathed this topic.  I researched the effects of chronic invalidation of emotional experiences in childhood and it’s relation to later emotional dysregulation, impulsivity and self-harming behaviors in adulthood.   How can being invalidated, unheard, misunderstood, subtly dismissed, and criticized be so harmful, as compared to verbal, physical and sexual abuse?   Because as a child, we are not born knowing what we feel.  We do not know that sad is sad and happy is happy.  We have not yet developed a sense of self.  We internalize that of what we see and experience.  We learn from the parents or primary caregivers in our life, and then also from our social environment.  If someone told you your entire life that the blue sky is red, you would think that everyone telling you it was blue was wrong…and crazy.  Your blue is red, that’s just the way it’s been.

Our attachment process begins with the parent’s gaze we hope we have to connect to as infants, the reflection of a smile, of a frown, of surprise, of concern.  When parents or caregivers reflect what we feel as little ones, we learn to identify it, understand it, feel safe with it.  Then with the learning of language we give words to the weather of our internal landscapes, and we learn if our landscapes are ok.  Therein can begin a long blissful summer or a relentless winter machine.  When parents can tolerate and contain the emotions of their little ones, they are given a greater chance of then learning how to tolerate and regulate their own internal worlds as they develop and grow up in a chaotic world.  When our feelings in childhood are not met with attunement and validation but rather they are chronically punished or invalidated, it is like telling water it isn’t wet, or sky it isn't blue.  It is telling someone that their private, innermost experience is wrong.  A young person does not yet have the tools to differentiate and say, “Wait a second, I’m ok, what I’m feeling is ok, this is clearly about them”.  A child in an abusive home does not have the ability to say, “Hey guys, I’m not taking this abuse, so I’m gonna be moving out and paying rent down the street”.  Children manifest resilient defenses and coping mechanisms to deal with whatever environment in which they find themselves, though these systems often backfire in adulthood.  And with chronic emotional invalidation, their internal world begins to get distorted, and their emotional landscape may begin to look more like a fun house of mirrors that no longer reflects themselves as they truly are.

With the transition and individuation into adolescence and adulthood, if we have received a pretty decent amount of emotional reflection and validation along with some boundaries for our behaviors and a secure attachment base from which to explore the world, we are likely more equipped to develop a whole and regulated sense of self; a sense of self where as adults we will be greater able to self-validate and not depend on those outside of us to validate our experiences as we depended on as infants.  We are more likely to feel differentiated and secure and recognize our capabilities as adults, versus connecting with the helplessness we embodied as infants.  We may develop a greater ability to be okay with ourselves when someone else isn’t okay with us, without having to control others or make them feel something else in order for us to feel something else.  That said, I must add a brief aside here and acknowledge that a child’s genetic temperament and resilience can also be a significant factor in how the dynamics of a family play out and take effect.  There is no perfect parent, parenting book, nor is there only one reason or cause as to why we turn out how we do.  The interplay of nature versus nurture is ever present. 

Once we navigate the sometimes treacherous and often idealized, longed for launch into adulthood, is it then wrong to seek validation?  Not at all.  As Oprah stated, it is the common thread the majority of us share.  The difference is that we cannot depend on it to be ok.  If you experienced trauma growing up, if you feel empty or like you know nothing in your life but wells that are dry, you have got to learn how to find places that are full, you have got to learn to fill yourself up.  Without this, you are creating a life of potential anxiety as it depends on all that is external to you to bring you buckets of water.  We cannot control others and we cannot expect others to be responsible for navigating our own internal territory.  Continuing to blame the past for our current circumstances can create stuckness and resentment.  We are no longer that helpless child in those same circumstances. We can choose to do the healing work, to begin expressing, releasing, repairing, forgiving.  We can re-learn new and adaptive ways of coping.  We can ask for what we need and we can share our feelings, but how we cope with what we get is up to us.  We are responsible for the choices we make.  When we base our selves and our experiences on others, we run the risk of becoming enmeshed, and enmeshment sometimes gets mistaken for love.   Enmeshment equals wherever you go, I go; whatever happens to you happens to me; whatever I feel you have to feel, or else you don’t care.  This is dangerous and brittle, therefore breakable.  Enmeshment thereby equals reactivity, and when we live in a state of reactivity, we live outside reason. 

So, the task at hand is to learn to differentiate.  That is just a big word for learning how to maintain ourselves in relation to others.  It is how we learn not to depend solely on validation from others. “[Differentiation] is the process by which we become more uniquely ourselves by maintaining ourselves in relationship with those we love” (Schnarch, 1997, p. 51).  In his book, The Passionate Marriage, David Schnarch (1997) states that “differentiation always involves balancing two basic life forces: the drive for individuality and the drive for togetherness” (p. 55).   When we are continually seeking a source to validate our childhood wounds, who we are, our sense of self, we end up fusing with another or desiring an escape from the other; we live through a ‘reflected sense of self’, our identity depending on relationships, leaving us prone to fragmenting when circumstances change in our lives.  “We’ve reduced adults to infants and infants to a frail ghost of their resilience, reduced marriage to providing safety, security, and compensation for childhood disappointments. We remove our essential drives for autonomy and freedom”. (Schnarch, 1997, p. 43).

So as we reach adulthood, our job is to somehow reconcile the tales of our childhood that may have left us wounded; vague reminders of play ground scars and the penetrating whispers of generations.  These attachments, these internalizations are tapes that have to be re-visited and re-recorded, thermostats that have to be re-calibrated, to reflect the capable adults we are in the now, not the wounded child we were then.  Without awareness and attention and action that wounded part of us will continue to seek out what is familiar –even if damaging - in an unconscious effort to meet the needs that were never met.  Healing and the journey into wholeness will permit healthy relationships to grow, as they will be based on the now, not on their residency in the void of your past.   Validate who you are, every beautiful piece, in all of its glorious imperfection.  Validate your existence, your experience, your efforts.  This acknowledgement and affirmation allows for acceptance; it brings accountability, wholeness and authenticity.  It allows a fighting ‘for’, not a fighting ‘against’.  Acceptance in the face of adversity of ‘what is’ allows for change to ‘what can be’.  

In conclusion, I will leave you with this….  

Get conscious.  Get intentional.  Shut off your auto pilot and be deliberate.  Listen to your inner voice, that inner dialogue.  Make sure it’s yours, make sure it’s accountable, and make sure it’s kind. 

-          Georgina K. Smith, Ph.D.

Dr. Smith is a clinical psychologist based in Santa Monica, California.  She specializes in treating trauma, addiction and eating disorders. 

Works Cited

1.      David Schnarch. (1997). Passionate marriage: Keeping love and intimacy alive in committed relationships.