“There are many here among us who feel that life is but a joke.
But you and I, we’ve been through that, and this is not our fate.
So let us not talk falsely now; the hour is getting late.”
Bob Dylan, 1967
This belfry, which sits atop the Chambre de Commerce et d’Industrie in Lille, France, has a certain appeal to me. It has a very strong feel to it, and I love the understated elegance of the gold rim around the clock. Very nice lines. Nice mix of stone and brickwork. Unfortunately, it has a little bit of a smug aura around it, too, but perhaps that is just my subconscious ‘read’ of the French in general. I doubt any self-respecting bats would reside herein. Unless there were free pastries delivered “tous les matins” (every morning)! THAT would be a different story altogether.
I wonder, though, do bats enjoy french pastry?
Moving on, can anyone guess as to why I chose the lyrics from “All Along The Watchtower”, copied above? If you guessed, “probably no reason at all, it’s just a song you like”, then you are VERY close! But, there is a pertinent reason.
When last we met, we talked about depression. We said a lot of very depressing things about depression, and I am anxious to leave that tone behind. I want to think a bit about how someone dealing with or suffering from depression can actually find a way out; how they might find the light at the end of the long, lonely, black tunnel.
So, if a person is mired in depression, no matter the cause, what can be done? As we established, depression is a global disease impacting every area of a person’s life. True, the “hub” of the disease lies in the brain, but everything about us filters its way through the brain in some ways. Now, I decided that I was not going to try to piece together what scientists think they know about the brain and depression. I strongly doubt that it matters much to any of you, or even to me for that matter, whether the left frontal or right frontal lobes are more involved in the symptoms of depression; whether the hippocampus, the limbic system, the right temporal or parietal lobes are involved, or none of those brain regions. I would guess that what matters most is: how can I help others who may find themselves trapped on the inside of depression?
The very first thing to realize and remember is this: it takes a village.
As we’ve said, depression is, by its very nature, a disease that first of all kills off the host’s (that is, the person afflicted by it) ability to do the things that could overcome it. Depression saps one’s energy, motivation, interest, concentration, and decisiveness. Depressed people are literally stuck in the mud, and often cannot even decide IF they ought to call someone for help or not. And if the thought goes through their mind, the negative thinking and belief systems that almost always accompany depression will tell them that no one cares enough about them to help, or that they’ll just end up being a burden, as they may believe they have been to those around them throughout their entire lives! Even when they finally decide they need help, and there might be some obscure soul out there who may be willing and able to help, their energy stores are drained down to the bone, and nothing gets done. And we have not really addressed to any degree those who have what is called, “anxious depression.” Anxiety mixed with depression can often be much worse than the slightly more common “vegetative” type. Folks with serious anxiety on top of their depressed moods, minds, and bodies, are often even more reluctant to reach out to others, fearing those others, or fearing the bodily discomfort and social embarrassment (humiliation?) that will certainly (they tell themselves) result if they actually open up to someone.
The bottom line is that when we encounter someone who is depressed, the very first thing they need is someone who is willing: Willing to give of your time. Willing to listen. Willing to not give them all sorts of advice. Willing, at first, to respect their privacy, but with time to gently nudge them into opening up. Willing to restrain your urge to rush in with 5 different solutions. Willing to just be present until the problem is laid out. Willing to do whatever it takes to “be trustworthy”. Depressives, no matter their flavor, have an extremely hard time trusting others. It’s not out of conceit. It comes from a feeling of having been beaten down, and a strong reluctance to be around anyone they suspect may beat them down even further. So, first establish that you come in peace, and keep establishing that. Then, when once you have won their trust, and heard their story, and given them privacy, the time will then come to softly introduce the thought of going “outside” for help.
Help may start anywhere. If I had strong faith in any of society’s “helping places” out there, I would heartily recommend that place first and foremost. I do not. One thing I do know about our “people-helping infrastructure” is that it is highly individual-dependent. In other words, it depends on the quality of the specific person you will find if you walk in a door or call a phone number, as to whether you will find help there. So, if you know of a pastor or priest who is very serene and understanding of true mental health problems and is willing to help, then take your friend there. If you know that the local mental health treatment center has a good reputation for having kind staff, and good, caring therapists and psychiatrists or psychiatric nurse practitioners, then go there. If your friend has a primary care doctor whom she or he trusts, then start there, and accompany the friend to the appointment. Again, recall that they will have a strong, “built-in” drive NOT to burden others. Unless gently pushed, they might not open up about what they’re going through. Your presence will help. If possible, I would try to find a good person in all three settings. Not just anyone. It might not be possible to find a good, “human” professional in any of those settings (physical health care, mental health care, spiritual care) in your area. But keep trying, please. You might be surprised, as might your friend.
Of course, in my view depression must be addressed on several fronts. Even though I have already stated previously that there is no such thing as a “chemical imbalance” when it comes to depression and other mental illness, it is nevertheless true that the brain is a biological organ, and it may very well be necessary, in order to “jump start” the depressed sufferer, to begin a course of medicine. There are some pretty good and pretty safe medicines, and medicine combinations, nowadays, and they should get better as more and more research is done. But medicine can never be the total solution. If so, there is no solution at all. If a person relies solely on medicine, and does not try to improve the way they think, or their relationship with their Creator, or their social life, or their physical health, then just as one of the quotes at the beginning of my last post stated, as soon as the medicine stops, or stops working, it all goes back to ground zero.
Medicine can, though, BEGIN the process of improving neurons’ functionality, and thus giving a person just a bit of “juice” to get moving forward. It can begin to give a bit of hope. It can help reduce what I call “emotional reactivity” (how and how intensely we react to emotions such as sadness, frustration, fear, anger): angry irritability which often accompanies depression, frequent tearfulness, anxiety, agitation/restlessness, etc. It can lift the overall mood and functioning of a person out of the deeper depths of the pit, and put a ‘floor’ under them so that they won’t sink back down into the darkness, where hopelessness and suicide may lurk. But, medicine can and will never be the full recipe.
Again, help from others is necessary for almost all sufferers in the beginning phases of recovery. To provide a listening ear. To be a voice of unconditional acceptance to them. To support, share some humor, to be a companion, even if it’s just for a few minutes or an hour every week or two. Once you or a helping professional establishes rapport and trust, and once the person’s energy and motivation is lifted off the dungeon floor a few feet, then perhaps they can begin to look at the “action steps” that they will need to consider in order to reach full recovery. They will need to consider some kind of exercise program. Doesn’t have to be like training for the Olympics. Doesn’t have to be P90X, MMA, or Zumba. Walking is great. And if walking is not possible due to physical health limitations, then some kind of stretching routine, or a very simplified yoga format can be very helpful. Research studies have shown, though, that regular exercise can be as effective in depression as any single medicine or psychotherapy. [ http://www.psychosomaticmedicine.org/content/69/7/587.abstract ]; [ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC474733/ ] Put them all together, though, and it gets much, much better.
In tandem with exercise is sleep, hygiene, and nutrition. In short, good self-care. Now here’s the rub: most persons with depression have a lot of self-loathing, or at the least, apathy about themselves. It is extremely difficult to help such folks to expend the energy it takes to form new, better habits of daily routine … but it’s important, and it feels good once those habits start to develop.
When you first introduce these topics to a depressed person, you’ll usually get either mild agreement (the needle will barely move a notch or two, but it still moves) or a blank stare. If you were to peel off the surface shell, though, you’d likely see that this is when they start to recoil at this concept of ‘self-care’. One of their false beliefs often is that their purpose in life is to tend to the needs of all others around them first, and then … that’s it. Nothing for them. They were often brought up to believe that their greatest satisfaction in life ought to be to make everyone else around them happy. Period. What a sham. Now, it’s important to emphasize that self-care is NOT about being selfish or self-centered. It’s about taking care of themselves so that they can be better able to do those things that they were TRULY purposed to do in life … to be children of God. To care for others as others care for them. To give and to receive. To wallow in the joyful grace of our Maker.
Beyond exercise and physical self-care, there is therapy, also known as psychotherapy. This is the process whereby a trained professional helps another person to change some things about themselves. These things are typically the way that person feels, thinks, chooses, and acts. The best forms (among many) for depression are cognitive, or cognitive-behavioral, therapy, and supportive therapy. In my way of thinking, cognitive therapy is the best out there, but with supportive features built in. This is the type of therapy aimed at identifying the negative, counter-productive, and just plain false, ways of thinking, beliefs, and self-talk that all of us engage in at one time or another. The vast majority of us practice false thinking and negative self-talk most of the time. But, we are either not aware of it, or too comfortable to change. However, depression is sort of the end result of such mental patterns, and in order for a person to recover they simply must also look at at least a few of their negative belief patterns. I hope to devote a future post to cognitive therapy and false thinking, but I warn you: whole books have been written about the subject; I shan’t be doing that! Just the highlights, I promise!
There are many other treatments available for depression now: meditation and mindfulness training, acupuncture, bright light therapy (especially during the fall and winter months for those afflicted with seasonal depression), and the newest form: transcranial magnetic stimulation. For those especially severely depressed, to the point of almost total shutdown, there is also a surgical treatment called deep brain stimulation, and the modern version of electroshock therapy: electroconvulsive therapy (ECT). All of these treatments have been helpful to at least a few folks out there, so they are “on the table”.
To review then, as stated above, recovering from depression is a process, a journey, and the “dump truck” method (starting 3 or 4 modalities all at once) will not work. You’ll lose them. Start quietly, where they are, with two ears and eyes open, and mouth almost completely shut. Listen. Keep secrets. Accept. Be trustworthy. As trust comes, then introduce the idea of going outward to seek help from professional sources. Depending on how severely depressed they are, medicine may be necessary up front to give their energy a boost. Once things begin to show some improvement, then the other areas will have a chance for success.
One thing I have long believed, though I’ve not often seen, is that for a person who has major depression to fully recover, they have to find a way to be in your shoes: to give to another what you have given them. To “pay it forward”. There is a concept out there in mental health lore known as the “wounded healer”. I am a strong believer in this power. Basically, this is when someone who has been wounded by pain of some sort – abuse, trauma, serious loss, injustice, oppression, depression, etc. – develops the special ability to connect with others similarly afflicted. This “healer” is therefore gifted; they can identify, connect with, and listen to, others who are also wounded, in ways that you and I perhaps cannot. I believe that those recovering from depression often can have this gift. And if, by some chance, they find a way or an opportunity to help someone else with depression, they come full circle. And the clean, soft, quiet, knowing smile and nod of the head will be all the evidence you’ll need, once you see it.
Craig Meek, M.D.