Out of the Blue: Six Non-Medication Ways to Relieve Depression (Norton Professional Books) (13 page)

I am suggesting here, as I did in the first chapter of this book, that the causes of depression are complex and that the recent rise in rates of depression is probably partly due to a growing social isolation and breakdown in community in industrialized countries.

When I grew up, I lived in a neighborhood. Now I live in a house and have very little connection with my neighbors.

Persistent social isolation is a stress factor, and chronic stress can be a factor in depression. On the other hand, having social connections and a sense of being in a community are protective factors against developing depression (although, of course, they don’t prevent depression in many cases). According to the U.S. General Social Survey, done yearly at the University of Chicago, people with five or more close friends (excluding family members) are 50 percent more likely to describe themselves as “very happy” than respondents with fewer (Davis, Smith, & Marsden, 2008). Finding potential and current social connections is what this pathway to connection is about.

Where are social connections to be found? In church communities and congregations, in interest groups (live or online), in neighborhoods, in extended family connections, in groups of friends, in support groups and self-help groups such as Alcoholics Anonymous, in musical groups, in volunteer groups, in political groups, and so on.

As I did with the client mentioned above, one way to discover potential connections is to ask the person where and when he has felt connected in the past. If no workable possibilities emerge from this inquiry, it may be time to encourage the person to experiment with finding any group to which he can relate.

Here is a little excerpt from a conversation with a client trying to find connection to a group or community:

Therapist:
Who are your peers?

Client:
Well, I had a group I hung out with in college, but we’ve drifted apart. Some of it was because we all got busy and some of it was me—I was already getting depressed and felt it was a burden to get together with them as a group or individually. It just felt too hard.

Therapist:
Are there any other groups or communities that appeal to you or that you’ve belonged to in the past?

Client:
I’ve been meaning to visit the Quaker meeting in town. I went to a Quaker meeting years ago, and I was so impressed that here was a group that were comfortable sitting in silence. Then every once in a while, someone would speak, and usually what they said was so wise I was blown away. But no one would clap or anything. After the person spoke, everyone would be silent for a time again. I always thought that I would like to explore that more but never have.

Therapist:
How about going to a meeting there this week?

Client:
I think I will. I think that would help me feel less alone.

TRANSPERSONAL CONNECTIONS

What I mean by
transpersonal
is “beyond people.” The first two realms of connections to challenge isolation involve people (or animals). This category of connection goes beyond beings and people. I sometimes refer to this realm as connection to “something beyond” and leave it vague like that.

There are three ways to find transpersonal connections.

Connection Through Nature

This kind of connection involves being in and noticing nature and the physical environment.

How many of us need to spend time in the outdoors every so often or we begin to feel small and disconnected? “I believe in God, only I spell it Nature,” said Frank Lloyd Wright. There is research that shows that being in nature and feeling connected to nature can be healing for people who are depressed (Berman, Jonides, & Kaplan, 2008; Berman et al., 2012; Kaplan, 1995; Ulrich et al., 1991). Of course, there is also some research showing the positive effect of exposure to sunlight for some people who are depressed, so encouraging your clients to spend some time outside in the sunlight, if any is available, could have a double benefit—exposure to nature and amelioration of seasonal affect disorder.

Years ago, some mental hospitals—or asylums, as they were called—were placed on large acreages for patients to wander around in or at least view. There was some thought that fresh air and natural settings were calming and restorative. Jung suggested that people work in a garden as part of their recovery. In the novel
Another Roadside Attraction
, author Tom Robbins wrote, “The further we separate ourselves from the dirt, the further we separate ourselves from ourselves. Alienation is a disease of the unsoiled” (1971, p. 86). There may be something to this, and it may be that connection to nature.

If it is workable, doing therapy in natural settings is worth a try. Another possibility is to have the person recall and relate her most profound memory of being in nature as a way of accessing this connection. Here is a sample conversation that illustrates this concept:

Therapist:
Can you remember a time in nature that was really good for you?

Client:
Yeah, I can. There was this one time, on spring break during college. I went to Mexico with a group of friends. We found this isolated beach and camped there for the week. None of us wore any clothes. The weather was perfect. We swam, talked, sunned, played music, and stared at the stars at night. I just felt at one and at peace.

Therapist:
Can you just close your eyes for a moment and evoke that feeling of being at one and at peace right now, or get any piece of it?

Client:
Yeah, I can. It’s not as intense, but I can feel that sense of being connected to the others, to myself, and to the whole universe.

Therapist:
And does reexperiencing that sense of connection help relieve the depression, even a little?

Client:
Yeah, it does. It does.

Connection Through Art

During my depressive episode, I found playing music helpful, both in connecting with myself and in finding a way to transform my pain. I joked later, when playing music publicly, that the good news about being depressed was that I’d spent countless hours playing the blues in E on my guitar and had gotten much better from those endless hours of practice.

The blues seemed a perfect reflection of my mood. Listening to and emulating the great blues masters helped me feel connected to something beyond my particular pain and circumstances.

Many depressed people, from Virginia Woolf to Hemingway to Diane Arbus to Vincent Van Gogh, have used their art to cope with and, at times, transcend their suffering.

There are two ways to use art for connection: to observe or participate in the art of others to feel less isolated, as I did when I listened to that Essra Mohawk record again and again, and to create art as a means of connecting as the art expresses and reaches out to others. Depending on one’s preferences, this connection may come through literature, painting, sculpture, theater, movies, photography, dance, poetry, or some other form of art.

I ask depressed clients to tell me what piece of art speaks to them, and they almost always, even in the depths of depression, can tell me something that either articulates what they’re feeling or is a source of comfort and connection for them. This may be one of the primary functions of art—to articulate and express the unspeakable or that which is difficult to communicate to others.

I’ve begun to make a list of art that I think articulates depression well, such as Teddy Thompson’s song “I Should Get Up”; James Taylor’s songs “Another Grey Morning,” “The Blues Is Just a Bad Dream,” and “Angry Blues”; and the Beatles’ “I’m So Tired.” Or books such as
Darkness Visible
by William Styron and
The Noonday Demon
by Andrew Solomon. In movies, I particularly like
What Dreams May Come
. My clients seem to appreciate that someone else knows something of what they’re going through, and these songs, books, and movies can bring them the sense that they’re not alone in their suffering. My inclinations tend to run to music and books, but you might create your own list of paintings, photographs, poems, and so forth that would be more natural for you.

I also have some recommendations, when the time is right, for inspirational movies of people who have made it through almost impossible circumstances and out the other side. These include
Buck
,
The Endurance
,
Touching the Void
, and
127 Hours
. Sometimes these become metaphors or touchstones for the person as she crawls her way back from the deepest hole she has ever been in.

Another way to investigate and encourage this kind of connection is to find out if the depressed person has any artistic habits or skills and encourage her to use those skills to express what she is going through (and/or transmute it).

In the following conversation, see how the therapist uses art as a means of fostering connection.

Client:
I can’t even find the words to express what’s happening to me.

Therapist:
Do you have any way of doing art that might be a way to communicate it beyond words?

Client:
I paint.

Therapist:
Could you create a painting called
Depression
between now and when we meet again?

Client:
I could try.

Therapist:
I had the impulse to quote Yoda—“There is not try, only do”—but I get it. If you can do it, I think putting your experience on canvas might really help in a few ways.

[A few weeks later]

Client:
I finally created the
Depression
painting.

Therapist:
Oh, yeah? How was that? Did you notice anything while doing it or after?

Client:
Yes. I felt better just doing something, especially something artistic. But more than that, I felt like some of the depression is sitting there on the canvas, and in some way, I have less inside.

Therapist:
Interesting. And do you think you should keep the painting or destroy it or give it away?

Client:
Hmm. I hadn’t really considered destroying it. That would be a first. I’ve never destroyed any of my paintings, but it might be good to do. I feel ambivalent about it. Like it has cooties, my depression, in it or something. So, yes, maybe destroying it. But I think I need to keep it around for a little while longer.

Therapist:
Okay. That makes sense.

Here’s another sample therapy dialogue that is more about finding some artistic expression that someone else has created as a means of reconnecting:

Therapist:
You mentioned you liked poetry. Is there any poem you know that speaks to you these days or gives you comfort?

Client:
There is one poem by Rilke. I don’t know the words exactly. I should look it up. It’s something about being in a rock, with no space. It’s about being stuck. That’s the way I feel.

Therapist:
Oh, yeah, I know that one.
I am so far in that everything is close to my face and everything close to my face is stone
, or something like that.

Client:
Yeah, that’s it!

Therapist:
Why don’t you find that poem and bring it in next time? We can read it together, and you can tell me how it articulates what you’re going through.

Connection to a Bigger Purpose and Meaning or to God and the Spiritual

This is one area that can save people’s lives when they’re depressed. As Nietzsche famously said, “He who has a why to live for can bear with almost any how” (as quoted in Frankl, 2006).

So, one way to help clients connect to something bigger, something beyond themselves, is to help them connect to the reason why they’re alive—the bigger purpose or meaning of their life.

I was reading a
Reader’s Digest
magazine many years ago on some plane ride. There was an article about a middle-aged man who lost his father. He had been very close to his father, and he missed and grieved for him. But he assumed that things would get better and that the grief would diminish over time.

The grief, however, not only didn’t diminish, but grew until it was so overwhelming that the man felt as if he couldn’t go on in a world without his father. The grief threatened to crush him. At that point, he knew he would die unless he found something bigger than the grief to help him. He found God then. God was bigger than the grief, and the man made it through that difficult period of his life.

God, spirituality, or having a bigger meaning or purpose (such as caring for and being a positive influence for your children, or helping others who are facing depression) can be the thing that is bigger than the person’s depression when it looms large and threatens to engulf her and swallow her whole. Investigating what kinds of big connections and meanings the depressed person has can help her keep her perspective in moments of challenge. Why is she alive? Whom does she live for beyond herself? What social injustice moves her and would she like to alleviate or stand against?

Mitzvah Therapy

I heard about the concept of Mitzvah Therapy from a friend and colleague, psychologist Saul Gordon. Saul was referred a client who had spent over nine years in therapy working on her sexual abuse aftereffects. We’ll call her Ginny. Ginny functioned pretty well in her job as a research scientist, but she got no joy or meaning from her career. At home, she would overeat, and she had become obese. She had no friends or close connections. She was frustrated that even after the work she had done with two different therapists, she was still depressed. So she stopped going to her second therapist and found Saul Gordon.

After hearing her story, Saul leaned toward her and said, “Those were some of the best trauma therapists in the area that you went to. It seems you did some hard work and cooperated with treatment. The conclusion I would make is that psychotherapy isn’t the right approach for you. I recommend Mitzvah Therapy.