Out of the Blue: Six Non-Medication Ways to Relieve Depression (Norton Professional Books) (22 page)

Along these lines, there is much to be done in helping people recognize when they’re at risk for relapsing after they’ve had one episode of depression, and in helping them recovery more quickly if they do relapse. In the addictions field, this is a major component of treatment, but it has not been addressed so much in the field of treating depression.

KEEPING AN OPEN MIND

This whole book has been about challenging what we think we know about treating depression. I have offered some new ways to think about and approach depression. They are not the only ones, just some possibilities. And people who are suffering don’t need to be met with ideologies and rigidities. They need to be met with as much creativity and possibility as we can muster to help relieve their suffering.

I assume that other writers, other therapists, and future therapists will offer still other possibilities.

I assume that we will learn more about the brain, the body, depression, psychotherapy, and psychopharmacology to relieve and prevent much suffering in the future.

A STORY OF POST-DEPRESSION THRIVING

Andrew Solomon relates the story of a woman he met in Cambodia who developed her own treatment for depressed women who had survived the Killing Fields of the Pol Pot regime, only to fall into depressions so serious that they stopped responding to and caring for their infants crying right next to them.

In the refugee camp, this woman, Phaly Nuon, who was later nominated for the Nobel Peace Prize and won several other humanitarian awards, saw these women and realized that nothing was being done to help them with their depression.

Nuon was also a traumatized survivor of the horrors of that time, who had seen her husband and her twelve-year-old sister and then her six-month-old baby die during the first forced march after Pol Pot took over. Later she would be tied to a tree and made to watch her daughter being gang-raped by soldiers. A few days after this, the soldiers gang-raped her. Eventually she escaped into the woods with her daughter and wound up in a refugee camp.

Nuon decided that she would do something to help the depressed women she saw all around her. She founded the Khmer Peoples’ Depression Relief Center in the refugee camp and created a three-part program to help the women. The women were given these instructions:

1.
Replace the horrors in your mind.
In order to do this, you must tell the story of what happened to you once to get it out, and then begin to fill your mind with things other than that horror story, so you can crowd that story out of your mind and begin to forget it. Things to replace the horrors are activities like playing or listening to music, doing embroidery, weaving, attending concerts, watching television, or some other thing that you enjoy.

2.
Accomplish one productive thing each day.
Go gather firewood, clean the house, take care of the children in the camp, or make skirts and scarves to sell to foreign visitors to the camps. The idea is to do any small activity each day so that you can say you did something useful and did some work that day to contribute.

3.
Learn to love again and care for others.
Give another woman a manicure and pedicure. (This would help them reconnect in a tender way to another person. It also involved doing something that would make the other person more beautiful and that would help her feel better about herself. This helped break down the women’s physical and emotional isolation.) (Solomon, 2001)

Many of the women recovered from their trauma and depression with this program.

As you may have noticed, Phaly Nuon’s program has something in common with the three principles of post-depression recovery I have detailed in this chapter as well as with some of the recovery strategies offered in this book.

She helped people both acknowledge their pain and suffering and connect them to non-depressing and non-traumatic things. This is like the marbling strategy in Chapter 2.

She had them get active and start moving and doing things, when they had become lethargic and unmoving. That physical activity helped them begin to come out of their frozen depression and back into life. This is the “brain growth” strategy in Chapter 7.

She made sure the activities they did were meaningful and contributed to others. This connected them to something beyond themselves. This brings in the transpersonal connection method described in Chapter 5, as well as the Three Cs of connection, compassion, and contribution spelled out above.

And she helped them reconnect with themselves and others physically through manicures and pedicures, fostering intrapersonal and interpersonal connections as described in Chapter 5.

This story illustrates that some of the strategies I have offered in this book have worked in the most extreme circumstances. This, to my mind, is better than a bunch of studies. Depressed people can’t wait for all the studies to be done. They are suffering right now; as Ortega y Gasset once said, “Life is fired at us point blank.” And people need something that might help right now. That is the spirit in which I have written this book and offered these possibilities.

Consider how you, as a therapist, might use any or all of these strategies and insights from the Cambodia example with any of your depressed clients. I have actually told the story of Phaly Nuon and her work to some of my depressed clients, and they have found it helpful to hear it.

SUMMARY AND SEND-OFF

I started this book by telling you that one of the origins of the book was the episode of deep depression I suffered as a young man. Obviously, I recovered and have gone on to live a good life (I am now about the same age as were my friend’s aunts, who seemed so ancient to me at the time). I have experienced love, raised a family, and had a career that has been quite meaningful and engaging. I hope I have contributed to others and perhaps even saved a few lives with my work. None of this would have been possible if I had succumbed to the darkness and killed myself.

As I said at the start of this book, if what I have written here helps even one of your clients find his or her way back from depression, or helps him or her stick around and function and make a contribution to life, it will have been worth the time and effort that went into it.

Because we have covered so much territory, here is a quick recap of the six strategies for relieving depression that I’ve offered in this book:

1.
Marble depression with non-depressed reports and experiences.
One of the challenges with depression is that the brain and the person get stuck in ever-deepening despair. One way to start to get traction for moving out of depression is to reactivate the brain circuits and memories of non-depressed experiences and the non-depressed self.

2.
Undo depression.
Discover the patterns that make up your clients’ depression (it’s not a thing, but a process) and have them do anything that is incompatible with that depression. This involves mainly what they do, how they view things, and the context they access and live within.

3.
Shift your clients’ relationship with their depression.
Have them get some distance, externalize it, just notice it, and value it instead of fighting it. Have them do anything to create some breathing room and a shift in the experience of their depression so they can get some traction for moving out of it.

4.
Reconnect your clients with themselves, others, and something beyond themselves
, that is, their bigger meaning and purpose for living. Since depressed people often feel disconnected, isolated, and alienated from themselves, others, and their bigger purpose, this reconnection can be healing.

5.
Reconnect your clients to a future with possibilities and hope.
Since depression often robs people of hope and a sense that they will get better, it is imperative to revivify that hope to help them make it through their depression and to the other side.

6.
Restart brain growth.
Since stress can slow or stop the growth of new brain cells, and since depression is partly brought on by stress and is stressful in its own right, get your clients moving. Help them find new brain stimulation and richer environments so as to encourage new brain cell growth and new connections within the nervous system.

Finally, I’ll leave you with a bit of advice for people who are depressed. It is wise and kind advice that comes from a fellow sufferer. I wish I’d heard and listened to these words when I was depressed, just as I wish I’d had access to and carried out the strategies in this book.

Listen to the people who love you. Believe that they are worth living for even when you don’t believe it. Seek out the memories depression takes away and project them into the future. Be brave, be strong; take your pills. Exercise because it’s good for you even if every step weighs a thousand pounds. Eat when food disgusts you. Reason with yourself when you have lost your reason. These fortune-cookie admonitions sound pat, but the surest way out of depression is to dislike it and not let yourself grow accustomed to it. Block out the terrible thoughts that invade your mind. (Solomon, 2002, p. 29)

APPENDIX

This is a handout you can copy and give to your depressed clients.

FIVE THINGS YOU CAN DO TO LIFT YOUR DEPRESSION

1. Stop Blaming and Critiquing Yourself

One of the common things that happens in depression is that your thoughts turn negative and they turn inward on you. Some depressed people berate themselves for not feeling better; for being weak, sick or flawed; for having trouble motivating themselves; and so on.

In the early days, alcohol problems were seen as a moral or personal weakness or flaw. People with alcohol problems are seen differently these days.

It’s the same with depression. Most people think of it as an illness, and when they really understand more about it, they feel sympathy and compassion rather than blame.

But of course, the problem with depression is that it’s hard to see the problem from the outside, and it sometimes seems like something that can happen to anyone in life (feeling down), so others don’t always understand and are sometimes unsympathetic or push you to feel differently.

But that can lead you to get down on yourself, and that often leads to your feeling even worse.

It’s not as if you are not responsible for anything that you do, but much of what you are feeling and experiencing is outside your direct control, so give yourself a break. If you could make yourself feel better, you probably would. If you could cheer up, you would.

Just imagine how you would react to a friend, family member, or other loved one who was feeling the way you do right now, and then try to turn that kind understanding and compassion toward yourself.

2. Find and Hang On to Non-Depressed Experience and Identity

Recall and hang on to as many non-depressed feelings, memories, and habits as you can. Hold on to as much of a sense of yourself outside or beyond depression as you can.

Depression can sometimes color your sense of yourself and your memories so that you find it hard to remember what it was like to feel any differently or better.

You may forget what kind of person you were or lose your sense of yourself as a good or competent person when you are in the midst of the terrible mood that has gripped you.

But those brain circuits and those memories are somewhere inside you, and if you can grab onto that prior sense of yourself or those better memories when they become available or when you get a glimpse of them, it can help you get some traction for coming out of your depression.

The brain tends to get grooved in whatever gets repeated, so even a short revival of any non-depressed circuits in the brain and the nervous system can help you find your way back.

3. Push Against Isolation

One of the things depression tends to do is invite you to pull away from others or push others away.

This may happen because you feel you would be a burden to other people, or because you lack the energy or wherewithal to explain what is going on with you, or because you don’t want to have to be civil, or in a good mood, or deal with anyone else.

But research shows that social connections are important for your ongoing health and well-being.

So, any way that you can allow or encourage or seek out connection with others, whether they be animals or humans, can help you find your way back, even if it feels really hard in the moment to make or keep those connections.

4. Connect With a Future Beyond the Depression

One the things depression often does is rob you of hope for a better future. It tries to convince you that you will never come out of it.

It is said that J. K. Rowling conceived of the Dementors, those spirits that can suck all the hope and good feelings out of people, based on her own experience of depression. When asked if the Dementors represented depression, Rowling said, “Yes. That is exactly what they are. It was entirely conscious. And entirely from my own experience. Depression is the most unpleasant thing I have ever experienced. It is that absence of being able to envisage that you will ever be cheerful again. The absence of hope. That very deadened feeling, which is so very different from feeling sad. Sad hurts but it’s a healthy feeling. It’s a necessary thing to feel. Depression is very different.” (Please see Ann’s full interview by visiting http://www.thetimes.co.uk/tto/life/article1717401.ece).

One of the ways to push back against this taking of the future from you is to write your current self a letter. Write it as if it is coming from your future self who has made it out of and beyond depression. Even if you find it hard to believe that that is even possible, use your imagination to project yourself to a time when you have emerged from the depression.

What would that future self say to you to give you hope or encouragement? What kind words would that self say to you in your current suffering? Put that and anything else you think might be important into the letter and hang on to it. Read it over when you need something to hold on to.

5. Get Moving