Working at Depression

Dr. Phil Palmer Counselling, Psychotherapy in Godalming July 08, 2013

Depression is one of the most common mental health problems of the modern world, with one in 10 men and one in 4 women experiencing periods of real depression during their lifetime. For those going through depression there seems to be no way out, as if they are trapped and confined in this state, and that it will go on like this forever. For those who care for people who are depressed, it seems impossible to understand why they cannot break free, cannot see hope, cannot even try to make changes that would so obviously benefit them. Overall depression seems perplexing and demoralising, reducing us to feeling powerless.

“It’s hard to answer the question ‘What is wrong?’ when nothing is right.” 1 And depression saps at power, saps at the will to change and robs us of hope. So how can we come to understand what is going on and how change can be made to improve quality of life?

There are many triggers by which we fall into depression. But often, it arises either from a sustained attrition of our feelings of well-being or major life changes forced upon us which take away crucially important positive aspects of our lives. Our response is to feel cut off, isolated and numb as if mentally we curl up away from the pain. These feelings can lead to irritability, anxiety, restlessness and over it all – helplessness. We start to do less, achieve less, lose interest in what previously absorbed us. As a consequence we isolate ourselves, finding it hard to contribute. Everything seems to take more energy when there is so little available. Sleeping becomes interrupted or chaotic which further feeds our tiredness and irritability.

If you are wondering whether you feel depressed then ask yourself how many of the following thoughts you have: I blame myself a lot; I have no self-confidence; the future is bleak; what’s the point?; I feel guilty; I can’t go on like this and yet I can’t do anything about it; I have been thinking about suicide. Then ask yourself whether you recognise a number of these symptoms: I have difficulty remembering things; I find it hard to sleep or I sleep a lot more than I used to; It is a struggle to get up in the morning; I find it increasingly difficult to make decisions; I have lost my appetite or I am eating a lot of comfort foods; everything takes more time; I lack energy; I turn to alcohol or other substitutes to try and lift my mood.

None of these are in themselves indicators of being depressed. We all of us experience at times in our lives putting on weight or having difficulty sleeping. Yet if you can relate to a number of these thoughts and symptoms, then you are probably depressed.

How do you respond to someone who is depressed?

One can feel heart-broken to see them so down, to recognise their need for you to help them, and yet everything you say has little or no effect. Still worse, watching them shut off saying you cannot understand. The most difficult feeling to sit with is the total inability to make a difference. It is so natural to feel frustrated when unable to help and start to feel angry, venting our frustration on their inability to even try. The situation seems impossible, better to let them get on with it until they are ready to work at pulling themselves out of this hole. How else are we to protect ourselves from the bleakness of it all?

The consequence, however, is they start to shun social contact, believing their depression infects the mood of friends once, inevitably, they give up trying in the face of overwhelming negativity. They can understand why, they cannot cope with it either. This barrier feeds the sense of losing a voice, of feeling isolated, of feeling beyond the reach and comprehension of other people and so the spiral twists drawing them further down.

“When you’re surrounded by all these people, it can be lonelier than when you’re by yourself. You can be in a huge crowd, but if you don’t feel like you can trust anyone or talk to anybody, you feel like you’re really alone.” 2

When we are down we value ourselves less. Maybe we have mucked up, maybe we have been excluded by others or maybe we just feel we ought to be coping better. Yet we still maintain a sense of our self-worth, we still know we are capable and so we say “next time maybe I will cope better”. Our self-worth, while being battered, pulls as back and helps us to feel positive once more. Yet if I lose so utterly my sense of self-worth, if I feel I am not worth the efforts of others, not worth trying to please with treats or absorbing interests, if I feel in my core that I am the problem then what is there to help me drag myself up? That is the desperation of depression, there seems no way out. So we look for others to rescue us. If we lose someone who is very dear to us, then we need someone to come and fill that void for us. How can we fill it ourselves when we believe we are not worth it?

“I am so demanding and difficult for my friends because I want to crumble and fall apart before them so that they will love me even though I am no fun. Depression is all about if you loved me you would.” 3

For me, that is how I understand the difference between feeling down and feeling depressed. For someone being with a depressed person they either feel excluded (I will only infect you if you stay around me) or over-whelmed (you must rescue me – you must do everything, and I feed off the worth you give me as I give myself none).

“I thought depression was the part of my character that made me worthwhile. I thought so little of myself, felt that I had such scant offerings to give to the world, that the one thing that justified my existence at all was my agony.” 3

There is no easy road out of depression. Sure there are physiological changes in the brain which anti-depressants help to reverse. This can lift our mood, but will not cure depression as long as the underlying belief of having no self-worth persists. I work with depressed clients through the relationship: being accepting of the client’s mood no matter how desperate; providing positive warmth towards them, seeing their worthiness and maintaining an interest in the client without any implied expectation that they need to improve. Change comes in its own time, but you can expect it to be slow, gradual and not always consistent. Clients do come to recognise they are valued and they start to develop once again a sense of their own self-worth. Given the right environment, acknowledging the difficulties and providing constant reassurance provides the catalyst needed for change.

Quotations:

1 Anon.

2 Fiona Apple

3 Elizabeth Wertzel