Depression in the Christmas Season

Think about it, Mary and Joseph had every reason to be depressed. Both of them were outcasts from their families and local communities, all for believing a story about a virgin birth told to them by an angel. And then there was the issue of Mary becoming pregnant. In today's diagnosis-laden society, such a story would not be believed by anyone and there would be much pressure to have the couple see a psychotherapist and get a prescription from a doctor. Others may have pressured Mary to consider an abortion. Another factor in their risk for depression is that the society of Mary and Joseph's era was a communal society. Everything was done together as a large extended family and everyone knew everything about everybody else as in the movie Fiddler on the Roof. So a once proud and upcoming carpenter now is accused of intimacy with a virgin and a young girl, probably about age 12, is labeled a prostitute by her betrothed. One can only image the pillow talk of Mary and Joseph's parents. Not your happy Christmas family by any means.

The root causes of depression are varied and extensive. Some have suggested that our biology has much to do with the frequency and severity of depressive episodes. Medicines do help to manage the symptoms of depression and offer many a form of freedom from an unbearable burden. The burden of depression can be thought of as a massive weight on the soul. A person who suffers from clinical depression has dark cloudy days, most days, for most if not all of those days. It is as if you can see a brighter place just over the next hill but when you walk toward the hill to the light the hill keeps moving farther away from you. As if relief from depression is always just outside of your reach. It makes no sense because a person should be able to reason their way out of depression, right? It is not easy and to many such a logical process is impossible.

It is useful to examine the process of how people function when it comes to using our reason or our emotions, or both, to resolve depression. Dr. Marsha Linehan (1993) suggested that we use two primary spheres of cognitive functioning in approaching a task presented to us. Such tasks can include the process of experiencing and working through depression. Dr. Linehan offered that humans use a “logical/reasonable mind” and an “emotional mind” to process experiences. She further offered that these spheres overlap and that within the overlap of logic and emotion wisdom can be found. Dr. Linehan is suggesting a balance between emotion and logic is useful to accomplish human tasks. However, conflict can also be found within the overlap of logic and emotions. So what could Mary and Joseph have gained from learning about balancing logic and emotions.

A main problem for Mary and Joseph was that what was happening to them was not logical in any conceivable manner. The couple knew that they had not known each other in a Biblical sense and yet Mary's belly continued to grow. This was illogical. Yet, the emotional realties surrounding the rejection of their story by friends and family caused severe distress and risked the overwhelming onslaught of hopelessness. But Mary and Joseph did have hope, a hope based on the reality of their separate encounters with the angel. Hope, not in their present situation which was difficult and at times depressing, but hope for their future, the future of their soon to be born son, and the future of humanity. The ability to identify future things to hope for or new beginnings to arrive is the stuff through which depression can be fought and potentially defeated.

A mother who loses an infant to Sudden Infant Death Syndrome (SIDS) or a father who loses a teenage child through a tragic car accident will have great difficulty in their ability to find hope. Hope is not on their horizon for likely a long time. However, this does not mean that hope cannot rise from the ashes of what was before. It is logical to assume that after an appropriate period of mourning a person should be able to rise above their grief and reconstruct a life that is forever hobbled by a tragedy. It is not possible to turn back the clock, so what is left. Some would offer that finding purpose in the midst of despair offers a path toward finding hope. Not hope for the past but for the future, as with Mary and Joseph. A challenge that faces a person mired in depression is to find a way to get out of the depressive loop, a loop of repeating remembering of the tragedy or series of events that forced the person into a depressed state. It is illogical to think that a person would choose to remain in a depressed state by continuing to recall depressing events, but this is where the “emotional mind” can take a person suffering from depression. The longing in a depressed person to return to life before the tragedy is real. So to is the risk for blaming oneself for not doing enough to prevent the tragedy. If only the SIDS mother had remained awake through the night the baby would not have died. If only the father of the now dead teenager had driven his child to the football game, his child would not have died. These are not logical thoughts but they are emotionally driven thoughts, feelings of longing for relationship with the child or person they have lost.

It is not useful to denigrate such feelings because they are a present reality to the person and often all that is available to them in the depths of severe depression. It is useful for loving family members or friends to be available to the depressed person, to listen to them without judgment and without trying to “fix” them. There is no official time clock on how long it takes for a person to recovery from a major loss such as a death. What is important is to provide a safe and psychologically healthy environment for a person to work through their grief. Yes, there will be those dark hours of the night where the tears of remembrance are one's only company. Yet, Mary and Joseph's child let us know that He would remember those tears, listening to the grieving without judgment, only understanding. Psalms 56.8 reads that “You [God] keep track of all my sorrows. You have collected all my tears in your bottle. You have recorded each one in your book.” The hope that Mary and Joseph had, their hope for their future, is available to everyone today. The message of Mary and Joseph is that they reached beyond themselves to God through the angel's messages to find hope. So also is it for the person suffering from severe depression. To find a way to reach beyond their private world of grief, to get it out in the open by talking it over with a safe person. To find, over time, a context for their loss that includes both the past and it's happy moments and a future, with its happy moments. Life, sadly, is not always fair. People do experience losses and death will arrive at every person's door. Yet, we do have the ability to choose how we will live. Will we remain focused on our losses or will we try to build upon our losses to make ourselves into stronger and healthier people, able to offer hope to others from the hope we have learned about as we have experienced our own losses.

History is full of people who experienced significant and chronic losses only to persevere and find a new purpose from out of the ashes of great loss. Mahatma Ghandi experienced great personal loss in his effort to pursue a life of non-violence for all. Mother Teresa experienced tragedy and loss every day in her mission of hope and service to the “untouchables” of India. Dr. Martin Luther King experienced great loss being persecuted and eventually killed by racist tormentors fighting against his struggle for racial equality. Each of these beautiful people found a way to look past their personal loss in the moment, past their battles with feelings of depression, to find a purpose that was greater than their current grief. To honor a loved one lost is to find a way to continue the expression of the hopes and dreams of the person now departed. An infant who died had their world before them, a world of discovery, a world of promise and hope. A soldier who died also had their world before them but chose to risk their life so others could live freely. Choosing to find a world outside of the chains of depression is like trying to define the future. There are no guarantees that the future will always be good and without loss. But, if a person makes the choice to not risk looking outside of their depressed world, they may never learn of the possibility that goodness and a better life are just around the corner.

The old proverb, nothing ventured, nothing gained, is a relevant concept for working through depression. Yet, working through and finding freedom from depression requires support and new perspectives on the tragedy, and the context of the loss. I am not suggesting that a quick fix or a magic phrase will bring immediate relief from severe depression. A deep wound takes a long time to heal. And, similar to the healing of a wound of the skin, the healing occurs from the outside downward into the inner recesses of the emotional tear. A grieving widow learns to put on a happy face rather quickly but the inner sorrow remains. This phenomenon of outward to inner healing of depression is where the support of a structured program of psychotherapy can be useful, reaching out to a safe person. The therapist is a neutral third-party, with training to help the person find alternative ways to think about and process the loss. The therapist will also be able to identify the differences between logical and emotional thinking to help the person sort through what are emotional factors and what is reasonable given the situation. One of the most important factors in working through depression is to find a way to find hope. Perhaps hope is only a shadowy mist at first, fleeting and fragile. But given time hope can develop into the substance of things unseen, sufficient to change mountains of grief into pastures of safety and plenty. Mary and Joseph's immediate loss and likely feelings of depression were changed to feelings of joy and feelings of hope through the birth of their child. So to can the suffering of depression be transformed into honor for the lost and hope for the future through reaching out and getting needed help. The sun may come out today rather than tomorrow, but one has to reach out.

Dr. Love

References

Linehan, Marsha M. (1993). Cognitive behavioural Treatment for Borderline Personality Disorder. New York: Guilford Publications. ISBN: 0898621836.

Linehan, Marsha M. (1993). Skills Training Manual for Treating Borderline Personality Disorder. New York: Guilford Publications. ISBN: 0898620341.

So THEY say you are an addict... now what?

Bob had been a professional stock broker since his early 20's and he always enjoyed seeing the money rolling in. He was good at his craft and he had dozens of clients, each worth more than he would likely make in his lifetime. He was also a devoted family man and a church-goer, with a wonderful wife and two children balancing their way through the struggles and drama of high school. Yet, Bob had a secret, a life-long, carefully managed secret, that he had long since learned to control, or so he thought.

Bob, of course, is a fictitious person but he could also be any man, woman, or child in our neighborhood. Addiction takes many forms, whether alcohol, drugs, food, gambling, sexual, power, or money; the psychological themes behind the functioning of an addiction are similar. With some addictions, such as drugs or alcohol, brain functioning is greatly altered due to the direct chemical processes of the substance used by the person. Other addictions, such as food or pornography, involve psychological and/or physical gratifications that reinforce the psychological need with a powerful physiological sensation that strengthens the belief that a person can have control or feel good if a certain behavior is followed.

Although the starting point of addictions is often debated in the scientific literature one of the root causes of addictive behaviors is psychological neediness. It has been said that addicts often cannot stand being “in their own skin.” What could possibly bring a person to feel so bad about themselves that they may hate themselves or want to be anyone else but them? In many cases, during a person's early to middle childhood is when the seeds of later addictions are sown. It may be that a parent, aunt, uncle, or older sibling is stuck in a pattern of addiction behaviors. A person may also have been the victim of one or many instances of psychological or physical trauma that has left the person emotionally and psychologically damaged, unable to regain the innocence that was theirs before the trauma. Also, severe and tragic loss, such as a family death, may lead a person to “pick up” a substance or poor behavior as a means to escape their psychological pain. These are all scenarios of the tragedy of addictions. Yet, when people who are close to you, believe in you, and hold you in high honor find out you have a dark secret of an addictive lifestyle what should you do?

Returning to our example, Bob has much to lose. He has built his public life as a model of success and he is receiving the just rewards of his hard work. However, his private life of addiction has been gaining ground on him in recent years. He has come to realize that he needs more of his “substance” than he did before to get the same good feelings and the good feelings do not seem to last as long. A common phrase in the recovery community is that an addiction will “take you where you do not want to go.” 12-Step programs describe this risk for using as “one is too many” and “a thousand is never enough.” Bob is experiencing the physiological and psychological symptoms of tolerance. This means that the body or the mind has come a place where more stuff is needed to satisfy the physiological or psychological need. It is as if the cup a person is holding for their coffee keeps getting bigger and they need more coffee to feel good.

When a person craves their “substance” they have a need that they often do not understand. People may eat to feel better or gamble to “have success” believing that through the external process of ritualized behaviors they will feel better and/or have success. The taking of substances or the pursuit of ritualized maladaptive behaviors usually works to make the person feel better, in the short run. Over time, however, tolerance is developed and more is needed. The Internet and newspapers are filled with the carnage of lives ruined by the pursuit of fulfilling painful psychological needs through substances or behaviors.

For our addict Bob, he has three paths to follow, a fourth choice, going “cold turkey” on his own is unlikely to be successful. Based on his new insight that he needs more substance to meet his needs, he could voluntarily check himself into a recovery program and get help. Yet, due to his thinking that he can “manage” his addiction, he is likely to believe that he can manage “just a little more” substance and “no one will know.” 12-Step programs call this “stinkin-thinkin.” Another choice for Bob is to give up and dive head-long into his addiction throwing caution to the wind and seeing how far he can go, it “sure would feel good.” This too is stinkin-thinkin. A quality choice Bob could make is to push back his pride and admit that he has a problem. This will be very hard for Bob to do because over the years he has built strong psychological walls of self-sufficiency. The idea that he has really been a failure all his life and kept it hidden from others will be hard to think about, much less do something about.

Fortunately in Bob's case he married a very intelligent and perceptive woman. Bob's recent changes in behaviors, coming home later, sleeping later, being more secretive than usual, had been noticed by her. She has taken steps to learn about the processes of addictive behaviors and recovery. As the daughter of an addict, she has seen these signs before and knows that they are ignored at great peril. Much to Bob's surprise, when he gets home late around 9:00PM on a Friday night he finds that there are many more cars parked on his street than usual. When he comes in the door he is met by his wife who leads him into the living room full of people. He is asked to sit down as he is met by his boss, his priest, his doctor, his parents, and his siblings, all there to try and interrupt the pattern of his addiction.

The “intervention” attempted by Bob's wife and friends is just one of many methods that are used to help people begin the process of recovery. Bob could bolt from the room but for the love of his family, friends, and supporters that will likely keep him there. A great deception addicts believe is that they could never seek help because they will be forever rejected by those they love. They may believe their life will be ruined without the support of their “drug.” The fact is, an addict's life is ruined, until they begin the process of recovery. Outside of a process of supportive recovery the addict remains adrift and lost on how to find health. I would like to offer 10 recommendations to those who want to recover:

1. If your secret is still secret, come clean now. You will likely have a better outcome in recovery because you initiated the process, confessed it, and recovery was not forced upon you.
2. Take charge of your recovery. Ultimately you will be the one who makes it succeed, not others.
3. Find a psychotherapist who will accept you in your current state and support your process of change. There are no miracle cures for addictions and it will be very painful at first.
4. Work with a psychotherapist on those early unmet psychological needs or losses that led you to “pick up” in the first place.
5. Be open, humble, and honest about EVERYTHING. You were a liar in your addiction and truth is better than lies. Truth may hurt a lot in the short run but over time it feels better and better.
6. Change your current behaviors, change jobs, routes to work, friends, anything that connects you to your lifestyle of addiction.
7. Find safe and supportive people to hang with, this may not always be your family.
8. Let other's guilt and shaming of your former lifestyle go right past you, don't take it in.
9. Find something outside of your self that can be a strong psychological pillar for you to lean on when you are in that lonely isolated place and are most likely to use. Some people find this support in a “higher power” but others find this through activities or by giving of themselves to others in a humble healthy way.
10. Stop thinking about the negatives in your life, focus on the positive. There is good in you and you know you have shown it to others before. Pursue the good and be good.

Dr. Love

Picking a Psychotherapist

“Pick me, pick me” shouts the four-legged jackass jumping high in the air at the back of the crowd in scene in a famous movie about a shy and greatly misunderstood green giant. We all laughed because the scene brought back those uncomfortable memories of our teenage years when popular others were picked while many of us remained in the lineup, unchosen. Why others were chosen over us is a complex topic and maybe will be a topic of a later “Notes.” However, choosing a therapist has some similarities to picking the best possible players for a half-court pickup game, but it is not always about the person with the best free throw shot.

The process of therapy is an intensely personal endeavor. We choose to go to someone for help because we have been unable to figure it out on our own. If we could have fixed it, why spend the time and money to tell another person about our problems? Also, therapy involves personal disclosure in a confidential setting. Even so, it is still telling someone else about how we have been hurt by another, or hurt ourselves. Therapy involves gaining trust in a stranger and keeping that trust. Many people find this very hard if not impossible to do.

So how do you know if a therapist can gain and keep our trust? Many times when we look for a therapist we will turn to trusted friends, a pastor, rabbi, priest, or our doctor for advice. Our friends may know someone who has seen a therapist and had good results who could make a recommendation. But then, both the friend and that other person would know that we need to see a therapist. Of course, we hide our own need by saying, “I have a friend who needs...” when we are the person in need. This is a dilemma because we are hurting and need to talk to someone, but who?

There are many resources that have referral sources including state and national therapist trade associations such as the American Psychological Association, the California Psychological Association, and the California Association of Marriage and Family Therapists. Individuals psychologists and therapists join these organizations for various reasons and one of the benefits they receive is to be placed onto a referral list for the association. This may be a good place to begin looking for a therapist but it is not the only place. Other resources also include mental health service agencies in the local community. These agencies are much closer to the community and they will be able to refer to appropriate providers or they may have their own therapists or service providers. The good thing about working with an agency is that they will usually have several options to help find the right therapist.

Talking with your family doctor is always a good step to take when dealing with a complex problem. Your doctor has your best interest in mind and he or she is not in the therapy business, so there is no conflict of interest. Also, your doctor will be able to tell if the problem is serious enough to require medications to stabilize the behaviors of the person in need. When you talk to your doctor, though, remember to ask them if they think seeing a psychologist or other therapist to work on the problem would be a good idea. Your doctor may be able to help with an anti-depressant or provide some good common-sense advice, but this may not be enough to find lasting relief to your problem. It is good to remember that complex problems do not go away by themselves and are not fixed quickly. Finding quality solutions to complex psychological or interpersonal problems is what professional psychotherapy is all about.

In looking for the right therapist for you, ONE SIZE DOES NOT FIT ALL! If a therapist does not seem right for you, or the “shoe does not fit,” find a new therapist. Psychotherapists can facilitate therapy through over four hundred different styles of therapy. Everyone is different, including psychotherapists. So, be yourself, explain the outlines of your problem to a prospective psychotherapist and see what happens. The right therapist will have the skills to help you feel good about yourself even as you work through the terrible things that have happened to you or the terrible mistakes you have made and now want to resolve. Over 85% of what works in therapy due to the fact that the therapist and their client were able to build a quality trusting therapeutic relationship that provided a secure foundation to heal the deepest hurts.

So ask friends or family for advice about seeing a psychotherapist if you don't mind everyone else knowing your business. Asking your doctor will be confidential and will always be a good resource. Asking a community mental health agency will also be confidential and is also likely a good resource. Remember, at the end of the searching the choice is up to you, not your family or your friends. You will have to live with your choice, but your choice does not have to remain final. If you find that the therapist you chose does not continue to help you to feel safe while in therapy even when working through very painful issues, consider another therapist. You are free to leave therapy at any time and your therapist will provide you with referrals to another therapist. As a psychotherapist, I consider myself but a small part of client's recovery from their problems. You are the major part of your recovery; find a therapist who will cheer you on!

Dr. Love

Starting a Clinical Psychology Practice

Getting people to find you on the web is a difficult thing. Well, here goes...

Dr. Chris Love, PsyD is a California licensed clinical psychology practice serving Crestline, Lake Arrowhead, and the greater San Bernardino mountain communities. Providing professional psychological services including psychological assessment for Personality Functioning, Substance Abuse, Cognitive & Intellectual Functioning, Forensic/Legal Evaluations, and Behavioral issues. Professional psychotherapist services include therapy for Families, Couples, Individuals, Seniors, and Adolescents. Located at the beautiful new Crestline Plaza in downtown Crestline, CA, my office offers full amenities including: ample, close, well lighted free parking, ADA compliant facilities, clean ADA compliant restrooms, a waiting room and receptionist, and a comfortable confidential therapy office. Therapeutic approaches utilized include Client Centered, Cognitive Behavioral, Interpersonal, Family Systems, Dialectic Behavior Therapy, Motivational Interviewing, and time-limited Psychodynamic.

Dr. Love