Out of the Blue: Six Non-Medication Ways to Relieve Depression (Norton Professional Books) (14 page)

“
Mitvah
is a Hebrew word that essentially means doing a good deed for someone without expecting anything in return. I suggest you find some local treatment center for abused and neglected children and volunteer there as many nights a week as you can and on the weekends.

“In addition, since you’re so overweight, I recommend you spend some of that time you’ve been sitting and ruminating to begin walking around the block. Start with one time around the block and increase it as you can.

“Come back and see me in a month and tell me how your Mitzvah Therapy is going.”

Ginny agreed to give it a try, and when she returned in a month, she was very enthusiastic. “You were right, Dr. Gordon, psychotherapy was the wrong approach. This Mitzvah Therapy is amazing.

“I’ve been volunteering at a local center. The staff there told me they were overwhelmed and underfunded, with too many children and too few staff. When I offered to do anything that would help them out, they asked me if I would just sit with and play with the kids while the staff made phone calls and caught up on their paperwork for a few hours several times a week.

“The moment I arrive at the center, the kids are all over me, wanting my attention. And that’s what I give them—my attention and my love. I had so much love in my heart and no one to give it to.

“I am giving out so much love, but what surprised me was that I’ve gotten back many times more love than I give out. I can feel my heart healing every time I’m there.

“Oh, and I have been walking. It was really hard at first and I cursed you every step of the way, but it has gradually gotten easier. I’m feeling better, as I’m eating less and losing some weight.”

Saul told her to continue her Mitzvah Therapy for another month and increase her physical activity. She agreed, and when she returned in a month, she was even more excited.

“If you thought my report last month was good, wait until you hear what I have to tell you this month.”

“What could be better than what you told me last time?” Saul asked.

“There’s this guy, Henry, who works at the center. He must have been watching me, because he asked me out for a date and told me he’d begun to be attracted to me because of how kind and patient I was with the children. We’ve been out on a few dates and I’ve started falling for him. Look at me, Dr. Gordon. I’m not the most attractive person and I frankly thought I would never have a relationship, but Henry says I have a beautiful heart and soul and he loves me as I am. This Mitzvah Therapy is good stuff!”

How might you use Mitzvah Therapy with people who are depressed? You might suggest that they do something that draws them out of themselves and their focus on their own unhappiness and prompts them to focus on helping someone else. For example, if they can get themselves out of the house, they could volunteer at a homeless shelter weekly. Or they could start a support and information website about dealing with depression. Or every time they feel hopeless, they could make a small donation to someone in the world who faces almost impossible conditions of hopelessness and poverty (my favorites are Kiva.org and Heifer.org, if they want some suggestions). Or, if they are so infirm that at this point they can’t really
do
anything active or physical, have them send out a prayer or some compassionate thought for someone else who is suffering in the world. Explore with them any spiritual or religious sensibility they have (or have had) and whether it could be helpful to them during this time. The idea is to connect the person, in her actions or in her awareness and intentions, to something beyond herself.

RITUALS OF CONNECTION

One of the things about depression is that it often impairs motivation and disrupts one’s daily life. A simple way to help someone get back on track is to help him restore or develop daily rituals of connection. This may be why people who have pets when they’re depressed seem to do a little better—that pet depends on them to feed, water, and clean up after it. The dog demands a walk. The horse must be brushed. Having something to do on a regular basis gets the person out of bed or out of the house and
doing
something.

Even if there are no pets, having daily rituals, which often can be carried out more automatically and therefore don’t take as much energy as new tasks, can be helpful. When I was depressed, I found washing the dishes by hand to be a particularly comforting and connecting daily ritual. Since I am often cold, having my hands immersed in warm water felt good. I connected to my body in a sensually pleasing way. I also got a sense that I had accomplished something, even though it was a small something, after I finished the dishes.

The kinds of rituals that relate to the topic of this chapter and that give the most bang for one’s buck are those that connect the depressed person to himself, to others, and to something beyond. Possibilities might include going to church once a week, going for daily walks, doing art, journaling, saying nightly prayers, engaging in morning meditation sessions, taking a yoga class twice a week, or meeting a friend for lunch once a month.

Here is a sample therapy conversation about daily rituals:

Therapist:
How has being depressed disrupted your daily routines?

Client:
I don’t have any daily routines anymore. Sometimes I can’t even get myself to brush my teeth.

Therapist:
What kinds of things did you used to do every day?

Client:
Well, I would get up and get the paper from the front door and then make some coffee and read over the financial section. Then I would shower and get dressed. Then I would wake up my wife and the kids and have breakfast with them.

Therapist:
Is there any part of that, depressed as you are, that you think you could add back in?

Client:
Well, I’m not sure I’m up for having breakfast with everyone, but I do miss that time with the paper and coffee in the morning. Maybe I could get back into that if I set an alarm. I used to wake up spontaneously, but that doesn’t happen anymore.

Therapist:
I think one of the things depression can do is rob us of our routines, so I think it might be good to try it. You up for it?

Client:
Yeah. And getting up earlier will probably be good for me too. I’ve been staying up too late and I’ve gotten out of sync with the family.

Therapist:
Okay, good. Let me know how it goes.

LIVING WITH OR TAKING CARE OF OTHERS WHO ARE DEPRESSED

Little is written about how to coach or help others who live with severely or serially depressed people. Some of your clients may be significant others or family members who are seeking your help in how to deal with their loved ones who are depressed.

Having lived with two people who were depressed, I have a little experience and know how challenging and frustrating it can be. And I know how helpless those of us who are on the outside looking in can feel. But there are some things one can do, and in this section I will offer some ways to help your non-depressed but concerned clients not alienate the person who is depressed and perhaps even help her move through and out of her depression.

Acknowledgment

The simplest thing I suggest that spouses, partners, friends, or family members do is to acknowledge what the person is going through. Sometimes they’re concerned that if they acknowledge the depressed person’s hopeless feelings and bleakness, it will somehow endorse or worsen the feelings. It rarely does so, and the feeling of being adrift, misunderstood, and alone is only deepened when the person has a sense that her loved ones or friends don’t comprehend or validate her felt experience.

This doesn’t mean that the loved ones should agree with the person that she is a terrible individual, that life isn’t worth living, or that she will never get better—only that it is beneficial to acknowledge that this is the way she is feeling or perceiving things to be. Thus, in guiding your clients, make the distinction between acknowledging and listening respectfully, on the one hand, and contradicting the depressed person or giving her the message that she shouldn’t be experiencing the things she is experiencing, on the other.

The opposite of acknowledgment is invalidation. This can come in many forms: trying to talk the person out of her feelings or experience, telling her to just feel or perceive some different way, or to silence her because it’s too disconcerting to hear what she has to say.

Compassion

The next thing to do is to help loved ones and friends draw upon their feelings of compassion for the suffering of the depressed person. This can be difficult to do when the depressed person withdraws or pushes them away or acts irritably or unkindly, but this is precisely the time when that person needs compassion.

It can be difficult for someone who hasn’t been depressed to fully comprehend the suffering of someone who is severely depressed, but if the person is pushing or pulling away or acting unlike she usually does, it’s typically an indication of how terrible she feels. To help her loved ones keep this suffering at the forefront of their awareness is not to excuse these behaviors (more about that below), but to help them feel some sympathy for the depths of the suffering that is inviting her to this behavior.

All sufferers can use mercy and compassion. There is a line in Rick Warren’s book
The Purpose Driven Life
that may help friends and family find compassion: “It’s not about you” (2002, p. 1). Help family members and loved ones realize that even though the person’s actions may impact them and that they may feel initially that those rejecting or irritable behaviors are some comment on them and on their relationship with the person who is depressed, it probably isn’t mainly about them.

Spurring to Action and Movement

When I was four years old, I had a bout of scarlatina that almost did me in. The doctor came to the house and gave me a shot with a needle that, in my distorted moment of fear and fever-induced hallucination, looked to be a foot in length.

I tensed my butt muscles so much in anticipation of that shot that I was sore for quite some time after the fever broke and the infection was cured. I refused to get out of bed, saying that I was too sore. The days stretched on as I remained bedridden, and one day my father, not usually my caretaker, came into my room and shut the door. He quietly explained that by the time he left the room, I would be up and walking. I cried and pleaded permanent damage from the needle, but he told me the problem was that I hadn’t gotten up and walked around to get rid of the soreness.

I still refused, and he told me that I would either get up and walk with him supporting me, or he would haul me out of bed and kick my butt until I hopped around the room with him chasing me. I wasn’t sure he was serious, but he didn’t smile. That image scared me more than the pain of walking, so with his help, I got out of bed and began to walk around the room. Within a ridiculously short time, I was walking without soreness, my imagined lifelong infirmity was gone, and I have walked just fine the rest of my life.

I think the same kind of technique is needed to get depressed people to take some action that they need to take when they can and to get moving (we’ll talk about the importance of physical activity in recovery in Chapter 7). By hook or by crook, by cajoling or manipulating, or by whatever nonabusive means you have at your disposal, it is important to coach the depressed person’s family members and loved ones to get the depressed person to
do
something, even though she will swear to them that such action and activity is impossible. This might include eating, taking medications, walking around a little, getting dressed, taking showers, doing necessary life maintenance tasks, and so forth. Any small step that family and friends can get the depressed person to take can be helpful.

Of course, if the person absolutely refuses to do anything, family and friends can’t make her, but most of the time, just to get her family and friends off her back, the depressed person will do something.

Changing Patterns and the Environment

We have learned that little babies in cribs thrive when their environment is rich—when they are read to, talked to, given music to listen to, and put in rooms with colors and moving objects. Similarly, the depressed person has regressed to a more primitive state, in part probably because of brain problems (again, more about that later), and providing new stimuli can help her recover. This may involve reading books to her, playing music the person finds soothing or encouraging, or pushing her to talk to friends, to learn something new, to go out of the house, or to be in nature.

There’s a line in James Taylor’s song “Another Grey Morning” that is clearly about living with a loved one who is depressed—it refers to a loved one being locked up inside and wanting her partner to move her. The depressed person is locked up inside and often needs some outside help to unlock herself. The principle here is, don’t let her life narrow down too much.

Since this kind of help doesn’t involved any volition or activity on the depressed person’s part, this is an ideal suggestion for friends and family. They can enrich and change the depressed person’s environment even when that person finds it hard to do much of anything. For instance, they can engage in future-oriented talk without minimizing or losing empathic connections. Even though the depressed person has often lost a sense that the future holds anything worth living for, her loved ones should not forgo such future-mindedness.

I once had a client who was constantly suicidal but had agreed not to act on that desire while we were doing therapy. She lived a distance from where I practiced and traveled monthly to see me. Between visits, we had a standing phone appointment every Sunday evening to check in and maintain her progress.

One Thursday between live sessions, she called me up and told me she couldn’t take it anymore and had decided that treatment was useless. She was resigning from therapy. She also said she was planning to wait a reasonable amount of time before she acted on her suicidal feelings so that no one could blame me for her act.