Out of the Blue: Six Non-Medication Ways to Relieve Depression (Norton Professional Books) (15 page)

I thanked her for being so considerate and told her I wasn’t accepting her resignation and that I would expect her to call as usual for our Sunday phone appointment. She sighed and told me that she wouldn’t be calling since she was not continuing the therapy. I told her I heard her and that I still expected her to call on Sunday.

The next Sunday she called as usual, and we continued the therapy. A few months later, she told me that she hadn’t been being dramatic or playing games when she had called to resign. She was perfectly serious and had decided to kill herself. I asked her why she had called then the next Sunday, and what she said was illuminating: “I don’t think my life is worth saving or that there is anything worthwhile about me. But you clearly do. And I decided, that since I was depressed and might have a distorted sense of things, I would use your faith about the worth of my life until I could find my own.”

And that, succinctly, is the task of the loved ones and caretakers of the depressed. Without being invalidating or minimizing the person’s suffering and desperation, they need to keep from getting sucked into the idea that there is no future, no coming out of depression, no help, no relief. They should be encouraged to hold quietly but firmly to the idea that life is worth living and that the hell the person is living will pass.

People do usually get better from depression. In the midst of the deepest and longest-lasting depressions, even family members can be discouraged and lose faith (and, of course, they also can get exhausted). Your task is to convince them to keep the faith and quietly communicate that to the depressed person.

Accountability

Friends and family members also need to hold the depressed individual accountable for her actions. Suffering doesn’t give anyone an excuse for being mean or irresponsible. Being depressed doesn’t make anyone act unkindly. The depressed person is still a human being and is responsible for her actions.

Let family members and friends know that, while they are encouraged to be sympathetic to the stress that the depressed person is under, they don’t have to excuse her or enable her in unkind or abusive behavior. The person doesn’t have to be chipper and upbeat, but it should be clear that it’s not okay for her to mistreat her loved ones or caretakers verbally or physically. If the depressed person does act badly, have family and friends hold her accountable and communicate that they expect better from her in the future. Have them ask for an apology if she has wronged them or someone else. The depressed person may not make that apology or offer to make amends while she is depressed, but often after people recover, they will do this voluntarily.

Deep Listening

Once, in the midst of my wife’s depression, she felt well enough to go out to a movie with me. We went to see the movie
What Dreams May Come
, starring Robin Williams and Annabella Sciorra (Bain & Ward, 1998). There is a scene in which Williams’s character, Chris, visits his wife Annie, played by Sciorra, in the mental hospital after she has tried to kill herself following the death of her children, for which she feels responsible. Chris has been trying to convince Annie that she is not to blame and to come back to him and to life. She has stopped speaking to him. He visits one day and confesses that he has finally realized that he has been part of the problem, because he left her alone in her guilt and misery and couldn’t join her. She looks at him for the first time, and they make a connection.

At this moment in the movie, I felt my wife’s elbow digging into my side. “That’s what you do. You leave me alone.”

As we drove home from the movie, she explained what she meant. When my wife was depressed and begging to be allowed to kill herself, something I couldn’t abide or support, I would start trying to convince her that things would be better one day and that she shouldn’t give up. This conversation never went well and often led to an argument.

After seeing that movie and hearing her talk about her experience of isolation, I realized she was right—I did leave her alone in her misery because I was so afraid that if I joined her there, I would lose her.

The next time she became distraught, the only things that came to mind to say were encouragements, but I knew those weren’t helpful. So I bit my tongue and just laid beside her and held her while she cried.

A while later, she told me that that moment was the first time she hadn’t feel alone during her depression. And, within a few hours after that, she was talking about plans for several months in the future.

We began to refer to this kind of interaction as “deep listening,” or listening without trying to fix or make things better. It involves just sitting with the suffering while avoiding being optimistic in response to the person’s pessimism. There is no need to give up hope for the person even when she is hopeless. But imposing that hopefulness on the sufferer is obnoxious and alienating.

Sometimes the person who is depressed may be quite irritable and blaming with her family, friends, the therapist, or with anyone who cares for her and is trying to help her. A depressed person may say, “You just don’t get it. This is the worst thing I have ever felt. I can’t
do
anything. If you felt this way, you would know that what you’re asking me to do is impossible. Just leave me alone.” And everyone else’s task is to stay connected, and as much as possible to let these angry accusations fall off their backs and not take them to heart. Their task (and yours as a therapist) is to hold hope for the person, to listen compassionately, and not to give up and go away. This can require the patience of Job, but most of the time it will pay off. Depression lifts. Things do get better. You and the person and her loved ones will find a way through.

As Simone Weil wrote and and I quoted above, “those who are unhappy have no need of anything in this world but people capable of giving them their attention.” The enduring nature of depression cuts the person off from herself, others, and the meaning of life. Helping to restore that connection in any way possible is important, and the first step is to listen deeply and connect with the person. First, you as a therapist can do this with your client, and then, with your help, her loved ones can be coached to do the same.

CHAPTER SIX

Strategy #5: A Future With Possibilities

Depression is often the collapse of hope for the future. This chapter shows a number of methods for reconnecting depressed people with hopeful futures to relieve their depression. It also details how to turn the devastating experience of depression into meaning and a direction for post-depression life.

One of the things that characterizes most people’s depression is the collapse of future-mindedness. Because the present seems so compelling and painful, people often forget that there is a future when they are in the grips of depression. So it is incumbent upon those of us who have a sense that the depression, like almost all things, will pass and that there will be something different in the person’s future, to hold that future, and to invite the person into that future.

If you remember the story of my friend holding out the hope of a farmhouse in which I could live without having to be around others and without having to have a job, you already know something about the potential power of this strategy, which is connecting the depressed person to a future with possibilities. As soon as she told me about the farmhouse and her offer, a possibility of a future with less pain and suffering immediately appeared for me. Instantly I wasn’t suicidal, as I could see a potential escape hatch from my current pain and suffering. I was still depressed, but not hopeless. I had a future to live toward, a future that promised some relief from my suffering. Likewise, when I compulsively listened to those lines from the Essra Mohawk record telling me that someday someone might love me and know what I was going through, I had a future with possibilities open up for me.

THE VICTOR FRANKL STRATEGY

I sometimes call this hope restoration strategy the Victor Frankl Strategy. Frankl, author of the bestseller
Man’s Search for Meaning
, was a holocaust survivor. He was arrested in the 1940s with his wife and his parents and sent to a concentration camp. Frankl survived. His wife and parents did not.

At a conference in 1990 in Anaheim, California, I heard Frankl talk about his life and work. In that talk, he told a story that struck me as a powerful example of this “future with possibilities” strategy.

Frankl had been transferred from that first concentration camp to several others and ended his captivity in the fourth camp, which was situated in what was then Poland. He had kept himself going in part with his work and a sense that he had a contribution to make to the field of mental health. He had been a student and protégé of Alfred Adler until he had begun to develop his own ideas and was pushed out of Adler’s inner circle.

Frankl’s original idea was that, instead of Adler’s “will to power,” humans’ most powerful driver is a “will to meaning.” He had begun to write a book about this idea when he was arrested by the Nazis, and they burned his manuscript just after he arrived at the first camp. Thus, the only place this idea existed was in Frankl’s mind. He distracted himself for many hours while in prison by writing the book over again in his mind and giving imaginary lectures about the topic. He survived several life-threatening incidents and began to have the idea that perhaps he was being kept alive for a purpose.

But one day, near the end of the war, his faith was challenged. Allied bombers had been making more and more incursions into German-held territory, and they had recently bombed a crucial bridge that was part of the German supply line. Frankl and his fellow prisoners were to be marched through the bitter winter cold to repair the bridge. As they were marching through a snow-covered field, the wind was blowing bitterly. Frankl had been ill with some sort of respiratory illness, and he was dressed in clothing too thin for the weather.

He began to cough, and one cough brought on another until he found himself collapsing to one knee in the snowy field, unable to proceed. The guard came over and told Frankl to get up and keep walking. He was slowing down the line and everyone was freezing.

But Frankl couldn’t get up. He was too ill and too weak. At his lack of response, the guard became enraged and began beating Frankl. Frankl collapsed to all fours.

Prior to this time, Frankl had had the sense that he was being kept alive for a purpose, but he suddenly thought that he had been deluding himself. He was going to die right here in this snowy field. He didn’t have the wherewithal to get up and keep walking.

Then, to his own surprise, he found himself no longer in the field, but instead he was giving an imaginary lecture in postwar Vienna on “The Psychology of Death Camps and the Psychology of Meaning.” Every word in this imaginary lecture was just right, poignant and nuanced. The audience was riveted. Frankl told them about the day he almost died outside the death camp in Poland. He had almost given up hope, and then, wonder of wonders, he found the strength to get up.

Just as he was imagining this part of the future lecture, in the field in Poland, he got up. He then told the imaginary audience that he took one step, and then another. That his feet hurt, his chest hurt, his back hurt, but he was walking.

Meanwhile, in Poland, he began to walk.

He continued imagining the future lecture the whole time he walked out to the work detail and rotely did what he needed to do. Time stretched out and he continued to be absorbed in this imaginary future lecture until he arrived back at the camp. He fell asleep that night imagining getting a standing ovation from his future imaginary audience.

I saw Frankl speak and heard him tell that story some fifty-two years later. He got a standing ovation from the audience in California at the conclusion of his talk there. Frankl had created that imagined future and was living it when I saw him.

As I heard this story, I was struck by how it paralleled my experience. We had both connected to a future with possibilities that had helped us get through one of the most difficult moments of our lives.

One thing to note is that Frankl didn’t just fantasize about a future in which things were better; he used that future vision to spur him to different and difficult actions in the present (standing up, taking a step, and then taking another) that could potentially lead him to that better future.

Andrew Solomon, on a trip through post–Pol Pot Cambodia—“The Killing Fields,” as they were called—remarked, “People who had suffered atrocities at the hands of the Khmer Rouge . . . preferred to look forward” (2002, p. 33). Wendy Kaminer, while writing her book critiquing the “recovery movement” in the United States, at the same time happened to be working on an article about Cambodian refugees to the U.S. who had come to this country after the Killing Fields. Both the codependents and the Cambodian refugee women met in church basements for their support groups, but Kaminer was struck by the difference in conversational topics between the two. The traumatized U.S. survivors spent much of their time discussing and detailing their abuse and maltreatment in the past. The Cambodian women almost never spoke about the past, preferring to help each other learn English, master the bus schedules, and talk about their future plans (Kaminer, 1993).

The depressed person, once connected with a meaningful and preferred future, doesn’t have to jump there instantly. She just needs to do something today that would be compatible with such a future coming true. As Abraham Lincoln said, “luckily, the future comes only one day at a time.”

FUTURE PULL

I also call this way of relieving depression Future Pull, since the object is to connect the person to a future that is compelling enough to pull him through the painful present. Now, there are many possible futures a depressed person could imagine and to which he could connect, but what we are aiming for in using this Future Pull strategy is a future filled with meaning, a reason to live and keep going, and the possibility of feeling better. Why bother putting up with the level of suffering that depression brings if one doesn’t think that that pain and suffering will abate someday? But there is more than the alleviation of suffering. If we can connect the depressed person to a future worth living toward—a positive, possibility-filled, meaningful future—it can give him something to move toward rather than just something to move away from.