MISCONCEPTIONS ABOUT DEPRESSION PART II

If you’re like most people, when you think of the word “depression,” your thinking is clouded by a lot of misconceptions, such as, “If I’m unhappy I’m depressed.” Depression is not the same as unhappiness. You have bad days and get down in the dumps. Who doesn’t? Maybe you have lost a loved one, been laid off, experienced a relationship breakup or a divorce. You feel pretty rotten, but in these cases of situational sadness, a change in circumstances or your perception of events can soothe emotional upheavals and lift your spirits. But if you get into a chronic, persistent habit of avoiding troublesome events instead of facing them, then you begin moving from sadness and unhappiness to learned helplessness and depression. Like all coping challenges, the key is the degree to which you get swept up in the avoidance pattern.

Confusing unhappiness with depression is not the only thing that can make evaluating depression difficult. For instance, you might get caught in a chronic pattern of actions that involve disengaging from life. Church and Brooks call this self-defeating pattern subtle suicide in their book of the same title, and they note how the condition can be confused with depression. Subtle suicide, however, is characterized by ambivalence, apathy and a “Who cares?” attitude toward life, and can be distinguished from chronic depressive disorder. Still, many people who show this ambivalence toward life are often misdiagnosed as depressed and prescribed anti-depressant medication, which doesn’t work well with subtle suicide.

Another misconception is believing your primary care physician is best equipped to diagnose and treat depression. Unfortunately, in the medical profession most diagnoses of “depression” are not made on the basis of formal psychological assessment, and informal diagnoses can lead to diagnostic errors and inappropriate treatments. For instance, anxiety, anger, and other emotions brought about by life circumstances can easily be confused with depression. A psychologist can distinguish these conditions from depression with appropriate diagnostic assessment.

The reality of comorbidity in psychological dysfunctions can also present diagnostic problems. Comorbidity means the simultaneous presence of more than one pathology, such as when a client shows depression, but also anxiety attacks and post-traumatic stress disorder. If the diagnosis is depression, the other conditions are overlooked and the use of anti-depressants will likely not work. The client will be frustrated and the practitioner will begin trial-and-error applications of one medication after another.

Misconceptions also occur over the biochemical imbalance issue. Many psychiatrists believe that their client’s problem results from such an imbalance in the brain, and medication can restore balance. Other professionals say this type thinking is like saying a headache results from an aspirin deficit in the brain. Such controversy can be confusing to the client.

One thing we can say is that a lot of research has shown that psychiatric medications are generally no better than a placebo for low and moderate levels of depression, such as Persistent Depressive Disorder (PDD). This finding should not surprise you because there are no medications that will empower you, or that will develop an action plan for you to navigate the challenges of life and develop more satisfying and productive actions. In PDD, such things are crucially involved in dealing with the disorder. More severe conditions, however, like Major Depression and Bipolar Disorder do respond positively to medications. Once again, the accuracy of diagnosis plays an important role.

The bottom line is, be cautious and seek information from a variety of sources. If you feel you have a persistent, chronic problem with your mood that interrupts your daily activities, you should consult both a psychiatrist and a psychologist. This combination will provide you with a thorough psychological evaluation and diagnosis, decrease the risk of diagnostic errors, and help you work actively as a participant in developing a treatment plan that may include medications.

ABOUT DEPRESSION PART I

You have probably heard of Bipolar Disorder and Major Depression, but perhaps not Persistent Depressive Disorder (PDD). The symptoms in PDD tend to be quite subtle, compared to bipolar and major depression where symptoms are much more severe and dramatic. For instance, suicide attempts, psychiatric hospitalization, and the need for anti-depressant medication are much more common with major depression and bipolar disorder.

PDD is largely a cognitive condition, a way of perceiving and thinking about events in your life in a negative way. If you think negative thoughts, especially about yourself, you are going to feel pretty rotten – you are going to avoid challenges and become more likely to get depressed. Negative thoughts preclude positive actions, and without positive actions in your life you will never feel satisfied and productive. Imagine waking up feeling pretty good, but going through the day repeatedly telling yourself, “I’m incompetent; I’m going to fail; I can’t do anything worthwhile; I’m a disappointment to others; I’m such a klutz everyone feels sorry for me.” How do you think you will feel at the end of the day? Satisfied or kind of “down”?

If you feel you might suffer from depression but tend to write it off as just having some problems dealing with life, you could be one of the “silent sufferers” afflicted with PDD. You go to work or school, you care for your loved ones if necessary, and generally function in the normal range of activities. But you have this gnawing feeling that most people seem to enjoy life more than you do. You seem to have more than your share of pessimism, guilt, lack of interest, appetite fluctuations, low self-esteem, chronic fatigue, social withdrawal, and concentration difficulties. Whatever your particular profile, you have a chronic discontent with yourself, and your negative thinking has become a way of life. You can even learn to tolerate this depressive state and are not really convinced that you suffer from a psychological disorder.

The seeds of PDD are usually planted in childhood or adolescence, and result from poor development and guidance in developing social skills, optimistic thinking, and a belief that you can deal with challenges. The results are early beliefs that you are helpless, have a tendency to dwell on the negative, and experience a steady build-up of stress. These conditions often lead some folks to seek psychological help, and frequently the psychiatric diagnosis of depression results in a prescription for anti-depressant medication. Unfortunately, this medication, which can be effective with Major Depression and Bipolar Disorder, is usually ineffective for PDD. About the best that can be expected from the medication is a temporary “kick-start” to developing new thinking and action patterns with the help of psychological intervention.

PDD is primarily an avoidance issue, the sorts of things that we discuss in this blog. With PDD you have developed long-standing actions that allow you to avoid facing challenges and maintain your symptoms. You probably tend to avoid stressors, unfortunately the very stressors that helped cause and sustain your depression and other life problems; in other words, you avoid the very stressors that you must learn to confront. As a result, you are likely caught in a vicious cycle of action patterns that is difficult to exit, and unlikely to be affected by anti-depressant medications. Your depression is accompanied by actions that rob you of energy, motivation, and positive attitudes that are needed to break free of the avoidance vicious cycle. As a result, your depression probably creates problems in other areas, such as social interactions, concentration and focus, alcohol/drug issues, etc. Such co-existence of problems is known as co-morbidity and is not at all uncommon. So, do not despair. If you are willing to work you can learn to challenge and face your demons, and possibly without long-term medication use.

ROOTS OF CHILD ABUSE

In previous posts we noted that child abuse can be passed on from one generation to the next. Abuse your child and you have increased the likelihood that your child will abuse his/her child, and so one down the line. Note that we said “increased the likelihood” not “guaranteed.” So let’s look at some of the psychological factors involved in this perpetuation.

Also, please remember what we have said previously about an individual as a complex array of puzzle pieces. We may isolate and understand some of those pieces, but there will always be more pieces. We can never have a complete understanding of an individual. Yes, we can make some really good educated guesses about one’s psychological dynamics, but our understanding will always be incomplete. For instance, if you hear someone say, perhaps in a courtroom as an expert witness, “This man is no longer a danger to society. He can be paroled without concern,” red flags should go up in your head. No expert should make such a bold and absolute prediction.

OK, back to perpetuating the psychological seeds of child abuse. First of all, let’s note that if you are raised in a physically abusive environment, you are seeing an aggressive role model; that model is telling you, “Violence and aggression are the way to resolve conflicts, and are appropriate reactions when you are frustrated and angry.” The research is quite clear that a cold, rejecting early home life increases the odds of later adult dysfunctions, such as child abuse.

An early abusive environment will encourage you to mistrust the world. You will see others as unreliable, dangerous, and social interactions are to be avoided for your psychological well-being. You will hold grudges, which will perpetuate your inner anger. These reactions will give you great insecurity in social situations. The result could be extreme withdrawal and disengagement from interactions with others or lashing out to harm them. The precise pattern is one of those puzzle pieces that is hard to predict in advance.

As we noted in an earlier entry, whether you withdraw or lash out to deal with your anxieties and anger, you will have a hard time learning how to interpret social signals. Among other things, you will be confused about how to give and receive love. This confusion will add frustration and more anger to the mix, and you will be likely to take your anger out on the source of your confusion.

The very presence of a child will likely tap into the recesses of your mind and awaken the anxieties, confusion, and anger of your childhood when you were abused. You will put yourself in the place of the child in front of you, and you will react to the frustrating social signals in the way you experienced: Abuse.

We have not painted a very pretty picture, have we? Remember, however, the transition from abused to abuser need not be inevitable. Just being aware of all the possibilities raised above can help you introduce new pieces into the puzzle that is you, or the puzzle that is someone you’re trying to help. Our personalities are not static and unchanging as we grow; we are capable of taking charge of those things we can control, learning to face and accept (not blame) some uncomfortable truths about ourselves, finding values that coordinate with a social conscience, and behaving in more personally satisfying ways by reaching new levels of self-awareness and self-actualization.

PERPETUATING CHILD ABUSE

Last week we talked about child abuse and considered one hypothesis about possible dynamics involved in at least some cases. Let’s look at another dimension to the problem of child abuse.

Years ago I was talking with the Director of a daycare facility. This particular daycare was registered with the local Juvenile Court, and children who had been removed from a parent’s care for safety were often placed in the facility during the day. The Director was sharing some of her observations in her facility of toddler-age kids (around 2) who had been removed from physically-abusive homes.

She said, “We often have a child who gets frustrated about something, angry over a toy, or any of a number of things, and starts crying. A lot of times one of the other kids shows some concern. I’ve seen them go to a crying kid and offer a toy, or ask, ‘What’s wrong?’ in a soothing way. Never, however….never have I seen a child from an abusive home behave in any sympathetic way toward another child. Right now we have two children from abused homes who have been placed with us by the courts. Just the other day, a child was pounding some blocks together and accidentally hit her finger. She was really crying and I noticed how many of our kids were looking over to see what was going on. Three or four actually came over and acted like they wanted to help the staff member who was comforting the child. The two abused kids? One was totally ignoring the commotion and going on with his playing; the other came over and shoved the crying child, shouting, ‘Shut up or I’ll beat you!’ I thought, my God, the kid is already a child abuser and he’s only 2!” Later she added, “You want to produce adult child abusers? Abuse them when they’re children!”

Years ago I was home one afternoon when I heard a crash against the front door and lots of yelling. I ran and opened the door and there was our 9-year old daughter, just home from school, and another girl I didn’t know, who ran when I opened the door. Our house was just a few yards from the school bus stop, and apparently the girl had chased our daughter right onto our porch and shoved her pretty good before I arrived.

Our daughter told me this girl regularly bullied her on the school bus, and this day decided to chase her. She said the girl lived just a block away and gave me her last name. “Oh, great,” I thought, “I’ve got to call this girl’s parents about this and complain.” I would rather navigate a mine field than confront parents I didn’t know. After all, some parents attack coaches who don’t play their kids enough! But then I looked at my panicky daughter……………

The girl’s last name and street was in the phone book, so I dialed the number (this was around 1979, guys!). I introduced myself and confirmed that this was the mother of the girl. I said, “Ma’am, your daughter just chased my daughter down the street to our house and attacked her right on our porch! We really need to do something about this”

“Well,” she said with clear anger in her tone, “my daughter just got home and told me how your daughter said I was a whore! What about that?” I thought, “Damn, this is going downhill in a hurry.”

“Ma’am, I promise you, I will talk to my daughter and guarantee that she will never say anything like that about you again. I apologize and understand why you’re upset. I would be, too.” [I know, you’re ready to barf but remember, if you want to soothe the wild beast, you need to play soft music.] “But, the fact is,” I continued, “We can’t have your daughter on our porch attacking our daughter. It’s not right.”

Pause. Silence. Was she loading the cannon for battle? Was she looking for her 6’6” 250lb husband to tell him to get the rifle out of the closet? My life was flashing before my eyes!

Finally, she calmly said, “You know something, I wish that last year I had done what you just did. Last year there was this older girl who bullied our daughter all the time, especially on the bus. I should have done what you did…..I should have called her mother and said we needed to do something. Instead, I just told our daughter to complain to the driver and sit as far from this girl as she could. I don’t believe it. Now she’s doing to your daughter what happened to her last year.”

For the next 5 minutes or so we commiserated about the impossible challenges facing parents. I made sure I showered her with understanding, still concerned she was married to the incredible hulk who would love to take me apart limb by limb. We worked out a good plan that presented consistent for the kids from their parents. I never talked to her again, and neither daughter ever again bothered the other again.

These two stories make the same point about child abuse: Being abused as a child will increase the odds that you will abuse children as an adult. How come? Just taking the first step in trying to answer that question will require some effort, so I’ll hold off until the next post.

DYNAMICS OF CHILD ABUSE

Child abuse can take many forms for many reasons. The boyfriend who puts out his cigarettes on his girlfriend’s child’s stomach, a child from another boyfriend, may have different psychological issues driving the action than the mother who regularly beats her two-year old, or than the young man who forces sexual acts on a 12-year old boy. All the actions are heinous, but we’re often frustrated in our efforts to understand and deal with child abusers because each case has unique features.

A colleague once described some preliminary data from his research. Some participants were moms who had physically abused and neglected their child, and, through court rulings, had temporarily lost custody of the child and been ordered to attend counseling sessions. A second group of moms also had one child, but had “normal,” stable home lives. For both groups, the moms’ child was between 2 and 5.

Each mom was tested individually. They were first wired up to a polygraph to measure physiological signs of arousal (heart rate, respiration, palm sweating), and then they watched two videos. One showed an infant smiling while lying on a mattress; the other showed an infant crying loudly while lying on a mattress. After each video the moms were asked how they felt while watching it, and what they thought was going on with the infant.

When the non-abusive moms watched the smiling video, they showed no physiological arousal. They said the video was pleasant to watch; the infant was obviously happy and enjoying interacting with whomever was present. The abusive moms, however, showed elevated physiological arousal when watching the smiling tape. Their interpretations of what the infant was feeling, however, were somewhat mixed. They said things like, “I’m not sure what’s going on”; “The kid may be tricking the caregiver into giving it something sweet”; “It may be burping and causing its expression.”  These moms did not enjoy watching the tape and seemed unsure about what was going on.

When the non-abusive moms watched the crying video, they show increased physiological arousal. This tape was very unpleasant for them, and they all said words like, “He’s really upset about something. Probably hungry, or needs to be changed, or just needs to be held and cuddled and talked to.” The abusive moms? They also showed increased physiological arousal to the crying tape. However, they interpreted the crying as criticism directed at the caregiver. “This baby is really angry at whoever is taking care of him. He’s saying that she’s doing a lousy job.”

So, what’s going on here? The researchers hypothesized that the abusive moms were poor at reading social signals from the infant. A smile, a cry…..what do they mean? What do they tell me I need to do? Abusive moms, the psychologists believe, just can’t interpret social signals. For most of us, a smile usually means, “I’m happy and love you”; a frown or cry means, “I’m hurting and need you to care for me.” Unable to sort out this information in their daily interactions with their child, the abusive moms get frustrated, angry, and lash out physically at the helpless child. Plus, when the child acts irritated, the moms conclude he is irritated at them.

Where could this insensitivity to social cues come from? One possible cause is that the abusive moms were raised in abusive homes. In fact, nearly 40% of the moms in this study indicated their childhood home was physically abusive. Imagine being raised in a home where you’re spanked, hit, pushed, and yelled at on a regular basis, regardless of what you do; whether you reach out lovingly to parents, or show anger toward them, or try to avoid them, the result is the same: anger and rejection aimed at you.

Being raised in such a world would make social signals a mystery to you: “What do I have to do to give and receive support and affection?” Simply put, this childrearing pattern makes it difficult to learn how to give and receive love. Thus, in other settings, when someone reaches out, you don’t know how to react. And when you don’t know how to react to a signal, that signal becomes aversive, a threat that reminds you of your inadequacies. And so it is for our abusive moms: “Why are you smiling? What do you want from me? What am I supposed to do? Damn you!” The crying infant? “OK, I get it…I’m a lousy mother. Why do you have to remind me? Damn you!”

The lesson here about social signals has broad relevance for everyday interactions far beyond cases of child abuse. Most of us, for instance, are not threatened by social signals from others because we recognize them and know how to react. But what about the young man who ends relationships as soon as the girl begins to get serious? What’s his problem? Deep inside is he anxious about commitment because he never really learned how to give and receive love? Are such positive expressions toward others mysterious psychological threats that must be avoided? If you are a regular reader of this blog, you know precisely the negative coping consequences of avoidance.

One final word: problems deciphering social signals are in no way the explanation for all cases of child abuse. As we said at the beginning of this post, each case is different and unique. Think of trying to analyze human behavior as doing a challenging puzzle. You may have three people before you, each one a child abuser, but each one will have different pieces to their puzzle. Yes, some pieces will appear in all three puzzles, but for the most part, each puzzle will have pieces not found in the others. Sensitivity to social signals is such a puzzle piece; it may appear in many, but not all, cases of child abuse.

 

 

 

 

COORDINATE ACTIONS WITH VALUES

In a recent post, we noted that coping with everyday life is like having conversations with life. As we said, every day you chat with life. A lot of these talks have to do with being happy. Sometimes you’re mad because you want to be happy, and life is not cooperating. So you shout out, “I’ve had it with you life; you stink!” Other times you’re on top of the world, happy (at least momentarily) and exclaim, “Life, you’re fantastic!” The problem is, even though these extreme reactions capture the moment, they’re lousy for having a conversation because they don’t last. So what’s missing?

As an analogy let’s consider a phenomenon from the world of perception. Imagine sitting in a dark room and in front of you are two small lights, maybe the size of a pea, and a couple of feet apart. The lights begin blinking in sequence: left light blinks on and off followed by the right light blinking on and off, then back to the left, etc. When asked what you see you say, “Two lights blinking on and off in sequence.”

Next, let’s begin shortening the time between the blinks until the time between the left blink and the right blink gets into milliseconds. At some point, your perception changes, and you say, “I don’t see two lights anymore. Now I see one light jumping back and forth.” Interesting. You are now perceiving a new property in your visual field: movement. Notice that neither light is moving, but when we structure the viewing conditions in a particular way, the experience of perceiving movement has emerged in your experience. No movement exists except in your perception; your reality has become dependent on an act of your mind.

“OK,” you ask, “what does all this philosophical mumbo-jumbo have to do with conversations with life?” Well, consider happiness. You can circle a future date on your calendar and write, “Will weigh 132lbs or less,” “Will be able to run a mile in less than 10 minutes,” or, “Will be smoking zero cigarettes.” You cannot, however, realistically circle a future date and write, “Will have achieved lasting happiness.” Wouldn’t that be nice? The fact is, like the movement in our perception example, happiness is something that must emerge, evolve, be created by you, specifically by structuring your environment in ways that will allow you to perform certain actions that bring you satisfaction, contentment, and intrinsic feelings of accomplishment.

“That sounds great,” you say, “but how do I go about restructuring things to make that satisfaction emerge?” The answer is actually pretty simple: You must coordinate your actions with your values. It’s amazing how easily you can overlook this basic truth about effective coping. Coping problems develop when you ignore your values and engage in actions that are inconsistent with those values. For instance, you put off investigating diets (an action) that may work for you even though you say, “I care about my health” (your value); you put off joining a gym (an action) even though you say, “I want to get in shape” (your value); you put off spending more time with your kids and spouse (an action), even though you say, “I value family” (your value); you put off signing up for a course at the local community college (an action), even though you say, “I want to become more educated” (your value).

Most resolutions –“I will do this,” or “I will do that” — fail because you do not connect your actions and your values. If you want good feelings to emerge from what you do, you must first identify those things that you really value, the things that are important to you, and then resolve to coordinate them with specific actions. Once you identify your values and choose appropriate constructive actions, those actions will tend to become a part of your routine; they will become automatic and it won’t take much effort to maintain them, making them more likely to result in the emergence of positive feelings.

Suppose you come into a lot of money, maybe through an inheritance, winning a personal injury suit, or hitting the lottery. You’re rolling in the dough and you’re happy. But as time goes by you realize you’re squandering the money on material things you don’t need. You’re still rich, but now you’re unhappy. You have no strategic plan for investing the money, or making it work for you to achieve some values-oriented results. So you do some soul searching. “What is really important to me in life? What sorts of values really define who I am?”

Suppose you discover that you genuinely want to reach out and help those less fortunate. You decide that a plan to put your money to work for the betterment of society would be a kind of self-actualization for you. You don’t want to toss money frivolously in others’ laps, but you want to structure a plan to make your money work for the welfare of others over the long run. So, with the help of a financial advisor you develop a foundation that for years and years will finance inner-city initiatives to improve the lives of kids who are willing to show a work ethic and improve their education and social conscience.

As time goes on you begin receiving letters from successful men and women who profited from your foundation. An observer might say to you, “When you read those letters you must really feel happy.” You reply, “Happy? I guess so, but I think I feel more satisfied, completed, contented, knowing that I have contributed in some way to the betterment of humanity.”

Here’s the really nice thing: When you coordinate your actions to your values, you will find you don’t have to be rich to have a positive effect on your world. When your values enter the picture, you time, your energy, your brawn, and your brain can express your humanity in magnificent ways. You feel worthwhile in many ways, and you don’t have to get hung up on an elusive search for happiness.

 

 

 

OPTIMISM MUST FOCUS ON ACTIONS

An eminent psychologist told how when he was young, he bought into his parents’ encouragement when they said he could be anything he wanted to be. “So I decided I would be a shortstop for the Chicago Cubs when I grew up. Of course, as I grew older, it slowly dawned on me that I had nowhere near the requisite skills to be a major league ballplayer. Mom and dad were wrong.”

So what did our famous psychologist do? Did he quit life and blame his parents for all his misfortune? Absolutely not. He focused realistically and positively on his strengths, and worked hard to develop those skills. The point is, when stressed over failure, you must focus on doing a realistic appraisal of your strengths and weaknesses and base your actions on them. Do a behavior inventory of daily activities. Are they actions that make you feel more adequate and bring you satisfaction? Cultivate those actions that make you feel productive. Remember that praise from others is nice to hear, but actions that bring you personal fulfillment are much more important in enhancing psychological growth.

Make efforts to interact with people who complement you and your actions. Maintain your autonomy in those interactions because independent action increases personal satisfaction. If material rewards come from actions that make you feel productive, consider the rewards icing on the cake, not the reason you’re baking the cake. Exercise caution about using mood-altering prescription medication until you have done a thorough behavior inventory. Appreciate and enjoy the little things, especially those that are consistent with your values. Perhaps a smile from a child, a quiet walk in the park, contacting a friend, a good movie or book, helping others in need….those things that bring you satisfaction. If you are spiritual, use faith to give you confidence and remind you everything is not for you to control, but you can develop the courage to challenge things under your control.

Coping with your life from a realistic optimistic perspective will spur you to empower yourself and initiate autonomous actions that will give you feelings of personal control. Coping with your life from a pessimistic perspective will encourage you to turn sheepishly to others to manage, direct, and control your actions. Would you seek counseling expecting the therapist to wave a magic wand and make you all better? Do you look for the miracle drug to turn your life around and transform you into a new person? Those are dead-end roads, folks.

But you must understand and accept that coping with challenges in your life may be worthwhile but it’s not always easy. You’re going to have to put forth some effort to determine what you can control, and focus your actions within that context.