Out of the Blue: Six Non-Medication Ways to Relieve Depression (Norton Professional Books) (12 page)

I once came across this quotation by Mark Nepo:

Each person is born with an unencumbered spot, free of expectation and regret, free of ambition and embarrassment, free of fear and worry, an umbilical of grace where we were each first touched by God. It is this spot of grace that issues peace. (2011, p. 3)

I think this must be right, since underneath the madness and despair that had gripped me, there was a clear-eyed, sane person watching out for me. I search for that in each of my clients, and even when it seems we’re not getting anywhere, I assume that somewhere in there, her Core Self is listening and watching and waiting for the opening to return to the driver’s seat.

Anyway, I think it was my Core Self that seized on that piece of music that gave me comfort and hope in my darkest hours.

Others may find such self-connections through journaling, through art, through praying or meditating, through dancing. Sometimes these pathways to oneself were well worn before the depression arrived; other times new pathways reveal themselves in the midst of depression. The idea is to search for and encourage the person to find any means of reconnecting to herself, however tentatively at first, and then to build on that connection until that connection remains solid enough to withstand assault on it.

Here is a sample conversation showing how the therapist and client might work to discover these connections:

Client:
I don’t even recognize myself anymore. I feel like an alien in my own life.

Therapist:
What kinds of things did you used to do to bring you back to yourself when you got too busy, too disconnected from yourself in everyday life?

Client:
I can hardly remember. That seems like a different life, a different me. I guess I . . . I used to keep a journal, and every so often I needed to get away from the city and be in nature. My cousin has this cabin I can use.

Therapist:
Do you think either of those things might help you come a little more back to yourself now?

Client:
I’m not sure. They might. I could use some time in a new environment. Maybe I’ll call up my cousin and ask him if the cabin is available.

Therapist:
And what about the journal?

Client:
I don’t think so. I’d just write about how depressed I am. I don’t think that would help. If I start to feel a little better, maybe that would be good to do again, though.

Connecting to the Body and the Senses

Many people who are depressed report that food loses its taste and enjoyment. Sex has no interest for them. They become alienated from their body; they hate their face; they see themselves as too fat, too skinny, too pasty, or whatever. They feel dissociated, disconnected from their physical and sensual self.

So, the next pathway to reconnection is through the body and the senses.

This may come through dancing, sex, athletics, yoga, eating fine foods, mindfully attending to the senses, and so on.

Parker Palmer, the spiritual writer, discusses a serious depression he experienced some years ago (February 26, 2009). Nothing could touch him. He would feel the sun on his face, but it didn’t really warm or touch him. He had no interest in anything. Friends and supporters would visit and try to talk to him and connect with him, but he could barely process their words.

One particular visitor, a Quaker man, began to visit every day. He asked Palmer if he could take off Palmer’s shoes and massage his feet. Palmer told the man that he really couldn’t feel anything through his body, so it would probably be a waste of time, but he assented.

To his surprise, he did feel something as the man massaged his feet. He felt . . . connected. The Quaker man returned daily, barely speaking a word, which was a relief to Palmer, since he couldn’t really follow or carry on a conversation. But this one connection, both to the man (we’ll get to this in the next section) and to his body, was the beginning of the end of Palmer’s depression and gave him some desperately needed comfort and relief that he began to look forward to each day.

It might be some particular food, or smell, or touch, or sight, but the idea here is to keep searching until one small connection to the body or the senses is found. Then expand on that, if possible, to create a stronger and deeper connection to the physical and the sensual.

Here’s a sample therapist-client dialogue:

Therapist:
Is there anything that gives you comfort these days?

Client:
Weirdly, taking a bath helps. My body feels relaxed and my negative thoughts diminish. I just drift, feeling more neutral. It’s funny; I hadn’t thought of that and really haven’t taken a bath for weeks. I should do that every day when I’m feeling so bad.

Therapist:
Sounds like a plan.

INTERPERSONAL CONNECTIONS

Connection to Another

I used to refer to this type of connection as connection to another person, until I had a client who was profoundly disconnected—from herself, from others, and from any sense of meaning or reason to live. She was constantly struggling with suicidal impulses.

When I asked her what had stopped her from acting on the impulses for so long, she replied without hesitation, “My dog. I love that dog. He loves me. No one would love him like I do if I weren’t here. I can’t leave him alone. He’s never abandoned me, like everyone else has, and I won’t abandon him, no matter how much pain I’m in.”

Obviously, our task in therapy was to help her get connected in other ways; we couldn’t count on the dog living forever. But after hearing what she said, I changed my label and my thinking on this kind of connection to encompass more than human beings.

Depressed people, even when disconnected from themselves and from the whole world, can, much more often than would be expected, connect to an animal. I had a client who was deeply connected to her rat, who lived on her body night and day, crawling in and out of her clothing routinely.

This category of connection refers to a one-to-one connection, the I-Thou connection that Martin Buber spoke about. It’s about an intense connection to one other being. Of course, this being is often another person rather than an animal.

William Styron writes of the intense patience and love his wife showed during his severe depression, and he remained connected to her in some way even when he felt he really couldn’t connect to anyone or anything. Andrew Solomon’s father dropped everything in his life to care for him when he became so depressed he couldn’t feed or bathe himself. I was married to someone who was so profoundly depressed that she was in a similar kind of state, and even though at times she railed against my attempts to keep her alive, much of the time she expressed gratitude for my never giving up on her, and she wanted no one else to see her in such a disheveled and desperate state. She had kept at least one connection when all else fell away.

So, here we are searching for one connection, to animal or human, and if one can’t be found, to try to encourage and nurture one.

My teacher and mentor, Milton Erickson, had a patient who was so disturbed that he found himself isolated from humanity. Erickson got a dog from the pound and told the patient that the dog was the patient’s dog and that he would have to come to Erickson’s home (where he also had his psychiatric office) to feed, water, pet, groom, and walk the dog daily. Erickson knew that the man was too unreliable to be counted on to care for the dog at his own apartment, but every time the dog came near Erickson, he would shoo him away to ensure that the dog got all the affection from, and thus bonded with, the patient. Caring for and bonding with this dog turned out to be a major factor in the patient’s treatment.

Equine therapy, which also uses this pathway, helps people find their way out of depression or other emotional or psychological problems by creating a one-on-one bond beyond horse and human.

All too many times I have heard depressed clients tell me that the reason they wouldn’t kill themselves is that they wouldn’t do that to or leave that legacy to their mother, father, spouse, child, or friend. This kind of connection can help people get through the worst times and bring them through situations they wouldn’t or couldn’t have gotten through on their own.

Now there can be a negative aspect to this kind of connection as well, so assess it carefully. For instance, one client would connect to only one friend when she was depressed, and their main focus was how depressed each of them was and how life was so terrible. This connection didn’t really provide relief from the isolation or connect the client to something helpful. It was more of the same, no different from the depression she sunk into alone, but amplified by the external element.

Of course, the therapy relationship offers a chance for this deep one-on-one connection. If trust and deep listening are present and time allows, the depressed person can find a place in which she doesn’t feel the need to be anything other than what she is. She can be cheerful or upbeat or fake, and this can create a deep bond, perhaps the only one she can maintain during the worst of the depression.

Indeed, there is considerable research that shows that the working alliance between therapist and client is one of the most significant factors in the effectiveness of therapy, much greater than whatever method or theory the therapist uses (Mallinckrodt, 1996). Being a therapist to someone in the throes of deep depression is an exercise in patience and persistence (and sometimes tolerance of irritability). One quality is particularly crucial in this situation: deep listening. More about that at the end of the chapter, but for now let me leave you with a quotation from Simone Weil:

Those who are unhappy have no need of anything in this world but people capable of giving them their attention. The capacity to give one’s attention to a sufferer is a very rare and difficult thing; it is almost a miracle; it is a miracle. Nearly all those who think they have the capacity do not possess it. Warmth of heart, impulsiveness, pity are not enough. (2009, p. 64)

So your task in fostering this kind of connection is twofold: first, to investigate and highlight existing connections to another that can be rekindled or drawn upon, and second, to deeply listen and connect to your client in the midst of her pain and, often, her irritability or attempts to push you away. Here is a sample dialogue illustrating these two ways to nurture connection with another:

Client:
I feel so disconnected from life.

Therapist:
Is there any person or animal you feel close to or don’t mind being around?

Client:
My cat.

Therapist:
What do you like about being around your cat?

Client:
The purring. I feel like my cat knows I’m suffering, and she purrs louder when I’m in a particularly bad place. It always helps me feel less alone.

Therapist:
So your cat is my co-therapist, eh?

Client:
Yeah, I guess so. Can you purr?

Therapist:
Not well, but I’ll work on it.

Client:
It must be horrible to listen to me complain and complain about how bad I feel and how things aren’t getting any better.

Therapist:
Not really. I feel bad because you’re suffering so much and because so far nothing we’ve done has helped you feel better, but I don’t mind being with you and listening when you’re suffering. No one should have to bear that level of suffering alone.

Client:
Thank you. Just hearing that I’m not boring you to death or driving you crazy helps. And it does help to have you, or anyone really, know what I’m going through. I don’t think I could bear this all by myself. My friends can’t take it, and I don’t want to upset my wife by telling her how I really feel. It would frighten her.

Connection to a Group or Community

A woman in her mid-twenties came to see me for therapy. She was depressed, but not majorly so. She had become bored with her life and dissatisfied with her work and friends. Everything felt empty. She spent most nights going to bars with friends, but those relationships were shallow. Meeting men in bars had initially been exciting, but that had ultimately become shallow and unrewarding as well. She felt flat, unenthusiastic, and didn’t really know what she wanted.

I asked her if there was ever a time she had felt connected, and she mentioned that she had grown up in a religion and had been really involved in the youth group there but had drifted away from that religion since she had left her childhood home. As we began to talk more about this time of connection, she said she had been thinking a bit about going back to church. I encouraged her to try it out, and she did.

She began to attend regularly and made some better and deeper connections there. She started to feel better and more engaged in life. She said, “My mother thinks you’re great, even though she’s never met you. You got me to go back to church. She said she thought therapy was a bad idea until now, but she’s become a great believer in therapy since she saw what it did for me.”

Social connections are at risk in modern societies. In the United States, shared family dinners and family vacations have decreased by over a third and having friends over to the house has decreased by 45 percent over the last thirty-five years. Participation in clubs and civic organizations has come down by over 50 percent in the last thirty-five years. Church attendance has decreased by about a third since the 1960s (Putnam, 2001).

We don’t have as many friends. The average number of people we consider close confidants dropped nearly one-third between 1984 and 2004, from 2.94 to 2.09. The average American has only two close friends. One in four Americans report that they have no one to confide in (Putnam, 2001).

Average household size has decreased by about 10 percent during the past twenty years, to 2.5 people. In 2005, more than one in three households were headed by a single parent. At the turn of the twenty-first century, 6.27 million people in the U.S. were living alone (Putnam, 2001).