Out of the Blue: Six Non-Medication Ways to Relieve Depression (Norton Professional Books) (3 page)

When I was a psychology student, I learned about a phenomenon called “state-dependent learning.” The essence of this phenomenon is that our brains associate certain memories with certain other things, such as specific environments, sensory experiences (smells, tastes, sounds, etc.), and internal experiences (emotions, thoughts, images, etc.). For example, if you study in a blue room, you are likely to recall the studied material better if you take the test in a blue room or with something blue nearby. If music is playing when you fall in love, hearing that song again will take you back to those memories. The brain works by association, and certain associations bring up other associations.

This extends to emotions as well. If you’re happy, you will more easily recall happy memories. Thus it follows that if you’re depressed, it will probably be more difficult for you to recall happier memories. So, when you’re feeling helpless and resourceless, it’s harder to get in touch with resources.

And what happens when a depressed person seeks help from a mental health professional? Most of us therapists tend to ask our clients to talk in detail about their depression. Now, of course, that is part of our task: to assess the level and history of depression. But an inadvertent side effect can be a deepening of the depressive experience as we bring it to the foreground. Indeed, a recent study shows that extensive discussions of problems, encouragement of “problem talk,’’ rehashing the details of problems, speculating about problems, and dwelling on negative affect lead to a significant increase in the stress hormone cortisol, which predicts increased depression and anxiety over time (Byrd-Craven, Geary, Rose, & Ponzi, 2008).

In recent years we have learned that repeating patterns of experience, attention, conversation, and behavior can “groove” the brain; that is, your brain gets better and faster at doing whatever you do over and over again. This includes “doing” depression, feeling depressed feelings, talking about depression, and so forth. Thus, we can unintentionally help our clients get better at doing depression by focusing exclusively on it.

To counter this effect, let’s talk about an alternative that I call “marbling.”

My father owned several meat packing plants, and early on I learned to look at a cut of beef and see how much marbling it had in it. Marbling refers to the fat streaks embedded between the leaner meat in a cut of steak. It gives the steak more flavor.

In a similar way, but with less cholesterol, I suggest marbling discussions and evocation of non-depressed times and experiences in with discussion of depressed times and experiences. This way we don’t just evoke and deepen the depression, and we also avoid losing contact with the depressed person by not listening to her or invalidating or minimizing her suffering. By going back and forth between investigations of depressed experience and non-depressed experience and times, the person who has been depressed is reminded of resources and different experiences, and often begins to feel better during the conversation.

William Styron, who almost killed himself while going through a serious depression because he had become convinced that he would never come out of that painful state, put it this way after he recovered: “Mysterious in its coming, mysterious in its going, the affliction runs its course, and one finds peace” (Styron, 2008). But in the middle of it, one often forgets that there is any other place, or any experience other than unremitting bleakness and pain. It can be a lifeline to people in the midst of depression to have even a glimmer of the possibility that there will be experiences outside depression.

One of the first ways I suggest implementing marbling is to discover, with the person who is depressed, a map of her depressed times, thoughts, actions, and experiences as well as a map of her non-depressed times, thoughts, actions, and experiences. This is like asking the person to join you as a co-anthropologist of her life so that she can help you learn about the contours and geography of her suffering but also of her competence and better moments.

Let me give you an example. While traveling to do a workshop in another city, I was asked to do a consultation with a woman, Cindy, who was spinning her wheels in therapy. Cindy would get stuck in severe depressions on a regular basis and would basically stop functioning, quit her job, and become very dependent on her therapist, whom she would call many nights during the week in the depths of despondency and desperate for help. This had happened with several therapists in different places in which Cindy had lived as an adult, and she was just about driving her current therapist to her wits’ end. The therapist told me, “I feel like Cindy is sucking the marrow out of my bones, she’s so needy.”

I began my conversation with Cindy by asking what had brought her to therapy. She said she would be fine, feeling confident and competent, and then she would get depressed, losing her sense of confidence and sleeping until noon. There didn’t seem to be anything she or the therapist could do. The depressive episodes typically lasted about two months, after which the depressed feelings would begin to lift and she would pick herself and resume her life.

I asked her to compare and contrast the more confident and competent times with the depressed times, and the following picture began to emerge:

During her depressed times, Cindy:

•
Stayed in bed until noon

•
Got up, but stayed in her night clothes

•
Sat in her living room

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Ate breakfast cereals all day

•
Did nothing

•
Talked only to her therapist and one male friend (who was also depressed)

•
If working and beginning to feel depressed, went to lunch alone

•
Thought about how she was getting worse and how she might have to move in with her father and step-mother if she couldn’t care for herself, or even be committed to a psychiatric institution if they couldn’t care for her or got tired of her

•
Took her shower and got dressed in the evening

During her confident and competent times, Cindy:

•
Got up, showered, and dressed before 9
A.M.

•
Went to work or met a friend for breakfast

•
Did art or played music

•
Spent time with her girlfriends

•
Met a girlfriend for lunch if she was still working

•
Gave herself credit for small or big accomplishments in the recent past (e.g., getting a paper and looking for a job, finishing an art project)

As we talked about this, Cindy began smiling at times, even while discussing her depressive experience. (I said that I wanted to learn the Cindy way of doing a good depression, and this phrase seemed to tickle her. She also got a kick out of my naming her depressive experiences “Depresso-land.” Of course, not everyone would take this renaming as she did; some would see it as minimizing or invalidating. We therapists need to be sensitive to each of our clients, and this knowledge emerges from our conversations with them.)

If we were making a map of Cindy’s “Depresso-land” and “Confidence/Competent-land,” this is what the maps might look like:

As you can see, this approach is very individualized. No two people’s maps will be the same. We often talk about “depression” as if it were a thing, but although many depressed experiences share common features, they always occur in specific and particular ways for the person in front of us. The non-depressed features are also very particular and specific. But we are so often focused on the suffering (as is the person experiencing depression) that we neglect to investigate and discover other experiences that don’t fit with depression.

I once read a book on Zen and art (Pirsig, 2006)—the title long lost to the obscurities of my memory—and the author said that when an artist draws a tree, he doesn’t draw the branches and the leaves. Instead, he draws the spaces between the branches and leaves, and a picture of the tree emerges. This resonated with me because that’s what I do when approaching depression. I’m interested in discovering and detailing non-depressed experiences, actions, thoughts, and experiences. That way, I learn about the person’s abilities, competence, and good feelings as well as get a sense of the suffering she has experienced.

ONE FOOT IN: ACKNOWLEDGMENT AND POSSIBILITY

Working with people who are depressed can require a delicate balance. They are usually lost in their depressive experience and perspective, so you have to join them in that experience and let them know you have some sense of what they’re going through. At the same time, you have to be careful not to get caught up in that discouragement and hopelessness along with them.

Think of it as having one foot in their experience and one foot out. I call this Acknowledgement and Possibility. It involves acknowledging the depressed person’s suffering, validating his felt sense of things, and inviting him out of that experience.

When people don’t feel heard, understood, or validated in their experience, they often resist any cooperation or change efforts. On the other hand, if all one offers is acceptance and validation, it’s all too easy to help the sufferer wallow and stay stuck in his depressive experience.

I remember a client I had early in my psychotherapy career who would come in week after week soaking up my kind acceptance, unconditional positive regard, and empathy. She would get her weekly support session and then go back to her miserable life. During one session—it was probably about our twenty-second—I heard myself saying, “So, you’re depressed again this week.” And realized I wasn’t really helping her.

Around that time, I began to study with the psychiatrist Milton Erickson. He had many creative ways of challenging his patients to move on and change. I began to incorporate some of his methods into my work and noticed that my clients were changing much more quickly than they had before. But I still liked the warm, kind, active listening I had learned in my elementary counseling training and didn’t want to lose that respectful approach. So I combined the best of both worlds and created this Acknowledgment and Possibility method.

This method not only respectfully acknowledges the person’s painful and discouraging experiences, but also gives him a reminder that he isn’t always and hasn’t always been depressed. It can illuminate and prompt skills, abilities, and connections that can potentially lead the person out of depression or at least reduce his depression levels.

I came across a letter that Abraham Lincoln wrote during his presidency that illustrates his deft combination of joining and inviting. (As I said earlier, Lincoln suffered from a lifelong tendency to depression, or what was called melancholy in those days. He had been close to suicide during two major depressive episodes in his younger years.) He found out that Fanny McCullough, the young adult daughter of one of his generals who had been killed during the Civil War, had fallen into a depression that was lasting much longer than the usual grief period. She had taken to her bed in despondency, and her loved ones were worried about her.

When Lincoln heard of her plight, he sat down and wrote the following letter. (Note: I have italicized some of the Acknowledgment and Possibility parts of the letter to highlight them.)

Dear Fanny,

It is with deep grief that I learn of the death of your kind and brave Father; and, especially, that it is affecting your young heart
beyond what is common in such cases
. In this sad world of ours,
sorrow comes to all
; and, to the young, it comes with bitterest agony, because it takes them unawares.
The older have learned to ever expect it.
I am anxious to afford some alleviation of your present distress. Perfect relief is not possible,
except with time
.
You can not now realize that you will ever feel better. Is this not so?
And yet it is a mistake. You are sure to be happy again. To know this, which is certainly true,
will make you some less miserable now. I have had experience enough to know what I say; and you need only believe it to feel better at once.

I was moved, and hope you are too, by the kind and powerful way Lincoln joins with Fanny’s grief and validates her suffering while simultaneously inviting her out of it.

THREE TECHNIQUES OF ACKNOWLEDGMENT AND POSSIBILITY

How do you join while simultaneously inviting? Here I will show you three simple methods for putting one foot in and one foot out when talking with people who are depressed.

1. Reflect in the Past Tense

This first technique may seem too simple, but it can have a subtle and helpful impact. It involves reflecting what the depressed person is telling you as if it has happened previously but is not necessarily occurring now. For example, if a person says, “I don’t want to see anyone,” you might respond, “You haven’t wanted to see anyone.” If the person says, “I am suicidal,” you might say, “You have thought seriously about killing yourself.” In each of these responses, you will notice that the reflection is couched in the past tense.

To give you a chance to practice this technique, here are two statements that a depressed person might make. Cover up my sample responses below the blank and fill in your “reflect in the past tense” response.