Judy Cares About… Depressed People

(Wake me up)

Wake me up inside

(I can’t wake up)

Wake me up inside

(Save me)

Call my name and save me from the dark

(Wake me up)

Bid my blood to run

(I can’t wake up)

Before I come undone

(Save me)

Save me from the nothing I’ve become

Now that I know what I’m without

You can’t just leave me

Breathe into me and make me real

Bring me to life

Evanescence

This psalm-like contemporary song by the group Evanescence often comes to mind while I work with depressed people. What a lot of people who have never been clinically depressed have trouble understanding is that depression is more than just “the blues” or a “bad attitude.” I become concerned that someone may be clinically depressed who experiences at least five of the following symptoms over at least a two-week period:

1. Depressed mood most of the day, nearly every day. This can be observed by the person him or herself, or by people close to the person.

2. Markedly diminished interest in the person’s favorite activities.

3. Significant weight loss or weight gain, without a change in diet having been made. Decrease or increase in appetite. For children, failure to make expected weight gains is observed.

4. Insomnia or sleeping too much

5. Restless movements or greatly showed movement, which is noticeable to others.

6. Fatigue or loss of evergy nearly every day.

7. Feelings of worthlessness, or excessive guilt, nearly every day.

8. Inability to concentrate, difficulty making decisions, nearly every day.

9. At least two angry outbursts, which is uncharacteristic behavior for the person.

10. Recurrent thoughts of death, thoughts of suicide but no specific plan for suicide. Thoughts of suicide with specific plans for how to carry out the suicide.

11. A pervasive sense of hopelessness. Person expresses that things will not get better. Inability to receive comfort as comforting.

Someone you care about may be experiencing a painful breakup, a job loss, the death of a family member, or a draining cross-country move. While struggling with these events, most people will experience good days and bad days. The clinically depressed person will have very few good days in their recent history, and to them, as they struggle with their symptoms, it seems that life will never get better. Of all the emotional problems that a person can experience, depression is probably the most responsive to psychotherapy, or “talk therapy.” Because the therapeutic experience can make such a huge difference in a person’s life, I have paid close attention to what works to alleviate depression, and what doesn’t.

My first priority with depressed clients is to make sure the client is safe, and to ascertain whether the client has a support network. I also want to get to know the client. His or her values, significant relationships, past achievements, and disappointments are all important. The first few sessions may be devoted entirely to these two goals, without attempting to resolve problems or make huge lifestyle changes. It is less effective to try to “fix” or solve a person’s problems than to simply empathize and listen to what is happening in the client’s world.

Once I know the client more than superficially, I try to increase the client’s awareness of their thought processes. Particular attention is paid in the session to negative thoughts that seem to be making the person more depressed. Some typical negative thoughts include:

• “I am a failure unless I am perfect”

• “I will probably be abandoned by those close to me”

• “My sins and failings make me unloveable”

• “I am a bad parent/sibling/friend”

The depressed person can have these thoughts in connection with their setbacks and problems, or even when things go well. For instance, when a family member says, “I love you,” the depressed person may immediately think about being undeserving of love because of their sins and failings. Once the client is more aware of a particular negative thought, the next step is to teach the client how to generate a positive thought that they consider to be a believable replacement for the original negative thought. The person who is reminded of their sins and failings when someone says “I love you” might benefit from remembering that the people they love are probably not perfect. One’s faith perspective can fuel the healing process. For instance, Christians believe that God loves them despite their failings and sins.

In addition to developing a trust-based therapeutic relationship, and replacing negative, self-critical thoughts with truthful positive ones, it is important for the therapist to help the client develop and nurture their own personal narrative, the story of their life. Once the depression symptoms start to improve, sessions can be focused on where the client came from, where the client is now, and where the client would hope to be in the future. The client’s inner goals and ideals figure prominently during this phase of therapy. Developing one’s personal narrative, the story of my life which I don’t give up to anyone or anything, safeguards people from depression. We all have responsibilities and roles to fulfill, and it is normal and right to do everything possible to make good on our promises. The problem is becoming lost in our prescribed roles, or a prisoner to our outward accomplishments. If personal goals and ideals are not nurtured along the way, but endlessly deferred, depression can result or recur. Everyone can benefit from developing their personal narrative, because people who know how to connect with and nurture their core can meet their responsibilites and keep their promises out of the wealth of their personal experience.

The plan for working with depressed people is not always as smooth and straightforward as the description above would make it seem. Some people have very severe symptoms, while their thoughts are all mixed up and unclear. The person suffers deeply, and seriously cannot envision a time when things will not be terrible for them. They find it difficult to connect with anyone. Inner goals and ideals seem very remote and unattainable. Life is so painful for these people that a few will even consider ending their life to escape the pain. This is when I point out, as sensitively as possible, that there must be a reason why their eyes opened this morning, why their heart is still beating and their lungs are still taking in oxygen, and why they know in their innermost center that this kind of suffering is not healthy. Something inside of them is saying “Wake me up inside”, “Cause my blood to run”, and “Call my name and save me from the dark.”

Even when every part of a person’s life seems to be working together to create a sense of hopelessness, there is always, paradoxically, an unseen internal, life-affirming force moving them toward healing. People who nurture their spiritual life recognize that force to be God. For others this may be symbolized as the love of family or friends, or the desire to do something good for the world. I care that my clients have the opportunity to talk about this inner drive towards healing, and contrast it with the hopelessness they feel. There is no program, diagram, or commercial product that can neatly produce hope and healing. Talking with someone who is trustworthy and empathic can, in its imperfect way, make a difference in a depressed person’s life.

If you would like to think more concretely about your personal narrative, perhaps it would be helpful to consider the following questions:

• What are the core beliefs that guide you? These are the most important things about your central self, aside from your roles.

• What are your basic expectations from life, and have you been disappointed in any of these?

• What is an ambition of yours?

• If you had a whole day free to do whatever you want, how would you fill that day?

• How would you wish to be remembered after you die?

• If a story about you were on television or radio, what would you hope to be said about you, not necessarily about your accomplishments, but about your character?