Warm Horizon

Notes from Jim

Remember that a mental-health professional will know a great deal about any depressed person’s problem because of her/his familiarity with it. These professionals will be very supportive and possibly the best friend you can find in your time of need. The sooner you can begin treatment, the more likely it will be short in duration and successful.

Many people with depression seem to believe that if they tell someone about it, the revelation will more completely solidify the problem. But know this: If you are feeling significantly depressed, and are making excuses, and are afraid to be evaluated, the problem is likely already solidified.

Also remember, when you involve yourself in treatment, you remain in control, and treatment decisions must be agreed to by you. (The only exception to this is if you are confused and/or out of touch with reality. Then, a legally designated family member would make those decisions.)

I worked with an inpatient who was a high achiever and owned his own home-maintenance business, which was long-established and quite successful. This man was in his late-forties and had become depressed after having to discontinue an antidepressant—because of suddenly developing very high blood pressure—that had worked quite well for more than twenty years. Within several days of discontinuing his medication, which is known to cause high blood pressure in many, he found himself resuming the same disabling symptoms of depression he had first experienced in his twenties. With the return of anxiety and suicidal urges, it was impossible for him to live comfortably—much less run his business. He was worried about his family. He was worried about his four employees. Emotionally, he was “a mess” and had no qualms about admitting it.

I chose this example to illustrate two points: (1) The proper treatment (medication in this case) can essentially eliminate the incapacitating symptoms of depression in many cases. (2) Medical treatments generally bring about alterations in brain chemistry that result in the lessening or arrest of symptoms but leave the generating factor(s) unaffected. Thus, the man above had a full return of symptoms as soon as the effects of his medication were gone. (Often, satisfactory effects from antidepressants last for only a matter of months before dosages are increased or new ones have to be tried or added.)

So we are faced with the choice of relying completely on treatment and making no effort to reduce our vulnerability to recurrent depression or of attempting to eliminate our vulnerability to depression through understanding, a change in perspective, and, possibly, a change in life-style. I am sure you will make the choice that is right for you.

In considering the reality of our early days in the human body, it is important to understand that we are born into the physical world without the ability to cope with its reality. That is, we have no way of understanding and thus anticipating cause and effect. Therefore, we naturally and automatically find ourselves resentful of reality. Consequently, if we suddenly feel pain without any conception of why, if we are unable to have a need met immediately, if we are scolded for a reason we can’t understand, or if we are guilty of some unacceptable behavior about which we have been warned but are incapable of controlling, we commonly summon tremendous rage in an effort to deal with the fear and vulnerability associated with the unacceptable circumstance. In essence, we are “set up” by not only being vulnerable to the physical world in general but, more specifically, by being vulnerable to the limitations of our caretakers.

From this predicament, we establish a tendency to perceive reality in ways that are suitable to us. Conversely, we attempt to refuse to accept the reality of any situation or circumstance that goes against our interests. And so it is with our narcissistic ways of early life. Our resentment of, and impatience with, reality manifests as demanding, stubborn, intolerant, and (attempts at) omnipotent behavior. And when we summon rage over being rebuked or denied in some way by our caretaker, our behavior will serve to prompt the caretaker to:

(The third response is the healthiest: no fear is instilled and no reinforcement of the rage occurs.) In each case, rage continues to be an available means of attempting to cope with reality.

One of the major points to be made in this program is that the worth of our self is separate from the worth of our actions. We have “no idea” of this fact early in life and that ignorance is probably the major factor in the development of the emotional “issues” that plague us throughout much or all of our lives.

The first person I heard make the distinction between who we are and what we do was Bill Russell, professional basketball hall-of-famer and former Boston Celtic. I had the opportunity to hear him speak to a local sports club in the 1970s. And in his speech he initiated his point with the following comments:

Although he made only a few more comments on the subject, his point was clear—at least to me: Don’t confuse what one does with who that individual is.

At any rate, when we are two or three years old, we do not have the ability to separate ourselves from our actions, or, most notably, from what happens to us. Therefore, if we perform in some way that is unsatisfactory or disappointing to our parents, then we conclude that we are inadequate—a conclusion our parents also may accept. Of course, the actual truth is that we have only performed or behaved in a manner that is disappointing to our caretakers. But unfortunately, being unable to make that distinction, we accept this false assumption and summon the emotions that naturally stem from it.

Furthermore, if we experience major trauma (physical or sexual abuse, abandonment incidents, major physical injury, and so on) at such early ages, the full gamut of negative emotions can be summoned with no conceivable means of coping available to us. The result is often a lifetime of emotional hang-ups and, commonly, episodes of depression.

It is not uncommon that persons with depressive illness find themselves saddled with psychological, physical, and sometimes sexual abuse on the part of their significant others. Depressed women, naturally, are primarily the victims of such behavior, but there are exceptions. And although many victims of abuse have low self-esteem that unfortunately serves to egg on their abusers, we must never lose sight of the fact that such behavior—even verbal abuse and threats—constitutes a crime, and should be treated as such.

Most victims of abuse—with depressive tendencies or otherwise—have abandonment issues and as such are deathly afraid of losing their relationship (or having it fail). Thus, unacceptable treatment on the part of their significant others is ultimately viewed as an indication that the relationship is failing which in turn drives the fear of separation up instead of driving the fear of bodily harm up. From that predicament, the narcissistic (childish and self-centered) impulses that culminate in abusive behavior are not only reinforced but are primed for further initiation—a problem abusers will never handle without extreme difficulty.

So if you are depressed and having to deal with an abusive relationship, you probably will not be able to resolve your depression until you get away from your abuser. And you likely will need much assistance and support to do so—so let close friends and perhaps those of a support group (Chapter 5) be your support. Such action is absolutely necessary if you are to move forward with your life and with resolution of your depression. You deserve better.