Last time I discussed some of the symptoms caused by depression. Now I want to talk about some of the causes of depression and the accompanying anxiety.
Fear of abandonment
It has been said that babies are born with two fears: fear of falling and fear of abandonment. Children who experience the loss of a parent through death or divorce or being placed into foster care will feel abandoned, which leads to questions: Am I not loveable enough? Will my present caretaker abandon me, too?
That fear can be completely unconscious. I know a couple who adopted a one month old baby boy. In the one month before they got him, his birth mother decided she couldn't care for him, his birth father, who was not living with the mother, took him, but soon realized he couldn't care for an infant, and the child was put into a foster home and adopted a couple of weeks later. Now most people think that a child that young won't remember those events, and they won't--not consciously. Now that little boy is six years old and has nightmares of his parents dying. He can't endure separation from them in order to go to school. He has no idea why he feels this way. He's receiving psychological counseling, but his anxiety is so strong that it will take a long time to overcome it. What happened to him in the first month of his life may haunt him into adulthood.
Adults who aren't aware that they fear of abandonment may sabotage a relationship rather than take the chance of being abandoned again, and they won't even be aware of the reason for their behavior. Then they wonder why they end up lonely and depressed.
Fear of being unloved
Sometimes people feel that their parents never really loved them, that somehow they were a disappointment. That assumption can lead to a lowering of self-esteem and self-confidence. In this case, it's important to understand that parents' expectations do not impose an obligation upon the child.
One of my college students suffered from anorexia. I learned that her parents were a doctor and a lawyer and she told me that they wanted her to become a doctor or a lawyer. (I had no way of knowing how realistic her belief was.) At that particular time, she was faced with having to declare a major. She really wanted to become a biologist, but was afraid she'd be letting her parents down, so she had starved herself to the point where she had to be hospitalized for a year. She saw her alternatives as disappointing her parents (and losing their love and respect) or spending her adult life doing work she really wasn't interested in. The internal conflict she endured made death seem preferable.
It's also important to have an adult view of your parents. When you're a child, your parents may seem to know everything and to be able to do anything, so when they fall short of your expectations, you feel disappointment that's easy to interpret as being unloved.
Remember, too, that parents and children often have different personalities. A father who grew up loving sports will have a hard time understanding a son who's not interested in playing ball. Such mismatches can have parents thinking there's something lacking in their child and the child feeling that he or she is a disappointment.
The death of a sibling or a friend or even being present at the death of a stranger can leave the survivor with a sense of guilt. Why wasn't it me? Why am I still here? As illogical as it seems, the survivor can feel he or she has no right to enjoy being alive. This is a form of Post Traumatic Stress Disorder, and is not limited to combat veterans. A teenager who survives a fatal car accident can be burdened with the feeling that he or she did something wrong or should have done something to prevent the tragedy. A parent who loses a child is another candidate for PTSD. Therapy is often necessary to overcome the guilt and accompanying depression.
Feelings of failure
Feeling like a failure can lead to depression, and if you feel this way, there are two important questions you need to consider: 1)Is it possible that someone--a parent or a teacher, perhaps--shamed you, and you concluded that you deserved the label of being a failure? 2) Have you defined yourself as a failure?
In either case, you need to consider how realistic your definition of a failure is. Realize that Thomas Edison made 1,000 attempts to produce a working lightbulb. He later said, "I didn't fail 1,000 times. The lightbulb was an invention that took 1,000 steps."
J.K. Rowling's idea for her Harry Potter books was rejected 12 times. Lincoln lost 8 elections before he became President.
Are you quitting after a couple of setbacks and defining yourself as a failure? When you look back, do you focus on those setbacks instead of remembering the things you did that worked? In an earlier blog I talked about horribilizing, expecting things to go wrong. Horribilizing leads to procrastination, and procrastination doesn't lead to success.
The bottom line is: A setback is not a failure, but persistence is a necessity for success.
As I mentioned earlier, depression leads to horribilizing, that is, always expecting the worst. When you're anticipating trouble, your body goes on alert, and your amygdala--the part of your brain that prepares you to deal with stressful situations--becomes more active. You go into fight or flight mode, which is a good thing if you're actually in danger. Blood flows from your skin to your muscles, which tense up, preparing to run or fight. Your heart rate increases, and your eyesight, hearing and sense of smell become more sensitive, alerting you to changes in your environment. Digestion is interrupted, because digesting your food is less important that preserving your life.
But if you aren't actually in danger, and you are on constant alert, consider the wear and tear on your body. Those always-tense muscles lead to aches and pains, including headaches. While increasing your heart rate temporarily--as in exercise--strengthens your heart, constant increased heart rate can lead to heart disease. Frequently interrupting your digestion causes upset stomachs, constipation, diarrhea and nausea.
Emotions are affected as well. You may be easily agitated, irritable, moody or frustrated. You might feel overwhelmed and unable to relax, leading to forgetfulness and inability to focus. Clenched jaws and teeth grinding often follow.
Your brain suffers, too. Constant stress depletes the brain chemicals serotonin and dopamine. Serotonin regulates your mood, sleep, appetite and digestion, as well as memory and sexual function. Low serotonin levels also lead to impulsiveness and aggression. Low dopamine levels affect your memory and ability to concentrate.
One study I came across concluded that 50% of Americans with major depression don't seek treatment for their depression. Instead they look for "something to help me sleep," "something to help me relax," "something for my upset stomach or muscle pains."
Why don't they seek help for the cause of their health problems? One reason is that many people still fear that seeking psychological help will stigmatize them. Another--more important--reason is that many of them don't realize they are suffering from depression. They see their lives as being inherently stressful and are unaware that much of that stress is coming from within themselves.
If you experience more than a couple of the symptoms mentioned above, consider that you may actually be suffering from depression.
Depression and anxiety are often connected. Because depressed people think negatively, they regularly assume (or fear) the worst possible outcome, a process I call horribilizing, which raises their anxiety level. Now they're not only living with sadness, they're on edge, worrying and constantly anticipating problems. They can get caught in a cycle of ruminating, endlessly thinking about how bad they feel or what awful things might happen. All of this increases the activity of a part of the brain called the amygdala, which is designed to alert you to danger. The trouble is, when the danger isn't real, your body is experiencing unnecessary wear and tear, for depression and anxiety put your body under constant stress, inviting muscle tension, headaches, asthma and panic attacks as well as long-term damage. (More about this in another blog.) When you learn to monitor your thoughts, you become aware that you're making assumptions that aren't necessarily true and wasting time and energy preparing to deal with things that probably won't even happen.
One of the best ways to monitor your thinking is to write your thoughts down. Then examine each statement and ask yourself, "Is this factual or does this idea reflect my feelings?" Suppose you've written a statement like, "I really don't want to go to work today." That's a feeling. Now you have to examine why you feel that way. Perhaps your answer is, "My boss is never satisfied and always criticizes my work." See what's happening? You're attributing your feelings to someone else's behavior. Now you have to ask yourself how realistic that is. The first thing to do is question the words "never" and "always." They are often a sign that you're horribilizing. Are you exaggerating? Is every single thing you do
being criticized? Do you find it difficult to accept criticism? If, so, why? Is it realistic to believe that everything you do is perfect? Are some of the criticisms valid? If so, can you accept that? Are you responding more to your boss's choice of words or tone of voice that you are to what is being said?
Remember that some people are tactless--and that is not a reflection on you--and some people simply have an irritable personality--and that isn't a reflection on you, either. How does your boss speak to other people? How do others respond to him or her? Learning to analyze your thoughts forces you to rethink the way you're looking at the situation, and almost always there is more than one way to interpret events.
Here's an example: I once worked for a man who spoke in a loud, authoritative voice. I felt intimidated, as if I was being ordered around. After thinking about it, I realized he spoke to most people that way. Two exceptions I noticed were when he spoke to small children or to someone he was asking a favor from. Then I learned that he'd been in military and that his hearing had been damaged in combat--two things that affected the way he talked when he wasn't consciously aware that the tone of his voice affected the present situation. I decided that his manner of speaking had nothing to do with me, and my the tension level at work dropped considerably.
That insight continued to pay off, even for others. Years later, a friend complained to me, "My dog won't listen to me, even though he behaves perfectly for my wife!" This friend had a hearing loss and had a habit of speaking loudly. Because of my insight, I was able to point out that animals and children respond to loud voices with alarm, triggering the fight or flight response, and they generally react by avoiding you or becoming combative. My friend was surprised, having never thought of that. When he consciously lowered and gentled his voice, his dog and his son both responded positively!
Experts claim that the average person thinks anywhere from 12,000 to 60,000 thoughts a day, and that 95 to 98% of them are the same thoughts you thought the day before. Furthermore, some studies show that 70 to 80% of these thoughts are negative. You might think it's surprising that everyone isn't depressed!
We all have concerns and worries, regrets and unfulfilled desires that generate negative thoughts. The difference between depressed people and non-depressed people is the conclusions they draw from these thoughts and the actions (or non-actions) they take.
Suppose Maxine and Andrea each receive a call from their child's school, advising them that their child has vomited and is running a fever. Both mothers are upset as they drive to the school to pick up their children.
Maxine is worried, but she's also feeling angry. She's thinking that she'll probably have to miss work for a couple of days if she can't find someone to take care of little Max. Maybe it's the flu, and he'll be sick for a couple of weeks. She calculates the loss of pay and/or the cost of a caretaker. She anticipates losing sleep with a sick child. Furthermore, she'll have to cancel her book group and her best friend's visit. She decides this is going to be a terrible week.
Andrea has different thoughts. She wonders how serious the situation is. She realizes it might be a temporary bug or possibly the flu. She'll ask the school nurse whether little Andy has been given anything to reduce his fever or settle his stomach. If not, she'll give him the appropriate meds at home. She'll also ask the nurse what's been going around the school and whether she should have the doctor check Andy out right away to minimize the effects of flu if that is a possibility. She knows she may have to miss some work or find a temporary caregiver, but she'll figure that out somehow. As for other things on her schedule, they're not as important as getting her child healthy again.
See the difference? Maxine is horribilizing, expecting everything to go wrong, feeling helpless and focusing on herself and how circumstances are going to affect her. Andrea is focused on her child and what she can do to make the situation better. She's made a plan. She has also prioritized her values, so she can easily give up what she considers less important.
Depressed people focus on problems and conclude they are helpless. Then they let their feeling of helplessness rule their actions (or non-actions). Non-depressed people focus on solutions and take control or look for help, regardless of their feelings.
Becoming aware of your thoughts and learning to change the way you react is key to overcoming depression.
Studies are finding that many people are depressed, some even severely, and they don't know it!
That may sound unbelievable, but I was depressed for more than twenty years before I was diagnosed, and I was surprised to learn that there was actually something wrong with me. I had just thought that life was hard, so it was normal to feel sad, tired, anxious and even hopeless.
Nobody else realized I had a problem because, in spite of my depression--my constant fatigue, my sleeplessness, my expectation that no matter how hard I tried, I couldn't possibly do as well as I should--I functioned pretty well. There's even a term for this--it's called smiling depression, although when I look at pictures of myself as a child, I almost never smiled after the age of three or four or five, because that's when my depression actually began.
I wasn't in the depths of depression all of the time. Instead, my general mood was one of sadness, of not being good enough, no matter how hard I tried. From time to time--and for no obvious reason--I would sink into a world of blackness where life seemed hopeless. Nightmares would haunt me, and sleepless nights left me more tired than ever.
I later learned in therapy that each increased depression came about after some incident that unconsciously reminded me of the roots of my depression, which I didn't remember because they occurred when I was so young. Whether the memories were repressed because they were so painful, or whether they were simply buried in my unconscious due to early childhood amnesia makes no difference. At the time it seemed that my depression was worsening for no clear reason.
One of the difficulties in treating a depression that began in early childhood is recognizing that the depression is long-standing. When I first went into therapy, the therapist quite logically asked, "What's been going on?" As I had just had a child and left my job to stay home with the baby, our finances were tight. My husband was a student and we lived out of town because the rent was cheaper, so I was isolated with an infant all day. "Understandable," the therapist said. "Your hormones are readjusting, you're not getting enough sleep, you feel you've lost your professional identity, and you miss the interaction of your coworkers. No wonder you're feeling down!" It is true that just talking to a sympathetic listener made me feel better for a while, but before long, I was down in the dumps again. By then we'd moved across the country, and I had to find another therapist. He took the same approach with the same results. And so did subsequent therapists.
I kept searching for someone who could break the cycle. When a therapist couldn't find an immediate reason why I should feel down, I was given antidepressants. They only numbed me. Then I finally found someone who thought to ask me about my childhood. It was only when, with his help, I was able to recall the initial incidents, and to view them with adult eyes and understanding, that healing began. I could then alter the patterns of depressive thinking that I had lived with for so long.
What sorts of things might be clues that you're depressed, but you don't realize it?
Are you always tired; unable to concentrate; often irritable, even angry; experiencing aches and pains that seem to have no cause; unable to enjoy almost anything; self-medicating with sugar, alcohol, caffeine, amphetamines or other drugs; beating yourself up; feeling numb; or thinking about death?
It's unlikely you'll have all or even most of these symptoms, but if you have more than one or two, you may well be suffering from depression. Remember, too, that if these symptoms have been around for a long time, it's important to look beyond what's happening in the present and discover the roots of your depression.
Today I'd like to address a specific form of faulty thinking that often plays into depression.
Do you feel that somehow you've been cheated? Does it seem that everyone else has it better than you do? In today's society where so much attention is directed to having better "stuff" than the next person, and where 20% of television time is devoted to telling you that you need the latest model of whatever they're selling, it's easy to feel that you should have a lot more than you do.
On top of that, when you look around and it seems that everyone else is enjoying themselves, it's easy to feel that you're being left out of something important.
I remember a time, earlier in our marriage, when we were living on a tight budget, a couple befriended us and invited us to their home. We were living in a small house (all we could afford) with second-hand and garage sale furniture. They lived in a tastefully furnished luxury apartment. I remember worrying that our three year old son might accidentally spill something or put sticky fingers on that expensive-looking sofa, but the woman dismissed my concern, telling me that she and her husband loved little children. We quickly discovered that they and we both played bridge, and soon I was faced with the necessity of inviting them to our home. I was in one of my deeper depressions at the time, and I felt totally inadequate. Their life seemed so wonderful. They played tennis regularly, traveled widely, belonged to several social groups and entertained a lot. In contrast, my husband worked long hours, we struggled to make ends meet, and depression drained my energy to the point where it seemed there was no joy in my life.
Then I learned that they, too, were struggling. They desperately wanted a child and for several years had gone from one fertility center to another, only to be told over and over that it was very unlikely that they would ever have a child of their own.
I was shocked to realize that we already had what they so desperately wanted. I learned a great lesson when I asked myself if I would trade places with them. I couldn't imagine life without our little boy. That would create a hole in my heart that nothing--not a beautiful home, lovely furniture, money, travel, or a busy social life--could ever fill.
The lesson I learned was that we all have gifts and we all face challenges, but sometimes we don't appreciate or even realize the gifts we already have, and often the challenges others are dealing with are not apparent to us.
We generally assume that our thoughts are true and logical and don't stop to examine them. Depressed people, however, habitually think negative thoughts that are exaggerated, unrealistic and often untrue, and the more negative thoughts you have, the more depressed you become.
How do you get rid of negative thoughts? First, you have to become aware of them. If, for example, you often think, "Nothing I do ever turns out right," you need to check the validity of that statement. Would it be more accurate to say, "Often the things I do don't work out"? How about, "Sometimes what I do doesn't work out"? Depressed people have a tendency to look only at those examples that back up their negative ideas and ignore the facts that contradict them. Beware of thoughts and statements that use the words "always" and "never." They are likely exaggerations and not a true representation of the facts.
Difficulty making decisions
Another trait of depression can be difficulty making decisions. Here's an example of how that ties in with unclear thinking: I once went shopping with a lady friend who was looking for some curtains for her dining room. After looking at a large number of samples, she found three that she liked, but was unable to make a decision, so she bought all three sets, charging them to her credit card. "I'll take them home and decide later," she said. I pointed out that since she charged the curtains, and she never paid her credit card up in full, she'd be paying a high rate of interest on all three sets until she returned the ones she didn't want. She shook her head. "But I really like all three. I just can't decide." I told her that if she really liked all three, it didn't matter which she chose. She'd have curtains she really liked. She couldn't see it. She was convinced there was a BEST choice, and she'd be miserable if she didn't make it. I don't know whether she ever made a decision, but whether she did or she didn't, I'm sure she ended up being miserable.
When I was teaching, students would sometimes approach me and ask whether I though they had writing talent.
I hesitated to use the word "talent" because so many people think that if you have talent, everything becomes easy.
They want to believe that they won't have to spend hours practicing and learning their craft.
On the first day of class, I used to ask my students to introduce themselves and tell the class what they liked to read and what they wanted write. One young man said he wanted to write science fiction. "And what authors do you read?" I asked. He replied, "Oh, I don't read much." He had no idea that the first thing writers do is read, read, read.
Otherwise, how are you going to know what's selling and what's already been done?
Another young man asked me, "If I write a story and send it to an editor, and it's rejected, does that mean I'm not a writer?" He had no idea that 99% of all manuscripts are rejected. Best selling authors have collections of rejection slips. Talk about unrealistic expectations!
Yet many people who think that everything comes easy to others tell me that their depression would vanish if only life lived up to their expectations.
More about unclear thinking next time.
I've heard people say, "I've tried therapy, and it didn't work." The fact is, sometimes it doesn't, and there are various reasons why. I had to go through several therapists before I found one who was really helpful. When we moved across the country, I had to go through another search for a therapist who realized what I needed.
If you haven't had a thorough physical exam before entering therapy, a depression that's due to a simple physical cause like a low thyroid may go untreated while you spend time and money talking about your feelings or taking antidepressants, neither of which will make the underlying problem go away.
Different kinds of problems require different kinds of solutions. Sometimes a therapist will first try what has often worked with other patients without realizing that your problem may be different. A good therapist will see pretty quickly that a method isn't working, and try something else, but a certain amount of patience is necessary, because depression often doesn't respond to treatment overnight.
If your depression has been coming and going for a long time (you might even be labeled a depressive personality), therapy may become a lot like an archeological dig to discover where the problem really began. In my case, I first entered therapy a few months after the birth of a child. As I had decided to leave my job to care for the baby, it seemed obvious the resulting financial strain plus the loss of my professional identity as well as the loss of camaraderie of my co-workers might be the root of my depression. Even though several sessions of discussing my feelings with the therapist did make me feel better, depression returned with a vengeance a couple of years later. By then we had moved again, and once more I had to go through several therapists before I finally found one who realized that I had repeatedly suffered from depression from early childhood. Thus began a long dig to uncover the memory of the incident that began my depression. Finding the right therapist is only part of the solution. You have to be willing to stick with it for the long haul.
Sometimes therapy doesn't work because the patient isn't doing his or her part. Often fighting depression requires you to make significant changes--in your thinking, in your daily routine, or in the way you view other people in your life. If you've made up your mind that you'll never be happy unless someone else changes, you're doomed to be depressed. The only person you can change is yourself, and making major changes in yourself isn't easy. The therapist can't make you change--YOU have to do it, and that takes work.
Therapy also doesn't work when the patient is blind to the truth. Sometimes we don't want to see the role we've been playing in our own unhappiness. You have to be willing to take a deep and honest look at your own thinking and behavior. I've known people who quit therapy because the therapist had the "nerve to suggest" that the patient's behavior was part of the problem.
Finally, sometimes we remain depressed because we want to hang onto unrealistic expectations when what we really need to do is accept reality. If you hear the word, "acceptance" and believe it simply means "quitting," I suggest you give some thought to the Serenity Prayer:
God grant me the serenity to accept the things I cannot change,
Courage to change what I can,
And the wisdom to know the difference.
When I was in elementary school, the little girl who sat across the aisle from me in second grade had trouble getting her homework done on time. Laboriously printing each word with a pencil, striving to shape each letter perfectly, she'd inevitably make a less than perfect letter. She couldn't bring herself to erase the letter and redo it--she had to start with a fresh sheet of paper and begin again. Despite our teacher's reassurance that it was all right to have an erasure on her worksheet, the girl insisted on doing it her way. Naturally, every assignment was an exercise in agony. I often wonder how her life turned out.
Are you a perfectionist? Can you never be happy with your accomplishments? Psychologists say there's a connection between perfectionism and depression. How can that be? There are many super achievers who aren't depressed, aren't there?
The difference is in how they think about themselves and what they accomplish.
Depressed people see a setback as a personal failure and react with self-criticism. Healthy people know they're not going to get it right every time, and they don't expect to. Imagine a baseball player who thinks he must hit a home run every time he comes to bat. That unrealistic expectation guarantees he'll fail the majority of the time. The student dooms himself to depression when he thinks that anything less than an A (or even an A+) is some sort of personal failure. This "all or nothing" thinking is common is depressed people.
Psychologists say that perfectionism is a personality trait, meaning you're born that way. So how do we get to a state of healthy desire to excel versus unhealthy perfectionism? The answer is in your thinking processes and in what you fear. There's a difference between a desire to excel--do your very best--and a desire to be perfect. Look at the standards you set for yourself. Are they excessively high? Do you believe that anything less than being number one is a failure? Do you believe that the only way to get others to admire and respect you is to be the best?
Where do these beliefs come from? Some say they're afraid of disappointing their parents. True, some parents set excessively high standards for their children, and in that case, it's important to realize that the problem lies with the parent and not with the child. A healthy parenting style means that parents realize that their child is not a carbon copy of themselves, and doesn't exist to fulfill their own dreams. Other parents may seldom express approval of the child's performance, simply because they have an aloof personality, or because they themselves were brought up that way. In this case it's important to realize that the child may be misinterpreting the parents' behavior as disapproval. In other cases, the child may simply misinterpret the parents' well-meaning messages. For example, a parent may try to be encouraging (Come on, Kelly, you can do better!) and the child reads that as disappointment in his or her performance. In all these cases, therapy can be very helpful.
Other perfectionists say they are afraid of not being accepted by their peers if they are not the very best at what they do. They fail to see that such reasoning means that either their peers are not the kind of people whose acceptance is worth much, or their belief is unwarranted.
Whatever fear drives your perfectionism, the results are often embarrassment, guilt and/or procrastination. After all, you can't fail if you don't try. But then you never succeed, either!
Last time I talked about how moods can be triggered unconsciously. Suppose I'm walking down the hall and I pass a man who's wearing the same aftershave my late father always wore. Because I miss my dad, I might experience a wave of sadness without realizing why. In a normal, healthy person that feeling would pass in a short time with no ill effect, but in a person who tends to depression, it may linger and become a mood--which lasts longer and is harder to dispel--unless something happens to distract her and lift her spirits.
If you pay attention to your moods--particularly to when they begin and what happened at that time, you can learn what triggers your moods, and knowing what triggers good and bad moods gives you control over your emotional life.
We all know difficult people, and dealing with them often drains us of energy and leaves us feeling down. The simple answer is to avoid them, but if it's a family member or someone at work, we are periodically faced with the unpleasant chore of dealing with that person.
If I know I must deal with someone who's difficult, I make a plan. I will not argue if that person is one who will continue an argument ad infinitum, I will not commit to doing something I really don't want to do, I will limit the time I spend with this person, and I will not hesitate to say, "NO!--even to a person in authority, if need be. Note here that saying, "NO!" does not mean arguing or getting angry. Simply explaining why you are refusing to do what that person is asking works wonders with most people, although with difficult people you may have to say, "No!" repeatedly.
I will be the first person to admit that I am by nature a people-pleaser, and I had to work hard to learn to stand up for myself, but knowing that I can stand up for myself has made my life a whole lot happier.
What if I must go to a place that brings back bad memories? I arm myself with thoughts of happy times and remind myself that the bad things are in the past and don't deserve my emotions now. I make plans to do something I enjoy afterward.
Such techniques will help you get through the rough spots. Even if you experience temporary unpleasant emotions, you will not give them the power to become a lasting mood.
Stephanie Kay Bendel is the author of EXIT THE LABYRINTH: A Memoir of Early Childhood Depression – Its Onset and Aftermath, MAKING CRIME PAY: A Practical Guide to Mystery Writing, and A SCREAM AWAY, a romantic thriller published under the house name, Andrea Harris. She has also written numerous short stories and articles on writing.