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Thoughts About Depression

Richard O'Connor, Ph.D., Undoing Depression: What Therapy Doesn't Teach You And Medication Can't Give You (New York, NY: Berkley Pub Group, 1999). Order on-line


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Undoing Depression
by Richard O'Connor
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I Don't Want to Talk About Itby Terrance Real
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Paperback (pictured above)

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This is an unorthodox theory of change and recovery. I remember how for decades the analytic community debated whether true "structural change," as opposed to mere "symptom relief," could ever come from anything other than full-blown psychoanalysis. Now prominent scientists argue that recovery can come only from medication. These dogmatic positions are appeals to magic, not reason. I believe that people can make substantial changes in how they live their emotional lives, in their personalities, even in their brain chemistry, by replacing what depression has taught them with new, more adaptive, ways of thinking, feeling, relating, and acting. (page 5)

Depression is a disease of both the mind and of the body, the present and the past. In psychiatry now we have pitched battles going on between opposing camps, those who want to treat the brain and those who want to treat the mind. Both sides have powerful motives for pushing their own theories, some of which are idealistic and some of which are ignoble. Unfortunately, the patient is caught in the middle....Too much time and energy is spent arguing about whether depression is "caused" by early childhood experiences or neurochemical imbalances. Whatever the cause in the past, the patient and his family have to recover in the present. From the standpoint of effective treatment, pursuing these questions is not terribly relevant. Depression, like agoraphobia - another disorder that we now know how to treat - develops a "functional autonomy." Once begun, it continues even after the immediate cause is removed. The patient can have all the insight in the world, but the symptoms have a life of their own. (page 58)

It is as if depressed people have a leak in the part of the self that contains a positive, nurturing self-image. Instead of having a good opinion of themselves - a reservoir of self-esteem - that can be sustained through the vicissitudes of life, they are overly dependent on love, respect and approval from significant people around them. (page 64)

Depressed people work harder at living than anyone else, although there is little payoff for our effort. But in the course of our hard work, we become very good at certain skills. We are like weight lifters who concentrate exclusively on upper body strength - massive muscles in the arms and trunk but little spindly legs underneath - easy to knock down. Depression permeates every aspect of ourselves, but we can free ourselves by consciously deciding to do things differently. People get good at depression - they overadapt and develop skills that, at best, just keep them going, and often make things worse. (page 72)

People with depression have lost parts of their selves - a sense of resilience, a core of aspirations, a feeling of vitality - but they don't seek these missing parts directly. Instead, they put on a false front. . . .Those who love them can't understand why they are so difficult to be with and so unhappy. They have become experts at the skills of depression. They adapt certain psychological defense mechanisms to keep their needs out of consciousness. They know how to fool people, but they don't know how to get their own needs met. Many people with depression are experts at fooling people. They cover their own emotions. They act happy and successful. A career, a cause, an exercise regime, can become an obsession. "If I didn't work, then I'd have to think about how miserable I was and how I didn't have any friends and how no one loved me." (page 85)

Heart disease is a good analogy to major depression. Heart disease is "caused" by a complex of factors, including a genetic predisposition, emotional factors like how we handle stress, and habits like diet and exercise. You don't catch heart disease from an infection. You develop it gradually, over time, as plaque builds up in your arteries. Once you cross an invisible threshold marked by standards of blood pressure and cholesterol levels, you have heart disease, and you have it for the rest of your life. Yesterday you were normal, today you have heart disease. . . . Depression may be a similar threshold disease - genetic and biochemical factors may determine a different level of stress for each of us that, once reached, puts us over the edge into depression. (page 89)

People with depression have a special talent for stuffing feelings. They can pretend to themselves and the world that they don't feel normal human emotions. They are very good at the defenses of repression, isolation, and intellectualization. They raise self-denial and self-sacrifice to the point where the self seems to disappear. (page 97)

It takes a great deal of practice for the depressed person to learn how not to experience emotions, but we get very good at it. Women get especially good at not feeling anger and men get good at not feeling sadness. All of us stop experiencing much joy or happiness. It seems as if when you lose the ability to feel painful feelings, you also lose the ability to feel positive ones. We go through life numbed. (page 100)

Depressives assume that everyone else is happy most of the time, and that there is something wrong with us for not feeling the same way. . . . But the important implication for depressives is that happiness, instead of being a normal state of being that we don't experience because something is wrong with us, is something that must be cultivated. We need to practice feeling good. When we feel happy, we need to express those feelings to others. When we feel proud, we need to let ourselves sustain the emotion. (pages 116-17)

Most depressed people are great procrastinators. Procrastination means putting off for a later time what "should" be done now. The "should" may come from without, as with the teenager who dawdles over homework, or from within, as with me planting my garden. When it comes from without, it's easy to see the rebelliousness that procrastination expresses. When it comes from within, it's hard to see immediately what purpose procrastination serves - but it may serve many. Most procrastinators don't really know how work works. They assume that all really productive people are always in a positive, energetic frame of mind that lets them jump right into piles of paper and quickly do what needs to be done, only emerging when the task is accomplished. On the contrary, motivation follows action instead of the other way around. When we make ourselves face the task ahead of us, it usually isn't as bad as we think, and we begin to feel good about the progress we start making. Work comes first, and then comes the positive frame of mind. (page 129)

One of the bitter ironies of depression is that depressed people crave connection with other people, while the nature of the disease makes it impossible for them to connect. (page 155)

Depressives must learn to listen to and take care of their bodies. Divorced from feelings, we tend to see ourselves divorced from our bodies as well. But our "true self" is not up in our head behind our eyes - it is our whole self, body, mind, and spirit. Ignoring body messages like pain, fatigue, and psychophysiological symptoms just sends us off for unnecessary medical care - depressives dramatically overuse physical medicine - and makes us feel more depressed because the medical care is ineffective. (page 183)

Creativity is the antithesis of depression. It is a way of saying that what I think and feel matters. . . . Depression is not just an illness, but a failure of creativity. We all face the problem of creating meaning in our lives. When we're depressed, we've lost hope for meaning. We all need to make a deliberate effort to make the self fertile; for the depressive, that effort is essential to life. (page 323)

Depression is a disease and a social problem, an illness to be treated professionally and a failure of adaptation that we must overcome through self-determination. These days, with managed care and medication so predominant, I'm concerned that professional help can't go far enough. Medication and brief treatment don't reduce the likelihood of future depression. The grim truth is that if you have one episode of major depression, you have only a one in two chance of avoiding another; if you have two, your chances of avoiding a third are only 30 percent; and if you have three episodes, your chances of avoiding future depression are only one in ten. But I believe very strongly that a self-directed program of recovery such as I am recommending can reduce those odds, and increase our satisfaction with our selves and our lives.

Living your life according to these principles will not be easy. It requires a total commitment to change. It means accepting that much of what you take for granted about yourself contributes to your depression, and that you, and no one else, have to devote a lot of time and energy to a continuous self-examination. Then it means that you will have to self-consciously practice new skills to replace your old habits of depression. Learning new skills is not easy, but it can be done. As you are doing this, you are likely to feel anxious and uncomfortable. Remember this is the way you feel when you try anything new; with enough practice the new skills become part of yourself. And you will begin to recover from depression. (page 307)

Richard O'Comnnor's Web site is at:

Related stories:

Did you know? ..., facts about depression, from Richard O'Connor, Ph.D., author of Undoing Depression.

The "Way" of Depression by James Dolan

Interview with Terry Real, author of I Don't Want to Talk About It

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