Dancing with Depression (2)

What is Depression?

BY KARL LA ROWE - PUBLISHED: 06/25/2014 - SECTION: ARTICLES & BLOGS, CONTENT IN A BOX, HEALTH & WELLNESS, HELP & INSTRUCTIONS, KARL LAROWE, PERSONAL DEVELOPMENT

Introduction:

This is the second in a series of articles to help bring depression “out of the closet,” to demystify it, remove the sense of shame or defect for having depression and provide some accurate information about what depression really is and ways to learn to “dance” with it rather than fight it.In the last article depression was presented from a first hand account from having experienced it. This article will focus on what depression is, and what can cause it.

What is Depression?

There are many opinions about depression – what it is and isn’t, how you get it and what to do about it. The following explanation is based upon my personal experience as an individual who has lived with depression since childhood, as a client who has received therapy and medication for depression, as a mental health investigator and examiner who has evaluated people with depression in court commitment hearings, as a clinician providing counseling for people with depression and as a speaker, trainer and consultant who has explored alternative explanations for, and approaches to, understanding and transforming depression.

There are many kinds of depression. In the “old days” depression used to be categorized as exogenous and endogenous with endogenous being believed to be more a function of hereditary disposition and exogenous or “reactive” being more of a result of life circumstances. It was also believed that endogenous depression exhibited certain vegetative symptoms such as sleep and appetite disturbances, loss of pleasure and energy.

Today it is recognized that depression cannot be so neatly categorized and that there are many forms of depression. There is also much debate about the causes of depression, how much is hereditary and how much is environmental and how effective antidepressant medication actually is in treating depression. There is also lively discussion about the role trauma and traumatic stress plays and how re-exposure to another person’s suffering can trigger our own (unresolved) pain.

In very general terms, depression can be seen as a mental and emotional response to internal and/or external stressors or triggers that can result in a mild to severe sadness, depressed mood and/or loss of pleasure that can last for days, weeks, months, even years. It can be a one time occurrence, “single episode,” or it can be recurring. It is usually assessed as a “major depressive disorder” if it lasts more than two weeks. It is very often precipitated by an external loss or other event that can trigger the emotion but not always. It is often accompanied by changes in sleep, appetite, energy level, crying spells, difficulty concentrating and sometimes a desire to isolate yourself. In acute or severe depression there may be suicidal thoughts and impulses.

What Causes Depression? 

While the exact cause(s) of depression is still unclear, the development of depression can be seen as a combination of genetic factors, personal history, family dynamics, social and cultural influences and life circumstance. There are also numerous medical conditions that can present as depression and a medical screening is always warranted especially in the development of sudden and severe depression in someone with no history or family history of depression and no clear precipitating event. Depression can also be part of other emotional and mental conditions and enduring personality traits.

In my personal experience as a client and as a therapist, depression is most often precipitated by a sudden loss such as the death of a loved one or an important relationship, loss of a job, finances, of position/prestige or some other significant injury to one’s sense of self. The precipitating external event often initiates or re-engages an internal process of emotional pain often accompanied by self-depreciating thoughts that can become intertwined and mutually reinforcing. Painful emotions can lead to self-depreciating thoughts that can trigger more painful emotions. While there is still much debate about which comes first, the thought or the emotion, I personally don’t think it matters. To me they seem like heads and tails of the same coin.

When depression is a result of the activation and intensification of an internal process that becomes self-perpetuating and self-reinforcing, there are often unresolved emotional issues at play; past personal trauma being one of the most common. The relationship between Post Traumatic Stress Disorder and depression is well known. When past trauma is re-activated by current loss and/or traumatic stress, sudden and intense feelings of depression, hopelessness and helplessness are often activated.Unraveling the tentacles of trauma that are wrapped around depression can be complex and challenging and will be discussed in more depth in the next article.

In most cases, depression is “caused” by a triggering event that is personally painful, even overwhelming to the person experiencing it. The event usually triggers thoughts of worthlessness and self-depreciation and feelings of hurt and loss. In more severe cases previous trauma, old memories and self-defeating mental schemas are activated that can trigger intense feelings of hopelessness and helplessness and a downward spiral is set into motion. Left untreated this kind of depression can become severe and require intervention.

Next article will examine severe depression often associated with trauma, suicidal thoughts and impulses.

Dancing with Depression (1)

Introduction:

Dancing with Depression will be a series of articles written to let depression "out of the closet." It is estimated 350 million people world wide suffer from depression and that only two in ten people are receiving treatment. The shame and stigma associated with having depression especially among professional and family care givers often prevents us from seeking the help we need.

In Dancing with Depression I will share my experience as a consumer and a clinician who has had a life long struggle with depression, - nearly lost to suicide, received traditional treatment including medication and counseling and has discovered and developed non-traditional approaches including Qigong, meditation, somatic experiencing, visualization, Focusing and others to transform depression from a life-endangering fight into a dance.

I will describe how depression feels from the inside and share my clinical experience as a therapist working with hundreds of people who have suffered from depression. I am also writing this article for professional and family care givers. There is a close relationship between compassion fatigue and depression. Those of us who are repeatedly exposed to the suffering of people we care and provide treatment for are particularly vulnerable to depression.

The Roar of Depression

It’s sometimes the case in my life that I come to a point of understanding far removed from the place I originally expected to go. When Lean-Gaik - my wife - and I planned our trip to Maui 8  years ago I was certain this would be a joyful journey of clarity and enlightenment. Memories of the magical sojourn I made thirty years ago to the Seven Sacred Pools – at that time an enchanting and secluded place in Maui – filled me with anticipation and expectation. I was not prepared for the painful trek that was to unfold.

Our accommodations at the Sheraton resort near Lahaina were quite pleasant. We settled into a spacious room on the fifth floor overlooking the ocean. From our balcony the island of Molokini looked like a water color painting sketched on the horizon with cotton ball clouds floating across the mountain tops. The turquoise sea was alive with its continual motion, flickering white caps and soothing songs. Two large palm trees danced outside our window swaying to the rhythm of the wind.

On our first morning Lean and I drove into the town of Lahaina for breakfast and some shopping. The morning air was cool and the traffic was light. We enjoyed ourselves leisurely strolling through one shop and then another. The pace of life is so much easier in Maui. It almost seemed as though people even walked and talked slower than the more hurried pace of Portland, Oregon. At about noon we decided to drive back to the hotel to make some plans for the rest of our trip. Little did I know this would be the beginning of one of the most emotionally excruciating holidays that I can remember taking.

Lean and I had known each other for over 18 years and married for 16 of those years. We met by way of divine synchronicity next to a Mayan pyramid in Merida, Mexico. I was in the Yucatan recovering from a failed marriage, depression and burnout in my job as an emergency room mental health therapist. A Chinese citizen from Singapore, Lean was completing her Masters degree in Science and Education at the University of Iowa. We met on a tour of the ruins in Chichen Itza and fell in love Christmas Eve. She has been my lover, teacher, soul mate and on certain rare occasions, my tormenter. This was one of those occasions.

It started with a silly, senseless, even stupid argument that triggered a cascade of raw emotion drowning out sensitivity and sensibility. Before I knew it, I was out of the car walking down the side of a busy highway going absolutely nowhere. I vaguely remember asking myself; “where the hell was I going in this burning mid-day sun at least 10 miles from the hotel?” I knew I would have to return to the car and face Lean’s anger – I kept walking. After an hour my cell phone rang and it was Lean, crying, angry and scared. I had abandoned her and she was terrified.

I walked back to the car and saw her sitting frozen in the seat like I left her two hours earlier. I looked into her eyes and sensed her fear, anger and sadness. I felt sick. We drove back to the hotel without saying a word. I don’t even remember how I got there. In the room she began to sob and scream. Why did I leave? Where was I going? What was she going to do? How could I do this to her? She wanted to leave, to go home – back to Singapore, she was going to abandon me.

I suddenly felt something inside of me give way.  The very foundation that I was standing on collapsed. There was a soft roar in my ears as I felt myself free-falling, twisting and turning into the bottomless pit of agony and despair I thought I had left behind years ago with the attempt I made to end my life.  But, here it was again, the same emotional black hole that shattered my sense of self into a million little pieces that day I learned of my mother’s suicide.

Bits and pieces of fragmented memories began to flood my consciousness; walking home from junior high school where I had just started seventh grade, cutting through the neighbors lawn to see my little sister sobbing in the kitchen window, walking in through the sliding glass door to find my father sitting in a darkened living room staring coldly out the window, and the icy words that tore through my soul and etched themselves forever in my memory: “Mommy’s dead.” Nothing more; no reason, no explanation, no preparation, just; “Mommy’s dead.”

As these and other memories surfaced, emerged and then disappeared under the radar of my conscious awareness, I could feel an emotional shift at a cellular level. Rather than feeling the flow of energy and awareness freely circulating through my body and mind, I could sense the residue of traumatic memories freezing thought, energy, motion - even time. I was captured, held prisoner in the cold, timeless hell of acute depression.

Depression is not an unfamiliar experience for me. It's been an un-welcomed companion for much of my life. From seeds sown in early childhood, depression has its roots buried deep into my body and mind sprouting sharp, thorny, poisonous thistles when the ground was fertile with loss or abandonment; both real and imagined. 

It sprang up several times in my work as an emergency room mental health therapist co-experiencing the trauma of my clients. It nearly took my life as my marriage failed and career tumbled. It was my Sifu – my Qigong teacher and mentor who taught me to dance with depression rather than fight it, to make it my partner – not my opponent.

This time I was caught, blindsided by depression. I had not seen it coming. Even though I had thrown away my Prozac 15 years ago after learning Qigong, I still have episodes of sadness, decreased energy and enthusiasm. The difference is, rather than sinking into a bottomless black hole for months without end, these ferocious beasts had been transformed into tamed pets. Today my depression roared. (To be continued...)

Building Resilience with Positive Psychology

How Focusing on Strengths and Positive Emotions Can Make You Stronger

BY KARL LA ROWE - PUBLISHED: 09/10/2014 - SECTION: ARTICLES & BLOGS, HEALTH & WELLNESS, PERSONAL DEVELOPMENT

Introduction

Building Resilience with Positive Psychology is a presentation that was delivered for the Trauma Recovery and Corporate Solutions conference: Understanding Human Resilience sponsored by Changi Hospital, Singapore August 15, 16, 2014. This conference featured international speakers and presenters on the theme of how the new Positive Psychology can be utilized to develop resilience in healthcare professionals.

What is Resilience?

Resilience, is defined by Fred Luthans as “the developable capacity to rebound or bounce back from adversity…is arguably the most important positive resource to navigating a turbulent and stressful workplace.” [1] It is recognized that healthcare is one of the most demanding and stressful professions today. Resilience is the ability to rebound from stress and adversity even stronger than before. According to Everly, et.al., [2] there are seven characteristics of highly resilient people including:

1. Presence of calm, innovative, non-dogmatic thinking;
2. Decisive action (Courage: not afraid to fail);
3. Tenacity;
4. Interpersonal connectedness and support (may be single most important predictor);
5. Honesty;
6. Self-discipline and self-control; and,
7. Optimism and a positive perspective on life.

Positive Psychology

According to Dr. Martin Seligman one of the founders of Positive Psychology, “The aim of Positive Psychology is to catalyze a change in psychology from a preoccupation with only repairing the worst things in life to also building the best qualities in life.” [3] Since 1997 Positive Psychology as an academic and research science has investigated personal strengths and positive emotions that are the hallmarks of resilience.

Character Strengths

Character strengths are the hallmark of Positive Psychology and are defined as: “A preexisting capacity for a particular way of behaving, thinking, or feeling that is authentic and energising to the user, and enables optimal functioning, development, and performance.” [4] In this definition character strengths are capacities we already have and often utilize without being fully aware of it. These capacities are authentic, that is they represent who we are at our core and energizing, we feel good when we utilize them.

There are obviously many advantages to knowing and utilizing our strengths including:

• Utilizing your strengths activates personal resources that are already present.[5]
• Developing and maximizing personal strengths builds self-confidence and self-efficacy [6]
• Recognizing and synergizing strengths with others builds personal and organizational resilience. [7]

 Positive Emotions

A second pillar of Positive Psychology is the development of positive affect or emotions. It is noted by researcher Barbara Fredrickson that: “People experiencing positive affect show patterns of thought that are notably flexible, creative, integrative, open to information and efficient. In general terms, positive affect produces a broad, flexible cognitive organization and ability to integrate diverse material.” [8]

In her research she describes this “broaden and build” theory which states that when people feel more positively, their thought process changes. In essence greater positivity:

• Broadens our perspective and builds enduring personal resources; [9]
• Facilitates “approach behavior” that prompt individuals to positively engage with others; [10]
• Positive emotions “undo” negative emotions; [11]
• Facilitates faster recovery from adversity; and. [12]
• Helps develop greater tenacity at work. [13]

Building Resilience

Building more resilience then is a process of becoming more aware of and consciously utilizing our strengths and positive emotions. By discovering and consciously utilizing our character strengths more in our work and personal life we tap inner resources we already have but may not be fully utilizing to increase our sense of confidence, self-efficacy and build personal and organizational resilience. By learning to cultivate positive emotions we develop greater tenacity at work by broadening and building our perspective, being more willing to positively engage others and recover faster from adversity by overcoming our negative emotions.

The U.S. Army became so interested in this approach it hired Dr Seligman to develop a training program to help soldiers more resilient. [14] The critical components to this training include:

• Self-Awareness: Identifying counterproductive thoughts, emotions and behavioral patterns.
• Self-regulation: Develop the ability to delay acting on negative impulses: Stop! Relax. Breathe. Reflect.
• Focus on the positive, develop optimism. Challenge counterproductive beliefs.
• Mental agility: flexibility and openness in thinking.
• Focus on strengths to overcome challenges
• Connection: building strong relationships through positive, effective communication. 

Conclusion:

Resilience is one of the most important capacities that we have in being successful at work and happy in our personal lives. According to the science of Positive Psychology we can develop resilience by learning to focus on our strengths and positive emotions. In the words of Albert Bandura one of the most famous and quoted psychologists of our time: “In order to succeed, people need a sense of self-efficacy, to struggle together with resilience to meet the inevitable obstacles and inequities of life.”

References:

1. Luthans, F., (2002). The need for and meaning of positive organizational behavior. Journal of Organizational Behavior 23, 695-706
2. Seven Characteristics of Highly Resilient People: Insights from Navy SEALs to the “Greatest Generation” Int J EmergMent Health. 2012;14(2):87-93.
3. Seligman, M., Csikszentmihalyi, M., (2000). Positive psychology: An introduction. American Psychologist 55, 5-14.
4. Linley, A. (2008). Average to A+: Realising Strengths in Yourself and Others . CAPP Press, United Kingdom
5. Carver, C. (1998). Resilience and Thriving: Issues, Models and Linkages. Journal of Social Issues, 54, 2, 245-266.
6. Peterson, C. & Seligman, M.E. Strengths of Character and Well-Being. Journal of Social and Clinical Psychology, Vol. 23, No. 5, 2004, pp. 603-619
7. Sutcliffe, K.M., & Vogus, T.J. (2003). Organizing for Resilience. In K. Cameron, J.E. Dutton, & R.E. Quinn (Eds.), Positive Organizational Scholarship (pp. 94-110).
8. Fredrickson, B. (2001). The Role of Positive Emotions in Positive Psychology. American Psychologist 56, 3, 218-226”
9. Fredrickson, B., Positivity: Top-Notch Research Reveals the 3-to-1 Ratio That Will Change Your Life. Three Rivers Press, New York 2009.
10. Fredrickson, B., Positivity: Top-Notch Research Reveals the 3-to-1 Ratio That Will Change Your Life. Three Rivers Press, New York 2009.
11. Fredrickson BL. What good are positive emotions? Review of General Psychology. 1998;2:300–319.
12. Ibid
13. Ibid
14. Barry M. Staw, Robert I. Sutton and Lisa H. Pelled: Positive Emotion and Favorable Outcomes at the Workplace. Organization Science, Vol. 5, No. 1 pp. 51-71
15. Seligman, M.E.P, et.al (2011). Master Resilience Training in the U.S. Army. American Psychologist Vol. 66, No 1 23-34