When I see someone with depression at their lowest ebb when everything seems black and whatever I suggest is met with profound negativism. They present in many different ways and may have some insight or may be in total denial.
Churchill referred to his depressive episodes as ‘the black dog’ and it has been suspected that it was Churchill’s recurrent episodes of depression that allowed him to realistically assess the threat of Germany.
Psychiatrist Anthony Storr described how Churchill used his experiences of depression to inform his political decisions: “Only a man who knew what it was to discern a gleam of hope in a hopeless situation, whose courage was beyond reason and whose aggressive spirit burned at its fiercest when he was hemmed in and surrounded by enemies, could have given emotional reality to the words of defiance which rallied and sustained us in the menacing summer of 1940.”
The quote that I find illustrates what I want to say is:-
“A pearl is a beautiful thing that is produced by an injured life. It is the tear [that results] from the injury of the oyster. The treasure of our being in this world is also produced by an injured life. If we had not been wounded, if we had not been injured, then we will not produce the pearl.” Stephen Hoeller
Over the years I have seen a huge variety of people with depression, head teachers, lawyers, research scientists, doctors, infact people of all ages from all walks of life. They all present with hopelessness and dwindling lack of interest in life and I see it as my job to help them discover a gleam of hope in order to work themselves out of this painful state.
They usually claim they have tried everything but nothing works, they don’t trust anyone and they don’t see a way forward.
However, as I reflected on the different people I have seen over the years and followed them up I feel uplifted by the fact that most of them have emerged out of this state to be happier, more fulfilled people and have turned around their lives in a positive way and this empowers me to feel hopeful about true recovery.
Something that I have suggested on many occasions that has been a help to some people is a simple idea based on the fact that collecting lots a minute pieces of positive experiences that would normally go unnoticed can subtly create a gleam of hope.
These minute positive experiences could be some food that tasted pleasant, making a note of a random smile from someone, the sun shining or simply a ray of sunshine through a crack, a pleasing picture or piece of music, anything that Seems momentarily pleasing. Saving a bus ticket, wrapper or newspaper cutting or putting a word on a scrap of paper as a reminder and then saving them in a ‘ chocolate box’ or equivalent and putting the box in a drawer( I suggest an underwear drawer – somewhere private) and to get the box out on a black day and trawl through these personal items.It is surprising how these minute events mount up in a short time and the overall effect can make life seem less hopeless.
When this gleam of hope is found and this may take a variable length of time and may need several consultations to build up a mutual trust in working together then a patient can embark on the 7 steps of recovery.
1)firstly in depression aswell as other chronic illness,it is important to accept help from people who really want to help us, from people who are really interested in our problems and listen to us, not just because it is their duty as doctors, but because they really want to help, and those people prescribe us medication, give us advice, and cognitive therapy. Allow yourself to accept such help, as it is genuine.
2) that you have to understand yourself. Meditation, yoga, anything. And above all, ask yourself, why did this mental illness occur? If you can answer this question, and I am sure you can, then this is already a great step forward.
We are now talking about the concept of mindfulness which I will be writing a separate blog shortly.
3)Change your eating habits.
We know that omega-3 fatty acids have innumerable health benefits. Recently, scientists have revealed that a deficit of omega-3 fatty acids is associated with depression. In one study, researchers determined that societies that eat a small amount of omega-3 fatty acids have a higher prevalence of major depressive disorder than societies that get ample omega-3 fatty acids. Other studies show that people who infrequently eat fish, which is a rich source of omega-3 fatty acids, are more likely to suffer from depression.
Sources of omega-3 fatty acids: fatty fish (anchovy, mackerel, salmon, sardines, shad, and tuna), flaxseed, and nuts.
Sources alpha-linolenic acid (another type of omega-3 fatty acid): flaxseed, canola oil, soybean oil, walnuts, and dark green leafy vegetables.
Also it has been found that people with low Vitamin D and or folic acid (spinach and advocado) tend to be more depressed.
4) We also need to change the way we communicate with others.
As one psychiatrist quoted,
“When a patient tells me his wife nags him I tell him to turn the tables on her. When she says: ”look at you in front of the TV again watching too much TV Football leaving me to do the washing up once more”, stand up and say:«you are right dear, I will do the washing up today.”
I think she will feel weak at the knees and you will gain something, because you have surprised her and, by doing so you have gained, and become more charming because you reacted differently. When the patient comes to me the following week he says: ”I surprised her, but I didn’t do the washing up”.”
I have used this in consultations using personal situations. Many years ago I remember this series of consultations.
Mr T had been going on holiday by himself for a few years because his wife was too miserable and depressed and I suspected he was depressed but in denial. When she went in hospital he came to have a routine blood pressure and complained how his wife was in hospital and even more miserable. She had seen me before going into hospital and complained as to how unsympathetic and miserable he was and how glad he was going on holiday by himself. (As patient confidentiality is paramount in any consultation neither party knew I had consulted the other.)
When I saw Mr T I suggested that it would be good if he took her flowers when he went to see her although it was something he had not done in many years.
When I saw Mrs T after she was discharged I reviewed her and she then said with a smile on her face “guess what doctor, my husband visited me in hospital and he brought me flowers!” I replied ” how lovely, I hope you said ‘thank you’ ” she replied, ” oh dear, I don’t think I did”
When Mr T consulted again he said, ” I did what you said doctor and eventually she even said ‘thank you’!
When I consulted them a few months later each one in turn gave me a bar of chocolate from Spain and reported how they had had a nice holiday together.
On each occasion I just smiled and later shared the chocolate with my family when they greeted me in the evening with “late again for supper,mum”!
5)We all need to find a better balance between work and leisure, find another pattern. Some of us have a pattern of 20 hours to 4 hours. It would be much better to have a pattern of 20 minutes to 4 minutes. Or better still 4 hours: 1 hour. Changing the rhythm doesn’t mean that you have to work less, just change the rhythm. Otherwise you risk burnout.
I often suggest to those people, who adamantly claim that they have to work late every night, to choose one or preferably 2 days a week to leave ‘on time’. The first week colleagues will question this ‘leaving early are you?’ But hold the head up high and leave with no reason given. The second week on leaving ‘on time’ the comments may be ‘leaving early again’ and again leave with head held up high and no reason given. The third week as you linger dreading a comment it will probably be ‘isn’t it today you leave early?’ It works and can be a chance to develop space for leisure even a quiet undisturbed cup of tea or a walk in the park.
6)Change your interaction with nature. To those of you who enjoy being outdoors I say: ”What do you think about when you for a walk in the park . About your problems. Why? Why is this wrong? Because every muscle cell has a memory. When we do stomach exercises, all our stomach cells are attuned to work with us . When we do push-ups, all our cells do push-ups. If we think about our problems every time we run uphill, then our cells will be full of problems whenever we run uphill. So, when we get depressed, somatisation causes pain in all those cells. It’s very simple. Every cell has a memory. I suggest that it is a good idea to change – go to Tai Chi before going for a run or alternatively concentrate on something else. When you run, imagine yourself in an ideal situation with the perfect partner, the perfect job or in a dream location.
Change your interaction with nature. If you used to go mountaineering take up caving, jogging take up rambling.
Take a trip to ‘Lammas Park or Walpole Park instead of Pitshanger Park. In short: make a change, because by doing this you will move from West Ealing to another place. Even if only for half an hour a day.
“Trying something new alters the levels of dopamine, which is associated with pleasure, enjoyment, and learning.”
7)What is most important?
For me the most important thing is to change your attitude towards music and dance. Listen to music for fun, sing or hum along with it with ear phones or in the shower if you don’t want to upset the neighbours. Sing in the car on your own, with your partner or children with feeling and passion!! Great on the school run…
Dance on you own, with your partner or children or your imaginary partner!
Dance to have fun try ‘strictly come dancing’ or karaoke in your own home or wherever… If you used to dance the Foxtrot, then dance the Waltz. If you used to dance the Salsa then dance the Zumba…