Category Archives: depression

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The Lies of Suicide

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In some way, all of us are affected by suicide. Whether you worry about the possibility that a loved one is considering it, have had a loved one attempt it or die from it, or whether you have grieved with a friend or neighbor when it happened, suicide leaves its mark.

pain of suicide

Every year, one million people attempt suicide in the United States. Over 40,000 Americans die from suicide every year. Suicide is the second leading cause of death in those aged 10 to 24 years. A surprising fact for many, the highest risk of death by suicide is actually older adult men.

Two people in the U.S. will probably die from suicide before you finish reading this article. Worldwide, there is one death by suicide every 40 seconds.

Most people who consider suicide are in the midst of a deep clinical depression. In the moment of the suicide attempt, the person really does lose touch with reality. They may not hallucinate, but they believe things that are untrue. They are momentarily delusional. Here are some of the lies of suicide:

1. “Everyone would be better off without me.”

2. “They’ll get over it soon.”

3. “My life will never get better.”

4. “There is no help for me.”

5. “I don’t deserve to live.”

6. “I’ll show them how badly they’ve hurt me.”

7. “I have no other options.”

8. “Nobody cares.”

Unfortunately, many deeply depressed people believe these lies, and they act on them. If they don’t succeed, and when the depression improves, they realize that they were lies, but in the moment they don’t know any better.

Suicide also conveys several lies for the loved ones that are left behind. Their grief is complicated by confusion and many, many questions. They struggle to make sense of the loss. They often blame themselves. Here are some of the lies placed upon the loved ones left behind by a suicide:

1. “I should have seen it coming.”

2. “I should have done something.”

3. “If only I had ……”

4. “What did I do to cause it?”

5. “She tried to tell me, but I didn’t listen.”

6. “He made a decision to leave me.”

7. “How could she have been so cruel?”

8. “Others will blame me. I feel so ashamed.”

The reality is that none of us can perfectly predict human behavior. Most people try to do the right, loving thing, based on what they know in that moment. They can’t know what is going to happen in the future. If they had known, they would have done anything to intervene.

We know that this horrible thing should not have happened. Our next thought is to ask who is to blame. We look at every interaction, every missed opportunity. But in the moment, we probably did what we thought was best. We didn’t know. We couldn’t know.

If you have a loved one who is depressed, and you have concerns that they may be considering suicide, talk to them. Ask them if they are thinking about it. Tell them how much it would hurt you if they did something to themselves. You won’t suggest the idea, and you might just give them the opportunity to change their mind.

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Seeing the Truth About Suicide

Suicide is always devastating to those left behind. Our depression often hides this fact.

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Suicide is the tenth leading cause of death in the United States. On average, there are 123suicide suicides each day. There were more than twice as many suicides as there were homicides.

 

I treat many people in my practice who are clinically depressed, and most of those report some suicidal thoughts. Suicidal thinking or urges is one of the primary symptoms of the disease. While not every depressed person is suicidal, the risk should always be assessed.

 

Suicidal risk can be categorized according to severity. I try to determine which of the following descriptions best fit the person’s current state.

 

  1. The depressed person has had some suicidal thoughts but has no plan for how he would do it. He just wishes he wasn’t here. He denies any intentions and can provide clear reasons as to why he wouldn’t do anything to himself.
  2. The person denies any intention to act on it but has determined a plan of how she would do it if she actually made an attempt. The more lethal the plan, the more severe the risk. Plans involving firearms or hanging represent greater risk, especially if the person has such means available.
  3. The person expresses uncertainty about his intentions. He can’t make a clear and believable no-suicide commitment. He often believes that his loved ones would be better off without him. He often sees suicide as a viable, and often the only, solution to the pain of his depression.

 

When I encounter a depressed person who expresses the belief that his suicide would have minimal impact on his loved ones, I ask him to do a little thought experiment. First, I have him think of someone he loves. I ask him to imagine that his cell phone rang at that moment in the session. I ask him to imagine that the caller was crying and having difficulty speaking. I then have him imagine that the caller told him that this loved one had committed suicide. I ask him how he would be impacted. I ask him how long it would take to get over that person’s suicide. I ask if he would have questions about what he could have done, or whether he might blame himself. I ask him if his life could ever be the same.

 

The response to the thought experiment is clear and often emotional. When we consider how a loved one’s suicide would impact us, we can see more accurately how our suicide would impact those we leave behind.

 

Suicide is always devastating to those left behind. Grief is compounded by questions, doubts, self-blame and often anger. Their lives are never the same. That’s the truth about suicide. Next week we’ll look at “The Lies of Suicide.”

 

 

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The Lies of Suicide

There are many false beliefs for the suicidal person and the grieving loved ones left behind.

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In some way, all of us are affected by suicide. Whether you worry about the possibility that a loved one is consideringcasket it, have had a loved one attempt it or die from it, or whether you have grieved with a friend or neighbor when it happened, suicide leaves its mark.

Every year, one million people attempt suicide in the United States. Over 40,000 Americans die from suicide every year. Suicide is the second leading cause of death in those aged 10 to 24 years. A surprising fact for many, the highest risk of death by suicide is actually older adult men.

Two people in the U.S. will probably die from suicide before you finish reading this article. Worldwide, there is one death by suicide every 40 seconds.

Most people who consider suicide are in the midst of a deep clinical depression. In the moment of the suicide attempt, the person really does lose touch with reality. They may not hallucinate, but they believe things that are untrue. They are momentarily delusional. Here are some of the lies of suicide:

  1. “Everyone would be better off without me.”
  2. “They’ll get over it soon.”
  3. “My life will never get better.”
  4. “There is no help for me.”
  5. “I don’t deserve to live.”
  6. “I’ll show them how badly they’ve hurt me.”
  7. “I have no other options.”
  8. “Nobody cares.”

Unfortunately, many deeply depressed people believe these lies, and they act on them. If they don’t succeed, and when the depression improves, they realize that they were lies, but in the moment they don’t know any better.

Suicide also conveys several lies for the loved ones that are left behind. Their grief is complicated by confusion and many, many questions. They struggle to make sense of the loss. They often blame themselves. Here are some of the lies placed upon the loved ones left behind by a suicide:

  1. “I should have seen it coming.”
  2. “I should have done something.”
  3. “If only I had ……”
  4. “What did I do to cause it?”
  5. “She tried to tell me, but I didn’t listen.”
  6. “He made a decision to leave me.”
  7. “How could she have been so cruel?”
  8. “Others will blame me. I feel so ashamed.”

 

The reality is that none of us can perfectly predict human behavior. Most people try to do the right, loving thing, based on what they know in that moment. They can’t know what is going to happen in the future. If they had known, they would have done anything to intervene.

We know that this horrible thing should not have happened. Our next thought is to ask who is to blame. We look at every interaction, every missed opportunity. But in the moment, we probably did what we thought was best. We didn’t know. We couldn’t know.

If you have a loved one who is depressed, and you have concerns that they may be considering suicide, talk to them. Ask them if they are thinking about it. Tell them how much it would hurt you if they did something to themselves. You won’t suggest the idea, and you might just give them the opportunity to change their mind.

 

 

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The Connection Between Non-Assertiveness and Depression

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Research has shown a relationship between non-assertiveness and depression. The studies indicated that people whocouple_talking_nicely are generally non-assertive are more likely to get depressed than others who are assertive. Assertiveness has been defined as behavior that enables people to act in their own best interests by expressing their thoughts and feelings directly and honestly.

Lets look at the definitions of non-assertiveness, assertiveness and aggressiveness. When we are non-assertive, we honor the other person’s rights, but don’t honor our own rights. When we’re aggressive, we honor our own rights, while trampling on the other person’s rights. When we’re assertive, we honor our own rights, while also honoring the other person’s rights.

In my counseling, I have seen many people who were experiencing depression that was either caused or worsened by an inability to be assertive. The client had allowed others to treat her badly, and was unable to stand up for herself. Over time, the pain and perceived helplessness of the situation led to clinical depression. Like the old idea of Chinese water torture, the drip, drip, drip of being mistreated, without self-defense took it toll.

There are many reasons that people have difficulty being assertive. We will look at several of them here.

1. There is a fear that the other person will get angry. In most cases, this isn’t a fear of physical violence, but rather, a fear of the anger itself. The non-assertive person may have experienced intense or inappropriate anger from a parental figure during childhood. The child associated danger with the anger. That association is maintained in the adult. Even though the victim will readily admit that they are not afraid of violence from the other person, they experience fear and anxiety, as if violence was a risk.

2. The non-assertive person fears disapproval from the other person. In this case, the focus is on the risk of disappointing the other person. No action is necessary. Just a disappointing look, or an anticipated loss of respect can keep the victim silent.

3. Sometimes the non-assertive person has a fear of “being mean.” This individual fears hurting the other person or inconveniencing them. These are the classic “people pleasers.” They work very hard to be nice, even if it means sacrificing their own needs.

4. The person’s self-esteem may be so low, that he feels he has no right to be assertive. He upholds others rights to defend their needs, but doesn’t feel he has the same rights.

This isn’t a comprehensive list of causes, and you may relate somewhat to them all. Changing from non-assertive behaviors to assertive behaviors can be difficult. It begins with small things. State your opinion in areas where you anticipate less resistance. At first, be assertive with people you feel will be more receptive. Practice the behavior.

You will be uncomfortable at first. You will feel anxiety and may be uncertain about whether you have the right to be assertive in a particular situation. Try this little mind experiment. Imagine a friend or loved one in the exact same situation as you are experiencing. Put them in your shoes. Would they have a right to be assertive if they were in this situation? Would you want them to stand up for themselves? If so, then you should be assertive as well. Practice the behavior you would want your friend to exhibit.

So, what if you are assertive and the other person resists, argues with or ignores your requests? You will have to be “persistently assertive,” meaning that you maintain you position, stating your disagreement calmly but confidently.

Also, don’t be surprised if the other person accuses you of being selfish or mean. When others are accustomed to you being non-assertive, going along, and never disagreeing, they will perceive you as mean or overly negative when you stand your ground. You may just have to push through this hurdle. Over time, they will get used to your assertive moments and actually see it as within your rights.

Learning to be assertive is a gradual process. You begin with the realization that you have the right to be assertive. Then you practice the behavior in less intimidating situations. Gradually, you state your mind in more difficult circumstances. Eventually, you will be able to be assertive without even realizing it.

 

Question: What other reasons come to mind for non-assertive behaviors? Share them here.

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The Impact of Self-Esteem Wounds on Mental Health

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This is the second in my series on the impact of self-esteem wounds. Today we’ll look at the wound’s impact on thedepressed_man_001 individual’s emotional health, mood and general quality of life.

I’ve practiced outpatient psychotherapy for over 32 years and I have seen so many people who were experiencing depression that was fueled by self-esteem wounds (negative beliefs about self and negative self-talk). Now, I want to point out that depression can be caused by multiple factors including chemical imbalances, genetics and physical disorders, and should be evaluated and treated by a professional. The evaluation can begin with your primary care physician, a psychologist, counselor, social worker or psychiatrist.

So, not all cases of depression are caused by self-esteem wounds, but such wounds are often a major contributor. I will first talk to my new client about his symptoms, which can include sad mood, crying spells, decreased energy and motivation, difficulty making decisions, sleep and appetite changes, and sometimes suicidal thinking. I then try to gather information about the factors that may be driving those depressive symptoms.

The client will often share a history of negative experiences in childhood, negative beliefs about herself and hurtful relationships in adulthood. She will often blame herself for negative life events, poor choices and perceived failures. She will interpret events in the most negative way possible. She will often be angry at herself for her perceived faults.

Her negative thinking seems to be a constant companion. She says things to herself that she would never say to another human being. She abuses herself in her mind. She never even notices it, because she has done it so long.

This kind of thinking drains her mood, impacts her choices and steals any pleasure or enjoyment. One client said that her depression took the color out of her life, and that everything seemed to be black and white.

The negative impact of self-esteem wounds isn’t limited to those with clinical depression. Most people, with self-esteem wounds, are functioning quite well. They don’t look depressed. They don’t act depressed. They work beside you, attend your church, and perhaps even live in your house.

Their lives may not be severely limited by such wounds, but they suffer nonetheless. They keep their pain to themselves. You would never guess that their minds are filled with self-critical thoughts and self-doubt, but they are.

Comment:  Knowing the pain of self-esteem wounds and the prevalence of those wounds keeps me motivated to share tools for healing. Help me share this message. Share this post and share a comment on the world’s need for healing of self-esteem wounds.

 

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The Far-Reaching Impact of Self-Esteem Wounds

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When a child experiences neglect, harsh or frequent criticism or abuse, his self-esteem is wounded. Since all childrenperson_in_crowd are egocentric, he will blame himself for his negative treatment. If the child is neglected or ignored, he will conclude that he is not lovable or likeable. If he is overly criticized, he will conclude that he is inadequate or incompetent. If he is abused, he will believe that he is bad, defective or even cursed. Thus, a wound to the self-esteem is inflicted, or what I call a “wound of the heart.”

No child is immune. Any child will respond to such negative experiences with similar conclusions. The difference between the child with low self-esteem and the one with a more healthy self-esteem is a difference in experience, not a difference in the strength or in the abilities of the child.

Further, without some intervention, the self-esteem wound will stay with the person throughout life. A child who believes she is unlovable or unimportant will usually maintain those beliefs in adulthood as well. The child who questions his abilities will doubt himself as an adult as well.

In this four-part series, we will examine the far-reaching impact of self-esteem wounds. We will look at the wound’s impact on (a) personal mental health and quality of life, (b) interpersonal relationships, and (c) educational and career performance.

In some ways, a self-esteem wound is similar to metastasized cancer. Over time, it spreads into all aspects of the victim’s life. The wound alters the person’s functioning and perception of every experience. Over time, it tends to impact everything.

In the next article, we will examine the impact of self-esteem wounds on the individual’s personal mental health and quality of life. We will look at the impact on mood, anxiety, and perception. We will explore the pain created by such wounds.

 

Question: Can you think of any other areas where self-esteem wounds have an impact that I need to cover? Thank you for your comments!

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Your Do-It-Yourself Guide to Fighting Depression – Part 4

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In the first three articles in this series, I have explored three basic changes you can make to fight depression. These changes were to increase depressed_personphysical, social and pleasurable activity. The behavioral changes are difficult because depression makes its victim want to decrease physical activity, withdraw from others, and avoid previously pleasurable activities.

I used the analogy that depression is like an ugly, mean troll that gets inside the victim’s body and makes him want to do the very things that feed it and make it grow. When a depressed person decreases physical, social and pleasurable activity, his depression worsens.

Today, we will consider the fourth do-it-yourself depression fighter, which is: question your perceptions. Yes, when you are depressed, you cannot trust your perceptions. Depression distorts our perceptions in several areas, and those distortions are fairly predictable.

Depression distorts our perceptions of ourselves, our current circumstances, our past events and our future. We’ll look at each of these in turn.

The most powerful negative perceptual distortion is the victim’s view of himself. The depressed person sees himself as inadequate, unimportant, unlovable and a burden to others. He believes that others would be better off without him. He focuses on his failures and mistakes and dismisses his positive attributes and successes. This distortion of self often contributes to suicidal thinking.

Such thinking is truly a distortion. As I listen to a clinically depressed person describe himself or herself, I am amazed at the differences between the person’s real self and perceived self. These negative perceptions are deep and strongly believed. Nevertheless, they are wrong.

The victim’s perceptions of his current circumstances are usually distorted as well. The depressed person focuses attention on the negative aspects of life, while seeming to totally ignore the positive aspects. He will acknowledge the positives when they are pointed out, but they soon fade from awareness.

Depression also distorts one’s memories. Past mistakes feel more dire and unforgivable. They stand out in the victim’s mind. They are analyzed and replayed over-and-over. Past successes are forgotten or ignored.

Finally, depression creates a painful and hopeless vision of the future. Expectations are negative and pain seems permanent. The future looks bleak.

All of these perceptions are distortions of the truth. The distortions are predictable. So is the impact.

To fight depression, the victim must understand that his perceptions are not real. He must not trust his thinking or his feelings. He must remind himself daily that those perceptions are inaccurate. He must listen to and trust supportive friends and family who assert that his negative perceptions are wrong.

Imagine that you participated in a research study for a new drug. The researchers were very clear that this drug would temporarily distort your perception, but that this distortion would appear very real. You would have to remind yourself constantly that the drug was making you see things that were not real. By not trusting your perceptions, you would be able to function fairly normally. Depression’s distortion of perception is very similar. Depression is a chemical imbalance and this imbalance distorts perception in the same way as the experiential drug.

You can take positive steps to conquer depression by increasing physical, social and pleasurable activities, and by questioning your negative perceptions. Take the first steps today. You’ll feel better for the effort!

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Your Do-It-Yourself Guide to Fighting Depression – Part 3

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This is the third article on do-it-yourself tools to fight depression. In the first two articles we began with the metaphor that depression is like a troll_3mean, parasitic troll that influences you to do the very things that will make him grow. He makes you decrease your physical activity and your social activity because doing so makes you more depressed, thus feeding the troll and making him grow.

The do-it-yourself techniques involve making yourself do the opposite. You make yourself do more physical activity and more social activity. You won’t enjoy it, of course. In fact, you will probably resist it with every once of energy you’ve got. But if you can make yourself do it. If you can get up and move. If you can reconnect with the people who care about you, you will feel better.
In this article, I want to explore a third tactic of the depression troll, as he attempts to grow stronger. He makes you decrease pleasurable activity. He does this in two ways. First, he saps your energy so you don’t feel like doing anything, even something you think you would enjoy. But worse, he takes away any pleasure you experience when you do previously pleasurable activities. Activities you used to enjoy, no longer feel pleasurable. There is a word for this in psychology; anhedonia – the inability to experience pleasure. The depressed person just doesn’t seem to enjoy anything.  Does that sound familiar?
Not surprisingly, the absence of pleasure worsens the depression, thus feeding the troll. So, what are we to do? How can we experience pleasure if the activities we used to enjoy no longer feel pleasurable?
I’m afraid the answer sounds a little like “fake it till you make it.” You have to make yourself do activities that were pleasurable before you became depressed. You identifying activities that you previously enjoyed, and you try to make yourself do them again,
You won’t enjoy them at first. You won’t look forward to them. In fact, you might dread having to do them, but doing them does help you in your fight against depression.
Of course, doing previously pleasurable activities won’t make a noticeable difference at first, but if you persist in doing those activities, you will gradually experience pleasure in them. Then they will serve to fight the depression and starve that mean ole depression troll,
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Your Do-It-Yourself Guide to Fighting Depression- Part 2

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In the last post, we looked at depression as being similar to a mean, ugly, parasitic troll, which had gotten your body andtroll_2 mind. This destructive troll wants to grow stronger, so it makes you do the very things that feed it. Unfortunately, as it grows stronger, you grow weaker. Such is the course with all parasites.

This troll makes you feel fatigued, weak, heavy, and drained so you decrease your physical activity. When you’re depressed, you just want to sit, or worse, stay in bed. You almost yearn to be still and move as little as possible.

The depression troll makes you decrease your physical activity because this worsens the depression. To fight the depression you must make yourself do as much physical activity as possible. While this can be difficult, and seem impossible, you can do little bits of activity at a time. Then you can gradually increase the amount of activity.

Today, will cover the second do-it-yourself tool to fight depression. While the depression troll works to make you decrease your physical activity, he also works to make you decrease your social activity. He makes you want to withdraw from others. He makes you isolate yourself.

The depression makes you uncomfortable being around other people. You feel that you don’t fit in. You imagine that they are thinking negative things about you. You perceive that they are judging you. You feel more comfortable when you are alone.

Even when you are around others, you don’t talk as much or share as much. You feel a distance, even when others are in the same room as you. You feel disconnected. You may perceive that others are backing away from you, but it’s more likely that they are simply responding to your distance.

Your do-it-yourself tool is to make yourself do the opposite of what the depression troll makes you want to do. You approach others. You identify those in your life that have been the most supportive and positive toward you, and you approach them. You call them on the phone. You write an email. You invite them to lunch or a Saturday shopping trip. You make yourself spend time with others.

Then you try to make yourself connect. You make yourself talk, even when you don’t feel like it. You make yourself talk, even when you don’t think you have anything to say. You force yourself to make and maintain eye contact. You connect.

This will be uncomfortable at first. Every fiber of your being will want to run away, find an excuse to withdraw and go back to bed. That’s normal. Connect anyway.

Even if you don’t enjoy this increase in social contact, it helps significantly in fighting the depression. It starves that parasitic depression troll, until he just decides to leave you. I don’t know why it works, despite the fact that you don’t enjoy it, but it does work.

Do it now. Call that old friend or family member. Send a re-connection email. Just come out of your room and spend time with your family. Look them in the eye. Smile. You’re not alone.

Question: What do you feel contributes most to the depressed person’s tendency to withdraw, even from those who love them?

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Your Do-It-Yourself Guide to Fighting Depression (Part 1)

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Are you suffering from depression? Is someone you love suffering with depression? Suffering is the operable term here, because depression is trolltruly painful. People with both chronic physical pain and clinical depression have told me that they would rather have the physical pain than the depression. The pain of clinical depression is hard to describe, but you’ll know it if you get it.

The most effective treatment for depression is a combination of medication and cognitive psychotherapy, but sometimes those treatments are unavailable or may not be working well enough for you. Whether or not you are getting professional treatment, there are several do-it-yourself actions you can take to fight your depression.

Sometimes it helps to have a different way of perceiving depression. Think of your depression as a parasitic, mean, ugly troll that has gotten into your body and mind. This troll wants to grow, and it doesn’t care what it does to you. It is truly a parasite. The depression troll grows by making you do the very things that will feed it. It makes you yearn to do the things that make it grow and become stronger. By resisting these tendencies, you can weaken your depression and starve that mean, ugly, parasitic troll and make him go away.

There are four areas where the depression troll influences your behavior. To fight the depression and starve the troll, you have to do the opposite of what he makes you want to do. In order to give each area proper attention, we’re going to consider the four depression fighters in four consecutive blog posts. This is the depression fighter for today:

DEPRESSION FIGHTER NUMBER ONE:

INCREASE PHYSICAL ACTIVITY

Your depression troll makes you decrease your physical activity. You feel tired all the time. You don’t feel like doing anything. You don’t want to move. You feel heavy and drained of energy. The troll makes you feel this way because it feeds the depression, making it grow. The less you move, the more depressed you become. In contrast, the more you move, the less depressed you become.

Any activity or movement helps. Even getting up from the couch and walking around the house helps some. Any activity that makes your muscles move and speeds up your heart and breathing fights depression. Walking is a very effective depression fighter. A 20-30 minute walk every day would be great, but any amount helps. It seems to help the nervous system’s balance the neurotransmitters (the chemical foundation of depression).

I do realize that getting up off the couch or out of bed can feel like a monumental endeavor. It can feel totally impossible if your depression is severe. You may have to begin with very small increases in physical activity. Take a shower and get dressed. Walk from one room to the next. Step outside for a little while. Try to push yourself, but don’t chastise yourself if you can’t. Just try again later. Keep trying. Persistence is often the key to defeating depression.

You might also recruit a family member or friend to help you increase your physical activity. Tell them to push you, without fussing at you. This can be a fine line, so they will have to be careful, but the benefits of a supportive friend can be enormous.

Next week, we’ll look at the second step in your do-it-yourself guide to fighting depression, but for now try to increase your physical activity as much as you can each day.

Question: Share some actions that have helped you or a loved one fight depression.