An Attitude of Gratitude Helps Heal Depression

“Gratitude turns what we have into enough, and more. It turns denial into acceptance, chaos into order, confusion into clarity…it makes sense of our past, brings peace for today, and creates a vision for tomorrow.” Melody Beattie

The alarm goes off and you roll over and groan as he sunlight beams brightly through your curtains. You wonder why you even bother to get up, since the voice of depression that chatters incessantly tells you that this is going to be like countless days before. Another day filled with responsibility, tasks to accomplish, traffic to fight and people to encounter who expect you to be on. It’s all you can do to get yourself in an upright position and muscle your way through the day.

Although it seems difficult to do, one remedy for counteracting the effects of depression is gratitude. Keep in mind that anything done with commitment and consistency can have a potent impact. As is so with any practice, the more you engage in it, the greater the benefit.

Robert Emmons, PhD from the University of California conducted a study linking gratitude with wellbeing. He discovered that those who regularly focused on that for which they were grateful, “reported levels of the positive states of alertness, enthusiasm, determination, attentiveness and energy compared to a focus on hassles or a downward social comparison (ways in which participants thought they were better off than others).”

Why Are Grateful People Happier?

  • They tend to be more optimistic; seeing the glass not only half full, but, indeed ‘all full,’ since although it might only be half filled with liquid, the other portion is air.
  • They are generally more relaxed and tend to go with the flow.
  • They see what is right and not just what is wrong with nearly any situation.
  • They have a higher level of resilience and can bounce back from most challenges they face in their lives.
  • They are better able to engage The Relaxation Response; a term that was coined by Herbert Benson, M.D, about which he says, “The relaxation response is a physical state of deep rest that changes the physical and emotional responses to stress… and the opposite of the fight or flight response.
  • They note a decrease in depressive symptoms such as excessive fatigue and lethargy, a loss of interest in life circumstances, poor appetite and sleep and/or a reduction in both.
  • They experience as sense of accomplishment.

How Do You Begin and Sustain a Gratitude Practice?

  • Begin and end each day with a mental list of what you are thankful for.
  • Keep a gratitude journal.
  • Take a gratitude walk in nature and notice all that your senses take in.
  • Surround yourself with grateful people. Motivational speaker Jim Rohn states that “You are the average of the five people you spend the most time with.”
  • Use positive self- talk, beginning with the words, “I am…” and then complete the sentence from there.
  • Listen to positive music, also known as Posi’. Many of these songs express gratitude.

Complex PTSD and the Realm of Dissociation

 

“Louise often feels like part of her is “acting.” At the same time, “there is another part ‘inside’ that is not connecting with the me that is talking to you,” she says. When the depersonalization is at its most intense, she feels like she just doesn’t exist. These experiences leave her confused about who she really is, and quite often, she feels like an “actress” or simply, “a fake.”

― Daphne Simeon (Feeling Unreal: Depersonalization Disorder and the Loss of the Self, New York, NY, US: Oxford University Press; 2006)

The majority of the clients I treat have been exposed to repeated traumatic episodes and threats during childhood. For many of these men and women their heinous histories of emotional, psychological and sexual abuse at the hands of trusted caregivers, have led to their suffering from complex PTSD. C-PTSD is more complicated than simple PTSD as it pertains to chronic assaults on one’s personal integrity and sense of safety, as opposed to a single acute traumatic episode. This chronic tyranny of abuse results in a constellation of symptoms, which impact personality structure and development.

The symptom clusters for C-PTSD are:

  • Alterations in Regulation of Affect and Impulses
  • Changes in Relationship with others
  • Somatic Symptoms
  • Changes in Meaning
  • Changes in the perception of Self
  • Changes in Attention and Consciousness

When one is repeatedly traumatized in early childhood, the development of a cohesive and coherent personality structure is hindered. Fragmentation of the personality occurs because the capacity to integrate what is happening to the self is insufficient. The survival mechanism of dissociation kicks in to protect the central organizing ego from breaking from reality and disintegrating into psychosis. Hence, fragmented dissociated parts of the personality carry the traumatic experience and memory, while other dissociated parts function in daily life. Consequentially, profound symptoms of depersonalization and dissociation linked to c-ptsd manifest. (Herman JL. Trauma and Recovery. New York: BasicBooks; 1997)

Dissociative disorders are conditions that involve disruptions or breakdowns of memory, awareness, identity or perception. In the context of severe chronic abuse the reliance on disassociation is adaptive as it succeeds in reducing unbearable distress, and warding off the threat of psychological annihilation. The dissociative disorders a survivor of chronic trauma presents with vary and are inclusive of dissociative identity disorder (formerly multiple personality disorder), dissociative amnesia, Dissociative fugue, and depersonalization disorder. Identify confusion is also deemed a by-product of dissociation and is linked to fugue states when the traumatized person loses memory of their past and concomitantly, a tangible sense of their personal identity. (Onno Van der Hart, Ellert R.S. Nijenhuis, Kathy Steele Dissociation: An Insufficiently Recognized Major Feature of Complex PTSD, Journal of Traumatic Stress, 2005, 18(5))

 

 

The treatment process for those afflicted with c-ptsd and attendant dissociative disorders is extensive and comprehensive. Depending on the severity of the repetitious traumas, even in progressed stages of recovery a client may find himself grappling with persistent feelings of detachment and derealization. Given that the brains mediation of psychological functions is dramatically compromised by the impact of chronic trauma, this neurobiological impact may be a strong contributing factor regarding lingering dissociative symptoms in survivors of c-ptsd. When a child’s brain is habitually set to a fear response system so as to survive daily threat, brain cells are killed and the inordinate production of stress hormones interferes with returning to a state of homeostasis. Turning to dissociative states to relieve the pain of hyperarousal, further exacerbates the effective use of one’s executive functions, such as emotional regulation and socialization. Accordingly, neuroimaging findings reveal that cortical processing of emotional material is reduced in those presenting with c-ptsd and an increase in amygdala activity, where anxiety and fear responses persists.

 

In spite of the harrowing repercussions of prolonged traumatic abuse and neglect, those suffering from c-ptsd and dissociative disorders profit from working through overwhelming material with a caring seasoned professional. Treating the sequelae of complex trauma means establishing stabilization, resolving traumatic memory and achieving personality (re)integration and rehabilitation. Integrating and reclaiming dissociated and disowned aspects of the personality is largely dependent on constructing a cohesive narrative which allows for the assimilation of emotional, cognitive, and physiological realities. And finally when fight/flight responses diminish and an enhanced sense of hope and love for self and others results from years of courageous pain staking hard work, the survivor reaps the rewards of this capricious and harrowing journey; one’s True Self.

Complex Relational Trauma

“To be lonely is to feel unwanted and unloved, and therefore unloveable. Loneliness is a taste of death. No wonder some people who are desperately lonely lose themselves in mental illness or violence to forget the inner pain.” –Jean Vanier (Becoming Human)

Many of the men and women I treat evince the agony of loneliness rooted in incessant relational trauma. Relational trauma pertains to a “violation of human connection” (Judith Herman 1992), which result in attachment injuries. These relational traumas encompass a vast range of violations, inclusive of childhood abuse, domestic violence, entrapment, rape, infidelity, bullying, rejection, psychological/emotional abuse, and complex grief rooted in unresolved loss of important human connections. The consequences of these relational traumas are profound, particularly when they are the result of generational patterns passed on to children.

Psychodynamic theorist Gerald Adler attributed an early failure in nurturing to the experience of annihilation. He contended that the absence of a primary positive soothing introject/caregiver creates an insatiable emptiness that impedes the development of an organized Self. Additionally, the ongoing exposure to negative persecutory introjects such as abusive parents, further exacerbates the threat of annihilation.

Furthermore, the relational bond between an infant and its primary caretaker impacts the structure and function of the developing infant’s brain. Abuse and neglect within the child-parent attachment bond is absorbed as cellular memory, causing neural dysregulation and consequentially an imprint of trauma that may be reenacted throughout life. Likewise, if primary bonding is characterized by safety and mirroring, neurological integration can develop normally and an imprint of relationships as affording safety and pleasure occurs.

Consequently, the psychological repercussions of relational trauma are manifold. Impairments with relatedness to others, affect regulation, difficulties with emotional self-regulation and behavioral control, alterations in consciousness, self-destructive behaviors, and a nihilistic world-view embody the plight of complex relational trauma. The relationally traumatized individual vacillates between pseudo-autonomy and needy desperation, relentlessly seeking rescue and rejecting real intimacy. Unable to empathically attune to others, vocalize intrinsic needs/desires, and fearful of hurt and rejection, yet hungry for attachment (s)he repetitiously recreates the destructive cycle of maltreatment and disorganized ambivalent attachment. Difficulties with regulating emotions and affect manifest in aggressive posturing, behavioral problems and addictive disorders.  Ubiquitous despair, self-hatred, and hopelessness contribute to a radically cynical perspective, which asserts life is devoid of all meaning and purpose.

The paradox of healing from relational trauma is that it is what is most feared which will repair and restore. Psychologist Carl Rogers emphasized the essential elements of unconditional positive regard, genuineness, and empathy as the reparative force inherent in a successful client-therapist relationship. Rogers wrote, “When a person realizes he has been deeply heard, his eyes moisten. I think in some real sense he is weeping for joy. It is as though he were saying, “Thank God, somebody heard me. Someone knows what it’s like to be me.” As philanthropist Jean Vanier points out “when we love and respect people, revealing to them their value, they can begin to come out from behind the walls that protect them.”

Thus, when a relationally traumatized client engages in a therapeutic process with a clinician who offers the opportunity for corrective connection, healing occurs. In the context of such a relationship, traumas can be effectively processed. Successful treatment necessitates allowing sufferers of relational trauma to safely know and experience all which has been disowned and silenced. The heroic and arduous journey of recovery for the relationally traumatized individual means repairing fragmentation, stabilizing the consequences of somatization and limbic system dysregulation, cultivating life skills, and developing a cohesive meaningful narrative that lends itself to a life-affirming sense of identity and an inspired frame of reference. Only then can the survivor of relational trauma experience the birthright she was denied; to give and receive love.

Addiction and The Holy Hunt

Where there’s emptiness there’s hunger. Passionate hunger fuels a need for connection and completion. We are innately driven to fill emptiness in a self-transcendent way through whatever we can attach to that offers us the promise of fulfillment.  In our desperation, the longing for wholeness, cohesion, connection, power, and love may cause us to compulsively latch onto a drug, a thing or a person.  There may be a momentary illusion of wholeness that results, and that compels us onward to acquire more.  We get caught up in a relentless pursuit of that moment of ecstasy, ignoring the destructive consequences of seeking this addictive connection.

The late psychoanalyst Carl Jung wrote to the founder of AA, Bill W, that alcoholism is a spiritual disease, which has at its base a drive for wholeness. In the misguided pursuit of wholeness the addiction becomes the primary connection. All other connections lose meaning and become inconsequential.  If we conceptualize spirituality as having to do with the experience of connectedness to whomever or whatever is most essential in one’s life, we can surmise that the addiction itself becomes a misguided spiritual quest. The object of the addict’s desire is the primary connection affording false hope and a magical sense of temporary cohesion/wholeness.

At first life seems manageable. The addiction is the magic formula that ends inexplicable pain. The addict succumbs to a temptation, which is greater than one can resist, and a power submission dynamic emerges.  In this dynamic the hidden wish  to not be responsible for choice, creates a relationship in which there is a denial of the soul’s capacity to move towards wholeness. The addiction hinders the soul’s capacity to choose and assume responsibility. In relinquishing the spiritual choice to align with the soul’s capacity towards wholeness, the addict finds less and less of himself and seeks out isolation as the best circumstance to enjoy his high.

Gary Zukav wrote, in “The Seat of the Soul”, “For the addict physical reality is not aligned with the reality your soul wishes to create. The suffering of the addict leads to a recognition of the need to release this form of learning and to choose the entrance of Divinity to shape one’s world. “ It is generally at this point of dark despair that a moment of Grace occurs. In AA this is known as a ‘bottom’. Freud referred to it as an “ego death’. St. John of the Cross, wrote of his “dark night of the soul”, whereby demystifying choice allows for a conversion experience. In this process Jung conveyed that opposite extremes are synthesized in a balanced way. The lower impulses inherent in the pursuit of the addiction are embraced and integrated so that more complete personality and an authentic sense of self results. It

is our very ‘shadow’, meaning the disowned parts of our selves, that potentially teach us what we need.

Framing recovery in the context of one’s place in the circular larger scheme of inter-connecting life helps make one conscious of one’s existence as a spiritual being, and catalyzes the grieving process in which memories of the soul’s abandonment becomes conscious. Our connection to the spiritual is only achieved as we come to see ourselves as extensions of God/Goddess and as channels for God/Goddess’s will. This involves choice. The notion of original sin in non-dualistic spirituality relates to our rejection of who we are as God’s children in God’s world. It is the notion of original sin that is originally sinful. Jung related that it is our alienation from who we are that is the source of our brokenness. Hence, in embracing, not dividing, we heal. Our sense of wholeness and connectedness reminds us of our sacredness. Its absence fosters the belief that we are disconnected from our divinity. This process of reclamation involves challenging and altering spiritual world-views, which reinforce addictive behavior. It is through self-knowledge of one’s shattered ness/separation that we are led to reclamation of self and wholeness.

Ways to Overcome Self-Doubt

About halfway through my Ph.D. program, I was accepted into a club where distinguished graduate students, decorated faculty, and social elite gather for intellectual conversation over expensive wine and exotic meats. While being a good student was a key component to gaining admission—and I had always thought of myself as one—it wasn’t until I started speaking with my peers that I began to feel like a fraud; I was sure I was not nearly smart enough to be among them. My thoughts were consumed with ideas of being “found out,” and I would often tell myself that my application must have somehow slipped into the “accepted” pile. It was a mere feat of luck, nothing more, and it was only a matter of time before someone took notice.

What was interesting was how quickly these thoughts created behavioral consequences. I was much quieter than my usual extroverted self and I rarely voiced my opinions. It became harder and harder to attend club events without feeling as though I wouldn’t be able to hold my own next time. It wasn’t until speaking with a colleague from the club one night that I realized I was not alone. As we walked home, she turned to me, defeated, and said, “You know, I really have no idea why they accepted me.” A proverbial “aha!” moment ensued.

The Impostor Phenomenon describes the experience of feeling like a phony, unable to internalize success. The concept, first described by Suzanne Imes and Pauline Rose Clance in 1978, proposes that people “who experience the impostor phenomenon persist in believing that they are really not bright and have fooled anyone who thinks otherwise… Numerous achievements, which one might expect to provide ample objective evidence of superior intellectual functioning, do not appear to affect the impostor belief.”

As it turns out, even the most accomplished among us can feel this way. In Sheryl Sandberg’s book, Lean In: Women, Work, and the Will to Lead, the Chief Operating Officer of Facebook shares that only after hearing a speech on the subject did she gain insight on why she often felt like a fraud: “Despite being high achievers, even experts in their fields, women can’t seem to shake the sense that it is only a matter of time until they are found out for who they really are—impostors with limited skills or abilities.”

At first, Imes and Clance thought feeling like a phony was unique to women alone, but countless studies since have shown that it can be a common experience for anyone who might feel like an outsider—and profession makes little difference. Take Oscar and Golden Globe-winning actor Don Cheadle, who said, “All I can see is everything I’m doing wrong that is a sham and a fraud.” Or, famed author Maya Angelou: “I have written 11 books, but each time I think, ‘uh oh, they’re going to find out now. I’ve run a game on everybody, and they’re going to find me out’.” Even the chief of the World Health Organization, Dr. Margaret Chan, remarked, “There are an awful lot of people out there who think I’m an expert. How do these people believe all this about me? I’m so much aware of all the things I don’t know.”

How does feeling like an impostor come about? Being raised in a home where one siblingis designated the “smart” one and the other “social” one could cause issues down the line. Despite gaining achievements throughout life, the “social” sibling may attribute his or her success to simply being social, not worthy or smart. Alternatively, any effort that the “smart” sibling puts into achieving a goal can result in feeling guilty for having to work to be perceived as smart. Members of minority groups are also prone to feeling like phonies, attributing their success to factors like affirmative action policies instead of their own abilities. Essentially, any scenario where you think that a factor other than your own abilities might have resulted in an achievement—like being nice, charming, or attractive—can bring about feeling like an impostor. This is because you believe the praise you receive for one ability (being smart) is wrongly attributed to another (being nice).

People who experience the Impostor Phenomenon often tend to dwell on their failures. They also experience greater stress, lower feelings of self-worth, and greater self-doubt and they’re more likely to self-handicap (avoid engaging in fearful activities in order to circumvent potential failure and maintain self-esteem). Luckily, there are ways to manage feelings of phoniness. With effort and guidance, change is possible.

1. Find a Mentor

Seek someone you admire and with whom you can be open. According to recent research, feeling like a phony is common, yet these feelings decline with age and experience. Chances are a mentor will be able to enlighten you on his or her own experiences and reassure you that you are worthy of your success. Not only will this help you realize that no one is perfect, but that you are not alone.

2. Take Time to Reflect

Find time to reflect on your own experiences. Keeping a “positive feedback” journal, in which you make a list of your accomplishments, any positive feedback you’ve been given, and the factors around your success will help you see the link between your own expertise and your success. This will help you internalize your worth.

3. Speak to a professional.

Find a good executive coach, therapist, or psychiatrist who is equipped with the tools you need to help you break out of negative thinking patterns to march on, fraud-free.

References

  • Clance, P. R., & Imes, S. A. (1978). The imposter phenomenon in high achieving women: Dynamics and therapeutic intervention. Psychotherapy: Theory, Research & Practice, 15(3), 241.
  • Clance, P. R., & O’Toole, M. A. (1987). The imposter phenomenon: An internal barrier to empowerment and achievement. Women & Therapy, 6(3), 51-64.
  • Want, J., & Kleitman, S. (2006). Imposter phenomenon and self-handicapping: Links with parenting styles and self-confidence. Personality and Individual Differences, 40(5), 961-971.

© Mariana Bockarova, Ph.D.

Cognitive Music Affects Cooperation, Productivity

A plethora of past research indicates that music truly has an effect on us: It has been shown to help middle schoolers develop higher verbal IQ; to reduce heart rate, blood pressure, and anxiety in patients with cardiovascular disease; and it can even allow us to perceive the faces of strangers as happier—provided we are listening to happy music, of course.

Now, newly published research in the Journal of Organizational Behavior titled “The sound of cooperation: Musical influences on cooperative behavior”, suggests that listening to happy music has a significant and positive effect on our willingness to be cooperative, as well.

In the first of two experiments, Cornell University researchers randomly assigned 78 participants to either Happy Music condition or Unhappy Music condition. The song selection in the Happy Music condition consisted of “Yellow Submarine” by the Beatles; “Walking on Sunshine” by Katrina and the Waves; “Brown Eyed Girl” by Van Morrison; and, the theme song from “Happy Days”), and “Smokahontas” by Attack Attack! and “You Ain’t No Family” by Iwrestledabearonce for the Unhappy Music condition. The selection of songs were previously rated by 44 undergraduate students for their warmth or coldness, as well as other variables.

Participants were asked to indicate certain demographic characteristics, such as age and major. They were then given tokens and asked, while listening to either happy or unhappy music, what portion of their tokens they would allocate for their own private use, versus give to a group pool, which consisted of two other participants. They could give between 0-10 tokens, and the contributions would be multiplied by 1.5, before being divided between the three participants in the group pool. This type of experiment is known as the Voluntary Contribution Mechanism. The results of the first experiment found that participants in the Happy Music condition contributed nearly one third more than those in the Unhappy Music condition.

In order to ensure that the Unhappy Music condition did not create a negative bias, such that the finding was due to participants listening to unhappy music may have become more moody and selfish versus happy music having a positive effect on mood and cooperation, the researchers added a control condition, where no music was played. The results were the same as the first experiment, which allowed the researchers to conclude that happy music indeed had a positive effect on a person’s willingness to cooperate, and contribute to the public good.

While it is difficult to find ecological validity in the study’s conclusions, given its experimental and highly structured design, the researchers nevertheless conclude that this work adds to the growing emphasis put on the physical features of workplace environments, and “draw[s] attention to the importance of soundscapes in relation to employee behavior,” as well.

Reference:

Kniffin, K. M., Yan, J., Wansink, B., & Schulze, W. D. (2016). The sound of cooperation: Musical influences on cooperative behavior. Journal of Organizational Behavio

Parental Alienation: A risk factor for depression

Parental alienation is a family dynamic in which one parent engages in many of the 17 primary parental alienation strategies, behaviors likely to foster a child’s unjustified rejection of the other parent. Not all children are susceptible to this form of emotional manipulation, but some are.

When successful, the PA strategies can result in a child claiming to hate and fear a parent who has done nothing to warrant the child’s vitriol, fear, and hostile rejection. Over the past ten years I have conducted a number of research studies on adults who were exposed to PA strategies when they were children. In each study I and my colleagues have found a statistically significant association between exposure to parental alienation in childhood and depression in adulthood.

These findings have been replicated in studies in New York, Texas, US national samples, and in Italy. The findings have been replicated with various depression inventories, and in different age groups. Even high school students will report higher depression when exposed to PA strategies. This association can be understood in light of attachment theory in that the child exposed to PA is being forced to forgo a relationship with an attachment figure and to deny that the loss the relationship has any meaning. The child is denied the opportunity to make meaning of the loss, which is a known risk factor for depression. In one of my studies, a respondent reported that when he was a young boy he came home from school one day and found an unknown man in his living room. His mother announced that this was his new daddy since the old daddy was a bad man.

For the next forty years the boy was not allowed to talk about his father, ask what happened to him, or even refer to him as “Daddy.” Unable to make sense of what happened and forbidden to process the loss, this young boy grew up to experience a multitude of problems as an adult, including depression. Another respondent in that same study told how her father would come to visit every Sunday but she was not allowed to open the door to greet him. In fact, she was forced to stand inside the house yelling at her father through the door to go away and never come back. When the father stopped trying to spend time with her, she was devastated and shared with me that many days – even years later – she felt so sad she couldn’t get out of bed.

What I have learned from stories like these as well as from my statistical studies is that parental alienation is a form of emotional abuse of children and it is, therefore, associated with may negative outcomes for children, including but certainly not limited to depression. Adults who had his experience as children should become educated about parental alienation in order to have a framework for understanding what happened to them.

Likewise, mental health professionals working with such adults should be informed about the phenomenon of parental alienation so that they can be as helpful as possible to this vulnerable population.

Mourning my Mom

Christmas day 2013 is when it all began. My very small family’s holidays were centred on Mom and her brilliance in the kitchen. On this day, she was scurrying around to get things prepared for us and fell down in the bedroom, her feet became tangled in the bedspread. She laughed when she told us the story.

From that day on she complained “a pulled muscle in her back.” She started physical therapy soon after but never seemed to kick the pain in her back. March came and her new affliction began: constant nausea. None of us knew it was related. Her pulled muscle and nausea were more than likely caused by her enlarged liver which was full of cancer and had spread from her lung.

Death came for my mom 6 days after she was officially diagnosed with lung cancer. From the beginning of the 6 days, she was very weak from being unable to eat much for the previous 6 weeks. She went from fully aware (still bossing my dad and me around) to unaware of things beyond her bed within that time frame.

We, as human beings, are guaranteed a grieving process unique from all others. Coping with loss is ultimately a deeply personal and singular experience. Nobody can help you go through it more easily or understand all the emotions that you’re going through. The best thing you can do is to allow yourself to feel or lean in to the grief as it comes over you. Resisting it only will prolong the natural process of healing.

Easier said than done. If you are anything like me, you don’t indulge in the pain, you run from pain. I typically dull my discomfort with my obsession to work, alcohol, and food …anything to pull the focus from what really hurts. However, I am a therapist and hopefully somewhat self-aware, so this is what brings me to writing this blurb. I am leaning into my pain by sharing my experiences with you, hoping that you who are grieving can KNOW that this is temporary, and you will heal from this pain, but it won’t be easy.

DENIAL AND ISOLATION.

There wasn’t much time to for me to deny it, but my mom had a couple of days to do so. On the Wednesday before the Oncologist appointment, my mom, dad, and I went to the emergency room of a local hospital because my mom’s doctor noted her yellow color and wanted some tests. After eight hours of caring for my dad who has many more health issues (wheelchair bound) than my mom at this time and my mom who is so weak she has to be in a wheelchair of her own, we were told, “You have cancer, but we can’t tell you how bad it is or in what organ it lies.” Two days later, we were at the Oncologist, and before we went in, my mom said, “We don’t know if I really have cancer.” I just nodded. But I knew it. I just didn’t know how bad it was. In talking with my dad, he says she never mentioned cancer or her dying on the hour and a half back home drive from the hospital. They spent the next day living the way they had for 50 years, except for the physical weakness in my mother and the ever presence of their only daughter moving in to take care of things. The next day is when it all changed forever; hospice came.

ANGER.

My mom’s anger was never voiced because she instantly became too weak to talk. When I looked in her eyes, I didn’t see anger, I saw “This is not what I expected; I don’t want to leave my family. I am disappointed. This will kill your brother.” Although I had little time to be angry for all the things that needed to be done for someone in hospice care and the other very unhealthy parent witnessing the ordeal, I found time to be angry with the initial physician she saw. It took him 6 weeks to send her for tests. My mom was uncomfortable, weak, and couldn’t eat much for 6 weeks because the doctor (or so I thought) was an idiot and “just a country doctor who didn’t care about my mom.” She was terminal, and I knew that 6 weeks would not have saved her, but I was still angry at him, and shortly after her death I convinced my dad to change doctors all together.

In the 6 days, before she died, I cleaned the house (it was in disarray because she had been sick for a month prior to this), my brother and I took care of my mom and dad’s personal care, laundry and linens, bought the groceries and prepared the meals, dealt with hospice, dealt with the visiting community members, paid the bills, located bank accounts and wills, and you name it. Who had time to be angry? There wasn’t much time to be angry and what would I be angry about? I guess I could be mad at her for smoking since she was 15.

In retrospect, I haven’t really been angry. I continue to grieve my mom’s death and my dad’s current dying process, but calling it anger never really nails it. I mean, isn’t this the natural order of things? Parents get older, they die, and you live life without them. This statement does NOT make it any easier for the person grieving. And the next person who tells me that…GRRRRR.

BARGAINING.

Bargaining is the normal reaction to feelings of helplessness and vulnerability and is often a need to regain control. For some control-freaks like me, this will be a more difficult stage because there is NOTHING you can do about saving your mom from death. Nothing. Secretly, my mom may have made a deal with God to postpone the inevitable. But probably not, my mom probably did not bargain with God in her last days. She had said to me many times before on days when her COPD had gotten the best of her, “I’ve done this to myself.” So I don’t think that bargaining with God for more time with her family was on her mind. Regret maybe.

My mom and I had a complicated relationship. So this phase has done a number on me in many different ways. This phase showed up as:

If only I had tried to be a better person toward her…given her a break on whatever we disagreed upon.
If only she had had another “better” doctor who would have treated her more effectively.
If only I had not been so wrapped up in my career, I would have paid more attention to her and got her the help she needed much sooner.
My heart is broken because I never could agree to disagree on what we didn’t see alike. I just want one more day with my mom to apologize or to make it up to her. I will never know if she forgave me or knew how much she meant to me or knew how much the holidays will NEVER be the same without her.

DEPRESSION.

Again, it wasn’t obvious that my mom was experiencing depression because it happened so quickly. I am not convinced my mom ever truly believed she would die so soon. Depression has been mine to bare. There were so many things to do and get done that my depression lingered backstage for several weeks, and came center stage a good two or three months after her death, and remains there. My depression has more to do with the change my little family has undergone and what it continues to go through due to my mother’s death and father’s illnesses. The concept of the finality of your family members leaving is pretty tough. You will never say another word to your mom, you will never get the joy out of buying her a gift, you will never be comforted by her chicken soup when you are ill, and you will never be able to apologize about not being the perfect daughter, and soon enough your father will be gone forever as well. Some get through this with prescriptions; some weather it out…but it ALWAYS comes in one way or another.

ACCEPTANCE.

The only words uttered by my mother in her last day was, “I want peace.” I believe that this was her voiced stage of Acceptance. This stage is marked by withdrawal and calm and a tightening of the visual aperture. Loved ones that are terminally ill or aging appear to go through a final period of withdrawal. She in her last day, appeared to be unaware of things occurring beyond her bed.

This stage is not afforded to everyone. I have not reached it as of yet, and she died 8 months ago. Of course, I have accepted I have spoken my last word to my mother and of course, I have accepted that my father is not on this earth for very much longer; however, I haven’t accepted it without a lot of emotion, and I am all but calm. I continue to lean into the pain every single day, and yes, I numb my pain with food and work, and calm still has not come.

When you experience grief, it is best to experience it with others (if it is a healthy support group). I share mine with my ever supportive husband, grief stricken brother, a couple of dear friends, and a group of intelligent and compassionate therapists (yes, therapists have therapists.) I believe I am doing it in the healthiest way I can…less numbing of the pain, and more leaning into it. But here I am in the final edits of this article, and I am weeping like she died yesterday. I miss her.

There will never be another holiday with her, and we will miss her huge spectacular turkey and dressing and delicious pies, her charm and sarcastic whit and beautiful voice and spirit. We are the lucky ones though; we got to meet her, even be born from her. She mothered us with all of her might. The holidays will still come, but they will never be the same. Eventually we will get through them and remember how lucky we are to have had her in our lives for almost 50 years. If you turn to God in this time, this is the scripture that gets me through the darkest of days. Psalm 3:3 “But you, O LORD, are a shield about me, my glory, and the lifter of my head.”

Wendy J. Poole

Dysthymic Disorder and Codependency

Stressed businesswomanDysthymia or chronic depression is a common symptom of codependency; however, many codependents aren’t aware that they’re depressed. Because the symptoms are mild, most people with chronic depression wait ten years before seeking treatment.Dysthymia doesn’t usually impair daily functioning, but it can make life feel empty and joyless. In the Shadow Sufferers have a diminished capacity to experience pleasure and may withdraw from stressful or challenging activities. Their emotions are dulled, though they may feel sad or melancholy or be irritable and anger easily. Unlike with major depression, they’re not incapacitated, yet they may have difficulty trying new things, socializing, and advancing in their career. Some may believe that their lack of drive and negative mood is part of their personality, rather than that they have an illness. Like codependency, dysthymia causes changes in thinking, feelings, behavior, and physical well-being.

Dysthymia was renamed “persistent depressive disorder” in the 2013 edition of the Diagnostic Statistical Manual V. (I use the terms “dysthymia,” “persistent depressive disorder,” and “chronic depression” interchangeably.) Symptoms must have persisted for at least two years (one year for children and teens) and includes at least two of the following:
• Low energy or fatigue
• Sleep disturbances
• Increased or decreased appetite
• Irritable or angered easily (for children and teens)
• Low self-esteem
• Difficulty concentrating or making decisions
• Feeling hopeless or pessimistic

The symptoms must create significant distress or impairment in social, occupational, educational or other important areas of functioning. Although mood remains persistently “down,” it may improve for several weeks of feeling better. Untreated, depression soon returns for longer periods. People are usually motivated to seek help in order to cope with a relationship or work problem or a major loss that triggers more intense symptoms. When they rise to the level of major depression, which can often occur in people with dysthymia (persistent depressive disorder), the diagnosis is “double depression” – major depression on top of dysthymia. Unlike chronic depression, an episode of major depression may only last a few weeks, but it makes a subsequent episode more likely.

Persistent depressive disorder affects approximately 5.4 percent of the U.S. population age 18 and older. The numbers may be much higher, since it often goes undiagnosed and untreated. Over half of dysthymic patients have a chronic illness or another psychological diagnosis, such as anxiety or drug or alcohol addiction. Dysthymia is more common in women (as is major depression) and after divorce. There may not be an identifiable trigger; however, in cases of onset in childhood or adolescence, research suggests that there is a genetic component.

Although stress can be a factor in depression, some people don’t experience a life event that triggered their depression. There are individuals with chronic depression who blame their mood on their relationship or work, not realizing that their outer circumstances are only exacerbating an internal problem. For example, they may believe that they will feel fine when they achieve a goal or when a loved one changes or returns their love. They’re unaware that the real cause is that they’re striving to prove themselves to compensate for feeling inadequate, or that they have no life of their own, have sacrificed self-care for someone else, or that they feel unlovable and worthy of love. They don’t realize that their depression and emptiness stem from their childhood and codependency.

Codependents, by nature of their addiction to people, substances, or compulsive processes, lose touch with their innate self. This drains their vitality and over time is a source of depression. Denial, the hallmark of addiction, can also lead to depression. Codependents deny their feelings and needs. They also deny problems and abuse and try to control things that they can’t, which add to feelings of hopelessness about their life circumstances. Other codependent symptoms, such as shame, intimacy issues, and lack of assertiveness contribute to chronic depression. Internalized shame from abuse or emotional abandonment in childhood causes low self-esteem and can lead to depression. Untreated, codependency worsens over time, and feelings of hopelessness and despair deepen.

Codependency and depression can be caused by growing up in a dysfunctional family that’s marked by abuse, control, conflict, emotional abandonment, divorce, or illness. The Ace Study demonstrated that adverse childhood experiences lead to chronic depression in adulthood. All subjects with a score of five or more were taking anti-depressants fifty years later. Other causes of dysthymia are isolation, stress, and lack of social support. (Research shows that people in abusive relationships aren’t likely to disclose it.)

Psychotherapy is the treatment of choice. It is more effective when combined with antidepressant medication. Cognitive therapy has been shown to be effective be eliminating negative thinking to prevent recurrence of depressive symptoms. It may mean healing trauma and PTSD from prior abuse.

In addition, patients need to develop better coping skills, heal the root cause, and change false shame-based beliefs that lead to feelings of inadequacy and unlovability. Goals should be to increase self-esteem and confidence, self-efficacy, assertiveness, and restructuring of dysfunctional thinking and relationship patterns. Group therapy or support groups, such as Codependents Anonymous or other Twelve-Step Program are effective adjuncts to psychotherapy. Lifestyle changes, such as exercise, maintaining healthy sleep habits, and participating in classes or group activities to overcome isolation are also ameliorative.
©Darlene Lancer 2015