Twice this week I have been talking to individuals, both of whom I have known for a long time, who struggle with the either or syndrome. This syndrome is common with certain states of mind. Those who are labeled as clinically depressed - unipolar or bipolar depressive disorder – seem to be unable to access more than one feeling at a time. If they are feeling good, right at that moment they might be able to express joy, appreciation or some other positive emotion. If, however, you ask them how they are feeling they will tell you that they are terrible. They go so far as to tell you that it has been a terrible day, week, month, year or life. At that moment the fact that that they reported feeling good a moment ago does not affect their overall assessment of the hour, day, week or life. It is not just that the good moments do not outweigh the bad moments. It is as if the bad moments cross out the good moments. The good moments never existed. If one reports being confused about what they are now reporting they will say that “you do not understand” or “the good moments do not count”.
Most of us are able to make such statements as, “It has been tough recently, but I am okay or I am going to be okay.” Even when we are feeling down/unhappy/depressed we can feel gratitude and even joy when a friend takes the time to just keep us company or tries to help us in some way. Not so for individuals such as the two people I talked to earlier this week. For them life is terrible, has always been terrible and will always be terrible. I recall when I was seeing the one person as a client. My office was right next door to the office of the psychiatrist who treated her depression with medication. He would hear her laughing during her session with me. Then she would see him and she would proceed to tell him how bad the depression had been. He would try to tell her that the depression could not be that bad because he just heard her laughing with me – a lot. His expectation was that individuals who had a serious clinical depression could not also laugh. I would try to explain to him about her not being able to connect the moments and reiterate the fact that she was still very suicidal. She and I would talk about the fact that her thinking was so either or.
When I was talking with another person who is again being treated at a mental health facility, he reported that the therapist said to him,”It is amazing that you have lived this long since you have been miserable your entire life.” If this was accurate I could certainly understand why she would say this. The truth is that he has not been miserable his entire life. The truth is that he has periods of intense enjoyment and appreciation. At one level he is a very spiritual man who is enormously kind and considerate. On the other hand, he is, at times, living on such a survival level and often with an active addiction that he will lie, steal and otherwise mistreat people to get what he needs to survive for that moment.
In a brief conversation with me on the phone the other day I heard:
· I am feeling overwhelmed. I am overwhelmed.
· My cravings for street drugs is intense. I am my cravings.
· I am feeling depressed. I am depressed.
· I am feeling very grateful.
· I am very happy to be getting treatment here.
· I feel cannot survive on my own at this time. I am helpless.
All of these were accurate reports of what he was feeling. The positive statements did not define who he was. The negative statements did define who he was. I simply suggested that he be gently and lovingly aware that he was using a lot of labels and that he was reinforcing the label until he became the label. In other words, the more he defines himself as a depressed person the more depressed he is. The more depressed he is, the more he thinks of himself as depression. I suggested that he just notice the feeling and work towards not labeling it. The problem is, of course, that there is an entire story which goes with the label. I recommended that if he is feeling as if he cannot focus and cannot stick with a task he could just notice the process and say something like “isn’t that interesting”. It is then likely that the feeling will pass or at least not be so controlling. He can then remind himself to breathe and to observe the breath. The chances are that the feeling will pass if not fed. Now, in his case, I do think that the medication he has started taking again will help decrease the frequency and intensity of his having difficulty focusing. The medication may also decrease the intense mood swings. He is still, however, going to have to practice not allowing his feelings to define him and correcting what he has spent a lifetime practicing telling himself. He has learned to think of himself as a failure and as someone who will always be a failure. He “knows” that he can have short time success. He is a bright, educated, talented man who has had many periods of success. Sadly when doing well his history is to become the well feelings, get off his medication and to quit working a recovery program. He also quits taking care of himself nutritionally, physically, emotionally, and spiritually. Pretty soon he has an empty gas tanks and the weak parts of his system take over – bipolar illness and addiction in his case.
The other person to whom I have been talking this week has a similar history. She is another very bright, educated, loving person who has been living in acute despair for 66 years. She has been reporting suicidal ideation for many, many years. Yet, there is something that keeps her alive. Over the years, she has practiced telling herself that the good moments do not connect or count, that she is incapable of doing much for herself and cannot have a life. Her life is lived pretty much in her bedroom and bathroom. She does go into the kitchen to warm up food which her brother prepares for her. She leaves the house to go to the doctor and the therapist. She is her depression. When she talks to me she is anxious, overwhelmed with the smallest task and cannot envision a more positive future. Yet, at times, during our conversation that bright, kind, and delightful part of her will make a cameo appearance. That person is still there but not often making an appearance. She has a long history of being able to rouse herself to help others clean house or do major chores for them but would be unable to get herself to do the same for herself unless she was having company and then could prepare the house for them. Eventually, she was unable to convince herself that it was worthwhile to do even that. Now she has told herself that she is unable to do these sorts of tasks. She does keep her appointments with her doctor and her therapist.
What I often hear from friends and family of individuals such as these two good people is that they do not try to help themselves; that they are needy and whiny; that they feel sorry for themselves. It certainly seems that way at times. Yet, the truths are:
· They have a very serious depressive illness which has an acute effect of their ability to function.
· They seem unable to connect the positive dots – the positive experiences/moments.
· They become their diagnoses and their labels. Yet, they are much more that those diagnoses and labels.
· It takes very intentional effort to stay centered when with these individuals and not get sucked into the labels or the depressive mood.
If we are going to be supportive and loving with such individuals, we need to take a very holistic approach, be very patient and begin as early as possible to help them correct the distorted messages of the depression. Some of those corrected messages will be:
· They are not their labels.
· The positive moments to count. All any of us have are moments.
· With help, they can quit feeding the story line.
· They can do things for themselves even it is one small task at a time.
· They deserve to be treated with love and respect.
· They can, one small step at a time, learn to treat themselves with respect – emotionally, physically, nutritionally and spiritually.
· They have to accept that they have a chronic illness and stay on medications even when feeling better.
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