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|Deconstructing Depression - Page 4|
Post-traumatic stress is another source of depression that can manifest itself in sudden feelings of intense helplessness, often set off by emotional or environmental events, which the client may not even recognize as triggers. Trauma victims can experience disproportionately powerful mental and physical states from even seemingly minor stressors, especially when they somehow evoke a version of the helplessness and sense of danger they felt during the initial trauma. They have a hard time believing anybody can help them, far less that they'll ever be able to help themselves.
Mike was the kind of client often referred to as "high functioning," but it was clear from our first session that he didn't think treatment would do him much good. He was a member of a small engineering company that relied on his specialty to round out their team. He wasn't happy at work, but said, "I know I'm stuck at this job for life." At age 50, he felt he was "too old" for anyone to allow him to change jobs. And he was sure that his colleagues would try to get rid of him if he didn't show more optimism for their new business plan. In fact, he'd come to see me only because they complained so much about his negativity and indecisiveness that he worried that he might be fired. To my first remark, that he didn't seem to hope for much, he rolled his eyes and wondered aloud why he should hope for anything. "No offense," he said, "but every time I've hoped that things would change, they got worse."
For Mike, the sensation of hope immediately evoked memories of loss, disappointment, and pain. He'd been verbally and physically abused throughout his childhood, and told that the abuse was his fault. No academic or athletic achievement won parental praise, and no amount of good behavior gave a reprieve from the abuse. For him, hope was a trickster—positive feelings of hope were entangled with negative expectations. He became tearful when he said he'd hoped he could have more in life—more peace, more love, and more feelings of being good enough—but he expected it would never happen. He was afraid even to try therapy because he had no hope that it would work—it would only result in more disappointment and pain.
I realized that to help him instill a sense of hope, it had to be modest in scale, so that it didn't trigger memories of loss and fear. Consequently, we made a plan for him to focus on small hopes—for a good dinner with his kids, or a pleasant afternoon at work without worrying about next week's meetings. I asked him just to note whether these small hopes actually were realized, so he could do a reality check to see what happened when he allowed himself to hope for small, everyday things. To his surprise, he discovered that allowing himself small hopes actually contributed to their realization. True, hoping for a good life was just too much for now, but it no longer scared him to hope for a nice evening or enough quiet time to get a report written. Bringing those small hopes to conscious awareness made him less fearful of hope itself.
Since remembering the past took Mike into negative, miserable territory, and thinking about the future made him anxious, I introduced the concept of mindfulness as a way to help keep him calm and anchored in the present. He practiced watching his breath and eating an orange with complete attention to the sense of the peel in his fingers, the fragrance of the burst fruit, the texture of one segment, the taste as he slowly chewed. He caught on immediately and found that he could remind himself numerous times every day that, "this day, at this moment, all is well." While Mike is still not ready to hope for big changes, these moment-to-moment exercises in mindfulness have made him feel less afraid of hoping and trying.
I also addressed his chronic sense of helplessness by asking him to become aware of how often he described negative aspects of his life with the coda, "I can't do anything about that." No matter the topic, from controlling his anger to reviving his children's desire to spend time with him, he essentially shrugged verbally, indicating his unrecognized feelings of helplessness.