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|Deconstructing Depression - Page 5|
We know from neurobiological research that language—coming from the left prefrontal cortex—modulates emotion by exerting control over the limbic system. So, helping Mike change his language—making it less about his inability to do anything, and more about his personal agency—could actually reduce his feelings of helplessness. I pointed out the times he said "I can't," until he himself became aware of how often he used this phrase. I then suggested he substitute "I won't" for "I can't" and notice how the change made him feel. He found that while saying "can't" made him feel helpless, "won't" reminded him that he was, in this moment, simply not choosing to try to change it. His internal discourse thus became less about helplessness and more about rationally appraising situations and his motivation to change them.
Situation-induced depressions may result from serious personal losses (job, spouse, death of a loved one), work burnout, or exhaustion from long-term care of a sick family member. In addition to causing sadness, discouragement, or a sense of meaninglessness, these stressful situations can engender physical lethargy and emotional isolation, which tend to be self-reinforcing: exhaustion and isolation breed more exhaustion and isolation. Furthermore, this kind of depressed client doesn't just need to change an attitude, but also the situation itself by doing something about it.
Paul was sent on a year-long job assignment to the other side of the country. Since his wife preferred remaining close to her two adult children and several grandkids, he went by himself. Lonely and cut off from his normal routines, he worked long hours—often 10 to 14 a day—to fill the void. When he finally returned home to his former job, his old world had changed: he'd been replaced as captain of his bowling team; he decided not to rejoin his men's club and church; his young grandchildren barely remembered him. In addition, his wife generally kept busy with activities that didn't include him, such as gardening, book clubs, and a women's golf league. Feeling even lonelier and emptier, he filled his hours with work, which at least gave him some sense of being useful, if not important. His increasing exhaustion and detachment made him irritable with everyone and disinterested in social activities; he grew aloof even from his wife and children.
Finally, his wife suggested they separate, which prompted him to seek therapy. In a classic case of burnout, like Paul's, working becomes a substitute for feelings and relationships. The adrenaline rush of nonstop activity or meeting deadlines creates the sensation of having feelings, temporarily obscuring an otherwise painful awareness of underlying emptiness and isolation.
Clients suffering burnout tend to complain about their intense responsibilities and the ensuing stress, but they don't see the depression lurking beneath the surface. Paul needed first to cool down his burnout, by taking straightforward, practical steps to restore his overall health—eat better, exercise more, improve his sleep habits. He needed to remember what he used to like to do for fun and begin doing it again. For example, he reinstituted a lunchtime basketball game with work friends, and the camaraderie and exercise together began to raise his energy. He slept better once he started getting some exercise, and even lost a few pounds—which made him feel less sluggish.
During his year away, he'd developed no social life, and spent his evenings watching TV alone until bed. It was a habit he kept up when he returned home, so his family finally stopped talking with him. He seemed to interact only when he was with his grandchildren—which wasn't often because he was too emotionally depleted and apathetic to initiate social contact with them. Such self-reinforcing isolation isn't unusual: depressed people show limited interest in others, who then lose interest in them.
To end isolation, Paul agreed that instead of waiting for his kids to become interested in him, he'd act as if he were interested in them. He thought that he could get up enough energy to call and invite them to come over once a week or a couple of weekends a month. Because his mental lethargy made it hard for him to think of activities at the moment, we planned specifically what he'd invite them to do—walk to the park or play a new video game—activities that he couldn't readily excuse himself from doing.
Isolated people often find that it takes less energy to stay isolated than to make the effort to connect with other people, even though the latter makes them feel better. Because Paul was genuinely devoted to his grandkids, he felt more responsibility to try hard for their sake. Interacting with his grandchildren gave him more opportunity to talk with his adult children about their mutual interest in the kids—beginning a cycle of self-reinforcing meaningful contact.