Deconstructing Depression - Page 6

 Attachment or Abuse-Induced Depressions

Depression stemming from attachment problems often manifests as a default attitude of negative expectations about the world and an inability to soothe oneself in adversity, which often results in a plunge into despair when the person confronts even minor upsets. A child who's repeatedly left uncomforted by adults when distressed first becomes frantic, then resigned and hopeless, ultimately shutting down emotionally. A child suffering from this kind of chronic neglect or even more severe attachment failure (physical and emotional abuse, for example) becomes an adult who tends to feel generally hopeless, with low expectations of self and others, and susceptible to sudden plunges into psychological despair. These clients exhibit dramatic shifts of mood, quickly descending from relative equanimity to abject misery as if "falling off a cliff."

Shawna had a history of neglectful parenting—her father was absent, her mother depressed, and neither offered her much warmth as a toddler or later protected her from bullying and abuse from a neighbor. As an adult, her mental default mode was set on "life is deeply unfair, and much more unfair to me than to others." My therapeutic goal was to help her balance her chronic sense of disappointment and victimization with more positive experiences of other people.

To refocus her attention and reset her automatic default from hopelessness to a more neutral wait-and-see attitude, I gave her several assignments. One was to "Say five positives" every day—find five good things about others' character or behavior, and then tell them. Besides being an antidote to the assumption that everyone else is unfair and mean, this exercise sets up a positive feedback loop: others, in response, are likelier to live up to your positive remarks than down to your low expectations. During several months, Shawna began to see some good in the world and feel slightly more trusting that people wouldn't always disappoint her.

Shawna had a tendency to make even the smallest setback a catastrophe. If a friend cancelled weekend plans or her boss told her that they had to discuss a problem, she'd regard it as a sure sign that the friend intended to dump her and the boss to fire her. Unable to tolerate such intense dread, she'd tranquilize herself by spending the weekend compulsively eating or drinking too much or losing a lot of money gambling. It's virtually impossible for these clients to prevent such impulsive reactions when they're primed, as Shawna was, to instantly dive into hopelessness. The ability to "put on the brakes" before emotionally crashing requires a cognitive recognition of what's happening and a capacity to forestall it through conscious self-soothing techniques. Having never been comforted as a child, Shawna simply didn't know how to comfort herself.

Such clients need to learn ways to put on the brakes consciously when their moods begin to slip, until that process eventually becomes an automatic reaction. Without support, clients like Shawna can't even get to this point. If, however, consistent support from someone else is available, they can learn fairly quickly to call for help before going over the edge into despair. Together, Shawna and I made a plan to call a lifeline. When on the verge of an emotional nosedive, she agreed to call either me or a good friend.

With Shawna's permission, I talked to her best friend and we agreed that instead of just offering sympathy, she'd refocus Shawna's attention to the possible positive interpretations of any situation that seemed desperate to her. If her boss told her they had to discuss a problem, the friend could say, "Your boss may want to brainstorm about the problem, rather than blame you for it." We also wrote "lifeline notes" that she could read when no one was available to talk. One, for example, reminded Shawna to identify three potential positive outcomes to a situation before assuming the worst would happen. This helped put the brakes on her tendency to get carried away by assuming the worst.

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