Undoing Depression: What Therapy Doesn't Teach You and Medication Can't Give You

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Overview

Like heart disease, says psychotherapist Richard O'Connor, depression is fueled by complex and interrelated factors: genetic, biochemical, environmental. In this refreshingly sensible book, O'Connor focuses on an additional factor often overlooked: our own habits. Unwittingly we get good at depression. We learn how to hide it, how to work around it. We may even achieve great things, but with constant struggle rather than satisfaction. Relying on these methods to make it through each day, we deprive ourselves of ...

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Undoing Depression: What Therapy Doesn't Teach You and Medication Can't Give You

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Overview

Like heart disease, says psychotherapist Richard O'Connor, depression is fueled by complex and interrelated factors: genetic, biochemical, environmental. In this refreshingly sensible book, O'Connor focuses on an additional factor often overlooked: our own habits. Unwittingly we get good at depression. We learn how to hide it, how to work around it. We may even achieve great things, but with constant struggle rather than satisfaction. Relying on these methods to make it through each day, we deprive ourselves of true recovery, of deep joy and healthy emotion.

UNDOING DEPRESSION teaches us how to replace depressive patterns with a new and more effective set of skills. We already know how to "do" depression-and we can learn how to undo it. With a truly holistic approach that synthesizes the best of the many schools of thought about this painful disease, O'Connor offers new hope-and new life-for sufferers of depression.

"...treats depression as a learned behavior that can be unlearned through thinking differently and incorporating coping skills into daily life."

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Editorial Reviews

From the Publisher
"An uncommonly thorough and useful guide."-Publishers Weekly

"Undoing Depression is distinguished by its common sense, its humanity, and its absence of dogmatism. It is a balanced and persuasive work that explores the dark predicament of depression, and the pathways toward help. I read it with great admiration."-William Styron, author of Darkness Visible and Sophie's Choice.

"This is a vital and invaluable guide for people who are struggling with depression, as close as a book can come to the curative effects of psychotherapy and medication."-Andrew Solomon, author of The Noonday Demon

"Undoing Depression is a book that anyone who has ever felt depressed, to any degree, can keep nearby as a useful companion. If you are really depressed, chain it to your clothing. Beautifully written, full of dependable and inspiring information, it offers countless creative things to do in the face of depression without trying to conquer it or win battles and wars. The intelligence in this book is deeply satisfying."-Thomas Moore, author of Care of the Soul and Dark Nights of the Soul

"Essential reading for anyone who suffers from depression. The wisdom in these pages speaks directly to each individual, as if O'Connor knows exactly what we're going through. MDSG runs dozens of support groups each week and at our literature tables this is always the bestselling book. Packed with the latest research and fresh ideas, this new, updated edition hasn't lost the engaging style and compassion of the original."-Howard Smith, Director of Operations, Mood Disorders Support Group

"This up-to-date, clearly written and illuminating book about the nature and treatment of depression is just plain wonderful. I view it as a gift to us all."-Maggie Scarf, author of Unfinished Business, Intimate Partners, and Intimate Worlds

Library Journal
O'Connor (Happy at Last), formerly executive director of the Northwest Center for Family Service and Mental Health in Lakewood, CT, and now in private practice, here revises and updates his successful 1997 title on depression. Continuing his sensible analysis of how everyday habitual behaviors can fuel depression and the most effective skills for combating it, he adds two new chapters, one on the importance of meditation and positive thinking and the other on stress-related diseases and afflictions that have an impact on depression. In addition, he provides current information on newly released medications for depression, cognitive concerns regarding depression, the benefits of exercise in overcoming depression, the link between post-traumatic stress disorder and depression, and new insights on the connection between depression and attention deficit disorder and emphasizes how his self-help exercises can assist psychotherapy in diminishing the need for psychoactive medications. VERDICT Though readers suffering from depression should consult a professional for the most appropriate mode of treatment, O'Connor's extensive experience and no-nonsense approach result in a refreshing new addition to the vast literature on depression that will be of value to helping professionals and erudite readers.—Dale Farris, Groves, TX
John M. Grohol
Richard O'Connor knows what he talks about in one of the most thorough, comprehensive, and enjoyable books I've ever read on the beast we call depression. As a therapist, a supervisor, an administrator, and perhaps most importantly, as a human being. O'Connor brings more to this topic than a simple recitation of facts and self-help methods. He brings the human experience home to the reader, in a way few writers do in this book genre.

O'Connor warns in the introduction that this is a book filled with stuff that the two distinct audiences (mental health professionals and laypeople) may not ordinarily share. But as someone, like O'Connor, who has grappled with the beast at one point in my life as well, I concur with his recommendation -- the book is best read in its entirety, skipping nothing. Each chapter offers not only in-depth and balanced knowledge and information O'Connor imparts to the reader, but also a good dose of humanity and caring. For instance, interspersed throughout each chapter are personal stories from therapy, and clients' own stories, bringing home specific, important points. It makes what might otherwise be yet another impersonal self-help book (from a mental health professional) into a relevant, useful guide easy to relate to aspects of one's own life.

O'Connor's writing is fluid and down-to-earth; he never gets mired in details losing the main point of his argument or discussion. He gives specific examples throughout each chapter, and keeps everything understandable while not minimizing the complexity of specific subjects. The book seems to have struck a very good balance between information, discussion, and related stories, keeping it interesting to read throughout.

The book is extensive, and its length may be off putting (especially to those currently suffering from depression). But its length is also its greatest strength, because it covers so many topics relating to depression so well. Offering a single guide to depression is a big undertaking, since depression infiltrates so many aspects of a person's life. Undoing Depression, however, addresses nearly every one of the most important aspects and gives sensible advice on how to improve them. The book has 22 chapters covering topics such as: a background regarding depression, what we currently know and understand about depression, how it's diagnosed, what are some of the theories behind it, how people are good at what they know (e.g., depression); how to start overcoming depression by learning new skills regarding out emotions, behavior, thinking, the self, and relationships; aids to recovery; how to put new skills to work through self, work, love, marriage, families, divorce, and community. The four parts of the book are well-organized and logical, and it includes two indices: Organizations promoting recovery, and a self-scoring depression questionnaire. The book ends with footnotes for each chapter, a recommended reading list, and an index.

If you're suffering from depression and have tried other self-help methods, books, tapes, psychotherapies, and medications, and you still seem to be stuck in the depression rut, you should try this book. Take it a few pages at a time, and you will get through it and glean knowledge from it which will almost certainly help you in some aspect of your life. While it won't perform miracles, it may be just what you need to put your depressive feelings into perspective and turn your life around. 358 pages

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Product Details

  • ISBN-13: 9780316043410
  • Publisher: Little, Brown and Company
  • Publication date: 1/7/2010
  • Edition description: Original
  • Edition number: 2
  • Pages: 374
  • Sales rank: 154,423
  • Product dimensions: 5.40 (w) x 8.10 (h) x 1.10 (d)

Meet the Author

Richard O'Connor is the author of four books, Undoing Depression, Active Treatment of Depression, Undoing Perpetual Stress, and Happy At Last. For fourteen years he was executive director of the Northwest Center for Family Service and Mental Health, overseeing the treatment of almost a thousand patients per year. He is a practicing psychotherapist, with offices in Canaan, Connecticut, and New York City, and he lives with his family in Lakeville, Connecticut.

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Table of Contents

Preface to the Second Edition VII

Author's Note IX

Introduction 3

Part 1 What We Know About Depression 11

1 Understanding Depression 13

2 The Experience of Depression 27

3 Diagnosing Depression 38

4 Explaining Depression 60

Part 2 Learning New Skills 75

5 The World of Depression 77

6 Emotions 84

7 Behavior 102

8 Thinking 124

9 Stress and Depression 138

10 Relationships 157

11 The Body 171

12 The Self 185

13 Treating Depression Medically 197

14 Psychotherapy, Self-Help, and Other Means to Recovery 220

Part 3 Putting the Skills to Work 233

15 Work and a Sense of Purpose 235

16 Living, Together and Apart 253

17 Children and Adolescents 274

18 Community 295

Part 4 A New Synthesis 305

19 The Rest of the Story 307

20 A Program for Recovery 312

21 Beyond Recovery 324

Appendix: Organizations Promoting Recovery 337

Recommended Reading 339

Acknowledgments 345

Notes 347

Index 367

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First Chapter

Undoing Depression

What Therapy Doesn't Teach You and Medication Can't Give You
By O'Connor, Richard

Little, Brown and Company

Copyright © 2010 O'Connor, Richard
All right reserved.

ISBN: 9780316043410

Part 1

What We Know About Depression

1

Understanding Depression

WE ARE LIVING in an epidemic of depression. Every indication suggests that more people are depressed, more of the time, more severely, and starting earlier in their lives, than ever before. Depression is not going to go away no matter how much we ignore it, scorn it, or neglect it. We need to attend to it as a major public health problem. But that’s difficult to do because the idea of depression frightens us all — we think of a descent into madness — and thus we avoid the subject. We have a natural wish to forget about depression, to hope that we are immune. Can you make yourself remember the sensation of pain? Most people react to the question with a cringe but really can’t describe pain or evoke the sensation in their memory. We repress it, push it away, so that most of the time we don’t think about it and we can get on with life. But when we hear the dentist’s drill, we suddenly remember exactly what it’s going to feel like. We do the same mental trick with depression. We’ve all felt it, but we believe we have to shut out the memory. We want to think of depression as something that happens to somebody else.

But it strikes closer to home now, because the incidence is increasing. For each generation born since 1900, the age of onset of depression is younger and younger, and the lifetime risk has increased. According to the most official, conservative estimates, approximately 6.7 percent of Americans will experience an episode of major depression in their lifetimes. When you add in the so-called milder forms of depression, I believe the rate goes up well past 25 percent. Every fourth person you meet is likely to have a serious encounter with depression at some point in their lives. And every fifth person is depressed right now: researchers estimate that almost 20 percent of the population meet the criteria for some form of depression at any given time — and that does not mean people who are temporarily feeling the blues and will be better next week, but people who are having real difficulty functioning in life.

This epidemic is not merely a result of growing awareness of depression, but a true growth in hard numbers. Nor is it only a phenomenon of American, or even Western, culture. A recent study comparing incidence of depression in Taiwan, Puerto Rico, and Lebanon, among other countries, found that for each successive generation, depression was likely to begin at earlier ages, and that over the course of a lifetime, the risk of depression kept increasing. Of all people with major depression, 15 percent will end their lives by suicide.

Clinical depression is a serious, often fatal illness that is so common it’s hard to recognize. But health economists consider it just as disabling as blindness or paraplegia. In terms of overall economic burden to our society, depression is the second most costly disease there is. This surprising news comes from the World Bank and World Health Organization, which measured the lost years of healthy life due to disease. The cost, in terms of direct treatment, unnecessary medical care, lost productivity, and shortened life span, was estimated at $83 billion dollars a year in the United States alone for the year 2000. Depression is second only to cancer in terms of economic impact, and approximately the same as the cost of heart disease and AIDS. The number of deaths from suicide in the United States each year (33,000) is approximately twice the number of deaths from AIDS, and shows no sign of declining. And the impact will only get worse: if current trends continue, children today will develop depression at the average age of twenty, instead of the thirty-plus we are used to. Yet only a third of people with long-term depression have ever been tried on antidepressants, and only a small number of them have ever had adequate treatment.

If this is all true, if depression is as dangerous and prevalent as I’m saying, you may well ask: Where’s the big national foundation leading the battle against depression? Where’s the Jerry Lewis Telethon and the Annual Run for Depression? Little black ribbons for everyone to wear? The obvious answer is the stigma associated with the disease. Too much of the public still views depression as a weakness or character flaw, and thinks we should pull ourselves up by our own bootstraps. And all the hype about new antidepressant medications has only made things worse by suggesting that recovery is simply a matter of taking a pill. Too many people with depression take the same attitude; we are ashamed of and embarrassed by having depression. This is the cruelest part of the disease: we blame ourselves for being weak or lacking character instead of accepting that we have an illness, instead of realizing that our self-blame is a symptom of the disease. And feeling that way, we don’t step forward and challenge unthinking people who reinforce those negative stereotypes. So we stay hidden away, feeling miserable and blaming ourselves for our own misery.

This is a dirty little secret of mental health economics: if you’re depressed, you don’t think you’re worth the cost of treatment. You feel guilty enough about being unproductive and unreliable; most likely your family members have been telling you to snap out of it, and you believe you should. You’re not likely to shell out a hundred dollars an hour to see a therapist, and if your insurance won’t pay, you’re not likely to put up a fight. Yet your therapist needs his fee, and insurance carriers often require you to be very determined before they will pay their share. They will play on your own guilt about your condition to make it difficult for you to get anything more than the absolute minimum treatment. They count on discouraging you from pursuing your claims in order to save themselves money; and, in doing so, they reinforce your depression. There are hopeful signs about “parity” for mental health services, but until the laws are changed and new regulations published, managed care plans still will find ways of drastically restricting coverage for outpatient care.

The decade between 1987 and 1997 brought extraordinary changes in how depression was treated in the United States, trends that have very likely continued since. The percentage of people being treated for depression tripled in that time, from less than one percent to 2¹ ³ percent (while the percentage of people receiving healthcare treatment of any kind actually declined slightly). But all that growth was due to the appearance of new drugs on the market. In 1987, 37 percent of people being treated for depression were taking an antidepressant; in 1997, it was 75 percent. Meanwhile, the proportion receiving psychotherapy declined from 70 to 60 percent, and the average number of therapy sessions declined as well. SSRIs (selective serotonin reuptake inhibitors; the new class of antidepressants — Prozac, Zoloft, Paxil, Celexa, Lexapro) were not generally available in 1987, but within ten years they were being prescribed to almost 60 percent of patients. By 1998, more than 130 million prescriptions for antidepressants were written each year in the United States, and Prozac, Paxil, and Zoloft were among the six best-selling drugs of any kind. By 2004, fully one-third of U.S. women’s doctor visits resulted in a prescription for an antidepressant. By 2005, 10 percent of the American population was taking an antidepressant. Here you have the intersection of two factors: the direct-to-consumer advertising of (and all the media hype about) the newer antidepressants, and the advent of managed care, which often requires treatment by a physician (not a psychiatrist), and reimburses less for psychotherapy. Most experts agree that treatment with medication and psychotherapy combined is best, but very little research is being conducted on combined treatment because in the U.S. drug companies fund research, and they’re not interested in supporting that conclusion. So psychotherapy for depression became the exception, and a scrip from your GP became the norm. Depression became chemical, and there was no need to look at the stresses in your life.

Then the news began to trickle out that medications weren’t so effective after all. We learned that in their testing, they had proved only slightly better than sugar pills, that the testing used measures that were designed to exaggerate the success of the meds, and that over the long haul, most people using them relapsed. We learned that the side effects were far more pervasive and serious than we had been led to believe, and subsequently realized that depression can’t be brushed off as a chemical imbalance.

Despite greater awareness and all the pills prescribed, depression remains amazingly underdiagnosed. That same study showing the remarkable expansion in treatment still notes that most people with depression get no treatment at all. Many people don’t realize they have it. When I worked at our community mental health center in rural Connecticut, we would see two or three new people every week who had trouble sleeping and other physical symptoms, felt anxious and overwhelmed, had lost ambition and hope, felt alone and alienated, were tormented by guilt or obsessional thoughts, may even have had thoughts of suicide — but they wouldn’t call it depression. They just concluded that life stinks and there was nothing they could do about it. They would go to their doctors for aches and pains, sleeplessness, lack of energy, and get a useless prescription or medical procedure or be dismissed as hypochondriacs. They might medicate themselves with alcohol and drugs. Their families didn’t know how to help; neither sympathy nor moralizing seemed to have any effect. In this way, the depressed person gets caught up in a vicious circle from which there seems to be no escape. Life like this does stink, especially when you blame yourself and don’t realize you have an illness.

Untreated depression will damage the course of your life. Men with early onset (before age twenty-two) major depression are only half as likely to marry and form intimate relationships as men with late-onset (or no) depression. Women with early onset depression are only half as likely to obtain a college degree as their female counterparts, and their future annual earnings will be substantially lower.

The real tragedy is that in mental health, where there is so much we can’t help, depression is one thing that can usually be treated effectively and efficiently. Many good, unbiased research studies have shown that treatment works. Most people improve quickly; though total recovery is often a slow, challenging process, it’s well within our grasp.

Janet was admitted to a psychiatric hospital in an acute state of depression. She was extremely upset and confused, could not organize her thoughts, could not drive to the store or take care of her children. She was obsessed with thoughts and impulses of suicide, though she did not consciously desire to kill herself. She couldn’t sleep, felt hopeless and helpless, and had lost all interest in ordinary activities. She was convinced she was losing her mind.

This all seemed to start recently when Janet found out her husband had had an affair. Although he seemed ashamed of himself and assured her it would never happen again, her world seemed to collapse. Within a few weeks, her ability to function had deteriorated dramatically. Her husband brought her to the family doctor, and together they arranged for an emergency admission.

After a week in the psychiatric ward, Janet felt much better. Just before she was ready to be discharged, she went home on a weekend pass. Her visit went smoothly until Janet discovered a letter her husband’s girlfriend had written to him while Janet was in the hospital. Again he tried to reassure Janet that the affair was over. But her condition took a dramatic turn for the worse, and she spent several more weeks in the hospital.

Depression is a fascinating condition. There is a great deal of value in thinking of it as a disease. The brain chemistry of depressed people is different from that of other people, and it is possible to find the same biochemical differences in the brains of animals that appear “depressed.” Over the long term, depression seems to result in loss of brain cells and shrinkage of certain parts of the brain (see Chapter 4). On a human level, helping people understand that they have a disease can free them from much of the guilt and self-blame that accompanies depression. They can learn different ways of reacting to stress and learn to take steps so that the danger of future episodes is greatly reduced.

But if it’s a disease, how do we catch it? If Janet’s husband hadn’t had his affair, would she ever have come down with depression? There was nothing about her to suggest susceptibility to depression before she got sick. Janet now thinks she has had a “breakdown,” she now thinks of herself as a mental patient — but isn’t this because her husband is a jerk? Is the depression in Janet, or in her marriage? If it’s in her marriage, how can the pills Janet takes help her feel more competent and capable? If it’s in Janet, is it the part of herself that sees the truth more clearly than she and her husband can admit to?

Most people who have had a true experience with depression have no trouble at all believing that something biochemical in nature has happened to them. The change in mood, in how the self and the world are perceived, seems so profound and overwhelming that it makes intuitive sense to feel that the self has been invaded by something alien. We do not feel like our selves. Something very powerful, something from outside us, has invaded and changed us.

But most people going through their first experience of depression also recognize that this feeling that seems so foreign is also eerily familiar. They remember many times from their childhood and adolescence when they felt the same way — alone, helpless, and friendless. They may remember their parents as kind and loving, but they wonder why they felt so unloved. They may have believed that they had to be perfect, and they may have tried very hard, but failed, and felt again the futility of their efforts. As adults, they may have thought they’d grown out of it, but here it is again. Winston Churchill referred to his depression as the “black dog” — the familiar beast that quietly pads in in the evening and settles down at your feet.

Depression is a disease both of the mind and of the body, the present and the past. In psychiatry now we have pitched battles going on between opposing camps, those who want to treat the brain and those who want to treat the mind — and those interested in the mind are losing the fight. The side that wants to treat the brain has all the support of Big Pharma, traditional medicine, and the gee-whiz media. But their research is almost always flawed. Unfortunately, the patient is caught in the middle. The family doctor, supported by the pharmaceutical industry, is likely to say, “Take this pill” — but when it doesn’t work, the patient just has another in a long line of failures to add to his baggage. The mental health professional is likely to say, “Let’s talk about it” — and the patient is likely to feel patronized, misunderstood, because how can simply talking lift such terrible pain?

It’s not an either-or question. Both ways of thinking are true. Psychotherapy and medication both produce similar changes in brain functioning. There is a biochemical process in depression, but the individual has been made susceptible to depression through life experiences. The current episode may be precipitated by an external event, but the event has set in motion a change in the way the brain functions.

When he was in his thirties, Robert went to bed for fourteen months. He was profoundly depressed, though he didn’t acknowledge it. A highly intellectual man, his mind was preoccupied with questions about the meaning of life. Unable to find a reason for living, he saw no reason to get up. He didn’t consciously feel depressed, he just felt empty. His wife did everything she could to get him out of bed — brought in doctors, family members, appealed to his duty to their child. It became a bitter power struggle between them. Finally, one day long after his wife had given up, Robert decided to get up and go back to work.

I got to know Robert fifteen years later. He had had other episodes in which he took to his bed for weeks, but never for so long. He and his wife had been separated for a few years, when she finally tired of his coldness.

Robert came in for treatment because he feared slipping back into his old ways. He lived alone now, in a house literally crammed with junk. There were days when he just couldn’t get out of bed. When he did, he procrastinated and couldn’t accomplish anything. He was troubled by his wife, who seemed bent on a nasty divorce battle. He still saw absolutely no purpose in living, but he wanted to resolve the divorce. He was dead set against medication of any kind, and since he never went into a major depressive episode while we worked together, I didn’t push it.

Robert had exactly the family background that is so common among depressed men: a critical, distant, hostile father and a shallow, narcissistic mother. He felt he could never satisfy his father or interest his mother. Because children can’t see their parents objectively, they make the way their parents treat them part of themselves; if you are treated like dirt long enough, you begin to feel like dirt. Instead of understanding that Father is too critical, the child experiences himself as inadequate; instead of understanding that Mother is cold, the child experiences himself as unlovable. These feelings persist into adulthood as the basis for a characterological depression, an existence without hope or joy.

I decided to try to go with Robert’s strengths: his intelligence, his intellectualized curiosity about the meaning of life, and his recognition that the world of feelings was foreign territory. I suggested that he do some reading so that he could better understand his own condition. Robert was fascinated with Alice Miller’s book Prisoners of Childhood, understanding that she was describing his parents and childhood with perfect accuracy. He learned that depression is not a feeling, but the inability to feel. He began to learn that when he felt like taking to his bed, it was in response to some interpersonal event. He wanted to learn better ways of responding.

Eventually Robert began a relationship with Betty. With Robert’s permission, Betty came in to see me; her devotion to him was obvious, but I was especially pleased with her “tough love” approach. She helped educate Robert about feelings. When he got mad at her, she wouldn’t let him withdraw. She teased and joked him out of his coldness. For his part, he was so moved by her evident love for him that he wouldn’t let himself act like the aloof, self-absorbed iceberg he used to be. Instead of ruminating about the meaning of life, for the first time he began to enjoy living.

The crisis in therapy came after a few months. Betty decided to move away from our small town, which had no jobs available. She had family in another state that would help her make a new start. Robert could come too. But he got caught up in obsessional thinking. He became terrified that his wife would break in and steal something he didn’t want her to have. But Robert knew intellectually that these worries were really trivial in proportion to the opportunity he had. With his new understanding of depression, he could see that he was displacing his anxiety about change and commitment to seemingly simpler things. Still it was very difficult for him to let go; I had to make him imagine in detail what his life would be like without Betty.

I saw Robert again, three years later. He was in town for another hearing on his divorce, which continued to drag on. He and Betty were living together, and he was working and happy. For at least three years, there was no sign at all of his depression.

What helped Robert so much? Was it the therapy, his relationship with Betty, or something else? How destructive was his marriage? His withdrawal into bed was at least partly a retreat from his wife’s nagging. Would medication have helped him sooner, or helped him even more effectively?

To understand depression, we should ask ourselves, what was it about Robert and Janet that made them respond to life stresses in the way they did? This is what sets them apart from other people. Many wives in Janet’s situation would have questioned their marriage, not themselves. Others might have shrugged off a husband’s affair. What made Janet so vulnerable? How could Robert become so immobilized for so long, and then one day snap out of it? To what extent did his coldness, his inability to feel, which seemed so much a part of him, contribute to his depression?

William Styron, author of Sophie’s Choice and winner of the National Book Award, wrote Darkness Visible to describe his own bout with depression. He referred to his experience as “madness,” feeling that the word “depression” is simply an inadequate expression of the experience — “a true wimp of a word for such a major illness.… Told that someone’s mood disorder has evolved into a storm — a veritable howling tempest in the brain, which is indeed what a clinical depression resembles like nothing else — even the uninformed layman might display sympathy rather than the standard reaction that ‘depression’ evokes, something akin to ‘So what?’ or ‘You’ll pull out of it’ or ‘We all have bad days.’ ”

Styron was right. People feel ashamed of being depressed, they feel they should snap out of it, they feel weak and inadequate. Of course, these feelings are symptoms of the disease. Depression is a grave and life-threatening illness, much more common than we recognize. As far as the depressive being weak or inadequate, let me drop some names of famous depressives: Abraham Lincoln, Winston Churchill, Eleanor Roosevelt, Sigmund Freud. Terry Bradshaw, Drew Carey, Billy Joel, T. Boone Pickens, J. K. Rowling, Brooke Shields, Mike Wallace. Charles Dickens, Joseph Conrad, Graham Greene, Ernest Hemingway, Herman Melville, Mark Twain.

Depression accounts for a large part of the business in most outpatient practices. At our clinic, we could see a big difference between self-report and diagnosis; only 12 percent of people told us when they first called that depression was their primary problem, but 45 percent of our patients ended up with a diagnosis of some form of depressive disorder. People usually called not because they were aware they were depressed, but because the depression had reached the point where their lives were in crisis — marital problems, drug or alcohol problems, trouble at work. But we would see someone who looked sad, tired, and defeated, couldn’t sleep, was irritable, hopeless, and blamed himself for the situation. Depression often grows in us so slowly that neither we nor those close to us notice the change, while an objective observer detects it right away. When I first decided to try medication and consulted a psychiatrist who knew me socially, I asked if he thought I might be depressed. He was amazed that I didn’t know.

Depression most often strikes young adults, but 10 percent of all children suffer an episode before age twelve, and 20 percent of the elderly report depressive symptoms. Both children and the elderly are amazingly undertreated. Estimates are that six million elderly persons suffer from some form of depression, but that three-quarters of those cases are undiagnosed and untreated, despite regular routine medical care. Depression in the elderly tends to get dismissed as inevitable, but in fact it is caused more by poor health and poor sleep than grief, loss, and isolation. Among the elderly who commit suicide, almost three-quarters visit a doctor within a week before their death; but only in 25 percent of those cases does the physician recognize a depression. In long-term care facilities, most of the patients are given some form of antidepressant, but is this because they are depressed, or to make them less sensitive to their living conditions? Do we call it depression if they are correctly seeing that the world treats them as useless and forgotten?

Twenty-five percent of all women and 11.5 percent of all men will have a depressive episode at one time in their lives. But this reported lower incidence among men may really be a mistake arising from the way we diagnose. Men are socially prohibited from expressing or even experiencing the feelings associated with depression. Instead, they act them out through substance abuse, violence, and self-destructive behavior. Across the United States, four men commit suicide for every woman who does, a dramatic reversal of the differences in reported depression. In Amish culture, where macho acting out is frowned upon, the incidence of depression is the same for both sexes. See Chapter 11 for a more thorough discussion of these sex differences.

Suicide, the “worst case” outcome of depression, is officially the tenth most common cause of death in America. There are 33,000 documented suicides annually, but the true incidence is probably double that (because police and medical examiners prefer not to label ambiguous, solitary deaths as suicide). One out of every two hundred people will eventually take their own lives. And although I personally think that suicide can sometimes be a rational choice for people who are in intractable pain or facing great disability, the vagueness of the boundary lines means that we have no reliable data on how many suicides are people who are really depressed, versus how many are “rational.” My experience is that far, far more suicides are truly depressed. Among adolescents, the suicide rate has quadrupled in the past twenty-five years. A few years ago in a small city near where I work, there were eight suicides among young people in one year. These were usually young men just out of school, often intoxicated, usually with no “warning signals” beforehand. An angry, bitter kid who has an unexpected disappointment, gets drunk, and has a gun close at hand is a disaster waiting to happen.

When I still worked in Chicago, I got to know Jane, whose twenty-year-old son had shot himself while she slept in the next room. This was a young man no one would have described as depressed; rather he was a troublemaker. With a history of arrests for minor offenses as a juvenile, he had been sent to a reform school when he was fifteen. Since being discharged, he had lived off and on with Jane and with friends. He worked occasionally, drank a lot, and got into fights.

On the night he took his life, Jimmy had two pieces of bad luck that probably put him over the edge. First he met his ex-girlfriend at a local hangout; she went out of her way to be snotty to him. Then he ran into his father at another bar. A true town drunk, the father barely recognized his son; when he did, it was to ask him for money.

Jimmy came home about midnight. His mother woke, got up and spoke to him, asking him if he needed anything. He was drinking a beer and reading a magazine, and as far as Jane could see, he was his usual self. She went back to bed. Jimmy went to his room and wrote a brief note, more a will than a suicide note. He wanted his brother to have his motorcycle, snake, and hunting rifle. Then he shot himself with the hunting rifle.

Jane kept asking me why. I couldn’t tell her what I thought was the true answer to that question, because I thought it was too cruel, but in my opinion she and her son were as much victims of chance as anything else. If you take any sample of impulsive, alcoholic young men whose lives are going nowhere, get them drunk, expose them to rejection, and leave them alone with a gun, some of them will shoot themselves. Which ones take their lives on any given night is just the law of averages. Are they depressed? They sure are, but they can’t admit it or show it.

Jane is like most survivors of suicide I’ve known. You certainly don’t get over it, but you learn to live with it. She was depressed herself for over a year, had terrible headaches (a psychosomatic symptom mimicking her son’s injury), was unable to work, became overwhelmed with stress, and went from doctor to doctor seeking relief from her pain. Antidepressant medications didn’t help; all I could do was listen while she grieved. Eventually her headaches became less frequent and she began to have a little more energy to put into her life. I think of her every time I hear of an adolescent suicide.



Continues...

Excerpted from Undoing Depression by O'Connor, Richard Copyright © 2010 by O'Connor, Richard. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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See All Sort by: Showing 1 – 20 of 28 Customer Reviews
  • Anonymous

    Posted March 31, 2001

    Thoughts and Actions That Can Overcome Depression

    The author is quick the point out (and he is correct) that this book will not improve or cure depression by itself. You need professional help for that. Instead, the purpose of this book (which it magnificently addresses) is to describe what the depressed person and the depressed person's family and friends need to be doing to provide the maximum likelihood of overcoming depression. That's a reasonable promise and premise for a book on this important subject, and you can begin to overcome your ignorance (and the harm it can bring) by reading this book and acting on its advice. First, the bad news. Depression is increasing. Worse still, the younger someone is, the more likely that the person will experience depression sometime. Even worse, many people are undiagnosed, and suffer alone with their affliction. Second, the good news. Around 70 percent of all those suffering from depression will improve with either drug therapy or mental health treatments. Those who get both do even better. Third, more bad news. Depression tends to recur for many people. The voice addressing these issues is an expert one. He is a psychotherapist who runs a community health center. More importantly, he has suffered from depression himself. I doubt if you can get more direct access to what depression is all about than from Richard O'Connor. I admire his caring to share so much of his own pain with us, and respect him enormously for this gift he has given us all. Depression is currently under reevaluation. No single paradigm seems to capture all of its elements. Undoubtedly, an improved scientific model for it will emerge. There are signs that it can have roots in disturbed relations between Mother and child, family dysfunction, possibly genetic disorders of brain chemistry (like using up seratonin too rapidly), other traumas, and poor thinking habits. Who knows what else may turn up? Many people try to deal with this problem too much on their own. Families often put up with the depressed person's behavior, not knowing what else to do. Others reject the depressed person, which will usually make the situation worse. O'Connor lays out common sense guidelines that should make a diference: for depressed people, for those who care about them, and for those who treat them. The author sees depression as a disease and as a social problem, 'an illness to be treated professionally and a failure of adaptation that we must overcome through self-determinination.' He outlines important principles for the depressed person: (1) Feel your feelings (depression is the suppression of feelings -- acknowledging those feelings often causes depression to improve). (2) Realize that nothing comes out of the blue (your depressed state has a root cause that you should look for in an event or situation). (3) Challenge your depressed thinking by questioning your assumptions, especially ones that center on meaningless perfectionism. (4) Establish priorities so that your energies go into what will be on what's most important to you. (5) Communicate as directly as possible to everyone around you. Depressed people are often poor communicators who don't get their emotional needs served. With better communication, they can experience a more supportive emotional environment. (6) Take care of your self. Learn to enjoy yourself. (7) Take and expect the right responsibility for yourself -- for your own actions. Depressed people often feel guilty about things that they have no responsibility for (like the death of a parent or the divorce of their parents). (8) Look for heroes. These role models can empower you to see the way to improve, especially if they were also depressed like Lincoln. (9) Be generous. Helping others puts your own situation into perspective. (10) Cultivate intimacy. This means letting down your defenses so people can see you as you are, and accept you for that. Depressed people often feel disgusted with their true selves, and hide that self from

    9 out of 10 people found this review helpful.

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  • Anonymous

    Posted January 29, 2008

    NOT A CURE, but a fabulous resource

    I have suffered from dysthymic disorder 'chronic, low-grade depression' for more than 25 years--since I was 14 years old. I've been to years of therapy 'which helped a lot' and taken a half a dozen different drugs--often two or three in combination 'which helped variously, some HUGELY, some not at all, but none for a long time'. I found this book to be an incredibly valuable addition to my arsenal of weapons to use in fighting my depression. More than any other thing I've tried, done or taken, this book made clear to me the role I have to and can play in my own process of being well. It's not sufficient 'for me at least' to take a pill or two, or to go to an hour or two of therapy a week. Hard as it is, ultimately being well requires that I act to be well. And in a completely sympathetic and non-judgmental way, O'Connor offers a detailed theory of how to do that. I recommend this book unreservedly to anyone who lives with depression. It is NOT a cure, but it is a very powerful tool--one that I already use daily and probably will use for the rest of my life.

    8 out of 8 people found this review helpful.

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  • Anonymous

    Posted August 16, 2004

    This one is the best!

    The best advice I could give someone who suffers from depression or who knows someone who does is to get this book. Reading Undoing Depression has brought hope into my life. Whenever I pick it up I find some help. My physician recommended the Web site, which led me to the book. This is one author who knows of what he speaks; he is not only a psychotherapist but is a sufferer of depression as well. And he is a stimulating writer, keeping you interested enough to continue reading even when you are not 'in the mood.' I am so very grateful Dr. O'Connor had the courage to share his personal experience.

    4 out of 4 people found this review helpful.

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  • Anonymous

    Posted January 5, 2003

    This book helps those who feel they are all alone!

    I loved this book. After years of suffering intermittent depression, Undoing Depression helped me realize that I am not alone with my feelings and how I deal with life at times. The author, a fellow sufferer, explains in lay terms the causes of depression and the ways to help yourself deal with future episodes...and get on with your life. It is not a cure-all, as depression can be a lifelong struggle, but there were great practical tips that the sufferer and family members can read to help the sufferer and to help them better understand that depression is a disease and not something that one can just snap out of at the snap of one's fingers. Many kudos to the author for writing such an important book and for talking about a subject that is so hard to understand...especially by those who suffer from it! This is a must read for those who have experienced depression in their lives...be it personally, or with a family member or friend. It gives great perspective to those of us who thought they were all alone with the feelings they sometimes have.

    4 out of 4 people found this review helpful.

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  • Anonymous

    Posted September 12, 2002

    Undoing Depression: What Therapy Doesn't Teach You and Medication Can't Give You

    I have read many self-help books and this is definitely on my top 10 list of the best. I found valuable information for myself that I didn't find with so many others I have read. I will definitely come back to this book periodically to review the great information.

    4 out of 4 people found this review helpful.

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  • Posted May 7, 2010

    I Also Recommend:

    Take the Confusion out of Understanding Depression

    I found this book to be very helpful in understanding what depression is really all about. Deep down I may have realized I was experiencing it, but never understood it fully. Richard O'Connor was very informative in guiding you through depression in an easy to understand method. This book would be helpful whether you are depressed, a family member or friend.

    2 out of 2 people found this review helpful.

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  • Anonymous

    Posted March 3, 2006

    Excellent Book in Real Terms

    I never knew I suffered from depression until I had a breakdown. Then in an effort to learn about my disease I read this book first and I'm glad I did! I could only read a few pages before I have to put it down to digest what I have read. I just never realized I had devised so many ways to cope with the depression over my 40 years, the sames ways all depressives do. My therapist agrees it's a good book, especially since it provides not only insight into the disease but ways to cope with the depression. This book is a great read for the person with depression or the person who wants to learn about someone with depression.

    2 out of 2 people found this review helpful.

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  • Anonymous

    Posted August 8, 2004

    Not everything is that simple.

    Whether using the steps outlined in this book, or RET, or others which give one some assistance in dealing with everyday issues, some relief can be found. However, it is too simplistic to believe that a disease--yes, with the same biological and medical definition behind it as cancer or lupus--a disease as depression can be 'cured' by following the steps from one book. My own experience has me see this book as idealistic, and possibly dangerous for anyone suffering from severe depression.

    2 out of 4 people found this review helpful.

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  • Anonymous

    Posted September 10, 2002

    Undoing Depression: What Therapy Doesn't Teach You and Medication Can't Give You

    Depression is epidemic in America, and being a personal and professional development coach, I'm stuck not being able to dispense medicine or therapy. What could I do to help my clients? Here it is. Written by a fellow-sufferer, it's full of the kind of personal insight that teaches. Good ideas for managing your depression once therapy and medicine have done all they can. Written in easy- reading English, not full of jargon. Gave me some great ideas!

    2 out of 2 people found this review helpful.

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  • Anonymous

    Posted March 6, 2003

    Rewiring the brain without medication

    I found O'Connor's book quite original and well-written. I come from the school of thought that the greatest component of depression is biological and is most easily undone by medication. Nonetheless, there is merit to what the man is saying, especially in cases of mild depression. I'd recommend the book to anyone suffering from depression.

    1 out of 1 people found this review helpful.

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  • Anonymous

    Posted February 9, 2003

    THE best resource for depression!

    Dr. O'Connor is incredibly insightful and describes depression with amazing accuracy. He offers a variety of useful techniques and sheds light on how depressed people reinforce their own depression. But the most healing aspect of this book is it's ability to make depressed people feel understood -- as if he can read your mind. This is because Dr. O'Connor is both a therapist and a recovering depressive. I finally understand what I'm doing wrong AND how to fix it.

    1 out of 1 people found this review helpful.

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  • Posted December 7, 2011

    Validating

    I really found this book both validating and helpful. Of course it is not a replacement for therapy but it gives excellent insight to what depression is and how the depressive mind thinks. Some of the exersizes were very helpful.

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  • Posted July 28, 2011

    Excellent!

    LOTS of information and help about and for depression. Written in language lay people can understand. While giving his own experience and opinion that is down to earth and educated, he also gives info about other view points and ideas without being dismissive. This book could be helpful for both the person newly experiencing depression because of all the easy discussion and is also great for the chronic depressive ready to take control of their life.

    Was this review helpful? Yes  No   Report this review
  • Posted June 23, 2011

    more from this reviewer

    a must read especially if you suffer for Depression

    a must read especially if you suffer for Depression.This Book was of great help to and some of thing i learn I've been practicing and i can truly say it has help me a lot with my Depression

    Was this review helpful? Yes  No   Report this review
  • Anonymous

    Posted August 16, 2002

    The part that gets left out

    Depression is epidemic in America, and being a personal and professional development coach, I'm stuck not being able to dispense medicine or therapy. What could I do to help my clients? Here it is. Written by a fellow-sufferer, it's full of the kind of personal insight that teaches. Good ideas for managing your depression once therapy and medicine have done all they can. Written in easy-reading English, not full of jargon. Gave me some great ideas!

    Was this review helpful? Yes  No   Report this review
  • Anonymous

    Posted August 13, 2002

    Life Changing

    I have read many self-help books and this is definitely on my top 10 list of the best. I found valuable information for myself that I didn't find with so many others I have read. I will definitely come back to this book periodically to review the great information.

    Was this review helpful? Yes  No   Report this review
  • Anonymous

    Posted August 29, 2002

    Smart Book, Intelligent direction

    This is an approach we have needed for years, attack depression with an analysis in an identifying, intelligent, and methods unique. This is a book you have to get into and focus upon to apply the method of undoing your problems. I recommend it no matter what level of depression.

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  • Anonymous

    Posted December 31, 2011

    No text was provided for this review.

  • Anonymous

    Posted June 3, 2011

    No text was provided for this review.

  • Anonymous

    Posted July 20, 2010

    No text was provided for this review.

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