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What If You Had a Broken Leg Instead?
Our first step is to discover what depression is — and what it isn't. (You might be surprised!) You'll learn why you may need to take a temporary break from some of your activities and how to talk to the important people in your life about what you're going through.
A woman's life had been turned upside down by a car accident. She was coping with a lot of pain, had given up her successful business, and was struggling with depression.
"Who have you talked to about what you're going through?" Ron asked her.
"No one," she answered. "I don't want to burden my friends. If they saw me like this, they'd be shocked. And I'd be embarrassed. I'll just wait until I feel better, and then I'll talk to them."
"What if you broke your leg instead?" Ron asked. "Would you still go out for coffee with them?"
"Sure," she said.
"How would it make you feel if you went out for coffee with them even though you had a broken leg?"
"It would feel awkward and like a hassle and a little painful, but I'd probably feel better for having seen my friends," she said.
"And how would you feel if you didn't go out?" Ron asked.
"If I stopped socializing, I'd feel isolated and lonely," she said. "It'd be depressing."
Bingo. If we don't see our friends and family, we feel worse. If we do see them, we feel better.
But Ron wasn't done. "And what if you did go out? How do you think your friends would feel if they saw you with a broken leg?" he asked.
"They'd probably be happy to see me," she answered. "It wouldn't bother them that I had a broken leg."
"So how is that different from going to see your friends when you're feeling depressed?" Ron asked. "They'll be happy to see you, and you'll feel better — so everybody wins. But if you don't go out to see your friends, you'll feel socially isolated and they'll miss you. Everybody loses."
TRY THIS: Use questions to explore how you're feeling. Ask them of yourself, or get a friend to help you!
That's why we need to look at our mood difficulties as if we had a broken leg — so everybody wins.
It's hard to do. When we have a broken leg, people line up to sign our cast, but when we're depressed, there's no cast to sign — so we sign out of our social lives, ashamed and embarrassed by our invisible illness. It's way better to take a risk, reach out, and break the silence. And we'll show you how.
You don't have to be diagnosed with depression to benefit from the strategies we'll teach you. If you feel bad or down or stressed, we can help you feel better.
Understanding what depression is — and what it isn't — is important, though. Depression is a highly treatable medical illness that negatively impacts how we feel, think, and act. It comes in all different shapes and sizes. Sometimes it's short-lived (though according to most authorities on mental health, it always lasts more than two weeks). Sometimes it's mild. Other times it's severe.
Sadness is part of being depressed. So is losing interest in things that used to get you jazzed. But there's also a whole list of symptoms that people don't usually associate with depression: trouble concentrating, indecision, loss of appetite, irritability, difficulty sleeping, and even body aches and pains with no apparent physical cause.
PEP TALK: Depression is a highly treatable medical illness. Yes, highly treatable.
One in six people will experience depression at some point, and the numbers are even higher for women. In fact, some studies show that one- third of women will experience a major depressive episode during their lifetime. So even if you feel alone, you definitely aren't. Half of those who have one episode of depression will have another if they don't get treatment. Eighty percent of those who've had two episodes without treatment will have a third.
Those last two stats aren't meant to make you feel worse. Quite the opposite. Studies have shown that the techniques we'll teach you, which are based on the treatment model called interpersonal psychotherapy (IPT), can help you avoid experiencing this soul-crushing illness again.
Depression goes by many labels: disruptive mood dysregulation disorder, major depressive disorder, dysthymia, premenstrual dysphoric disorder, persistent depressive disorder, clinical depression, postpartum depression, perinatal depression, seasonal affective disorder, and even unspecified depressive disorder.
PEP TALK: If you find it hard to believe you'll ever feel better, that's probably the depression talking. It's common to feel negative and pessimistic when you're depressed — but stick with us.
Some labels you may have heard. Other labels you may have been given. It doesn't matter whether your depression is chronic and mild, related to your hormones, tied to the low light of winter, or anything else. We can help you with them all.
Only a trained health professional can diagnose depression, but as far as trusted, validated self-administered assessments go, we like the World Health Organization's Major Depression Inventory (MDI). It only has twelve questions, and you can access it online for free. Just remember, a questionnaire can't diagnose depression. If a diagnosis is important to you or your score on the quiz has you concerned, see your doctor.
Depression is not a sign of weakness, proof that you're a bad person, or a form of punishment. You don't deserve to be depressed. And you didn't bring it on yourself. No matter how many times your mom tells you to buck up, your buddy tells you to get off your butt, or that little voice inside you says, "Suck it up, buttercup," it's not a matter of simply trying harder and — poof — bye-bye depression.
You aren't selfish, lazy, self-centered, a whiner, or to blame — which is hard for a lot of depressed people to believe, since feeling ashamed and worthless are key symptoms of depression. Depression isn't a curse. And it isn't a blessing either (even if a well-meaning person tells you it'll make you stronger). But it is a very treatable illness.
Depression can affect anyone — even therapists. During the weeks after my first child was born I was a mess of emotions. Even now, decades later, it's still hard to admit. I remember pacing the hallway in my apartment, wishing I wasn't so tired, wishing my husband understood how I was feeling, wishing I knew what I was doing. I'm not sure who was crying harder, me or my daughter. I was a therapist. Wasn't I supposed to have all the answers? My feelings of incompetence were overwhelming.
PEP TALK: Depression is not something you deserve. Don't let anyone — most of all you — tell you it's your fault!
When my mother-in-law was in palliative care, I experienced mood difficulties again. It was probably while eating my twentieth bag of cookies that I realized it wasn't just my mother-in-law I was grieving — it was my mom.
You'd think I'd have figured it out sooner. My mother-in-law was in the same hospital that my mom had been in twenty years earlier, and every time I visited I had to walk past the room where my mom had been so ill. Back then, I was too busy being the strong one, the capable one, and the one everyone admired to really grieve my mom's passing.
Trust me, this is a journey. I'm still learning that experiencing feelings is okay. And I still sometimes turn to the bag of cookies.
PEP TALK: It takes guts to acknowledge you have a problem and work on making things better. You are one brave, smart, and courageous person!
Depression may not be the only thing on your plate. If you have anxiety, a concussion, a learning disability, an eating disorder, or any other physical condition or mental illness as well as depression, you may find it takes longer to feel better. You may also need some extra help from your family doctor, a therapist, or a support group. Think of it as having two broken legs instead of just one. You'll need some extra time to heal, and a wheelchair, not just crutches. Be patient and you'll make progress!
Depression definitely has a cultural component. Some languages don't have a word for depression as we use the term in English; if that's true of the language you learned to speak first, there's a greater likelihood that you'll express your depression physically, as pain, digestive problems, headaches, and more. There may be a strong taboo against talking about mental illness in your culture. It may be seen as bringing shame on your family, as evidence that you've sinned, proof you've been cursed, or simply that you're British — stiff upper lip and all that. Be aware that these forces will influence your attitude toward depression and affect who you can feel safe talking to about it.
Depression can be so severe that you feel like harming yourself. First, you need to tell someone how you're feeling. Then you need to see a doctor. You may worry that you'll scare the person you tell. You may feel as though there's nothing a doctor can do for you. But I'm telling you, help is available. Depression is very treatable. Don't do something you can't undo. Ask someone for help. Your safety is more important than anything else.
THIRTEEN SIGNS YOU MAY BE DEPRESSED
If you find you've been experiencing a number of the symptoms on this list for at least two weeks and they've been affecting your relationships and your day-to-day functioning, you could be depressed:
1. I feel sad a lot of the time.
2. I just don't care about things anymore.
3. I'm overcome with feelings of guilt.
4. I feel worthless.
5. I can't concentrate.
6. I've gained or lost weight (without dieting).
7. I'm having trouble sleeping, or I sleep all the time.
8. My performance at work or school is suffering.
9. Making decisions seems harder than it used to.
10. I'm experiencing physical symptoms that don't have a physical cause.
11. I avoid seeing my friends.
12. I think about hurting myself.
13. I just can't seem to see the positive side of anything.
It's not common, but mood difficulties can have a physical cause, such as a vitamin deficiency, Addison's disease, multiple sclerosis, pancreatic cancer, traumatic brain injury, or Lyme disease. Depression can even be a side effect of some medications. Ron is still embarrassed to admit that one of his clients, who had been working hard in therapy but wasn't making any progress, ended up having hypothyroidism. As soon as her doctor started her on medication, all of the skills she'd been practicing with Ron worked like a charm. Visit your doctor to rule out any physical illness or condition that could be causing your depression.
Outside of a biological cause like a disease, deficiency, or medication side effect, no one knows exactly what causes depression. Is it a biochemical imbalance? Is it about serotonin levels? Genetics? Is it something we pick up from our parents growing up? Is it our personality? The reasons for depression are controversial and complex. This is one way depression differs from a broken leg — in most cases there's no defining moment or single event we can point to as the cause of our emotional pain and malaise.
But that doesn't stop us from asking why. Many people look at their lives — their family, their health, their partner, their job — and say, "I've got it so good. So why do I feel so bad?"
Ana, whom we met in the introduction, wonders why she isn't over the moon when she has such a healthy, beautiful baby girl. So many couples struggle for years to conceive, with so much heartache and expense. So many babies are born with health challenges. "What's wrong with me?" Ana wonders.
Kate, the second of the four individuals we'll follow through this book, is shocked when her doctor suggests she might be depressed. "I know I've been feeling sad and low since my husband retired, but I'm so lucky that we can afford to live on one income," she says. "It's my friends who worry they'll never be able to retire who should be depressed, not me."
Becky, whose brother died of cancer, knows how fleeting life is. "I should be making every second count," she thinks. "So why can't I get out of bed?"
It's also tempting to point a finger at the past. John, the fourth person we'll regularly check in with on these pages, has spent his whole life feeling inadequate and incapable because of the way his parents and siblings treat him — so it makes sense to him that his depression is their fault.
Do you think your mood difficulties are linked to your childhood, your first romantic relationship, your choice to study one subject in college rather than another, the city you settled in, or your career path? Spending time in the past may help you to answer the question why, but it won't give you the tools to feel better in the present.
The founders of interpersonal psychotherapy saw a pattern among the people they helped with mood difficulties. Their patients, they discovered, were all experiencing problems in at least one of four different areas in their lives at the time they became depressed: life transitions, complicated grief, social isolation, or interpersonal conflict. These four problem areas aren't causes, but they are contributing factors to why people feel sad, blue, down, and depressed. At least one of them can almost always be linked to a recent depressive episode.
TRY THIS: We won't spend too much time dwelling on the past to find answers. Instead, we'll look at what's going on in your life right now.
Your problem area (or areas) — whether it's conflict with another person, grief that won't go away, a life change, or lack of supportive relationships — may be connected to what happened years ago, but we'll be keeping the focus on what you're experiencing in the present and what you can do in the here and now to feel better. In Week 4, we'll describe each of the problem areas in detail and help you pick one to work on. (To be true to interpersonal psychotherapy, which is a short-term approach that helps people feel better in eight to twelve weeks, we talk about "weeks" throughout the book. Ultimately, the pacing is up to you. Read as quickly or slowly as you like!)
You Deserve a Break Today
You may need to take a temporary break from some of your day-to-day responsibilities and commitments to work on feeling better.
It's another good reason to think of your depression as if it were a broken leg. When we have a broken leg, our priorities have to shift. Recovery becomes our most important job, so we go to medical appointments, do the exercises the physical therapist prescribes, and put our feet up (literally) when we're tired. We won't be taking the kids to the park, hitting the dance club, spring-cleaning the house, or hosting the big family dinner. It's obvious that we can't do what we'd normally do, so we don't try. And we might even accept the help that others offer us.
Depression is a medical illness as legitimate as that broken leg. We need to give ourselves permission to take the time we need to figure out what interpersonal problem is contributing to our unhappiness and learn new skills to cope. Taking time off isn't forever. It's just until we're back on our feet.
Depression is hidden — often even to ourselves — so we think we have to power through it. We beat ourselves up for having a short fuse, not being able to concentrate, feeling tired, lacking drive, missing deadlines, or being indecisive.
The temptation to suck it up and keep going will be very powerful if you feel you're the only one keeping your family's boat afloat. You might be working three jobs and still struggling to make ends meet; have an ill parent, a child with a disability, a partner who can't manage without you, a demanding job, or an unsympathetic boss; or there may be strong cultural expectations for your role.
Sometimes to take care of others, you have to put yourself first. Go for coffee with a friend instead of volunteering at the food bank. Sit down with your spouse to discuss how to divide up the household chores to lighten your load a little. Take your social media accounts down for a while. Ask your sister to take the kids for a weekend. Talk to your boss about next week's deadline. You might discover that some of the things you thought others needed you to do for them are actually your own expectations of yourself. Think of taking care of yourself as a job. Make a list of self-care tasks and schedule them on your calendar.
PEP TALK: The world isn't on your shoulders alone. Sometimes when you step back, it makes room for others to step forward.
Work is often the last place we want to lighten our load. We worry that the boss may not be willing to modify workloads or change deadlines or that asking for time off or light duties may affect our next promotion — or worse, we'll be demoted or fired. We may not have any sick days or disability insurance.
If these are your concerns, here are some ideas. Check with your human resources department in case there are resources available at your workplace that you don't know about. If you can't talk to your boss, maybe you can speak with a coworker or two. They may have some advice or ideas about how to manage, and they may offer to help.
In the end, if you have to keep your depression hidden at work, that's okay. Just make sure your friends and family know that a lot of your energy is going toward keeping your job and that you may need some extra help at home.
Now, not everybody has to give something up in order to feel better. Becky, for example, has no one relying on her now that her brother has died, so she sleeps a lot during the day. She's already stopped going to school, answering emails and texts, picking up the phone, and seeing her friends. She doesn't eat much. Showering is always optional. Becky already has the space in her life to make positive changes — she just needs help taking that first step.
Tell Someone about It
If you've been keeping your depression to yourself, it's time to share the burden with someone else. If we let others know about our temporary limitations, we're more likely to receive support for our efforts and new ideas for how to cope. Opening up also gives others the opportunity to share their struggles with us — experiences we may never have known they had. Suddenly, we don't feel so alone anymore.
It's normal to feel shy, scared, embarrassed, and anxious about telling people. Many of us — me included — have our feelings of self-worth tied up with being seen as one of those people who have their act together. (It's common among people in helping professions. We help others, but we don't always have the skills to help ourselves.) If you're used to being the capable one, it can feel uncomfortable to admit to others that you're struggling. Plus, if you haven't reached out for help before, you don't know it's possible for someone to offer you support and show they care.(Continues…)
Excerpted from "Feeling Better"
Copyright © 2018 Cindy Goodman Stulberg and Ronald J. Frey.
Excerpted by permission of New World Library.
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.
Table of ContentsIntroduction: Get ready to feel better
True confession: I’m one of those people who skips introductions. I’m busy. Just get me to the good stuff. This is your journey, so skip to Week 1 if you like. But if you’re interested in knowing more about us, the approach that we use, and the four main characters we’ll follow over the next 12 weeks, read on.
Week 1: What if you had a broken leg instead?
We spend our first week together discovering what depression isand what it isn’t. (You might be surprised!) You’ll learn why you may need to take a temporary break from some of your activities and how to talk to the important people in your life about what you’re going through.
Week 2: Draw your social circle
This week we play detective, investigating the kind of relationships you have and identifying what you wish was different about them. These relationships (and how you handle them) hold the key to your mood. This week’s work will help open the door to a new world of possibilities with the people in your life.
Week 3: Name that feeling
This week we help you make connections between your feelings and the interactions you have with others. With practice, you’ll become better at naming your feelings, understanding where they come from, and choosing how you want to handle themwith the end result of feeling better.
Week 4: Choose your own adventure
This week, we help you figure out which one of four problem areas you were experiencing around the time you started to feel down or depressed. Choosing a problem area will help you focus your efforts over the next few weeks and give you specific steps to take to feel better. Added bonus: the skills you learn can be applied to any future problem!
Week 5: Goal get ‘em
This week, we help you set goals related to your problem area that you can work on for the rest of the book. By making these goals SMART (specific, measurable, achievable, relevant, and timely), and focusing your efforts on achieving them, you’ll build your confidence and prove that you have the power to make yourself feel better.
Week 6: Mirror, mirror
This week is all about reflection. We start with a quick recap of everything you’ve accomplished since Week 1. Then we help you take a closer look at a recent incident that bothered you. By examining what happened and exploring your feelings in a constructive way, you’ll be learning a skill that we’ll build on in the weeks to come.
Week 7: Who can you share that with?
This week we help you share your feelings about your problem area and goals with someone in your circle. You’ll get advice on who to talk to, suggestions for starting the conversation, and tips for getting the most out of the encounter so you can experience first-hand the mood-boosting power of interpersonal connection.
Week 8: Out with the old and in with the new
This week we help you change things up. We coach you through the steps: choosing what to change, deciding what you want to do instead, coping with the fear of the unknown, trying out your new approach, checking in on your emotions afterwards, and sharing your experience with your “who.” You can make yourself feel betterand this week proves it.
Week 9: What did you expect?
Our expectations influence our feelings. This week we’ll help you reflect on your own expectations and imagine what another person’s expectations might be. Then, if it feels right, we’ll coach you through having a discussion to clarify expectations with someone in your life. With your new understanding you can decide what you want to do to feel better.
Week 10: The rehearsal
Practice doesn’t make perfect, but it can help us feel more prepared. This week we give you some strategies for practicing an important conversation or interaction so, come show time, you can choose an approach you’ve rehearsed and be ready for what might happen.
Week 11: Just do it
You’ve done what you can to prepare, and now it’s show time. This week, we help you set realistic expectations for the interpersonal event that’s going to get you to your goal, give you some examples for inspiration, and cheer you on from the sidelines. You’ve got this!
Week 12: Do your happy dance
It’s our last week together, and time to celebrate what you’ve accomplished. We’ll help you reflect on what you’ve learned, recall who you can rely on, and plan for future moments that may be stressful for you. If you tried anything new over the last 12 weeks, you’ll be feeling betterand that’s worth getting out your dancing shoes (and inviting someone to dance)!