Depression – The CommonSense Approach

A Clinical Psychologist's Guide to Identifying and Dealing with Depression

Tony Bates

• Publisher: Gill Books
• Year: 1999
• ISBN:
  9780717165735
• Topic: Développement personnel
• Subtopic: Santé mentale et bien-être

In Depression – The CommonSense Approach, clinical psychologist Dr Tony Bates approaches the whole area of depression with sympathy, understanding and knowledge. Depression is far more common than we want to believe. There are many forms of depression and varying degrees of severity, but all are serious and debilitating for sufferers and their families. Dr Bates explains depression, outlines the common and not so common signs, looks briefly at some of the theories that have been put forward to explain it, and provides those affected with the necessary tools to help deal with it. This is a practical and easily accessible book. The prescriptive chapters will provide sufferers with the help they need to deal with self-defeating behaviours and to change patterns of relating to others that keep them vulnerable to depression. The key message is that clear and compassionate thinking helps build self-esteem and gives us back a trust in ourselves that gets lost when we become depressed. Dr Bates also address important issues that are frequently overlooked for partners and families who live with a depressed person. The CommonSense Approach series is a series of self-help guides that provide practical and sound ways to deal with many of life's common complaints. Each book in the series is written for the layperson, and adopts a commonsense approach to the many questions surrounding a particular topic. It explains what the complaint is, how and why it occurs, and what can be done about it. It includes advice on helping ourselves, and information on where to go for further help. It encourages us to take responsibility for our own health, to be sensible and not always to rely on medical intervention for every ill. Other titles in the series include Depression – The CommonSense Approach, Menopause – The CommonSense Approach and Sleep – The CommonSense Approach.

Depression – The CommonSense Approach: Table of Contents

Foreword by Professor Paul Gilbert

• 
  Introduction
• Recognising Depresson
• What Causes Depression?
• A Major Obstacle to Recovery: Hopelessness
• Overcoming Depression: A Recovery Plan
• Getting Started
• It's the Thought that Counts
• Changing your Self-image
• Putting it All Together: Tom's Story
• Living with a Depressed Person
• Beyond Depression: Staying Well and Dealing with Setbacks
• Self-help Books: A Guided Review
• 
  Useful Addresses

Introduction

Depression is a thief that steals from people; it robs them of energy, vitality, self-esteem, and any pleasure that they might previously have enjoyed. For some the physical intensity of their pain and despair makes suicide appear the only possible solution. Depression makes one self-centred but not selfish. As with a throbbing toothache, it’s hard to think about anything except your own personal hell when you are depressed.

Depression can have a very destructive impact on families and loved ones. Children cannot but sense and feel troubled by a parent’s dark moods, partners even more so. The effort to alleviate the pain of depression in a loved one inevitably fails and even the most well-intended interventions of friends and spouses can leave all concerned feeling helpless and alienated. Depression can create havoc in the lives of all it touches and sow seeds of misunderstanding and anger that persist long after the gloom has lifted. While this book is primarily intended as a guide to recovery for the sufferer, it is also written with relatives and friends of the sufferer in mind, in the hope that it may make sense of what can be a difficult problem to grasp from the ‘outside’. Understanding of the problem by all who are affected can act as a bridge between those who feel isolated and those who feel alienated by depression.

Susan was tall, blonde and in her late twenties. Her outward appearance suggested a self-contained, confident woman, but her eyes told a different story. She looked as if she’d rather have been anywhere but my office the day she first arrived. Her movements were awkward and stiff. Eye contact was avoided and I hesitated to ask her why she’d come, sensing it might be an invasion of a privacy which was being anxiously guarded. We danced around the central issue for a while as I pieced together a profile of her family background, her schooling and occupation, and her current circumstances. She relaxed a little but when I asked what had brought her to see me, her fragile holding together gave way to a flood of tears.

Words failed Susan as she tried vainly to account for her terrible sadness. She felt she had no right to complain but she described how in recent weeks she had found herself collapsing into tears for no apparent reason, overcome by the feeling that she was stupid, worthless and completely out of control. She apologised repeatedly for her demeanour. She struck me as someone who didn’t normally, if ever, let down her guard about her inner struggles. But on this occasion the intensity of her inner pain refused to be silenced and she had sought counselling to help her make some sense of it all.

In writing this book, I think about Susan on that first visit, and many others who have come and confronted the intense inner pain that is depression. All have been confused and frightened by what was happening to them. Their own desperation, the experience of ‘losing a grip’ on work and life, or the helpless exasperation of close loved ones, prompted them to reach out and look for help. I imagine you are reading this book having struggled also with depression, perhaps directly, or indirectly through living with someone who is visited and revisited by this problem. My hope is that you will find in Susan’s story, and in the account of others’ struggles with depression, some echo of your own experience. Also that you will discover that you are not ‘mad’ or ‘stupid’ or ‘horribly selfish’. There are reasons why someone becomes depressed; being able to understand and make sense of the experience restores morale.

In this book we will consider some strategies for moving out of depression and these will be mostly straightforward and practical. However, there is another theme that will run through these pages and hopefully make sense to you: if depression distorts my sense of who I am, how do I recover a sense of my true self? Maybe you’ve never been very clear about who you are. One of the advantages of struggling with depression is that you take up a quest to get to know and express your true self.

As we travel together through these pages, you may want to consider that you are not what your present negative mood says you are: you are not the ‘stupid’, ‘inadequate’, ‘hopeless’ or ‘unlovable’ person that you believe you are right now. You’re a human being, no better or no worse than others whom you admire. You’re as unique and as interesting as they are and equally deserving of respect and encouragement. Don’t expect to feel convinced of this at the moment, but even your choosing to read this book suggests that somewhere inside, you believe that you deserve more. This book will speak to that part of you that wants more out of life, that inner voice that refuses to give in to depression. It may only be a tiny voice at the moment, but my aim in these pages is to strengthen that voice and help you discover a truer, healthier sense of who you really are. Someone who includes and makes room for personal vulnerability, but who never loses sight of their capacity for joy. Someone you’d be glad to wake up to each morning.

How can we even aspire to achieve something so important in a short book such as this? Let me say this first so neither of us has any illusions: nobody can magically take away depression. I can only join with someone who is in this particular pain and help them to discover a strength in themselves to fight it. You will need to struggle and do battle with your inner demons of shame, self-criticism and self-loathing on which depression feeds. You may be drowning under the weight of all this now and you need a solid ally to help you fight your way back. As allies go I’m not the worst. I’ve worked with depressed people for over twenty years and battled through my own dark night of the soul. Like a tracker who has been in and out of the jungle many times, I can serve as a guide to help you plot your course and prevent you from going round in circles, retracing your steps through the same waste ground over and over.

Sarah’s Recovery Journal
Excerpt 1

Depression is like an assignment in life that nobody ever sets for you to do. No one tells you beforehand how difficult it’s going to be, how time-consuming it is, how painful it can be. You’re not prepared for it and when it happens you want to give it all away and collapse into nothing. Because there are no real signs, no real markers, no sheets handed out beforehand telling you what it’s going to be like. And before you know it you’re being judged, not on your progress but on your failures, on your weaknesses. The judge isn’t a fair one with guidelines and suggestions. The judge is yourself, the ‘worst’ around, who shatters your confidence and who plays on your vulnerabilities until you get to the point where you want to break. You want to give up on this assignment which seems so wasteful and pointless. But it’s really the most important assignment you’ll be given. It’s an essay which is long and tiresome but where you must come out with full marks. Those full marks won’t be given for content or structure or quality. They’ll be given each time you believe in yourself and care for yourself a little more. And you’re the one who calls out the grade, because you’re the one giving yourself those stars. The assignment is you, and you are the judge, the expert, the one who knows you and cares about you and loves you enough to say, ‘I’m worth it, I’m worth 100 per cent.’

I’ve tried to combine the best advice from scientific research with the most practical tips learned from the people I’ve helped. Ultimately, it is these people who have taught me the most, and provided critical insights from their struggle with depression.

One of the stories which is revisited throughout this book is that of ‘Sarah’, a twenty-year-old woman who struggled successfully with a severe depression for twelve months. During all that time she kept a journal. With her permission, key excerpts have been selected to illustrate the issues addressed in each of the following chapters. The first excerpt above was written towards the end of her recovery.

There is much more that could be said about this problem than any one book could cover. This book is no substitute for you finding a trustworthy professional to work with you in your recovery. Self-help literature is often most useful when it is employed as an adjunct to personal therapy. We will talk more about this later, but do consider that there is a time for recruiting some one-to-one specialist help in the fight against depression. Finding the right person may take time but one of the benefits of reading this book may be that it will clarify what you may need from a professional in your particular struggle to overcome depression.

CHAPTER 1

Recognising Depression

Depression! Depression is not a word that for a long time I would have applied to myself. In retrospect, however, I would probably now accept that I have been depressed over a long number of years and in need of some help.

We have all been ‘a bit depressed’ on occasions. We often use this phrase to describe how we feel when life gets too much for us. Yet it rarely implies that we are suffering from depression in the sense that it is meant in this book. It is important to distinguish those times when it is normal and expected that one might feel sad from those times when we are caught in the grip of what is termed ‘clinical depression’.

The everyday use of the term ‘depression’ more often refers to what can happen when we are dealing with some stressful or challenging event in our lives that wears us down. Relationships at home or at work that are full of conflict can contribute to this sense of ‘life being too much’. It may be that we are understandably sad, even shattered, by the loss of someone we loved. There is a period of feeling very low that inevitably comes in the wake of such a loss which reflects just how much that individual meant to us. A time of mourning is very important in that it allows us to acknowledge the absence of a loved one and adjust gradually to living our lives without them. While this can be a heartbreaking time, a person can endure and survive it with loving support. After the period of acute mourning has passed they can feel stronger in themselves and appreciate how their lives have been both saddened and deepened by their grief.

Clinical depression is not just about feeling sad, bereaved or overstressed. It is characterised by a persistent low mood, a lack of energy, difficulty with concentration and memory, and a striking lack of interest in things that are normally a source of pleasure and stimulation. Unlike the experience of being sad or upset, depression doesn’t respond readily to the concerns of others, some pleasant distraction, or some novel or joyful event. It holds the sufferer hostage and seems to refuse to consider all reasonable offers to set them free. Depression generally provokes a withdrawal from others and a turning against oneself. The sufferer is left with the conviction that they have not merely suffered some setback or important loss, but that they themselves are ‘losers’, and that nothing will ever be resolved in their life.

Sarah’s Recovery Journal
Excerpt 2

These days I don’t know what to do with my time. Almost everything seems so futile, nothing seems to have any importance any more. I don’t feel really depressed all the time just bogged down with living. I spend a lot of time in a daze, as though I’m hiding things from myself; my memory is blocked, my feelings are blocked and I feel like a walking stone statue. Some of the time I think I feel OK, but then my mood changes and I become frightened again. I move back on occasions during the day to those so familiar periods of despair when inside my head I can hear myself screaming, ‘Help me, what am I supposed to do?’

In the early stage of her depression Sarah described her experience in her journal. Her account conveys the sense of confusion and isolation so characteristic of depression.

Depression is characterised by a particular set of changes in the way a person thinks, feels and behaves. As well as being an experience of psychological suffering it reduces a person’s sense of physical well-being and affects their sleep, appetite and level of energy. The primary symptoms of depression are discussed below and illustrated in the following diagram. Symptoms generally are grouped according to how they impact on our thinking, feelings, behaviours and physical state. Each group of symptoms impacts on the others, drawing the individual deeper into a negative mental and physical state.

SYMPTOMS OF DEPRESSION

Thinking Characteristic of Depression

A depressed individual’s thinking is characterised by extreme self-criticism, pessimism, hopelessness about the future, and a profound conviction that they are in some way a failure as a human being. For depressed people important achievements in their past no longer seem to count as they focus exclusively on every sign of failure or weakness that they can possibly point to in their life. These preoccupations seriously reduce their ability to concentrate — a very depressed person may find it hard to read more than a paragraph of a newspaper or book. Such is their loss of confidence that even the simplest decisions they are faced with can prove to be an enormous strain: they cannot trust themselves to do the right thing.

Perhaps the most common presentation of depression is where the individual experiences obsessive negative thinking from which he or she can’t distract themselves. These individuals are constantly troubled because they experience themselves as being out of control and helpless in terms of managing their lives. Living each day feels frightening and unpredictable. They dread that something bad could happen because they feel that they have no reserves to cope with any further stress in their lives.

Feelings Characteristic of Depression

A depressed person may be in such intense distress that they are r...

Table of contents

• Cover 
• Title Page
• Contents
• The CommonSense Approach Series
• Please note
• Foreword by Professor Paul Gilbert
• Introduction
• Chapter 1: Recognising depression
• Chapter 2: What causes depression?
• Chapter 3: A major obstacle to recovery: hopelessness
• Chapter 4: Overcoming depression: a recovery plan
• Chapter 5: Getting started
• Chapter 6: It’s the thought that counts
• Chapter 7: Changing your self-image
• Chapter 8: Putting it all together: Tom’s story
• Chapter 9: Living with a depressed person
• Chapter 10: Beyond depression: Staying well and dealing with setbacks
• Self-help books: A guided review
• Acknowledgments
• Copyright
• About the Author
• About Gill & Macmillan