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August 21, 2018 - Welcome Guest!

Advice » Mental Health

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Nearing my end...

Question:

I am a 41-year-old divorced woman with a graduate degree in business. I have no children, by choice. I am an only child and my parents died 10-15 years ago. I am a vice president of my company and have significant operating responsibilities. I own a condo and live alone. I had a fairly normal childhood in an upper middle class family and most of the time got along well with my parents. I was married for three years and have been divorced for six. Since my marriage, I have not had a boyfriend, and haven't dated at all for three or four years.

Men ask me out, but I have no interest in dating or meeting anyone, let alone getting involved. When I was dating, and I suppose this was true of my marriage as well, I could be emotionally or physically intimate with someone, but not both. I am physically healthy, and never get sick. I use the gym in my condo three or four times a week to stay in shape. But I do it for vanity, not for health reasons - I never go to a doctor for checkups because for most of my adult life I have felt that I'd rather be dead so who cares if I get sick; there's plenty of health and disability insurance to cover the cost between getting sick and dying. My one "ailment" if you can call it that I have diagnosed myself as suffering from a rare form of insomnia: I have no trouble falling asleep, but awaken towards the end of the third hour and then cannot go back to sleep. It affects me off-and-on, and there does not seem to be any correlation between anything else happening in my life and the sleeping disorder.

I have been depressed for most of the past 10 or 15 years, and think of killing myself at least once a week. I keep an adequate supply of drugs in the bathroom for when I am ready to do it. I tried seeing several different psychiatrists, psychologists, therapists, etc., but found them to be a waste of money. However, I have done a great deal of reading on depression, suicide and hopelessness and understand that a primary cause of my depression may be the isolation of not trusting people. I was taught growing up to rely on myself alone, and the few times I did allow myself to become vulnerable to someone I was hurt, betrayed or used. This includes two of the therapists with whom I consulted in the past. 'Nuff said. The depression is so acute at times that I cannot go to work. Fortunately, I have seven weeks of vacation and three weeks of sick days, and that is enough to cover the absences.

Here are my questions:

  1. Can you suggest a reading list of generally available books - but not the "self help" nonsense one finds at an airport newsstand -- on trust issues?

  2. In my professional life, I am very much in charge but feel I have no control over my personal life. Are there books available on this dichotomy? In particular, I'd like to read how I might wrestle some control over my feelings of helplessness and hopelessness.

  3. Are there any on-line sources regarding details about suicide? If I do decide it is time, I don't want to botch the job by not taking a sufficient number of pills and need some information. I have prescription drugs, not over-the-counter, obtained under false pretenses from an unknowing acquaintance who works in a hospital.

  4. When I have completed the reading, how much time should I figure on being a "normal" amount before I begin to see some change in my outlook? I am willing to give myself three months to one year, if that much time is necessary, but not let this drag on forever. Please do not suggest I look for another therapist as I have no interest in climbing back on that merry-go-round. I would appreciate some reading suggestions, and I can take it from there. Thanks much for your help.

Traci (41 year-old woman) from Chicago

Answer:

Dear Traci,

First, I am so sorry to hear of your experiences of being hurt, betrayed, or used particularly by counselors who by the nature of their profession should never ever betray a client's trust.

Depression is an illness that strikes indiscriminately in any socio-economic group. Nor does it discriminate between levels of intelligence or different ethnic or cultural groups. No one seeks it out. When depression knocks on the door, we don't say: "Hello, please come in" but sink beneath its dismal cloud. It is not anyone's fault. It is an illness from which people can and do recover following intervention and treatment. Clinical depressive illness generally underlies suicide ideation. Treatment typically would be hospitalization; antidepressant medication; and/or cognitive therapy (CT). Severely depressed persons generally benefit from medication which allows them to reach a level where CT can start to be effective.

Psychologists believe that there may be a genetic predisposition to clinical depressive illness that may be triggered by some life event such as stress. Certain traumatic life events occurring in childhood may also trigger depressive episodes later in life. Such psychological stressors are death of a parent; physical, mental or sexual abuse as a child; a pattern of negative or mixed messages received by the child. These or any other traumatic life event are believed to trigger at some later time depression and/or post traumatic stress disorder (PTSD).

The Cognitive view (thinking influences feelings and behavior) is that although depressive ruminations may not trigger a depressive episode, such dysfunctional and negative thought patterns may serve to maintain and reinforce a depressive illness. Albert Ellis and Aaron Beck, independently of one another, first proposed the concepts of Cognitive Therapy which is now considered to be an important element in the treatment of depression, as it is in the anxiety disorders. This is so because one of the symptoms of depression is distorted thinking (depressive ruminations, sad thoughts, self-doubting, self-damning, or damning of others). For recovery to take place, it is important to intervene in such an ever-closing ring of self-criticizing thoughts by monitoring, challenging, and replacing the irrational cognition or thought with something that is more rational and which makes more sense. Further, it is essential to discover those schemas or core beliefs about ourselves which often lie outside consciousness.

You speak of the primary cause of your depression perhaps being the "isolation of not trusting people". If one cannot trust another human being it is generally because one has experienced a breaking of trust in some way as a child or adolescent. You say you were "taught...to rely on myself alone". But being autonomous is not the same as "not trusting". In any event, while it is good to be independent of others, we are not islands and do need people. Trust can be regained bit-by-bit, step at a time. When people prove themselves worthy of a little trust, then we can give more. To trust no one means that you are giving power to those worthless people who first abused your trust. Do not let such people have such power. Whether or not your father unknowingly (or knowingly) taught you not to trust, I do not know but we all need, to be psychologically healthy, to trust certain others. Some might let us down, but others will not. Whatever the cause of your depression, it is important to treat that as well as the depression itself if you are ever to lose that feeling of lack of control and helplessness in your personal life which is so at odds with your successful professional life.

As for the sleeping pattern you describe, this is a symptom of depression. One strategy however is the following which has been around for years, and Buddhists use this as a method of relaxation leading to meditation. Breathe in gently but deeply to the count of one. Breathe out saying to yourself the word: Relax. Breathe in again to the count of 2 and out saying relax. Do this until you reach ten, and then start again. If you lose count, start again. This strategy seems to stop obsessive thoughts and allow one to regain the dream status of sleep. I hope it is helpful for you. I am glad, Traci, to hear that you are exercising. You might think it is just vanity. However, exercise has been found to help in some cases those who are resistant to treatment for depression.

Finally, you speak of work and your success in that area, and your personal life and your disappointment in that area. Do you think you could be compensating by putting everything into your career to compensate for the gap in your personal life? Moreover, you don't speak of any other interest that you may have. Of course, a career is sometimes (sadly not always) one's creativity and love. Even so, for a balanced life of well-being I believe we need not only home and career (however well they are both going) but an absorbing interest. This may be charity: a few hours a week of giving for no reward can paradoxically bring forth much reward. And practically, it can provide a place to meet new friends who are not lovers. More importantly, it can take you away from depressive ruminations about self and life for just a short time as can any interest such as learning a musical instrument, painting, writing etc. Beck presented what he called a triad of depression. That is: Negative thinking about self, one's environment, and the future. The idea of course is to change these negative thoughts and the underlying schemas leading to depressive ruminations as outlined above.

2000 years old, some ancient documents called the Nag Hammadi Codices were found in Egypt in 1945, reputed to be the writings of a religious cult. Whether or not you are a spiritual person, the following seems to be so wise, and feels so right: "If you bring forth what is within you, what is within you will save you. If you do not bring forth what is within you, what is within you will destroy you." According to that it might be an idea to find what talent or gift it is that you are not fully utilizing.

Well Traci, I have given you a lot to think about. I know that you do not want to work again with a therapist, yet that is what I would advise, otherwise you give those therapists who let you down more power than they deserve. Please think about it. Should you reconsider, state initially that you feel you have been betrayed and hurt by previous therapists and would like an assurance that this would not happen again. And further, search for someone who is well versed in cognitive therapy since it is the cornerstone of recovery from depression. Thousands have recovered. Why should you be the one who doesn't? You deserve recovery too. As you mention reading, there is an extensive list of books to read in terms of depression given on my web site. Whatever you decide to do, may I wish you every best wish

Sincerely,

Pat Ryan

This question was answered by Pat Ryan. Pat is a registered psychologist and has a private practice in Wollongong, Australia, having worked in several esteemed drug & alcohol therapeutic communities. Her aim is to empower: to safely explore relationships, emotions, unresolved conflicts, patterns of behavior and symptoms of disease--a structured cognitive behavioral approach as the predominant theoretical context with psychodynamic contribution.

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