Sunday Morning Coffee: Depression

It is of particular concern to me when I meet a teen boy or girl who is struggling with depression.  It just makes me so sad to know the battle that is being waged, and how unexpected it is for a lot of kids and their families.

Because I work in a Christian counseling office,  I usually ask  sometime early in our work together about my clients’ spiritual relationship with God. One of the things that confuses them is that they have often been taught that a good Christian doesn’t experience depression. Feelings of strong guilt grow along with the depression, and it’s one of the first things we need to discuss.

It is so damaging, no matter a person’s age, to be told that he just needs to get right with God, just needs to trust the promises of God. The implication, then, is that he is NOT right with God, that he has NOT been trusting God. The feelings of despair will continue to grow if this negative pattern of thinking is not confronted with the truth of God’s Word.

 

It is true that there is always a spiritual piece in depression. David, whose Psalms often reflect the struggle he had with depression, made it clear that he knew when he had sinned against God, and he wept and repented, and sought for restoration.  I am not overlooking the possibility of sin lurking in a person’s heart, but I also know, from walking with my own husband through a terrible depression,  that he did search his heart, begging God to show him if there was some hidden sin.

The truth for a lot of people who experience depression is that they are worn out, body and soul. Exhausted.  Often, their personality type is that of the melancholy, who is an analytical, detail-oriented perfectionist who easily falls into feeling of guilt and even shame when things don’t go perfectly. These thoughts and emotions can lead to insomnia, or to a need to sleep ALL the time.   Slowly, the person’s supply of the “feel-good chemicals” created in the brain and the gut become depleted, and a serious depression follows.

Treatment, to be the most effective, needs to address body, soul, and spirit.  Proper diet, hygiene, exercise, maybe medication, and good talk therapy to help replace the negative thinking patters with  positive, biblically-based thinking all work together to bring the person back to normal.  Done well, therapy gives him tools to recognize  negativity and take steps to turn it around.

It is so important to encourage, not to scold. To focus on positives, not to preach. To use prayer as a positive force, not an opportunity to lecture.

Starting with my husband’s experience, and all during the 17 years since I started working in this field, I’ve seen dozens and dozens of depressed believers who feel they’re the most sinful people on earth. I’m so thankful to have a different understanding of the whole subject now, and to be able to offer help and hope.

I love my job.

 

 

Grief and Depression

(This was first posted on Feb. 1, 2013.  Contrary to the first paragraph, it ended up NOT being the final post on depression–a couple more to follow.)

 

I believe this will be the final Friday Depression post.  I’m thinking of moving on to other counseling topics, and I would love your input.  If there is something you’d like to suggest as a future post, please comment here, or on my page, or via Facebook or email.  I really hope you’ll help me out with some ideas.  The response to these Friday posts has been so encouraging to me.  I’d like to continue with something else that will be helpful.

Today, I want to address how depression and grief are closely related. In my practice, I often see widows or widowers who are so deeply grieving that they can hardly function in their daily lives.  They come to counseling hoping to find out what is wrong with them, and when I say, “There is nothing wrong with you.  You are experiencing a normal grief reaction to the deepest loss of your life. Go ahead and grieve, and don’t worry about the people who tell you to get past it now, and move on with your life.  They don’t understand, although they believe they are helping you.  They haven’t experienced your particular path, even if they have themselves lost a spouse.  Each individual has to grieve his own loss in his own way. There is no right way to grieve.  Nobody gets to make the rules for how you deal with your loss.”

Back in the early 1900’s, polio was a greatly-feared plague that crippled and killed children by the score.  Dr. Elizabeth Kubler-Ross worked with polio victims, and witnessed often the deep grief of parents whose precious children were torn from them.  She observed their grief and developed what we now refer to as The Five Stages of Grief, a model to help people understand that what they’re enduring is normal. Here is a chart of these stages of grief, with a sixth stage included:

Shock and denial is the typical reaction to the death of a loved one.  I believe God has provided this reaction as a buffer to help us absorb what has happened.  I remember when my nephew was killed in a drunk driving accident when he was only 23; then, 19 months later, his dad, my only brother, was killed in a one-vehicle rollover.  The  grieving over my nephew was compounded by the fresh shock of his dad’s way-too-early death.  He was almost 49. I live very far away from where they were, so the loss for me wasn’t nearly as difficult as it was for my mom, niece, sister, and sister-in-law. Still, there was a period of time in which the unreality helped me to begin to accept that I would never see them again in this life.

One important observation here is that these stages may or may not come in the order shown on this chart; also, most people cycle through them multiple times during the grieving process,  It’s not a one-size-fits-all deal, nor is it once-and-done.

Anger is a natural part of grieving.  A life has been cut short, and there is absolutely nothing anyone can do to bring it back.  Don’t feel guilty about being angry.  Anger is never called a sin in the Bible; it is how we act out our anger that makes sin a part of the picture.

Bargaining is also normal.  Some have called this “foxhole Christianity,” because of the tendency of soldiers dug into holes in the ground to say, “God, if You’ll just get me out of this alive I promise I’ll serve You for the rest of my life.”  Bargaining is an attempt on our part to make some sense out of what has happened.

And now, depression.  The loss is overwhelming.  Sometimes, it is accompanied by financial instability, which is very frightening for a widow, especially, who has never handled the finances.  The survivor is swamped by loneliness, fear,  dread of the future.  Anxiety comes barging into the person’s life, dominating and controlling like a bully on the school playground.  There is no escape.  Loss of sleep becomes a state of being; hunger goes away, desire for friends and companionship dwindles to nothing.  There is no joy, no future, no purpose, no point in going on.  Deep weeping, sobbing, moaning and fear begin to characterize the person whose life has suddenly been turned upside down.  For many, it means selling a beloved home; moving in with children, or going to an apartment.  The loss of treasured belongings triggers more depression.  It seems as if the pit just keeps getting deeper.  Despair is very black, and very lonely.

That is often the point at which people come to seek professional help.  Sometimes an anti-depression/anti-anxiety medication is indicated and is helpful.  But the most helpful thing I can do for people in this situation is to assure them repeatedly that it is normal.  What they are experiencing is normal, and they are not crazy, insane, losing their minds. It takes time–a lot of time–to process such a fundamental life change.  Sometimes it’s even worse if the marriage was difficult, because now the survivor experiences guilt on top of everything else.

If you are walking this difficult path, or someone in your life has had such a loss, it is important to talk.  It helps the person to repeat the story of what happened.  It may seem like endless repetition to those who listen, but it is therapeutic and even necessary for the person to be able to verbalize this most cataclysmic event.  Patience on the part of others will help the grieving person to heal.  And don’t forget, some day it will be you.

In my experience, it takes up to three years before the most acute grieving is done.  It does slowly get better during this period of time, but there are difficult days that roll around every year that slow down the process.  Birthdays, anniversaries, the date of the death, family holidays like Thanksgiving and Christmas, all bring a fresh sense of loss.  This is normal. 

Finally, acceptance of the new normal begins to set in, and the person begins to be able to make plans and carefully enter a new phase of life. Here are some things you can do if you are trying to help a person through the grief process:

1.  Listen.  Endlessly.

2.  Reassure the person that her grief is normal.

3.  Share the tears.  Go ahead and cry with her.  It’s good therapy.

4.  Pray for and with the grieving person.  A broken heart is acutely painful.

5.  Never tell the person, “It’s been six months–a year–two years–you need to put this behind you and get on with your life,”  You are piling guilt onto grief.  Don’t. It’s unkind.

6. Include the grieving person.  If she is a widow, she will be acutely aware of how alone she is now.  If he is a widower, he often just wants to sit at home and fall deeper into depression. You can help.

7.  Watch, learn, and listen.  Someday it will be your turn.

Hope will surface again, especially for the believer who knows she will one day see her loved one again. God is always good. Death is a normal part of life.

King David and Depression

(Since it’s Friday, I have chosen to pull up a post that still, after several years, gets lots of hits.  Originally written and posted in 2014, it shows up nearly every day on my list of ten most-viewed posts. I looked up the stats yesterday and found that over 19,000 people, about 5.5 % of my total readers, have accessed this post.  Maybe not every single one of them read it, but it amazes me how much interest it has engendered over the years. I did a fairly long series on depression in 2017 under my “Friday Counseling Issues” category.  You can find them near the bottom of the right side of the page, listed individually and under “Counseling Issues.” When you find the category, you’ll need to scroll all the way to the bottom and read from the bottom up for continuity. 

David’s story is one of the most dramatic in the Bible.  He didn’t have an easy life, and he often made terrible decisions.  Still he is named “a man after God’s own heart”  (Acts 13:22). He earned that title because he always repented of his sin with great remorse; he always begged God to cleanse him and restore him to His favor (Psalm 139: 23-24).

There are many times in  the Psalms that David wrote in which he declares his great sorrow.  In Psalm 6:6, David says he is weary with his groaning; that all night his bed is swimming in tears. You will easily find other places in Psalms where this experience is repeated. His grief over his sin was great.  His soul was weary with grieving, crying over the state of his disobedience to God, and the terrible results that followed.

Now I want to focus on Psalm 13, which is a little gem describing the steps David took from depression to prayer to victory.  It is a retrospective song, written from the vantage point of age, so that David can be objective about his earlier experiences.  In this Psalm, he was running from King Saul.  He was alone, as yet without the support of his band of mighty men. He was in the northern reaches of Palestine where it was dry, rocky and dusty, and the peopled were unfriendly. In the first two verses we hear five complaints:

1. How long will You forget me, Lord?

2. How long will You hide Your face from me?

3. How long do I have to confer only with myself?

4. How long will I have daily sorrow?

5. How long will Saul have victory over me?

This Psalm has often been called the “how long Psalm,” or even “the howling Psalm.”

Things weren’t going well at all.  Not unlike most of us, when the going got rough David complained and wept, feeling very sorry for himself and even going so far as to accuse God of forgetting about him.  Of course that wasn’t true, but please, haven’t we all felt like that at some point in our lives?  The problem comes when we begin to believe that what we feel must be the truth.  It is never safe to believe that how you feel is the truth.  “Follow your heart” has become a very popular saying, but it is dangerous because our hearts are deceitful and desperately wicked (Jer. 17:9).

In the second set of verses, David apparently starts to get his thinking straight.  He begins praying instead of complaining.  He asks God to hear him and wake him up so he won’t “sleep the sleep of death.”  Anyone who has experienced that craving for deep, oblivious sleep  that never has to end will understand that David is describing an aspect of deep depression. The only thing that seems to bring peace is to sleep so long and so deeply that  the depression is escaped, at least for a time.  In verse four, instead of complaining that Saul is the victor David asks God to have the victory.  Nothing wrong with  praying that God will prevail.

Finally, in the last two verses, David gets it right.  He reveals three important aspects of answered prayer:  Trust in God’s mercy; rejoice in His salvation; sing praises to God for His bountiful dealings.  We are told to pray with  gratitude in Phil. 4:7.  Gratitude goes a long way toward eliminating whining.  If we turn our minds to God’s mercy, goodness, and grace we are much better able to deal with the vicissitudes of life, including depression.

Most important, I believe, is to rejoice in God’s salvation.  Some time ago, I was impressed with a wonderful truth.  In this passage, David says he will “rejoice in THY salvation.”  He didn’t say he would “rejoice in MY salvation.”  Salvation belongs to God.  He provides it for us when we receive His Son as our Savior, but redemption is His.  We cannot lose what we do not own.  We never need to worry that we’ll lose salvation, because the victory is the Lord’s, and no one can take us from His hand. That truth alone should help boost us out of the pit of depression and despair.

As you read through the Psalms, look for David’s descriptions of his soul’s agony.  You will be surprised at how quickly you can identify with this man that most of us see as a great and powerful king.  We forget that man is only man, after all, and that we are subject to our own weaknesses, just as David was.

What Causes Depression: Part Two (reposted from Jan. 4, 2013)

(If you are seeing this thread for the first time, I’d like to suggest you go back to the first part on this post. You can find it here)

Last week we talked a little bit about a possible genetic connection; we also discussed the melancholy personality that is more prone to depression than the other three main personality types.  However, those two things are by no means a complete picture of the causes of depression.  Today, I think I want to talk about trauma and how it can play into depression. I don’t think I’ll be able to cover the whole picture, so hang on.  We may have to finish this one next week.

Let me remind you, if I may, of my own personal journey.  I’ve been taking Effexor for about six weeks now, and my husband tells me there’s no comparison, that I’m getting back to my “normal” self now, whatever that means 🙂  Because he had his own depression journey 16 or more years ago, he’s very sympathetic and supportive.  I’m blessed.  Not all spouses give that kind of support.

So where it started with me is hard to pinpoint, but I suspect the seeds were sown some years ago. I deal with trauma every day that I work in my counseling office.  The trauma can range from the loss of a child through miscarriage, illness, or suicide to divorce or death of a spouse; from a job loss to sexual and or physical abuse at the hands of a stranger or a spouse.  Someone, years ago, made a table of “stress numbers.”  One side was bad stress, like divorce. The other side was “good stress,” like a wedding.  The stress number of each was 100.  Isn’t that interesting?  I do remember, after my own wedding and honeymoon, going through a period of listlessness, complete physical exhaustion.  I had graduated from college one week, and was married the next.  Probably foolish, looking back, but I wasn’t willing to wait one minute longer than I had to.  Was my reaction depression?  I don’t know.  I just remember needing to sleep a lot, and having very little initiative and physical energy.  Maybe I had mono.  That’s something else that has surfaced since I was 50, almost 16 years ago.  My doctor told me that the mono test clearly indicated I’d had it before. Huh.

All right, back to trauma.  You may say, “But I’ve never had any real trauma in my life.”  That may be true, by your own definition.  But there is “Big T” trauma, like loss of a child or spouse, severe physical illness or accident injury, or financial loss.  Then there is “little t” trauma, like the stress of going to college for post-graduate work, or even the daily care of an ill child or parent.

Military veterans are often diagnosed with Post-Traumatic Stress Disorder. If they have seen their buddies die horribly, or been severely wounded or, worse, captured and imprisoned, their trauma is severe.  Part of PTSD  is severe depression, often incapacitating enough that it totally changes their lives.

The lesser traumas tend to be cumulative. A part of my family moves far away; I deal daily with the painful problems of my clients; relatives die in auto accidents; my mother lingers painfully for nearly two years before she takes her last breath.  Life is just hard, and  I’m no longer young. The depression creeps up subtly; it doesn’t develop into full-blown pathology overnight.

The accumulation of trauma has affected my entire system, including my brain, which is the source of the “feel good” chemicals we all need in order to maintain a “normal” state of mind.(Since I wrote this four years ago, studies are showing clearly that about 85% of serotonin is actually created in the gut, not the brain)   I use the word normal carefully, because my normal may not be your normal.  That’s an important thought to keep in mind.

So, could I have prevented this at some point?  Maybe.  Maybe if I’d come home from my mother’s funeral and NOT jumped right back into work.  Maybe if I’d grieved more openly when my nephew, and then later my brother, both died within 19 months of each other, instead of keeping it buttoned down tight.  Maybe if I’d taken a vacation somewhere in that two-year period. Maybe if I were better at compartmentalizing. Maybe. . . .but I’ll never know.

One thing I do know is that my faith in God has never wavered, even through another deeply personal loss that I cannot discuss here.  I honestly do not know how people survive such losses without God to sustain them; without His Word to comfort, encourage, and ground them.  I am so thankful that even when I would forget to “take my burdens to the Lord and leave them there,” He always found a way to remind me to do so.

Trauma wears us out; physically, emotionally, intellectually, and spiritually drains us of our energy and will to go on. When the physical body becomes depleted, ALL of it is affected, including the brain. The brain is the source of serotonin, along with several other mood-stabilizing chemicals. Both the brain and the body need time to heal. When we don’t take that time, we can suffer depression.

Fourth Post on Depression

Depression: Why Did This Happen? Will it Come Back?

ON DECEMBER 28, 2012 BY GRANONINE IN COUNSELING ISSUES, DEPRESSION EDIT

There are so many factors that can play into depression.  Today I’m going to cover as much as I can in a reasonable amount of space.  This could well end up being a multiple-part topic.

Let’s look at genetics first.  One of the questions I always ask a new client who presents with depression is, “Who else in your family, in your own generation or your parents’ or grandparents’ generations, has had a “nervous breakdown,” or been given some sort of medication for nerves, such as Valium?”  Almost without fail, there is someone.  Typically, there will be more than one in the family tree who has suffered from depression.

So, is there a “depression gene”?  Honestly, I don’t know.  I found some articles on the subject.  Here is one link you may find interesting.  Just remember, this whole topic is in a very new state of research:

http://www.msnbc.msn.com/id/40908471/ns/health-mental_health/t/depression-gene-really-exists-new-study-claims/#.UN3FjOTAeSo

What I do know is that some people are more resilient about how they handle stress than others are, and there is a personality type that can “run in the family” that does not handle stress well without some help.  This is why I look for the genetic connection; it helps me understand if there is a generational tendency toward depression, and knowledge helps me know how best to help my client.

What personality type am I talking about?  The Melancholy, according to the study I like best.  There are other studies that call it by different names, but the traits are the same.  Here is one thumbnail sketch:

Much more can be said about this personality.  It is the deepest, richest, most complex and most contradictory of all the four basic temperaments.  Often, the Melancholic is richly gifted in some way.  Many of our most beloved writers, poets, composers, artists and other creative people are/were deeply melancholy.  They are indeed perfectionists, and they are world-class worriers.  While they can be super organized, to the point of OCD, they can also live in utter chaos because they want to be orderly and neat, but they think they have to make that happen all at once.  It’s so overwhelming that they simply walk away from the task and start some other project–or go read a book  Melancholics are sentimental, holding on to relationships even after they are cold and dead. They are almost always the “dumpee” rather than the “dumper” in relationships.  They are deeply introspective, always looking inward to see how they’re measuring up to their own often unrealistic expectations.  That in itself is depressing.  Melancholics are born with a strong sense of guilt, although they’re often not sure what it is they’re guilty of doing/thinking/feeling that is so wrong. They tend to allow people to use them, then complain about how no one appreciates them. “I’ve given up everything for my kids/husband/friend/work and no one appreciates/understand/knows what I’m going through.  No one loves me.  Everyone takes advantage of me.  I’ll never be understood/appreciated/happy.”

It’s a self-fulfilling prophecy.

At the same time, these folks are tremendously generous and others-oriented. Yet, they can be unbelievably critical, narrow, self-righteous, and unforgiving.  Unforgiveness turns to self-pity turns to bitterness turn to depression. Tim LaHaye wrote a wonderful little book many years ago titled How to Win Over Depression.  It’s an excellent resource.  I also like his book on the temperaments.  The latest rewrite that I know of is called Why You Act the Way You Do. I read his first temperament study years ago, and it’s been a most valuable resource ever since.  It’s title is The Spirit-Controlled Temperament. 

All right.  I suspect that’s about enough for this week.  There is a great deal more to say on the how and why of depression, but I guess we have lots of time now that we don’t have to worry about the Mayan Calendar any more!

 

 

 

More on Depression and Medication

Third in the series on depression that I’m recycling from Dec. 2012.

 

There is a third class of antidepressants known as MAO Inhibitors, or MAOI’s.  You can read all about them here: http://pharmacist.hubpages.com/hub/What-Are-MAO-Inhibitors.

As with the others, the targets of this class of medication include serotonin, dopamine, epinephrin–all the so-called “feel-good” chemicals that the brain produces.

The question I’d like to address today is, “If depression can be treated without medication, then why take the pills?  Wouldn’t it be better to get to the root of the problem instead of just masking it?”

There are some assumptions in those questions.  I hear the questions a lot, because unfortunately, there is still stigma attached to taking medication for “nerve problems,”  or “emotional problems.” People of faith worry about depending on medication instead of God, believing that if they could just pray enough, read the Bible enough and deal with whatever their lack of faith is, they’d get better.  What follows is how I answer all that in my office, usually in a first or second visit with someone who is typically depressed, anxious, and embarrassed to be sitting in a “shrink’s” office.  This could take several posts to really get the job done, I’m not sure.  We’ll see!

So, let’s pretend you’re sitting in my office, we’re getting to know each other, and I’m seeing clear indications of depression.  The first thing I’m going to do is reassure you that you’ve made a good choice to find some help; that you certainly are not alone in your misery, and that it WILL get better. About this time, I will point out that there’s a box of tissues sitting right behind you on the back of the little sofa you’re sitting on.

Once you’ve told me your story, or at least enough to get us started, I’m going to ask you about the stressors in your life.  That question always gets me a wide variety of responses, from floods of tears to anger to uproarious–but sad–laughter. The reason I ask that question is that more and more clinical evidence is pointing to the reality that anxiety comes first, then depression.  Anxiety is just another word for fear.  Every single one of us deals with some level of anxiety at some point or points in our lives. It can stem from marital relationships, extended family, an obnoxious neighbor, illness, financial stress, job stress– to just about anything else you can think of. These are anxious times we live in, but that’s nothing new.  The folks who lived through World War I  thought it was Armageddon.  It was supposed to be the war to end all wars.  Those who endured through the Holocaust thought nothing could ever be worse, and then the atom bomb and nuclear warfare became something new to fear.

On a much smaller, but far more personal scale, most of us experience anxiety just in the routine of our daily lives, rarely thinking about the predictions of world-wide disaster.  The disasters at home are far more consuming. So you, sitting in my office, begin to tell me that you can’t sleep, that you often have sweaty, heart-pounding moments when you think you’re going to die; you can’t get a deep breath, you feel buzzy and faint, and then it passes and you’re terrified of the next attack.

Which takes us to a conversation about anxiety, panic attacks, anti-anxiety meds, and whether or not to use those meds. Please understand that not everyone who experiences depression will experience extreme anxiety and panic attacks.  It can be a part of the total picture, but it doesn’t have to be.  Sometimes, people who live with panic attacks have some deep trauma that has never really been addressed.  This can be Post-Traumatic Stress Disorder, common among military veterans and victims of childhood sexual abuse and/or rape; victims of natural disasters like tsunamis, hurricanes, and so on.  There are special treatments for this type of problem, including EMDR, which is a specialty of mine.  You can google it to find out more about it.

All right.  Just a quick note about anti-anxiety meds and then we’re done for today.  Here is a list of the most common medications:

• Alprazolam (Xanax) – approved for GAD, panic disorder; used off-label for agoraphobia with social phobia
• Chlordiazepoxide (Librium) – approved for anxiety (in general)
• Clonazepam (Klonopin) – approved for panic disorder; used off label for anxiety (in general)
• Diazepam (Valium) – approved for anxiety (in general)
• Lorazepam (Ativan) – approved for anxiety disorders (in general)
• Oxazepam (Serax) – approved for anxiety (in general)

GAD, by the way, stands for General Anxiety Disorder.   These medications are almost always prescribed “as needed” and can be helpful in calming you down if you suffer from panic attacks. Also, several of the common antidepressants are considered anti-anxiety as well.  Sometimes a physician will prescribe both, suggesting the anti-anxiety be used only when absolutely necessary.

And yes, I know there’s a lot of controversy about all this.  Be patient.  I’ll get there eventually!

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Depression, Again

Those of us who blog via Word Press have access to several interesting options.  One that I like a lot, and just recently added to my site, lists the ten most-read posts for each day. The one that is almost always on the top of the list is:

https://lindasbiblestudy.wordpress.com/2013/01/25/king-david-and-depression/

The fact that this post is nearly always at the top, every single day, leads me to realize just how many people are struggling with depression.  With that in mind, I want to encourage you to read all the posts that covered the topic of depression. You can start here and read all of the rest of the depression posts by following  the the word “Next” at the bottom  of the post. Maybe you aren’t the one who has depression; maybe it’s a family member or a friend, and you’re looking for ways to help. Maybe you’ll find something in one of my posts that will help.  I hope so.

Friday Counseling Issues: When it Goes Well

Another topic suggestion from Kathleen Duncan:  What has been the most encouraging outcome you have seen in one of your cases? Pick a case you thought might never get better, but they did! What made the difference?

**************************

After  nearly 14 years in the counseling field, that’s a tough one. Since the newest memories are the freshest, I think I’ll tell you about a couple I just started seeing about a month ago.  We’ll call them  Dan and Fran.

This is funny if you’re not fighting about who does what chores, or if, for instance, the husband objects to doing any houehold chores!

This is a fairly young couple, both working at responsible jobs although not being paid as much as they’d like.  I’m not going to go into detail about their issues.  Let me just say that it was clear they had developed a habit of talking AT each other instead of WITH each other; that they had persistent habits in their efforts of communication that I have often referred to as “the crazy dance.”  It’s as if someone had choreographed their statements and responses, and they had learned the routine so well that they just didn’t know how to break it.

They’d been together for a long time, since high school.  No children.  Dogs they adore. A house that needs a LOT of work that they can’t always do without some professional help. He’s more laid-back; she’s more uptight. She’s ordered, he’s catch-as-catch can.  In terms of personality, you have a strong choleric/melancholy (Fran) married to a strong sanguine/choleric (Dan).  That’s a strong leader type, detail-oriented perfectionist with a happy, people-oriented  leader who isn’t quite as strong as she is.  He has no problem with missing a dish or two when he has kitchen duty. It drives her crazy when he doesn’t do the whole job.

Are any of you recognizing yourselves?  Most of us have this type of conflict to some degree.

To complicate matters, she was struggling with some pretty severe depression. She had medication, but wasn’t faithfully taking it. So there were all the difficulties associated with depression.

Here’s what we did:

1.  Take your meds.  You won’t sleep well or be able to function well until the fog lifts off your brain. Promise?  Yes?  Good. (She’s following through, and the difference is visible)

2.  I introduced them to one of my favorite communication techniques, called Active Listening, or Speaker/Listener.  You can learn about it here, or from hundreds of other sites if you just search “active listening.”

3.  We discussed their nonexistent sex life, and I suggested they have dates with the ultimate goal of intimacy. If you schedule it, you will think about it ahead of time.  It’s one of the best aphrodisiacs I know. (And they have to kick the dogs off the bed and out of the bedroom!  Good grief!)

I shared with them  that what they are experiencing is SO normal! I got them laughing with my own stories of fussing over different ways of folding the towels on putting the toilet paper on the spindle. How silly is it to fight over these things?  They are not the hills you want to die on! They are so insignificant that the best way to deal with them is to laugh.

There are some basic principles I always emphasize in marital counseling:

1. If either partner HAS to win ALL the time, the marriage is doomed.  No one wants to be the one who HAS to lose.

2. You don’t have to attend every fight you’re invited to.

3. Not every disagreement needs to turn into an argument/fight.  Sometimes, you can agree to disagree as long as neither partner is hurt by doing so.

4. You need to learn/develop the gift of forgiveness; you need to be able both to give it and receive it.

5. Humility goes a long way toward smoothing a rocky path.

6. Humor is a great aphrodisiac.

7. How you disagree isn’t as important as how you make up afterward. Mercy, kindness, forgiveness, and letting go are far more important than winning.

Obviously, we’re just scratching the surface here.  I could write on this topic for a long time.

One thing I don’t want to leave out, though, is spirituality.  I am a Christian, and my counseling is always strongly based on biblical principles and values. If the couple I’m working with share those beliefs, then of course we weave God’s Word throughout the whole process (One thing I never do, though, is start by preaching “wives, submit. . . .”  There’s a right time and a wrong time for that. Something else I could spend a lot of time writing about.) The truth is that God created male and female, and He ordained marriage.  He loves it.  He told us how to do it.  When I can use the Word, the counseling process is a joy. If I’m dealing with someone who objects to “religion” in their counseling, I can still teach biblically sound behaviors and ways of thinking.

This couple is doing very well.  They like Active Listening, which, when properly used, eliminates anger, debate, accusation and pain.  They’re learning to separate the important from the unimportant. They laugh a lot in my office, which is a total delight to me.

Believe me, it’s not always like that. Not at all. And those times, those couples, are enough to break my heart.

Aging: Depression

Contrary to what it may seem, depression does not come pre-packaged with aging. Not all older people are depressed; not all older people experience a major depressive episode.  As with any other population or demographic, depression needs to be treated as a serious condition and not “just part of growing old.”

Here are some signs that can be typical of depression across the age spectrum:

• Sadness
• Fatigue
• Abandoning or losing interest in hobbies or other pleasurable pastimes
• Social withdrawal and isolation (reluctance to be with friends, engage in activities, or leave home)
• Weight loss or loss of appetite

• Sleep disturbances (difficulty falling asleep or staying asleep, oversleeping, or daytime sleepiness)
• Loss of self-worth (worries about being a burden, feelings of worthlessness, self-loathing)
• Increased use of alcohol or other drugs
• Fixation on death; suicidal thoughts or attempts

If these symptoms appear and persist across time, the elderly person who exhibits them probably should be seen by a medical doctor. There are other things that need to be ruled out before clinical depression is diagnosed. Things that can cause depression include a long list of medications that has not been recently reviewed for how these meds interact with each other.  Also, depressive symptoms can be the result of low blood sugar, diabetes, thyroid issues, cancer–it’s a pretty long list.  Many medical conditions can be the underlying reason for depression, especially in the elderly when the condition has become chronic.

Not all elderly people who are depressed will manifest symptoms of sadness.  Sometimes their complaints will include, instead: Low motivation, a lack of energy, or physical problems. In fact, physical complaints, such as arthritis pain or worsening headaches, are often the predominant symptom of depression in the elderly.

Here are some depression clues that often appear in older adults:

Unexplained or aggravated aches and pains Feelings of hopelessness or helplessness Anxiety and worries Memory problems Lack of motivation and energy

Slowed movement and speech Irritability Loss of interest in socializing and hobbies Neglecting personal care (skipping meals, forgetting meds, neglecting personal hygiene)

Often, older adults fall into depression because of normal life transitions. As they see the end of their lives approaching, they can begin to believe there is no longer any point in going on, and they just give up. Here are some situations in which the elderly can feel depressed:

• Health problems – Illness and disability; chronic or severe pain; cognitive decline; damage to body image due to surgery or disease.
• Loneliness and isolation – Living alone; a dwindling social circle due to deaths or relocation; decreased mobility due to illness or loss of driving privileges.
• Reduced sense of purpose – Feelings of purposelessness or loss of identity due to retirement or physical limitations on activities.
• Fears – Fear of death or dying; anxiety over financial problems or health issues.
• Recent bereavements – The death of friends, family members, and pets; the loss of a spouse or partner.

Sometimes, it is difficult to say whether the person is suffering grief over  the losses that accompany old age, or if it is clinical depression. Loss is a part of life for all of us, but the elderly can feel especially helpless when it comes to losing a spouse, a child, or a beloved pet.   Fear is often a constant companion to the elderly person  who is facing prolonged, painful illness and death.   Sometimes that fear devolves into depression.

Other symptoms that suggest depression, not just grief:

Intense, pervasive sense of guilt. Thoughts of suicide or a preoccupation with dying. Feelings of hopelessness or worthlessness.

Slow speech and body movements. Inability to function at work, home, and/or school. Seeing or hearing things that aren’t there.

How to Help

I cannot stress enough how important it is to get a thorough physical workup for the elderly person you may suspect is depressed. Once that has been accomplished and appropriate recommendations are made concerning medication, then it is important to get the person into some sort of therapeutic environment, preferably with someone who specializes in geriatric care. Getting the depressed elder to talk is vital to his recovery.   There are Area Agencies on Aging in every county in America that can help point you toward getting good help.  Your medical doctor may be a good resource.  If the elder you are helping has a strong faith, then his church may be a good source of help.

Also important is to make sure the person has as much activity and contact with others as is reasonable considering age, health, mobility, and  transportation options.  Most communities have senior citizen centers with good programs to help people find new friendships and activities.

If the person is homebound, that makes it a bit harder to keep her involved with other people.  Many churches have programs of visitation for elderly shut-ins. Again, the Area Agency on Aging in your area is a good resource for getting help. Family involvement is of vital importance whenever possible.

You can find a lot of good resources online.  Here’s a good place to start:

http://www.cdc.gov/aging/mentalhealth/depression.htm

Never just accept that an older person is going to be depressed.  It is NOT necessary, and there is help.

Aging: The Heart

I am not a medical doctor.  I am not qualified to diagnose or treat any medical condition.  What I share with you today is information widely available.  I am keeping it as simple as I can so I don’t make any egregious errors. It certainly has been interesting and enlightening–and motivating–to read on this topic this week.

The first thing that came to mind as I started looking for information this week was the scripture verse John 14: 1, “Let not your heart be troubled. . . .”

Before I talk today about some physical changes, I want to make application as well to emotional changes that occur as we age.  I’ve probably mentioned before that I heard a speaker years ago at a women’s conference who said, “If you are a negative, whiny, complaining, criticial young woman, you’re going to be a nasty, mean, miserable and lonely old woman.  You are becoming what you will be.”

That statement is true not only of our spiritual and emotional selves, but also of our physical selves. We need to be good stewards of these incredible bodies with which God has gifted us.

“A man is as old as his arteries.”
Thomas Sydenham, MD, English Physician, 1624-1689

Stretched end-to-end, the arteries, veins, and other vessels of the human circulatory system would measure about 60,000 miles. On any given day, the heart pumps about 1,800 gallons of blood through this vast network. In an average lifetime, the heart pumps approximately one million barrels of blood—enough to fill more than 3 supertankers—through the circulatory system.

(http://www.nia.nih.gov/health/publication/aging-hearts-and-arteries/chapter-4-blood-vessels-and-aging-rest-journey)

High blood pressure and atherosclerosis commonly develop as we age.  At age 65, nearly 40% of all deaths are heart-disease related. As we grow older, that statisitic increases a whole lot.

Unless you live with your head in the sand, you know how important a healthy lifestyle is to the heart.  Smoking, lack of exercise, a diet rich in salt and unhealthy fats all increase the risk of heart disease; that risk includes diseases of the blood vessels and arteries as well. You can read in depth about cardiovascular disease and atherosclerosis here.  Right now, I’d like to talk just a bit about how we can slow down the process so that our years here on earth are more productive, healthier, and less of a burden on our loved ones.

There is so much written about how we eat.  If you’re going to believe all the hype out there, you really can’t eat much of anything without risking cancer, heart disease, and general pollywoggles of the diflammatorium.  Health gurus and nutritionial specialists can’t seem to agree on a lot of things–butter or not butter?  Bacon or not bacon?  That list is endless.  I remember when margarine was touted as the savior of the health of mankind, and it has since turned out that the stuff is only one little molecule away from being plastic. Blech. There is NO margarine in my refrigerator!

Food is obviously important, but I want to stress here is the common sense approach. It’s a no-brainer that we need to avoid too much sugar and fat.  If you shop on the perimeter if  your grocery store, you will do pretty well.  All the processed empty calories are in the middle shelves.  Most of those aisles we can blow right by without missing much.  What’s on the perimeter?  Produce, dairy, meat and seafood.  Usually the bakery, too, which you have to close your eyes to as you whip your cart past it at lightning speed 🙂

The key is deep, dark color, whole unprocessed foods, and no added sugar or fat. It’s the way our grandparents lived, and their rate of heart disease was a lot lower than ours.

Exercise never loses its importance.  This is my biggest stumbling block. Inherently lazy, I find a lot more pleasure in a cup of tea and a good book than I do in a brisk walk on a cold/hot/windy/humid/wet/snowy/icey day.  Get the picture?  I KNOW how important it is for my heart that I move, walk, get up off the couch.  I wish there were a pill to give me the will.  A “will pill.”

We’ll talk about diabetes in another post, but I mention here because I have learned that the minute you are diagnosed with Type II, you are also a heart patient.  Type II can be controlled with a little self-discipline.  Diet and exercise play a huge role

What happens to the emotional and spiritual condition of an aging person who develops heart disease?  Most typically, depression can set in, and old-age depression is not the same as depression that younger people can experience.  Older people who are sick or debilitated because of heart disease often feel useless and hopeless, and their last years  become nothing more than ticking off the days until they die.

That’s not cool. There is help out there, tons of information on how to improve your heart health and thereby improve your overall health.  We need to live as much as we can until we lay these old bodies down to die.  Live until you die. Don’t die years before your body gives out on you.