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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Reggie BoStar on June 4, 2006, at 14:32:16
Hi All,
I've had episodes of severe depression since I was 10 (a few traumas seem to have started it). The latest one has lasted for over 10 years; I'm 55 now. Between episodes of severe depression, I suffered from dysthymia all the time. Essentially, I've never been consistently happy since those traumas when I was 10. One of the end results was alcoholism, starting when I was 22 (I was a late starter). I'm "in recovery" now but could best be described as a severely depressed "dry drunk" with occasional thoughts of suicide. What keeps me from acting on those thoughts is a terror of dying - so, I'm stuck between the proverbial rock and a hard place that many severely depressed people inhabit.The latest counseler is trying the cognitive approach, specifically by helping me identify possibly irrational beliefs that may be keeping me severely depressed. The first one she tried was a biggie with some content suggested by me:
"The remainder of my life will amount to nothing and then I will die."
This is essentially what I believe, and my mental task is to identify this belief as irrational in order to ease my depression. However, I had to make a change in order to increase the accuracy of the belief:
"My life has not and will not amount to anything, and then I will die."
The "has not and will not" verbage is what I really think, and is making this cognitive approach a poser for me. Because my life thus far has in fact amounted to constant dysthymia and extended periods of severe depression, literally nothing has happened. I never had a family, a career that provided fulfillment of any kind - in fact, nothing that has provided any real fulfillment.
This is making the cognitive approach all but impossible for me. Because of my history, I can't imagine that the "future tense" of this belief is irrational - I just don't have any experience with alternative ways to live, and thus can't know how to make the "future tense" seem irrational:
"My life will amount to nothing and then I will die?"
Well, why shouldn't it amount to anything? How can the "cognitive approach" beat this one down?
Should I in fact be using the cognitive approach at all? Is there another way to deal with someone with my type of history?
Thanks to all who took the time to read this long vent. Have a good day and best wishes to all!
Reggie B
Posted by Larry Hoover on June 4, 2006, at 18:35:20
In reply to Severly depressed, cognitive approach not working, posted by Reggie BoStar on June 4, 2006, at 14:32:16
Reg? What do you mean by nothing?
I'm totally serious about the question. How do you measure that? How will you know when you have it, or something else in its place?
If you helped an elderly person across the road, just by being alongside, as they tottered across, is your presence meaningless? I did that today. I defied traffic to take us both out, as it seemed they almost were willing to take the elderly one, alone. Just by adjusting my pace.....
Is a series of similar vignettes also meaningless?
To whom?
When is enough enough?
Have you done any volunteer work, Reg? I know some people in some care homes who would dearly love you for your meaninglessness, simply by being there with them.
Just wondering.
Lar
Posted by fallsfall on June 4, 2006, at 19:15:21
In reply to Severly depressed, cognitive approach not working, posted by Reggie BoStar on June 4, 2006, at 14:32:16
What kinds of therapy have you tried in the past? Have you also tried medication?
I have been on disability for depression for the last 11 years. I did congnitive behavioral therapy for 8 1/2 years, but it just helped me learn to live with the pain - it didn't do much to remove the pain. I'm in psychodynamic therapy now (my therapist even does analysis with some people), and it has made a world of difference. So, my experience tells me that a different therapy approach can help sometimes.
Our histories are a bit different, so I don't know which other kinds of therapy might work for you. How long have you been seeing this therapist? If she is new, I might suggest giving her a chance to see if she can work with your objections. I also am a firm believer in talking to your therapist about the difficulties you are having in therapy. Hopefully, she is a good enough therapist that if she can see that her way isn't working she could point you in a direction that might work better.
Good luck.
Posted by Reggie BoStar on June 4, 2006, at 19:29:23
In reply to Re: Severly depressed, cognitive approach not working » Reggie BoStar, posted by Larry Hoover on June 4, 2006, at 18:35:20
Lar,
By "nothing" I mean "nothing". Bear in mind that everything is relative. While you may consider helping someone across the street or being similarly polite to strangers significant, I consider it automatic behaviour because I am not antisocial in the psychological sense.I do, however, also suffer from severe social anxiety which makes me extremely uncomfortable in the presence of other people. While this doesn't rule out some sort of volunteer work, it does mean that the discomfort will prevent me from feeling a sense of fulfillment from it. Recall that one of the "nothings" I described was a self-fulfilling career. That would also apply to volunteer work.
We could wage philosophical war about the concept of "nothing" to the point of being reductionists about it, debating the difference between "something" and "nothing" and how one cannot exist without the other. That would get us "nowhere"; hence the relativistic approach I take, which is the more practical route in real life. Conceivably, I could also simplify the matter by renaming "nothing" to "nothing fulfilling to me"; but we would still be stuck in a relativistic quandry, because your definition of "fulfilling" would undoubtedly be different than mine. So I will stick to my first statement, "By nothing I mean nothing."
Measuring nothing is meaningless, by the way. I will know I have something else in its place when there is something to measure.
Reggie B
Posted by Reggie BoStar on June 4, 2006, at 19:34:05
In reply to Re: Severly depressed, cognitive approach not working, posted by fallsfall on June 4, 2006, at 19:15:21
Hi FallsFall,
Thanks for that input. I don't know much about psychodynamic therapy, but at this point I'll try anything. I'm going to do some internet homework on it and take it up with my therapist. You're right about her - she is a good enough therapist to try another approach if the current one isn't working...Thanks again for that input,
Reggie B
Posted by Larry Hoover on June 4, 2006, at 19:37:27
In reply to Re: Severly depressed, cognitive approach not work, posted by Reggie BoStar on June 4, 2006, at 19:29:23
> Lar,
> By "nothing" I mean "nothing".Very well said, Reg.
It's helps me, maybe more than you, to understand your experience through those questions.
Fallsfall has definitely touched on another aspect of therapy, the form it might take. But also, there is the counsellor variable itself. I know that I was asked identical questions by two different counsellors, because I recall how differently those same words came to me. The counsellor variable itself is an important one.
I hope somebody here has an idea that touches you, and offers you hope.
The thing is, just as I don't know what nothing is to you, neither do I know what is fulfilling. I started with the easier question.
Regards,
Lar
Posted by Larry Hoover on June 4, 2006, at 19:41:34
In reply to Severly depressed, cognitive approach not working, posted by Reggie BoStar on June 4, 2006, at 14:32:16
Reggie, I just realized you never once mentioned medication, or dietary measures. There are factors apart from cognition that have a great bearing on state of mind. Depression is not just a thinking disturbance.
Can you describe other therapies or treatments you've tried already?
Lar
Posted by pegasus on June 5, 2006, at 9:28:08
In reply to Severly depressed, cognitive approach not working, posted by Reggie BoStar on June 4, 2006, at 14:32:16
Hi Reggie,
It sounds like your working definition of your life "amounting to nothing" is tied to what gives you a sense of fulfillment. Since you say that nothing since you were 10 has given you the slightest sense of fulfillment, it seems reasonable (i.e., not irrational) to me that you conclude that your life will not amount to anything in the future.
But also, it seems to me that the way you equate fulfillment to your life amounting to something leaves a bit of room for hope. The hope would be that you may someday be able to find something that does give you a sense of fulfillment, however small. If you can find even a tiny toehold on fulfillment, then cognitive therapy is designed to help you build on that. And then your life can start "amounting to something".
That's where finding the right therapy/therapist, medication, dietary or lifestyle changes can also potentially help. Being able to find nothing fulfulling can be caused by physical issues with which medication, diet, exercise, sleep, etc. often help. Also, developing a good therapeutic relationship often brings meaning to people's lives. It can help you develop other relationships in your life as well, which can add to the sense of a fulfilling life.
I don't know if this will work for you, I just want to point out that from my perspective (a lifetime struggling with depression and anxiety) your situation doesn't necessarily seem hopeless. I recognize, though, that within the middle of depression, these types of arguments don't carry much water. It's part of the suite of symptoms of depression. That's also where a good therapist can help - sometimes you need someone that you can trust to see things outside of the veil of depression when you can't see there yourself.
I wish you much luck.
peg
Posted by fairywings on June 5, 2006, at 14:20:59
In reply to Severly depressed, cognitive approach not working, posted by Reggie BoStar on June 4, 2006, at 14:32:16
Hi Reggie,
You didn't say whether you'd been working with your T very long or not. Asking her to change approaches might work....I guess some are able to do it, some not. My old T was CBT, but I told him I didn't want CBT, so although he changed a lot of things, he didn't change his basic way of doing things...which was good because he really challenged me....which might not work for you. Mu current T has changed a lot of things, which is probably why I work better with him. I don't have to fit his mold. Like others said, you didn't mention meds, diet, exercise...other factors that might have an effect.
If you're not opposed to being around people,even though it's hard, and you're not opposed to vol. work...is it possible you could raise Pilot dogs or something? Although it might not give you a sense of satisfaction...it might. Who knows what might bring us out of depression, or when it might happen.
I hope you find something that will give you meaning.
fw
Posted by orchid on June 5, 2006, at 16:57:09
In reply to Severly depressed, cognitive approach not working, posted by Reggie BoStar on June 4, 2006, at 14:32:16
My personal feeling is that CBT is only helpful for mild to moderate depression and shorter episodes. Long time severe depression might need some other form - I don't know what but maybe psychoanalysis or regressive therapy etc.
Posted by Jost on June 6, 2006, at 23:06:09
In reply to I don't think CBT works well for severe depression » Reggie BoStar, posted by orchid on June 5, 2006, at 16:57:09
To go back to one thing (and not to belabor it, but to ask):
At one point, you say you haven't done anything, and at another point that you haven't done anything fulfilling. These are different, possibly--because in the latter case, you could have done things, but they might not feel fulfilling.
I say this because this is the case with me, especially at some points. Now is one. I've done various things, at times, that have had the potential to be meaningful, but they don't amount to anything that seems to justify the trouble (pain) of being alive, and all that.
Last night, I had a terrible nightmare in which everyone was being killed by terrorists, and I'm sure I was about to be killed, and I was just trying to escape or hide, but knew that I would eventually be killed, in this kind of senseless, brutal, horrible way. But it wasn't just that--while I was dreaming, I had the thought that even if I didn't die at that moment, eventually I would die, and it would be just about as horrible, brutal, and senseless as this (ie being killed by terrorists) was.
When I woke up, a friend was trying to tell me it was just a dream and that I must have heard on the radio that some Iraqis had been pulled out of a bus and killed. But that only make it worse.
I was thinking this before I went to bed, because my work seems utterly futile and pointless, and the other things I've tried never amounted to much. I'm angry at my therapist, and feel that he can't help. And I perceive him to be very disapproving and frustrated with me because I haven't done better, become successful, turned over a new leaf.
Also I have this chronic shoulder injury, which means I'm in a moderate or more amount of pain when I work (my work involves a fair amount of heavy use of my arm)--and so I dread doing it and dread not doing it, because that makes my life even more empty.
Yet I haven't done nothing-- I've done things, even things that are pretty good-- although no one has seen them and I haven't been successful in the world. I can't make money, and often waste time, because I"m afraid to assert myself with people I work with--I let them do a bad job and try to make up for it, which gets in my way, and then blame myself for not demanding more. But I'm afraid of alienating them completely with my demands.
Sorry for ranting, but I've been so very oppressed with the question you posed at the beginning the thread. I wish there were some answer, method of just attaining meaning and then having a hold on it.
Sometimes I think the only way is just by insisting to yourself that it's there-- in the way CBT says you should struggle against useless or unhelpful beliefs. But it's very hard to do that, too, when you feel overwhelmed with the futility of things, and exhausted or in pain.
So, what have you done, even if it's not fulfilling? Maybe if you argued with your belief that it's not worth anything, you'd slowly be able to believe something different.Jost
Posted by Reggie BoStar on June 7, 2006, at 18:47:46
In reply to Re: Severly depressed, cognitive approach not working, posted by Larry Hoover on June 4, 2006, at 19:41:34
Hi Lar,
Well, the therapies have amounted to a kind of mix of psychodynamic and CBT, in the context of both groups and one-on-one. I usually always start out with a psychodynamic approach, because I want the therapist/group to know how I got where I am. There are a few pertinent childhood traumas that always need to be aired, at least in my mind. From there the therapy proceeds along whatever protocol is used by the therapist/group. I've been at this a long time (since the middle 70's), so I've tried a lot of different mixes of those two disciplines.The physical treatment has consisted of ECT in July of 2006. This resulted in panic attacks but no reduction in depression that I could preceive.
As far as meds go, here's a paste from the "biological treatments" board:
Lamictal 200 mg/day
Cymbalta 60 mg/day
Neurontin 1600 mg/day
Buspar 60 mg/day (for those panic attacks caused by ECT)
Campral (for alcohol cravings) ~2100 mg/dayThere are also meds for hypertension, high cholesterol, and urine retention (go figure on that last one, but if I don't take the med, I have to be catheterized now and then, Ugh!).
That about covers it, in a nutshell.
Take care,
Reggie B
Posted by Reggie BoStar on June 7, 2006, at 19:15:13
In reply to Re: I don't think CBT works well for severe depres, posted by Jost on June 6, 2006, at 23:06:09
Hi Jost,
Sorry that first question depressed you. It was quite a poser to be tossed out in a psych board; I should have been a little more considerate about the feelings of other readers.Unfortunately, for my sake I had to raise the issue in at least some form, and as my bad luck would have it, I couldn't come up with a better way.
One thing is certain: beating it down is going to take a lot of work in terms of re-evaluating some of the things we were a little too hard on ourselves in the past.
On the way out of the clinic, for example, I held the door for a wheelchair patient who was entering the building - the doors are automatic, but because of the way they swing they can jam a wheelchair between the sets of doors; so I got there ahead of time to keep that from happening. The guy thanked me profusely as he passed.
Perhaps part of the solution to trying to answer the question of meaning is to add up the smaller episodes of fulfillment like the one I experienced when I held those doors. This won't make the big issues go away, but at least the sum of those episodes will give us something to work with.
I picked up another clue today. In taking up the question with my therapist, I added a few more detailed questions which are also constantly on my mind. She observed that ruminating on even one such question is not just a sign of severe depression - it can also indicate a combination of anxiety and OCD. This triple threat - depression, anxiety, and OCD - can be caused by a major neurochemical problem of some sort. Thus, meds as well as therapy need to be considered in attacking the problem.
She also cautioned me to remember that the sorts of things we've been talking about in this thread are incurable; they can be managed, but not cured. To me this meant that I'll always be grappling, to some degree at least, with the question of whether or not my life has or will have any significant meaning; but with the help of meds and therapy, I'll be able to manage it better, live with it, and learn to make room in my mind for a more positive outlook.
I hope I made some sense in that last paragraph. It's the gist of what I've been thinking since my visit to the therapist today: the door-holding idea, and the perspective about managing the tough questions with therapy and meds so a positive outlook can get a foothold.
Hope this helps,
Reggie B
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