How we internally react to our depression is also crucial. As a depression patient myself, I notice that I typically get reactive to my depressed moods. At the slightest hint of a depressed mood, I will typically tighten up and armor up. I think that depression means I am weak, that I cannot handle my life and my responsibilities – so I hate it. But my reactivity and hate (instead of helping) only fuels my depression, making it deeper and tougher to work with.
Because this is true, working with depression is typically counter-intuitive. In essence, fighting depression doesn't work. Depression will not be intimated or scared away. Getting mad at yourself and the world because you are depressed only deepens and strengthens the depression. This has the net effect of placing me at war with myself – and when that happens, I lose.
So what's a more useful reaction to depression? Let's start with an analogy: working with depression is like falling into quicksand – the more you struggle, the worse things get, and the faster you sink. On the other hand, if you can just slow down, become mindful and grounded, and place your arms and legs away from your body, then you begin to float, then you can very slowly begin to inch your way out of the quicksand.
Here is another analogy I use with my patients: working with depression is like being in a Chinese finger trap – the harder you pull, the more you panic, the worse you are trapped. Just as in the quicksand analogy, the solution lies in relaxation and acceptance of the present moment as it is. The solution lies in making friends with your depression; in making your depression an ally in your evolution. In the end, I had to make friends with my depression, I had to "invite the demon in for tea" (to borrow a Zen phrase), and only then, once I had the courage to stay and connect to my demon of depression (without adding or subtracting), only then do I have the chance to dissolve it or transform it into a more useful emotion.
Exercise: After relaxing for a few minutes with your eyes closed, in your mind's eye, call forth your depression and instruct it to take a shape (e.g., an animal, a person, a thing, etc). What shape did it take? If you could speak to this creature "Depression" – what would you say? If it could reply, what would depression say in return? If you could touch your depression, what would it feel like? If you could smell and taste your depression, what would it smell and taste like? After doing steps 1-4, have you noticed any change in your depression? Has the depressed mood increased or decreased? Is it as solid and heavy as it was before, or have things shifted a bit somehow?
After making some room for depression, indeed after inviting it in for tea, the depression typically decreases in intensity, or is dissolved altogether. This occurs because the questions you asked of your depression – they are mindful and curious questions. They were not blaming, judging, or insisting – only curious and grounded. And in response, the depression must weaken, for you are no longer fueling it.]]>
First, it should be clear from the start, not all depression is "pathological." In fact, there are perfectly appropriate times when human beings are supposed to feel depressed. Significant psychological trauma, the loss of loved ones, and the diagnosis of a terminal illness are among the legitimate reasons that human beings become depressed. In essence, depression is a natural part of our trauma and grief processing.
Having said that, there are many people with a biological predisposition to clinical depression. For these people, depression is a reoccurring obstacle in their lives, making it tough to thrive and grow. This kind of clinical depression is called "major depression," and if left untreated, it can be quite destructive and dangerous.
Therapy does not seek to eliminate depression. As we said before, depression has its place in the pantheon of human emotions. Psychotherapy seeks to help the patient change their relationship to their depression.
Depression is almost always supported by a narrative. Like two by fours in a solid foundation, a good depression narrative upholds and supports a depressed mood. A depression narrative is also pretty easy to spot in that extreme words are used with great frequency – words like "never," "always," "all," and "nothing." In essence, while reality is actually very nuanced and relative, a depression narrative is very simple, extreme, and full of black and white thinking.
My depression narrative goes something like this:
"I am the unsung hero of an unfair universe, and despite the fact that I try hard and do the right things, I never seem to get ahead! I am always blamed when things go wrong, and I get stepped over and I’m deprived the good things in life. I deserve good things too! Basically life is rigged, so what’s the point?"
My narrative is projecting blame outside of me and onto the people, places, and things around me. This is an "angry depression." Many times, however, the depression narrative will be internal, blaming oneself for all the trouble and difficulty experienced. This is a "self-loathing depression" and it’s this type of depression that is typically associated with suicidality.]]>
But, unless you commit suicide, the time and manner of your death are completely unknown to you. The impermanence of life, that fact that death can come at any time and in any way, is the frequent source of existential crisis in humans. Some people die in the womb, some die when they are children, some die as teenagers and young adults, some die when they are middle aged, and some die when they are elderly. According to the World Health Organization, over 200,000 people will die this very day all across the planet. Some will be the victims of crime, some will die in car and industrial accidents, some will die in war and some will die of natural causes (illness, old age, etc).
We are all met with unfortunate circumstances beyond our control. For instance, have you ever lost a job that you really liked or loved someone who ended up betraying or leaving you? Did you ever love someone who died or have you ever picked up the phone to hear that a loved one had been diagnosed with a serious illness? These are unfortunate circumstances that you did not want, did not ask for, but still they occurred. In other words, despite that fact that you did not want them, they happened anyway and there is absolutely nothing that you can do about it. You must somhow learn to live with the loss and go on.
Additionally, we are all separated from things that we want or desire. Over the years, some people I have helped wanted to be famous, some wanted to be rich, some wanted to be educated. And despite that fact that they wanted it, circumstances conspired in such a way that what they wanted eluded them. Some people just wanted to be physically healthy, some want to live in a politically stable country, some just want to find that one special person who they can love and who will love them in return. But despite all their efforts, what they desire and crave eludes them.
And lastly – all of life is impermanent. It is a strong desire in man to create a legacy, some notion of immortality or permanency in life. Some people feel they create this through their children, some through the work that they do and the contributions that they make. But ask yourself this question: in a hundred years, when you and everyone you ever knew is dead, who will remember you? Even the greatest kings, emperors and holy men are, for the most part, relegated to the history books. As mighty as the Roman Empire once was, it is now a series of ruins across the Mediterranean. The Earth is simply one planet, in one solar system in one galaxy – constantly in motion, always dynamic, moving from one moment of present time to the next. The universe itself is in motion, always moving, always shifting and fluxing and, as modern science is learning, our universe may just be one of many universes somehow intertwined and interdependent, one on another.
Modern psychotherapy teaches us to improve the quality of our lives not by suggesting that these sufferings are somehow avoidable, because they are not. Nor does it suggest that we are too special and this shouldn't be happening to us - we are not special. Psychotherapy teaches clients to make room for, make peace with, and make meaning from their sufferings. It teaches us to stop running and avoiding and denying and minimizing and blaming. It teaches us to own ourselves; it says that when we feel bad that doesn’t necessarily mean that anything is wrong – nothing necessarily needs to be “fixed.” Pain and despair are just as much a part of life as are joy and exuberance. And when we begin to see the nature of our consciousness, when we begin to tap into that nature, to work with our thoughts and emotions, then we begin to transcend living simply (and futilely) to avoid pain and we begin to live beyond life and death. Psychotherapy can be an amazing guide along that path.]]>
1. Birth 2. Aging 3. Sickness 4. Death 5. Unfortunate Circumstances Beyond Your Control 6. Separation from People, Places, and Things You Desire 7. Impermanence
It is useful to walk through these sufferings to make them more readily apparent to you. We begin, of course, with birth.
All humans are born. According to the World Health Organization, approximately 250,000 people will be born this very day. All of us begin in the uterus, enveloped in warmth and darkness, with all of our needs being automatically met. We are then forced, through violent muscle contractions, into a world that is illuminated; where we must breath with our lungs. We are utterly helpless, not even able to lift our own heads. We are completely dependent on other beings (primarily our mothers) for every single aspect of our survival. So dependent are we that if left to our own devices, for even s short amount of time, we would surely die. This state of complete dependence is not a pleasant one. And we have said nothing of the mother’s experience of the birth. Despite that fact that tremendous emotional bonding usually takes places after the birth, the mother’s experience of the birth itself is, without doubt, quite physically painful. Many women also experience psychological suffering after the birth. There is post-partum depression and, additionally, the often inevitable disorientation of the family unit as it shifts from its original state to accommodate a brand new member. Thus in addition to the joy and happiness usually associated with a birth, there are also the above realities.
Now we turn to aging. All humans age. From the moment sperm and ovum met in the womb, we are in fact getting older. The cells divide and multiply and we are born, We age in an ongoing, unceasing fashion; all the way until the moment of our death. And we humans tend to be rather uncomfortable with our ages. When you ask a child how old they are, they typically reply in fractions, such as, “I am 4 and a half.” Always wanting to be older, most children tend to up their ages as much as possible without stretching the truth to a lie. Teenagers do the same thing. If a young man is fifteen years old he will readily say, “I am almost sixteen.” And when we arrive in our late thirties and forties, we commonly begin forgetting birthdays so we remain “thirty-five” as long as possible. We become uncomfortable about people knowing just how old we are. We search for and exert energy to have the appearance of youth. Botox, plastic surgery and the stereo-typical mid life crisis are evidence of this discomfort with our ages. And aging brings inevitable physical suffering with it. For instance, how is your body now compared to twenty years ago? Are there any differences you can think of? And how will your body be different from its current state if you fast forward your life twenty-years?
Now to sickness. All humans fall sick. From the simple infections and colds of childhood to cancer and AIDS, human beings are vulnerable to illnesses of all shapes and sizes. Books attempting to chronicle medical pathology fill whole sections of the library. There are so many things that can go wrong with the human body that science must compartmentalize into armies of specialized doctors who focus only on very specific areas of the human body. Now, please think of the last time you had the flu – how did you feel? Your experience of life became much different than it is when you are physically healthy. To see this clearly, all you need do is visit the nearest cancer ward or hospice and talk to some of the patients you find there. And as we age, we become increasingly vulnerable to sickness. When a man turns forty, his doctor will begin routinely checking him for ailments and conditions that he never would have looked for when that same man was twenty years old. No human can avoid sickness and everyone falls sick at least once before they die.]]>
The problem is that the man viewed the car as a source of happiness and prestige, almost as if "happiness and prestige" inherently existed IN the car itself (like happiness was actually mixed into its metal and rubber). But the car is just a piece of machinery and has no inherent quality of "happiness" or "prestige" within it. Yet somehow (very subtly but very profoundly) the man believed (long before he bought it) that the car possessed these qualities; thus if he could own the car, then these qualities would become his qualities. Of course this unrealistic expectation could not be upheld for very long and, when reality came crashing down, he became dissatisfied which he readily exited through anger and agression; he blamed the car and lashed out at it.
We go through this same process with the people, places and things of our lives. We imbue them with qualities (good and bad) that they do not actually possess. Then we get disappointed, dissatisfied, upset, and we often blame and lash out. Sometimes we just become dissatisfied and move on. We develop a wander lust, a seven year itch, we upgrade to the new model of wife, boyfriend, or job - and many of us believe that with this next upgrade, we will finally find satisfaction and happiness. To become realistic is good and healthy. What use is there in believing in falsehoods and exaggerated misperceptions? We are not children any more.
It is better to see things as they are, this is useful. To see the good and the bad, to experience the disappoints and joys - to stop believing that you can somehow escape disappointment, pain and difficulty is useful. Why is this useful? Because if you are a human being, you will suffer in very predicable ways (see previous blog). You can not escape disappointment, pain, sadness, depression, hurt, guilt, and worry. Why pretend that you can? This only makes the suffering inherent in human life worse. Uncomfortable thoughts and emotions (depression, fear, loss, helplessness, etc) arise when people die, when they are are diagnosed with illnesses, when they are faced with the realities of aging, when they are met with unfortunate circumstances beyond their control, or when they are separated from the people, places and things that they want or desire.
To stop fighting a battle you can not win is intelligent. Better to conserve your resources and create awareness of reality as it is. To become comfortable with the fact that there is no happiness and satisfaction outside of you; to deeply realize that you are the source of much of your own suffering; to see how you actively pour fuel onto the fire; to learn how to work with your mind and your emotions - this creates meaning and this is the point of psychotherapy.]]>
You will have your heart broken a few times. Someone or something will betray and violate you. Why walk around deeply believing that "this won't happen to me" only to feel blind-sided, victimized, and enraged when it does? Better to conserve your resources, create awareness of reality as it is, and cultivate the positive mental qualities that will actually produce happiness and flourishing in your day to day life. At this point, psychology Denver has become established.
In stage three, the client now has everything required to safely, skillfully, and effectively unpack all the twisted conflicts, unhealthy childhood lessons, abuses, traumas, addictions, losses, resentments, depressions, "closed-heartedness," and compulsions that have caused so much mental anguish and thus tainted his or her entire life. Now the client begins to learn how to profoundly work with her mind (all her afflicted thoughts, emotions, judgments, opinions, beliefs, perceptions, memories, fantasies, etc). Now her unhealthy habits, thoughts, and feelings can be transformed into ever deepening mental awareness, clarity, insight, meaning, and genuine happiness. In essence, now her experience of suffering becomes the cause of an ever deepening psychological freedom. Such a freedom naturally develops the wisdom that begins to transcend living in the past and the future, it transcends worrying and stress, it transcends living for mundane pleasure and avoiding anything painful or unpleasant. In fact, such wisdom transcends mundane concerns altogether, such that the client now begins to live beyond the concepts of life and death themselves.
Learning to effectively and consistently interrupt our afflictive cycles and transform them into positive and healthy cycles marks the usual completion of AMI's therapy process. At this point, awareness, clarity and insight are well developed enough that the client is capable of being their own therapist (at least most of the time).
Many laymen believe that psychological intervention means long term psychotherapy - but this is not necessarily so. According to Dr. Parker Wilson, a counseling psychologist, long term psychotherapy is sometimes required, but often short term psychotherapy can create the desired effect. It simply depends on the client and his or her presenting problems. Additionally, most believe that therapy is an individual process only, but most often couples counseling and family therapy are periodically used to enhance and deepen the individual process. Because these concurrent treatments can become so complex (especially around family therapy), these interventions should be administered by a psychologist in Denver.
To deeply realize (and become comfortable with) the fact that there is no permanent and abiding sense of happiness and satisfaction outside of you; to become "OK" with the fact that you are not that "OK," to deeply see how you actively pour fuel onto already raging and unhealthy emotional fires; to stop being so averse and reactive to your own sense of aversion and pain; to deeply realize that you are the author of much of your own psychological suffering; to gain psychological authenticity and to learn to become more still, stable, and clear; to learn how to work with your thoughts and your emotions; to learn to transform your negative habits into the cause of happiness and flourishing - this is the point of AMI's mindfulness based cognitive psychotherapy.]]>
This second stage is a deliberate and liberating process of examining the client's major behavioral patterns and then asking, "Will this behavior pattern produce happiness, neutrality, or sorrow in my life?" Since all human behavior begins as thought and/or emotion, if a behavior is unhealthy it undoubtedly has unhealthy thoughts and emotions underneath it. For all the behavioral patterns that produce sorrow, the thoughts and emotions underlying those behaviors is sought out and analyzed. AMI's psychology in Denver uses mindfulness meditation and a deep consideration of personal ethics to help the client cultivate healthier thoughts and emotions. At this point, mindfulness and psychotherapy again come together in that the client's new and healthier thoughts and emotions will now yield healthier behaviors. The effect of these healthier behaviors now begins to create a distinct mind state characterized by an increased sense of stability, calm, balance, peace, and happiness.
The final phase of AMI's mindfulness based cognitive psychotherapy is the cultivation of penetrative insight. As Caitriona Reed said, “It is by the patience you call forth by returning your awareness to this very moment that you enliven your life, not by your aspiration to gain or attain. By coming home to this still center of awareness the way is made clear.” Based on the foundation of mindful awareness and upon the psychological effects of increased positive behavior and decreased negative behavior, the client has now eliminated much of the confusion, emotional overwhelm, insecurity, and disorientation that had plagued him or her. Because these afflicted mental states have been lessened, the client has automatically increased their mental awareness, clarity, and insight. With these increases in awareness, clarity, and insight the client is now capable of making profound changes in his or her life. The client is now capable of working with their own mind.
Moreover, using AMI's techniques for cultivating equanimity, compassion, and kindness, the phase three client is now capable of nothing less than emotional alchemy; in essence, the client can now frequently and increasingly transform wrath into patience, depression into satisfaction, greed into generosity, grief into meaning, and pride into humility. These transformations simply add to the client's already increased sense of awareness, clarity, and insight. This is what creates such positive results from psychotherapy Denver, and this does not necessarily require long term psychotherapy. As the client continues to foster and reinforce these new and healthier mental patterns (which only lead to increasingly positive words and behaviors) their sense of mental stability, balance, peace, and happiness continues to grow ever stronger. The experience of psychotherapy Denver now grows even deeper. Often, at this point, couples or a family therapy process can be added to deepen the effect.]]>