|
The Mood Disorders Support Group of New York City |
| NEWSLETTERSLECTURESDEPRESSION IN THE NEWSCONTRIBUTELINKSDIRECTIONSCONTACT US |
M O O D S |
||
Newsletter of the Mood Disorders Support Group of New York City | ||
February2000 |
|
When printed, this page will automatically re-format itself.
Formatted for Printing |
By Richard O’Connor, Ph.D.
When I decided to write Undoing Depression: What therapy Doesn’t Teach you and Medication Can’t Give You, I wanted to convey a simple idea: recovery from depression is possible, but it takes hard work. Medications are very helpful for many people, but they really don't complete recovery. In order to have any credibility, I knew I needed to be open about my own depression, but I realized I was taking some chances professionally.
Most clinicians who have revealed their own history do so as part of giving up clinical practice for other work, but I clearly did not want to do this. Working with patients has been a great source of joy in my life, and I wasn't about to give this up. But, I suspected many professionals would look askance at me, and some patients might not like the idea of seeing a therapist who has depression himself. My worst expectations haven't come true, but I've had some interesting experiences.
There is considerable stigma about depression in the everyday professional community. In my professional workshops, I ask participants, hypothetically, if they’d feel safe discussing their depression with colleagues; almost no one does.
In the mental-health clinic where I used to work, it was OK to see a personal therapist—everyone has problems--but it wasn't OK to take antidepressants. Almost everyone on staff was taking meds, but no one talked about it openly, only behind closed doors, only to trusted friends.
Since I've come out of the closet, so to speak, I've found that generally the more experience and confidence clinicians have, the more willingly they accept my openness and reciprocate in kind.
Many patients seek me out, because they know I've suffered with depression. They feel this gives me added understanding. But they don’t want to know the details of my struggle. Even those who've read my book say things that make it clear they've forgotten--or repressed--some aspects of my story.
I think that's quite understandable, and I try to respect it. Being honest and authentic with patients doesn't really require a lot of self-revelation, though I try to answer questions when they're asked.
The details of my story aren't going to be particularly helpful to anyone else.
People always want to know if working with depressed patients gets me down. Luckily, my depression has never affected my work very much, nor my ability to evaluate it objectively. I have great joy when patients feel better; I take pride in doing a good job. But I recognize that although I do the best I can, recovery doesn't happen overnight.
If my depression has helped my work, it's because I can better understand the shame people with depression feel and their need for hope. Depressed patients feel deeply defective, and asking for help is just another manifestation of weakness. In fact, although people desperately desire help, they may feel unworthy of it.
The worst psychoanalytic methodology was shame inducing--the analyst as a remote presence who never showed warmth or interest and selectively reinforced the patient's most humiliating revelations.
The worst aspect of medication is shame. The physician may ignore what you say, focusing instead on how depressed you come across. The doctor may rush you out after 15 minutes, or make you feel somehow to blame if the drugs aren't helping.
We need to tell people that although it's natural to be embarrassed at not being fully in control of themselves, the depth of their mortification is unjustified and, in fact, part of the disease.
Depressed people also desperately need hope. I haven't found a shortcut for giving hope yet, but the therapist's realistic hope for the patient is a big first step. It involves the therapist's whole relationship to life. Therapists are human, make mistakes and can forgive themselves. They can be honest without being undone by shame, can face the worst in the patient and in themselves without being overcome by despair. If the patient participates with the therapist making sense of experience, staying determined, keeping perspective, it engenders hope.
We have to keep in mind that depression is a disease like alcoholism; it shapes us, it changes who we are. It's not our fault, but we still have to take responsibility for our own recovery. That’s impossible to do without hope.
Dr. O’Connor is an author and a therapist in New Canaan, Connecticut, and in New
York City.
He will lecture to MDSG on June 5, 2000 about
"Depression: The Disease That Causes itself."
You can purchase (and read more about) Dr. O'Connor's first book Undoing Depression : What Therapy Doesn't Teach You and Medication Can't Give You from Amazon.com by clicking here. Doing so will result in a referral fee being paid by Amazon to MDSG, at no cost to you. The book was re-issued in January 1999 and as of May 2000 Amazon was selling it for $10.36 (the price can change at any time). His upcoming book Active Treatment of Depression is scheduled to be published in January 2001. Amazon is currently accepting orders and will ship the book when its published.
by Rich Satkin, Chairperson of MDSG
The first Surgeon General's Report on Mental Health is historic; it increases public awareness of mental health and mental illness. Although the report is replete with research findings and documentation, it is generally quite readable.
Many MDSG members will find it compelling reading! It assesses mood disorders from childhood to old age and focuses on biologic, genetic and psychosocial factors in depression and bipolar disorder. It also looks at treatments, including pharmacotherapy.
First, according to a 1996 study, mental disorders collectively account for more than 15 percent of all disease. Only cardiovascular illness supercedes it. Second, even the most severe, persistent mental illness is usually treatable, including the most recurrent and episodic. The report principally recommends that people seek treatment.
Third, widespread stigma explains substantially why two-thirds of people with diagnosable mental disorders do not seek treatment. Surprisingly, people with mental illness, especially those with psychosis, are more often perceived as violent than ever before. Media stereotypes and deinstitutionalization contribute to this false impression. Based on several studies, "there is a small elevation in risk of violence from individuals with severe mental disorders (e.g., psychosis), especially if they are noncompliant with their medication."
In fact, there is very little risk of violence or harm from casual contact with individuals if they are compliant with medication. "The overall contribution of mental disorders to the total level of violence is exceptionally small," according to the report.
It also discusses public health focusing "not only on traditional areas of diagnosis, treatment, and etiology, but also on epidemiological surveillance of the health of the population at large."
As such, the report has been criticized for supporting misallocation of scarce public funds. Critics say it focuses on less severe mental illness instead of manic depression and major depression.
When budget battles are fought, these "turf" arguments are understandable. But the Surgeon General's report encourages us to promote public education, reduce stigma, and enhance affordable treatment. We support this.
You may get a copy of the Surgeon General’s report by logging onto the internet at www.surgeongeneral.gov.
with Dr. Ivan Goldberg
Q. I thought I had PMS, but my doctor says I have premenstrual dysphoric
disorder (PMDD). What is it?
A. PMDD is a depressive disorder occurring around the time of
menstruation. A woman with PMDD is unable to carry out family, work, or school
responsibilities. It's a severe form of PMS. Antidepressants help both PMS and PMDD.
Q. Will Tylenol increase my lithium blood level? Should I avoid it?
A. While it's true ibuprofen (Motrin, Advil and others) can increase
lithium blood levels, acetaminophen (Tylenol) does not. It's safe for people taking
lithium.
Q. My doctor says I have both bipolar disorder and borderline personality
disorder. Lithium and Depakote haven't stabilized my moods. Will Lamictal help both my
mood swings and borderline symptoms?
A. A double-blind, placebo-controlled study indicates that Lamictal can
help people with borderline personality disorder. Rejection sensitivity and impulsiveness
improve.
Q. I am breastfeeding and, therefore, reluctant to take an antidepressant. What
antidepressant is the safest for the baby?
A. Of all of the antidepressants, Zoloft appears in the smallest
quantities in breast milk. It 's safe for the baby.
And what marketing genius devised a moniker like Nardil? Sounds like the secret ingredient in Preparation H. Why not "Nardilly" or "Narnifty?"
Renaming meds is what the new newsletter contest is about. Take drugs that don’t mimic the mental condition they’re supposed to alleviate, and create something more apt.
Of course, there are medications that more or less get it right, to name a few: Elavil, Cylert, Restoril, Asendin, and Wellbutrin. But there are many others that need work: Mellaril is helped by calling it "Mellowchill," Xanax could be "Xanadu," Paxil becomes "Paxadaisy," Klonapin is "Close-Your-Eyes," Valium as "Val-iiiiiiiii-yum-yum," Dexadrine—why not "Doodle Dandy?" And Thorazine is vastly improved by relabeling it "Knuckledragger." Get the idea? Be clever and you’ll win a prize. Try renaming Parnate, Buspar, Desyrel, Luvox, Depakote, Lamictal, Tofranil or any of the scores of psychiatric meds that tickle your fancy.
Send as many entries as you like to via e-mail to newsletter@mdsg.org. Deadline for all entries is April 15, 2000.
First prize is a $25 gift certificate to Pamela’s Café in the Village, second prize is a copy of The Essential Guide to Psychiatric Drugs by Jack M. Gorman, M.D., and third prize is a seven-day, 28-slot pillbox and a pill splitter/crusher.
The
Reader’s Corner (Book Review)by Betsy Naylor
I Don't Want to Talk About
it:
This book concerns the violence that fathers perpetrate on young sons,who then understand they're not worth much.Without an understanding of depression, men express these feelings in rage, aggression, substance abuse, and other addictions like workaholism.
Memories of the events causing feelings of hurt and inadequacy are repressed, but the feelings--and the anger--remain. Clearly, this toxic legacy continues from one generation to the next, unless a man heals his early wounds before inflicting them on his son.
Depression is a major consequence of childhood abuse and neglect. However, its expression often differs by gender. For example, women tend to turn their pain inward, while men discharge it through action. Denial -- both of the trauma and the feelings it engenders--fosters shame and self-hatred. Our culture does not help: it is uncomfortable with men who cry or show vulnerability. Depression in men is viewed as weakness, leading to further shame and stigma.
The author's father was deprived and abused. He, in turn, abused his son - Dr. Real, a psychologist specializing in helping men recover from childhood trauma. He's best writing about the process of getting better, letting go of self-defeating behavior, and acquiring peace of mind. He knows the issues and points out which activities help most.
Often, the patient does not even realize that family or work problems stem from depression. Early therapy tries to bring the childhood injury out into the open, with all its attendant feelings. Dr. Real then helps his patients connect past and present. "Feelings are not endless, but our numbing attempts to avoid them can last a lifetime," he writes. Dr. Real invites family members to therapy sessions to let conflicts play out.
The case histories are composites. Stories read like dialogue in an absorbing novel. People's dilemmas become fascinating as the reader tries to imagine how these impossible situations can be resolved. Then, in a pivotal moment, the patient breaks through denial, feels vulnerable and often wants to change. These true-to-life experiences show people getting better. In some cases, Dr. Real recommends medication to aid therapy.
He points out some sociological truths about depressed men in our culture. Perhaps because of his own experience, he assumes too wide an application for his solutions. Not all depressions spring from childhood abuse. Most depressed people remember some early attacks on self-esteem--- even good parents have bad moments. But do they all require psychotherapy aimed at post traumatic stress?
An epilogue tells how Dr. Real and his father found peace by accepting each other. The author hopes his experience will inspire others.
You can purchase (and read more about) Dr. Real's book I Don't Want to Talk About It : Overcoming the Secret Legacy of Male Depression from Amazon.com by clicking on the links below. Doing so will result in a referral fee being paid by Amazon to MDSG at no cost to you.
The hardcover edition was printed in January 1997 and as of February 2000 Amazon was selling it for $16.80 (the price can change at any time) http://www.amazon.com/exec/obidos/ASIN/0684831023/themooddisordsup
The paperback edition was printed in March 1998 and as of February 2000 Amazon was selling it for $12 (the price can change at any time) http://www.amazon.com/exec/obidos/ASIN/0684835398/themooddisordsup
By
Michael Horowitz
Many readers of this newsletter already know how difficult getting out of the house can be for someone suffering from depression. An Internet-connected computer provides a plethora of communication options. This article is an introduction to the what, where, and how of chatting about depression and bipolar illness on the Internet.
Say "Internet," and most people think “the web” (a.k.a. the World Wide Web, or WWW). The web is a great thing, but it’s a one-way means of communication. The classic two-way communication on the Internet, of course, is E-mail, but chatters will find lots of other choices.
Chatting on the Internet typically means typing sentences on your computer that go immediately to all the people you are chatting with. You can chat only with people who are logged onto the Internet. If E-mail is like sending a letter, then chat is like a conference call.
The virtual place where a group of people get together for an online chat is called a room. The Internet contains chat rooms for every human endeavor, good and bad. Chatting online, for the price of a phone call, is somewhat different from chats around the office water cooler. For one thing, distance is irrelevant. You can chat online with people in different cities, states, even countries.
But keep in mind you are often chatting with strangers, some well-meaning, some not. Realistically, you can’t verify who your chat partners are. Some will be truthful online, others not. This anonymity works both ways, however, and you may find it liberating to discuss certain things with total strangers.
The anonymity stems from the fact that only a user ID identifies participants in a chat room. You chose the user ID, and it is separate and independent of your E-mail address (chats on AOL are slightly different; see below). Different chat systems have different rules for picking your chat user ID (also called a handle or nickname).
Chat rooms are usually unmoderated. This means the actual topic being discussed can differ from the advertised topic.
Technical Background
Java is a popular technology for chat. Java programs, called applets, are transferred to your computer when you enter a chat room, so there’s always a delay before the chat room appears on the screen. Some web sites tell you that the applet is being downloaded and to please be patient, but many do not.
Let’s Chat
One web site devoted to chat is www.support-group.com. In its own words: “Support-Group.com allows people with health, personal, and relationship issues to share their experiences through Bulletin Boards & Online Chat and provides links to support-related information on the internet.” It currently has four regularly scheduled chat groups related to depression and bipolar disorder (all times in this article Eastern Time):
You first have to sign up with them and receive a chat user ID, which they refer to as a nickname.
On the Talkcity web site (www.talkcity.com), you can chat about just about anything. The site can be intimidating, a good place to start is their calendar of what's going on now. Although they prefer you register, you can chat as a guest without registering. As of February, 2000 they have these depression related chats:
C. Everett Koop, M.D., the former U. S. Surgeon General, has a web site devoted to health. Chats related to mental health are listed at http://go.drkoop.com/community/chat/mental.asp and include many that are mood-disorder-related; you must register before chatting.
AOL Chat
Chats, one of the most popular features of America Online (AOL), are available only to AOL members. (AOL members can also participate in the other types of chat mentioned above.)
Chats on AOL are anchored at keyword “People Connection” which has a schedule of chats and instructions for users new to chat. However, keyword “Health Talk” is a much better place to find chats and message boards about depression and bipolar disorder.
There are too many chats on “Health Talk” to list here. For depression, there is at least one scheduled chat every day. For bipolar disorder, there is a chat every day except Sunday.
AOL limits chat rooms to about 25 people so they often fill up. With this many people in a chat room, several conversations go on at once.
Your AOL screen name identifies you in an AOL chat room, and AOL suggests creating a new screen name just for chatting (go to keyword “Screen Names”). AOL Parental Controls can prevent children from entering chat rooms.
And More
The next issue will cover three other types of two-way communication on the Internet: Instant Messaging, Newsgroups, and Message Boards. We’ll describe more places to chat about depression and bipolar disorder online.
With your feedback and additional information, we will update this online version of this article. Let us know about your chat experience and send E-mail to webmaster @ mdsg.org.
Michael Horowitz is MDSG’s webmaster.
On Feb 16, 2000 both the New York Times and Washington Post had stories about how heavy use of the Internet can make people socially lonely. Salon magazine also reviewed the original study and came up with a different conclusion.
The Mood Disorders Support Group
P.O. Box 30377
New York, N.Y. 10011
Phone_______(212) 533-MDSG
Fax________ (212) 675-0218
E-mail_____ info@mdsg.org
Web________ www.mdsg.org
MDSG/NY sponsors a series of lectures on various aspects of mood disorders. Anyone
can attend our lectures. More information is available on our lectures page
at www.mdsg.org/lectures.html. Our
next lectures are:
Cognitive-Behavioral Treatment of Depression and
Bipolar Disorder Elizabeth
Nelson, Ph.D. March 6, 2000
Early Temperamental Qualities in Bipolar
Children Joseph M. Nieder, M.D. April 10, 2000
Can We Defeat Chronic Depression?
James Kocsis, M.D. May 1, 2000
Depression: The Disease That Causes Itself
Richard O'Connor, Ph.D. June 5, 2000
The Mood Disorder Support Group depends on membership fees and contributions for its
operating expenses. A one year individual membership is $35, a one year family
membership is $50. Memberships and contributions to MDSG are tax-deductible to the
extent allowed by law. MDSG is an IRS-recognized 501(c)(3) organization..
| NEWSLETTERSLECTURESDEPRESSION IN THE NEWSCONTRIBUTELINKSDIRECTIONSCONTACT UStop |
Subscribe to the MDSG
 feed |
For questions or problems contact webmaster@mdsg.org |