People who are troubled by persistent and hard to manage thoughts are offered a variety of treatment approaches. What we call worry, rumination and obsessional thinking can derive from several diagnoses including depression, anxiety, obsessive-compulsive disorder, post-traumatic stress, brain injury, mania and others. While hopefully moving towards resolution of the symptoms, some people may find relief by distracting themselves. Mp3 players can do this. I have suggested this to patients and hear that it can help them temporarily escape troubling or intrusive thoughts. Players are readily available and can be had inexpensively.

Music is right for some people but I think podcasts are particularly good distracters. Music’s moods and lyrics can sometimes evoke unwanted thoughts whereas podcasts can help people think about different things. Most are free and available on websites such as CNN, NPR and iTunes. Content can be news, culture, arts, sports, comedy, spirituality, science, cooking, business, politics, hobbies, it’s nearly endless. eBooks can also be uploaded from numerous websites, usually for a fee. People should experiment with content that helps them feel better, learn something interesting or focus on the lives of others. I advise people to listen while washing dishes, exercising, doing yard work, walking or when it’s otherwise safe to be distracted. Those inclined to substitute media for human contact should bear this in mind so as not to increase any sense of isolation or interfere with relationships.

Moods come and go but depression feels like it will never leave. Here are the main things one needs to know,  it’s common, it’s serious, it has nothing to do with being “weak” and it’s treatable. Many people put off getting help and suffer needlessly. (Read that last part again.)  There is a stigma everyone recognizes but still often perpetuate by not getting help.  People can have liver disease or heart disease but when the mind is involved we call it “mental illness”, not a brain disease even though many of the symptoms are physical, mediated by grey matter.

The most common of these are an array of painful emotions that can include feeling worthless, helpless, hopeless, guilty, ashamed, lonely, sad, dead or numb.  Self doubt, low self-esteem, even self-loathing are common.  People are often more irritable and lash out at others, likely to throw themselves into work or to drink more.  Sometimes anything anyone says can feel abrasive or somehow insulting.   Mornings are often worse.  Worrying and anxiety are often part of it, sometimes including a preoccupation with death or suicide.  People have less energy, are unmotivated and have trouble enjoying things they know should be enjoyable.  Many people withdraw from social contact.  Some lose weight, some gain and many have difficulty concentrating or remembering things.  Sleep patterns are disrupted, fatigue sets in, libido may decrease.  Frequently there are assorted pains, headaches, stomach upset and increased proneness to accidents.  Symptoms can occur in combination.  Depression can be mild, moderate or disabling and last for weeks, months or years.

In children and adolescents depression may appear very different from adults.  Younger children may seem lethargic, cling to parents, refuse to go to school, pretend to be sick or worry about losing a parent.  Older ones may get into trouble, withdraw, feel misunderstood or angry.  They may become preoccupied with violence and “dark” thoughts, get into fights, engage in risky behavior, cut themselves or develop extreme eating patterns.  Since some of these can occur for periods of time during normal development they may be mistaken for normal mood swings.  It can be tough for parents to know when things are serious.  Untreated, depression in children can affect development including identity, social adjustment, academic or career functioning.

There are several formal classifications of mood illness.  There is major depressive disorder (single episode or recurrent), dysthymic disorder (a condition lasting at least two years, one year in children), psychotic depression (involving delusions or hallucinations), postpartum depression, seasonal affective disorder (SAD) and bipolar disorder.  Depression often accompanies other conditions such as heart disease, some cancers, hypothyroidism, diabetes, substance abuse, attention deficit disorder, post-traumatic stress disorder, eating disorders or obsessive-compulsive disorder.  Distinguishing between an adjustment phase after a major loss and depression can also be a challenge.

The current thinking is that most depression involves an interaction between psychological factors, biochemistry, genetic vulnerability and stress.  The Colorado rates of depression and suicide are among the highest in the country.

You can help yourself through periods of mild depression by distracting yourself, exercising regularly, eating well, setting realistic goals, getting support and confiding in friends.  Spend time with people and do not expect yourself to just “snap out of it”.  Simply acknowledging depression and taking care of yourself in small ways can provide some relief.  Depressed children may need more time with their parents, more structure and extra support.

Should things get worse or just not get better and daily functioning becomes a challenge, it’s time to consult a professional. A consultation is not a commitment to do anything but an opportunity to get information.  Expertise is available from most psychologists, psychiatrists, clinical social workers and licensed professional counselors.  Don’t assume that every therapist is equally knowledgeable about depression.  If treatment is recommended it is usually psychotherapy and/or medication.  Psychotherapy helps most people, has lasting benefits and may reduce the likelihood or severity of future episodes.  Many physicians prescribe medications though I usually recommend psychiatrists.  Medication does not address underlying problems.  Psychotherapy alone may be adequate but may be impractical if one’s daily functioning is significantly impaired.  Mind or brain?  We know now that just as medications change moods and the kind of thoughts people have, the kind of mental processing that occurs during psychotherapy can alter how the brain operates.  It works both ways.

Getting help can be a hard step to take.   We feel we should be stronger, can’t afford it, don’t have time, don’t believe anyone can really help or just don’t want to deal with itt.  There is more open discussion of psychological problems these days and more awareness generally.  There is often pride to be had from bearing up under adversity.  There is also a price for trying to just push through when an individual becomes a source of worry to others, when someone else bears the brunt of hurtful remarks or for a parent’s emotional withdrawal from a child.  In the extreme, suicide creates massive problems for those left behind.  Suffering for a cause sometimes makes sense.  Depression is not a cause.

Autoplastic adaptation: The subject tries to change himself, i.e. the internal environment.

Alloplastic adaptation: The subject tries to change the situation, i.e. the external environment.

Usually when I see a couple, each person hopes the other will become a more attentive and responsive partner.  Sometimes from themselves but more often it is from the other person that some kind of change is wanted.  After an auspicious beginning and the passing of some years, both partners can end up feeling they give too much, get too little and are not understood by the other.

It’s worth recalling that in human development people learn to get their needs met in two ways.  First, a baby cries out and someone comes to pick it up, to feed, change or cuddle them.  Then, baby learns to make internal adjustments, for example only by learning manners and saying “please” can one get the cookie.  An expectation has been set by the outside that we must grow or change to meet.  Both actions make relationships work, the request and the adaptation.  It’s an exchange.  The balance between these two approaches is affected by a one’s own early history, temperament, culture and life experience. Each person brings to a relationship expectations of what is normal “give” and normal “take”.  Within couples there is also a balance.  We must make some alterations in ourselves and expect the other person to make some on our behalf.

Once a partner in a couple can “hear” and empathize with the perspective of the other, change begins.  This shift of attention, itself,  is a very important change.  This is what’s needed from both people for long-term success of a relationship. Some things may never be negotiable but might be easier to tolerate if the meeting of needs feels more fairly distributed.  In my view, couples in trouble don’t have to solve all their problems, become different people or even stop fighting.  They just need to make a better deal.

Take a walk every morning.

Focus on what you have.

Divorce is a Developmental Opportunity

This article was originally published in Divorce Edition Magazine, Oct./Nov. 2007

“I just married the wrong person” is the wrong answer to the question of “what happened in your marriage?”  It may be accurate in the sense that the two of you could never have become a good fit.  This happens often enough but it is  not helpful if what you want is to do better the next time.  Divorce is a first rate opportunity to clean up our own psychological acts.  As long as we choose the fiction that our marriages unraveled because of the other person’s shortcomings, another painful divorce is probable should we marry again.  The divorce rate for second marriages is actually higher than for firsts so failing to take a good hard look at oneself can be self-defeating.  If you have children, it might even be unfair. “Being entirely honest with oneself is a good exercise,” said Freud.  It is also hard work.  The good news is that people can make substantial changes in how they relate.  As such, a second marriage can be better than the first partly because the fit is better but also as I hear it, “Marriage is not about finding the right person, it’s about being the right person.”

There is an appropriate time for undertaking this task and the first few months of post-divorce adjustment are probably not optimal.  There is too much else to think about.  Dealing with the initial shock, making necessary practical changes, setting up a new household, working out parenting or financial issues, helping children adjust, and beginning to grieve should come first.  The exception is if you are already in the process of developing another relationship.  In that case I would suggest being very cautious.  A relationship waiting in the wings towards the end of a marriage or one quickly begun at that time is highly vulnerable.  The intense, pent up need people have felt coupled with the reduced judgment available when so many other demands are being made by the divorce are stressful.  Relationships used for anesthesia tend to be brief.

Where does one start?  Pay attention to all those things you hated hearing from your former spouse, the ones repeated until you knew they were coming.  You may have asked your friends about these, wondering if he/she might have had a legitimate point.  Include reviewing past relationships and sort through the nasty bits for truths.  Source of useful information are the friends and family members who know you best.  Friends can be very intimate but they are not sharing your bed nor the responsibilities of running a household.  Ask the ones who’ll speak objectively about how they saw you contribute to strife or dissatisfaction in the marriage.  Ask sincerely and explain that your aim is to do better next time.  They may be honored by your trust and might also have wanted to say something for years but been too polite.

Novels, movies, plays, television dramas and songs are also sources wherein you might spot the way you and your spouse related to one another.  Talking with other divorced friends can be particularly useful.  Venting is fine; just recognize it for what it is. Couples have reputations among other couples for how they treat each other, who’s respected or maligned, who strives to dominate, who avoids conflict and who foments it, who mistreats and who tolerates mistreatment or attacks in passive ways.

If you can do it, perhaps the best source of information about how you relate in a marriage is your former mate.  This is tricky and depends upon the current state of things between you.  If you believe you will be mistreated, mistreat them or recycle an old argument, don’t bother.  Written communications are sometimes less passionate and they may have questions in return.  The process of listening to each other in a new way while attempting to minimize judgment can be healing for both of you and be of great service to children if you have them.  Whether or not you actually can have this kind of dialogue, treat your former mate with respect as you move along in the process.

Psychotherapy is also valuable for learning about oneself, dealing with old internal conflicts and with fears of starting again.  None of us know whether we are repeating a pattern until a relationship is well along the way towards intimacy.  We can try to be aware only to find we are precisely where we did not want to be again.  Making a few meaningful discoveries can change the course of our lives.