Thank you for your question. Boy, oh boy were you put through the wringer. My heart ached to read of your experiences. I suppose the short version of my answer would be to see a therapist soon as you can, if only for the reason that you mention suicidality from your teens and depression today. This is not to be alarmist, but depression is something you don’t want to go unaddressed for long, more a sign of trauma than any “character issues.”

Clearly, your mother’s traumatic flight and your dad’s withdrawal left psychological scars that now need attending. This is not to blame anyone; the tragedy of mental health issues (you mentioned your father’s depression) is that those afflicted often end up passing on their condition by creating, as the authority figure in the home, a psychological mood or atmosphere of depression, anxiety, etc., which children are liable to absorb. They don’t call them the “formative years” for nothing. These wounds are passed along from generation to generation until someone has the courage to say “enough” and get some professional help. The good news is that you are young and in an excellent position to get help, and in so doing, start life over again and find contentment and purposeful living. Your experience, believe it or not, can be a vehicle for compassion and empathy for others down the road.

I am a fan of author and psychoanalyst George Atwood, who says in his excellent book The Abyss of Madness that, to paraphrase, people become depressed when depressing things happen to them. There are so many ways in which your trauma would upend anyone’s psyche. The most common question people ask me is, “Is this normal?” I usually say I gave up on normal a long time ago. Also, we therapists can relate to the childhoods and suffering of the people we work with more than we sometimes let on.

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Yet another wounding occurs when the abandonment pain is not acknowledged or permitted to “exist.” A depressed parent may withdraw for self-protection and neglect the child, who cannot help but take it personally. Of course, as a young adult you now want to drink alcohol and blot it all out. What happened was wounding indeed, but not only were you alone with the abandonment, but you also had no one to even acknowledge or help you cope with its scarring legacy. Thus you were in the impossible situation in that you couldn’t have or not have these feelings; the terrible loneliness you experienced was compounded by not having a caring witness to empathize and help bear your very understandable feelings—a kind of solitary confinement.

You sound like a psychologically resilient person who survived a very difficult upbringing, who cares enough to do something about it now. I would encourage you look for a therapist who understands the kind of trauma you experienced, someone who is willing to be patient with you as these injuries to selfhood—which, actually, you seem to have borne quite nobly or you wouldn’t even be writing—begin to heal. Consuming vast quantities of drink or drugs is understandably tempting, but I encourage you not to. In the end, it will only erode your self-esteem and, in a sense, repeat the abuse by neglecting the hurt that needs a safe place for healing. You’re worth the effort (even if it doesn’t always feel like it). Thanks again for writing.

All my best,
Darren

Being deserving means having an expectation of goodness in your life. It is the goodness of people, relationships, and situations that we all want and deserve in our lifetime. We are all deserving of:

• a safe place to live and work
• relationships and people who love us
• colleagues and employers who respect and support us

The idea of being deserving isn’t a new one. But for someone who is not used to feeling deserving or worthy, it can be a difficult concept.

As a black woman, I grew up with conflicting messages from my family telling me that I was capable and deserving of whatever my heart desired. But then I went into the world only to be told directly and indirectly how undeserving I was. Whether I was undeserving of the same respectful treatment my colleagues were given, of being seated at a restaurant, or of the promotion that I’d worked hard for, I was constantly told and reminded how undeserving I was.

For many people, there is a tension between what we come to believe we deserve and what others tell us we deserve. Whether it’s an outsider or ourselves limiting our expectations, though, it makes it more challenging to live a fulfilled life. Perhaps the limitations you experience in life are a result of a deeper belief that you don’t deserve more. Though it doesn’t feel good, it is familiar to stay in a situation that you’re used to.

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But it doesn’t have to be this way. There are steps you can take toward having the life you want and deserve.

First, ask yourself, “Do I deserve good things in my life?” If the answer is no, why not? Why can’t you have the relationship, job, or life that you want? Take the time to write your answers. You may surprise yourself with the thoughts that are unconsciously swirling around your head. Many times, these buried thoughts come from long-ago experiences that hurt us and continue to influence us today. If you don’t uncover them, you can’t change them!

Now that you know where your feelings of being undeserving come from, you have some investigating to do. Are the comments that were made to you 20 years true today? Were they true then? Don’t give yourself an automatic answer; take the time to expose the validity, or lack thereof, of these thoughts.

A true investigation requires more than just your perspective. Gather three people who are honest, who love and encourage you. Ask for their opinion and thoughts about the messages you received when you were younger. Picking the right three people is key. They shouldn’t be people who will agree with you no matter what; otherwise, you won’t believe them. Nor should they be the people who initially conveyed these messages! They need to be people who will be honest with you while loving and supporting you.

Once your investigation is complete, you need to review this new information. Ask yourself again, “Am I deserving?” and “What am I deserving of?” Are your answers any different than the original ones?

What do you want to do with this new information? Do you want to hold onto it and ponder it? Or are you ready to take action and make changes in your life?

If you are ready to make a change, repeat the following daily: “I am worthy and deserving of goodness.”

Imagine the difference on your psyche and in your interactions with others if you move from saying “I’m worthless” day after day to saying “I am worthy and deserving of goodness.” Repeat “I am worthy and deserving of goodness” each time you go outside. Whether you’re leaving for work in the morning, taking a lunch break, or going to the store, say it. In doing so, you will challenge your thinking and your beliefs about your worth. It will lead you to the interactions, relationships, and situations that you are truly deserving of!

What or who makes you feel deserving? Let us know in the comments section below.

The world can be a cold and cruel place, and as such, every display of warmth and goodness makes a difference. Performing random acts of kindness for those around you—such as opening doors, offering to help carry groceries, giving free hugs, or buying a cup of hot coffee for a stranger—can trigger a ripple effect, reverberating outward into the masses and spreading the good vibes like wildfire.

However, if you’re feeling lonely and unloved, showing kindness to others is often a stretch; in fact, it can be nearly impossible to do so with any amount of sincerity.

“We have all heard the adage that ‘you can’t love anyone else if you don’t love yourself first,’ and this is 100% true,” says Marla B. Cohen, PsyD. “When we are not practicing self-love, we may begin to see ourselves as unlovable and unworthy of the love and kindnesses shown by others.  This can lead to a sense of distrust with other people and a tendency to devalue others and reject some of the kindness and care coming our way.”

An important component of this practice, Cohen adds, is acknowledging that imperfections and mistakes are a part of being human. “When we are judgmental and critical of ourselves, and when we saddle ourselves with unrealistic expectations and unending obligations, we become dependent on others around us to help, heal, or save us.  As this is an impossible task, we inevitably become resentful of others, because no amount of love, concern, or assistance from another will feel adequate if we are in a constant state of self-criticism and self-imposed pressure.”

[fat_widget_right]Silencing the critical voices within can be a challenge, but it’s one worth taking on—and small acts of kindness toward ourselves can be incredibly transformative. “Self-kindness helps stop the constant flow of negative self-talk, criticism, judgment, and relentless pursuit of perfection that most of us have come to see as normal.

When we treat ourselves with kindness, compassion, and understanding, we feel worthy, nurtured, and secure.  When we provide ourselves with an unconditional environment of safety and security, we free ourselves up to take more risks in service of our potential.”

Simply put, the more gentle and forgiving we are with ourselves, the more likely it is that these positive vibrations will overflow into our interactions with those around us. “When we accept our own imperfections and limitations, we are much more able to have empathy for others’ shortcomings.  This helps us be more accepting and loving in all of our relationships,” says Cohen.

So if you’re feeling the need for a little therapeutic love boost, treat yourself to one—or all—of the following random acts of self-kindness:

1. Take a hot bath.

Soaking in a hot tub, preferably with Epsom salt and aromatherapy oils, can do wonders for sore muscles and a worn-out spirit. Light a candle and turn on some relaxing music to add to the experience.

2. Go for a walk.

Ideally, this will be in a favorite park or neighborhood. But it could be as simple as a walk around the block. Moving your legs, breathing the outside air, and taking in the sights and sounds will naturally increase blood flow and endorphins, thereby warming your body and bettering your mood.

3. Buy a special treat.

What makes you smile? Candles, jewelry, a good book, a trinket from an antique or thrift store, a bar of chocolate, flowers, a latte from a local coffee shop—there are so many small purchases that can make a big difference in how you feel, if only for a few moments. Cohen adds that it’s a good idea to keep the purchase around $20 or less to avoid buyer’s remorse. Whatever you choose, allow yourself to savor the indulgence.

4. Schedule a massage.

Touch is a powerful form of pain relief and endorphin release. Giving yourself permission to make an appointment with a massage therapist sends the message that you are worthy of tenderness, care, and relaxation. Your body, mind, and spirit will thank you.

5. Meditate.

Setting aside the time to simply be—for a few minutes or a few hours—tells your inner taskmaster to simmer down and be still. Using candles, soft music, dim lights, and comfy cushions during meditation will help to set the mood, and slow, rhythmic breathing will guide you into a relaxed state. You can incorporate a mantra or simply allow your mind to become empty, letting go of one nagging thought at a time until all that remains is the sound of your heart beating and breath going in and out.

6. Pick a card, any card.

Have you ever had a bad day and come home to find a card from a loved one in the mail? Knowing that someone is thinking good things about you can be an uplifting and powerful heart warmer, so imagine making that gesture of kindness for yourself. “I love to encourage my clients to go to a card store and buy themselves a loving card,” says Cohen. “It’s wonderful to write a note inside, honoring and appreciating yourself, and offering yourself encouragement.”

7. Decorate your personal space with positive messages and mantras.

Cohen encourages her clients to surround themselves with physical reminders of positive, encouraging messages. “In my office, I have painted rocks and notecards bearing messages such as ‘I matter,’ ‘I am worthy,’ ‘I will take time for me,’ and ‘I am enough,’” she says. “Keeping these kinds of messages around where you can see them regularly can really help the practice of self-care and kindness.”

8. Take yourself on a date.

The idea of going to a restaurant or a movie sans friends or a romantic partner may seem a bit daunting. But all it takes is one time to realize that the experience can actually be quite enjoyable. What restaurant do you typically only go to for special occasions? What type of food do you love to eat but never feel like making at home—or don’t know how? Is there a movie or a live show you’ve been wanting to see? Make a reservation, buy the tickets, and go solo. Bring a book to read if you can’t handle the thought of eating alone and without conversation. Your self will be immensely grateful for the gesture.

As a final thought, Cohen says, “I encourage people to consider all of the ways they show love and kindness to others, and then urge them to treat themselves with the same attention, consideration, nurturance, forgiveness, and respect.”

We all have many wounds. Broken hearts, shattered dreams, abuse, and trauma all leave battle scars that may not be outwardly apparent to others, but can cause a lifetime or even generations of experiencing the same issues, as patterns are often repeated and handed down as part of the family legacy.

The pain sustained throughout the years frequently leads us to develop defensive shields that serve to protect our vulnerable hearts from being wounded once again. And yet, this outer armor ends up not only closing us off from others, but also ultimately from the beauty and wonder of our own souls.

As a psychotherapist working from a depth perspective, I have been fascinated and privileged to have been able to witness the soul at work every day in my interactions with clients, as well as out in the world. The soul always strives to attain a state of wholeness or unity and seeks to reestablish harmony when an imbalance exists.

For example, I have frequently noticed that individuals with deep inner wounds often spend a lot of time engaged in outer pursuits in order to avoid looking within and facing the discomfort that they feel, yet at the same time they often experience a deep yearning for something more meaningful in their lives. If the gap between their inner and outer state becomes too painful to bear, they may finally feel compelled to explore their inner world through some type of creative endeavor, spiritual practice, or by entering into an empathic therapeutic relationship. This type of inner work can lead to an inner transformation that creates a more balanced perspective.

One of our fundamental needs as human beings is to be deeply heard and understood. When we experience pain in silence, we tend to feel cut off and separated from others and unable to enter into satisfying relationships. Unfortunately, as we grow up, we are taught that certain aspects of ourselves are unacceptable and unlovable, which in turn leads us to feel different from others.

We therefore start to reject those traits and identify only with the characteristics that are deemed pleasing to others in order to try to fit in. But deep down, we are aware of this inner conflict that is going on between our outer persona and our inner authentic being, which can lead us to feel unworthy of love and disconnected from ourselves and from others. In order to heal, we often require the presence of an empathic other to help us to examine more closely the inner dynamic that has been occurring.

Soul work involves shining a light inward in order to begin to integrate more and more aspects of our being that we have learned to repress. Individuals who have gone through trauma or abuse especially can end up with deep scars that lead to feelings of unworthiness, low self-esteem, and fear of true intimacy. They frequently learn to hide their true nature behind a false self as an adaptive measure designed to protect them from the trauma or abuse that they have suffered.

In so doing, they inhibit all of the characteristics that they believed to be unlovable or unwanted, but that actually make up a vital part of their essence. By turning their gaze inward, however, and exploring the aspects that they had originally rejected—often because they were deemed unacceptable or shameful—they can reconnect with their ability to love on a deep level and become more compassionate and understanding of others, as well as of themselves.

The Apaches have a legend that exemplifies this inner soul work. They believe that our spirits are born with us in the form of raw diamonds and that our goal in life is to obtain as many facets or cuts on our spiritual diamonds as possible. Each facet polishes the diamond and makes it shine a little more.

A new cut is formed every time we are faced with a problem or difficulty in our life and we use the opportunity to try to learn something new about ourselves. All of the struggles and suffering that we are faced with therefore become occasions for us to grow and fulfill our purpose for living. At death, the Apaches believe that our diamond spirit is returned to the Eye of God, to shine within the heavens for all of eternity. Each facet becomes another sparkle in the Eye of God.

In the same manner, I believe that turning our attention inward and doing our own soul work is our true purpose in life, which can lead us to experience a greater sense of wholeness and unity. By starting to look at the deeper patterns at work in the soul and how these are played out in our lives and in the world, we can begin to see our interconnectedness with all beings and things.

Each individual soul has a particular path to follow that intertwines with all of the others around it. By working to become more conscious of our own particular role and purpose in the world and how we relate to others, we can begin to heal from our sense of isolation as separate beings and come to feel that we are all truly connected on a deep soul level.

First, let me say that I admire your candor, your self-awareness, and your desire to work on this issue. I believe that all of these things will ultimately make you successful in addressing this issue and coming to a place of greater satisfaction in your life.

Jealousy is often a protective strategy fueled by more vulnerable feelings, such as worthlessness or feelings of inadequacy. No therapist can tell you exactly what the particular vulnerability is, but a skilled therapist can help guide you toward identifying and transforming whatever it might be in your case. Establishing a context for the origin of these feelings within the safety of a therapeutic relationship can help you to challenge the feelings and begin healing.

Healing the wounds of the past will likely foster a sense of confidence in your ability to make changes in your present life. For example, you specifically mention feeling jealous of colleagues. Are you satisfied and fulfilled by your work? My hunch is that you are not. If my hunch is correct, it makes sense to start thinking about what you want out of your work. Are you in the field you want to be in? Do you want to move up into a higher-level position? Do you want to explore options at a different company? Answering these questions and others that might arise may point you in a different direction professionally. It sounds like there is also significant dissatisfaction with your personal life. A similar assessment of what it is that you are seeking can be applied here, too.

As for Facebook, you are not alone in the experience you describe. In fact, a recent study indicates that the more young adults use Facebook, the more dissatisfied they become (Kross, Verduyn, Demiralp, Park, Lee, Lin, Shablack, Jonides, and Ybarra, 2013). It seems to me that people very often post the good stuff of life on Facebook. They share promotions, successes, home purchases, marriages, the births of children, and vacations. So, you can walk away feeling like everyone’s life is better than your own. But the truth is, no one’s life is perfect. Everyone has challenges, pain, and frustration—they just might not choose to share those things in a Facebook status.

Looking inward, healing old wounds, determining what you want, and creating a plan to get it can be very difficult work—I certainly don’t wish to imply that it is simple. Because it can be difficult, even painful, work that takes time, I do hope you will consider partnering with a therapist who can support you throughout the process. Collaborating with a therapist can also help you to explore ways to make yourself more comfortable as you seek to make changes in your life. You don’t have to wait until you accomplish your goals and dreams to be happy.

Reference:

Kross E, Verduyn P, Demiralp E, Park J, Lee DS, et al. (2013) Facebook Use Predicts Declines in Subjective Well-Being in Young Adults. PLoS ONE 8(8): e69841. doi:10.1371/journal.pone.0069841

All the best,
Sarah

Are you a “beaten dog”? Rest assured, I’m not calling anyone names here. But have you been kicked around, treated like nothing, and hurt? Do you not feel loved unless you are treated badly? This is what I mean when I say “beaten dog.” If you are offended, maybe some truth is staring you in the face. If you are not offended, I’m glad—and while this may not apply to you, perhaps it does apply to someone you know.

If it does apply to you and you can see how this role has affected your life, I want to apologize. No one should feel beaten, abused, and treated so poorly that he or she feels unworthy and believes life is cruel. I hope you seek help in breaking this mind-set and take hold of the reality that you ARE worthy!

Some questions you can ask yourself:

1. When someone is nice to me, do I question it? Do I question that the niceness is sincere?
2. When things are calm and smooth, do I need to throw a fit so that I can verify that I am loved via being yelled at?
3. Do I want or tend to take advantage of a person’s niceness because I believe I can?
4. Do I pick negative, hurtful people to be around?
5. Am I envious of others who are in healthy relationships?
6. Do I want a healthier relationship but believe I can’t have one?
7. Do I believe that this is how things will be for the rest of my life and that nothing—not even me—can change?

To change a self-belief statement or self-perception, admitting the need to change is a must. If you change for someone else, the change may not last long. Identifying how you respond to the above questions is key. Looking at ourselves can be a difficult and painful challenge, but it is where healing begins.

A self-belief statement can be defined as how you view who you are, how your “world” is, and how things (positive or negative) happen/happened to you. When someone is brought up in a negative, abusive, and painful environment, a negative self-belief is formed. The self-belief statement can be changed, but it can be difficult and takes time.

To change a negative self-belief statement:

1. Identify and be aware of your negative self-belief statement. As Dr. Phil says, you can’t change what you don’t acknowledge.
2. Self-examine your thoughts and mind-set, and take responsibility for why your belief statement is negative.
3. Acknowledge what you can and can’t change. Example: You can’t change what happened to you growing up, but you can change how you respond and whether the past controls you.
4. Grieve. You lost out on a healthier childhood, the unspoken expectation that the adults in your life would be there to help you grow. Let go of the pain. Mourn. Cry.
5. Forgive. It’s a hard thing to do. Forgiveness is for YOU, not for them. To lose the power that the past has over you, forgiveness is key. Forgive shortcomings, failures, pain, whatever. Let go. Forgive yourself for not being perfect. When you forgive, you’ll feel less weight on your shoulders and be able to move on a little easier. Forgiveness is a part of a cleansing process, allowing healing to begin.
6. Redefine yourself—who you want to be, how you want to be, the type of people you want to be around, etc. Your personality may not totally change, but you can choose to be happier, to not let the same roadblocks stand in your way, and to have healthier relationships. You can choose to be a person who is not going to allow yourself to be kicked around anymore. Find what is good in your life; maximize those things while minimizing your weaknesses.
7. Be at peace with yourself. Self-acceptance is a great accomplishment. No one can do this for you. When you love and accept you, other people will see that and be drawn to it. Self-acceptance allows your inner beauty to shine.

This is a process. It’s not always easy. Personal growth is not a straight journey. It has lumps, bumps, breaks, and is topsy-turvy. But if you are moving toward health, you will get there.

While not everyone’s experience is the same, when people have a major depressive episode, generally the world looks, feels, and is understood completely differently than before and after the episode. During a major depressive episode, the world can literally seem like a dark place. What was beautiful may look ugly, flat, or even sinister. The depressed person may believe loved ones, even their own children, are better off without them. Nothing seems comforting, pleasurable, or worth living for. There’s no apparent hope for things ever feeling better, and history is rewritten and experienced as confirmation that everything has always been miserable, and always will be.

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When this reality shift happens, it’s difficult to remember or believe what seemed normal before the episode. What the person believes during the episode seems absolutely real, and anything that conflicts with it is as unbelievable as a memory or message telling him or her that the sky is purple. For example, if the person is unable to feel love for a spouse, and someone reminds the person that he or she used to feel that love, the person may firmly believe he or she had been pretending to himself/herself and others—though at the time he or she really felt it. The person can’t remember feeling the love, and can’t feel it during the episode, and thus concludes he or she never felt it. The same process happens with happiness and pleasure. Attempts to tell the person that he or she used to be happy, and will feel happy again, can cause the person to feel more misunderstood and isolated because he or she is convinced it’s not true.

Even if nothing was wrong before the episode, everything seems wrong when it descends. Suddenly, no one seems loving or lovable. Everything is irritating. Work is boring and unbearable. Any activity takes many times more effort, as if every movement requires displacing quicksand to make it. What was challenging feels overwhelming; what was sad feels unbearable; what felt joyful feels pleasureless—or, at best, a fleeting drop of pleasure in an ocean of pain.

Major depression feels like intense pain that can’t be identified in any particular part of the body. The most (normally) pleasant and comforting touch can feel painful to the point of tears. People seem far away—on the other side of a glass bubble. No one seems to understand or care, and people seem insincere. Depression is utterly isolating.

There is terrible shame about the actions depression dictates, such as not accomplishing anything or snapping at people. Everything seems meaningless, including previous accomplishments and what had given life meaning. Anything that had given the person a sense of value or self-esteem vanishes. These assets or accomplishments no longer matter, no longer seem genuine, or are overshadowed by negative self-images. Anything that ever caused the person to feel shame, guilt, or regret grows to take up most of his or her psychic space. That and being in this state causes the person to feel irredeemably unlovable, and sure everyone has abandoned or will abandon him or her.

It’s difficult to describe all of this in a way that someone who’s never experienced it can make sense of it. I can’t emphasize enough that when this happens, what I am describing is absolutely the depressed person’s reality. When people try to get the person to look on the bright side, be grateful, change his or her thoughts, or meditate, or they minimize or try to disprove the person’s reality, they are very unlikely to succeed. Instead, they and the depressed person are likely to feel frustrated and alienated from one another. I do believe cognitive therapy has an important place, but generally not in the throes of a major depressive episode.

Support for People with Depression

So what does a person whose reality has shifted in this way need? Please keep in mind that I am talking about a major depressive episode—severe depression that has lasted more than two weeks. I would take a different approach for someone with milder depression, or one that is a response to a terrible loss.

For some people in a major depression, psychotropic medication works and is the only thing that works. The same could be said for electroshock treatment, though it’s not for everyone. Many people will emerge from major depression in time, though episodes seem to make more episodes more likely, so if medication works to end the episode, it’s usually prudent to take it. Nutrition, acupuncture, and other body-based treatments as well as therapy can help without the side effects of medication.

What Loved Ones Can Do

Loved ones can gently hold and show love and commitment to the depressed person, try not to take on the person’s reality, but also not argue with him or her about it. They can also gently remind the person that depression causes his or her perspective on everything to change, and he or she is unable to think outside of depression mode at the moment. It is a time for the person to avoid making decisions, or avoid doing anything significant that requires a nondepressed perspective. If this is a repeated experience for this person, it can be helpful to discuss all of this between episodes so he or she is more prepared when caught in the quicksand.

As someone who loves a person with depression, it can be emotionally difficult or stressful at times to support that person. It can be beneficial to focus on your own needs and self-care, and to reach out for help if you need it such as seeking the support of a counselor or therapist.

The uninvited house guest often stays on well beyond the point of “wearing out his or her welcome.” Likewise, for many people, chronic illness/disability is not a short-term inconvenience but rather a long-term, often permanent way of life. In the early stages of adaptation, the changes that happen in our lives and families may seem tolerable—at least while we still think there is a chance that the diagnosis is wrong or the cure is in the magic pipeline offered by big pharma.

Eventually, denial and bargaining give way to anger and depression. The uninvited guest is still ever-present, and no amount of cajoling or suggestions result in change. Bouts of anger may become a way of life for a while.

Anger
Many people flow in and out of anger and depression, rather than progressing neatly through one stage and into the next. It is often said that depression is anger turned inward, which makes expression of anger in a safe and effective way very important. Getting adequate support from formal and informal support networks is critical.

It is not unusual for tempers to flare and fuses to shorten during this period of adjustment. People who are typically long-suffering seem to be constantly on edge; those with fewer coping skills may be in a chronic state of agitation and irritability, if not outright rage. It often seems as if they are pushing away those who are closest to them at the time when they need them most.

Loved ones may unconsciously spend less time with the person who seems to find fault in their best efforts. Children are often left confused and afraid. Doctors and other providers frequently find themselves being blamed for their inability to help. This is all part of the process of adaptation.

While most people understand cognitively that their loved one is struggling and coping as well as can be expected, their own feelings of inadequacy and powerlessness may lead them to retreat on some level—if not physically, then emotionally. This often feels like abandonment to the person who is already overwhelmed by disability or illness. It is very important for caregivers and loved ones to be aware of their own feelings and find support.

Coping skills: Separate the person from the behavior. Try to remain aware of the real target for your anger—the illness or disability, not the person in your midst. Remember that we often treat those we love the most with the least respect; make amends as soon as possible if you do so. Give each other a break and extend the benefit of the doubt when possible. If your loved one treats you badly, remember that everyone is under extreme stress and doing the best they can at that moment. It is also good to remember that your caregivers and medical providers are probably not inadequate, but the resources they have to work with may be.

Caregivers and loved ones should speak up if they are being treated badly. Being sick is not an excuse to mistreat people, particularly if there is a pattern of abusive behavior developing. These behaviors need to be identified and discussed in a calm, loving way (not in the heat of the moment). This may require professional help, or perhaps the assistance of a minister or family friend who is not emotionally involved.

Most of the time, the person who lashes out or treats people badly feels guilty and needs the opportunity to make amends. For those who are unaware of how their behavior comes across, specific examples of the unacceptable behavior or hurtful/abusive language helps them develop a better awareness of their inappropriate behavior. In some cases, this is a manifestation of the illness or disability. In others, it may be the result of coping skills that are maxed out. Either way, left unattended, it usually gets worse. This is not the time to let conflicts and hurt feelings stack up. If you need help addressing these issues, ask your medical provider for a referral. Providers often have therapists or chaplains they work with who may be able to help.

Depression
Depression often occurs during the adaptation process, and may happen at other times or continue. Clinical depression can be very difficult to manage. It is more than sadness or disappointment; depression is a collection of symptoms that exist most days for two weeks or longer and create some level of impairment in daily functioning. The symptoms may include many of the following:

• sadness/tearfulness
• low energy or agitation/irritability
• loss of interest in things previously enjoyed
• problems with concentration/foggy thinking or trouble making decisions
• changes in sleep or eating patterns
• feelings of guilt or worthlessness
• thoughts of death or suicide/not wanting to live
• rumination/negative thinking
• others (physical pain, changes in motor skills, etc.)

If you or someone you know have four or more of these symptoms that are present for more days than not over a two-week period, talk to your medical provider about getting help.

There is also a type of depression called situational depression that is a normal reaction to a loss or change. Almost all people with chronic illness or disabilities and their loved ones experience this. The same symptoms are involved, but the symptoms may not be present most of the time, or may not be severe enough to impair your ability to function (relationships, work, taking care of your kids, etc.).

Situational depression can linger or become more serious after a while, becoming clinical depression. If the symptoms begin to impair functioning or last longer than a few weeks, it is wise to speak with a medical provider or therapist. People with situational depression are often able to experience periods of happiness when receiving good news, or other momentary reprieves from the darkness of depression. Those with clinical depression may be unable to experience even brief moments of relief when the situation calls for it.

The best treatment for depression is believed to be a combination of talk therapy, exercise (I know—it is very hard to exercise when you are depressed), a good diet, and medication, if deemed medically necessary. The right intervention for depression depends on which type of depression you are experiencing. For those with a few symptoms that are not present all the time, self-help may be sufficient. People with four or more symptoms that are present most of the time probably need to see a therapist and possibly a psychiatrist.

Anyone who is suicidal should seek professional help immediately. This national hotline is for people struggling with depression. The crisis line is staffed 24 hours a day by trained volunteers: 1-800-273-TALK.

Coping skills: I recommend that people talk with a therapist when dealing with situational depression and try to get as much activity in as possible. This may mean simply walking outside to get the mail, sitting on the porch for 20 minutes to have a cup of coffee or juice, watering the plants, or walking the dog. Sunshine is another natural remedy that increases vitamin D, which is often deficient in people who are depressed and those who do not go outside often. Eating properly is also critical, and there are natural supplements available at your local health store that may help with situational depression. Talk to your medical provider or therapist about these options.

Support groups and self-help groups can be very helpful. Groups provide a great resource for people living with chronic illness and disabilities and their loved ones. You can find online and local resources, and most are free. Many are affiliated with local hospitals or nonprofit agencies that serve people with chronic illness or disabilities.

If depression is serious enough to impair functioning, or you/your loved one has thoughts of suicide or not wanting to live, it is important to get professional help immediately. Start with your medical provider or therapist unless the person with depression has a plan to cause self-injury or death.

In situations where someone’s safety is at risk, call 911 or the local emergency number for your area, or take the suicidal person to the closest emergency room. Your role in the situation is not to intervene, but to get professionals involved as soon as possible. If the suicidal person is unwilling to go to the ER (or medical provider’s office during business hours) or you believe it may be unsafe to transport them, simply call for the emergency medical providers to come to you.

Don’t worry about the person who is suicidal being upset by your actions—when people are in crisis, they are usually not thinking clearly, so it becomes crucial for you to make good decisions on their behalf. The medical professionals who are trained to help in these situations will make the decisions once they arrive. This will likely mean that the person who is suicidal will be transported to the hospital for an evaluation, and may need to stay there for a few days until stabilized.

Again, it is not up to you to make that decision, only to make sure the person is safe until medical professionals can take over. It is a lot of responsibility and instills fear in most of us, but in the end, when your loved one is thinking rationally again, he or she will likely be grateful. If not, you will know that you have done what you needed to during the crisis.

Ongoing thoughts of suicide or not wanting to live need to be addressed with mental health and/or medical professionals regularly. Some states (Washington, Oregon, and Montana) permit medical professionals to participate in a well-thought-out, documented plan to end life (known as rational suicide), but most do not. Discussion of a patient’s end-of-life wishes should also be considered carefully and documented in a legal document for your specific state. Legal resources such as a living will specifically identify a person’s end-of-life wishes.

It is a good idea to talk about signing a consent form that allows you to discuss your loved one’s mental health (and physical) treatment with medical providers and therapists. This will enable you to enlist their help if depression becomes unmanageable or a crisis occurs. The consent can be relinquished at any time if the patient is considered to be of sound mind, and could be a great resource. Fortunately, resources are available to assist you in being prepared for a suicidal crisis should you need them.

There are many issues to be discussed regarding suicide, including family members’ thoughts and feelings about it. It is important to remember that euthanasia is against the law in all U.S. states, and assisted suicide with the help of a physician who prescribes a lethal cocktail after careful planning and documentation is legal only in Oregon, Washington and Montana. Legal professionals should be consulted if “rational suicide” is something you or a loved one is considering.

Adaptation
Using the analogy of the uninvited house guest, this is the period when people have settled into their routines and learned to live together with whatever adjustments are necessary. The initial period of adjustment after a disability or illness almost always requires going through each of the stages in the process outlined here. It can take a long time for some to arrive at adaptation, and not everyone in a family gets there at the same time. With some luck, a lot of support, good communication, and teamwork, the process will likely resolve in time for most people.

Unfortunately, surviving the initial period of adjustment does not ensure there will not be others. As mentioned earlier, people tend to get emotionally triggered when there are relapses or new symptoms/stages of the illness or disability occur. Triggering means that some reminder of the initial trauma (usually diagnosis or the actual accident or illness) sets off the same cascade of emotions experienced at the time of the original event.

Living in fear of a relapse or a change in physical status creates a certain amount of anxiety for everyone. The unpredictability of living with a chronic illness or disability will be the focus of our next article.

In the meantime, please share below how you have effectively coped with anger and depression.

Depression makes it difficult to function in daily life, but adding discrimination to the equation makes it even more troublesome.

A new study in the journal The Lancet stated that out of the 1,082 adult participants with major depressive disorder, 79% reported that they have experienced discrimination. People who experienced discrimination while depressed had more depressive episodes, social difficulties, and issues finding and keeping a job. They also were less likely to reveal a diagnosis of depression.

These results suggest that more works needs to be done in the area of preventing discrimination and eliminating stigma. Discrimination can prevent people with depression, who may be worried about disclosing their diagnosis, from getting the help they need. While getting a job and growing social networks can help fight depression symptoms, those pursuits become more challenging in the face of discrimination.

How, specifically, does discrimination affect people with depression? How can the general public be more understanding? And what options do people with depression have? Mental health experts and other professionals have some answers.

Dr. David Sack, CEO of Elements Behavioral Health and Promises Treatment Centers, said by email that sensitivity toward people with depression often is lacking.

“The most common example has to do with intolerance toward peers/friends/relatives that comes from not understanding that depression is a disease that the individual cannot simply will themselves out of,” he said.

Sack said a supervisor might question an employee’s motivation and commitment due to symptoms of depression, even if those symptoms don’t reflect how the employee really is.

“How often have we heard that this or that person claims that they are depressed just so they can get time off from work or won’t have to take responsibility for mistakes they’ve made?” Sack said.

Although many people know the basics of depression thanks to widespread awareness initiatives, prejudice, bias, and stigma still are rampant.

Viola Drancoli, a clinical psychologist, said in an email that friends and family members of people with depression might exhibit discriminatory behavior with them because they may feel drained from being around someone who expresses sadness, pessimism, irritability, and a lack of motivation.

This could push someone with depression into isolation. A person with depression might prefer being alone so he or she doesn’t have to attempt to hide feelings from others.

“The social isolation often starts a vicious cycle in which the (client’s) negative outlook on life is reaffirmed, they feel let down by family and friends, and symptoms may worsen,” Drancoli said. “This is especially dangerous for individuals who have suicidal ideations and need support and monitoring.”

Drancoli said it’s important for family and friends to be supportive. She suggests volunteering to help out with chores that might be difficult for someone with depression to complete when he or she is struggling to function, as well as patiently listening without judgment. Loved ones can gently encourage a person with depression to exercise as well, as this has been shown to boost mood.

People with depression who believe they have been discriminated against have the law on their side. Sack said that discrimination against people with any disabilities, including mental issues such as depression, is forbidden by the Americans with Disabilities Act. The civil rights law, enacted in 1990, defines disability as “a physical or mental impairment that substantially limits a major life activity.” Some states have additional laws against discriminatory behavior.

“An individual who is concerned about discrimination at work will want to speak with their supervisor or the director of human resources first,” Sack said. “Most companies have strong policies to promote fairness and nondiscrimination.”

Justine Lisser, a senior attorney advisor in the Office of Communications & Legislative Affairs at the U.S. Equal Employment Opportunity Commission, said by email that if an employer has at least 15 employees, it must abide by the ADA. Employers need to provide “reasonable accommodations” for people with disabilities, as long as the employer isn’t deeply burdened as a result.

“For example, if a person with depression is hired for a position that requires an 8 a.m. start time, but due to the effects of (antidepressant) medication the person could not start until 10 a.m., it would be a reasonable accommodation to permit the employee with depression to start at 10 a.m., assuming that it would not cause an undue hardship for the employer,” Lisser said.

The EEOC has successfully enforced employee discrimination laws in a few cases involving people with mental health issues. In one case, a sales associate at a video retailer experienced harassment because of his social anxiety disorder and depression. His employer was ordered to pay $70,000 to settle the discrimination suit, according to an EEOC press release from March 2012.

There are many parallels between living with a disability and dealing with an uninvited house guest. If you have ever had an uninvited house guest, I am sure you remember moments when things may have been uncertain and, at times, tense or uncomfortable. At the very least, having an uninvited guest requires some adjustments, much like living with a disability.

An uninvited guest may arrive unannounced, leaving no time to plan or prepare. Likewise, in many cases people living with disability have little or no time to plan for the many changes to come. While there may have been no way to prevent the disability and requisite life changes, having time to prepare—psychologically and literally—can make a huge difference in a person’s ability to adapt and cope.

A period of psychological adjustment is required for a person who has a disability, his or her spouse/partner, parents, and other family members. The adjustment process people frequently talk about resembles the grief process in many ways. Like the grief process, people often experience feelings in what seem to be stages. Similar to the grief process, this adaptation process usually begins with a period of denial.

Denial
In my work with couples and families living with multiple sclerosis, I often hear concerns that one person seems to be “stuck in denial.” To people who have moved through the initial denial stage, it may seem as if their loved one is not progressing as quickly as others. The truth is, different people work through this period of adjustment differently, and it takes as long as it takes. The denial stage usually happens at the time of diagnosis or disability, and may come up again at other times. For example, in a progressive illness, if one begins to lose mobility or other limitations arise, the initial stage of the adjustment process may be triggered again.

It may seem clear to a caregiver/partner or family member who has been helping someone walk even short distances that a mobility device is needed (cane, walker, scooter). For the person who is having mobility difficulty, admitting that it is time to talk to a doctor about a mobility device may affect his or her identity, hope for recovery, or future progress. If so, working through the denial and bargaining, and then later stages of adaptation, may be necessary. It is not unusual to see all members of the family triggered by new developments that start the process over.

Denial is believed to be a protective measure that prevents us from becoming emotionally overwhelmed. Denial slows down the process of coping with traumatic events, giving us more time to psychologically prepare ourselves for the onslaught of feelings. The process of denial, known as a defense mechanism, should not be rushed or sabotaged by well-meaning loved ones who are at a different place in the adaptation process. Doing so can cause the person who needs more time to become emotionally overwhelmed without the necessary skills to cope effectively.

Coping skills: A person with disability and his or her family members should try to be empathetic and understand things from the perspective of others. Be honest, but gentle, about your perceptions. Choose the time to discuss these issues carefully—not when either of you are tired, frustrated, or angry. Always talk to your loved one(s) before bringing up concerns with doctors or other professionals.  Caregivers and family members should keep in mind that their needs are important, too. Take care of yourself and make sure you have plenty of support. When children are involved, be very careful what and how you share information with them. Children need to hear things based on what is appropriate for their age and stage of development. Ask for guidance from a professional if you are unsure how much to tell children or how to talk to them about disability.

Bargaining
The stage that usually follows denial is bargaining. During this time, people often are looking for second opinions, alternative therapies, and other remedies. It can also be a time when we promise the gods that we will turn our lives around if given a second chance without the disability or diagnosis.

It is true that finding the best medical providers, keeping a positive outlook, and staying informed of new research and possibilities is important. However, this can also be a time when people are vulnerable to scams and false promises. Unfortunately, there are a lot of companies and people who offer products and services that guarantee outcomes without doing the necessary research required to back up those assurances.

It is a good idea to check out any new or experimental treatments carefully before trying them—particularly if there is a large commitment of money, resources, or time involved. Check with local and national nonprofit organizations that provide services to people with your specific issue or health challenge. Agencies such as the National MS Society, American Cancer Society, and others often have information about ancillary and alternative therapies. They may be able to send you information or answer your questions.

Coping skills: Make decisions together based on facts. Find local and national organizations that you trust to support you and provide well-researched information. Be sure that any second opinions or ancillary providers have access to all the information you have from other providers. In some cases, taking medications or treatment without being fully aware of how they interact with your other treatment can be life-threatening. Make a commitment to fully investigate any new or experimental treatments before deciding to try it. Ask for and check references when appropriate. Verify the credentials of all providers before visiting them. At some point, you may have to accept a new reality that you had not planned for and do not welcome. If you have prolonged difficulty coping with the diagnosis or prognosis, find support from a professional or support group to help you with the transition.

Over the next few months, I will explore additional aspects of disability, how it affects the lives and relationships of the people involved, and ways of coping with these situations. If you have ideas to share about how you have effectively coped with any of the situations presented, please join the discussion by leaving comments below. Likewise, if you have questions, feel free to ask for input from others who read the blog.