Depression is a mental illness in which many millions of Americans suffer from every year. According to depression statistics from the Centers for Disease Control and Prevention (CDC), about 9 percent of adult Americans have feelings of hopelessness, despondency, and/or guilt that generate a diagnosis of depression. At any given time, about 3 percent of adults have major depression, also known as major depressive disorder, a long-lasting and severe form of depression. In fact, major depression is the leading cause of disability for Americans between the ages of 15 and 44, according to the CDC.
Here at The Meadows, the majority of our patients may have this problem, along with addictions or other issues.
Traditionally, most family physicians and psychiatrists will prescribe antidepressant medication. Very often these medications will relieve some to most of the symptoms. All too often, however, many people re-experience their depressive symptoms after the medication dose is eventually decreased or stopped.
Then what? Well, they will probably end up taking antidepressant medication again.
Dr. Shelley Uram recent spoke to the Meadows campus about an additional approach to depression that has often been found to be quite helpful.
The underpinnings of many depressive episodes may rest on certain beliefs and expectations of ourselves and others that are not met. This perceived failure triggers negative emotions, which can ultimately lead to altered brain neurochemistry that can lead to another depression.
By "nipping in the bud" our deep false beliefs and their related expectations, the cycle of repeated depressive episodes may be decreased or stopped.
This was a very insightful presentation that helped the audience gain a better understanding of depression and the impact it has on our lives.
Dr. Shelley Uram is a Harvard trained, triple board-certified psychiatrist and a Distinguished Fellow of the American Academy of Child & Adolescent Psychiatry. She speaks around the country about how psychological trauma often interferes with our ability to thrive in life. She is best known for communicating very complex information in an interesting and easy to understand way.
Dr. Uram conducts patient lectures and provides ongoing training and consultation to the treatment staff at The Meadows. When she isn't working as a Senior Fellow, she's conducting workshops, lectures and seminars across the United States, Canada and the United Kingdom; or working as a Clinical Associate Professor of Psychiatry at The University of Arizona College of Medicine.
Dr. Uram has written numerous articles about psychological trauma and the brain and is currently writing a book on the subject.
At The Meadows treatment center in Arizona, our competent and compassionate clinicians and therapists specialize in treating not only the symptoms of depression, but also the underlying causes. We help patients heal and find freedom from debilitating depression, and learn the skills necessary to build and re-build fulfilling relationships. To learn more about our treatment of depression, click here.
To learn more about The Meadow’s innovative treatment program for depression, contact an Intake Coordinator at 800-244-4949 or use our online form.
By Cathy Kelley, LCSW, Counselor at The Meadows
John is a 64 year old male who retired early despite the cut in his income (now living at poverty level) and the loss of his medical coverage to avoid dealing with the distress of "having" to work with people he didn't get along with. Conflict with coworkers and bosses has been a theme throughout John's career. John has lived alone since his divorce 18 years ago and he has not dated anyone over the past 18 years. He spends most of his days sleeping. When awake, John listens to music or watches the television. John doesn't answer his door and limits his phone calls to his 90 year old mother who he continues to attempt to get approval from. If you listen to John he is very critical of himself (as was his father towards him) frequently calling himself stupid, dumb, fat, loser, or ugly. John often states that he "hates" people. John believes that life and people have taken advantage of him and that he is powerless to change the outcome because it is his "bad luck" in life. John's cholesterol and blood pressure are high. John buys in excess (more movies, music and model cars then he could see, hear or assemble in his lifetime). John denies that his hopelessness, isolation, excessive sleep, lack of energy, lack of motivation and loss of enjoyment in the things he used to enjoy could be symptoms of depression. Yet, John (who is a real person) truly needs help to get out of the abyss of his depression.
Needless to say, for John or anyone else for that matter to continue to live such an isolated, lonely and unhappy life with the belief that life is simply something that has to be tolerated would be a very sad outcome. John's struggle is but one of many examples why it makes sense for a person to enter treatment later in life. The fact is that growing older does not offer immunity to suffering and what greater loss then the loss of opportunity to have lived life with a sense of contentment over the journey versus pain, suffering and resentment over what was and was not experienced. As the saying goes "life is not a dress rehearsal." We get one shot at this life and do you really want to reach the end of your life filled with regret and remorse, knowing the opportunities to live life differently are gone? Or worse yet, do you want to throw away the opportunity to experience inner peace and healing because you are "too old?"
It is not easy dealing with all the age related issues of being an older adult. We often are faced with the illness and or death of our parents, friends or spouse. Our children are usually grown by this time living their own lives which can be joyful or distressing based on how well they are doing as adults and how much we depended on our role as a parent as part of our identity, purpose and value. We can be facing a number of health issues from fairly minor to life threatening. Careers are often winding down or ending. Retirement may not seem to be all it was cracked up to be. Again, if we have felt we found our purpose, identity and value through our careers it can be a set up to begin to feel worthless when our career is over. We become aware that time is limited and that we don't have forever to figure it out.
So, why would you consider entering treatment at this stage of life? When there is a never ending list of reasons you can come up with of why it's not a good idea to go inpatient such as you can't change, you're spending part of your kids' inheritance, this is as good as it gets, you have vacation plans, you want to sleep in your own bed, it's not that bad, your family depends on you to be there for them, or your just "too old" to name a few of the rationales often given.
The truth of the matter is no matter what age you are it takes courage to come into treatment and people typically do not make such a choice when their life is going in the direction they would like it to be going. It is far more likely to happen when everything you have tried is not working, there is a real possibility that you could lose your job, family, or friends, the pain of life continuing as is feels worse than the fear of entering treatment or the negative outcomes have become too high a price to continue to pay.
For the older population, what is known is that there are greater risks involved when you become sick or injured and that at any age emotional well being effects physical well being and vise versa. One example of this is that people are three times more likely to develop depression after a heart attack and that one in three people who have had a stroke develop depression. In addition, the depression increases the risk of a second heart attack or death from a heart attack or stroke. A second example of how our emotions and health are correlated is the impact that stress can have on the body. Research clearly shows that stress can create several medical problems i.e. raise blood pressure, suppress the immune system, produce muscle atrophy, elevate blood sugar, place excessive demands on the heart, increase the risk of heart attack and stroke, kill certain brain cells, speed up the aging process and shorten life spans. In addition, when stress is chronic it can even rewire the brain, leaving you more vulnerable to cancer, infection, diseases, ulcers, asthma, anxiety and depression.
The body in essence is attacking itself with the surge of biochemicals ( dopamine, epinephrine (also known as adrenaline), norepinephrine (noradrenaline), and cortisol (which can lead to bone loss, brain cell death and immunosuppression ) that stress activates. Unfortunately, the body does not distinguish between real and perceived danger. So whether you are running for your life or creating catastrophes in your mind your body is responding in the same way with a biochemical dump. Now add such things as alcohol, drugs, trauma, or grief, on top of anxiety or depression and it is fairly easy to see how your life can become seriously compromised.
If you have been struggling, there is a rhyme and reason to the obstacles that have been blocking your way to joy, peace and happiness. However, your life experiences do not define who you are but more what conclusions you have come to about yourself and life in response to what you have been told, witnessed or viscerally experienced. Your life experiences make sense out of the nonsense of how your thoughts and behaviors can become so off course with the facts or even self-sabotaging such as overspending, taking on too many projects, never saying no, having affairs etc. The truth (data) and your experience may not fit together such as being told as a child it's your fault your parent was unhappy or angry or that you were unplanned, a disappointment or worthless. The experience (what you heard, saw or felt) is real but the message is misguided (you are lovable, you have value and worth and you are perfectly imperfect - better known as human) and in all likelihood the messages and behaviors you experienced as a child were similar to the experiences your parents or caregivers received in their childhood. It is what is familiar and known and in all likelihood will continue into each new generation until there is additional information and options. Family systems typical will not know how to do it differently or that there are other ways of communicating, feeling, coping, loving or being relational with self or others without adequate data and though many of us have said "I will never..." we frequently find ourselves repeating the words or actions that we swore we would "never do."
Remember today you have a choice on the quality of your life experiences and whether you spend the rest of your life with joy and happiness or pain and suffering. It is never too late to reclaim your authentic self and to heal old wounds. None of us get a free pass from our history and time alone is not the healer of all wounds. It takes courage, desire and effort to interrupt old negative thoughts and behaviors, to identify the lies you may have told yourself about who you are and to reconnect and release painful experiences. However, it is much easier than living in the depths of despair, addiction and fear.
If you have taken on the role of judge and jury over the outcome of your life - Stop! Do not impose or accept a life sentence of suffering (this is based on a distorted belief of self and or life). Life was not designed to be endured it was designed to be embraced and you were not created to be tortured or to rescue the world. You were created to be uniquely you. You can continue to suffer until death (old message) or you can take a leap of faith in yourself and life (the truth) that your senior years have much more to offer than loneliness, regret, resentment or pain. You can find peace and healing if you are willing to embrace, explore, release and accept the truth of who you are in the presence of all you have experienced and what you have and have not done in your life. Age is not a viable reason to neglect your physical, spiritual and mental well being. It is the exact opposite.
Resources from the following websites: Mayo Clinic, University of Maryland, U.S. News Health
Cathy is a Licensed Clinical Social Worker in the state of California and Arizona. She has a Bachelor of Science degree in Human Services and a Master's Degree in Social Work with a sub-concentration in severe and persistent mental illness. Cathy has worked as a counselor at The Meadows for several years. Cathy's areas of experience and passion are trauma reduction work, addiction, mood disorders, and relational issues. Cathy has over twenty years' experience facilitating groups and has been trained in EMDR.
It is paradoxical, but the Christmas season, a time that should be filled with compassion, empathy and joy, is a time when many people are sad and depressed. This phenomena is so widespread that it has been named the Christmas (holiday) blues.
Ask any practicing psychotherapist and they will tell you that they see a disproportionate number of emotionally disturbed and/or depressed clients during the Christmas holidays than at any other time of the year. Since drinking and holiday cheer are so acceptable, alcoholics and other drug or food addicts tend to act out extensively during this season. I'll return to this last point in a moment.
No one knows when Jesus Christ was actually born. Traditions point to December the twenty-fifth, a time which corresponds to the onset of winter. No one knows why the celebration of Jesus' birth was early on enmeshed with pagan festivals of light, dealing with the onset of winter.
Winter is the season when days grow shorter and there is less sunshine. Winter is the season when darkness has it's dominant rule.
Sunlight is essential for both our physical and emotional health. In winter cold, dark dreary days are commonplace. The pagan festivals of light were intended to confront the darkness. In Christianity this combat was taken over by decorated Christmas trees and landscaped lawns with lighted trees. The lights and festive brightness symbolizes that Christ the Savior is the light of the world and has triumphed over the darkness of sin. Why then the Christmas Blues and depression?
The darkness itself and loss of sunlight is one reason given to explain larger numbers of depressed people during the winter months.
Another reason for the blues comes from the loss of our "magical childhoods". We gradually have to give up the magical belief that a wonderful caring old man with a sled full of toys will fuel the energy of eight tiny reindeer to fly over rooftops, and bring us toys.
The loss of "magical beliefs" is sad and we will also have to deal with the loss of other magical beliefs (like the fact that we will die and go to a wonderful place called Heaven). No one really knows anything about death or dying. As the years go by we experience suffering and the loss of loved ones; grandparents, parents, siblings and dear friends. We especially remember lost loved ones because Christmas is a time of love and joy. As grown-ups we cannot explain why nature natures (why hurricanes, droughts, tornadoes, tsunamis, floods) happen. Being an adult means leaving the magic of childhood.
If you grew up in a family where your parents were emotionally immature and childish, they could act out their suppressed rage, resentments and other unresolved wounds on each other or on other members of your extended family. I counseled people who dreaded seeing their in-laws and relatives at Christmas.
I mentioned earlier that alcoholics and other types of drug addicts act out during the Christmas holidays more than at other times of the year. If you are a child of an alcoholic (like myself) your memories of Christmas can be very painful. I can only think of one really happy Christmas during my childhood. We were also very poor, but I would have traded my toys any day for family peace, love and the absence of anxiety, shame and tension.
Like many children of alcoholics, I became a drinking alcoholic myself. I began binge drinking and having alcoholic "black outs" (periods of anmesia) at age sixteen. I can remember being drunk a large part of every Christmas season til I reached my bottom on Dec. 11, 1965. I spent eight days in the locked ward of Austin State hospital. I got out a few days before Christmas and enjoyed the most intimate time I had ever had with my family.
Sobering up during the holidays was great for me and my family. Many people thing of the Christmas holidays as the worst time to reach out for help; to do an intervention; or to go into treatment. In fact it is one of the best times. We can give our loved ones no greater Christmas gift than a sober recovering self. And for treatment centers that have family week, nothing can replace a family connecting (often) for the first time in an intimate embrace of support and love. Some of my most powerful memories are the "family week" at my former hospital in Ingleside California or at The Meadows where I am now. I encourage those of you who are using and/or depressed during the Christmas holidays to focus on the major source of your blues. The poet says "if winter comes, can spring be far behind?" You can recapture some of your magical childhood by letting your inner childlike self create new traditions and new family rituals. It's certainly okay to grieve for your deceased family members, just put some boundaries on your grieving. Life is so fragile and subject to fate and unexpected tragedy, don't let this time for celebration and love pass you by!
Clients frequently ask me if their mental and emotional struggles are a result of their genes or their environment. My answer is always the same - "yes". Of course, my simplistic response refers to the interaction between genes and environment that characterizes nearly all mental health conditions, but it clearly belies the centuries of debate on this fundamental and contentious topic. In recent decades, the Cartesian dualism that has traditionally dominated the nature-nurture debate has given way to scientific theories that describe complex, bi-directional relations between genes and environment. These theories of human development have also furthered our understanding of "neural plasticity" the exciting notion that our brains are more malleable and open to change than we once thought.
First, a brief historical regression may be helpful. In the early part of the twentieth century, psychoanalysis was the dominant perspective in psychology and its guardians were particularly keen on environmental influences. In fact, parents of the baby-boomer generation were likely told that schizophrenia was entirely caused by cold, unresponsive mothering (i.e., so-called "schizophrenigenic mothers"). Behaviorism, which rose to prominence in the early-to-middle part of the century, saw human development as a process of learning based on stimulus-response interactions between an organism and its environment. By the nineteen-sixties, the "cognitive-revolution", with its emphasis on internal mental states and the promise of neuroscience advances, largely eclipsed these theories, but still had relatively little to say about the role of genetics.
In the second half of the twentieth century, geneticists began conducting large twin and adoption studies and found that a number of psychiatric conditions showed evidence of genetic heritability. For example, studies showed that schizophrenia occurs in 1% of the general population, but this increases to 6% if a parent is affected and 48% if an identical twin is affected. Findings such as these clearly showed that genetics play a role in many forms of mental illness. However, by the end of the twentieth century, the pendulum had swung too far in the direction of genetic influence, with some researchers claiming that single genes could be wholly responsible for complex phenomena like depression, violence and even suicide (e.g., one research group claimed to have found "the suicide gene").
At the turn of the twenty-first century, genetic theories relying on simple one-to-one relations between a single gene and a psychiatric condition were supplanted by "diathesis-stress" models, which posited that genetic diatheses or "vulnerabilities" could interact with environmental stressors to produce deleterious outcomes. The most prominent study of this genre was published by Caspi et al. in 2002 and showed that the relation between childhood maltreatment and later-occurring antisocial behavior was much stronger for individuals who had the less efficient form of the MAOA gene (a gene that improves the function of nerve transmission in the brain). In other words, genetics alone didn't predict poor outcomes; it was the combination of a genetic predisposition and the stress of childhood maltreatment that led to an increase in antisocial behavior.
Although this particular gene-environment interaction has been replicated a number of times, some researchers have questioned whether the diathesis-stress model tells the whole story. In the last decade, researchers began noticing that when individuals with a genetic "vulnerability" experienced lower levels of environmental stress, they often fared better than those with individuals with the "favorable" form of the gene. For example, in the graph from the Caspi (2002) study (see above), under conditions of no childhood maltreatment, individuals with the "inefficient" form of the gene (red line) actually had lower levels of antisocial behavior than individuals with the "efficient" form of the gene (blue line). In the Caspi study, this difference wasn't statistically significant, but it raised questions about whether it could be a significant finding if studies were designed to see the phenomenon more clearly.
Jay Belsky, a professor of mine at the University of California at Davis, was one of the first to propose that particular genes (like MAOA) may confer risk or benefit, depending on the environment. Instead of thinking of certain genes as merely a liability, he argued that these genes might increase susceptibility to environmental conditions, "for better or for worse". Belsky and colleagues" theory of "Differential Susceptibility" is rooted in an evolutionary argument that, under circumstances where the future is uncertain, it makes sense to have some offspring that are less sensitive, and other offspring that are more sensitive, to environmental conditions. Like a well-diversified financial portfolio with some money in conservative, robust holdings and some money in high-risk stocks that can respond dramatically to market swings (too close to home for some of us), differential susceptibility posits that some people have a more "fixed" genetic makeup that is less vulnerable to environmental conditions, while others have a more plastic or malleable genetic makeup that is more susceptible to the environment, whether it be positive or negative.
Of course, this theory comes with the exciting possibility that reducing environmental stress (e.g., child maltreatment and relational trauma) may be particularly meaningful for individuals with genetic susceptibilities. In a study published in 2008, Bakermans-Kranenburg and her colleagues tested this hypothesis by investigating 157 families with toddlers who showed elevated levels of externalizing problems (e.g., hyperactivity, oppositional behavior, aggression, etc.) They found that their Positive Parenting and Sensitive Discipline intervention program was most effective in reducing externalizing behaviors in those children who had a version of the dopamine gene (DRD4) that has been linked to externalizing behavior and attention-deficit hyperactivity disorder. That is, children who would have traditionally been thought of as carrying a dopamine-related genetic "vulnerability" were in fact most responsive to the positive environmental changes associated with the parenting intervention program.
The results of this study, and many others like it, suggest that improving environmental conditions during childhood can drastically enhance developmental outcomes, especially for those children who are genetically susceptible to environmental influences. However, these findings might also apply to adults - especially considering recent research showing that the brain remains plastic or malleable well into adulthood. For adults with adverse life experiences who are recovering from conditions like depression, addiction, and post-traumatic stress, the genetic susceptibilities that previously contributed to their sensitivity to adverse environmental conditions may also facilitate their responsiveness to the positive changes associated with recovery treatment. In other words, by improving environmental conditions, what was once considered a vulnerability may actually become the very means for plasticity and growth.
As the Serenity Prayer suggests, it takes courage to improve our environmental conditions and there is much of our day-to-day circumstances that remains beyond our control. However, even when we cannot change our external environment, we can always alter our perspective of it. Approaching ourselves, our fellow beings, and the world with a greater measure of acceptance and compassion can literally change the subjective experience of our environment, and in many cases it can also lead to objective changes in the environment. This shift in perspective is bound to feed back into the biology of our being, perhaps most noticeably for those individuals who at one time may have been considered genetically vulnerable, but who might actually be predisposed to resiliency, especially if the right environmental conditions are established.
How many significant figures of history actually suffered with PTSD? We may never know. The diagnosis, now part of our collective 21st century lexicon, did not exist before 1980. Many historians point to the Civil War with the description of Soldier's Heart as the earliest attempt to describe emotional consequences of war. Jonathan Shay wrote about warriors from Greece who incurred the invisible injuries we now diagnose as PTSD. The earliest medical descriptions of PTSD started in the 1830s during the early era of railroads. Numerous collisions and explosions resulted in a condition called "Railway Spine", something akin to mild traumatic brain injury at first, but later described as a psychiatric condition consistent with PTSD.
Did Clara Barton suffer with PTSD? On the basis of Melinda Henninberg's article, (http://www.washingtonpost.com/lifestyle/magazine/clara-bartons-enemy-depression/2012/04/04/gIQAdryXzS_story.html), I would say it was quite likely. More importantly, what can we learn from Clara Barton's rather extraordinary life? I think there are many lessons applicable to modern observers:
Does growing up in a dysfunctional family better prepare you to survive during war, chaos and/or insanity? There is no absolute answer to this question, but a dysfunctional family may actually help you endure the unmanageable. No exotic constructs needed here; if you grew up having to dissociate to survive, you may simply have "more practice"- the equivalent of early military training. Conversely, some individuals are less prepared for chaos if they grew up in a "crazy" family. A lot depends upon context, types of stressors, etc.
My personal observation is that a dysfunctional family background may make you stronger during a crisis, but in the long term it might make recovery, or at least a balanced recovery, much more difficult. Early studies conducted at the University of Minnesota described a population of "invulnerable children". These were kids who grew up with schizophrenic and alcoholic parents but did not have overt problems as adults. In fact, many were highly adaptive and showed no signs of outward difficulty. When this population was studied more closely, researchers learned that outward coping masked many harsh consequences. They later gave up their quest and decided "invulnerable" was a flawed concept. On the flip side, growing up in a safe and nurturing family is no guarantee you will not develop harsh symptoms. We need to consider multiple variables- including frequency of exposure to trauma, intensity of the trauma, duration of the trauma and age of exposure. Invulnerability is a seductive illusion, but even those who look intact may endure severe suffering.
Clara Barton, the founder of the Red Cross, and her struggle with the "black snakes" of depression, illustrates the complex consequences of exposure to and immersion in trauma. While she lacked comprehension to describe the extent of her suffering, her self-described "depression" was insufficient in capturing the multiple and complex symptoms of what we would now call PTSD and co-occurring disorders. Ironically, Clara Barton"s symptoms propelled her into an excessive, perhaps addictive attraction to violence and war, providing her partial relief and affording comfort and relief to millions as well.
Jerry Boriskin, Ph.D, a Senior Fellow at The Meadows, has been at the forefront of the treatment of PTSD, addiction, and co-occurring disorders for more than 30 years. He is the author of several books, including PTSD and Addiction: A Practical Guide for Clinicians and Counselors and At Wit's End: What Families Need to Know When a Loved One is Diagnosed With Addiction and Mental Illness. For more information about Dr. Boriskin, please visit his website at http://www.jerryboriskin.com/.
For more about The Meadows'; innovative treatment program for PTSD and other disorders, see http://www.themeadows.com or call The Meadows at 800-244-4949.