Ask Betsy: How do we ever get over the loss of someone we care about

I’m not sure we ever get over the loss of someone who was special to us. We just stumble forward as best we can, hoping that the pain of their memory and loss of our time with them will soften over time. What has surprised me most about the losses in my life is that the loss of my black lab 25 years ago is the loss I feel most often. Alice was playful, happy, not-too-bright, but always loving, even when I left her home alone for long periods of time, or was too busy to play with her. 

I think in the end, time is the best healer. Time, and also finding a place in your heart to hold your fond memories of those you’ve lost. When I accidentally broke the hydraulic mechanism on one of my brother’s kitchen stools, he said “You HAD do do it! You coudn’t leave well enough alone, could you?” 

We both cracked up. I knew he didn’t care about the chair. He was making a joke out of it by channeling our deadmother’s voice. He did a flawless impression of her kind of response to an accident or dumb mistake. In that moment, I loved my brother and we both remembered our dead mother for the crazy shit she used to say to us. 

The picture above is me with my dad, his beloved Mini, and wife, Marcia. I miss the crazy shit he used to do, too!

Ask Betsy: How do I keep my depression from recurring

The greatest fear for most people who have suffered through and survived a long depressive illness is that it will recur.

And recurrences are common, especially if you have had 3 or more episodes.The reason is simple. Depressive symptoms are never completely forgotten. And because depression tends to last for weeks, months, or years, the symptoms of the illness become deeply-grooved and easily triggered ways of being.

Think about anything you do over and over. The more you repeat anything, the better you get at doing it. And whatever we get good at becomes easier to do the next time. And in the case of depression, once your brain has “practiced” being depressed for long enough, it takes less and less to trigger another depressive episode.

For example, my first episode of depression began with a series of migraines that made it impossible for me to sleep, feel emotionally-fragile and exhausted, and caused a dark mood that worsened as evening approached in anticipation of yet another sleepless night. The longer these symptoms lasted—which began in the winter, and during perimenopause (a hormonally-difficult time for many women)—the worse I felt. Within weeks, I was sure i had at least a brain tumor, and might also be suffering from some extreme gastrointestinal condition.

As far as I knew at the time, I wasn’t depressed. I was physically ill. I felt—and still feel when I get a rash of migraines—like I had a full-body flu. But after getting checked up one side and down the other, I got a diagnosis of clinical depression, which turned out to be exactly what was causing my symptoms. My first episode was brought on by a perfect storm: perimenopause (with its attendant hormonal instability), migraines (with all of its dirty rotten symptoms), and an exhausting period of care taking for a dying grandmother (which took a terrible toll on me emotionally and physically).

I eventually dug my way out of this episode, but it took two years of medication trials, steadfast support from friends and family, and a lot of physical and mental health therapy. Because I wasn’t just depressed, but had almost crippling anxiety, I was exhausted, but also wired. This meant that I was compelled to keep moving, to do everything I could to get better. I did yoga and tai chi. I walked twice a day. I forced myself to drink protein shakes so I wouldn’t lose more and more weight (which happened anyway), and I worked with my medical team to find a medication regimen I could tolerate.

My advice to you now—while you’re well—is to develop a plan to increase your mental and physical resilience, and weaken the neurological bonds that have been created to make depression easier to fall into. There are two programs designed to help you do this. One is called MBCT, which stands for Mindfulness-based Cognitive Therapy, which is an 8-week program that consists of 8, 2 hr. classes in yoga, meditation, and cognitive therapy designed to prevent depression relapse. The other is almost the same. It’s called MBSR—which stands for Mindfulness-based Stress Reduction—and it is virtually identical to the MBCT program, only without the cognitive therapy aspect. The link to this second program (actually created by Jon Kabat-Zinn as the first program like this) offers you a chance to take MBSR for free.

As one therapist who was diagnosed with a brain tumor once wrote: “Do it now! You don’t learn to meditate after you’re diagnosed with a brain turmor.”

The MBCT program has been scientifically-proven to reduce depression relapse by 50% in people who have suffered 3 or more episodes of clinical depression. No other treatment I know of (and I’m a highly-motivated therapist and fellow sufferer) gets the kind of results this program gets. It doesn’t require that you stop taking your meds—which I do NOT recommend you do either—but it does require daily practices that strengthen your mind and body’s abilities to maintain stability under fire. This means that even though your body will remember traumatic events, people, situations, seasons that have triggered dark episodes, you will be in a stronger place mentally and physically to challenge and replace depressive habits of thinking and reacting so that slight triggers do not cause you to slide back into the dark rabbit hole of depression.

I will warn you, though, the tools you learn in the 8-week course require daily practice, and that practice needs to continue between episodes, otherwise, you won’t be able to call on them when you need them. What you’re trying to do is weaken your tendency to slide into despair with the least provocation/memory of a depressive episode, and strengthen your ability to quickly catch a slip before it gathers steam and turns into a slide.

I also strongly recommend; that you NOT play games with medications that are working. I have on countless occasions decided that I no longer need the medications I’ve been on. This is especially true when I’ve been depression-free for years. And each time I have done this, I have eventually crashed. Don’t do it. The medications that work for you are helping. In fact, both cardiologists and neuroscientists will tell you that the worse thing for the heart and brain is untreated depression. There is evidence that the SSRIs (the most commonly-prescribed antidepressants) have been found to promote the growth of new neurons in the brain (neurogenesis), which is a great thing, especially since untreated depression can cause neurons in the brain to die, causing a shrinking of structures in the brain that regulate emotions and deal with stress.

I have just created a Facebook page called @counselorsgetit. It’s about supporting other therapists and professionals to remove the stigma surrounding mental illness by sharing out own experiences with it. This blog is my attempt to be a part of the solution. If you need help, ask for it. If you’ve made it through another nasty episode, now is the time to develop these skills.

Tricky Tuesday: How to communicate with someone who refuses to talk to you 

Today’s Tricky Tuesday is about breaking through the silence when someone you care about is unwilling or unable to talk to you.

First off, you must understand the distinction between those two states–Unwilling or unable. While the two may exist at the same time, they don’t necessarily.

You must understand the distinction between these two states—unwilling or unable. While the two may exist at the same time, they don’t necessarily.

Unwilling can mean many things:

  • I’m hiding something.
  • I’m afraid of your reaction.
  • I’m ashamed of something I did.
  • I’m stalling for time to come up with an alibi or excuse.
  • I’m showing you how it feels to be shut out.
  • I’m trying to guilt you into doing something you forgot to do, or don’t want to do.
  • I want you to suffer.
  • I’m trying to make you think I know more than I do about something you did (so you’ll confess).
  • I’m actually protecting you by not saying what I’d like to say right now.
  • I need to focus on another task or issue that can’t wait.
  • I refuse to talk about this with others present.
  • I don’t feel safe or equipped to talk about this topic, except in therapy.

Unable can mean something very different:

  • I’m over-stimulated right now and my brain isn’t working well enough to talk.
  • I’m not sure what I’m feeling because my body is flooded with multiple feelings at once.
  • I can’t find the right words.
  • I need more time to process what I’m feeling.
  • I can’t be pressured into talking.
  • I’m too tired.
  • I need to better-rested before we have this conversation.
  • You always interrupt me or tell me what I should be thinking or doing, so I can’t get my thoughts out.

The situation

Ben and Joel have adopted a child. Initially, they were thrilled, but for the past few days, something hasn’t felt right.  Ben came home from work Friday, agitated. He barely acknowledged Joel or the baby the entire weekend.

Before the baby came, the couple had agreed: Ben would keep working as a teacher, and Joel would take unpaid leave from work to stay home with their new baby. Then, once school was out, Ben would take over for the summer and Joel would go back to work.

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The silence was deafening.  Joel knew something was wrong, but Ben refused to talk and insisted everything was fine. The truth was, Ben had lost his temper with a student who made an offensive joke about gays.  Witnesses saw Ben chase the boy down the hall and shove him against a locker.  Ben was fired.

There is nothing unusual about this kind of problem. When shame takes over, it becomes painful–if not impossible—to speak about it.

The Talk to Me, Already!  card was designed to give the person who’s feeling shut out a way to connect with the person unwilling or unable to speak. It allows the Sender to express their hurt, anger, suspicions, or fears from a distance when the person in the room is unreceptive. Below is an example of screenshots I took an Express Yourself ECard Joel might have written to Ben. The remaining checklists (not visible on the first screenshot) give Joel a chance to express both his hurt and his love for Ben, as well as his desire to know the truth so he can be part of whatever solutionthey need to come up with as a couple.