MAY '09 - The Nyack Villager

Mental Health Notes
by Daniel Shaw, L.C.S.W
Depression
No, not the economic one—the
other kind. Depression, once an
illness that dared not speak its name,
is now familiar to most Americans.
It affects men and women, young
and old, and plenty of us. Depression
can be minor or major—that
is, less or more seriously afflicting. It can
come in a single episode, or it can be recurrent
or chronic.
Andrew Solomon, the brilliant author
of a comprehensive work on depression
entitled, e Noonday Demon,
described it as the aloneness within us
made manifest. “e only feeling left
in this loveless state,” Solomon wrote,
“is insignificance.” Another great
poet of depression, William Styron,
likened it to “darkness visible.”
To those who have not known clinical depression,
its powerful, poisonous grip can be hard
to understand. e depressed person, instead
of eliciting our compassion, can seem to just
want pity, who isn’t trying, who wants everyone
else to be as miserable as he is. ose who
love a depressed person are deserving of compassion
themselves; the depressed person is
often very hard to live with. He cannot feel
loved, no matter how sincerely and with how
much devotion others try to love him. He
clings to his loved ones, even as he pushes
them away. His self-loathing is often turned
on those who love him, who then feel the
brunt of his profound disappointment in himself,
his discouragement and self-contempt.
e more he hurts those who love him, the
more he sinks into shame, guilt and despair.
Depressed people need help but often are too
afraid, discouraged or ashamed to seek it.
ose who love them need to push, insist, or
demand, if need be, that they get help. Two
things help: medication and psychotherapy.
e SSRI medications (Selective Serotonin
Reuptake Inhibitors), such as Prozac and its
many successors, have been the most effective
medical treatment to date. With relatively few
side effects for most people, they have helped
relieve the worst symptoms of most kinds of
minor depression, and they are very often successful
in controlling recurrent major depression.
However, these medications
do not turn sorrow into joy—an
SSRI is not a panacea. Rather, they
help to diminish obsessive rumination.
For the depressed person, this
can mean that the compulsion to
obsess over an endless litany of cruel
judgments against himself can be
controlled and eventually even
stopped.
But habits of self-loathing run deep and have
not sprung out of thin air. e terrible
thoughts and feelings of the depressive have
meaning—and therapy is the means by which
the traumatic origins of depression can become
known. People typically think of “trauma” as
a terrible incident of some kind of violent assault.
But trauma can also be developmental.
Developing as a child in a family led by caregivers
who are ill—for example, with alcoholism
and other addictions, mental illness,
personality disorders and mood disorders—
can be a significantly traumatic experience.
For those who have grown up under these
conditions, where trauma is cumulative, and
rooted in childhood dependence on unstable
caregivers, the sense of utter, desolate aloneness
can become a lifelong, haunting presence,
like a curse one is helpless to dispel. Too
often, depressives blame only themselves for
their difficulties, not realizing that their upbringing
all but guaranteed they would eventually
fall prey to depression. erapy not
only illuminates the origins of depression, but
helps to create a path toward healing, growth
and change.
If you have healed your depression through
exercise, spirituality, service to others or meaningful,
inspiring work, or through a loving relationship—you
are among the lucky. If
you’ve tried it all and still suffer, seek the help
of a licensed mental health professional. It is
never too late to get help for depression, and
to claim the right to a life of meaning and
possibility—a life in which it is possible to
love and be loved.
Daniel Shaw, LCSW, practices psychotherapy in
Nyack and in New York City. He can be reached at
(845) 548-2561 in Nyack and in NY City at
(212) 581-6658, shawdan@aol.com or online at
www.danielshawlcsw.com ✫
22 The Nyack Villager May, 2009