Breakdown & Its Discontents

 

https://nam.edu/burnout-among-health-care-professionals-a-call-to-explore-and-address-this-underrecognized-threat-to-safe-high-quality-care/

https://www.psychologytoday.com/us/blog/in-therapy/200811/therapist-burnout

https://www.telegraph.co.uk/health-fitness/body/i-was-an-nhs-psychologist—but-i-suffered-from-depression/

https://pdfs.semanticscholar.org/beef/22b6f2644eb0a77b69b877ccca79440473ad.pdf

https://www.psychologytoday.com/us/blog/campus-confidential-coping-college/201604/depressed-psychologists

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3156844/

From burning bright to simply burned out

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Blooming Annihilation

April is the cruelest month, breeding

Lilacs out of the dead land, mixing

Memory and desire, stirring

Dull roots with spring rain. — T. S. Eliot (excerpt from The Waste Land)

For many unknown reasons, and for many speculative reasons, suicide rates tend to peak during the spring and early summer. Counterintuitive to most assumptions, winter is not the apex of self-inflicted obliteration, and a range of factors continue to be studied as to why this suicidal surge coincides with the blossoming seasons. According to the CDC, more than 41,000 suicides occurred in 2013 with roughly 51 percent of successful attempts facilitated by the use of firearms (most recent available data).*

Some plausible hypotheses for the spike in suicides during the flowering months include an increase in cytokine production (inflammation response molecules), a seasonal reduction in melatonin (an evolved physiological response to springtime), and the cumulative effects of an extended “winter’s nap” that leads to a significant decrease of vitamin D by the time March arrives. A combination of these factors may result in increased agitation that exacerbates any underlying mood disorder, but intervening variables and the nature of individual sensitivities make it empirically difficult to determine any statistically significant causation.

In The Waste Land, T. S. Eliot goes on to reminds us that “winter kept us warm, covering earth in forgetful snow” and how “summer surprised us.” One possible explanation for the rite of spring suicide trend might be the jarring effects incurred when transitioning from a state of relative hibernation to a state of full exposure to new weather conditions and altered social dynamics. The protective insulation of winter’s coat may allow those suffering from depression to avoid acknowledging how disconnected they are from the world until shifting temperatures thaw the landscape of frozen emotions to reveal a person’s most precarious vulnerabilities. Witnessing the exhilaration of others as they embrace a variety of unrestricted activities can also be invalidating to one’s sense of worth. Furthermore, environmental changes accompanied by warmer weather are an existential reminder of metamorphosis, inevitability, and the impermanence of experience. In other words, safety is an illusion and fluctuation is the sine qua non. Cold weather forces social proximity, whereas warmer weather causes dispersion. If a person is already feeling isolated during the winter, the intensity of abandonment may become overwhelming as their acquaintances leave the security of their cabins to resume more active lifestyles during sunlit intervals.

For those who suffer from ongoing suicide ideation or demonstrate a history of suicide attempts, proper assessment, de-escalation, and clinical stabilization is necessary. During therapeutic processing with clients presenting suicidal ideation, I have discovered three effective de-escalation techniques based on the Socratic dialogue that place conversational pressure on maladaptive cognition while illuminating behavioral discrepancies to disassemble the emotional atmosphere of desperation.

  1. Argument from irreversibility: One thing’s for certain, if a suicide attempt is successful, there is no way to change your mind. It’s not as if you can reflect on the critical moment and say to yourself, “If only I had waited another week, because I would have felt differently.” As the psychologist Daniel Gilbert reminds us concerning the unreliability of affective forecasting, no one can successfully predict how they will feel in the future or how their lives may transform in unexpected ways. Even a prosaic recreational distraction or transient change in perspective can make all the difference in circumventing the decision to embrace an incontrovertible ending. Remember, forever is a lot longer than your current disposition.
  2. Argument from personal appraisal: Most clients I have spoken with who have discussed suicidal thoughts often mention feelings of low self-worth. To establish a minimum foundation of self-worth is necessary, although not sufficient. Nonetheless, a tactic that I’ve employed is an argument from statistics and how the individual is “worth more than being a statistic of suicide.” Creating feelings of empowerment by further demystifying the dramatic lure of self-destructive behavior may close the trap door to endless descent. Keep in mind, this technique is not meant to minimize the lives of those who have committed suicide, but it challenges solution aversion for those who consider suicide an option while proposing a durable baseline of self-worth.
  3. Argument from modest gratification: Although anhedonia (the inability to experience pleasure) is commonplace among the symptoms of chronic depression, most individuals enjoy some pattern of daily interaction or some small sensory experience that would be unattainable without existence. For example, when accused that life must be pretty bleak and meaningless based on admitted philosophical inclinations, the American biologist James Watson cleverly replied, “But I’m anticipating having a good lunch.” Miniscule anticipations matter and we often take for granted how many of these ephemeral sensory experiences provide us with micro-meanings. In addition, if there is one object, activity, or person you care about, this capacity for future engagement should dissuade a commitment to macabre yearnings.

Being the recipient of life is more improbable than not having life at all; so in the springtime of our darkest hours, it behooves us to reconsider the brevity, importance, and fortuitousness of human phenomenology.

*For more information: https://www.afsp.org/understanding-suicide/facts-and-figures

Dedicated to the memory of Gerald Taylor Jr. (1978 — 2014)

Serviceable Despondency

Depression is a disorder of mood, so mysteriously painful and elusive in the way it becomes known to the selfto the mediating intellectas to verge close to being beyond description. William Styron

Behavioral norms and stereotypes often stigmatize or prematurely dismiss complex maladies such as depression. For example, mentioning depression in certain company can imply failure. The depressed individual may also be perceived as experiencing a lack of motivation, or possessing the inability to obtain a proper perspective on life’s vicissitudes. However, it’s the colloquial descriptions of depression (e.g., “having the blues”) that should not be confused with clinical depression, and clinical depression is not generally alleviated by blaming the victim.

Exploring the idea of there being an evolutionary advantage to depression could explain how, in some cases, the process of contemplative brooding can result in adaptive resolution. According to some speculations promulgated by evolutionary psychologists, the genetic proclivity for an individual to succumb to depression may indicate a type of (counterintuitive) selective advantage—theoretically described as the analytical rumination hypothesis (ARH). Keep in mind that most justification for the ARH model is based on the statistical prevalence of depression (Scientific American states that 30 to 50 percent of people have met current psychiatric criteria for Major Depressive Disorder at sometime during their lives). Perhaps depression can be seen as an ipso facto opportunity for the brain to adapt to misfortune, but not in a way that benefits the species as an overall evolutionary adaptation. After all, depression is a costly defense mechanism with disabling effects on one’s ability to function and survivenot to mention the potential consequences of suicidal behavior or substance abuse. Even if a protective impetus is initiated by the symptomatic nature of depression as an adaptive response (i.e., psychosocial “hibernation”), it would not be as adaptively useful as one’s ability to overcome depression. Since the empirical evidence for the efficacy of cognitive behavior therapy in treating depression is good, this suggests that neurological plasticity via salutogenic priming plays a significant role in reversing the pernicious effects of this disorder. In other words, the learned therapeutic skills one employs to battle depression may increase the likelihood of recognizing it’s emergence in the future. This reflective capacity may also reduce the potential of being victimized by severe depression later on if the experience of adaptively processing negative thought patterns is committed to episodic memory.

It should be noted that the causes of depression are as debated as the prescribed treatments. Furthermore, a combination of biological and environmental factors for depression are often equally involved in unquantifiable ratios. In fact, recent studies have shown that serotonin levels have less to do with depression’s actual effects as does the reduction in neurogenesis, changes in neuronal connections, relentless stress, long-term anxiety, and psychological disillusionment.

The phenomenology of depression has been the topic of many poems, books, paintings, musical compositions, and artistic endeavors. Michael Foucault, Ernest Hemingway, Ludwig Wittgenstein, and Sylvia Plath are just a few of the notable figures who have suffered from disillusion-based depression (sometimes described as intellectual depression). William Styron’s Darkness Visible: A Memoir of Madness is filled with caliginous metaphorical allusions attempting to describe the visceral experience of Major Depressive Disorder. Similarly, the British biologist Lewis Wolpert vividly recounts his bout with depression in a partly autobiographical and scientifically informative investigation entitled Malignant Sadness: The Anatomy of Depression.

Counteracting the effects of depression requires a comprehensive therapeutic approach with additional pharmacological intervention when necessary. The important thing to remember is that depression is a complicated abnormality and no two individuals will necessarily respond to treatment in predictable ways. The more we learn about depression, the more we may discover the brain’s capacity for developing resilience in the wake of adversity.

(This article originally appeared as Depression: A Silver Lining? in the NPI newsletter, Summer edition, 2012).