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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by g_g_g_unit on February 13, 2012, at 6:21:10
How do you not hate others for being alive (figuratively speaking), active, well?
How do you not hate yourself for failing to live up to your standards? How do you not blame yourself for everything that's been lost? How do you learn to forgive yourself?
How do you maintain your dignity without falling into either isolation and bitterness or dependency on others?
Posted by SLS on February 13, 2012, at 8:22:48
In reply to depressive emotions, posted by g_g_g_unit on February 13, 2012, at 6:21:10
> How do you not hate others for being alive (figuratively speaking), active, well?
>
> How do you not hate yourself for failing to live up to your standards? How do you not blame yourself for everything that's been lost? How do you learn to forgive yourself?
>
> How do you maintain your dignity without falling into either isolation and bitterness or dependency on others?
You asked all of the right questions with precision.Have you thought to engage in psychotherapy and ask the therapist those exact same questions?
CBT is a valuable tool. However, you first have to be convinced that your thoughts are distorted and influenced by the biological depressive state. However, some of the issues you have are probably best treated using some kind of interpersonal therapy. Many of your negative thoughts are actually based in reality. It is quite human to think and feel the way you do regarding the effects that depression has had on your life. It is not fair, and you really do deserve to be without this hideous disease.
These are normal human reactions to your very real plight in life:
- hate others for being alive
- hate yourself for failing
- live up to your standards
- blame yourself for everything that's been lost
- isolation
- bitterness
- dependency on othersIt will be good to talk things out. I think you can make progress with these issues.
I can't really describe in depth how I deal with these issues for myself. I would have to really think, and it would take too long. It becomes second nature as a habit - CBT. I have been, for the most part, successful. However, depression is an insidious and unyielding beast that must be battled every moment. Quite often, the beast beats me. Sometimes, not. I very rarely feel like actually win, though.
- Scott
Posted by Phillipa on February 13, 2012, at 9:57:12
In reply to Re: depressive emotions » g_g_g_unit, posted by SLS on February 13, 2012, at 8:22:48
Scott very well said. Phillipa
Posted by bleauberry on February 13, 2012, at 12:00:03
In reply to depressive emotions, posted by g_g_g_unit on February 13, 2012, at 6:21:10
Well this probably isn't the answer you were looking for and probably belongs in a different category than meds, but all of your questions can be answered with one word. Jesus. Learn more about Him and those questions you asked will begin to melt away into insignificance.
Keep in mind too that those kinds of questions are telltale signs of a depressed person. If you were not depressed today, those issues you asked about would look like hills rather than mountains. Things are always blown grossly out of proportion when depressed.
Jesus loves you and gave his physical life for you that you may never have to ask those questions, so make his sacrifice count.
Posted by sigismund on February 13, 2012, at 12:12:34
In reply to depressive emotions, posted by g_g_g_unit on February 13, 2012, at 6:21:10
>How do you not hate others for being alive (figuratively speaking), active, well?
That is called envy. How do you avoid it? It's a big question.
>How do you not hate yourself for failing to live up to your standards?I care less about my standards now than I did once. Maybe by learning acceptance?
>How do you not blame yourself for everything that's been lost? How do you learn to forgive yourself?There are a lot of words that start with 'for' that are interesting words....forbearance, forgiveness. By learning some sympathy for the situation you are in, rather than the ways in which you fall short? This is what the Christian Communion service emphasises.
>How do you maintain your dignity without falling into either isolation and bitterness or dependency on others?I think I understand the dependency you mean, but we are all somewhat dependent. Maybe youth is associated with a big gap between aspiration and reality? Find steps you can (enjoyably?) take, rather than concentrating on those steps that are beyond you.
Posted by sigismund on February 13, 2012, at 12:58:27
In reply to Re: depressive emotions » g_g_g_unit, posted by sigismund on February 13, 2012, at 12:12:34
For example, I imagine you do not get any pleasure out of how nice you look. But you will, when you see the photos in 50 years time.
Posted by phidippus on February 13, 2012, at 15:08:25
In reply to depressive emotions, posted by g_g_g_unit on February 13, 2012, at 6:21:10
>How do you not hate others for being alive >(figuratively speaking), active, well?
Everybody has a dark secret. It is naive to assume others are as well as they seem.
>How do you not hate yourself for failing to live >up to your standards?
I'm always doing the best I can. I guess I have no standards.
>How do you not blame yourself for everything >that's been lost?
Loss is a part of life. How can I blame myself for natural law?
>How do you learn to forgive yourself?
Do I need to forgive myself?
>How do you maintain your dignity without falling >into either isolation and bitterness or >dependency on others?
It all depends on how you want to see yourself.
Eric
Posted by Phillipa on February 13, 2012, at 20:30:05
In reply to Re: depressive emotions, posted by sigismund on February 13, 2012, at 12:58:27
Oh how true!!!!
Posted by Raisinb on February 14, 2012, at 11:23:17
In reply to depressive emotions, posted by g_g_g_unit on February 13, 2012, at 6:21:10
I agree with others: this is a case for therapy. These are existential issues that even non-depressed humans deal with. They should be worked with. Personally I'm not a big fan of CBT; it always seemed like a band aid (when I need major surgery), but it helps many. The research says that whatever a therapist's orientation, the empathic steady relationship will help.
Religion does help many people. It is a light in the darkness, and again, research bears this out. However, if you don't believe it, you don't, and you can't make yourself. I used to believe in god, and now I am an atheist and I can't imagine going back. I simply do not believe in it anymore. I admire faith, but I see it as just another small human attempt to control and predict a chaos that just can't be controlled or predicted. That said, if religion is something that works for *you* then grab onto it with both hands.
Your post seemed to ask: how do I not feel these things that are painful to me, conflict with how I think I should be, and make me hate myself? It is different for everybody, speaking personally, I don't think you do make yourself stop. I think it makes it worse to try. I think you do everything you can to live through it, including therapy, exercise, meditation, church, kickboxing, or whatever else there is.
Again, I am speaking personally, and this may sound flip: you have to accept that it's gonna hurt. You will feel these things. There might not be answers. You live through it anyway. After about 20 years of mental illness, that is what I have come to.
Posted by SLS on February 14, 2012, at 14:06:35
In reply to Re: depressive emotions, posted by Raisinb on February 14, 2012, at 11:23:17
> Personally I'm not a big fan of CBT; it always seemed like a band aid...
How much time did you give CBT without obtaining results before you discontinued it?
I think that a top-down approach to psychotherapy like CBT is a good tool, and almost always helpful. However, it is probably not terribly effective to treat dysfunctional psychodynamics that run deep in the psyche. Both CBT and psychodynamic therapy can be coadministered. I like to think that CBT can help stabilize someone's thoughts and emotions when exercised on a daily basis while the problematic psychodynamics are being addressed using a bottom-up psychotherapy.
One of our posters had made an argument as to why CBT can actually hurt more than it can help in certain situations. I think it was Violet.
- Scott
Posted by raisinb on February 14, 2012, at 14:47:22
In reply to Re: depressive emotions » Raisinb, posted by SLS on February 14, 2012, at 14:06:35
Sounds like I'd make the same point as Violet. I think CBT can actually exacerbate certain issues, rather than helping. Certainly that's the case for me.
I've tried it various times for various lengths of time and always come to the conclusion it isn't for me. It's too simplistic, for one; my brain doesn't respect the "identify problematic thinking patterns and fix them" approach. That's partly intellectual snobbery. I've spent years analyzing and fighting with my thoughts and emotions; I dreamed up the main tenets of CBT and a million variations before I even heard of it. None of it ever changed how I felt, and frankly, I think it's dangerous for severely depressed people to suggest that merely changing your thoughts will help you. Telling a person who already believes that she's deeply damaged and thus always wrong and unable to trust herself that her problems are because she is "faulty" in her thinking is not *wrong* per se; it's simply unhelpful because it exacerbates her deeper issues. Telling her to fix her faulty thinking puts her in an extremely unhelpful, endless, crazy-making struggle against herself.
This is where Marsha Linehan is a freaking genius. She realized all this, altered CBT to DBT, a system that can accept ambiguity, paradoxical versions of truth, and validates the patient while moving her towards change. Keep in mind, this is aimed towards people who have borderline-type issues (which I certainly do, even if I don't qualify for the personality disorder dx). She says in the beginning that there was a whole group of patients that she dutifully applied CBT to, and it just didn't work.
Posted by sigismund on February 14, 2012, at 17:37:06
In reply to Re: depressive emotions, posted by Raisinb on February 14, 2012, at 11:23:17
Freud seemed to be saying that we could give up the fanatasy of a life without inner conflict.
At one point he said to a patient
'I do not doubt that it would be easier for fate to take away your suffering than it would be for me. But you will see for yourself how much has been gained if we succeed in turning your hysterical misery into common unhappiness. Having restored your inner life, you will be better able to arm yourself against that unhappiness.'And in a book
'I have not the courage to rise up before my fellow men as a prophet, and I bow to their reproach that I can offer them no consolation.'
That kind of thinking is very attractive to me.
Posted by SLS on February 15, 2012, at 7:02:21
In reply to Re: depressive emotions, posted by raisinb on February 14, 2012, at 14:47:22
> I think it's dangerous for severely depressed people to suggest that merely changing your thoughts will help you.
CBT is much more sophisticated than that, as you know, if practiced fully and with guidance. The goal is to discover and change core beliefs.
Top-down paradigm:
- Cognitive distortions
- Intermediate beliefs
- Core beliefsCBT helped me and did not make things worse. Perhaps I am an exception. I doubt it though. I watched a great many depressed people profit from CBT when I was a patient at a partial hospitalization program.
In my way of thinking, CBT is not a replacement for other forms of "talk-therapy". Unfortunately, very little work of any sort can be accomplished when someone is severely depressed. Maybe your "band-aid" metaphor is appropriate in these cases. When my depression is untreated and at its most severe, my mind is frightenlingly inactive and simply does not function well enough to operate at levels so deep. I think CBT might help people who are severely depressed precisely because it does not need such sophistication of thought in order to be productive. Maybe we are talking about two different types of depression.
> Telling a person who already believes that she's deeply damaged
and thus always wrong and unable to trust herself that her problems are because she is "faulty" in her thinking is not *wrong* per se; it's simply unhelpful because it exacerbates her deeper issues.How exactly does telling someone that their core issues can be addressed exacerbate deeper issues? My CBT facilitators never called our thinking as being wrong so much as distorted by depression. It was not our fault. It sounds to me like the approach that you were subject to was unnecessarily harsh and counterproductive. I like Aaron Beck's methods more than those of Albert Ellis.
> Telling her to fix her faulty thinking puts her in an extremely unhelpful, endless, crazy-making struggle against herself.
This is not how I experience CBT. I was never made crazy. It never seemed like a struggle so much as a new habit to exercise. I have never been told that a lack of success was a personal failure. Just trying is a success.
DBT sounds good to me.
- Scott
Posted by Raisinb on February 15, 2012, at 9:03:31
In reply to Re: depressive emotions » raisinb, posted by SLS on February 15, 2012, at 7:02:21
Scott--
Yes, I didn't mean to suggest that CBT was *inherently* any of those negative things--it is indeed *meant* to be helpful. The problem comes when some of its core assumptions--again, not wrong or invalid--have a bad interaction with a person's core issues. For me, it is simply the absolute wrong intervention. For many, it is life saving.
Posted by SLS on February 15, 2012, at 10:36:21
In reply to Re: depressive emotions, posted by Raisinb on February 15, 2012, at 9:03:31
> Scott--
> Yes, I didn't mean to suggest that CBT was *inherently* any of those negative things--it is indeed *meant* to be helpful. The problem comes when some of its core assumptions--again, not wrong or invalid--have a bad interaction with a person's core issues. For me, it is simply the absolute wrong intervention. For many, it is life saving.I appreciate your posting this stuff. I found it very informative and thought-provoking.
- Scott
Posted by jono_in_adelaide on February 15, 2012, at 17:03:47
In reply to Re: depressive emotions » Raisinb, posted by SLS on February 15, 2012, at 10:36:21
Very good and perceptive questions GGG
can I suggest a course of CBT with a skilled psychotherapist?
How are you going with your meds? Whats your current combo?
Best of luck
Jon
Posted by g_g_g_unit on February 15, 2012, at 19:47:53
In reply to depressive emotions, posted by g_g_g_unit on February 13, 2012, at 6:21:10
Thank you for all of your responses. I really appreciate not being denigrated. Sometimes illness can give rise to ugly, shameful emotions and it's reassuring to be able to share them here.
For the record, I'm currently doing both CBT (with an OCD specialist) as well as psychotherapy (with my psychiatrist).
I've found my psychiatrist's approach to all of this marginally confusing. His conviction is that the only escape route from shame (as opposed to guilt) is to maximize your functioning, to "emulate those you envy".
But what if emulation is beyond your current capabilities? I said that I appreciate his encouragement, but, without wanting to insult him, the thought that I might regain any functionality is a distant fantasy, if the last 3 and a half years of depression (not to mention OCD, ADHD) are anything to go by.
What if there really is no hope? Shouldn't it be his job to counsel me and temper my expectations? Maybe, as a result of illness, medication, I'll never reach the standards or goals I set for myself, or live the life I might have been capable of without illness. In that case, if the only escape from shame is achievement, then how do you ever learn to forgive or appreciate yourself?
I likewise found CBT's approach to this unhelpful. It was suggested I seek out alternative sources of self-worth - e.g. as a family member. But really, that just encourages the kind of dependency I'm so wary of. Being some rag-doll who exists for others doesn't fill the void. There's nearly nothing I'm able to achieve on a day-by-day basis that aligns with my self-interests. I feel like a shell.
And to answer Jono's question, I'm currently taking Parnate.
Posted by papillon2 on February 16, 2012, at 7:55:33
In reply to Re: depressive emotions, posted by g_g_g_unit on February 15, 2012, at 19:47:53
CBT and DBT have taught me skills that enable me to cope with depression, but they're never going to be (anywhere near) cure-alls. Just another tool in my arsenal.
I do however agree with Raisinb about CBT not always being a good thing (or, for that matter, any type of psychotherapy other than 'supportive'). CBT is very good when you're dealing with a thought that is inaccurate. You can unpack the thought, look for evidence, re-evaluate your situation and greatly lessen the intensity of related feelings, provided you don't start berating yourself for having an incorrect thought, aka "why the hell are you thinking this way you f*cking loser". When your thought is accurate, however, closer examination only serves to make you more painfully aware of just how hopeless and helpless your situation is. This is NOT a good thing. Hopeless + helpless = suicidal.
And again, that's where DBT comes in: teaching you how to sit with and tolerate horrible thoughts and feelings, all without judging yourself. Things may indeed be hopeless and helpless, but you can put up with it for a minute at a time without hurting yourself.
One might say that CBT lightens your load, while DBT strengthens your muscles. Either way, your depression becomes easier to carry.
On a related note, I think that doctors should be more aware of the side effects and risks of psychotherapy and be made to counsel patients accordingly. Just like pharmacotherapy, psychotherapy can worsen depression and cause other emotional problems or trauma, especially in the short-term. Few people like to admit this.
Posted by g_g_g_unit on February 16, 2012, at 22:35:58
In reply to Re: depressive emotions, posted by papillon2 on February 16, 2012, at 7:55:33
When your thought is accurate, however, closer examination only serves to make you more painfully aware of just how hopeless and helpless your situation is. This is NOT a good thing. Hopeless + helpless = suicidal.
>
> And again, that's where DBT comes in: teaching you how to sit with and tolerate horrible thoughts and feelings, all without judging yourself. Things may indeed be hopeless and helpless, but you can put up with it for a minute at a time without hurting yourself.
>Hmm, this is true. I've noticed that, in undergoing ERP for OCD, my therapist is less likely to reassure me. For example, I said I often get the (intrusive) thought that "I'm a loser" and she said, "Well, you could be .. it's a real possibility after all".
I know that sounds callous, but I think the point is that we can't protect ourselves against every possibility. Maybe she was viewing it as an OCD thought - as opposed to a core belief - which explains her approach.
But would that kind of exposure to a possibility be more in line with DBT than CBT, which might try to examine why one is/isn't a loser?
Posted by g_g_g_unit on February 16, 2012, at 22:40:22
In reply to Re: depressive emotions » papillon2, posted by g_g_g_unit on February 16, 2012, at 22:35:58
I guess I found it quite jarring, like I wanted to be told I'm not a loser.
But I also know that reality is harsh, and that sometimes it feels like therapy sugarcoats things. I mean, I don't believe I'm a loser, but I do, for example, feel like I'm less interesting, charismatic etc. when medicated. I've even been told so. Facing up to these things sucks, but sometimes it's easier than trying to find evidence otherwise.
Posted by Raisinb on February 16, 2012, at 23:24:07
In reply to Re: depressive emotions » papillon2, posted by g_g_g_unit on February 16, 2012, at 22:35:58
DBT does prescribe exposure sometimes, I think, but it's not the main point. DBT would teach you to balance acceptance and change, so instead of "I'm a loser" vs.,"I am not a loser," you might try to get to a more helpful synthesis, like, "I am trying the best that I can and I cant really do anything more," AND "I need to do better anyway." The goal might be to tolerate the paradox/uncertainty, as that is how life is, really. DBT isn't too interested in what is "true," absolutely--more, "what is being left out of this perspective?"
I'm probably not explaining it too clearly. It's based on dialectics (think Marx) and eastern mindfulness perspectives. Linehan's Cognitive Behavioral Theraoy for Borderline Peersonality Disorder is a great book.
Posted by papillon2 on February 17, 2012, at 1:31:33
In reply to Re: depressive emotions, posted by Raisinb on February 16, 2012, at 23:24:07
CBT does that too, though. A typical CBT worksheet using your example of "I'm a loser" might be:
1. How strongly do you believe this thought?
2. How does this make you feel? How strong are these feelings?
2. What is the evidence for this thought? How strong is this evidence?
3. What is the evidence against thought? How strong is this evidence?
4. How strongly do you now believe this thought?
5. How do you feel now? How strong are those feelings?The above is heavily bastardized, but you get the idea.
In the end, you might decide that you aren't really a loser, or maybe you're not as much of a loser as you initially thought you were. You might go on to doing some problem solving on some of the things you have used as evidence that you are a loser, or you might undertake experiments (exposure work) to test your theory that you are a loser.
Posted by SLS on February 17, 2012, at 6:58:04
In reply to Re: depressive emotions » papillon2, posted by g_g_g_unit on February 16, 2012, at 22:35:58
> When your thought is accurate, however, closer examination only serves to make you more painfully aware of just how hopeless and helpless your situation is. This is NOT a good thing.
Hopelessness and helplessness are learned responses. They might not reflect the whole of reality. One can remain constructive and hopeful while they look for alternatives in life. If none exist, then there might be alternative ways to deal with a lack of alternatives. However, if someone is functioning well within a milieu of denial, it might be best to just leave them alone.
I have been in such places. The only thing is, God never came down and told me that there was no hope for me. I probably wouldn't have believed him, anyway. :-)
- Scott
Posted by Phillipa on February 17, 2012, at 18:27:20
In reply to Re: depressive emotions, posted by papillon2 on February 17, 2012, at 1:31:33
Yes that is CBT as have experienced it and incorporated this into my life I just realized. To me to say someone is a loser isn't theraputic to me? It's hurtful. Phillipa
This is the end of the thread.
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