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Posts Tagged ‘sarasota’

What is Depression?

Tuesday, July 16th, 2013

130715 DepressionEverybody gets the blues.  When the dog dies, you lose a job or a boyfriend, a check bounces, the roof leaks, you get sick, your team loses – you feel down, sad and empty.   In a relatively short time though, you bounce back.  You get better because the circumstance changes, you take some action or your feelings just go away.

For some of us, though, things don’t get better.  Our mood is persistently sad.  We lose interest or pleasure in activities that we once enjoyed. We experience a significant change in appetite or body weight.  We can’t sleep or sleep too much.  We don’t have any energy.  Feelings of worthlessness or inappropriate guilt are complicated by difficulty thinking or concentrating.  We have recurrent thoughts of death or suicide.

If you have five or more of these symptoms during the same two-week period, you meet the diagnostic criteria for Major Depression.  How bad do the symptoms have to be?  Most of us tend to minimize how bad we are feeling, but the defining question is do the symptoms interfere with your ability to function: to get things done around the house, to go to work, to interact with those you love.

130715 depression1The problem is more pervasive and serious than we think.  6.7% of us will contract Major Depression during the next year, and there’s a one in five chance that sometime during your life you’ll suffer from this condition.  A recent study sponsored by the World Health Organization and the World Bank found Major Depression to be the leading cause of disability in the United States and worldwide.

And Major Depression can kill you.  Over 80% of people who die by suicide have Major Depression.   We tend to think that this extreme outcome is pretty rare, but suicide is the tenth leading cause of death in the U.S.  In 2009, it accounted for 34,598 deaths.  Suicide is a major, preventable public health problem.

How do we prevent suicide? By treating the underlying depression.   Women tend to suffer from depression more than men, and this has biological and cultural sequelae.  The primary reason may be that while men tend to “act out” – fighting, drinking or other acts of aggression, women who are depressed tend to turn inward, feeding that sense of hopelessness associated with depression.

130715 Depression2Depression can appear two other diagnoses.  First, depression is associated with Bipolar Disorder, which was previously known as Manic-Depression.  Persons with Bipolar Disorder swing between the “poles” of major depression and mania, which is abnormally and persistently elevated mood, accompanied by grandiosity, decreased need for sleep, racing thoughts and impulsive behaviors.

A less severe form of depression that lasts at least two years is known as Dysthymic Disorder, or dysthymia.  Many people with dysthymic disorder also experience major depressive episodes.

To see the criteria doctors and therapists use to diagnose depression, click here.

Next time, I’ll talk about how treatment of depression has changed over the last few decades.



Cross My Heart: How To Tell When An Addict Is Lying

Sunday, June 23rd, 2013

130622 liar3

130622 Denial

One of these people is an addict and one isn’t.  Guess which one is lying:

“Are you an addict?”   “No.”

“Are you an addict?”  “No.”

It’s a trick question.  The answer is neither is lying.  The non-addict is telling the truth, and the addict is in denial.   (For sake of simplicity, the term “addict” will be used to refer to someone who abuses drugs and/or alcohol.)

Denial is closely associated with addiction, and we’ve all heard the old joke that ends “it’s not a river in Egypt.”  But what’s the difference between lying and denial? Lying is conscious, denial is subconscious.  Denial is one of the defense mechanisms codified by Sigmund Freud.  In Freudian psychoanalytic theory, a defense mechanism is a tool we use to keep painful truths from moving from the subconscious to the conscious.

Dysfunctional defense mechanisms can be pathological (delusional projection), immature (fantasy, passive aggression, acting out), or neurotic (intellectualization, displacement, repression).  There are also functional, or mature, defense mechanisms, like humor, sublimation and altruism.

How do defense mechanisms work?  Think of the ocean.  Above the water is consciousness – the things we’re aware of, that we can see.  Under the water is the subconscious – the things that we’re not aware of.  They’re in the dark.  They’re unknown.  They may or may not be dangerous.  They may eat us alive. They’re scary.

Now here’s the crazy part: both you and the addict are denying the addiction, and you don’t even know it.  If we hooked you up to a lie detector, both of you would pass.  The addict denies it because to acknowledge it would mean taking responsibility.  You deny it because if you don’t, you’ll have to admit your powerlessness.  Your challenge is to break through your denial so both you and the addict can survive the addiction.  Al-Anon and a good therapist – alone, or together – can dislodge your denial.

Denial often takes the form of minimization or blame.  Minimization is underestimating the effects of the dysfunctional behaviors. (“At least I don’t do crack.”  “I never drink liquor.)  Blame is just what it sounds like, but alcoholics raise it to an art form. (“If you were married to my wife, you’d drink too!”)

Now, it’s not all about denial; addicts are also masterful liars. Pop Quiz: If you ask her how much she had to drink, and she says “two drinks” when she had ten, is this denial?  No!  It’s lying!  (Denial would be, “Yeah, so I had ten drinks.  Everybody drinks like that.”)

Addicts lie about things big and small.  They lie so often, they often can’t keep their lies straight.  This is why you’re starting thinking maybe you’re the crazy one. Sometimes it seems that addicts lie when there’s no good reason to.  It’s as if they intentionally lie just to stay in practice.

 130622 liar1In the end, you can’t stop the addict from lying, but you can stop buying into it. Then you can stop enabling, and start healing.

As I said in the beginning, addiction refers to those who abuse alcohol or drugs, since alcohol is really a drug.  Both lie, and both deny. But how can you tell the difference between an alcoholic and an addict?  Here’s how:

An alcoholic will steal your wallet and lie to you about it.  An addict will steal your wallet and then help you look for it.