When we hear the word depression, we may think of a few different things. As a part of a depression assessment, a therapist may ask someone to rate their depression on a scale of 1-10, with 1 being not depressed at all, and 10 being too depressed to get out of bed. So, what happens when you are severely depressed, but you manage to get out of bed and go to work? Does this mean you’re really not that or you’re being over dramatic with yourself?
“High Functioning Depression.” Yes, it’s there and it’s all too real. As with most things, people tend to see the world in a very black and white way- if you’re really that depressed, then you wouldn’t be able to get function, would you? That isn’t necessarily true. High functioning depression takes its’ toll inward and making it difficult for the depressed person to communicate and have a quality of life.
A large part of what makes depression so painful is dealing with the self-defeating symphony of critics telling you not only are you not good enough, but your loved ones have also lost interest in you. Depression is akin to another person, whispering into your ear to not get too excited that you had a good day at work, because tomorrow is bound to go wrong. Depression will tell you your friends aren’t calling because they are no longer interested or invested in you. Depression will also hold onto you, with all of its weight, making you tired and angry as you drag it with you throughout your day.
With this cacophony of negative input, you get up, shower, go to work, go home, and it becomes more normal as the days go on to slip into the feeling of “this is how it is.”
Just because you are able to maintain a job and make it through the day does not mean that this needs to be good enough.
When should you seek help for high functioning depression? Look at the quality of life- are you having more bad days than good days? Are you feeling hopeless, helpless or like your life is out of control? The good news is, depression is something that can be managed and the even better news is you never have to go through depression alone. Just because you are able to make it from the day to day does not mean your depression doesn’t warrant seeking help.
We’ve all been there, maybe it’s been a reoccurring theme in our lives with significant others, maybe it’s been a specific issue we experience time and time again. When it comes to our maladaptive behaviors, it can feel as though we are starring in our very own Groundhog’s Day.
I cannot express how much I dislike the statement “ doing the same thing over and over again and expecting a different result is the definition on insanity.” I personally believe it is the definition of behaviors and actions that once served us in some way and now linger as our go to behaviors- sometimes consciously and sometimes unconsciously. Does this make you insane? No. Does this make you frustrated wondering why you keep bumping into the same emotional walls like an emotionally blind mole? Maybe.
So why do we keep doing what we do, even knowing in hindsight it’s not the best choice? This is always a good question to ask; are you the type that is maybe too negative, judgmental or makes too many excuses for other people? I would encourage you to take a moment and ponder this question.
Now, let’s deconstruct that problem and take a look at what is happening under the surface. Do you tend to tolerate an unusual amount of dysfunction? Perhaps that’s what used to serve you best. As children, we do not have a choice of where we live or how we grow up; we must simply adapt to the situation at hand. Perhaps you had to tolerate your living situation to remain stable. Do you tend to be too loud ? Is it possible, that behavior once served you well as being the only means of being heard in a family full of other people and now as an adult it is no longer serving you well?
Or, perhaps, you remain silent and do not speak up- did speaking up ever have consequences to you?
We take the behaviors we have learned to adapt with and these behaviors don’t always serve us later on in life. Perhaps being silent as a means to avoid conflict in the past now mean you have been passed up for promotions which is leading to feeling depressed or confused. Or maybe the adaptive behavior of needing to mediate familial conflict has now molded a person who puts the needs of others before his or her own.
None of these are traits are bad or wrong, they are simply a product of our environment(s) and experiences. When the same problem keeps resurfacing, it is often helpful to look to the beginning, from there we can understand them and learn to recreate a new way and more adaptive behaviors to better meet our needs.
Something I will often ask my clients is if they have a pet. Even during an intake, I will write down any animal as part of the family system. This is not just for the amazing pictures they will share with me and heartwarming stories- this is to assess to see if the person across from me has a certain type of support.
Something phenomenal happens when you ask a pet owner or just an animal fan about their current or past pets; no matter how depressed, anxious or stressed they appear, suddenly their whole body shifts. I will see the person break out into a smile as their eyes shine with positive emotion as they describe their pet to me.
Animals have an incredible ability to express and give love in a way most people can not accomplish. Animals have a way of being therapeutic in a sense that they do not ask for much of anything other than their love and return it tenfold . A man by the name of Carl Rogers is known as the founder of Humanistic Psychology, which focuses on fostering client-centered growth in an environment that provides acceptance and most importantly “unconditional positive regard.” The theory behind unconditional positive regard is the person can facilitate personal growth because they are being accepted for who they are, no matter what. Carl Rogers developed this theory while working with children who had been through abuse. I like to think of all pets & animals as little fluffy Carls- they provide us with unconditional love no matter who we are, what we have been through, how we look or what our story is.
Another beauty I often find in the human-animal bond are the similarities and gifts that can be found when two creature share an alike struggle. More often than not, I will hear stories of how a wounded person will take on a rescued animal- often that animal’s behaviors may mirror their own: a wary look that says “ I don’t know if I can trust you” and then over time, the animal begins the process of learning the language of love for perhaps the first time and flourishes. This same concept applies with people who are survivors- with optimal conditions in a nonthreatening environment, people can learn to rebuild trust and confidence despite their experiences with abuse.
There are numerous remarkable programs where rescue animals are rehabilitated with remarkable results for both parties. One such program is at the Washington State Correctional Center for Women. Per their website, these programs have had some astounding results: “ At this time, 100 percent of the inmates who have been released have found employment. Additionally, over the past three years the recidivism rate has been zero.” I believe interacting the dogs helps the women handle the depression and other challenges that come with being incarcerated. Through training a rescue dog, these women now have a strong sense of purpose. There are many programs where those who are incarcerated are given rescue animals either to train, or house inside a correctional center resulting in a much lower mental illness rate and recidivism rate.
It would be odd for me to think of animals as separate from therapy in the sense of what they provide. When I think of my therapeutic specialties ( working with children and with chronic illness) it is only natural that I believe animals would be beneficial for both of these populations.
For children, growing up with a pet teaches them so many things. Animals have the ability to help teach empathy, responsibility and can improve socializing skills for children. There is a myriad of research on how animal assisted therapy helps children diagnosed with Autism , even helping to improve social skills for these children. For children of abuse, they can strongly identify with an animal that has been a survivor itself, and create a safe loving bond with this animals. I have had the privilege of witnessing child survivors of abuse build confidence and trust through the safety of a pet.
For those with a chronic illness, a large part of the challenge is dealing with the depression and social isolation. I will always ask my clients about pets; pets have such a wonderful ability to help lessen the feelings of isolation and loneliness. A pet doesn’t care that you can’t make it to the shower every day or put on real pants. A pet is just happy for your existence and will remind you of this consistently. I often hear “ I don’t know where I would be without my pets” with those struggling with chronic illness and/or mental illness.
Every day is a wonderful to give your pet extra appreciation, love and snuggles. If you’re wondering about the benefits of having a pet, I encourage you to research the benefits, responsibilities and check out where you can adopt your next best friend.
"Animals are such agreeable friends―they ask no questions, they pass no criticisms." ― George Eliot
If someone goes to therapy, specifically a CBT therapist, they may hear the term “core beliefs.” In my mind’s eye, I have always imagined this as a structure of pillars. These pillars contain our deepest set of beliefs about ourselves and begin construction from day one. Deep within these pillars lay messages that come in from our environment, our parents, friends, life experiences, genetics and our perceptions of the world around us.
If someone were to ask you what your deepest innermost feelings were about yourself, chances are the immediate answer would be “I think I deserve to be loved and successful.” Many of us do feel this way when prompted for an answer- however in order to really understand ourselves it is important to take a look at what our behaviors are saying. Are you thinking one way, but your behaviors are acting the opposite?
It is not uncommon for people to say they deserve true love, yet feel as though it is mandatory to settle for a less-than ideal partner. Sure, they may not make you laugh or be interesting, but it’s good enough. Some of us may be complacent in our careers with bosses we despise but feel, well, it’s more than most have and who am I to deserve anything more than other people. The beauty in therapy is linking the thoughts and behaviors- are my behaviors telling me I’m just not good enough, I don’t deserve anything special or I am inherently unlovable?
To get to the root of the matter, it’s time to fill up the ol’ brain tank, put on some comfy cozies ( I am a firm believer that all therapy should be held in the comfiest of clothes, preferably with a loving animal by your side. Stay tuned for my future collaborations with the founders of the Snuggie) and prepare to talk a trip down memory lane.
While there is certainly a lot to say for not dwelling on the past and not living in the past, it is certainly worth visiting the past to take a look at how it has shaped us. Those who have experienced abusive childhoods may find they experience tremulous relationships with other people whether it is romantically, professionally or in their day-to-day lives. It is tough to understand why it seems as though we can’t get it right, or the world is out to make our lives harder.
Taking this a step deeper, looking into the past, is it possible throughout a childhood filled with abuse that what was communicated on an unspoken level was “this child is undeserving of love and safety” or “this is the only type of love you are good enough for.” With these damaging messaging staying deep within the roots of our emotions, we may unknowingly act on these core beliefs through being inherently drawn to people who may take advantage of us or be abusive.
Another common situation I have seen is one where a child is parentified ( a child having to grow up too fast, assume the responsibilities of an adult, take care of their family, etc). When this child grows up, it is possible this adult now seeks out the ‘fixer uppers’ and surrounds themselves with people who need constant caretaking, be it through a significant other or having friends who are always in a crisis situation.
None of this is bad or wrong on the individual’s part- as people we go to our baseline behaviors. It is our natural default programming. The beauty of therapy is the ability to link our emotions, our core beliefs and build a newer, stronger story that doesn’t involve us going to our old maladaptive behaviors that created unhappiness. As with changing any habit, new behaviors take time- starting a whole new set of behaviors from scratch after 30, 50 or however many years of hardwiring does take work and commitment; it is important to be mindful and gentle with yourself when taking on any new task.
Watching people learn about themselves is akin to watching a scuba diver exploring a sunken ship for the first time-sure they may have an idea of what happened but until they get in there to explore, they won’t have the whole picture of what lays underneath.
“Feeling sucker” or my personal favorite “tear vampire.” We get a lot of creative names in this profession, and hey it makes sense. We do ask a lot of our clients as we are often asking them to do some of the most difficult work anyone could be asked to do. And the feelings- oy vey- all the feelings. We often ask of you to go deep into the corners of your heart and mind, dust off the cobwebs of THAT time or THOSE feelings and not just take a look at them, no, but take them out for an all expenses paid vacation.
Ugh, we know, we know. We understand that instead of Bad Feelings popping up every now and then or have bad episodes that you’ll kinda out of, now it’s here and loudly cracking it’s gum in your ear when you’re just trying to relax. You're probably thinking we have made a wrong turn, the less time we spend with Bad Feelings, the less we have to face them. But listen. While Bad Feelings is eating your leftovers you were saving for tomorrow’s lunch-time ruminations,Bad Feelings is telling you about it’s weaknesses.
The more we can tune into what is creating the anxiety, depressions and dissatisfactions, the more understanding and control we have over them. Before jumping into the mitigating events, it is equally as important to be able to accurately label what the emotion is. Anger, depression and confusion are expressed differently in every person. Our emotional expressions are formed from our environment, parenting, genetics, and learned behaviors.
With that said-the more we can understand about Bad Feelings where it came from, why it’s here and how it came to be, the less it becomes THAT friend who seemingly never leaves your apartment when you want to go to bed and something we can manage with newly acquired tools.Through exploring, challenging and confrontation, we can begin to pick apart the lies Bad Feelings has been telling us throughout our lives. Bad Feelings doesn’t do well with confrontation and it haaaaates reality checks. Bad Feelings lives for “alternative facts” and when confronted with challenging its' faulty belief system, its' deeply planted roots start to wither away one by one.
Through challenging it’s existence and reasons for staying, Bad Feelings will start spending less and less time hanging around. Sure, it’ll come by for a visit, but now you know the ways to challenge it and have the tools to take control these feelings instead of these feelings controlling you.
We often put our emotions on the back burner without giving credit as to how much they drive our decision making, beliefs about our worth, and overall self esteem. I would encourage anyone to take the time to do a self-inventory to ensure you are giving yourself the best chance at happiness; after all you do spend the most time with yourself.
He was a best friend, wise and caring, who taught me so much without ever speaking a word. He taught many of us the value of patience, the importance of taking time out in the day to smell and eat the roses, but mostly he taught us the power of unconditional love.
His name was Reacher, he was a 170 plus pound St.Bernard who loved nothing more than to take walks, play with his jolly ball toys, his other dog pals and not so discreetly climbing on top of your lap melting into a cuddle puddle.
Perhaps the greatest gift of all was the joy Reacher brought to numerous people, whether it was through seeing in picture or in person. Even as an adult dog, he still had puppy fuzz on his head. His tongue was a bit too large for his mouth, so it always protruded. Reacher’s eyes were always a bit of a mystery, lost between the heavy folds of his face- often, I would get the question “where are his eyes?” To which the only honest response would be “no one really knows.” Needless to say with a punim like a marshmallow with a tongue, he brings about an unequivocal joy to everyone.
Reacher was not just any old dog, he was the family caretaker. It would be easy to dismiss such a large beast as just that-an animal. Reacher was a caretaker and the best therapist I’ve ever known. You could not walk past him without pausing for a moment to step into a Reacher’s world with a quick belly rub. At the end of a long day, Reacher would hoist himself up to join you on the couch, lean up against you letting out a large sigh inviting you to unwind and shake off the stress of the day.
There was a time where I experienced a situation that made the world seem frightening and overwhelming. Reacher knew this. To calm me down, he would lay on top of me and let me pet him until I was calm. Reacher gave me the gift of being able to take walks in the world without fear because I knew with him by my side that I would always be protected. This dog gave me so much without ever asking for anything. Even in his old age, he would run outside to gather his favorite jolly balls to bring in and show you. Upon coming home, he wouldn’t just wag his tail- your entrance got a whole butt wag from him.
Reacher didn’t just take care of my family; he took care of his pack. He raised a very spirited Anatolian Shepard puppy. Reacher never once growled at him when the puppy ate his precious toys. Similarly, Reacher never once growled or had an adverse reaction he was around little kids poking around his face trying to find his ever-elusive eyeballs. Reacher was patron of patience.
No matter who you were, Reacher would show you unconditional love and slobber. He was a best friend, a therapist, a mentor and a good boy. He is and forever will be one of the greatest loves of my life. I can’t ever truly capture the wonders of our Hoggy Doggie, our Reacher-Creature, our best friend. I can only hope to express my gratitude for the gift of Reacher’s friendship.
“But you don’t look sick!” is probably one of the most frustrating things a person with an invisible illness can hear. Yes, it is nice to hear that we don’t look like death, but hearing the words “but you don’t look sick” undermines and discounts the illness the person is struggling with. These along with “but you’re too young to be that sick” or “but you seemed fine last week” are often interpreted by the sick person as “ I don’t believe you are really sick. I need more proof.” Realistically peaking, the majority of the time, these are not attacks against the person who is sick, rather a way of a healthy person trying to understand how a person who looks normal on the outside can be sick on the inside. People tend to have preconceived notions in their minds of what certain people or experiences must look like.
So as someone who has an invisible illness such as Lupus, Lyme, or any other illness that may not present itself as a visible illness, what is the patient to do when they are being challenged not just by society, or maybe by others who believe they are trying to do good such as check to see if your disabled parking badge actually belongs to you? I would suggest using these as ripe opportunities for education. If a stranger feels strong enough to comment on your intimate medical details, then it can be deemed appropriate to take the time to educate them on your invisible illness should you choose to. Choosing to be an advocate is a personal choice- while it would be ideal to live in a world where people don’t question each other and all differences are accepted- until then it is up to us to educate and advocate for the change we would like to see.
So how do we explain to friends or family member that some days might be better than others? spoon theory. This is a very helpful way of framing to someone how some days might be better than others. This theory can be applied to other invisible illnesses such as depression as well.
It’s a tough world out there, and with an invisible illness, the world is made even more complicated. We cannot control how other people react to us, but we can control how we respond to other people. Go on out there and advocate, Spoonies, you’re the change we need!
For the past year we haven’t been able to escape it- the impending election. Today it’s finally here, after months and months of coverage, commercials, Facebook ads and rants- the day has come.
I personally have never seen so much political anxiety on a individual and national level. Every single person who I’ve spoken to has experienced significant levels of anxiety no matter who their choice of candidate is. To say this election is unusual is an understatement.
Something else I have noticed, as I am sure you have as well, is the online community has become extremely nasty towards one another. When it comes to religion and politics, there is a very small chance anything we say will sway someone to think in an opposite way. I have heard so many times in the past few months “ I had no idea * insert name* was such an idiot, so I stopped talking to them!” in relation to the election. I have also witnessed so much online name-calling and mudslinging, it would make a sailor blush. It is more than okay when together with like minded folk to talk and wonder about how people could vote for the “other” candidate, however, we need to be cognizant of how we react to each other from behind a computer screen.
Bullying is bullying, even if it is under the guise for a just cause. It is okay to put up memes, updates and whatever else you please, but going on to other people’s pages or specifically targeting someone for the sake of shaming or name calling still constitutes as being a bully. This election has everyone up in arms, and I too find myself getting incredibly upset over certain candidates or props. No one is remotely close to being perfect. What is important to keep in mind is just because we are angry at politics does not give us a free pass to go and beat up on strangers or friends. You know that saying “agree to disagree?” That applies here as well. Let’s face it, when was the last time you hear someone say “ wow, that meme in that comment thread, about 50 comments down really changed how I’m going to vote!”
The truth is however set we are in our internal beliefs, that person who is making those outrages statements is equally as set in theirs. Telling them off is just going to make them angry, which may feel good to us initially, but when was the last time hate or anger turned into something productive? This is not meant to be preachy, rather to invoke a sense of taking a step back to ask ourselves “is this really who I am- someone who makes hateful comments for no real reason?”
No matter the outcome, we will always need our friends. No matter the outcome, it is important to embody what we want most from this election, which is to make this country better. Making this country better is something we can all start doing by being a little nicer to one another.
The good news? There is one huge thing we can all agree on- democrat or republican, libertarian or writing in for Bernie, there is no greater rush than getting that “I voted” sticker.
“He hit me!” “She stole my toy!” How often have we heard these statements on the playground, in the car or even in strange places where kids are in separate rooms, not even remotely in the same place? When it comes to children, there is almost as much literal mud slinging, finger pointing and name calling as in any presidential election year.
I won’t lie to you, usually the fastest way of resolution is stepping in as an adult and solving the problem ourselves (“No, Billy, your sister was downstairs, there’s no physical way she could have hit you from 50ft away. Apologize.”) At times, rationalizing with a young child can feel like herding some seriously sassy cats.
As a mental health professional, I truly believe in “choose your battles.” That said, there is a good reason why we have an obligation to our children to teach and assist them in how to problem solve on their own. Kids aren’t born as natural problem solvers or sharers. Why? Their brains! Our brains develop into our 20s. Problem solving, empathy, complex emotions and rational thinking are all skills we develop later on in life- this is why we don’t hold kids to the same standards as adults.
Because kids are more “back brain” based (survival and instinctual parts of our brain) we need to work out their brains like a muscle to engage their “front brain” (reasoning, logic, empathy) so they can begin learning these skills early on. Your kid isn’t going to get it right all the time- when they are arguing with their sibling, for example, they will need a moderator who is willing to take the time to step in and say “okay, both of you are upset. How are you both going to fix this?” Even if you’re met with a blank gaze, it is important to push, “ I’m not always going to be in the room to solve your problems, let’s do this together. I’ll listen and help you guys decide what’s fair.” Chances are your kids will feel much better because they not only got a say, but they were empowered by solving this all on their own!
This same principle can be applied for consequences in asking “since you didn’t do your chores last night like we agreed, what do you think is a fair consequence?” Many parents are pleasantly surprised to find that instead of their child answering “nothing” they are usually happy to be involved in the first place. This also helps engage their problem solving brain parts. The more these parts are used in the brain, the stronger these abilities get. With younger kids, we can tailor these skills to be age appropriate by first giving them options (“which sounds more fair to you, no tablet for the night or more chores tonight?”)
Yes, this takes up more time. This is not because I don’t see that in addition to your 40+ hours of working per week, making dinner, doing laundry and cleaning are going unnoticed. It’s okay if there are nights your kids have fries for dinner or you let your kid go on errands in their favorite Halloween costume in June. In the long run, these are not the things that will alter their future; what will alter their future is their ability to engage with other people from a place of empathy, understanding and knowledge that they will have to solve issues on their own. It is hard to see kids upset, crying or disappointed when there is a quick fix. However, the rewards are much greater when we see our children out on the playground assisting other children during playtime to ensure everyone gets a fair turn, or as young adults having the ability to assert themselves in a productive manner.
And for all those times they are arguing and yelling at each other? Just remember, if Lester Holt could do it, you can do it too!
Not all of us are someone who envisions sitting with a book in that perfect reading nook we saw on Pintrest, drinking a warm mug of coffee as we fantasize about rain coming to California. What do raindrops in California and mental health have in common? Loneliness.
Alexis has been a part time contributor to the online website Patientworthy which is dedicated to education and awareness of rare and serious diseases. Links to articles written by Alexis: