|
Treating Depression
STEPS IN THE TREATMENT OF DEPRESSION
The point of psychological treatment is not to make the depressed feel better, but to make how they feel less of a factor in their day to day choices. If depressed people start thinking better and doing better, they will usually feel better as well, but it’s merely a positive side effect.
Step 1: External control
Antidepressant medications can work wonders. Medication may not cure, but for many people, it makes them feel well enough to do the things that will cure.
Step 2: Increasing pleasant activity
The second step in treating depression is to disrupt the downward spiral by getting people up and moving. Depressed people need to turn off the television and get up from the couch. Vigor follows the prime directive of biology: use it or lose it.
Step 3: Figuring out which kind of depression you’re dealing with
Discrimination is critical, because depression is really several disorders that share a few symptoms, but are different enough in their basic nature to warrant almost opposite approaches to treatment.
Depression is loss
Grieving a loss is hard work. You have to load up all the memories and haul them from one part of your brain to the other, from is to was, crying all the way, tired from not sleeping, and feeling like you just can’t go on. After that, you have to figure out who you are now that a big part of who you were is gone. Treatment for this type of depression involves encouraging people to talk about what they’re feeling.
Depression is a broken feel-gooder
Many depressed people are not so much sad as unable to be happy. Talking about how they feel makes them worse. Treatment for this sort of depression involves less talking and more doing.
Depression is guilt, anger-turned-inward, and disturbed social relations
Most depressions involved confused and confusing relationships with other people. People who blame themselves are also quite likely to blame others. Often they are willing to trade vindication for healing. Treatment for this type of depression involves sorting out which is them and which is you, then focusing on you.
Step 4: Separating Thinking, Feeling, and Acting
Whatever else it may be, depression is a distortion in thinking that causes negative feelings, which lead to self-defeating actions, which cause more negative feelings, which further distort thinking, and so on. There are no straight lines in depression, only downward-twisting spirals.
Step 5: Living at the Crossroads
At the heart of depression is global thinking, the tendency to see life as a series of impossibly distant endpoints rather than a process that must be taken a step at a time. Ultimately, the cure for depression lies in moment-to-moment choices.
|