Break the Silence, Break the SEAL (Suffering Even A Little)

The Discomfort in Depression

DEPRESSION…It’s intimidating and scary, it evokes avoided emotions, and the word is cloaked in shame.  In a data summary, the Center for Disease Control and Prevention (CDC) (Pratt & Brody, 2014) reported that between 2009-2012, 7.6% of Americans age 12 and older met the criteria for various forms of depression.   Depression is most prevalent among females and people ranging from middle age to elderly.  In 1998, 20% of adolescents were diagnosed with major depression (Rohde, Stice & Gau, 2012).  However, given the rise in use of social media and bullying, I can’t help but wonder if the statistics for adolescents with diagnosable depression has spiked in the past few years.  “Nearly 90% of persons with severe depressive symptoms reported difficulty with work, home, or social activities related to their symptoms” (Pratt & Brody, 2014).  So, why aren’t more people talking about this mental illness and its impact on society in its entirety?  There’s a wealth of information on depression floating across the Internet, in books, and in research articles.  This piece on depression is intended to offer basic information on depression and promote more open communication about the disease.    

Fleeing the Discomfort

Have you ever said to anyone, “I feel depressed”?  Freely answer this question!  What were the responses that others gave you?  How did you feel after saying the statement?  Using the statement “I feel depressed” has become second nature in our society.  We say things like “this is depressing”, when we really mean that something generates a feeling of sadness in us.  Generally, we overuse the word depression and it’s not synonymous for sadness.  Depression is much more profound than sadness.  I haven’t said it often but the time that I did say it, oh buddy!  It was like my emotions had declared war on me.  My well-self fired the first missile at my fragile-self.  There was a sense of inner hostility for admitting my experiences.  As a result of a significant loss, the winter season, and isolation, I was very vulnerable to depressive symptoms.  I’ve had people tell me that I’m an open book.  I don’t know how true that is but I do know that there is something cathartic in being vulnerable and seeking help.  Let’s be honest; sometimes, we hope others don’t talk to us about their depression.  In our society, wellness is more about portrayal and less about what’s actually happening internally.  Most people hope to never experience depression and they pray for those living with it.  Depression is real and alive!  Unfortunately, it’s not like annoying solicitors that approach our doors without invitation; it won’t go away if we ignore it. 

The Depth of Depression

Emotion evoking issues and conversations about depression are most likely to be avoided.  People typically respond the same to unfamiliar emotions.  They don’t respond!  Matters that force us beyond our comfort levels tend to promote self preservation and we are wired to disconnect.  So, what is depression?  How is it distinguished from sadness?  Depression is an illness with prolonged symptoms of profound sadness, hopelessness, shame, and disinterest in general life activities.  It influences the emotional, mental, physical, and spiritual wellness of people suffering from the illness. See chart below for more concrete examples of how persons may be affected by depression.   It is an intense emotional disturbance that has the ability to affect daily living, relationships, and may present somatic symptoms.  Somatic symptoms are also known as physical ailments such as aches and pains.  Depression varies in type to include the following:  major depression, persistent depressive disorder, postpartum depression, seasonal affective disorder, situational depression, atypical depression, premenstrual dysphoric disorder, bipolar disorder, and psychotic depression. 

Depression differs from sadness, in that symptoms must be present for two weeks or longer and there is noticeable change in daily functioning.  Additionally, depressive symptoms may not be the result of substance abuse, a medical condition, or bereavement.  Depression is accompanied by sadness; sadness is a normal emotion.  Sometimes we call it the “blues” but it’s not a continuous experience.

  

 

How to Help Without Killing the Relationship

This is the part where things get difficult.  Learning how to support someone with depression can be challenging!  From personal experience, there will be times when you want to embrace the person in your life living with depression and times when you want to close all communication.  Remember that denial and impaired judgment accompany depression.  Depression can be toxic to relationships; it transforms the people we know and love, making them nearly unrecognizable.  We pull our hair out in confusion and pray silently that they see themselves as others experience them. 

Unfortunately, persons dealing with depression look through different lenses then those around them.  Yelling from the mountain top at persons living with depression, that they need help, is not effective.  This will be least helpful and certain to cause a strain on the relationship. 

Furthermore, much like the common cold, depression can be contagious.  Essentially, living or spending significant time with persons struggling with depression will likely cause you to become depressed.  Be attentive to your own emotions, changes in daily functioning, and the status of your significant relationships.  Having a sense of awareness is necessary when supporting someone with depression.  I’ve taken the liberty to compile some indispensable points about supporting others with depression, based on research and articles (Bernstein, 2010).

Common ground

• Have you experienced depression? Have you gone through something very difficult that influenced the person you’ve become? Sharing your own vulnerability will reduce the shame associated with depression.

Ask questions

• Gather information about how the person sees himself/herself. Inquire if the person notices any changes in his/her daily functioning (i.e. motivation, hygiene, sleep habits, etc.). Only explore what’s easy for the person to identify. 

Suggest

• If the person observes or mentions easily identifiable issues or changes, encourage him/her to see his/her practitioner. General physicians are less intimidating than counselors or psychiatrists. 

Support 

• If you are available and willing, offer to attend an appointment with the person. Seek support for yourself; learn how to be supportive and avoid compassion fatigue/burnout. Enlist the help of others who care about the person(s) living with depression.

To summarize, depression can be destructive but it's manageable and treatable.  If you only take away one critical point from this blog, remember that a meaningful and fulfilling life is achievable while living with depression.  I don’t intend to cover the various forms of treatment, as I always encourage treatment to be sought in-person by medical professionals.  Treatment for depression may include medication-antidepressants, psycho-social supports, physical activity, modified nutrition plan, and/or psychotherapy (therapy).  Depression is not preventable due to genetic predisposition, situational and/or environmental factors which are oftentimes uncontrollable.  It’s important to remember that millions of Americans are living with depression; this disease does not discriminate.  If you are living with depression or know someone living with depression, don’t give up on them or yourself.  Remember to seek support when needed, be vulnerable to reduce shame, and know that you are never alone. 

Until next time, live on purpose; life gets better! ℠

Bibliography:

Adaa.org. (2015). Depression | Anxiety and Depression Association of America, ADAA. Retrieved 14 June 2015, from http://www.adaa.org/understanding-anxiety/depression.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM–5). 5th ed. Arlington, VA. 2013.

Bernstein, E. (2015). A Way Out of Depression. WSJ. Retrieved 12 June 2014, from http://www.wsj.com/articles/SB10001424052748703946504575470040863778372.

Pratt L. A., and Brody D. J. Depression in the U.S. Household Population, 2009–2012. NCHS data brief, no 172. Hyattsville, MD: National Center for Health Statistics. 2014. Retrieved from http://www.cdc.gov/nchs/data/databriefs/db172.pdf. Web 12 June 2015.

Rohde, P., Stice, E., & Gau, J. (2012). Effects of Three Depression Prevention Intervention on Risk for Depressive Disorder Onset in the Context of Depression Risk Factors. Society for Prevention Research, 13(6), 584-593. Doi:10.1007/s11121-012-0284-3.

The Washington Post. (1993). Living with Depression Effective Treatments are Available: Final Edition.  Retrieved 12 September 2014.


Guest Editor: K. E. Bruno

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Bringing the "Ope." Hope Through Coping

Tree of Life

Life happens to the best of us!  How we respond to it determines how we will navigate future circumstances, challenges, losses and changes.  How do you manage the stressors of everyday life?  How do you handle loss?  If we are honest with ourselves, it's difficult at times.  If you have children, how do your children deal with stress or sadness? Stress, sadness, depression and grief do not discriminate based on age, gender or race. There is hope for navigating life's journey and it can be found in healthy coping.  

Personally, I confess, there have been times when I had no clue how to handle the personal losses and stressors in my life!  I am the queen of juggling acts. However, things became chaotic when graduate school met full-time job, when part-time work was introduced to homework, and friends and family weren't forgiving of my absence from social events.  After several significant losses piled up from childhood to adulthood, I searched high and low for ways to survive.  I learned coping skills, which thrust me out of survival and into living mode!  Are you wondering what coping skills are now?

Coping
What are coping skills?  Coping skills are specific efforts, both behavioral and psychological, that people do to manage, tolerate, reduce, or minimize stressful events.  There is no one way to cope with stress or grief.  Some people have found the things listed below to be helpful in coping during stressful time or during the grief process. These items may be listed on a dry erase board, construction paper or some other visual aid as a reminder of what can be done.  It's been said that people are more likely to succeed at the things they put in writing! Hint. Hint.

Talk to family or friends Seek counseling Read poetry or books Engage in social activities Exercise/jog/walk Eat healthy foods Draw or make something special Play with a pet

Seek spiritual support Take time to relax Join a support group Be patient with yourself Let yourself feel grief Paint "hope" rocks!  Listen to music Scrapbook Dance

Journal/Video journal Play with soft toy Blow bubbles Send a note to heaven Put together a puzzle Build something with Play- Dough Ask for a hug from someone you trust Cry

Coping Kit

The cherry on top of a sundae is a coping kit!  I've spent a few years working with children and adults in the human services field and counseling.  Let me just tell you, coping kits can be a life saver literally!  Making a coping doesn't require much effort and it can be fun with a little creativity.  For all those interested, I've provided some guidance below on how to create a coping kit.

A shoe box or wooden craft box will work best and allow for creativity in personalizing it! This kit will allow persons to keep items that can help them cope with overwhelming emotions.  Some of the following items can be used: construction/brown wrapping paper, scissors, glue, stickers, photos, magazine pictures, glitter, flowers and etc.

When decorating the box, think about what calms you down.  If you don’t know what calms you, test out some of the suggestions mentioned above.  Also, discussing ideas with friends and family is a great place to start too! Once you figure out what is most comforting or calming for you, then you can build your box. The contents of the box should be age appropriate. Suggestions for items to put in the coping skills box:

Stress ball 
Bubbles
Crayons/markers
Pens/pencils
Coping Skills Flashcards
Music (iPod/MP3 player/CD)
Puzzle or coloring book
Positive written affirmations
Journal or mini notebook
Cards/stationary for letter writing
Coloring book/sketch pad
Positive self improvement books
Photos/pictures that are calming
Personalized deck of playing cards
Written safety plan of contact numbers

The box pictured is a grief coping kit.  It was created for children and adolescents but adults could totally enjoy some of the things in this box.  Items in the coping kit should be based on the context of what the user needs at the time.  For the adults that may read this, it's okay to whip out some Play Dough!

A grief coping kit may be helpful, for some people, to manage the emotions associated with their loss.  However, on the grief journey we remember those we love who have died.  Remembering our loved ones isn't always easy or pretty.  I can say that it hasn't always been easy for me.  But, if we are lucky enough to have a few good memories, those we cherish deeply, we must handle them with care. I consider myself to be sentimental and creative!  After my most recent loss of my maternal grandfather in the fall of 2013, my coping skills kicked into overdrive.  Making a memory box was one of the things that I've used; hopefully, it will be helpful for others.  I've provided some guidance below on creating a memory box.

Making a Memory Box

Memory boxes are a creative way to maintain mementos and reminders about what we cherish most about those we love who've died.  During the journey, over time, grief will resolve and the memory box may be needed for less emotional support. The box below was created for display at the NBC 4 Health & Fitness Expo for the organization A Legacy Left Behind.  The following suggestions are for creating a memory box:

Container  

• Secure a safe container that you can properly store until you want to revisit your memory box. You may decorate it if you would like but it is not necessary.
• Shoebox, jewelry box, shipping box, craft box, etc.

Collection     

• Gather objects that remind you of your loved one. This will vary depending on the loss. If items are too large for your box, take a picture of the item and include the picture in your box. Some items may include but are not limited to letters, obituary, jewelry, fabric from clothing, or items that are symbolic to the loss of your loved one (i.e. Ornaments, pressed flowers, figures, etc.)

Visit

• Visit your memory box when you need some reflective time or when needed.

Share

• Tell someone you trust about what it was like for you to create your memory box. Give brief description of what some of the items in your memory box represent for you and your loved one.

Note:  An alternative to memory boxes are memory boards because they capture the sentimental memories of a loss. Memory boards can go on cardstock paper, poster board or scrapbook paper. Words, notes, images, pictures and/or crafts may be used to create your memory board.

Solid as a Rock! 

My work with C.O.P.S. Kids/Teens Program as a part of National Police Week really stirred my creativity last year.  This was a great keepsake for youth grief groups! Acrylic painted smooth stones for writing words of encouragement and a coping resource.  I allowed my group to use stickers to add words, if they didn't want to write on the stones.  Stones were painted with regular sponge brushes and acrylic paints.  After the stones were decorated I coated them with Mod Podge as a sealant.

Please feel free to leave feedback! 

 Bibliography:

Alegacyleftbehind.org,. 'A LEGACY Left Behind - Lifting Empowering Guiding Awarding & Cultivating Our Youth'. N.p., 2015. Web. 2 June 2015.

Nationalcops.org,. 'Concerns Of Police Survivors : Programs'. N.p., 2015. Web. 2 June 2015.

Taylor, Shelly. 'Macarthur SES & Health Network | Research'. Macses.ucsf.edu. N.p., 2015. Web. 2 June 2015.

Yourdictionary.com,. 'Cope Dictionary Definition | Cope Defined'. N.p., 2015. Web. 2 June 2015.

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Depression & Motivation

www.everydayhealth.com

Bibliography:

EverydayHealth.com,. 'Motivation For Depression Study - Depression Infogram - Everyday Health'. N.p., 2015. Web. 2 June 2015.

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