3 Mistakes Professionals with Depression Must Avoid
Hey you! Do you struggle with depression? Do you find yourself having a difficult time functioning at home, school and/or work? Are you feeling sad most of the day, most days? Do you feel discouraged, isolated, ashamed? Do you have a lack of interest in once cherished activities? Has your libido decreased? Do you experience suicidal thoughts? If you find yourself saying yes to all or most of these questions you might be suffering from clinical depression. The Diagnostic Statistical Manual 5th Edition (DSM 5) outlined that clinical depression, such as major depressive disorder, is categorized by experiencing a persistent and debilitating form of sadness and hopelessness that affects one’s perception of their self, others, and the world (American Psychiatric Association, 2013). Professionals, such as therapists, physicians, and entrepreneurs can be preoccupied with the “daily things that have to get done”, and thus unable to recognize the signs or symptoms that their psychological wellbeing is at risk. Therefore, professionals can go on to deny their struggles, minimize and believe they can treat their depression, as well as struggle with a loss of control.
The first mistake professionals with clinical depression should avoid is denial. Nancy McWilliams, a psychoanalyst, described the concept of denial as a “dissociative phenomenon” that appears to be rooted in an evolutionary means of coping to avoid mourning (McWilliams, 2004). What McWilliams is essentially stating is that a part of our psyche is broken off from the conscious mind and buried within the unconscious mind. Many professionals attempt to compartmentalize by, for instance, focusing on the tasks that need to be completed for the day. By focusing and prioritizing menial tasks allows the painful thoughts, feelings, and past experiences to stay buried. However, nothing stays buried.
McWIlliams outlines that stressful thoughts, feelings, and/or past experiences can forcefully penetrate the conscious mind by way of intrusive thoughts, flashbacks, and dreams. There is a defence mechanism known as splitting where the psyche can be split into two or more parts, and some of those parts are then denied and forced into the unconscious mind. For example, painful childhood traumas can be broken off in the psyche and placed in the unconscious as a means for the conscious mind to focus on the present and function on a day to day. However, when stressful events occur the mind can be triggered in remembering painful experiences from the past, which can induce feelings of guilt, shame, remorse, disgust, anger, loneliness, and/or worthlessness. Some people vacation there in their mind, only visiting those negative places in the psyche, other times people can live in the dread and despair as if they are stuck in a negative feedback loop that perpetuates the pain.
However, it is not the whole story because another part of the psyche is resilient. There is evidence to suggest that you can act from the resilient part of your psyche because you have been able to promote your own sense of growth either by accepting a job opportunity or even reading this blog to work towards understanding yourself better.
The threat to your mental health has to do with unconsciously acting from the side of your psyche that feels the despair and remembers those past harsh childhood experiences. For example, it is not uncommon for professionals like you to unconsciously, and somewhat consciously, believe that you are “not good enough” or “unlovable” or “unworthy”, and thus act in accordance with your internalized thoughts. For instance, you might turn down a job opportunity because you thought you were unworthy. Feeling unworthy may be unconsciously associated with the trauma you experienced during your childhood where your father repeatedly proclaimed your efforts were not enough or “you could have done better”. Not feeling as though you could live up to your father’s standardized can have a devastating effect on the psyche, especially on the adult psyche.
Now what? What do I do? One way to combat denial is to face it head on. You don’t know what you don’t know. But, as you begin to find out you can then challenge yourself to face your distress. For instance, if you are feeling sad because you received a harsh evaluation from your boss, then go ahead and feel your feelings. It is important to validate your feelings. In addition, you might then reflect and remember your difficult childhood upbringing and the relationship with your father. Rather than avoiding those painful associations from your childhood, you have the opportunity to dive into the pain, to explore it, and to release it. On your own you can certainly reflect and analyze what has happened to you. However, it is in your best interest to work with a therapist who is a trained professional to aid you in the exploration of your psyche.
The next common mistake professionals with depression make, and need to avoid, has to do with minimizing their issues and avoiding treatment. Professionals like you - especially therapists and physicians - have a nasty habit of minimizing symptoms, forgetting or disregarding the benefits of self-care, and avoid treatment typically due to the belief that you can overcome you feelings, thoughts and/or past on your own. Additionally, some of you may hold the belief that you would be judged for attending therapy and be seen as “weak minded” or, “crazy” or, “sunstable”. The reality of the situation is that if you suffer from clinical depression then you require treatment from a professional(s). Just as someone with a broken leg and ankle requires treatment from a physician. You can combat your denial, and gently challenge yourself to build your insight, but you can’t treat yourself. Even therapists need good therapists.
In addition to therapy, if advised by your physician, you can benefit from the use of antidepressant medication, such as selective serotonin reuptake inhibitors (SSRIs). SSRIs essentially work on maintaining the chemical balance in your brain, which can reduce feelings and internalized thoughts associated with depression. For instance, after 6 to 8 weeks of taking your antidepressants - as prescribed - then you may start to feel there is hope and you are not “worthless” but rather valuable. The misconception with medication is that it will help you feel better, rather the medication aid to focus on the biopsychological response to depression. In other words, with medication you might feel better, but without the use of therapy you may be highly reactive in stressful situation and unsure how to cope.
The combination of therapy and medication can have advantageous effects. Research suggests that medication and therapy can help people like you to, in a sense, feel better as well as learn about their unconscious resistances and bring up painful memories to mourn (Xie et al., 2021). Over time it is possible that people, with the help of therapy, can work with their physician to reduce or eliminate their medication, and use therapy as a primary treatment. You don’t have to take medication and attend therapy for the rest of your life, but treatment is a long-term commitment and investment in yourself.
The threat here is that professionals like you continue to minimize their issues. Therefore, you may not seek help when in need, or reach out for help when in crisis and everything feels like it is crashing down. It is not uncommon for professionals who minimize their issues and attempt to treat their depression on their own to experience a crisis situation that induces the urgent need for mental health services. But why do you unconsciously, and maybe consciously, wait until you are in crisis? Why not access the resilient part of your psyche and acknowledge what you need for your mental wellness, and what you ultimately need in order to be the best you.
If you have not already done so you are doing to want to check out think video below (click on the link) where I provide psycho-education around suicide, which includes: the risk factors, warning signs, as well as what to do if you or a loved one is struggling with suicidal thoughts.
https://www.youtube.com/watch?v=PV9dhKhrzm4
The last common mistake professionals with depression make, that you should avoid, has to do with an inability to relinquish control. It is not uncommon for professionals such as doctors and lawyers to be meticulous about the way their day is organized, or how they complete tasks. When it comes to therapy, it is encouraged that patients relinquish control to the treatment. What does that mean? For instance, if you are engaged in a psychoanalytic treatment then part of the treatment may include lying on a couch and talking about anything and everything that comes to your mind, then relinquishing control would include talking to your therapist about exactly what you thought and feel. Some people might censor and judge their thoughts and feelings, and thus refuse to be honest with themselves and the therapist during the session.
The threat here is that people like you who deserve the full effects of the treatment are not receiving it. Whether you are fearful of other’s judging you, or you judging you, by you being honest with yourself and your therapist allows you to work through the painful thoughts and feelings. It is not easy being vulnerable.
One way to combat the threat of control is to relinquish control a bit at a time. For example, if you are beginning therapy then don’t agree to the treatment with the first therapist you interview. I suggest you make a list of different therapists in your area and interview them. Determine which therapist you feel is a “good fit”, and what their treatment approach might be. You are interviewing for the position of therapist and you want and deserve the very best. So, there is no rush in finding your good fit.
It is a misconception that you have to give up control and are at the mercy of the therapist and the treatment. No. Definitely not. Therapy is your treatment, and you always have a say! It will, however, take time to build a therapeutic relationship, and it will especially take time for you to build a relationship with yourself so you can access the resilient part of your psyche more often.
If you are unable to attend therapy or you are on a wait list, then it will be in your best interest to challenge the part of you that needs to be in control. Freely journal and explore why you need to be in control? What would happen if you were not in control? What would be the worst case scenario?
You can go as deep into your psyche as you like. Once you have gathered sufficient information about your psyche you can then, using your rationality, analyze your fantasies, fears, and past experiences, trying to understand who you are and process your emotional pain. If you are in a position to gently challenge yourself by relinquishing control to your journal, then when you are in a position to attend therapy you can be better equipped at allowing the session to flow, free from judgment, free from control, and without reason, to see what comes up and what needs to be processed.
Learn more about therapy for depression here.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (Vol. 5, No. 5). Washington, DC: American psychiatric association.
McWilliams, N. (2004). Psychoanalytic psychotherapy: A practitioner's guide. Guilford Press.
Xie, Y., Wu, Z., Sun, L., Zhou, L., Wang, G., Xiao, L., & Wang, H. (2021). The effects and mechanisms of exercise on the treatment of depression. Frontiers in psychiatry, 12, 705559.
