July, 20 2018

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Depression: Recognizing the Warning Signs

Dr. Richard O'Connor

One of my most vivid experiences as a therapist came about ten years ago when I was working with a 15-year-old young man I'll call Tom.

Tom's story

Tom was a good-looking and intelligent boy whose mother had brought him to our clinic, insisting that we get him to "shape up." She had reason to be concerned. Despite his potential, he had failed one year of school already and was on his way to failing another. He was suspended from school as often as not because of petty rule-breaking, and he had been arrested for breaking and entering a local store after hours.

We tried family therapy, but it didn't work. Tom lived with his mother and stepfather, the natural father disappearing years ago. The mother and stepfather had a stormy marriage. Tom and his stepfather didn't get along at all, sometimes coming to blows, and mother was right in the middle. The stepfather stormed out after the second family session and Tom was assigned to me for individual therapy. To my surprise, he usually kept his appointments.

The incident I have in mind happened after almost a year of therapy. Tom had already told me that he used marijuana and alcohol regularly, that he'd been sexually active since age 8, and that he'd engaged in a lot more petty crime than anyone ever suspected. He wasn't bragging about any of these things, and I believed him.

There are no accidents

One afternoon he told me sheepishly about what happened when he came home from school the previous day. He'd been talking to his mother when he took off the pullover sweater he'd worn to school. To his chagrin, a plastic bag of marijuana fell on the floor right in plain sight. His mother knew what it was, but Tom somehow talked her into believing that he was only holding it for a friend.

Being a determined psychotherapist, I of course told Tom that this was no accident, and more or less accused him of wanting to get caught. He denied any such intention, instead laughing at how he'd fooled his mother again. Nothing I could say could make him think differently.

To our mutual amazement, however, exactly the same thing happened a month later -- the pullover, the marijuana on the floor, the same cock-and-bull story that Tom's mother swallowed again.

This time not even Tom's powers of denial could stand up to the implications of his actions. When I said that he must be disappointed and hurt that she had believed him, Tom agreed. This six-foot 180-pound kid with a police record who was the terror of his principal's office then started to cry.

Love is a verb

He talked for the first time about how much he wanted his mother to love him, and how convinced he was that she didn't because she let him get away with everything. He talked about how he must really be an awful case to be abandoned by everyone responsible for him. He felt that, despite the trouble he was in, he was more of an adult than anyone else in the house because he saw things as they were and was capable of acting unselfishly. I agreed.

This was the beginning of some progress for Tom. The best we could do was help him see his mom objectively, as a limited, self-centered woman who cared about him but not in the way he needed. He had to grieve for and give up on the idea of the mother he wanted, who would care enough about him to make him feel good about himself. Instead, he had to limit his self-defeating behavior and start doing things he himself would be proud of -- in other words, to start functioning as his own parent. This is a tough job for a 15-year-old, but there are millions of kids out there for whom this is the best hope.

Whatever they do, they want you to notice

Since then I've heard the same kind of story over and over. Kids wave the red flag in front of their parents. Their grades drop, they get in trouble, they come home drunk. They get abused by their boyfriends or they get suicidal. They get in car accidents or get pregnant.

Don't think that means they will fall into your arms when you confront them. By no means are teens that easy -- you have a fight on your hands. But your child will be much better off if you will respond to the red flag.

Teens aren't capable of making the decisions they have to make today without our help. When they need help, they have ways of letting us know. Unfortunately, they often don't ask for help with words, but with dangerous or self-destructive behavior.

It's the parents' job to get the message.

About Dr. Richard O'Connor and Depression

Richard O'Connor is the author of three books, Undoing Depression: What Therapy Doesn't Teach You and Medication Can't Give You, Active Treatment of Depression, and Undoing Perpetual Stress. For fourteen years he was executive director of the Northwest Center for Family Service and Mental Health, a private, nonprofit mental health clinic serving Litchfield County, Connecticut, overseeing the work of twenty mental health professionals in treating almost a thousand patients per year. He is a practicing psychotherapist, with offices in Canaan, Connecticut, and New York City. He currently is working on his fourth book — about happiness.

A graduate of Trinity College in Hartford, O'Connor received his MSW and Ph.D. from the University of Chicago, followed by postgraduate work at the Institute for Psychoanalysis and the Family Institute. He has worked in a wide variety of settings, from inner-city clinics to wealthy suburbs.

R ichard O'Connor and his family live in Lakeville, Connecticut. He participates as a leader and a member in a free self-help group in Sharon, Connecticut, for victims of depression.

Six Simple Steps to Help Fight Depression

• Get help. Don't be ashamed of needing medication, and don't give up until you find something that helps. And see a therapist.

• Identify your feelings and moods. Depression is a self-destructive effort to avoid feeling. Accept that emotions are natural and helpful. Learn that mood changes don't come "out of the blue" — they are always started by an event, a memory, a dream. Use the Mood Journal to identify what starts your mood changes.

• Challenge depressed thinking. People with depression remember and blame themselves for bad events, while they forget about and give others credit for good events. Their low expectations mean they often don't prepare adequately and give up too easily. Worst, they think they are essentially different — damaged somehow — from other people. These are all learned habits of thought that can be unlearned. Pay attention to your assumptions and beliefs.

• Let others know. Depressives fear intimacy more than most people. We put on masks for the world, because we believe our true selves to be shameful, unworthy. But this belief is wrong. When we're with someone we can trust, sharing our thoughts and feelings — even if they seem unimportant — is good for us.

• Take care of your self. Learn to pay attention to messages from your body. Depressives abuse themselves by not eating right, not exercising, then expecting to work 12 hours straight. They will deny a minor ache or pain until they have an ulcer or a chronic back condition. Take time for moderate exercise, eat healthy but delicious meals, and allow yourself some pleasure in life.

• Practice detachment. We spend far too much time and effort trying to control things that aren't worth the struggle. Many things that worry us are really unimportant; we've just gotten overinvolved and lost our bearings. We may find that we're trying to change things that we realistically cannot change. Instead of battering your head against a brick wall, learn to walk away.

To learn more about depression and Dr. Richard O'Connor visit http://www.undoingdepression.com

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