Shirah Vollmer MD

The Musings of Dr. Vollmer

Downward Spirals…

Posted by Dr. Vollmer on March 11, 2013

Manheim, thirty-three does not really see the point of getting up in the morning. He is recently divorced, unemployed, overweight and missing his two young daughters, ages four and two. He feels “useless” and “ugly,” he tells me. “You do not want to get out of bed, and then at the end of the day you are mad at yourself for not doing anything. You have yourself trapped in a space which pushes you down further every day.” I say, trying to help Manheim understand that his negative mood leads to low productivity which then leads to a more negative mood. “I wonder if there is a way you can turn that screw around so you go up and not down,” I say, pointing out that this is a series of negative events which will get more severe if he does not jump-start his life, in some way. My narrow path is that if I am too blunt, I risk making Manheim feel worse about himself, and yet, if I am indirect, then he will withdraw even further away from me. He needs a hand to pull him up, but at the same time he gets a hand, he tries to pull that hand down. This delicate course means that my hand pulling up has to be stronger than his hand pulling down. This strength often comes in the form of directness, as this kind of communication conveys the power of my conviction that one positive move can turn the spiral the other way. “It sounds like you get waves of depression,” I say, understanding that at certain times the black sets in, and he cannot see clearly, but also understanding that this black state is not constant. “You need to push forward after the wave recedes.” I say, reminding him that his moods change, allowing him to take positive steps in his life. Manheim felt understood and for this, he thanked me as he left my office. He did not necessarily feel less depressed, but he did feel less alone, he told me, such that he does not know if he can turn his life around, but he did know it was good to share his dark thoughts.

11 Responses to “Downward Spirals…”

  1. Jon said

    I find that when I am in one of the “black states” there are two things that help – talking with friends and just putting one foot in front of the other.

    For Manheim, you, Shirah, are able take the part of a friend – someone who cares. That is most helpful. Even better would be having a larger support network.

    The statement, “You need to push forward after the wave recedes.” is true, but Manheim might even be able to push forward when his wave of depression is still incoming. If he is able to see a few practical things that need doing, and do them, then that activity alone might be able to help change the tide.

    • Yes, I agree Jon, but depending on the severity of the wave, sometimes one can “man-up” and other times the wave is just too big. Therein lies the complexity of depression. Thanks.

  2. Ashana M said

    I know this cycle intimately. The problem is the belief that one’s life has no purpose. Life without his daughters is so painful it doesn’t feel worth living. I haven’t found anything helps with this (other than medication) aside from acknowledging the terribleness of one’s losses.

    • Yes, the loss must be grieved, hopefully followed by the ability to nurture others, as in this nurturing comes deep satisfaction. Thanks.

      • Ashana M said

        I would question whether the same activities are satisfying for everyone, but I agree it would be followed by something else that provides purpose and meaning in life.

        • Shirah said

          Yes, I agree that it is never one size fits all, but as a general principle, when people try to help others, including animals, then there is greater life satisfaction.

          • Ashana M said

            Interesting. Are there published studies you could point me to? I do know that people generally become more helpful people when they begin to help. Thanks.

  3. Holly said

    Shirah, it is so true regarding the nurturing of others. It can bring deep satisfaction as well as potentially providing some of the answers to one’s neurotic dilemmas, and an antidote to feeling a lack of agency in one’s life.

  4. Shelly said

    The problem with the blackness is that one feels that one has no purpose in life and that one’s life has no meaning. As if one is transparent or doesn’t exist and that life goes on without you. Yes, these feelings wane and it surely does help to have caring and supportive friends, but people suffering from depression can’t simply “man up” and overcome their illness. Everything seems black. They know that their symptoms will go away but at the time that they are living them, it is intensely painful for them (and those who live with them).

    • Shirah said

      Yes, Shelly, I agree. There are degrees of blackness and those that have not gone to the depths have a hard time understanding the difference. Thanks.

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