“No man is an island, entire of itself. Every man is a piece of a continent, a part of the main.”
—John Donne
Eighth Week Overview
In this week you will learn ways to strengthen your connections with other people, thereby creating a solid foundation of social support.
In sharing my personal story of how I survived a depressive episode, I wrote that social support was an essential ingredient in my healing. Having loving relationships not only helped to alleviate my depression, but has also played a huge part in preventing its recurrence.
Social scientists have documented that social support provides a major buffer against stress, protects against mental decline, bolsters the immune system, and contributes to longevity. Our culture values independence and individualism. But when solitude is not balanced by connectedness, the ensuing isolation can lead to mental and physical illness. Conversely, when people experience meaningful connections with friends, work, a hobby, a pet, or anything beyond themselves, healing can result.
A dramatic example of this principle occurred when Stanford University psychiatrist David Siegel took a group of women with breast cancer and asked them to meet ninety minutes a week for six months. To Siegel's astonishment, the support group members lived twice as long as the women who received medical treatment but had no weekly group support.
Many other studies, such as those found in Dean Ornish's groundbreaking book Love and Survival, unequivocally demonstrate that love and intimacy promote mental and physical health. I have identified six levels of connection that I believe are extremely helpful to healing from depression:
Let's explore them in detail.
1) Family and close friends
This is often the first line of defense against emotional or physical illness. During my depressive episode, I was fortunate to have my wife Joan as my caretaker. In addition, I had three to four close friends who took shifts to help care for me.
In researching this section, I read numerous first person accounts of people who survived life-threatening depressive episodes. Each of these survivors—such as writer William Styron, TV reporter Mike Wallace, newspaper reporter Tracy Thompson and psychologists Kay Jamison and Martha Manning—had the loyal and steady supportive of family (spouses, family and children) and friends.1 As novelist and recovering depressive Andrew Solomon wrote:
Recovery depends enormously on support. The depressives I've met who have done the best were cushioned with love. Nothing taught me more about the love of my father and my friends than my own depression.2
2) A mental health professional
Not everyone is fortunate enough to have a loving spouse, parent, or close group of friends. However, there exist a great many qualified and compassionate health care professionals who offer care and treatment for depression. These include psychologists, psychiatrists, psychiatric nurse practitioners, clinical social workers, marriage and family therapists pastoral counselors, clergy, and drug and alcohol counselors.
By now, the eighth week of the program, you should be connected with a counselor, therapist and/or prescriber. If this is not the case and you would like to form such a relationship, please refer to the information contained in Week 2 of the program.
3) An ally/mentor
These include support people such as a rabbi, minister, priest, 12-step sponsor, teacher, coach, or any trusted person in whom with whom you can confide. Although you may not have a “professional” relationship with such individuals, they can nevertheless can be there to listen as well as to validate your feelings and help with problem solving.
4) Group support
A sense of belonging to a community makes us feel part of a larger whole which in turn promotes a sense of well being. Examples of group support include:
I have always been a huge believer in the power of community as it is expressed in groups. In his classic work, The Principles and Practice of Group Psychotherapy, Irvin Yalom identifies eleven “therapeutic factors” that are universally present in the group experience. These include:
The value of altruism is depicted by the Hassidic story about a Rabbi who had a conversation with the Lord about Heaven and Hell. “I will show you Hell,” said the Lord, and led the Rabbi into a room containing a group of famished, desperate people sitting around a large, circular table. In the center of the table rested an enormous pot of stew, more than enough for everyone. The smell of the stew was delicious and made the rabbi's mouth water. Yet no one ate. Each diner at the table held a very long-handled spoon—long enough to reach the pot and scoop up a spoonful of stew, but too long to get the food into one's mouth. The Rabbi saw that their suffering was indeed terrible and bowed his head in compassion.
“Now I will show you Heaven,” said the Lord, and they entered another room, identical to the first—same large, round table, same enormous pot of stew, the same long-handled spoons. Yet there was gaiety in the air, and everyone appeared well nourished, plump and exuberant. The Rabbi could not understand and looked to the Lord. “It is simple,” said the Lord. “You see, the people in this room people have learned to feed each other.”
Ever since hearing this story, I continue to picture the diners in heaven using their overly long spoons to feed each other across the table. Herein lies beauty of a group support—that in extending ourselves in compassion to help others, we become fed and nourished.
The Power of Social Support: Lessons Learned From Geese
Geese, like human beings, are social animals. Recent scientific discoveries about geese fly in a “V” formation reveal five important lessons about our interdependence and our need for each other.
Fact #1: As each bird flaps its wings, it creates an uplift for the bird following behind. By flowing in a big V formation, the whole flock adds at least 71% greater flying range than if each bird flew on its own.
Our Lesson: By sharing a common direction and sense of community with others, you get where you are going more quickly and easily because you are traveling on the thrust of one another.
Fact #2: Whenever a goose falls out of formation, it suddenly feels the drag of resistance flying alone, so it quickly gets back into formation and takes advantage of the lifting power of the bird immediately in front.
Our Lesson: There is strength, power and safety in numbers when we travel in the same direction with others who share a common goal.
Fact #3: When the lead goose gets tired, it rotates back into formation, and another goose flies at the point position.
Our Lesson. It pays to take turn doing the hard jobs and sharing the leadership. This means that sometimes you will be the pillar for others; at other times they will rely on your strength.
Fact #4: The geese in formation honk from behind to encourage those up front to keep up their speed.
Our lesson: We all need to give and receive active support and appreciation.
Fact #5: When a goose gets sick or wounded, two geese drop out of formation and follow it down to help and protect it. They stay with the goose until the crisis resolves. Then they launch out on their own with another formation, or they catch up with the original flock.
Our lesson: Like the geese, we need to stand by each other in times of need as well as when we are strong.
Check with your local hospitals, mental health centers, or the National Alliance for the Mentally Ill (1-800-950-NAMI) to see if any depression or anxiety support groups exist in your area. Or you may participate in one of the groups listed at the beginning of this section much as a 12-step group.
Another option is to start your own depression/anxiety support group, or ask a counselor to start one for you. For the past year, I have been facilitating such groups and can attest to how much more quickly people heal when they come together in community. Please refer to Appendix B to learn the specific steps that you can take to form a support group.
5) Community Service
Life's most persistent and urgent question is, “What are you doing for others?”
Serving others—by volunteering in the community or by helping someone in need—is a marvelous way to experience interconnectedness and to experience the therapeutic factor of altruism. A fundamental symptom of depression (and unhappiness in general) is self-absorption. Service allows us to transcend our suffering by shifting our focus away from ourselves. As author Tracy Thompson writes in regard to her own recovery, “Help others. Be of service. Only in this way will you find your way out of the prison of self.” In this vein, an article in Psychology Today reports that volunteer work leads to a phenomenon called “helper's high”—a physiological change in the body that produces physical and emotional well being, as well as relief from stress-related disorders.4
The amount of service that you perform does not have to be large. If you are feeling limited in your capacity to give, start with some form of service that requires a low level of commitment—such as nurturing a pet or a plant. Extending yourself even a little bit will be good for the recipient and good for you.
The Prayer of Saint Francis of Assisi
This is one of my favorite prayers and is a perfect expression of the principle of selfless service, a way of giving that comes back to us tenfold.
Lord, make me an instrument of Your peace.
Where there is hatred, let me sow love.
Where there is injury, pardon.
Where there is doubt, faith.
Where there is despair, hope.
Where there is darkness, light.
Where there is sadness, joy.
O, Divine Master, grant that I may not so much seek.
To be consoled as to console.
To be understood as to understand.
To be loved as to love.
For it is in giving that we receive.
It is in pardoning that we are pardoned.
And it is in dying that we are born to eternal life.
An intriguing example of the therapeutic value of altruism can be found in the life of Mary Todd Lincoln, wife of President Lincoln. She and her husband suffered clinical depression throughout their lives due to the early death of a parent—Abe his mother and Mary her father. (The death of a parent before the age of eleven is a major predictor of depression in later years.) In the midst of the Civil War, Mary experienced a second depressive breakdown, triggered by the loss of her favorite son and the absence of her husband who was preoccupied with wartime activities. Shortly after her boy's death, Mary began to volunteer as a nurse's aide in civil war hospitals. Although the drop of a book at home would have set off a panic attack, to the amazement of her friends Mary was able to stay calm amidst the sounds and shrieks of the tormented patients. By taking the focus off herself through serving others, she was able to transcend her fears.
6) Domestic pets and other animal friends
In addition to the support of human beings, I want to mention the support of animals, especially pets. The unconditional love that we give to and receive from our animal friends can be as healing as human love. (This is why pets are increasingly brought to hospital wards and nursing homes.) A loving relationship with a cherished pet provides a level of bonding and intimacy that can strengthen ones psychological immune system and help keep depression at bay.
I know of this connection first hand. In the depths of my depressive episode, I adopted a stray cat named Gabriel from the humane society. A month later, he was hit by a car. The operation to repair his fractured jaw was prohibitively expensive (I was unable to work because of my illness) and I considered the option of having him put to sleep.
Then a medical intuitive who specialized in working with animals told me that Gabriel was not ready to make his transition as he had “much more to do in this lifetime.” She encouraged me to proceed with the operation, saying that Gabriel was a mirror for me, and that as he regained his strength and vitality, so would I. Over the next six months, this is precisely what occurred.
To illustrate the healing power of animals, I share the following excerpt from a letter I received from one of my workshop students.
Dear Douglas,
Kansas City is now cold and wet—pretty typical for this time of year. I just wanted to let you know that my depression has been in remission since September 9th. That is a record of almost three years. Remember my crazy dog? Well he has grown and matured enough since you last saw him and had enough training to make him a Service Dog. He goes almost everywhere with me. My doctor gives a lot of credit for my new found health to the dog. He thinks the dog was sent by God with a purpose in my life.
Warmly,
Jenny
Expanding Your Support Network
Given the importance of social support to mental and physical health, it is important to ask ourselves, “How can I expand my circle of support? How can I meet new people and make new friends? “Having multiple source of support is especially important for anyone suffering from depression. Given the severity of the disorder, the depressed individual can easily “wear out” a friend or fmily member. As I learned through my own episode, it takes a whole village to see someone through a dark night of the soul.
Here are a few ways that you can create more support in your life:
Once you meet people, the best way to build supportive relationships is to spend quality time in mutually enjoyable activities—long walks, a meal, a movie or concert, etc. As you share common interests with people of like-mind, you will feel closer and more connected to them. At some point, you may wish to determine if a new friend is the type of person who can be of support to someone who suffers from depression. Ask yourself, “Is this person comfortable with intense feelings? Can he or she listen without judging or jumping in to fix the problem.”
If this is someone who you feel safe with and want to be a member of your “mental health support team,” you can do the following:
1) Ask if they are willing to be a supporter. Tell them what you need from the relationship.
2) Say that you are willing to be their supporter so that it is clear that the relationship is a two-way street.
3) Assure them that you have other people in your support network so that they will not have to be available for support at all times.
Blocks to Asking for Support
While people who suffer from depression and anxiety need more support than the average person, they often have the hardest time asking for it. Reasons may include:
Feelings of unworthiness and the fear of rejection and often lie at the root of many depressed people's social phobia. Both of these can be overcome through counseling, and in some cases medication. Try saying the affirmation, “I am a lovable person and who is worthy of support, attention, respect and love.” If your immediate response is, “No, I'm not!” you may want to explore the source of that belief. You'll probably find that it is rooted in the early childhood experience of not feeling unconditionally loved. This universal wound can be healed by creating “new imprints,” either with your therapist or another loving presence. Ultimately, you can learn to reparent yourself and give yourself the unconditional love and attention that you deserve.
Arnold Patent, an old teacher of mine, was found of saying, “The universe is a “mutual support system.” If we look at the interconnectedness among the communities on our planet as well as the symbiosis between plants and animals, we understand that we are not meant to go through life alone—or struggle with depression alone. Before my illness, I was a believer in the healing power of love and community. As I continue my recovery, I have come to believe that depression may offer a potential gift in its ability motivate us to reach out to others for connection, love, and support.
Sherry's Story: Early Morning Telephone Angels
In the latter part of December, just days before Christmas, I had just ended a 10-year relationship with a man I still have great feelings for. In addition, I became victim of an airborne mold which contaminated my rented apartment and made me extremely ill. The trauma of ending the relationship, losing my home, and the blow to my health, sent me into a severe depression. I soon became very suicidal, as I could see no way out of what was happening to me. I had discovered that my worst time was usually first thing in the morning, but that frequently if I talked to someone—even over the phone—I could get myself into a better frame of mind. I thought to myself, “Wouldn't it be great if I had a program in place where a someone would call me every morning.”
I shared my request with a minister at my church, and we put out the word for volunteers. I quickly was presented with seven people, for the seven days of the week. One person had promised to call me every Monday, another every Tuesday, etc. On the many days that I awoke with that horrible feeling in my head, I could always count on someone calling me at about 9:00 A.M. to check on me. They were there to listen, and to encouraged me to get dressed. Sometimes we would say a prayer; at other times my telephone angel would give me a simple affirmation to say throughout the day. On the days I woke up feeling pretty well, I could talk to my caller about the good feelings I had and about how to make them last the rest of the day.
It is now two months later, and I my healing is definitely happening. The people of church can see the great improvement. I am coming alive again. I am learning to focus again, to start my world over again. I have an apartment of my own again and am slowly finding that many of the personal possessions which I had been told I had lost have been cleaned and are being returned to me. What a blessing it is to know that I CAN reach out to people for help and that people really do care about me and will support me in any way they can.
I am truly grateful.
This Week's Goals/Assignments
Here are you assignments for the coming work:
1. Fill out the “Assessing My Social Support Inventory” and the “Social Support Goals Sheet” that follow. Choose a goal from this sheet as a goal for the week.
Ongoing Self-Care Activities
Assessing My Social Support
Please take a few moments to answer the following questions as a way of assessing the quality of social support in your life.
1. What makes a person supportive for me?
2. What are the main sources of social support in my life? (Choose from family, friends, work relationships, group support and ally/mentor). How often do I meet with these people?
3. How satisfying are my personal relationships? Can I be my true self with the people with whom I associate? Are there people in whom I can confide?
4. Do I feel loved, valued and appreciated by others? Do I have opportunities to express my love and caring to others?
5. Do I feel part of a community? Am I involved in any a regular support group such as a 12 step group or a master mind group?
6. Do I do volunteer work or belong to a social organization?
7. How is my social life?
8. What are some things that I can do to attract new support into my life?
9. Do I have any blocks to my asking for and receiving support? If so, how might I deal with them?
Creating Goals for Social Support
Using the answers from your wellness inventory, write down the social support you now have and the support that you would like to incorporate into your life.
Social support I now have:
1.
2.
3.
Social support I would like to make part of my life:
1.
2.
3.
Take one of these goals and make it a goal for the week.
My Goal Sheet for Week 8
This week's starting date_____________My coach/buddy ____________________
Date/time we will connect _____________________________
Goal or Goals _______________________________________________________
___________________________________________________________________
___________________________________________________________________
Benefits of attaining this goal____________________________________________
___________________________________________________________________
___________________________________________________________________
Action plan _________________________________________________________
___________________________________________________________________
___________________________________________________________________
Ongoing goals (check off the ones as you accomplish them)
______ Read my vision statement daily (upon awakening or before bed)
______ Chart my moods in the Monthy Mood Diary
______ This was my average mood on the better mood scale.
How was my mood this week?
Record your moods below for each day of the week.
Day | Mood | Comments |
Mon | ||
Tue | ||
Wed | ||
Thu | ||
Fri | ||
Sat | ||
Sun |
1 The books written by these authors are listed in the bibliography.
2 There are also times, though fewer, where relationships on the job can provide significant support.
3 I will discuss Master Mind groups in chapter on spiritual support.
4 Luk, Alan, “Helper's High,” Psychology Today, October 1988, Volume 22, #10, pp. 39, 42.