When therapy doesn’t work

I'm suicidal a year after my miscarriage. Nothing helps

Topics: Since You Asked, depression, Suicide, Miscarriage,

When therapy doesn't work (Credit: Zach Trenholm/Salon)

Dear Reader,

I’m so happy to report that the  June 2012 issue of The Sun features a generous excerpt of “Citizens of the Dream,” my book about creativity.

It’s deeply gratifying that The Sun saw fit to showcase the book.

Dear Cary,

What happens when therapy doesn’t work?

I’ve battled most of my life with depression, the causes of which are probably not of very much importance (absent alcoholic father, frequent moving, mentorless young adulthood, spotty employment, fear of commitment, and the crowning insult, a miscarriage and the end of a relationship). Perhaps these things, along with hopefully some joys and accomplishments, are just things that make up life. Unfortunately, I have been short on joys and long on disappointment, which has led me to become a very negative person.

After my miscarriage last year, I decided to give therapy yet another chance. Despite going into it with an open mind, I have come to the realization that no one can help me. Not a therapist, not my mom, not any friends, not my astrologer. Sure, people will listen for a while. They will give well-meaning advice and pep talks. They may even tell me that I am full of good things and that the world is a better place with me in it. I have even tried things like pharmaceuticals, acupuncture and the like. I’ve done all the things that are suggested to people like me. Volunteer! Exercise! Take up a hobby! Do some yoga! Meditate! None of it helps, and all I want to do is end the pain in the only way I know how. I know that this will cause those around me to suffer, but I cannot hang around and be miserable indefinitely just so three or four people don’t have to deal with my loss and be sad for what, two or three weeks, plus maybe around the holidays?

I would like to know your thoughts about someone like me. I’m sure that there are many others for whom therapy was not helpful and who continue to suffer every day.

Miserable in Paris

Dear Miserable in Paris,

You will get over this depression.

A significant number of women remain depressed almost three years after a miscarriage.

But they come out of it. You will, too.

One study showed that 13 percent of women who had a miscarriage remained depressed 33 months after. That’s almost three years.

The fact that you are still depressed does not mean therapy didn’t work. It means you’re not there yet.

While you’re getting well, when thoughts such as “Therapy doesn’t work” and “No one can help me” arise, tell yourself what bipolar author Terri Cheney tells herself: “That’s my depression talking.

Of course, let’s be intellectually honest and admit that life has a tragic dimension. People will die unhappy. Some of us will not be able to rise out of whatever it is we are stuck in. Some of us will die senselessly in automobile accidents, others will be tortured by madmen, others will commit unspeakable crimes and get away with it, others will put guns to our heads and the trigger will jam …

To be equally honest, life has a miraculous dimension, and some of us will wake up one day and realize it’s not so bad after all, and our hormones will balance out or our neurotransmitters will start transmitting after being jammed, or we will eat the right carrot or see the right television infomercial and buy a juicer or get a crystal that cures us, and we will walk barefoot on the sunny streets of Santa Barbara believing that a fortune teller in Venice read our palm and everything is settled now, nothing to worry about, everyone is fine.

While we’re at it, let’s admit that no one really knows. But I want to be one of the ones who says, I want you to make it. I believe you will come out of this depression. I have been depressed myself, and I have read about depression and followed treatment regimes and read many letters from depressed people and talked to depressed people, and my experience has been that most people come out of it if they don’t kill themselves. So don’t kill yourself. Give your body time to heal. If you need to crawl into bed and stay there for a few days, do it. But also do the things that will eventually bring you out of it.

Maybe no one thing you do will cure you of depression. But each thing you do will help a little bit: eating well, exercising, talking about your experience with other women who have experienced the same thing, doing yoga, meditating, sleeping well, walking in fresh air, reading books with hopeful messages, studying “Feeling Good” by David Burns and doing the exercises in it, continuing therapy or finding a new therapist who will be more engaged, taking time off, getting a massage, doing breathing exercises, taking vitamins, getting your hair cut, doing one nice thing for your body every day, staying out of situations that make you depressed, seeking out laughter, seeing funny movies, staying away from alcohol and caffeine, taking a sauna, swimming, sailing, riding a ferry, being in the mountains, taking a long drive to a resort, seeing a great chamber orchestra, hearing jazz, giving money to street musicians, riding the Metro, buying some clothes, talking on the phone to people who really love you, petting a dog, going to a museum, standing on the Seine watching the tourists go by in boats, walking by Cathedral Notre Dame, taking the Eurostar to London, eating a croissant, checking your adrenal glands, remembering to laugh every hour … all these things together may help.

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Still, you may remain depressed for a while. And it’s not easy to do what you need to do to get over depression when you are depressed. That’s the maddening thing about it. It’s hard to think well. It’s hard to form an intention and carry it out. I know. Yet we do what we can. We eke out a little life while waiting for rescue, while waiting in our shipwreck in our floating misery being eaten by the tides and pecked at by birds, while waiting to reach some kind of land and eventual comfort and bliss.

What happens when therapy doesn’t work is you keep trying. You try different things. You try cognitive therapy. You try everything. You try nutritional supplements, and you don’t stop any one thing. You keep doing all the things that could possibly work. You keep an open mind. You try antidepressants. You read and learn everything you can. You use your intelligence to tell yourself the truth, which is that you are going to come out of this, and then you try to believe yourself when you’re talking to yourself.

You tell yourself what happened: You had a miscarriage and a relationship ended and your support system fell apart, and you acquired a serious depression which you are eventually going to emerge from.

Here are some other things you can do. They may work and they may not. You might as well give them a try, while you’re waiting. Write down all the accomplishments you have ever had. Include things that happened in school and things that happened when you were a child. How were you able to take care of yourself and others in your household? Write down all the things you are proud of. Visualize the things you would like to have in the future. Visualize happiness. Visualize pleasure and exhilaration. How were you able to save others from abuse? How were you able to recover from trauma? What were the high points of your relationship? Envision them. Envision your happy moments.

Write down even all the little accomplishments you have had. Make a list of all the times you have felt happy. Look at them. See what elements they had. See if you can re-create some of those moments. Post this list on the wall where you can see it several times a day.

It can’t hurt.

As long as you are alive, you have a chance. Life, if you don’t die, is long. One or two years is not so long a time. I first visited a psychotherapist about 20 years ago, and I have seen several since then — four total. Four different practitioners of different healing arts, well, more actually, if you count others; and then there’s all the help I have gotten from individuals, and chance encounters, and all the meditation and exercise and walking and talking and traveling and reading and working.

I’m not depressed today. I’m listening to Bach, looking out over the garden, where there are purple flowers.

I would try everything. I would try fish oil supplements and exercise and vitamin B. I know for me nutrition is extremely important; I cannot have alcohol and only rarely can I drink coffee, and I must eat plenty of fish and vegetables and take vitamins. I must. I don’t care what the science says. That’s what I have to do.

Attitude also makes a difference.

We have this friend who thinks she is the luckiest woman in the world. She was walking across the street right in front of her house and a truck ran a stop sign and crushed her. She was dragged under the truck because the driver didn’t see her. But people saw her being dragged and screamed, and the truck stopped and she survived.

She’s in a wheelchair now but considers herself lucky because she survived. She was lucky enough to get an elevator put into her house so she could travel between floors more easily and not have to be carried. The thing is, with her roommate, they have to always remember to keep the elevator at the correct floor. Well, so her roommate’s friend comes over and leaves the elevator at the wrong floor. And she backs her wheelchair into the elevator and falls to the bottom.

But she survives! She considers herself the luckiest woman in the world because she survived.

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