Depression Treatment News
Reported rates of depression have increased dramatically in the last few years, possibly related to the COVID-19 pandemic and its associated stressors, like social isolation (1). However, it seems that many people who report depression symptoms are not getting treatment (2) while others are questioning whether antidepressant medications are as safe and effective as we’ve been told (3). And while there have been some new and promising treatments, they are not widely available due to cost and lack of access. That’s the bad news, in a nutshell. The good news is that there are many proven effective non-medical alternatives for treating depression. This article will briefly summarize current medical treatments for depression as well as alternative treatment options.
New(ish) medical treatments include Transcranial Magnetic Stimulation (TMS) and Psychedelic-assisted therapy, of which ketamine or Spravato is the most well known. TMS and Spravato have both been approved by the FDA for “treatment-resistant” depression, which simply means depressive symptoms that haven’t responded to conventional treatment with a medication like Prozac or Zoloft, the selective serotonin reuptake inhibitors (SSRIs).
TMS involves having your brain “zapped” by electromagnetic charges. While that may sound scary, it is painless and relatively risk-free, with a fairly good success rate. The downside: it must be administered at a doctor’s office in a series of sessions, usually about 30 over six weeks, and it’s expensive if your insurance plan doesn’t cover it. Recently, researchers at Stanford University School of Medicine have developed a new version that can be completed within five days, which could be a game-changer if it’s approved by the FDA and covered by insurance (4).
Ketamine has been around for a long time. Originally developed as an anesthetic, it became popular as a party drug due to its hallucinogenic properties. Some doctors have been using ketamine infusions on an experimental (“off label”) basis to treat depression, which again is fairly costly and not covered by most insurance plans. I have a few patients in my practice who’ve had this treatment; while one experienced remarkable results, the others did not. In 2019, the FDA approved a nasal spray version of ketamine, Spravato (5). I don’t know anyone who’s used Spravato, so I can’t speak to its effectiveness, but at $3000 to $6000 per month, and with no research on its long-term effects, it’s simply not a viable option for most people. If you’d like to learn more about ketamine treatment for depression, see the notes below for a link to a fairly readable scientific article (6).
Another psychedelic drug currently being studied as a depression treatment is psilocybin, the active ingredient in “magic mushrooms” (7). A recent study found that just 2 doses could relieve depressive symptoms for up to 12 months (8). Psilocybin is classified by the federal government as a controlled substance, and therefore cannot be prescribed by a doctor nor obtained over-the-counter, though a number of states and cities have recently passed legislation to decriminalize it. There’s a lot of money being poured into psilocybin research right now, and many universities have established centers for psychedelic research, so one way to get this treatment may be to join a clinical trial (9).
Meanwhile, as doctors are prescribing more antidepressant medications than ever, others are questioning the efficacy of these medications, and whether their risks outweigh any benefits. A recent analysis in a respected medical journal concluded that “the real-world effect of using antidepressant medications does not continue to improve patients’ health-related quality of life over time.” (10)
We have been taught to believe that SSRIs (selective serotonin reuptake inhibitors) are safe and non-habit forming, so they can be taken indefinitely, and also discontinued easily. This is only partially true. SSRIs do have fewer harmful side effects than the older generation of depression meds. They are not addictive in the same way that opiates or benzodiazepines are, meaning you won’t develop cravings. However, their effects and side effects are definitely not harmless, quitting them abruptly can have negative consequences, and many people have found that even a tapered withdrawal may cause unpleasant effects, which can last for months or years in some cases. A study published in The Lancet, the British medical journal, in 2019 demonstrated that withdrawal from standard antidepressant medications is much more protracted and difficult than most doctors believe. (11)
I just watched a very interesting webinar on Antidepressant Drug Withdrawal Syndrome, which is a real problem for many people, so whether you are on an SSRI, thinking about taking one, or wanting to get off one, you might want to watch it too!
So what can we conclude from all of these studies? First, the mechanisms of how antidepressant medications work are still poorly understood. The theory that depression is caused by a chemical imbalance, specifically a lack of serotonin, has not been scientifically proven, in fact there’s very little evidence for it.
Second, depression is not like getting the flu or strep throat. There’s often no clearly identifiable cause, such as a virus or bacteria that can be tested for. There isn’t a predicatable course of illness. It shows up differently in different people, and even in the same person at different times. There’s debate about whether it should be considered an illness, for these reasons. Maybe it’s just part of the human condition? And third, we need to keep in mind that research on new treatments is usually funded or sponsored by pharmaceutical companies, who routinely sacrifice scientific rigor in their drive to push a new product to market, putting profits before people’s health and well-being.
There are many alternative treatments for depression, most of which are cheaper and have few or no side effects; many have been scientifically proven to be effective. Let’s start with dietary changes. Did you know that 95% of the body’s serotonin is produced in the gut? As Leslie Korn writes in Nutrition Essentials for Mental Health, “the standard American diet, consisting of overly processed foods containing refined sugars, leads to chronic inflammatory states and neurotransmitter imbalances. Inflammation is now understood to underlie most mental illness, including depression. Chronic low-level inflammation contributes to depression and cognitive decline.” (12) Read my blog post about how dietary changes can improve mood here.
Other effective approaches for treating depression include behavioral changes, especially improving sleep quality and increasing exercise; herbal remedies (St. John’s wort, tryptophan, 5HTP); nutritional supplements (Omega 3 fish oil, vitamin D, and B vitamins, especially folate); self-help groups (the Depression and Bipolar Support Alliance); social support networks, and various forms of psychotherapy, including cognitive-behavioral therapy (CBT and ACT) and of course my favorite, Mindfulness-based Cognitive Therapy (MBCT). MBCT has been proven to be at least as effective as antidepressant medication in preventing the recurrence of depression (13).
That’s the real news about depression treatment: if you start with improving sleep, exercise, and nutrition, then add social support, CBT, and mindfulness, it’s possible to achieve better and longer-lasting recovery from depressive symptoms, at least for many people. So rather than keep chasing after that elusive “magic pill” (which I don’t believe exists) doesn’t it make more sense to try some of these alternatives?
NOTES
- According to the most recent National Survey on Drug Use and Health, taken prior to 2020, depression rates were already rising among teens and young adults
- Trends in U.S. Depression Prevalence From 2015 to 2020: The Widening Treatment Gap, published in the American Journal of Preventive Medicine, 63(5)
- Antidepressants Don’t Work the Way Many People Think, by Dana G Smith, New York Times online edition,11/8/22
- The short timeframe Transcranial Magnetic Stimulation developed at Stanford University School of Medicine, NPR 2/6/22
- FDA approves Spravato (esketamine), a nasal spray for “treatment-resistant” depression, New York Times online edition 3/5/19
- A fairly readable scientific article to learn more about Ketamine treatment for depression
- This is a good overview of Psychedelic-assisted therapy
- Recent study on Psilocybin treatment for depression at Johns Hopkins University
- If you’re interested in How to find Psychedelic therapy, including how to enroll in a clinical trial
- Analysis concluding that antidepressants don’t improve quality of life
- The seminal study in The Lancet demonstrating the antidepressant withdrawal syndrome is real
- Korn, L (2016) Nutrition Essentials for Mental Health
- Kuyken, W., et al. (2016). Efficacy of Mindfulness-Based Cognitive Therapy in Prevention of Depressive Relapse: An Individual Patient Data Meta-analysis From Randomized Trials.
Back from Burnout
It’s been a while since I’ve written here – let me explain my absence. Early this year I began to recognize the signs of something resembling burnout in myself, and decided to take the advice I often give to my patients, to take a step back from some of my activities and responsibiilities in order to focus more on my well-being. The activities I chose to give up were writing blog posts and newsletters, teaching online mindfulness classes, and taking new patients.
At the time I thought this “break” might last for a month or two, but as it turned out, I needed much longer to heal and restore what was depleted in me. It wasn’t as simple as “get more rest,” nor was it about setting boundaries or saying no to excessive demands on my time. That’s the prescription for typical burnout, but this was a different kind of emotional exhaustion. I practice what I preach about self-care, so I was getting plenty of sleep, regular exercise, and healthy nutrition, and I’ve got good boundaries. Then why was I so exhausted?
I am a “silver lining” person, usually able to find the good or beneficial even in the worst of circumstances, and I had been doing that for the first year of the pandemic, but then it stretched into two (now three) with no clear end in sight. Those first months of the lockdown were hard, but there was a sense of “we’re all in this together” that made it feel more like an adventure. Then when vaccines became available, there was a sense of relief, and hope that this would be over soon. Instead, it got worse, fueled in large part by all of the people who refused to get vaccinated, mostly for reasons that made no sense to me. I no longer felt like we were all in this together.
I am also a person who has always felt a deep connection to Mother Nature, and when my batteries need recharging, I head to the woods, or the ocean, or just my garden. During the lockdown, I was grateful to have a yard and garden, and to live in a neighborhood that’s safe to walk in, where I could access trails into the hills. I was able to spend more time outdoors, which helped, but it’s also depressing to try to grow things during a prolonged drought, and with all of the extreme weather events (remember that day in August 2020 where the sun never came out, and it felt like we were on Mars?) Forest fires, hurricanes, floods and mudslides – we are experiencing the harsh reality of what our reliance on fossil fuels has done to the planet, and yet, people aren’t changing their habits, and fossil fuel companies have doubled down.
On a related note, I’d been working hard to maintain my optimism for the benefit of my patients and students, as well as colleagues and friends, all throughout the dark years of the previous administration. But here we are, still living under that dark cloud six years later, with nearly a third of adult Americans still believing the lies about a stolen election and voter fraud. Those lies and the people who promote them threaten the very foundations of our democracy.
As I write that last paragraph I realize I risk losing a few of you as readers, which points to one of the gravest concerns that I have about the world we are living in today: we seem to have lost the ability to even listen to, let alone respect differing views, opinions and perspectives. That factor alone has affected my motivation to write, because I believe what makes something worth reading is its potential to stimulate thought, challenge existing views, and offer a new perspective. And I simply can’t pretend things are okay when they are definitely not okay.
My training as a psychotherapist was traditional, in that I was taught to keep my personal views and opinions separate from my work with patients, and to not share anything about my personal life. When I was a young therapist, still in therapy myself to heal my own childhood wounds, that proscription suited me nicely. But over time, as I healed and matured, and as the field of psychotherapy itself changed, I began to share more of myself with patients. I brought my experience with therapy, 12-Step programs, and mindfulness meditation into sessions. I “showed up” for my patients in a new way, which not only felt more authentic for me, but also allowed the work we were doing together to go to a deeper level. This was more satisfying for me as a therapist, and led to deeper levels of insight and healing for my patients.
I experienced a similar sense of satisfaction teaching mindfulness classes, as I was able to observe my students struggle with the practices week after week, and then suddenly have an “aha” moment that was transformational, perhaps life-changing. Even when I was teaching in the evening, after a long day of seeing patients, I would come home feeling grateful to be doing this work.
But the satisfaction, gratification, even joy that I experienced from my therapy sessions and mindfulness classes began to dissipate once everything moved online. I didn’t notice this right away, as I was so busy just mastering the technology, and relieved when it all worked and we could see and hear each other. And I was glad to be able to still provide support to my patients and students, as we all struggled through that initial phase of the pandemic.
Soon it became clear, however, that something was getting “lost in translation.” A day of Zoom sessions would leave me depleted, rather than nourished. Many of my colleagues noticed this, too (though I wasn’t seeing my colleagues in person anymore, either). Eye strain was part of it, as was the distraction of seeing myself as well as my patient on the screen. Phone sessions were easier in a way, and yet the challenge remained one of establishing a genuine connection. Telehealth can easily become simply a check-in. I noticed that mindfulness classes became more superficial, too. It’s difficult to dig deep into someone’s experience when you can’t see what’s happening in their body.
What I’m getting to here is what I’ve come to understand as a primary cause of my burnout: the loss of personal connection. Zoom and FaceTime are great tools that clearly have value as a way to connect, and I appreciate their convenience, but I think we’ve all come to realize that something gets lost, and that something is an intangible, hard to measure or define, energy. Without getting all “woo woo” I’ll just say, science has shown us humans are energetic beings, and we are biologically hardwired to read each other via “body language.” We also need each other’s physical presence for emotional regulation. We are “wired for touch.”
There’s another piece here for me, which is so personal that I’m hesitant to share it. During the past two years both of my adult sons moved to the East Coast, one of them taking my new grandson with. Talk about a loss of personal connection through touch! I wholeheartedly supported their moves as being right for them, and was able to appreciate what the Buddhists call “sympathetic joy,” when you’re happy for someone else’s happiness, even if it may cause you unhappiness. But still, it’s been a loss, one that I know many of you can relate to.
It’s not just my own lost connections that depleted me. As an empathic and highly sensitive person, I have felt a collective grief for the loss of millions of lives to COVID (a trauma that we have not fully acknowledged as a society). And I feel the effects of the many ways in which all of us have become isolated and disconnected from each other, both as a result of the pandemic as well as the polarized political climate. The positive energy I had once felt from the #MeToo movement and Black Lives Matter dissolved into despair, as women’s rights and BIPOC rights are increasingly threatened everywhere, ultimately at the level of the US Supreme Court.
There are objective data that confirm this societal trauma: we’ve seen significantly higher rates of anxiety, depression, substance abuse and suicide, not to mention increases in domestic violence and gun violence, over the past couple of years. Besides political and economic factors, there’s a biological explanation for this too: when human beings lose their sense of connection with other humans, despair, hopelessness and alienation take over.
I didn’t arrive at this self-diagnosis until after I’d already embarked upon its cure. Sometimes we can only see clearly in hindsight; action is necessary before insight appears. As I began to see more patients in the office, led a few mindfulness meditation groups in-person in the park, and finally felt safe enough to travel to visit my sons and their families, my personal dark cloud began to lift. I also focused on “changing the things I can,” as the Serenity Prayer reminds us. This turned out to involve a move to a new home, with a dedicated and Zoom-friendly home office (after two and a half years of improvising) as well as a last-minute decision to find a way to keep my Pleasanton office, which I’d barely been using. Both decisions required navigating through uncertainty and letting go of control, but ultimately feel right.
Now I’m gearing back up to see patients two days a week in the office, following COVID protocols, while continuing to offer telehealth sessions the other weekdays, which feels like a more sustainable balance. I am also planning some in-person mindfulness classes for 2023, starting at Las Positas College in January-February. Today I’m meeting some new colleagues for lunch. And I am really looking forward to taking a week off next month for my first in-person meditation retreat in several years!
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Burnout in the Helping Professions
“There’s no shame in taking a step back to focus on self-care.” As I was saying this to one of my clients recently, it hit me: if I truly believe that, then I need to practice what I preach! It was obvious to me that my client was suffering from burnout, due to the demands of her job as a mental health professional as well as her family caregiver responsibilities, and equally obvious that she absolutely deserved to set some boundaries, ask for help, and take a break to recharge her batteries. And yet, even though I was beginning to see signs of burnout in myself, it was a real struggle to acknowledge this, and give myself the same permission to step back.
This is the dilemma that many of us in the helping professions face: if you’re a nurse, doctor, psychotherapist, social worker, or teacher, you may have received training to recognize the signs of burnout, and you may know what to tell your patients, clients, or colleagues to do to relieve it. In fact, you might spend your days counseling others to take a step back, set some boundaries, reach out for help, and get some rest. But when it comes to you, you’re far more likely to tell yourself to just push through the exhaustion, and ignore the growing cynicism and feeling of detachment from the work that you used to love.
So what exactly is burnout? The World Health Organization (WHO) defines burnout as “a syndrome resulting from chronic work-related stress, with symptoms characterized by feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and reduced professional efficacy.”[1] It is not a medical condition or mental disorder.
Christina Maslach, professor emerita of psychology at UC Berkeley and co-author of the Maslach Burnout Inventory (MBI), describes burnout as “feelings of exhaustion, inefficiency and cynicism, defined by a detachment from work and a lost sense of meaning.”[2] Developed in 1981, the MBI was the first instrument to measure burnout, and remains widely used today.
Are people in the helping professions more likely to experience burnout? According to recent surveys [3,4], burnout seems to be growing among workers across occupations, fueled by COVID-19 pandemic-related trends in working from home, remote schooling for children, and staffing shortages. But healthcare workers and educators have been hit the hardest, and even prior to the pandemic, these occupations have historically been most impacted by burnout. To understand why, we can examine the traits of people who are most vulnerable to burnout, but even more importantly, we need to look at the characteristics of jobs that burn people out.
Burnout doesn’t happen to slackers, but rather to those who are the most conscientious and hardest working, and who regard their work as a calling.[5] The traits of people who are most vulnerable to burnout include:
- Being a helper, by nature or occupation;
- Scoring high on conscientiousness and agreeableness (Big Five Personality test);
- Taking pride in one’s work ethic and dedication;
- When the going gets tough, they don’t quit, they just work harder; and
- They believe that asking for help is a sign of weakness.
Do any of those ring true for you?
Burnout is caused by chronic and excessive job-related stress, not by any deficiency in the individual. The characteristics of occupations that have highest rates of burnout include:
- Involving the provision of direct services to people in the areas of health, mental health, and primary education;
- Responsibilities are loosely or vaguely defined, additional responsibilities are constantly being added;
- Success is difficult to measure, there’s never an endpoint or goal post;
- Rewards are intangible, few, or fleeting;
- Job demands exceed what is humanly possible, given time and resource constraints.
Therefore, it is increasingly difficult to do the job well, or meet the needs of those you are supposed to serve. Does this sound like your job?
How do you know if you’re suffering from burnout? In my experience, these are the key signs:
- You’re more impatient or irritable than usual;
- You don’t feel well-rested after a night’s sleep;
- You’ve stopped doing activities that normally bring you pleasure or involve self-care;
- You find yourself saying or thinking more often, “I just don’t care” about your job; and
- You don’t feel ready to go back to work after your regular days off.
You may also find yourself getting more and more behind on routine work and household tasks, and thinking more often about quitting, changing jobs, or retirement.
A key point: burnout is not the same as depression. Because there is a significant overlap of symptoms, those who are suffering from burnout may believe, or may be told, that they’re clinically depressed, however, the causes of burnout are different, and so is the treatment. (Of course, it’s possible to have both burnout and clinical depression, in which case you will need to address both conditions.)
What is the treatment for burnout? Ideally, a signficant amount of time off work. For some people, a couple of weeks might be enough, for others, a month to a year may be needed. Of course, this is not possible or realistic for many people, so then you will need to implement these self-care tasks while continuing to work:
- Start with setting some boundaries. Learn to say “no,” or “not now,” and let go of any non-essential tasks;
- Ask for help from colleagues, or delegate if you can;
- Prioritize getting more sleep and exercise, eating healthier, and reaching out to family and friends for social connection;
- Change your attitude or approach to work. Become willing to be “good enough” rather than “great;” commit to leaving work on time, or if you work from home, create boundaries to separate work from home and family life;
- Take some time to review your life goals, and what gives you a sense of meaning and purpose. If it’s not your job anymore, then begin to explore other options.
- Finally, I highly recommend seeking out a psychotherapist to assist you in this process.
When I saw my client again, she seemed a bit happier, and reported that she had set some limits with the family members who had been most demanding of her time. She’d also resumed her exercise routine, was making plans for a trip with friends, and was actively looking for a job that was less direct-service oriented. And how did I address my own incipient burnout? I have decided to take a break from teaching mindfulness classes, even though I love doing so, to give myself more time for rest, relaxation, exercise, and visits with friends and family.
Notes:
1. Burnout an “occupational phenomenon”: International Classification of Diseases WHO. 28 May 2019. Referenced in Wikipedia page on occupational burnout.
2. Christina Maslach, quoted in Zuckerman, C (2021, April 30) How to Beat Burnout without Quitting Your Job. NYT online, retrieved March 28 2022.
3. Survey by Robert Half Int’l, referenced in Maurer, J. (2020, December 16) Remote Employees Are Working Longer Than Before. Retrieved from SHRM HR Today, online ed.
4. Threlkeld, K. (2021, March 11) Employee Burnout Report: Covid-19’s Impact and 3 Strategies to Curb It. Retrieved from Indeed.com.
5. From “The Exhaustion Funnel,” handout from my MBCT course.
What Does It Mean To Move On?
In a recent poll, 70% of Americans agreed with the statement: “It’s time we accept that Covid is here to stay and we just need to get on with our lives.” New York Times writer Charles Blow cites this in last Sunday’s column, and goes on to say, “The number of lives taken by Covid in this country alone – north of 900,000 – is almost unfathomable. But, somehow the public has absorbed and reckoned with it in some way. We have taken on a Darwinian sensibility about it all, accepting it as sudden thinning of a herd, a form of natural selection. It is both sad and stunning.”
I’m not sure I agree with Blow’s take on the poll results. To me, they speak of denial rather than acceptance, in the same way that anyone grieving a loss has experienced those well-meaning folks who say, “it’s been three months (or six, or twelve), isn’t it time to move on?” Americans as a society don’t deal with death very well, it makes us uncomfortable, and as a result we don’t allow ourselves to grieve. Instead, we tell ourselves and each other, “move on.”
But just as most people are profoundly affected by the death of a loved one, and find it difficult to move on, it seems to me that we as a society have been profoundly affected by the events of the last two years – either caused by the pandemic or resulting from its politicization – and as a result, we are really struggling to reconcile what our eyes and ears tell us is true with what our minds want to believe, and with what our hearts are able to absorb.
Our minds want to believe that life is fair, that we live in a just society, and that if we “do the right thing,” we will be rewarded with a happy and successful life. Isn’t that what we were told, by parents, teachers, or other well-meaning adults (who also wanted to believe)? How do we reconcile these beliefs with what we have experienced?
The unfairness of who the virus’s victims have been: young people, parents of young children, healthcare providers, adults in their prime, beloved grandparents; the injustice of access to costly treatment options being a function of wealth, status, and race; the surges of contagion and hospitalization being driven by those who don’t do the right thing, who refuse to mask up or get vaccinated; and finally, the shock of realizing that even though you did everything right – masking, sanitizing, quarantining, getting vaccinated, social distancing, depriving yourself of life’s pleasures – still, you came down with the virus anyway. How do we make sense of it all?
The answer for many people seems to be, “move on.” In other words, just ignore what we’ve seen, stuff our emotions, numb out with more TV, social media, shopping, drinking or drug use, and pretend that we’re fine, totally fine. Is that what “normalcy” looks like? To me, that looks like delusional thinking and denial.
Denial, as I often tell my patients, is a normal defense mechanism, and as such, has a protective function, which is to cushion us from the full impact of a grief or trauma too big to bear. Most children and many adults will instinctively move into “magical thinking” following a loss or a traumatic event, where one part of the mind does know what has happened, but another part acts as if everything is perfectly okay. I think this may be what is occurring for many people.
Last spring people were talking about “languishing,” from an article by the organizational psychologist Adam Grant, that described what I and many others were feeling then – “a sense of stagnation and emptiness. It feels as if you’re muddling through your days, looking at your life through a foggy windshield.” Indeed, Grant seemed to capture the zeitgeist of the moment, however, that was a very different moment than the one we’re in today.
There was a guest essay in Sunday’s NYT, by executive coach Brad Stulberg, who references Grant’s article, and has this to say: “But now, nearly a year later, as with just about everything related to Covid, we’re sick of languishing too. We want to feel motivated, and to get unstuck. The question, of course, is: How?”
Yes. I have been wanting to feel motivated and to get unstuck, for months now. At first I thought maybe I was still “languishing,” but actually I don’t think that’s what’s happening, for me, or for most of us. I believe we are grieving, whether we know it or not. Whether or not in denial, we are numb, but not from “numbing out,” rather from the shock of recognizing that the losses we’ve experienced aren’t just a bad dream that we can awaken from.
We are also angry, perhaps very angry, yet without a clearly identifiable person or cause to direct our anger toward, just like what happens when a loved one dies. We may engage in bargaining, promising to be a better person or devote ourselves to a noble cause if we can just be done with this stupid virus, and feel happy again. And many of us have fallen into depression over the past year, as so often happens after a loss.
These stages of grief, familiar to most of us, were first described by Elizabeth Kubler-Ross, in her classic book, On Death and Dying. As I’ve discussed with many of my patients, the stages do not occur in a linear way, like chapters in a book, but rather as amorphous feeling states that we go in and out of over time, usually a long time, longer than we expect or want. We can experience all of them – denial, anger, bargaining, depression – at the same time, even as we have moments, days, or weeks of feeling relatively calm and “normal.” That’s what grief looks like. Doesn’t that seem a lot like what we’re experiencing today?
There’s another stage of grief that Kubler-Ross identified, which because she listed it last, we tend to assume is the final stage: acceptance. Actually, acceptance comes and goes just like the other stages, though it does tend to grow over time as the reality of our loss(es) sinks in. Some people have the mistaken belief that acceptance means “I’m A-okay with what happened, and I’m good to go now,” in other words, moving on. However, that’s not what Kubler-Ross meant, as she was really writing about the experience of the person who is dying, coming to a place of peace and acceptance of their fate. Circle of life, and all.
Acceptance, for the loved ones who remain living, is actually a starting point, rather than an end to grief. As David Kessler, a student of Kubler-Ross and author of Finding Meaning: The Sixth Stage of Grief, writes, “meaning is not in the death itself, or in how they died, but rather it’s what is in us afterward.” The process of grieving can be transformational. It has the potential to transform us into a wiser and more compassionate human being, or it can leave us bitter and uncaring. Which path will you choose? Kessler reminds us, “we can’t heal what we don’t feel.”
I believe that it is going to take years for most of us, both individually and collectively, to truly make sense of what we’ve lost during this pandemic, and come to an understanding of how that loss has transformed our lives and our world. We will be making progress when we can acknowledge the enormity of our losses, and start talking about how we’ve been affected.
A letter to the editor of the San Francisco Chronicle caught my eye yesterday morning, as I was reading the paper over breakfast. Unlike most letters to the editor, it reads like a poem, and I quote it in its entirety here, having received permission from the author, because she sums up my thoughts and feelings more eloquently than I can:
An Open Letter to my fellow Americans
“Let’s move on,” everyone says
But, there is no where else to go
This illusion of movement to a future promised land,
just beyond the horizon of inconveniences
“Let’s get on with our lives,” you say
Have you been asleep all this time?
Haven’t we all been living our lives through the mess, the sorrows, the death and disease? What is this life you’re so anxious to get on with?
Will it look so much different than the now-moment you’re in,
that you proclaim so loudly in my ear and make such a fuss,
so I can understand what you’ve given up?
Truth is, your life will go on looking much the same
Many of you haven’t given up all that much
The illusion of normalcy, whatever that is
The luxury of not hearing about one million dead Americans
The permission to stop caring
It’s not easy, with one’s hearts and eyes open to a painful truth
But it’s not all bad
Because we are here
And that means we’re alive
Breathing, beating, dancing alive
Every morning a song
Every evening a prayer
This is our lives
The unbearable weight of being here.
(Alicia Parker, MFT)
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The Year of Wait and See
Well, we’ve made it to the end of 2021 – what a weird and wearying year it’s been. A year of “wait and see,” of plans made, changed, cancelled, then made and changed or cancelled all over again. It’s been challenging to live with so much uncertainty, hasn’t it?
As a trauma counselor, I’m familiar with the emotional numbing that can happen when the nervous system is bombarded with threats to one’s well-being; lately I’m seeing this not only in many clients, especially the educators and healthcare professionals, who have dealt with the worst of it, but a bit in everyone, myself included, as we are all bombarded with threats to our whole society’s well-being, which I shall not enumerate here – no doubt you are well aware.
This is also the time of year that people who are prone to seasonal depression, like me and some of my clients, may struggle even without a pandemic. It’s been hard to sort out what part may be SAD (seasonal affective disorder), triggered by the loss of sunlight, versus normal sadness about all of the pandemic-related losses we’ve witnessed or experienced.
And yet there was much to be grateful for this past year, in my life and I hope in yours. First, I was among the first to be vaccinated, and now I’m boosted too, and so far have avoided getting the virus. The same is true for most of the people I know. With the vaccines and boosters have also come new treatments for those who do get COVID, so that even as we are dealing with a new, more contagious variant right now, the chances of getting seriously ill or dying from it have been dramatically reduced.
Second, the world has opened up again. It’s hard to even put into words how nourishing it was to be able to return to live music performances this summer and fall, in venues where I felt safe because proof of vaccination and masking were required. I’ve heard similar feelings from many others. Support for the performing arts has never been stronger. And while some events got cancelled recently, and some holiday plans changed due to the virus or the crazy weather, still the stores and restaurants remain open, and judging from the full parking lots at the shopping mall across from my office, business is good!
After last year’s lockdowns, shutdowns, and other deprivations, our gratitude for what we have grew.
We learned to appreciate what’s most important, and for most of us, being able to get together in-person with at least small groups of family or friends is top of the list. If we can just do that, we’re okay. We didn’t miss the commute to work, or long days in the office, and we learned that an awful lot of jobs can be done just as well remotely. Even, apparently, psychotherapy. While I still prefer seeing clients in person, I learned that for some clients, a Zoom or phone session is actually preferable.
And I never thought I’d say this, but when our neighborhood pool re-opened in May, for the first time in over a year, I couldn’t wait to get up at dawn to plunge into a cold body of water! I’ve learned how important my morning lap swimming is to my overall well-being. To paraphrase an old saying, perhaps a pandemic is the crucible in which all life’s lessons can be learned. What new insights or life lessons have you gained in the past year? And how would you like to apply them, going forward?
“Come, look up with kindness yet,
For even solace can be sourced from sorrow.
We remember, not just for the sake of yesterday,
But to take on tomorrow.”
(from New Day’s Lyric, by Amanda Gorman, published in the SF Chronicle, 12/31/21)
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