How to tell when a relative is depressed

Originally posted in the Santa Monica Daily Press July 25, 2013

Dear Life Matters,

I am writing to you because my wife’s mother seems very lonely and we are both worried about her. I love my mother in-law and we do our best to have her come by or to visit her as often as we can. But we both work and we have three children to care for as well.

On top of this, we can’t tell if she might be depressed as well?

Can you help us in whatever small way with seeing the difference and how we can help her?

Signed,

Forever Grateful

Dear Grateful,

It is so refreshing to hear of your very real concern. It is really nice that you care.

Loneliness is a pervasive problem these days, but there is an extreme problem with chronic loneliness in particular.

Many folks suffer from situational loneliness after a loss, death, divorce or even a job loss where you no longer have the same contact with your co-workers. Situational loneliness is normal and usually passes after a bit of time.

But chronic loneliness is truly painful and can actually lead to serious health problems, both physical and mental.

According to a number of studies, social networks are rapidly declining. You may wonder how that can be with social media sites like Facebook and Twitter, which seem to offer us an easier way to stay connected. Sometimes the interactions aren’t substantial and these sites can give us a false sense of security. Because they are sometimes technology challenged, the elderly may have a harder time using those sites and can become even further isolated.

Interestingly though, research suggests that the loneliest group seems to be between age 40 and 50, which may be due to changing family dynamics, but might also some-what support the theory that social media is related to the decline of real in-person support groups. The younger generations may be more used to this, but I really think that only time will tell.

Not all can be blamed on the Internet and social media. With the mobility afforded to us these days, extended families and close networks have been declining for some time.

Whatever the reason for the decline in social support, chronic acute loneliness is like a deep pain in the heart and it often takes on a life of its own. What I mean by this is that it can become self-perpetuating, causing the person to feel and therefore behave in ways that increase isolation. There is good reason to be worried, as this can become dangerous. Not only is the pain of loneliness increased, but also the health risks of not having a social support system are enormous.

High blood pressure, sleep disorders, increased cortisol levels, weakened immune systems, substance abuse and even diabetes and Alzheimer’s have been associated with chronic loneliness.

All of this is very depressing, but is it depression? Loneliness can definitely be a depressing condition, but it is not necessarily depression, clinically speaking. I believe that it can lead to it but it does not always and it is a separate issue.

Depression            includes an obvious depressed mood, if not reported by the person, is observable by others. It includes changes in appetite, insomnia or hyper-somnia, weight gain or loss, hopelessness, loss of interest in things that used to interest the person, difficulty with concentration, fatigue and lack of energy, crying for no reason, and thoughts of wanting to die.

A depressed person might lie in bed all day, sleep long hours and forget to eat or have no appetite for it. Or they might not sleep and be filled with anxiety and agitation and not know what to do with themselves.

On the other hand, a lonely person might go out for a walk or stroll through the mall or grocery store, hoping for some social interaction but usually not knowing how to make it happen because loneliness does take on a life of its own. Their best friends might be the waitress at the coffee shop or the postman or the grocery store checker. Or they may actually have a number of social interactions that superficial in nature.

Those who are severely depressed might not want anything to do with people. So my guess is that your mother-in-law is lonely and while it might be hard for her to start something new, having become embedded in her lonely ways, getting her to go to church or temple, join a book club or Bingo game, anything that includes social interaction at least once a week might just get her moving toward building a social support network. Since so many people are in the same boat, these groups tend to bond rather quickly if you can just get the folks to go.

Pets are also an excellent idea for people who are alone and lonely.

You might also consider hiring a geriatric social worker to help you and to help her become more comfortable with starting new things and meeting new people. This professional could also tell you for sure if a clinical depression might be involved.

What to do if someone you love mentions suicide

Originally posted in the Santa Monica Daily Press August 22, 2013

Dear Life Matters,

I am seriously worried about my brother who has mentioned suicide a couple of times now. He has been depressed, but he is also very irritable and agitated. He actually makes it difficult for us to be nice to him sometimes. I don’t know if he is just mad about something and wanting to upset us or if he might be really suicidal. I don’t know what to do.

Signed, Worried

Dear Worried,

I think you should take this serious and that we should always take someone serious when they threaten suicide. If it were in a context of joking, maybe not, but I would still pay attention to see if it is said again or if you notice anything different or unusual about the person. In this case you do.

I think a lot of people tend to blow off these kind of comments because they can’t deal with the thought of it themselves, or it is simply too hard to believe, but suicide is a very real thing and it happens more than it should.

You speak about “us,” so it sounds to me like your brother might be young and you are still living with your parents or family. If I am correct, it might be interesting for you to note that young people in their late adolescence think about suicide more often than any other age group. And it is the second leading cause of death for young people between the ages of 18 and 25. So, as you can see, we really do need to take it seriously.

The good news is that most people who consider suicide or become actively suicidal do not completely want to die. More likely than not they are divided between wanting to live and wanting to die and even then the part of them that wants to die really wants to kill off some kind of inner emotional pain. Examples of this type of pain might be powerful feelings of shame or humiliation, self- hatred, feelings of hopelessness, rejection and not belonging or feeling like a burden to others. If you hear your brother talking like this, you and your family should get him help as soon as possible.

A psychotherapist that knows how to deal with suicide will help him see his divided self and focus on constructive ways to rid him of these powerful negative thoughts. Many suicidal people are helped when caught in time because deep down they do not want to die. We want to appeal to the part of him that wants to live.

Other clues that a person may be suicidal include some that you have already mentioned: agitation, irritability, pushing people away, isolating, low tolerance for frustration, disturbed sleep and alcohol and drug abuse.

People who are most at risk are those who have unresolved trauma, have an alcohol or drug problem, or suffer from a mood disorder or mental health issue. You may suspect any of these things, but a professional should be the one to determine if it is true.

Your brother is lucky to have a sister like you and hopefully a family who takes him seriously and truly cares about how he is feeling. People who are alone and feeling completely isolated are at the most risk for completed suicides.

You might want to call the National Suicide Prevention Lifeline at (800) 273- 8255. They can give you more information and help you to find an appropriate therapist for your brother.

Also, bring in your family and any close friends who truly care and are willing to help. You are most likely feeling helpless, but you really can help by building support, supporting the side that wants to live, allowing him to vent his negative feelings so that they have less power over him, but most of all, getting him the professional help he needs. Never agree to keep it a secret or hold it in confidence for someone. That would be very bad for you and for any suicidal person.

I want to end on a positive note by saying again that not all of him wants to die. There is a side to appeal to, just don’t try it alone.

No More Sex After Baby?

Originally posted in the Santa Monica Daily Press September 5, 2013

Dear Life Matters,

I don’t know what is happening to my marriage. All seemed great before the pregnancy, but now not only is everything about the kid, but we never, and I mean never, have sex anymore. My son is 19 months old now, so you see, it’s been awhile.

We use to have so much fun together, we partied, always had a good time and the sex was fantastic. I just cannot believe we are the same two people.

It is not just my wife either. She did have post-partum depression and during that time I played mom and dad while she had some treatment. But after that, when she was much better, she did not have any interest. But the thing that bothers me the most is that I can’t imagine even touching her in a sexual way anymore. Once she was obviously pregnant, I just was turned off. Our obligatory attempts at making love have been futile and downright embarrassing.

I don’t want to leave her, I love her, but I can’t bear this sexual situation much longer. Can you shed some light and give me any recommendations?

Thanks, Frustrated

Dear Frustrated,

This is not uncommon when a baby has just been born. Hormones are all over the place, sleep deprivation and then a post-partum depression that required treatment — that is a lot. Have you ever discussed your feelings about having the baby and about your wife’s depression? Did she feel supported during that time? Did you resent her condition because she couldn’t come through for you and your son?

You said you didn’t want to touch her once she was pregnant. I have counseled men who just couldn’t have sex during the pregnancy. Even though medical science has proved otherwise, and with doctors’ assurance, they just felt superstitious about it, like it was somehow wrong. Some men have talked to me about having a hard time with it after the baby is born because they feel like it’s no longer clean, or quite frankly, many of them can’t put it into words. If a mother is breast feeding, many men do not want to go anywhere near her breasts.

The other thing is that some men have what is called a “Madonna/Whore” complex. Once married or after pregnancy and child- birth, a wife is viewed as the Madonna and therefore, untouchable. The roots of this are generally pretty deep and beyond the scope of this article, but if you suspect you have this, you should seek therapy.

All of these things need to be worked out. I would guess that you and your wife have many unspoken thoughts and feelings and while it may be difficult, your best hope is to talk it out. If you can’t do it alone, see a marriage and family therapist.

You also mentioned that you had great fun and partied a lot before the pregnancy. I wonder what did you mean by this exactly?

If you were using lots of alcohol and other drugs, but then had to stop because of the pregnancy, you may have a problem with sober sex. This is not unusual. Alcohol is very dis-inhibiting and makes sex a lot easier and freer unless you go too far and then can’t have it at all. But it sounds like you had a very satisfying sex life before giving up partying, as you call it. I am not saying that this is the entire problem, but it is definitely something to consider.

It is most likely a combination of all of those things and I am not sure that you can work this out alone. You might want to see a certified sex therapist who is also a licensed psychotherapist. This is probably your best bet.

Start talking with you wife now and see if you get far enough along in the conversation that you both agree to see a sex therapist.

Avoid attacking or blaming. Blame your problem on adjustment to pregnancy and a child, or to possibly not knowing how to have sober sex. Remind her of how much you love her and how important this is.

Our “selves” are deeply connected to our sexuality so it is important that you do not ignore this. It is bad not only for the marriage but for each of you individually. It will, if it hasn’t already, affect how alive you feel, and your general self-esteem.

I say don’t wait any longer; 19 months, plus the duration of a pregnancy, is a long time.

Getting Rid of Bad Habits

Originally posted in the Santa Monica Daily Press September 26, 2013

Dear Life Matters,

I am struggling to understand why the friends I have had for years, and some family, who have always professed their love and support for me are suddenly pulling away from me. I never hear from them or at least not very often. I am no longer invited to many of the same social gatherings, but even worse, when I do see them they seem to make critical comments every chance they get. These comments are usually in the form of a joke, but they are no joke and they are always sarcastic, which really stings.

Some of my other friends say that it is because they are embarrassed or ashamed of their own bad habits and my quitting mine just highlights theirs.

Whatever the case may be, I feel very hurt and rejected.

Signed,

Confused and Sad

Dear Confused,

Well, this definitely begs the question of, “What bad habits?”

Given that you have written to me, I am thinking that they might have been some unhealthy addictive behaviors. Whether it is drinking, smoking, doing drugs, gambling, or a shopping or sexual addiction, what else could be so bad for you that would, at the same time, cause your longtime friends to back off or change their view of you? If this has been the case, the obvious answer would be that they did these things with you and while you have stopped, they are still doing them.

Your “other” friends may very well be correct. It’s a good guess that some of your friends are distancing themselves from you because they are ashamed or embarrassed by their own destructive behaviors and your quitting makes them more aware of what their bad habits are.

With addictive behaviors, when someone stops or gets clean, their partners in crime really feel uncomfortable and will either try to sabotage the new behavior or get away from that person. Usually, they try to sabotage them by pointing out how silly or lame the person is while making fun of the newly found sobriety. If and when that doesn’t work, then they will back off because the newly clean person becomes like a mirror, making them look at themselves, which can be difficult. While this rejection might hurt you, in the end you will be better off without them and you will not miss them.

Beyond addictions, it is also true that a group’s cohesiveness is dependent on a common bond. So anyone who begins to deviate from the group’s norm becomes a threat to the group and they will be made to feel like they are doing something wrong. If they cannot be persuaded to come back into the fold, they will be rejected. It is necessary for the group’s survival and is not necessarily a conscious kind of thing.

An example of this might be that you decide to go back to school and all your other friends are dropouts and make fun of school. Or perhaps you decide that you want to become part of a religious group and you and your friends have always been atheists. Or maybe you have been a workaholic and decide you are going to try to take it easy for a while. Anything that goes against the group norm will be considered deviant and the person doing it will be made to feel it.

So, whether you are going against your family’s values and are being judged or you decide that you want to do or be something different from what your group is about, you will be deviating from that group and they will try to pull you back in or, if that doesn’t work, reject you. It’s just the way it is.

It really isn’t even personal and if you can step back from it far enough, you will see it for what it is worth.

I don’t know what your case entails, but what I have said here is true. So if you are taking better care of yourself and your old friends don’t like it, so be it. Don’t let them drag you down.

Hopefully, this sheds a little bit of light on this and makes you feel better.

I hate my mother, I love my mother

Originally posted in the Santa Monica Daily Press October 10, 2013

Dear Life Matters,

I am having a really hard time. I can’t even say what I really want to say because you won’t publish it. But I hope you are listening and really hear what I am desperately trying to say.

My mother is divorced. For a long time now I have somehow become her go-to guy, her best friend. Actually, I feel more like the parent than her son. She is constantly texting me messages about her boyfriend problems or her medical problems or whatever. It seems everything is a problem for her. I would call her a drama queen except I think the situation is worse than that.

I think she is one of those women who were strikingly beautiful (she used to model) and decided that all she needed was a rich man to take care of her and she would be just fine. Well, she has definitely had a number of well-off guys who did take care of her, but throughout it all I still was her best buddy.

It used to feel good, like I was somehow really special to her, but I am now beginning to see it differently. I feel special only to the degree that she can and does use me. She truly has no life or her own. She lives through others and she lives through me most of all and I do not know how to get away!

I am very ashamed to tell you the horrible things I have said to her and terrible names I have called her. But not even that works.

I am in my 20s and have always done well in school. I am one semester away from graduating from a prestigious university, but I just cannot seem to get it together and finish. I must admit that I have taken to smoking pot every day and, honestly, it is the only relief I have. It is the only way I can get away from her! I don’t know if it is the bud or my anger at her that keeps me from graduating?

She begs me to finish and she pays the tuition. I think she wants me to finish so, when all else fails, I will be there to take care of her. I cannot ever see a life of my own, for myself.

So, I do love her and want her to be well and happy, but I also harbor extreme rage towards her. I just hate her sometimes for being so selfish and robbing me of a life.

Signed, Hate/Love

Dear Hate/Love,

I can see that your situation is dire. It is most unfortunate when we have a parent who lives through us, which is what you seem to be describing.

I think most, if not all, of us love our mothers at some level, but it is certainly true that an intrusive and selfish one that cannot see that she needs to back off and let you breathe is intolerable. It does lead to extremely angry feelings; perhaps rage is the best term for this. We all need the space to be ourselves and grow into who we are meant to be. It sounds like you are being robbed of this experience right now and actually for some time now.

I think it is extremely sad when beautiful women (and it can happen to men too) just rely on their looks and charm to capture that person who will take care of them in the fashion that they see fit. It normally does not work. They can’t keep the relationship because it is too shallow or someone moves on to a younger model. Actually, I have counseled a good number of these women who have objectified themselves and many of them hate their husbands or partners, and they really are miserable. This is sad, but we need to first help you.

I think it is most important to focus on you right now! She is obviously getting to you, but let’s think of how you can gently back off and begin to take care of yourself.

Is smoking so much grass keeping you from finishing your college degree? If you step back and think for yourself, is this degree something that can put you ahead and that you would like to have, independent of your mother? Are you punishing your mother by not graduating when it might well be the best thing for you personally?

I think you should seek some counseling to separate yourself and learn to think for yourself and do what is best for you. Your university healthcare center most likely can and will provide you with no cost counseling. Get it now and do what is best for you.

We can tackle the mom problem later and most likely the college counselor can help with that too.

Mom needs serious help, but we need to start with you.

Learning to Live without Ma and Pa

Originally posted in the Santa Monica Daily Press October 24, 2013

Dear Life Matters,

I recently got news that my father is very ill and I am not handling it well at all. I find myself in complete denial and shock because somehow, even at my age, I am not prepared to lose my parents.

I am single and have no children. I think in some way I am still living as if I am a young person and the “child” of my parents. Suddenly I am realizing my age, how fast time passes and how empty my life is in some ways. I have a great career and I do have a long-time lover, but my life will be really empty without my parents and I feel like I cannot face it. I am already feeling like an orphan.

What is the best way for me to cope with this? I have been advised to visit my father as soon as possible because his condition is terminal. This would be a rather big trip for me and I definitely would have to take time off and make arrangements.

I keep thinking that it can wait, that he might recover, that he doesn’t sound so bad on the phone and, quite frankly, I am terrified of how I will react if I see him.  But I want to do what is right, whatever is best for him and for me.

What do you think?

Signed,  

Middle-aged and scared

Dear Scared,

I am sorry for your dilemma and the imminent loss of your father. Loss is always painful for all of us, no matter who we are or when it occurs.

But there is definitely something to say about the cycle of life and when or why it feels natural at certain times and not at others.

I think you bring up a very important point, whether you know it or not.

You say that you are not married and do not have children. What you are saying is that you have not lived what we have come to know as a conventional family life here in America. I think that this may be part of the reason that you are having such a hard time.

There is a natural cycle of life that, albeit painful to all, is more acceptable and easy to deal with when loss feels natural.

We know, for example, that anyone who has lost a child finds it virtually impossible to get over it. A big part of the reason is clearly that it is so unnatural, so outside the normal cycle of life.

We expect to deal with the death of our parents at some point and this is hard enough, but when loss occurs outside of the normal cycle, it is exceptionally difficult to deal with. You, like a number of folks these days, are without a family and I believe that this makes the cycle seem less natural.

If you had children, and a family of your own, you would feel and see the natural cycle of things. You would also still have a family, even when the elders pass.

But if you do not have this family continuity, the emptiness is not only more obvious, but also more profound. Your loss comes not only as a painful surprise, but it is probably one that has not been anticipated or planned for because you have no family of your own, no continuation of the family.

This is regretful and something many people have to deal with these days because without children, grandchildren and a normal cycle of life, a parent’s passing will probably be more painful.

You cannot change your circumstances, but, to answer your question, the best way for you to deal with it is to face it and deal with it directly. We handle things that we are mentally prepared for better, an advantage that those with families and the expected normal cycle of life have, but you can begin to prepare yourself for what is normal by embracing what is going to happen, whether you feel prepared for it or not.

Your friends or advisors are correct; you should definitely prepare to go visit your father and the sooner the better. You will be very sorry if the unthinkable happens and you have not seen him and said your goodbyes.

The people who deal with loss the best are those who have prepared themselves and have said their goodbyes. Also, if there is any unfinished business, keep in mind that emotional closure is very important as well. Once someone is gone, you can no longer go back and finish things. Do it now, while you still can.

Are you a love addict?

Originally posted in the Santa Monica Daily Press November 7, 2013

Dear Life Matters,

My friends have been ribbing me a lot lately, saying that I am a “Love Addict!” I think they might be joking but then I also think that a part of them is serious. I do know that I have some relationship issues but I really thought this was the sort of thing that only females experienced.

I am not sure why but I love new relationships and that feeling of being in love. I love the sparks that fly, the intimacy that is so powerful, the chemistry, but once that begins to settle down or fade, usually around three to four months, I begin to get bored.

Usually, I lose interest, find fault with the woman and kind of just drift away looking for the next partner who will also be thrilling, but I am also always hoping that it will last longer. So far, it never has.

I really do not want to spend my life alone so help!

Signed,

Maybe a love addict

Dear Maybe,

First off, this addiction as you call it, is not just for females. Many men like to think that they are stronger than women and don’t have these kinds of issues but you do. Physically different (or stronger) does not make you completely different emotionally nor does it render your brain activity different in response to this sort of stimuli.

Anyone can be a love addict. Popular culture encourages it and our quick paced lives, always wanting answers and solutions immediately as if people were made up of the same components as a Google search, definitely has contributed to relationship problems. For all the good of the Internet, its down side is that many folks expect immediate results and if and when they do not get them, they move on quickly.

This is simply not how real relationships work. Each one is different and there is no blue print sent from the heavens to tell us exactly how one should go.

Movies, and music perpetuate the notion of perfect love, love at first sight and some of the things that we might all want to believe in but to stay close to your question, all of this can feed into love addiction.

Most of us love that wonderful feeling that comes with falling in love. Early on it is intoxicating. Preliminary research following reactions in the brain has shown that the early stages of love intoxication light up the same neurobiological pathways as cocaine or similar drugs that get us high.

So clearly the dopamine (pleasure) center is involved when we first fall in love. And it is intoxicating and people do feel high but that phase in a relationship never lasts more than a few months. It begins to diminish once we are drawn closer to each other and then comes the next phase where we take the blinders off and we find out if the one we are with is the one we are meant to be with.

In this phase we deal with how we are at settling our differences? Can we resolve problems? Or are our differences or conflicts too great to make us truly compatible?

It is here that some folks bail before ever having given it a chance. They want no part of it, and they are out to find the next love as quickly as possible, never looking back, much as you describe about yourself.

For it to really be called an addiction, there must be consequences that one ignores and yet, keeps up the behavior anyway. In your case, perhaps it is the loneliness that you ignore?

There is another aspect to this behavior that may or may not be related to love addiction. Fears of attachment can derail budding relationships because attachment can lead to loss, which is the real fear involved here, and of course loss is painful to all of us.

A good number of people have difficulty with attachment and once they start to feel attached, they run away out of fear. It is often like a knee jerk reaction, they don’t even realize what they are doing. Spoiling the relationship before it gets dangerously close or finding fault with a potential partner so that there is good reason to get away are common defenses against the feared attachment.

Attachment and abandonment issues can lead to love addiction but they are not necessarily one in the same. Some people avoid relationships all together.

Other folks have these issues but are also totally taken by the intoxicating effects of first being in love or some consider sexual connection, with the same high, to be a real relationship, until they realize that it just isn’t.

Either way, you end up with a problem and probably alone. Love addiction can have much more serious consequences.

If you would like, e-mail me and I can give you a couple of good books that might help.