Question and Answers

Question

Answer

Helping a loved one who is depressed can be very difficult. Sometimes caregivers feel helpless and unsure of what to say or do. Fear can cause helpers to be overbearing, hovering and treat the depressed person like a child. This is not particularly helpful for either the depressed person or the helper.

Here are some principles to keep in mind when someone you love is depressed.

1.  Listen, listen, and listen.
2.  Be non-judgmental but give honest responses
3.  Avoid platitudes or cliches.
4.  Do not treat the person as an invalid.
5.  Try to be yourself. This is very important, as persons who are depressed can be very sensitive to changes.
6.  If you can’t be yourself because you are worried tell them so. Ask questions as needed.
7.  Do not be afraid to bring up feelings, events or questions about suicide if this is a concern.
8.  Engage in physical activities with the person, even simple walks can be very helpful. Be outside as much as possible.
9. Call the person at different times of the day.
10.  Find out what the worst time for the person is and try to be available then.
11.  Talk about other things beside feelings.
12.  Keep conversations & activities short if the person appears tired.
13.  Ask about feelings.
14.  Do not be a martyr, take care of yourself.
15.  Talk about your own feelings with honesty but do not say things like “I know how you feel, I went through the same thing.”
16.  Statements of suicide intent should be taken seriously. Encourage the person to call a suicide hot line or their therapist. Ask them what their therapist suggested they do if these thoughts come up. If unsure of what to do, do not hesitate to call the police to have the person taken to an emergency room for suicide assessment.
17.  If suicide threats are a common occurrence, talk to the person’s therapist (with permission) about how to deal with this situation.
18.  Encourage treatment. Offer transportation and company to appointments; combine with a social event such as a movie or lunch.

Take a look at my book “Behavioral First Aid:Managing Emotions During Emergencies”
It is a practical crisis intervention Guide: Learn to calm emotions, prevent violence, and reduce panic in an emergency. Written for those who work with people in distress: EMS, Counselors, Customer service personnel, Nurses, Social Workers, Teachers, and more. Clear practical examples and advice, no psychobabble!

I have always been thrifty as I grew up in a poor family.  As a professional I used to be somewhat embarrassed at my thriftiness. NO MORE!  I am now personally cutting back even more in my life, downsizing and trying to not WASTE money. It is nice to know I am not alone.  I am sorry for those who are being forced to downsize  due to the economy, but I sense that some of us are enjoying it also. 

   It now is no shame to look for bargains, shop in the second hand stores and compare bargains with others. You can even say “I want the cheapest one” (or lease expensive if you want to say it with a little more class). I hear people saying this all the time and it makes me proud!  We no longer are shamed into spending more then we want to (or can) by some pushy sales person.

I often play a game with my friends. it is no longer about who bought the most expensive item, but who got it for less.

I feel more green these days ( and yes virtuous), waste very little, shop for bargains, use my leftovers for creative meals, eat more vegetables and fruit, shop farmers markers, compost and recycle like mad. I am even looking for less packaging when I buy things. Did you notice some stores are responding to these new consumer demands by lowering prices? The Wegman’s grocery store in our area did just that and I wouldn’t be suprised if they have increased their profit with more customers.

The NY times and the web are full of advice on how to save money. I love to read them and say smugly to myself, I KNEW THAT a long time ago!

Make being frugal a challenge and it can come close to fun. I am proud to say I am using some of my extra cash in my volunteer work in Africa. One of my biggest thrills is going to garage sales and buying kids books for 10 cents for the orphanages in Kenya. (no hard cover so I can get as many as possible in my suitcases).  Some times when I tell the seller these are going to an orphanage I get an even Better Deal.

When thinking of my values Simplicity is right up there with Authenticity and Generosity.  Think about your values and how you try to live them. It will truly give you a boost.

By the way this post is by no means meant to make light of the people who are struggling to pay the rent and eat.

NOW HERE IS A CHALLANGE FOR YOU!

Lets do something a little different! Send me you best frugal / simplicity tip, BUT pick one that made you feel good and tell us how that happened.  After  one month I will send a free copy of my book “Behavioral First Aid: Managing Emotions During Emergencies” to the one voted best by my readers. Vote in the comment section when you find one you like, you can vote for as many as you want.  Looking forward to hearing from you!

Why are people so surprised about the high rate of suicide in the military? When are we going to wake up? Denial is so rampant in this country; few will face the fact that our culture of war, aggression and greed leaves most of us (except those who benefit from it at the cost of everyone else) feeling hopeless, angry and even suicidal. Our superficiality, unrealistic expectations and denial (disguised as optimism) result in total shock and even suicide when the real world hits us. We should all visit some 3rd world countries to see how most of the world lives. Maybe then we would stop living in a bubble of our own making. I love America; we are a great country, with even greater potential. If only we could use our energy and resources to really help others and ourselves in different ways we would truly be great.

Have a special day, do something kind for someone else and something terrific (and free) for yourself.

Dear Dr. Duffy,

Sometimes you think you know someone— and you really don’t know them at all.  I thought I knew my sister- I thought her selfishness was harmless-  I had no idea that there was nothing she would not do to get her way or get what she wanted.
My sister Mary and my brother Joe were fighting twenty years ago- it was horrible.  My Father went by to check on my sister- she was screaming about our brother Joe- our Father went home and went to bed and died – right then- it was too much for him! He told our Mother that he could do something with the children when they were little- but now there was nothing- nothing he could do– I was talking to my Mother on the phone when he had the heart attack- he said her name– I was trying to get her to make him go to the hospital- he wouldn’t.
Now 20 years later- here we are again….about 2 yrs ago our Mother discovered breast cancer- had the removal and went on trying to save herself, survive.  I stayed at the hospital with her and our roles sort of changed – I  just did my best to take care of her and knew our days were limited– as we they all are, but there is something about this- it is an unbelievable reality.  The thing that happened was that my siblings did not have the same mind set– my little brother did- Bill  was the baby and they just became closer.  I think I just realized that she was my Mother – the only one I would ever have and I was going to try my best to make the rest of her days as pleasant as possible- spend time with her- I called her every morning and every night— I never was ever jealous of any time any of the others spent with her- actually I was relieved because I really worried about her.

However Mary was still up to her bad behavior. She had married an older man who  had children  she did not care for- my sister was in huge fear that her husband would die and she would have to split their belongings with his adult  children- so my sister talked my brother and law into signing a quit claim on their house.  My sister promised she would always take care of my brother in law- which did not happen- she then starting picking on him and being mean to him.  One night she even called the police to have him removed from the house.  The police said they could not do this- because they were married– so you guessed it- she started divorcing him. She ended up getting most of his money.
 I did witness all of this- and so did our Mother– it was horrible.  Then my sister started in on me- same thing – picking on me- talking bad to me– My sister called and said horrible things to me– on and on– I did not listen to anything she said- by then- I had thought she had just lost it!
Then she started picking on our Mother– yes our Mother – who by now had had cancer my Mother was devastated – so disappointed and angry at my sister— I actually said to my Mother- I will say anything you want me to – to Mary to make her leave you alone— my Mother said,”don’t you dare” my Mother said to tell my sister when she was gone- that my sister was no longer her daughter.
Recently my Mother was so upset- so I grabbed my daughter and we ran to spend the night with her.  When we got there it was 90 degrees in my Mother’s house- she thought the AC was broken- I messed with it- it was just frozen up–got it back on – turned on some fans- tried to calm my Mother- there was no calming her.  Our Mother was sick with the stress from my sister- my sister had been calling our Mother and saying horrible things to her– my sister actually told my Mother she was never going to speak to her again– My Mother told her you will probably get your wish- because I am in stage 4 cancer. Of course pneumonia set in– my Mother went to the hospital- she had lost her will to live…. our Mother died shortly after.

I was with her when she died and I am still sad- I don’t think I will ever really get over this.
Oh but now my sister is trying to steal my part of what I was supposed to inherit— it is awful…..

Thank you for listening,

Sharon
 

Dr Duffy’s Answer

Dear Sharon,

This is all very upsetting. We often have ideas and beliefs (understandably so) about what we want and should have in a family and end up being very disappointed and angry.

Your sister has been behaving badly for many years, this will probably not change. It sounds like both your parents could not give up on her (this is not unusual for parents). You however need to let her go. She will only cause you more grief.

Sounds like you did your best for your parents and it was a good thing your mom had you!

What you probably need to do now is cut off ties with your sister, as letting her abuse you more would just make things worse for you. Let yourself get angry, it is important not to let yourself be in the victim role! I suggest you find a good counselor to talk with to try to come to terms with your feelings and the things that have happened in your family.

You need to let a lawyer deal with the financial end of things and fight for your rights. You then can focus on taking care of yourself personally. You do not deserve to let your pain and anger effect the rest of your life. She shouldn’t have that much power over you!

Wishing you the best.

Dr. Duffy

Response from Sharon

Thank you very much- you are very right.  my sister keeps pulling our chain – I think because it is all she now has left of the family.
we are taking the house to a judge this week to try to force it to sell.  so we can be away from her-
she lies to people – so there is no telling what she is making up—
it is exhausting to have a toxic sister like this- I appreciate you and I know you are right on target!

Thanks again

Sharon

Peace in times of Crisis

I did some crisis intervention today with workers at an organization where a fired  employee had killed 2 staff members.  I have been going over it in my mind, and two lessons  remain in my head.

• Remember the best predictor of violence is a past history of violence.  We must know a person’s history if we are to evaluate them for violence potential. Today with so much fear about being sued  people are often overly cautious about sharing information with  others.  Remember it is not slander if it is true!

Our own fear is sometimes our worst enemy.

• The other reminder I had  (believe it or not) was about the goodness of most people. Many of the people I spoke today with were more worried about others  then about themselves. They were brave and did some pretty amazing things to deal with a horrible situation.  Sometimes it is so hard to remember how good and caring most people are due to the attention to all the bad. This incident reminded me about that.

Thank you, it is a privilege to be able to offer a little help. Peace

 I was thinking about this and wondering why this was so much worse then in the past. What I thought might be a contributing factor is the new military policy of extending duty time at will. This is very hard on soldiers or anyone for that matter. As we all know, you can live through almost anything when there is an end in site. However, when the end time is unsure, or can get extended or put off at any time for unknown reasons, those affected feel out of control, helpless and hopeless.

 Helplessness, hopelessness (having no belief that things will get better) are major factors in depression and potential suicide. Hope for the future and change for the better is what keeps us holding on through bad times! I believe these factors may also influence suicide bombers who have no expectation for anything better on this earth, thus make their decision to die in hopes of something better on the other side.  

 So the question becomes, how do we keep up hope in a world that makes this difficult?

 Here are some of my ideas about activities and thoughts that may help ward off hopelessness. Please send your ideas to help expand the list.

•  Avoid hopeless situations, books, movies, people etc.
•  Try to surround yourself with upbeat (but realistic) hopeful people and thing.
• Expose yourself to positive TV shows, movies etc. Go see a good comedy or read a hopeful book.
• Avoid newspapers and news for a while. It’s ok not to watch the news daily.
• Stop thinking so much! We tend to try to solve problems in our heads even those with no solutions.
  Rumination is the experience of going over and over situations or thought in our head. This is a useless exercise and does not help anything. Try some meditation or other thought stopping techniques. 
• Eat some comfort foods, putter in the kitchen make a healthy heartwarming soup.
• Spend time with friends who are uplifting, don’t spend a lot of money arrange a weekly potluck, card or game night.
•  Avoid people who are depressing or negative, some people seem to make themselves feel better by bring others down.
•  Do not allow yourself to constantly talk of hopeless things.
•  Expose yourself to the sun, or sunlamps if necessary.
•  Take 3000 mg of fish oil a day.
• Work on some small, sure to be successful, fun projects to donate or give away.
• Sit by a fire.
• Visit a museum.
• Spend time with children, if you don’t have any offer free babysitting to someone who needs it. 
• Help someone else. 
• Do volunteer work. 
• Do not do, read or watch scary things. 
• Take short walks often. 
• Avoid TV 
• Read a fabulous (not deep or sad) book.
•  Read magazines or short stories. 
• Visit a church.
• Go to library.
• Shop at a thrift store.
•  Experience nature. 
• Listen to calm uplifting music; try some relaxation tapes. (Check out my site for a sampler of relaxation techniques) 
• Work with an eye on what needs to be done today, let the future take care of itself. 
• Keep goals short term. 
• Keep self-expectations reasonable.
•  Keep expectations of others reasonable. 
• Sing, hum, dance, skip, ride a bike (do exercise that does not feel like exercise). 
• Get a Massage, if you can afford it trade back rubs with a friend (not at the same time). 
• Stop thinking so much. 
• Do not start new intimate relationships at this time. 
• Cultivate old faithful friends.
• Avoid overly sweet, silly, Pollyanna-ish, insincere people, places and things. 
• Its ok to be avoidant sometimes. 
• Take care of pennies dollars will take care of themselves.
• Remember constant worry does not help and makes you feel worse. 
• Put up pictures of nature, loved ones animals.
• Be social but cultivate solitude also.
• Place some upbeat sayings and posters where you can easily see them. 

Send me your upbeat sayings and I will post mine later.

In Kenya I found myself developing a new prospective. So many events that I would normally think of as a crisis are accepted as part of life. Things like  not having enough to eat, having your few belongings stolen or your life threatened, or having no prospects for a job,school, or future. Although these things are all cause for sadness to the people who experience them and the people of Kenya worry about these events, they are also accepted as part of life and not seen as a crisis. Initally, my reaction to all of this was rage at the injustice, and of course an attempt to remedy the situation. This of course reflects my usual aggressive reaction to a crisis, that is: “fix it”.

I was actually able to help a few people to get food and return to school and try to build a future. My efforts however seemed less then a drop in a very big bucket. This was very discouraging at times and I found myself lowering my expectations for success and becoming more insensitive to these things. I can certainly  see how constant exposure to these “crises” can lead to giving up altogether. If I felt this desire to give up  after only a few months, I can only imagine how one would feel after a lifetime of these experience.  Crises becomes a daily occurances that is not even recognized as a crisis or causes much in the way of emotional upheaval. This dulled reaction is of course normal and necessary because it would be impossible to live in a constant state of emotion turmoil and stress.

From the outside this is lack of reaction is often seen as a shortcoming of the people,  sometimes called laziness or lack of caring. It took me some time to realize what was really going on and not to be angry and judgmental about the people who appear to just “accept their fate”. It is a matter of survival, I did the same on a smaller scale as I learned to accept things I didn’t think I could. I am not sure if this is good or bad, only necessary.

 Recently a teenage boy who jumped out of a dorm window while drunk left a local college campus and community deeply shaken. He will probably be paralyzed for the rest of his life.  After hearing about this I read a distressing study about teenage self-destructive behavior. The Child and Adolescent Self harm Study From Europe (Brunel University September 4, 2008) reveals more disturbing data about teenagers and cutting.

1.    One out of four cases is not reported and 25% had not told anyone else. How many do we not know about?

2.    Alcohol is a factor in one out of five cases, drugs in one out of eight cases.

3.    Six in ten self-harmers talk of suicide.

4.    Thoughts of self-harm are said to occur in 6 out of every 10 teenage girls and 1 in 10 boys.

5.    59% of these teenagers said they wanted to die.

How To Help

 Recognize those at risk

1.    Those with family history of suicide or self injury or risky behaviors

2.    Those who have been sexually, physically or emotionally abused.

3.   Those who are self critical, with low self esteem, depression anxiety, substance abuse problems and  eating disorders.

 4.    Teenagers who are impulsive with few problem-solving skills are at higher risk.  

 Prevention Involves Teachers, Families, Friends And Other Social Supports

1.  Teach coping skills in school and at home
2.  Encourage healthy social networks.
3.  Educate teenagers and adults about the problem.
4.  Promote programs to help teenagers develop healthy friendships and decrease secrecy.
5. Do not expect more from teenagers then they can do. Remember they are not always sufficiently mature enough to make high level decisions that require recognition of long term consequences.

 References:

Mayo Clinic Website: Self-injury

 Science Daily: September 7, 2008

Did you know that nearly 5,000 teenagers commit suicide each year and that suicide is the third leading cause of death among those aged 15-24 ?

There has been a number of teenagers suicides in the news lately that have been connected to bullying. Many of use are worried and frustrated about the rising problems in schools with bullying and teasing. The connection between bullying and teen depression and  suicide is becoming clearer.  It has been shown that teen suicide is often related to depression that can be worsened by rejection,  isolation,  being bullied, and not fitting in. 

I found what I think is a great video about a program to reduce bullying, teasing and foster acceptance in schools. It is a program worth looking at if your childs school is not addressing this issue in a serious ongoing, manner.  

Take a look!

Of course we can’t expect the schools to do it all. Here are some things that parents can do.

• Keep your children out of your marriage problems.  Certainly you need to talk to your teenager about what is going on because they are well aware of it already. Sometimes their imagination is worse then the reality so be honest with them .  Do not subject them to your fights and arguments or ask them to take sides. Try to remember that no matter how angry you are at your spouse, you both want whats best for your children.
• Acceptance of your teenager (not necessarily his/her behavior) is critical. Yes I love you and always will BUT I do not love that behavior and won’t allow it.
• Reassure him/ her that you love him no matter what.  Remind him that no matter how bad things seem you want to help and problems can be solved.
•  Listen to what they say, you don’t have to agree just acknowledge you heard and try to explain (briefly) why you disagree. No long debates.
• Even if you say it a hundred times, it helps to say ” I love you and will not let you do anything I believe will end up hurting you.”
• Ask him/ her to talk about her feelings. Listen carefully. Model this by talking about your own feelings ( I am frightened for you when I see you doing risky things)  (see my blog on listening)
• Do not make light of  problems ( relationships, thinking no one likes them etc.)  Avoid terms like “puppy love”, break up of relationships can be Very traumatic for kids and often is a precipitant to suicide.
• Do not give glib answers or get angry.
• If you are worried about your child, don’t be afraid to say the word “suicide.” Using the word will not “give him/her ideas” but will provide relief by saying its ok to talk about this.
  
• Remove guns from your home.
• Seek professional help. Finding a good therapist is difficult. Ask around, school counselors may be a good source of referrals but usually can not handle this problem on their own.
• Get help yourself to deal with this. Do not be ashamed of this problem, it is not uncommon enough.