The Love Song of the Depressed

Today is World Poetry Day, a day celebrating the penned works of many artists throughout the centuries around the globe, many of whom struggled with their own mental illnesses, emotional disturbances, and deep, personal demons. Much like those who created them, the characters in many of these proses mirror their own existential chaos and provide a fictional window into the minds of our clients and their daily struggles. In The Love Song of J. Alfred Prufrock, by T.S. Eliot, the eternally downtrodden J. Alfred is reflecting back on his somber journey through this world and making a self-appraisal of what he has become today. But in the daily depression and devastation his life had become, Prufrock found comfort in the monotony of it all. In spite of living in misery, it was unvarying, unwavering consistency; though things never got better, they could never get worse. This doesn't mean, however, that he never dared to dream of what could have been. In a moment he asks himself "Do I dare disturb the universe?" Do I dare to break through this carefully arranged mortality of gloom and despair and try to seek out some light, some happiness? Do I dare risk the disappointment and heartache I may find if I am unsuccessful? Do I dare to change my life?

This is a question many of our clients face before they decide to seek mental health services, and some are still grappling with it well into the middle phase of treatment. We typically refer to this as resistance. But the term resistance indicates some underlying tone of opposition or defiance, and can be a very superficial perception of what our clients are truly struggling with. Sometimes it can be frustrating when our "resistant" clients refuse to follow through with our recommendations. Sometimes we want to pull our hair out when they just come to session to vent on a repetitive cycle of grievances rather than to try and work with you to find solutions that can end these daily tribulations. I once had a client who, after two years of treatment with little to no progress, openly admitted that she didn't want help, she did not want to get better, she did not want solutions, she only wanted "someone to complain to." Unfortunately, after verifying once more that she would not willingly work towards her treatment goals and personal betterment, we closed the case and I left her in her dark void.

But this is not often the outcome for clients of county-contracted agencies. In a private practice, if a therapist determines that the individual is not truly ready for treatment, they can recommend that services stop at that time. In fact, it's unethical for a therapist to continue seeing a client and taking their payments knowing that they are not in a frame of mind to benefit from treatment. But in our agencies, we are rarely permitted to close a case simply because they are not ready. We fight and sweat and scream and cry trying to get our clients to that place where they might be ready. And it's rarely an easy task.

Much like our dear Mr. Prufrock, I had a client just last week who is struggling to find her own motivation to disturb her universe. Having been in a depressed state for the better part of 15 years, she was at least insightful enough to recognize that she prefers being on rock bottom. "If I'm at my bottom, there's nowhere to fall. It's steady, it's stable, and I'm okay here. I'm unhappy, but it's safe." She continued "if I get up, if I start climbing that ladder out of my hole, soon I will be above the ground, and then if I slip, I'm going to fall farther down again, and I'm too scared of that. I'd rather just stay here." Another colleague of mine discussed a similar situation with her own client today, finding herself struggling with his refusal to utilize any of the interventions or tools that she provided. And again, this is not outright defiance, this is not him yelling in her face "I don't want your help and I'm not going to use your stupid mind tricks!" This is simply him staring blankly at her with resounding "I don't knows" whenever she asked him questions about how to help himself. They've gone over this multiple times. He knows. He is simply too scared to take the help. You're drowning, but relaxing and sinking to the bottom of the sea is easier than kicking and fighting to keep your head above the surface. Depression is just easier. Not better, but easier.

This is a battle I'm all too familiar with after recovering from a 12 year bout of depression myself. Especially given that I was diagnosed when I was 9 and probably had symptoms much earlier than that, I didn't much recall what it was like to be happy. As I meandered through my teens, as my demons grew larger and my world became darker, it was hard to see any light that may have been shining through that darkness. But this was my life, the only existence I have ever really known, how could I leave it behind? I remember thinking the same thing my client did: at rock bottom, there's nowhere else to fall. When I was 19, after one too many days in Hell, I finally made the choice to disturb my own universe; I finally realized no matter how scary that risk might be, it couldn't have been worse than the fate that awaited me if I stayed in that eternal night. I was 21 by the time I was fully recovered, and even since then I've had a few slips here and there and I've fallen down a few rungs on my own ladder, but one must tighten their grip and climb back up the best they can. As part of the depression game, sometimes the lack of motivation and the hopelessness our clients are enveloped in make it damn near impossible to get them to jump over that abyss and start moving forward in their lives. Sometimes you have to be their tireless cheerleader, sometimes you just have to sit with it, meet them where they're at, and wait until they reach their own awakening, which only they can do alone. Sometimes, they need a little friendly therapeutic push. As I've told my clients, you may fall, but if you try you have a 50% chance at succeeding and finding happiness. If you don't try, you have a 100% chance of failing and feeling this way forever. So let me know when you're finally sick and tired of being sick and tired.

I had been in therapy off and on for a few years in my teens, but with a therapist who never challenged me and me not yet ready to challenge myself, I stayed stuck far longer than I should have or needed to. I will never get that childhood back, but I want to save my clients from the same fate of wasted time. Some clients need that reality check and some clients need a little more empathy and unconditional positive regard to guide them to this final realization. Sometimes we as therapists need to recognize that resistance for what it really is, comfort in familiarity and fear of the unknown; we need to understand it, and we need to address it appropriately. Sometimes I share with my clients this solemn love song and Prufrock's tale of woe. For me, this poem has become my mantra, and I have the famous line tattooed on my shoulder, just in case I need to glance in the mirror and give myself a little reminder to never stay stuck for long, wherever I may find myself. Just because it's comfortable, does not mean it's where I'm meant to be.