A Brothers depression a sisters anguish

The following letter illustrates how depression affects every generation in the family. In our Web chat on Tuesday we will talk about the difference between depression and sadness and how to deal with both. And we will also talk about what family members can do.

Dear Dr. Dan

My brother is in his 40s and has been divorced for 8 years.  His heart was broken unbearably by his divorce as he was still in love and wasn't expecting this.  He is always just staving off the profound loneliness by throwing himself into his work (he is a teacher/administrator), marathon running and similar intense activities.  Over these past 8 years, I have been an ear for him to share his feelings with and he is very stoic but also forthright about his profound loneliness.  He cried deep, anguishing tears to me last night.  There are times to try and offer solutions but also, those times it is equally important to just listen and affirm the struggle and pain.  I sensed last night, all I could do was affirm his pain.  I hesitantly suggested that it is often darkest before the dawn and he reminded me I've been saying that for the last year.

I was afraid, frankly, that he was suicidal and I asked him if he would be alright tonight.  He said he was and reassured me that as distraught as he is, he wasn't considering doing anything harmful to himself and I believe him.

Can you offer me any advice to pass on to him, Dr. Dan?  It is so difficult to see him suffer

worried sister

After eight years of suffering, the problem goes beyond the very human experience of grief and loneliness and becomes a clinical issue of depression. Now, I don't want to oversimplify this and suggest that if he simply gets treatment for depression (generally psychotherapy and medication are pretty effective), that his problems will go away. On the other hand, if there is a clinical depression, it means his brain, the very organ he needs to work his way through this is impaired by an imbalance of neurotransmitters like serotonin.

I want to respect how he experiences his anguish as profound loneliness. I think loneliness is one of the great human fears. And most humans I know do what your brother does, work hard stay busy ruminate frequently and stay away from our demons. Almost everyone has experienced the difference between being alone and loneliness. One hurts and one doesn't. Loneliness causes anguish when we ache for something different than what we have right now. Loneliness is the pain of grasping for something that isn't there. We tell ourselves we can't survive without companionship. Or that we all are alone because we are defective or unlovable. Or is that this loneliness we feel now will last forever. But it is this ongoing mental activity that is stimulated by that grasping that causes the anguish.

Sometimes loneliness is universal, and sometimes it is a symptom of depression. When I suffered clinical depression years ago, loneliness and shame were with me constantly. Ideally, your brother can learn through psychotherapy that went his mind is racing, it's simply a racing mind rather than the voice of truth. And when he aches for something different, it's just an ache that feels sad and painful.

So that ideally he can become less afraid of his own mind. But even good psychotherapy cannot cure one's sense of loneliness and isolation. This must be done by expanding one's lens and caring for more than one's own pain. Your brother has many talents that could benefit others who suffer. What a great gift to the world if he could get involved with big Brothers or the Boys and Girls Clubs or any other charitable organization in which he could help others. I have found in my professional experience that reaching out to others not only helps diminish the pain of isolation, it can diminish the impact of depression also.

And your letter also brings up a very difficult issue of what can we say to a loved one who is depressed? Certainly becoming a cheerleader or motivator only creates more distance. Understanding and empathy are certainly the first steps, but you don't want to reinforce your brothers self-pity either.

When someone is feeling sad distressed, they typically feel out of control so the last thing you want to do is try to "take over". So I would simply ask him questions about the big picture: "what would you like with your life and how can I help?" Or would you like your life to be different and do you have any ideas about how to make that happen?

we will talk much more about these issues on Tuesday.

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