Depresssion with disability—learning acceptance, compromise, and dignity
It would not surprise most of us to think that people with severe, life-changing diseases and disabilities might become depressed. In essence, living with chronic disease means, as Blair Justice3 notes in A Different Kind of Health, a “shifting of identity.”He states, however, that “studies show that people can be both fully aware of the severity of their physical condition and retain a sense of well-being.”
For some of us, attaining this sense of well-being takes a long time and considerable effort. It is natural to define ourselves by our illness, especially when the illness involves many hospital visits, painful treatments, uncertain diagnoses, doctors who have differing opinions, and decreases in energy that make days short and opportunities for relief limited.
I have found that I can decrease illness as my identity and reduce my depressive feelings by making new friends in many venues and by inviting people with special talents in art, photography, music, and writing to join us in our home and at some of my longer visits for medication infusions. Examining new ideas gives me a sense of well-being and the ability to maintain my dignity while still accepting compromises in my daily life.
As one of my favorite teachers showed me, a major means of coping was eloquently stated by T. H. White4 in The Once and Future King:
“The best thing for being sad,”replied Merlyn, “is to learn something. That is the only thing that never fails. You may grow old and trembling in your anatomies, you may lie awake at night listening to the disorder of your veins…There is only one thing for it then—to learn. Learn why the world wags and what wags it. That is the only thing which the mind can never exhaust, never alienate, never be tortured by, never fear or distrust, and never dream of regretting…"
Continuing creative projects
I have been a photographer for many years, exhibiting my black-and-white photos, and sharing ideas with other photographers. Therapy has had a remarkable influence on my concepts for my photography. I express my feelings and my insights metaphorically through my photos. Photography is challenging and a way to look toward the future during a time that is full of uncertainty and pain. Although my mobility is limited, I can make photos of objects of beauty and symbolism, such as this surreal window that, for me, suggests looking onward and forward, although the path to insight may have many layers.
I also write poetry, and even in my darkest moments when I write my poems, I find out more about myself and my “less conscious”person. This poem is an example of this process.
I dream I am walking
walking and running
I dream I am running
until I am breathless
and I stop running.
I dream I am swimming
swimming and diving
First from the low boards,
then from the high.
I dream I am dancing
dancing and sweating,
dancing in time to the
music of fast dancers;
I dream I am sleeping
I dream again,
dreaming I am floating
dreaming I am dreaming
knowing I am not dreaming. (2006)
Accepting help when needed
One of my largest losses has been foregoing driving because of the effects the disease has had on my eye muscles. My therapy has helped me accept both my limitations and having to have a caregiver take me where I need to go, as well as help me with daily needs. This care has made it possible for me to have the energy to continue to show my photographic work in different places and to experiment with new photographic processes.
Dealing with the past and unhelpful family relationships
We are all products of our past relationships and happenings, our reactions to them, our ways of coping, the degree to which we have held on to “immature reaction patterns,”and the amounts of affection or dysfunction we experienced in our growing years. It is certainly possible to find out, even as we age, that parents, siblings, or spouses have problems that prevent them from sharing love easily. This can be especially true for one’s elderly parents who suffer strokes or have dementia.
Having a loved family member reject us when we reach out to him or her, especially as we climb the ladder from depression to hope, is tremendously painful. Whether the causes involve old hurts or jealousies, lack of communication for long periods, or fear and guilt regarding the disease process, the result can be an even greater difficulty in communication and an increase in sadness for both people.
When this involves the relationship with an aged parent, both psychopharmacological and geriatric psychotherapy can be very helpful.
Anger and resolution
Regardless of our wish for equanimity, anger is also a natural part of life, a normal reaction to the bad things that happen to us, to things we cannot control, to the death of a loved one, to one’s own or another’s disease, and to other significant losses.
Anger is a normal response, but if allowed to become overwhelming, can be destructive, can be “turned inward”along with guilt and can contribute to depression.
In Harold S. Kushner’s5 book, Overcoming Life’s Disappointments, he writes of an interpretation of Moses’ striking of the rock to get water in the desert for his tired and hungry brethren. This interpretation is that Moses is not frustrated and angry at his people for being so demanding of him, but rather, that he is angry at God for having imposed an “impossible burden”on him. The result is that Moses does not live to see the promised land to which he has been leading his flock for 40 years.
We, like Moses, have reasons to be angry at our “impossible burdens”—our diseases, our losses, those who have slighted us. But as Harold Kushner5 points out, we can prevent our anger from becoming a major and self-defining issue. Psychotherapy can help us learn harmless ways to vent anger, other than subjecting our spouses and family members to our temper, our sarcasm, or our withdrawal.