HOW UNDERSTANDING IMPERMANENCE CAN HEAL DEPRESSION AND GRIEF

 

One of the most important tenets in Buddhism is that all phenomena are impermanent. All things and all beings are constantly changing. Nothing stays the same, and ultimately everything dies. We tend to consider this bad news. However, accepting impermanence can also be considered good news. If everything stayed the same, there would be no possibility for growth. Also, understanding that nothing stays the same can alleviate feelings of hopelessness, helplessness and overwhelm.

We all struggle to hold on to others and to things, and resist impermanence. This leads to tremendous suffering. The incorrect belief that things are “stuck” and will never change also results in great suffering.   I have observed in my years as a psychotherapist that the struggle to resist impermanence and the belief that things don’t change are universal. It is only through letting go of the resistance to change and impermanence that true healing and growth is possible.

For example, many of my clients with depression feel mired in difficult situations that they believe are permanent. It can take a lot of work for them to give up the beliefs that keep them stuck. I too am prone to depression. My Buddhist practice and study have been invaluable in helping me let go of my negative beliefs. I now know that those beliefs are just insubstantial thoughts that I no longer need to hold on to. Of course, I get thrown back into feelings of hopelessness on occasion. When that happens, I call on a friend to remind me that whatever situation is getting me down is impermanent and will change. My friend’s reminders are just what the doctor ordered at those times, and I feel a tremendous weight lifting and the restoration of hope just from hearing the words “remember that it’s impermanent.”

A big part of my psychotherapy practice is working with grief and loss. I have found that clients who have difficulty acknowledging that everyone dies have a very difficult time processing their grief. Of course, the death of a loved one or beloved pet is never easy. Although death is never easy for those left behind, always remembering impermanence helps ease the way, and despite profound sadness and grief, those who “grieve well” know that death is a natural part of life.

One of the most significant moments in my meditation practice occurred about fifteen years ago. My wonderful cat Andy was “meditating” with me at the time. I recall having a clear realization that Andy would not be with me forever. My emotions went from sadness to acceptance. I was left with a profound sense of the preciousness of life, knowing that the fact that nothing lasts is what makes life so precious. Andy, who died last summer, has ever since been my reminder of both impermanence and the preciousness of life. As the great Buddhist master Dilgo Khyentse Rinpoche said:

                                     Life is fragile, like the dew hanging delicately on the grass,  crystal drops that will be carried away on the first morning breeze.                                

                                                                            

GRIEF AS AN ESSENTIAL INGREDIENT IN GROWTH AND HEALING

 

As a psychotherapist, I am constantly inspired by my clients’ courage and commitment to change, and their willingness to face their struggles with open eyes, minds and hearts. My clients have taught me that an essential ingredient in overcoming and healing from life’s difficulties is grieving what has been given up in the name of growth– even if it is something negative or dysfunctional like addiction or an abusive relationship.

My work with “Sally” beautifully illustrates the healing power of grief in growth. Sally came to see me regarding her difficult relationship with her mother. It became apparent to me early on that Sally was tethered to her mother and that her mother was controlling, narcissistic and manipulative. Sally clearly loved her mother, and it was understandably difficult for her to see how her life was enmeshed with her mother’s and controlled by her mother’s neediness. Despite being a “grown up” with a keen intellect, wonderful sense of humor and a successful career, Sally still lived with her mother. When declining health forced her mother to enter a nursing home, Sally lived alone for the first time in her forty years of life. At first, she was fearful of living alone, and was unclear about what she wanted in her living situation. Sally has gradually gained more confidence in her ability to live independently, and eventually bought the family home, which is now in her name alone.

More importantly, with the perspective of space and time, Sally was finally able to clearly see who her mother is and the impact she has had in Sally’s life. She has essentially gone through the stages of grief described by Dr. Elizabeth Kubler-Ross, a psychiatrist who delineated the process people in grief experience.

The first experience Dr. Kubler-Ross describes in the grief process is denial. Sally was in denial for many years about her mother’s manipulative and narcissistic nature. People consider denial a “bad” thing, but it is necessary to our survival until we are ready to move on. Sally’s denial allowed her to maintain the status quo, which included career success. It was only when the status quo became uncomfortable and no longer workable that Sally was able to move forward in her process of growth.

The second grief experience described by Kubler-Ross is anger. I was hopeful that at some point in our work together Sally would have the courage to be angry at her mother as a step on her path to separate and differentiate from her. As a deeply spiritual person, Sally believed that anger was “wrong.” It took a while for Sally to understand that there is an inherent wisdom in the energy of anger, simply telling us that something is not right. Sally was ultimately able to express anger about her mother’s manipulation and control. This was a huge factor in Sally’s emotional separation and differentiation from her mother. She was able to use the energy of her anger to make the wise decision to buy the family home.

The next stage in Kubler-Ross’s model, bargaining, played out in a number of ways in Sally’s journey to healing and growth. When her mother first moved to the nursing home, Sally visited her daily, at a great cost to her own health and emotional wellbeing. On the brink of exhaustion, Sally has made a “bargain” with herself to visit her mother less often. This has been a gradual process for her, and has become increasingly easier despite her mother’s protestations as Sally has come face to face with her mother’s control.

When I assess for depression in the grief process, I always listen to how the bereaved talks about the loss. If the focus is inward on what he or she “should” have done, it may indicate depression, whereas if the focus is outward toward what has been lost, it is a sign of healthy grief. Sally rarely presented as depressed in our sessions. However, in her process of healing and asserting her independence, Sally did have some moments of depression. For example, she would berate herself for allowing herself to be manipulated by her mother and not seeing how her mother controlled her. I assured her that she did the best she could at that time, given her mother’s narcissism.

The last stage in the Kubler-Ross model is acceptance. It has been inspiring and beautiful to watch Sally work with the process of acceptance. Acceptance necessarily includes forgiveness. Sally has come a long way in understanding who her mother is, and she now sees that her mother’s mental ills resulted in large part from being emotionally abused by her own mother. Sally has also come a long way in seeing that her mother’s actions toward her were also abusive. She is grieving the opportunities she has missed because of her enmeshment with her mother, and has developed self-understanding and self-forgiveness. In giving up what she considered an idyllic relationship with her mother, Sally has been grieving the loss of what was, while also rejoicing in her new wisdom, confidence and growth.

 

The Importance of Self-Compassion

We throw the word “compassion” around so much that it can seem like a trite cliché.  Yet, the more I listen to my therapy clients, the more I realize that compassion — particularly self-compassion – is the key to healing ourselves and our relationships.

Compassion means “to suffer with.”  The word is generally used to describe empathy toward another.  However, I am clear that one cannot really have true compassion toward another without experiencing his or her own suffering and having kindness and empathy toward him or herself first.

The Sanskrit word maitri has been defined by Tibetan Buddhist master Chogyam Trungpa as unconditional friendliness, particularly toward oneself.  Pema Chodron, a student of Trungpa’s and a master in her own right, observes:  ” I teach about maitri a lot. In fact, sometimes I think it’s the only thing I    teach. I also teach about        compassion a lot, but actually compassion is a form of maitri so this unconditional friendliness to oneself, it seems to be what most of us do not have”  (www.shambhala.org/teachers/pema).

I have made this same observation in my work as a psychotherapist.  Most of my clients come in complaining of depression and low self-esteem.  They think that something “out there”–even something as beneficial as caring for others —  is going to make them “better.”  When I tell them that what will heal their depression is kindness toward themselves, some look at me as if I were speaking a foreign language – the idea of self-compassion is that alien to them!

For many, the messages they received in their families of origin have contributed to their low self-esteem and negative self-talk. Western culture’s emphasis on perfection doesn’t help.  Because of these familial and cultural messages, many believe that’s just the way it is, and their beliefs about themselves can’t be changed.

For example, a client I’ll call “John” recounted in his first session with me his regrets about the breakup of his marriage, and concluded “I’m a failure.”  In my work using the modality of mindfulness-based cognitive therapy, I challenged John’s belief, asking how doing something that he now regrets means he’s a failure.  I told him that he did the best he could at that time, and encouraged him that the key to his healing will be having compassion for himself and his human imperfections and neuroses. My homework for John was to simply notice when he calls himself a failure, what triggers it, and to start to challenge that long-fixed belief.  Changing these thoughts takes time, practice and discipline because they are so habitual and deep-seated, but it certainly can be done

I can challenge and have compassion for John, because I had to do the same work myself.  As I have recounted in other articles, after a period of regular mindfulness meditation practice, I was able to not only notice my negative self-talk, but realize that was just another thought, and that I could relegate those thoughts to my mental trash heap.  In fact, I told myself that if someone could have magically heard the way I talked to myself, they would have to turn me in to the police for abuse!

The Buddhist teachings on buddhanature or basic goodness are very helpful in developing self-compassion.  Those teachings tell us that we all have buddhanature, but due to our habitual tendencies and patterns, it is obscured and we have difficulty experiencing it.  An image I have found helpful is that of the sun in a cloudy sky.  The sun is always there, even on a cloudy day, but we can’t see it.  Imagine being in a plane, and seeing the sun in a clear blue sky after rising to an altitude above the clouds.  Indeed, the sun was there the whole time.

The next time you make a mistake or do something you consider less than “perfect”, take a breath, and try not to go on automatic pilot and start beating yourself up.  Instead, have compassion for yourself and all others who suffer in that way and remember the image of the sun in a cloudy sky.  Yes, you made a mistake and you can feel regret about it, and resolve not to do it again. Remember that your thoughts about your mistakes and imperfections are just fleeting clouds, and the sun of your self-worth is there the whole time.

 

 

 

FACING THE GRIEF OF AGING AND EMBRACING YOUR LIFE

I look in the mirror and see new lines on my face, a bit of drooping in places that never drooped before. I could wallow in self-pity and mourn the loss of my youth.  Instead, I choose to celebrate my years and experience.

I reflect on the rich, crazy and wonderful times I experienced in my life – being a hippie in the ‘60s; being a denizen of CBGB’s and part of the burgeoning punk rock scene in NYC in the ‘70s; coming into my own in the ensuing years; experiencing life as an entertainment lawyer, and giving it up to follow my dream to become a psychotherapist.

Here are some tips I have learned for embracing aging and letting go of grieving the loss of youth:

  • Know that wisdom comes from life experience, not from reading about it.
  • Appreciate yourself and what you have learned.
  • Celebrate your accomplishments.
  • Acknowledge your imperfections without judgment.  No one is perfect, young and old alike.
  • Accept your limitations.  So what if you can no longer run a four- minute mile?
  • Embrace patience.
  • Have compassion for yourself, and for all others on this path called human existence.
  • Celebrate impermanence.  After all, if things were permanent, nothing whatsoever would be possible.
  • Relish interdependence.
  • Reinforce your personal sense of spirituality through the beauty of nature, the arts and life’s little miracles.
  • Share your gifts and experience with others, and teach them what you have learned through life’s trials and triumphs.
  • Enjoy the quiet times.
  • Create a list of things you’d like to accomplish, and set about doing them.  It’s not too late.
  • Have a sense of honest humility about the things you’d like to accomplish but know that you may not be able to.  It’s OK.
  • Don’t dwell on regrets.  Again, nobody is perfect.  Acknowledge what you’ve learned from mistakes along the way.
  • Maintain a sense of humor and perspective, and laugh often.

Treating Depression in the Elderly

Contrary to popular belief, depression is not a “normal” part of the aging process, but a treatable mental health condition. Symptoms of depression include feelings of worthlessness, hopelessness, helplessness, guilt, isolation and unrealistically negative beliefs about oneself. These feelings not only affect the depressed person, but also their family members, loved ones and caregivers.

Depression is unlikely to go away by itself, and the guidance of a professional counselor, in addition to a physician, is often warranted. In fact, psychotherapy has been found to very likely help the depressed senior live a happier, more fulfilling life and decrease the risk of suicide.

There are a number of things a loved one or caregiver can do to help alleviate a depressed senior’s depression. These include:

1. Make sure the depressed person sleeps and eats regularly.
2. Reinforce rewarding experiences and activities, including exercise.
3. Explore spiritual or religious beliefs as a source of personal comfort and support.
4. Allow the depressed person to tell his or her story, called “life review”, through techniques such as guided journaling, letter writing, autobiography or collage.

A counselor or psychotherapist trained in narrative therapy can be particularly helpful for helping seniors find meaning and a sense of integrity and ease their feelings of depression.  Narrative therapy is particularly helpful in helping depressed clients reconcile the inevitable losses incurred over a lifetime and find meaning in those losses in the context of their lives through the telling of the story of their lives. The role of the narrative therapist is to bear witness to the complexity and rich nuances of the evolving story and collaborate with the client in to make sense of his or her losses and find healing and growth through the process of reconciling those losses and acknowledging the contributions they have made in their lives.