By Michael MacMunn, LICSW

This is the first of a two-part series on depression. In this issue, I will explore what depression is and what causes it. In the next issue, I will describe how depression is treated and prevented. If you or someone close to you suffers from depression, it is important to educate yourself about it and seek treatment from qualified mental health professionals.

Depression is a serious illness, not a harmless part of life. It is a complex disorder with a variety of causes. It is never caused by just one thing. It may be the result of a mix of factors, including genetic, chemical, physical, and sociological. It is also influenced by behavior patterns learned in the family and by cognitive distortions.
Depression affects millions of people in this country. It is always troubling, and for some people it can be disabling. Depression is more than just sadness or “the blues.” It can have an impact on nearly every aspect of a person’s life. People who suffer from depression may experience despair and worthlessness, and this can have an enormous impact on both personal and professional relationships. In this newsletter, I will describe many of the factors that may cause depression, and I will explore strategies for preventing it.

Depression Is Pervasive

When a person suffers from depression, it can affect every part of his or her life, including one’s physical body, one’s behavior, thought processes, mood, ability to relate to others, and general lifestyle.

Symptoms of Depression

People who are diagnosed with clinical depression have a combination of symptoms from the following list:

• Feelings of hopelessness, even when there is reason to be hopeful
• Fatigue or low energy
• Much less interest or pleasure in most regular activities
• Low self-esteem
• Feeling worthless
• Excessive or inappropriate guilt
• Lessened ability to think or concentrate
• Indecisiveness
• Thinking distorted thoughts; having an unrealistic view of life
• Weight loss or gain without dieting
• Change in appetite
• Change in sleeping patterns
• Recurrent thoughts of death
• Suicidal thoughts
• A specific plan for committing suicide
• A suicide attempt
• Feelings of restlessness or being slowed down

When a person is suffering from depression, these symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning. This means that the person’s family and social relationships, as well as work life, are impaired.
When a person is suffering from depression, symptoms such as these are not the result of a chronic psychotic disorder, substance abuse, general medical condition, or bereavement.

Grief, Sadness, and Depression

Depression may include feelings of sadness, but it is not the same as sadness. Depression lasts much longer than sadness. While depression involves a loss of self-esteem, grief, disappointment and sadness do not. People who are depressed function less productively. People who are sad or disappointed continue to function.

Depression and Socioeconomic Factors

Depression does not seem to be related to ethnicity, education, income, or marital status. It strikes slightly more women than men. Some researchers believe that depression strikes more often in women who have a history of emotional and sexual abuse, economic deprivation, or are dependent on others. There seems to be a genetic link; depression is more common among parents, children, and siblings of people who are diagnosed with depression. The average age at the onset of a depressive episode is the mid-20s. People born more recently are being diagnosed at a younger age.

Physical Causes

Many physicians believe that depression results from a chemical imbalance in the brain. They often prescribe antidepressant medication, and many people find relief as a result. However, there is no reliable test to identify such a chemical imbalance. It is unknown whether life experiences cause mood changes, which create changes in brain chemistry, or whether it works in reverse.
Depression may be associated with physical events such as other diseases, physical trauma, and hormonal changes. A person who is depressed should always have a physical examination as part of the assessment process to determine the role of physical causes.

Signs That Professional Treatment Is Needed

If you or someone you know is depressed and exhibits any of the following signs, it is extremely important to seek the assistance of a medical or mental health professional.

1. Thinking about death or suicide. This is always dangerous and you should see a professional therapist immediately.
2. When symptoms of depression continue for a long time, you may need professional help. Acute responses to events are normal, but they should not last beyond a reasonable time.
3. Your ability to function is impaired by your depression. Seek help before your life situation deteriorates to a serious level.
4. You have become so isolated that you have no one with whom to check reality. Seek out someone to share your thoughts and feelings with.
5. Depressive symptoms have become severe.

In my next newsletter, I will discuss the treatment and prevention of depression.

Please pass this newsletter along to a friend. Or call 562-8045 to request additional copies.

Michael MacMunn is a Licensed Independent Clinical Social Worker and a Licensed Alcohol and Drug Counselor in Westfield. Call 562-8045 for a consultation.

By Michael MacMunn, LICSW

Addiction to alcohol and other drugs is a chronic disease. It is progressive, continuous, and long-term. Alcohol or drug abuse means that a person has control over whether he or she drinks or uses. Alcohol or drug dependence means that a person has lost all control over his or her drinking or using behavior.

Addictive Behavior

People who suffer from addictive diseases engage in compulsive behavior and gradually lose control of their lives. They continue to drink or use drugs, even when they know it will lead to negative consequences. They tend to have low self-esteem and almost inevitably suffer from anxiety and depression.

If someone in your life suffers from addictive disease, you have experienced his or her extreme behavior, ranging from depression to exhilaration. You probably have also experienced the person’s state of denial (“I can quit anytime” or “I don’t have a problem”), dishonesty, frequent disappointments, and the series of ruined relationships. These are the hallmark behaviors when a person suffers from addiction to alcohol or drugs.

Who Is Affected by Addictive Disease

Alcoholism and drug addiction affect people from all parts of society. Addictive disease affects rock stars, writers, artists, and homeless people. Victims also include stay-at-home moms, teenagers, and corporate executives. There are addicts who are students at top universities and physicians in your local hospital. They may be teachers at your neighborhood school or salespeople at the local hardware store.

Studies have shown that there is a genetic predisposition to alcoholism. About half of all alcoholics had an alcoholic parent. Men seem to be more vulnerable than women to the alcoholic traits of their parents. Women may be more affected by factors in the environment (such as financial and life circumstances) than by inherited factors.

The Physical Side of Addiction

Chronic alcohol abuse produces long-lasting damage in many areas of brain function. It damages the capacity for abstract thinking, problem solving, memory, and physical dexterity. It also impairs verbal, visual, and spatial ability. The extent of damage to brain tissue depends on the extent of heavy alcohol abuse. When the drinking stops, a certain amount of healing is possible.

Prescription Drugs

Prescription and illegal drugs with psychoactive side effects target the brain and can change a person’s mood. This causes these drugs to be potentially addicting. Some people think that if a doctor has prescribed a drug, it is not addictive. This is not true.
It is important to tell your doctor if you:

• Are an alcoholic (using or in recovery)
• Have ever been addicted to any drug
• Have taken more than the prescribed dose of a prescribed drug
• Have taken a prescribed drug for a long time
• Take a prescribed drug with alcohol

Addictive disease is often progressive and can be fatal. Thankfully, with proper treatment, recovery is possible.

Treatment

The first phase of treatment of addictive disease focuses on the physical effects of alcohol or drug use. This phase can include detoxification or treating life-threatening disorders such as liver failure.

Since addictive disease is primarily a brain disease that results in behavioral symptoms, the main treatment is psychosocial therapy. Treatment usually focuses on the irrational feelings and distorted thinking that accompany chronic alcohol or drug abuse.
Alcoholism and drug addiction are chronic diseases that require a lifetime recovery plan. Most successful treatment plans include a focus on the 12 steps ofAlcoholics Anonymous and involve ongoing, long-term participation in self-help groups. Patients who have been hospitalized for treatment may continue group and individual psychotherapy after they leave the hospital, in addition to attending 12-Step meetings.

Treatment of the Family

Addiction affects every member of the patient’s family. As the disease progresses and the patient continues to drink or use, it causes a range of emotional, spiritual, and financial problems for almost everyone involved, including family, friends and coworkers. When the family is ready to begin the recovery process, Al-Anon and Alateen are excellent resources. A qualified family therapist who understands the process of addiction and recovery may also be consulted to work with the family.

What to Do When an Alcoholic or Addict Won’t Stop

Sometimes the alcoholic or addict is in such a strong state of denial that the best alternative is to arrange an intervention. This process involves arranging for a professional interventionist to organize a meeting of the family, friends, and employer of the patient. The interventionist helps the group prepare a confrontation that will be followed by the patient entering a treatment center. The patient’s family and friends usually write a brief statement describing how the drinking or drug use has affected them. The interventionist and the group then meet with the patient and read their statements to the patient with the guidance of the interventionist. These interventions, when managed by professionals from respected treatment organizations, often result in successful treatment of the addiction.

Michael MacMunn is a Licensed Social Worker and Drug and Alcohol Counselor. He specializes in addictions treatment and codependency issues. Call 413-562-8045 for more information.

By Michael MacMunn, LICSW, LADC

In this month’s newsletter, I would like to help you explore the challenges and opportunities that come at midlife. You will have an opportunity to take a look at issues that are specific to the Baby Boomer generation. You will also have a chance to begin the process of your own midlife assessment with a list of questions presented at the end of the newsletter. I call this assessment the Midlife Checkup.

Benefits of the Midlife Checkup

Taking the time to assess how your life is going at this point can result in benefits such as these:

• It can help you identify and intensify your inner strengths.
• You can find your own voice and express it your own way.
• You can accept your changing physical self.
• It is an opportunity to forgive those with whom you’ve been angry.
• It can help you find ways to reduce stress.
• You can learn to simplify your life.
• You can reenergize yourself in preparation for the second half of your life.

The Baby Boomers

The Baby Boomer generation is at midlife right now. This generation includes almost 78 million Americans born between 1946 and 1964.

The Boomers are the largest generation in U.S. history. They have had a major impact on American society as they have passed through every life stage. They are passing through midlife in their own unique way, differently from their parents and differently from Generation X, the group born in the years after 1964.

The first Boomer turned 50 at the beginning of 1996, and the remaining 78 million will observe this anniversary sometime between now and 2014.

According to Rocking the Ages authors J. Walker Smith and Ann Clurman (researchers at Yankelovich Partners) and authors like Gail Sheehy, people passing through middle age typically experience the following kinds of feelings:

Great expectations:

Most Boomers are beginning to recognize their own limitations. Growing up in the comfortable 1950’s, the Boomers learned to expect unlimited growth and endless possibilities. They believed their good luck would never end. Now that they are turning 50, many are shocked to discover that there are limits to life’s possibilities.

Regret:

As people reach midlife, they must face up to the loss of some of their dreams and regret the mistakes they have made. It is not easy for anyone to face the person one will never be.

Loss:

At midlife, everyone has to face the loss of beauty and youth, valued by our society. In her book New Passages, author Gail Sheehy calls this experience “The Body Blues” or “The Vanity Crisis.”

Meaning:

According to Sheehy, the “universal preoccupation” of the middle years is “the search for meaning in whatever we do.” As they face the fact that time is limited, the Baby Boomers typically become even more intent on this need to analyze and search for significance.

Change:

The midlife years can be a time of radical change for many people. This is the result of endless questioning and evaluation of how one has lived life thus far. Many midlife crises become mid-life meltdowns, says Sheehy, because some people react to feelings of emptiness or disillusionment by destroying everything they have built.
The Boomers developed a value system that is based on a sense of entitlement and which values individuality. Because they hold these values, Boomers respond differently to each life stage than do other generations. You can see these values reflected in scenes like those from television shows from the 1950s and early 60s.

According to Smith and Clurman, four important characteristics of the Baby Boomer value system are:

Self-absorption:

The Boomers (once called the “Me” Generation) have the reputation of being more narcissistic than other generations. Because of the times they grew up in, they have always been fascinated with themselves. The indulgence they experienced at home in the 1950s and the world’s seemingly limitless possibilities created a fascination with self and a feeling of specialness.

Sense of entitlement:

As a generation, the Boomers see themselves as superior to others. They have always assumed that they could have life their way and that the rules were meant for others, but not for them. They feel entitled to rewards and view themselves as winners. They expect success and cannot accept failure.

Need for control:

The Boomers need to feel certain and to sense that they are in control of life. They have a difficult time dealing with uncertainty.

Reflection:

Baby Boomers have always valued introspection and take pleasure in asking questions.
For most people, life at age 45 or 50 doesn’t match the dreams they had at age 20 or 30. When people reach age 45 or 50 and are even slightly disappointed by their achievements and experiences, their feelings are likely to be compounded by these factors of self-absorption, sense of entitlement, and a need for control. But there is also a positive side to this. The tendency to reflect and explore can help one look for new possibilities instead of being stuck with feelings of disappointment.

Keep all of this in mind as you complete the Midlife Checkup. It is a list of 10 unfinished sentences that will help you assess your life to date. The items on this list provide a framework for conducting your own assessment. Please add your own ideas that you think will help you reflect on your life’s direction.

The Midlife Checkup

1. My most important accomplishments are…

2. I am disappointed about…

3. I would describe the person I turned out to be as…

4. I want to change the following things about my self and my life…

5. Things I want to do before I die…

6. If I knew I couldn’t fail, I would…

7. Things I have mastered…

8. Things I want to keep…

9. I want to keep these relationships…

10. Add your own items…

Please pass this newsletter along to a friend. Or call 562-8045 to request additional copies
Michael MacMunn is a Licensed Independent Clinical Social Worker and a Licensed Alcohol and Drug Counselor in Westfield. Call 562-8045 for a consultation.

By Michael MacMunn, LICSW, LADC

What Is Self-Esteem?

Self-esteem literally means to esteem, or respect yourself. Possessing high self-esteem means that you have a positive image of yourself. Let’s look at where such a positive self-image comes from.

In her classic book Celebrate Yourself, Dorothy Corkville Briggs makes a distinction between the real you and your self-image. She says that the real you is unique and unchanging. Most of your self-image—what you think is true about yourself—is learned. It is not necessarily accurate at all!

Where are your beliefs about yourself drawn from? Where did you learn them? If you think about it, you’ll see that they came from:

• What others said about you
• What others told you
• What others did to you

Your self-image is the result of all the messages you heard about yourself as a child. These messages added up to a set of beliefs about who you are. It may have nothing to do with who you really are.

For example, you may believe things like:

• I’m not very smart.
• I’m naturally passive.
• Girls aren’t any good at math.
• I’m too old to start over.
• All of the women in the Mac family become doctors.
• I’m painfully shy.
• The Macs never lie.

In addition to learning to believe certain things during our early years, there are certain situations that make most people feel inferior or lacking in self-esteem.

Some examples are:

• Being criticized
• Not being loved
• Being rejected
• Experiencing failure

What Low Self-Esteem Feels Like

In situations like these above, it is not uncommon to feel emotions such as:

• Sadness
• Inferiority
• Anger
• Jealousy
• Rejection

Cognitive Therapy

Cognitive therapy is one of the most successful methods for helping people feel better about themselves. Cognitive therapists help depressed and anxious people feel better by identifying how faulty ways of thinking are making them feel bad. They believe that faulty thoughts cause us to feel bad, which makes us feel bad about ourselves.

Cognitive therapists call these faulty ways of thinking “twisted thinking.” Cognitive therapy is a process where the client analyzes his or her thoughts and beliefs, and learns to substitute more healthy ways of thinking and believing. These therapists help their clients feel better in four steps: First, identify the upsetting events that cause bad feelings; second, record your thoughts about the event; third, identify the distortions in your thinking process; and fourth, substitute rational responses. When the client successfully completes these four steps, the client usually feels better about him- or herself.

Thinking the right kinds of thoughts is one way to feel good about yourself. Now let’s talk about a second way to increase your self-esteem: by taking a look at your life environment and seeing whether it supports you feeling good about yourself. You may find that some nourishing elements need to be replenished. Here are some questions to ask yourself:

Do you have people in your life who:

1.         Treat you with love and respect?

2.         Encourage you to do and be anything you want?

3.         Help you find out what you want to do, and how to do it?

4.         Encourage you to explore all of your talents and interests?

5.         Are thrilled when you succeed?

6.         Listen to you when you need to complain?

7.         Help you bounce back from failure without making you feel bad?

Take a moment to think about each of the items on this list. Note where your environment is providing adequately for you, and where it is lacking. This can give you clues to how to build your own self-esteem.

Strategies for Esteem Building

1. Pay attention to how you are feeling from moment to moment. Tune in to what your five senses are experiencing. Take it down to the most basic level of “I feel warm right now,” “I feel light-headed,” “I feel a tightness in my stomach.”
2. Revisit your interests and goals. Make a list of things you’d like to do and learn. Today, take one step toward learning more.
3. Spend less time with critical people and more time with those who appreciate you.
4. Spend some time with yourself at the end of each day. Review what happened and how you were feeling. Write about it in a private journal.
5. If you are feeling bad about yourself, consider finding a therapist to help you get your life on a positive track.

Please pass this newsletter along to a friend. Or call 562-8045 to request additional copies
Michael MacMunn is a Licensed Independent Clinical Social Worker and a Licensed Alcohol and Drug Counselor in Westfield. Call 562-8045 for a consultation.

By Michael MacMunn, LICSW, LADC

In the last newsletter, we discussed what stress is and what causes it. In this issue, you will learn how to manage the stress in your life and protect yourself against it.

Learn to Have Healthy Relationships

This subject could fill an entire book. In the limited space of this newsletter, let’s look at the key components of this stress-reducing strategy.

1. Identify the sources of stress in your relationships. Write about them in a journal. Make a list of people who cause you stress and explore what the issues are.
2. Resolve the underlying issues. For each of the situations identified in step 1, assess what needs to happen to resolve it. Make a list and design a plan to improve the situation.
3. Learn skills to improve relationships. Relationship skills are learned. We are not born knowing how to get along well with others, and most of us learned only limited skills from our parents. Identify the skills you need to develop, and make a plan for yourself. You can learn these skills by reading books, taking classes, or working with a therapist.
4. Avoid toxic people and situations. Some people have a toxic effect on you. If you can, limit the amount of time you spend with them. Look for opportunities to decline their invitations. When these people are family members, remind yourself that you don’t have to feel guilty about avoiding anyone who makes you feel bad about yourself. In work situations, look for ways to rearrange your schedule or your workspace to avoid interacting with such people.
5. Seek out positive people and situations. This step is the reverse of the previous step. Look for opportunities to spend more time with people and in situations that make you feel good. Think about people who make you feel good about yourself and look for ways to increase time with them.
6. Watch what you eat.

Some substances amplify the stress response. These include:

• Caffeine stimulates the release of stress hormones. This increases heart rate, blood pressure, and oxygen to the heart. Ongoing exposure to caffeine can harm the tissue of the heart.
• Refined sugar and processed flour are depleted of needed vitamins. In times of stress, certain vitamins help the body maintain the nervous and endocrine systems.
• Too much salt can lead to excessive fluid retention. This can lead to nervous tension and higher blood pressure. Stress often adds to the problem by causing increased blood pressure.
• Smoking not only causes disease and shortens life, it leads to increased heart rate, blood pressure, and respiration.
• Alcohol robs the body of nutrition that it might otherwise use for cell growth and repair. It also harms the liver and adds empty calories to the body. During times of high stress, eat more complex carbohydrates (fruits, vegetables, whole breads, cereals, and beans).
• Get moving. The human body was designed to be physically active. However, in most jobs today, people are sitting down most of the time. They hardly move at all except when it is time for coffee break or lunch. When faced with stressors, we respond with our minds, not our bodies. It is no wonder that many of us have a difficult time responding to stressful events.
• Exercise is one of the simplest and most effective ways to respond to stress. Activity provides a natural release for the body during its fight-or-flight state of arousal. After exercising, the body returns to its normal state of equilibrium, and one feels relaxed and refreshed.
• Look for ways to let go of tension and anxiety. Meditation and progressive relaxation are two valuable ways to regenerate and refresh yourself. You can purchase meditation and relaxation audiotapes or record your own. This is especially important because your health and long life depend on minimizing stress and achieving a sense of balance and well-being.




Suggested Reading

Jeff Davidson, The Complete Idiot’s Guide to Managing Stress. New York, NY:Alpha Books, 1997.
J. Barton Cunningham, The Stress Management Sourcebook. Los Angeles, CA: Lowell House, 1997.
Peter G. Hanson, Stress For Success. New York, NY:Doubleday, 1989.
Peter G. Hanson, The Joy of Stress. Kansas City, MO:Andrews &McMeel, 1985.

Michael MacMunn is a Licensed Independent Clinical Social Worker and a Licensed Alcohol and Drug Counselor in Westfield. Call 562-8045 for a consultation.

By Michael MacMunn, LICSW, LADC

In this newsletter, we will explore what stress is and what causes it. In the next, you will learn how to manage the stress in your life and protect yourself against it.

Stress Is a Response

Most experts define stress as a response to life situations like the following:

1. Having too many responsibilities
2. Vague or confusing expectations
3. Having to do unpleasant tasks
4. Facing too many distractions
5. Having to do tasks for which one is unprepared
6. Working with difficult people
7. Being bored
8. Being sick
9. Experiencing too many changes
10. Being in physical danger
11. Living or working in a crowded space
12. Not getting enough exercise
13. Poor nutrition
14. Not getting enough sleep
15. Not enough time to relax
16. Being dissatisfied with your physical appearance
17. Abusing drugs or alcohol, or being close to someone who abuses them

Social and Cultural Causes of Stress

Stress has become a factor in our culture in the last 20 years because of things that were originally designed to make life less stressful. Conveniences such as ATM machines, microwave ovens, and fax machines have made life easier in many ways, but they also have woven an expectation of instant gratification into our culture. And this causes stress.

Here are a few other examples of products and services that were invented to make life more efficient and productive, but which sometimes seem instead to add to stress:

• 24-hour stores and restaurants
• One-hour photo developing
• Drive-thru fast food
• 10-minute oil change
• Web sites, with their instant access to unlimited information
• Catalog and Internet shopping
• Personal computers
• E-mail
• CNN Headline News
• 30-minute pizza delivery

Stress at Work

Almost everyone complains of stress at work these days. It often results from one of the following:

1. Having too much or too little work to do
2. Having to do work that is very complicated and demanding
3. Having to do work that is boring and repetitive
4. Having unclear goals and expectations
5. Having to follow changing or confusing procedures
6. Being at a career dead end
7. Working in a company with an impersonal management philosophy

Who Work Stress Affects Most

Stress affects people in every type of work setting. People at the top of organizations suffer from stress because of excessive workloads, unrealistic expectations, and isolation. The phrase “it’s lonely at the top” has some truth to it. Middle managers often experience stress because they have responsibility for the people who report to them, but lack the control to execute what is expected. With the recent epidemic of corporate downsizing, middle managers have also been given greater and greater workloads. Managers who manage to keep their jobs often feel like they are living in the shadow of termination. Professionals suffer from their own brand of stress caused by monotony. Doctors, lawyers, and other professionals often perform the same kind of work for many years, resulting in boredom and desperation. Workers at the lower levels of today’s organizations often feel stress caused by boredom and the frustration of dealing with the public. They also may feel less successful than their coworkers in higher-level jobs and may feel stressed by their lack of status.

Why Workplace Stress Has Increased

1. The nature of work has changed. The fight-or-flight responses to stress are ineffective in response to the stresses of today’s life.
2. The workplace has become decentralized. In many places, people no longer work together in one place, but may be scattered around the world or work from home, connected by technology.
3. People change with each generation. Baby Boomers differ from Generation Xers in terms of their values, work ethic, and their definitions of success. These generational differences contribute to stress at work.
   1. Overall, women are still paid less than men for the same work.
   2. Women still face a glass ceiling as they climb the corporate ladder. A recent report stated that only 2% of the members of top management of North American corporations are women.
   3. Women who choose to have children are usually responsible for the logistics of child care.
   4. Women with children often do more housework when they get home than their husbands do.
   5. Compared with men, women with children also tend to experience more guilt feelings about leaving their children to go to work.

How Stress Affects Women

Both genders experience stress. It affects women in some unique ways, however. Here are a few of them:

In the next newsletter, we will explore ways you can manage stress and keep it from detracting from the quality of your life.

Michael MacMunn is a Licensed Independent Clinical Social Worker and a Licensed Alcohol and Drug Counselor in Westfield. Call 562-8045 for a consultation.