The easiest way to show someone who is suffering from a mood related issue that it is clinically significant is through something called the cognitive triad. This method was developed by Dr Aaron Beck, a key figure in research on depression, and is simple and nearly 100% accurate.
There are three questions to the triad.
1) Are you feeling hopeless, or can others see that you are acting hopeless about the future? (EX: Plans are avoided or put off. Things seem to not be worth thinking about regarding upcoming events. Holidays that were once looked forward to are not, etc.)
2) Are there feelings of hopelessness about the outside world? (Has interest in outside activities diminished? Favorite things are avoided or ignored? Expressions of despondency or irritability about situations in the outside world [such as work] are shown, etc.)
3) Are there feelings or actions that support hopelessness about one's own self? Has self-care or dress or diet or person hygiene or simply trying to look as good as before, diminished? etc.
If the person has all three, this is a direct marker for a clinical level of depression, whether caused by biochemistry, circumstances or both. The triad does not give a specific mood disorder diagnosis of course, but it does identify clinical issues.
Trauma can cause depression as well as biochemistry, and she sounds like she has been through a great deal. Medications for depression only help about 50% or less of people who take them, and the best practice protocol for depression, mild or severe is medications combined with weekly cognitive behavioral therapy. CBT as it is called, combined with medications where appropriate, can raise treatment outcomes to 80% or more. Most therapist practice CBT; it is short term; highly effective and can be accessed via a referral from a family doctor. As with all therapy, it is confidential.
What would I do if this was my sister? I would ask your sister the questions outlined above. If she has now, or in the past met the criteria I would express my concern to her as well as raising the fact that medications alone are almost never the answer, and that many people recover through talk based therapy.
Her ongoing irritability is also a classic sign of depression, and she is suffering, without doubt. Importantly, not all depressions are severe and one of them, dysthymia (also known as chronic depressive disorder) is very common in 30-50 year old women, yet is it highly treatable. She can easily feel better by dealing with it if she wishes.
You cannot make her go to therapy, but you can be a resource of encouragement for her to do so. Soft words, over time, break hard bones. Encourage her that no matter the reason, she can feel better... and why suffer? Over time, with steady encouragement and motivation from you she has a very god chance of trying some supportive professional assistance. Steven
It took me ages to write my follow up - so I am really disappointed that it did not post - I am not sure I can remember everything now.
She met the criteria in the past - at the end of her marriage - but some fairly dramatic stuff went on as it turned out that after seven years of marriage she knew nothing about who he really was - he went to jail and she divorced him. It was really awful as her kids were involved. Anyway - cannot go into the details, but it only lasted about 3-6-months and she has pulled through.
I know that the answer to all of the questions now would now be "no". She is making plans for a vacation with her new man and very excited about it and is looking forward to finishing her degree to move on in her life.
I have been reading about Schema Therapy and thought that might be something she would benefit from because what I have noticed is that there are definite patterns in her life – she never holds a job for more than three years, she has never stayed in one residence for more than three years – there always seems to be some compelling reason that she has to move or change jobs. Although she is a generous, kind and caring person who is always doing volunteer work – she rarely gets along with the people she works with because I think she thinks very differently from them and has very different values (ie: she values family not consumerism) and is working in jobs that she is not suited for and that she dislikes intensely but does them to provide for her family.
She always has a plan for the future and is always forward looking – but things rarely work out the way she has planned or expected. She doesn’t do anything by halves – and is very passionate, compassionate and high energy. She is also ultra-sensitive to other people’s moods, or the things they do or say – she often clues into things that no one else does, but she also takes things more personally than other people tend to.
As I said before, I thought this was just her “artist’s temperament” but now after some of the articles I have read I am wondering if this is all part of a pattern? That perhaps she was affected deeply by our father leaving her mother when she was two and rarely having the opportunity to see him. He married my mother when she was seven and I was born, so we have never spent more than a weekend or a summer together here and there growing up and when I was a little older than seven he left my mother.
He is now married to someone else with whom he has been with for over twenty years now and we have a half-brother who is almost the same age as my nephew. When he was brought home (he is adopted), and when my nephew was born we all made better attempts at being a ‘family’ – but it hasn’t always gone smoothly and I have always felt guilty about how much more time, affection and support from our father that my brother and I have received compared to my sister. The last five years have been the best – but with my sister in another province it is more challenging to keep ties.
My sister was raised primarily by her grandmother as her mother didn’t really want to be a mother and was in university for the first seven years of her life. Then when she started working she dragged her across the country here and there and never stayed in one place long (so that is where we assumed my sister learned that from) and when her grandmother died she was hit hard at fifteen, because I think she had a closer bond to her than to her mother. She has always seemed like regrettable baggage for her mother and I know my sister thinks so too. So by sixteen or seventeen my sister left home and none of us even saw her for fifteen years as she left the country and eventually got married overseas. She cam home to give birth to her second child since there was a big earthquake where she was living and then a year after that, she came home for good to escape her wretched husband. Even though he completely abandoned her and their children, she kept hope for over ten years, that there would be a change for the better. When he finally sent her divorce papers, she finally moved on, met and married the guy she was with for seven years who also turned out to be a jerk.
So – I am wondering if there is some online psychological test that I could get her to do just for the fun of it that might get her to see these patterns and see that maybe there is a different way of living? Or am I making a mountain out of a mole hill? I wanted some advice before taking this any further because I think people who read things like this can start thinking too much :)
Thank you for the post. The information is helpful, and do know what you mean about losing posted material. I have lost my share of them, and it is really frustrating as you can never duplicate what was written in the first place.
Your sister sounds like she had a major depressive episode at one time and now has resolved it. However, there seems to be patterns in her life that do not seem to allow her to experience the full richness of life. At times, she almost appears to be self defeating in her behavior.
I am sure that her general temperament has a lot to do with her patterns, at least in a basic sense, but it the patterns where she seems overly sensitive and those that limit her enjoyment of life are most concerning to me.
This tends to be a pattern that is most often seen in adults who experienced a great deal of emotional rejection as a child. The sense of deep, but often invisible to others, inadequacy and insecurity creates patterns such as you describe here.
For, what is really being said here is that your sister is hurt; and that developmentally when she experienced this hurt she became stuck in a developmental stage of life, unresolved. Normally as a child, we become self accepting and move away from our parents and caregivers and grow accepting of ourselves But for her...she was painfully rejected, and loss on top of that, and now shows that rejection through the behaviors you describe. Although functional, she is still, I am certain, deeply hurt.
What can you do? I would recommend that she see a therapist as this is something that can be resolved. And, as a teacher of counseling I often tell my students that the methodology of therapy is not as important as the need to address the issues. So, the type of counseling is important, and Schema Therapy is good, but really the competence of the therapist in these cases is most important rather than the theoretical approach.
On line tests tend to be very limited. Certainly depression scales abound on-line such as http://psychcentral.com/depquiz.htm but these can only identify simple issues such as general depression or anxiety.
I often find that offering a book that you have read as a wonderful way to raise the issue without seeming pushy. Few people when they hear that you liked a book and thought of them will utterly reject the suggestion. Now: which book is best.? I would recommend: Adult Children of Parental Alienation Syndrome: Breaking the Ties That Bind by Amy J. L. Baker and Adult Children of Abusive Parents by Steven Farmer. Both are very good and the second one is a classic within the field.
I hope these suggestions insights and resources were helpful. Steven
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