“It’s taken me a long time to get here,” Jessica lamented in her first session. “I don’t know what my problem is. I just feel unhappy. Something is missing in my life, but I don’t know what I want or what it could be. I’m a 46-year-old married woman. My marriage to Peter is fine and I like my job as a speech therapist well enough. I feel boring and bored and maybe have more anxiety than I should. What do you think is wrong?”

Jessica’s statement at the start of therapy began our quest to understand Jessica’s sense of emptiness. In our sessions, her talk was tinged with melancholy. Jessica said that when she looked in the mirror she saw “a not very attractive, aging, unsatisfied woman who feels empty.” Apart from Jessica’s sad demeanor, she brought urgency to the sessions with her intense desire to find out “what is wrong with me?”

Jessica grew up in a suburb of a large city as the younger of two daughters. Her parents divorced when she was 9 years old. Her father quickly remarried and had a child with his new wife. Jessica had vivid memories: “I was crying and my father was hugging me. He said he was moving out because he and my mother had too many problems to stay together.” A tearful Jessica continued: “I remember thinking, ‘How can he leave me?’ I couldn’t stop crying and ran to my room.”

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Jessica and her sister saw her father weekly for a little more than a year, but when he became involved with his wife to be, their visits became less frequent. She recalled, “It was never the same after he left. I never saw him alone and I couldn’t hold onto the feeling that I was special to him. I lost that when I lost him.”

Jessica tried in our sessions to recapture what growing up was like. She wondered if she had been sad even before her father left: “I think I’ve always been sad. Maybe our whole household was sad. My mother was not an energetic or happy person. She often seemed far away. I think she was depressed after my father left and she definitely became more anxious. I was always anxious, too. My sister, who is five years older than me, always did her own thing. But I was very attached to my mother. I felt a strong need for her, and it must have gotten more intense after my father left. She wasn’t very affectionate, and I was very clingy. I remember we used to play cards a lot and we’d go shopping together. I wanted to be around her. I didn’t have a lot of friends. When I went to high school, I started to make friends, but I was always nervous around them. I felt different and not part of the group, so I didn’t do as much at school or with them as I now wish I had.”

When Jessica left home for college, she became somewhat more engaged with the world. She had her first date at the end of her freshman year and dated occasionally throughout college. For the most part, she focused on her education. The college and graduate school Jessica chose was two hours away from home. She spent most weekends and school vacations home alone with her mother (her sister had married and moved to California).

Jessica recalled her conflicted feelings about going home: “I missed my mother when I was away at school, but I don’t know what I missed, exactly. Going home was pretty boring. My mother wasn’t very interested in what I was doing. Whenever I was excited to tell her about my classes or my patients when I was in grad school, she seemed to change the subject. I don’t know what it was, but being around her made me anxious about school and dating and I guess about most everything. Still, after grad school I moved back near my mother and got a job as a speech therapist. When I think about it now, I don’t get why I went home. I think I felt my mother wanted something from me, but I don’t know what.”

I asked Jessica to talk more about her experience with her mother.

“It’s hard to describe,” she said. “I felt so ambivalent about her. I loved her desperately but always felt something was missing in our connection. I wanted her to tell me I was terrific, to give me the feeling she was interested in me and my life. I wanted to feel like she took pleasure in what I did and who I was, but she never did. If anything, I made her feel good. I felt she needed me, but I didn’t know what she needed me for. She was very sensitive, and I was very anxious around her. It didn’t take much for me to feel I had hurt her. She seemed like a pretty lonely person. I think I felt I was supposed to do something to make her life better. She seemed to like it when I was around, but she never seemed to want me very close to her. It was confusing because I also needed to be with her, but it never made sense to me that I felt that way.”

Jessica was beginning to recognize that her mother was limited and couldn’t provide her with feelings of being special that she desperately needed and longed for. Jessica also began to appreciate the consequences of her strong feelings that she would hurt her mother by being special or fulfilled.

Tears started to flow: “You know, she died too young. She developed heart problems and became very sick when I was 32. After that, I spoke to her every day and visited as much as I could, even if I didn’t want to. All my energy was focused on her. She was very depressed, and I was very careful not to make her feel worse by telling her anything that was good in my life.”

Jessica’s mother was ill for four years and died when Jessica was 36, 10 years before she came to see me. During her illness, Jessica’s mother was a constant companion in Jessica’s mind.

“I got more anxious and very depressed,” Jessica recalled. “My mother was dying, and I felt totally helpless. I was so worried that I would say or do something that would upset her. I was preoccupied with thoughts about what I should be doing for her and what she would think about my life. Sometimes I still catch myself wondering what she would think about me. I’m very sad that she never got to meet Peter or know that I married. But sometimes I think marrying Peter was a betrayal of my mother. She never felt very good about herself. How would she feel if my life went well? I think it would hurt her. She might think I was arrogant if I said I had a good life or expressed excitement about my accomplishments. I’d feel like I was being mean to her.”

Even now, after the death of her mother, Jessica still expresses a strong need for her mother: “Since my mother died, she is in my head more than ever. I find myself wondering what she would think about everything: would she like something I bought or would she be OK with my coming here?”

“What kind of response would you want from your mother now?” I asked.

Jessica began to sob: “I wish she would give me a big smile and look really delighted with me. I don’t think I ever got that from her.”

As we continued to explore Jessica’s relationship with her mother, it became clearer that her mother had been unable to provide Jessica with the basics for developing positive self-feelings and a sense of being valued, admired, and recognized. Jessica’s mother couldn’t mirror Jessica’s excitement, enthusiasm, and good self-feelings back to her. Consequently, Jessica infrequently experienced these feelings as part of herself. This left a space inside Jessica, which I believed was what Jessica described as “something missing.” Growing up, Jessica did not know that her need and longing for her mother was her effort to find her missing good and valuable self in her mother’s experience of her.

Jessica was beginning to recognize that her mother was limited and couldn’t provide her with feelings of being special that she desperately needed and longed for. Jessica also began to appreciate the consequences of her strong feelings that she would hurt her mother by being special or fulfilled. We spent many sessions talking about all the ways Jessica had held herself back in her life. She became aware of how her relationship to her mother governed her choices and kept her trapped in patterns of behavior, thought, and feeling that interfered with her ability to enjoy life, engage with people, and ultimately feel self-confident and pleased with herself and her life. She began to understand how, unconsciously, she had lived her life to assure that if her mother contrasted her life to Jessica’s, she wouldn’t feel threatened by finding too much “good stuff” in Jessica’s life. Jessica wondered if she was only able to find a partner and marry after her mother’s death.

Jessica and I worked hard exploring her attachment to her mother. Now she has emotional knowledge (knowledge with feelings attached, not just thoughts) about that connection. She knows she connected to her mother by becoming like her: she internalized her mother’s sadness and duplicated the absence of her mother’s good internalized self-feelings. She knows that her sadness about her missing good self-parts was a kind of mourning for the absence of a nurturing mother and the good feelings she was never able to obtain from her.

Now Jessica is freeing herself from protecting her mother. Now she can be there for herself. She can nurture her missing parts and change her internal world. She will be able to own a new sense of self-confidence and self-esteem and follow her own wishes, get her needs met, and feel special.

Note: To protect privacy, names in the preceding article have been changed and the dialogues described are a composite.

Feeling empty from time to time may be a normal part of the human condition. But if you experience persistent feelings of emptiness, there may be something you can do about it.

What does emptiness feel like?

• You don’t have a sense of purpose.
• You perceive a lack of meaning in your life.
• You’re not happy, but you’re not particularly sad, either.
• If someone were to ask you how you feel, you might say, “I don’t know.”

What causes feelings of emptiness? No one knows for sure, and there may be more than one cause. A common reason you might feel empty is self-alienation—feeling like a stranger to yourself. This sensation develops over time, usually as a result of pushing away unwanted emotions.

Our emotions are an important aspect of our experience of ourselves and our quality of life, yet most of us have some degree of trouble allowing ourselves to have certain feelings. Anger is one emotion that many people try not to experience, for example.

What happens to our feelings when we refuse to acknowledge them? They stick around in the shadows of our minds, gumming up the emotional works and, eventually, cutting us off from ourselves altogether.

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The result? We feel empty. We have a pulse, but we’re not really alive.

Life is an emotional experience.

If you come from a family that didn’t “do” certain (or any) emotions, you’re at increased risk of feeling empty.

Here are some ideas for getting out from under this uncomfortable state:

• Stop looking “out there” for a sense of purpose. Your purpose springs forth from your uniqueness. It’s not something that floats around the earth independently like a cloud, waiting for you to find it. If you don’t have a strong sense of who you are, it’s can be hard to feel in touch with your purpose. You are someone in particular. You have a story, of which you’re the star.
• Think about this question: “Who is the person experiencing this feeling of emptiness?” Your authentic self is the person who cries when you’re sad, and laughs when you’re tickled. It’s your authentic self who wants to inhabit the void, filling you with meaning, purpose, and connection. Start where you are: Someone is feeling empty. Who is it?
• Ask yourself how you might feel if you weren’t feeling empty. Look at your life—past, present, and/or future. What comes up as you think about it? Any so-called negative emotions such as anger, disappointment, or despair are showing you what might be hiding under a numbing blanket of emptiness. Are you protecting yourself from something you’d rather not know? Be curious, not judgmental. Compassionate, not accusing.
• Embrace your emotions, whatever they are. This is the same as embracing yourself. Although emotions aren’t literally a part of you, they’re a reliable reflection of you in this moment. How you feel in any given moment is the road that connects you with your authentic self. Try a little constructive wallowing in any emotions you have, and remember: curiosity and compassion, not judgment, is the goal.
• Be a joiner. There’s meaning in connection with other people. Consider sharing your sense of emptiness with another person. If there’s no one in your life you trust with that information, a support group could be valuable. A grief support group might be a good choice. Many of us have endured enough loss in our lives to fit right in. You can’t be closer to another than you are to yourself. Be honest and kind to yourself, rather than looking to other people to fill you up.
• Root out shame. There is nothing inherently wrong with you. It’s hard to be close to someone you despise, and shame encourages you to reject yourself.
• Try therapy. A good therapist holds up a metaphorical mirror, helping you see and appreciate who you are. If you need a little help, find a therapist in your area.

You don’t have to live your life feeling empty if you don’t want to. You deserve a good relationship with yourself and a meaningful, purposeful life. Let this article reach that part of you that’s there under the surface, waiting to reconnect and dispel those feelings of emptiness.

Surprisingly, studies show that some of the seemingly less dramatic kinds of experiences, such as neglect, in childhood actually do more harm than overt abuse such as physical violence. Neglect isn’t talked about as much as physical, sexual, or even verbal abuse, and depressed adults who experienced neglect in their childhoods often wonder why they’re depressed.

Even when people think about neglect, they picture parents who are too drunk or high to take care of their children, who prioritize adult sexual relationships over their children, or who don’t care about their children and thus don’t bother to feed them or provide clothes and other necessities. They may imagine parents who are irresponsible and who forget or don’t know how to take care of their children’s needs. All of this happens, but it can happen without such extreme dysfunction.

Sometimes neglect can happen even when parents are trying to be responsible, when they simply don’t have the resources to parent fully. For example, when one parent leaves and the other has to work two jobs to provide food and shelter, they may have to leave the kids to fend for themselves or let the older ones to do the best they can to parent the younger ones. I’ve had clients from families in which this happened when the older one was as young as 3, taking care of a baby or two.

But neglect can also happen in families in which one or both parents are depressed, have demanding jobs, or have so many children that there isn’t time to meet all of their needs. It can happen when one of the parents, siblings, or grandparents is chronically or gravely ill or dealing with mental issues. Often this requires the rest of the family to put most of their time, energy, and attention into that person. It can even happen in families that value individuality and independence. Thinking they are teaching these values to their capable children, parents may overlook concrete and emotional needs even capable children have.

Neglect can cause children to miss learning the skills they need to be fully functional adults. When kids have to teach themselves how to handle life, they often don’t learn the best ways. Neglect can cause children to feel profoundly lonely and empty. It can make it more difficult for them to form friendships, causing them to feel even lonelier and preventing opportunities to develop social skills. They may feel like they don’t fit in anywhere, and learn to cope alone. Perhaps most insidiously, neglected children often conclude they aren’t worth parental attention and care, or that their needs aren’t important or just aren’t ever going to get met. These beliefs, carried into adulthood, undermine the ability to develop loving, respectful, equally powerful relationships.

Not through parents’ intention or direct action or message, but through lack of action, children can turn in on themselves—blaming themselves for how bad they feel. They can grow up with these invisible wounds, not even associating them with their parents, who may be loving, well-intentioned people.

Clearly, there is a huge range of severity of neglect, depending on factors such as how young the child is when it begins, how extensive it is, whether there’s a basic foundation of love and respect from parents, whether there are other adults who provide at least some of what the child needs when parents don’t, what other abuse is involved, and whether other resources are available.

How people cope with neglect also varies, just as it does with abuse and trauma. Neglected children may cope by clinging and being dependent; by giving up and lacking motivation or hope; by withdrawing and resisting human contact; or by acting out with crime, dangerous sex, etc. They may experience depression, anxiety, self-attacks, eating issues, or addictions. Any or all of these results of the neglect can follow the child into adulthood.

If you don’t understand why you’re depressed and think you had good parents and no trauma, consider what you might not have had. Did you struggle with anything your parents didn’t protect you from or help you with—even things like unrealistic standards for yourself? Did you have to take care of yourself more than your friends had to take care of themselves, or that you would expect of your children, nieces, nephews, or godchildren? Did your parents show no interest in things that were important to you? Did you have to work at getting your parents’ attention? Did you get physically or emotionally hurt because your parents weren’t paying attention? Do you feel like your needs aren’t important? Do you not expect to have them met? Check in with yourself, your journal, your therapist, and maybe your siblings to see if you can find ways your parents weren’t there for you that others are for their kids … and look at how it affected you.

While not everyone’s experience is the same, when people have a major depressive episode, generally the world looks, feels, and is understood completely differently than before and after the episode. During a major depressive episode, the world can literally seem like a dark place. What was beautiful may look ugly, flat, or even sinister. The depressed person may believe loved ones, even their own children, are better off without them. Nothing seems comforting, pleasurable, or worth living for. There’s no apparent hope for things ever feeling better, and history is rewritten and experienced as confirmation that everything has always been miserable, and always will be.

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When this reality shift happens, it’s difficult to remember or believe what seemed normal before the episode. What the person believes during the episode seems absolutely real, and anything that conflicts with it is as unbelievable as a memory or message telling him or her that the sky is purple. For example, if the person is unable to feel love for a spouse, and someone reminds the person that he or she used to feel that love, the person may firmly believe he or she had been pretending to himself/herself and others—though at the time he or she really felt it. The person can’t remember feeling the love, and can’t feel it during the episode, and thus concludes he or she never felt it. The same process happens with happiness and pleasure. Attempts to tell the person that he or she used to be happy, and will feel happy again, can cause the person to feel more misunderstood and isolated because he or she is convinced it’s not true.

Even if nothing was wrong before the episode, everything seems wrong when it descends. Suddenly, no one seems loving or lovable. Everything is irritating. Work is boring and unbearable. Any activity takes many times more effort, as if every movement requires displacing quicksand to make it. What was challenging feels overwhelming; what was sad feels unbearable; what felt joyful feels pleasureless—or, at best, a fleeting drop of pleasure in an ocean of pain.

Major depression feels like intense pain that can’t be identified in any particular part of the body. The most (normally) pleasant and comforting touch can feel painful to the point of tears. People seem far away—on the other side of a glass bubble. No one seems to understand or care, and people seem insincere. Depression is utterly isolating.

There is terrible shame about the actions depression dictates, such as not accomplishing anything or snapping at people. Everything seems meaningless, including previous accomplishments and what had given life meaning. Anything that had given the person a sense of value or self-esteem vanishes. These assets or accomplishments no longer matter, no longer seem genuine, or are overshadowed by negative self-images. Anything that ever caused the person to feel shame, guilt, or regret grows to take up most of his or her psychic space. That and being in this state causes the person to feel irredeemably unlovable, and sure everyone has abandoned or will abandon him or her.

It’s difficult to describe all of this in a way that someone who’s never experienced it can make sense of it. I can’t emphasize enough that when this happens, what I am describing is absolutely the depressed person’s reality. When people try to get the person to look on the bright side, be grateful, change his or her thoughts, or meditate, or they minimize or try to disprove the person’s reality, they are very unlikely to succeed. Instead, they and the depressed person are likely to feel frustrated and alienated from one another. I do believe cognitive therapy has an important place, but generally not in the throes of a major depressive episode.

Support for People with Depression

So what does a person whose reality has shifted in this way need? Please keep in mind that I am talking about a major depressive episode—severe depression that has lasted more than two weeks. I would take a different approach for someone with milder depression, or one that is a response to a terrible loss.

For some people in a major depression, psychotropic medication works and is the only thing that works. The same could be said for electroshock treatment, though it’s not for everyone. Many people will emerge from major depression in time, though episodes seem to make more episodes more likely, so if medication works to end the episode, it’s usually prudent to take it. Nutrition, acupuncture, and other body-based treatments as well as therapy can help without the side effects of medication.

What Loved Ones Can Do

Loved ones can gently hold and show love and commitment to the depressed person, try not to take on the person’s reality, but also not argue with him or her about it. They can also gently remind the person that depression causes his or her perspective on everything to change, and he or she is unable to think outside of depression mode at the moment. It is a time for the person to avoid making decisions, or avoid doing anything significant that requires a nondepressed perspective. If this is a repeated experience for this person, it can be helpful to discuss all of this between episodes so he or she is more prepared when caught in the quicksand.

As someone who loves a person with depression, it can be emotionally difficult or stressful at times to support that person. It can be beneficial to focus on your own needs and self-care, and to reach out for help if you need it such as seeking the support of a counselor or therapist.

The Family Man, starring Nicholas Cage, is a great Christmas movie, and I watched it last night. Nick’s character makes a choice at the beginning of the movie and, more than a decade later, is a very wealthy man. There’s a message from his old girlfriend, Kate, but he does not call her at that point. After a brush with fate, the next morning there’s a change in his life: He’s with Kate, two kids, little money, and he’s got to figure out what is important to him.

When he finally realizes what is important, he wakes up having never been married, and meets up with Kate—who is going to be flying to Paris and wants to give him back his old stuff. Back in his penthouse, he sifts through a box of memories. He goes to the airport to try to stop her and convince her about the life they would have had if only he’d made a different choice. If you have not seen the movie, I do not believe I totally spoiled it for you, but if I did, I am sorry. I wanted to capture the basics of the movie, but you will have to watch it to get the essence of the movie.

It’s Christmas time, and every year at this time, we are scrounging around to get the best gifts for our families or friends. The stores are packed, the after-Christmas sales will be going on very soon, people will be returning gifts to get what they really want, and the attitudes of people are not always joyous. If you do not need to be out shopping, then don’t. Each year, the shopping comes earlier and earlier, more sales, etc. I also think that each year, the meaning of Christmas—the birth of Jesus, being around family, friends, sharing love, kindness, helping others, and spreading cheer—diminishes. This is my opinion.

We each have a choice to make. Yes, I have fallen into making sure that my family and friends get the “best gift,” and feel so ragged that it can be hard to be joyous. Having a kid changes your perceptions on what is important and what is not.

With my almost 2-year-old son, I am reminded that it is not about the quantity of gifts that I give or receive but rather the quality of the time I spend with my family and friends. Whether it’s baking homemade peppermint patties (York need not worry about going out of business), decorating cookies, reading about the birth of Jesus, or watching holiday movies, it’s what I am doing with family and friends that counts. It’s watching my son’s face light up when we play with Legos together, or crash his trains and get the toy ambulance to come and help the trains get all bandaged up. The quality time I have with my husband is very important as well—how I do my part to strengthen the relationship (not talking about sex), the unity that we have, and help each other stay focused and not get lost in the emptiness that can come with giving a gift because it’s on sale.

Almost all Christmas movies are about being with the ones you love, spreading joy and cheer, laughing, playing, creating memories, etc. Many are also about people who are trying to get ahead and how empty they may feel because they are not connected to their friends or family. It’s like a wake-up call, and it happened to Nick in The Family Man.

This is your wake-up call. Remember: Each day, not just at Christmas time, tell your friends and family how much you love them, and play with your children and friends’ kids when you visit them. Allow the children to help you relive your childhood memories, and after Christmas, keep spreading that joy all year long.

Watch The Family Man. It might remind you of what is really important and help you find balance in your life.

Depression makes it difficult to function in daily life, but adding discrimination to the equation makes it even more troublesome.

A new study in the journal The Lancet stated that out of the 1,082 adult participants with major depressive disorder, 79% reported that they have experienced discrimination. People who experienced discrimination while depressed had more depressive episodes, social difficulties, and issues finding and keeping a job. They also were less likely to reveal a diagnosis of depression.

These results suggest that more works needs to be done in the area of preventing discrimination and eliminating stigma. Discrimination can prevent people with depression, who may be worried about disclosing their diagnosis, from getting the help they need. While getting a job and growing social networks can help fight depression symptoms, those pursuits become more challenging in the face of discrimination.

How, specifically, does discrimination affect people with depression? How can the general public be more understanding? And what options do people with depression have? Mental health experts and other professionals have some answers.

Dr. David Sack, CEO of Elements Behavioral Health and Promises Treatment Centers, said by email that sensitivity toward people with depression often is lacking.

“The most common example has to do with intolerance toward peers/friends/relatives that comes from not understanding that depression is a disease that the individual cannot simply will themselves out of,” he said.

Sack said a supervisor might question an employee’s motivation and commitment due to symptoms of depression, even if those symptoms don’t reflect how the employee really is.

“How often have we heard that this or that person claims that they are depressed just so they can get time off from work or won’t have to take responsibility for mistakes they’ve made?” Sack said.

Although many people know the basics of depression thanks to widespread awareness initiatives, prejudice, bias, and stigma still are rampant.

Viola Drancoli, a clinical psychologist, said in an email that friends and family members of people with depression might exhibit discriminatory behavior with them because they may feel drained from being around someone who expresses sadness, pessimism, irritability, and a lack of motivation.

This could push someone with depression into isolation. A person with depression might prefer being alone so he or she doesn’t have to attempt to hide feelings from others.

“The social isolation often starts a vicious cycle in which the (client’s) negative outlook on life is reaffirmed, they feel let down by family and friends, and symptoms may worsen,” Drancoli said. “This is especially dangerous for individuals who have suicidal ideations and need support and monitoring.”

Drancoli said it’s important for family and friends to be supportive. She suggests volunteering to help out with chores that might be difficult for someone with depression to complete when he or she is struggling to function, as well as patiently listening without judgment. Loved ones can gently encourage a person with depression to exercise as well, as this has been shown to boost mood.

People with depression who believe they have been discriminated against have the law on their side. Sack said that discrimination against people with any disabilities, including mental issues such as depression, is forbidden by the Americans with Disabilities Act. The civil rights law, enacted in 1990, defines disability as “a physical or mental impairment that substantially limits a major life activity.” Some states have additional laws against discriminatory behavior.

“An individual who is concerned about discrimination at work will want to speak with their supervisor or the director of human resources first,” Sack said. “Most companies have strong policies to promote fairness and nondiscrimination.”

Justine Lisser, a senior attorney advisor in the Office of Communications & Legislative Affairs at the U.S. Equal Employment Opportunity Commission, said by email that if an employer has at least 15 employees, it must abide by the ADA. Employers need to provide “reasonable accommodations” for people with disabilities, as long as the employer isn’t deeply burdened as a result.

“For example, if a person with depression is hired for a position that requires an 8 a.m. start time, but due to the effects of (antidepressant) medication the person could not start until 10 a.m., it would be a reasonable accommodation to permit the employee with depression to start at 10 a.m., assuming that it would not cause an undue hardship for the employer,” Lisser said.

The EEOC has successfully enforced employee discrimination laws in a few cases involving people with mental health issues. In one case, a sales associate at a video retailer experienced harassment because of his social anxiety disorder and depression. His employer was ordered to pay $70,000 to settle the discrimination suit, according to an EEOC press release from March 2012.

There are many parallels between living with a disability and dealing with an uninvited house guest. If you have ever had an uninvited house guest, I am sure you remember moments when things may have been uncertain and, at times, tense or uncomfortable. At the very least, having an uninvited guest requires some adjustments, much like living with a disability.

An uninvited guest may arrive unannounced, leaving no time to plan or prepare. Likewise, in many cases people living with disability have little or no time to plan for the many changes to come. While there may have been no way to prevent the disability and requisite life changes, having time to prepare—psychologically and literally—can make a huge difference in a person’s ability to adapt and cope.

A period of psychological adjustment is required for a person who has a disability, his or her spouse/partner, parents, and other family members. The adjustment process people frequently talk about resembles the grief process in many ways. Like the grief process, people often experience feelings in what seem to be stages. Similar to the grief process, this adaptation process usually begins with a period of denial.

Denial
In my work with couples and families living with multiple sclerosis, I often hear concerns that one person seems to be “stuck in denial.” To people who have moved through the initial denial stage, it may seem as if their loved one is not progressing as quickly as others. The truth is, different people work through this period of adjustment differently, and it takes as long as it takes. The denial stage usually happens at the time of diagnosis or disability, and may come up again at other times. For example, in a progressive illness, if one begins to lose mobility or other limitations arise, the initial stage of the adjustment process may be triggered again.

It may seem clear to a caregiver/partner or family member who has been helping someone walk even short distances that a mobility device is needed (cane, walker, scooter). For the person who is having mobility difficulty, admitting that it is time to talk to a doctor about a mobility device may affect his or her identity, hope for recovery, or future progress. If so, working through the denial and bargaining, and then later stages of adaptation, may be necessary. It is not unusual to see all members of the family triggered by new developments that start the process over.

Denial is believed to be a protective measure that prevents us from becoming emotionally overwhelmed. Denial slows down the process of coping with traumatic events, giving us more time to psychologically prepare ourselves for the onslaught of feelings. The process of denial, known as a defense mechanism, should not be rushed or sabotaged by well-meaning loved ones who are at a different place in the adaptation process. Doing so can cause the person who needs more time to become emotionally overwhelmed without the necessary skills to cope effectively.

Coping skills: A person with disability and his or her family members should try to be empathetic and understand things from the perspective of others. Be honest, but gentle, about your perceptions. Choose the time to discuss these issues carefully—not when either of you are tired, frustrated, or angry. Always talk to your loved one(s) before bringing up concerns with doctors or other professionals.  Caregivers and family members should keep in mind that their needs are important, too. Take care of yourself and make sure you have plenty of support. When children are involved, be very careful what and how you share information with them. Children need to hear things based on what is appropriate for their age and stage of development. Ask for guidance from a professional if you are unsure how much to tell children or how to talk to them about disability.

Bargaining
The stage that usually follows denial is bargaining. During this time, people often are looking for second opinions, alternative therapies, and other remedies. It can also be a time when we promise the gods that we will turn our lives around if given a second chance without the disability or diagnosis.

It is true that finding the best medical providers, keeping a positive outlook, and staying informed of new research and possibilities is important. However, this can also be a time when people are vulnerable to scams and false promises. Unfortunately, there are a lot of companies and people who offer products and services that guarantee outcomes without doing the necessary research required to back up those assurances.

It is a good idea to check out any new or experimental treatments carefully before trying them—particularly if there is a large commitment of money, resources, or time involved. Check with local and national nonprofit organizations that provide services to people with your specific issue or health challenge. Agencies such as the National MS Society, American Cancer Society, and others often have information about ancillary and alternative therapies. They may be able to send you information or answer your questions.

Coping skills: Make decisions together based on facts. Find local and national organizations that you trust to support you and provide well-researched information. Be sure that any second opinions or ancillary providers have access to all the information you have from other providers. In some cases, taking medications or treatment without being fully aware of how they interact with your other treatment can be life-threatening. Make a commitment to fully investigate any new or experimental treatments before deciding to try it. Ask for and check references when appropriate. Verify the credentials of all providers before visiting them. At some point, you may have to accept a new reality that you had not planned for and do not welcome. If you have prolonged difficulty coping with the diagnosis or prognosis, find support from a professional or support group to help you with the transition.

Over the next few months, I will explore additional aspects of disability, how it affects the lives and relationships of the people involved, and ways of coping with these situations. If you have ideas to share about how you have effectively coped with any of the situations presented, please join the discussion by leaving comments below. Likewise, if you have questions, feel free to ask for input from others who read the blog.

One of the most common methods for assessing the behavioral and emotional state of a child is a parental report. This type of evaluation usually comprises a parent’s observation and evaluation of the child’s feelings, mood states, and behaviors over a period of time. But just how accurately do parents gauge the emotional temperature of their children? That was the question at the center of a recent study conducted by C. Emily Durbin of the Department of Psychology at Michigan State University. Because parental reports can vary quite dramatically from reports obtained by other observers, such as teachers, counselors, and classmates, Durbin wanted to determine what factors, if any, skewed parents’ perceptions.

Durbin chose to focus on the effects of maternal depression on parental reports. She based her decision on the fact that other conditions, such as alcoholism, parental anxiety, and family distress, have been shown to influence maternal reports. Durbin extended the existing research and compared mothers’ reports with those of unbiased observers on a sample of 190 children ranging from 3 to 6 years old. Participants were instructed to rate levels of sadness, fear, happiness, surprise, and anger in the children after they completed 10 emotion-inducing tasks. Durbin found that the mothers with a history of depression or anxiety tended to rate their children as less happy than mothers with no such history. Additionally, these same mothers viewed their children as overly fearful, and rated girls as sadder than boys. This could be a result of maternal sensitivity to emotions such as fear and sadness. However, the outcome showed a significant disparity between observers’ ratings and those of the mothers with a psychological history. “These mothers may have greater difficulty setting aside their perceptions of the child’s typical emotional adjustment to focus solely on rating the behavior the child is currently exhibiting,” Durbin said. Although the sample size was limited to young children and did not contain a large number of mothers currently exhibiting depressive symptoms, the results warrant further investigation. Durbin believes it is essential to expand this research to include older children, comparison to other assessment tools, and evaluation of other aspects of childhood development.

Reference:
Durbin, C. Emily, and Sylvia Wilson. Convergent validity of and bias in maternal reports of child emotion. Psychological Assessment 24.3 (2012): 647-60. Print.