“That’s ridiculous. You look fine.”
“If you like fat.”
“You’re not fat.”You can’t talk depressed people into feeling better. Don’t even try. It
will only wear you out, and it won’t do them a bit of good. What both of
you need to do is pay less attention to what they feel and more to what
they do. This is the secret to helping depressed people without becoming
enmeshed. Everything else is commentary.
Steps in the Treatment of Depression
The point of psychological treatment is not to make depressed persons feel
better, but to make how they feel less of a factor in their day-to-day
choices. If depressed people start thinking better and doing better, they’ll
usually feel better as well, but it’s merely a positive side effect.
Step 1: External Control
As we saw in the last chapter, antidepressant medications can work wonders.
For some lucky folks, they can even make the whole disorder disappear.
All depressed people should at least discuss the possibility of medication
with a physician or therapist, especially if they’re not eating, thinking about
suicide, or they’re sleeping less than five or six hours most nights.
Medication may not cure, but it makes many people feel well enough
to do the things that willcure. Your job is to help them keep doing those things.
Step 2: Increasing Pleasant Activity
Behaviorists conceive of depression simply as a lack of positive reinforce-
ment. Depressed people don’t get much out of doing what they used to
enjoy, so they stop. The problem is, if depressed people do only what they
feel like doing, they’ll become even more depressed. The second step in
treating depression is to disrupt the downward spiral by getting people up
and moving. They will see any activity as absolutely pointless, so don’t try
to explain; make them do it to humor you.
172 ❧Explosions into Sadness