When the psychiatrist suggests that Randy should go into the hos-
pital for electrotherapy, his wife hits bottom. From his first
complaints of job stress, through his disability, and on into his
depression, Randy’s wife has always tried to stand by him, but
often it feels like standing idly by. At some intuitive level, she knows
that Randy’s attempts to make himself feel better by doing less were
making him worse, but she doesn’t know what to do about it.
Randy, meanwhile, just stares at the TV.Television is poisonous to depressed people because it keeps them
from noticing that they’re really doing nothing.
Randy, his wife, and I agreed that his situation was serious
enough to warrant drastic action. At my suggestion, they moved
the television and the couch to their son’s garage, and every day
before she left for work, Randy’s wife would pile things on the bed
so he would have to have to move them if he wanted to lie down.
We enrolled Randy in a day treatment program that met
twice a week. He hated it, but he went. Every day, we set him a
series of tasks. Every afternoon, he had to call my office and
report on his progress.
In the evening he and his wife would go for a walk, then
fix dinner together.Behavioral therapyinvolves similar task assignments as well as the
charting of activity and mood over time to demonstrate, with scientific
precision, that what you do determines how you feel. The problem with
this approach is the doing.
For behavioral therapy to work, there has to be enough emotional con-
nection with the therapist to provide motivation. Irritation works just fine.
At first Randy thought I was picking on him. I agreed, and
pointed out that he was also paying me to do it. For an instant
I saw the ghost of a long dead smile cross his face. In our ses-
sions I’d drag his mind out into the fresh air. We’d discuss cur-
rent events, for which he’d have to prepare by reading the
newspaper, something he once enjoyed but had stopped doing174 ❧Explosions into Sadness