World Mental Health Day is a day to celebrate the importance of our mental health, which is as important as our physical health. Mental illness is as real as a wound in your body. Don’t underestimate it just because you can’t see it. I am very passionate to spread awareness about this subject as my own grandma ha struggled with suicidal depression for many years and it was not easy for her nor us. To read about her story, click here. I am happy to have Meg Gitlin of @citytherapist share her insights and helpful tips on the blog today.
Tell Us About Yourself
I am a licensed psychotherapist/clinical social worker in private practice in Manhattan. I specialize in working with young, highly motivated individuals who are looking to better understand themselves and their goals, improve coping mechanisms, and get support as they navigate the stressors of their personal and professional lives. I often consider mental health as comparable to investing in other component of our physical health, in both a preventative and a symptom-focused way.
I am committed to de-stigmatizing mental health and want to do whatever I can to change the way people view therapy – from something that signifies weakness to an investment in yourself that can help you lead a more fulfilled and meaningful life.
What inspired you to work as a psychotherapist?
As the daughter of two psychotherapists, I would say that a curiosity about psychology and an awareness of mental illness was a formative part of my upbringing. I was inspired by my parent’s love of helping people, and found that I was highly attuned to the emotional states of those around me.
Any advice for someone who is going through a heartbreak?
- Try to get used to the idea that this will be painful and the feelings may last longer than you’d ideally like. A meaningful break up is disruptive, physically and emotionally painful and sometimes feels reminiscent of the mourning process. I emphasize that individuals are way more resilient than they know, and that it is human to react strongly to this kind of loss.
- Invest in therapy or find a safe space to reflect and heal. Even for people who have no history of anxiety, depression, or trauma, going through a significant breakup or divorce is life-altering and access to a professional who can give you the tools to help you navigate this transition is invaluable.
- Get off social media. The first large-scale, ecologically valid study of its sort has just been published from Penn University showing the causality between social media consumption and anxiety, depression and loneliness. The bottom line was reduced exposure to Instagram, Facebook and Twitter led to decreases in both anxiety and depression. When people are vulnerable (as those going through a significant breakup or divorce typically are), the impact was even more pronounced.
- Activate your support network and be clear about what you need from your loved ones- they aren’t mind readers!
- Identify things you didn’t love about your ex- and get in touch with your angry side (in moderation), instead of just feeling sad. I try to get my clients to look at their partners more critically. This is often met with resistance because they are hyper-focused on how their own flaws or shortcomings contributed to the end of the relationship and are often still putting their ex-partner on a pedestal. However, as long as you don’t perseverate or get stuck in the anger, it can be an important stepping stone in the grieving process. It also fosters hope for the future and the idea that there may be someone even better or more compatible for you!
- Pursue passions or friendships that you may have put on hold during your relationship. It will feel good to connect to a new (or long-forgotten) part of yourself.
- Lastly, avoid contact with your ex (radio silence is optimal)! It helps avoid setbacks and the confusion that comes if they express ambivalence. The sooner you cut contract, the sooner you can start to heal. Reach out to a trusted friend or family member when the urge strikes!
Family members get affected when they see their loved ones struggle from depression and they need their own support and help. What are some tips you can give to those who are taking care of someone struggling with mental illness?
Think of being on a flight, and putting on your own oxygen mask before helping with the mask of the person sitting next to you. This is not different. Don’t be a martyr, meaning, don’t neglect your own physical and emotional needs under the false but well-intentioned belief that your total devotion to the cause will somehow alleviate your loved ones’ pain. It won’t and in fact, the opposite is often true – if you don’t properly get the support you need to deal with the pain and strain of having a mentally ill loved one, it may ultimately render you incapable of caring for them.
Find someone to speak to that you trust, or even better – has dealt with a similar experience. This may be a friend, another family member, a spiritual advisor or a therapist. Don’t be shy about asking your family member’s doctor for supportive resources. That’s what social workers are for!
Educate yourself – being informed about your loved one’s mental illness is no different than researching a physical disease. It normalizes their symptoms, provides resources and makes everything less daunting and scary. While it may feel like it at the time, you are not the only person in history who has ever dealt with this, and learning about other’s experiences can give you hope and make you feel less alone.
Lastly, I try to remind people that the distress they feel from someone they love being in pain is normal and a reflection of how much they care. I try to remind people that humans are resilient by nature and that they can handle challenges that will inevitably arise. There will be ups and downs, and patience is key. Healing is never linear, celebrate the good times and don’t lose hope in the bad times.
Things people should avoid saying to someone struggling with depression? I for instance know that we shouldn’t tell someone “It can be worse, or you have a great life, you will get over it.”
- You have no reason to be depressed.
- Think happy thoughts.
- Happiness is a choice.
- Other people have it way worse.
- Lately I’ve been getting the sense that you’re going through a tough time, I’m here for you.
- What can I do to support you right now?
- You are not alone. I may not fully understand, but I care and want to help.
- Depression is real.
- You are important to me.
- It makes sense based on _________ that you are having a hard time right now.
When my grandma tried to kill herself, I blamed myself for not knowing she was that depressed. What advice can you give to the survivors of suicide and how can they understand that they shouldn’t blame themselves?
I would advise anyone who has lost someone to suicide to seek help under the care of a trained professional, like a grief specialist. The complex emotions and trauma that accompany this kind of loss are best managed with the support of a group and/or a therapist. The key is not to isolate and find ways to connect with others. If you are looking for a support group, a simple google search can connect you to groups in your area (example – suicidepreventionlifeline.org).
Oftentimes when individuals are suicidal, they are not forthcoming with loved ones about how much pain they are in because they do not want to be a burden and/or they are ashamed and don’t feel that they will be understood. We can never know what someone is going through, so be mindful when making assumptions.
Whenever we think about depression and suicide, it is important to keep your eyes and ears open to some of the early signs (sadness and withdrawal, no longer engaging in activities they used to enjoy, frequent crying, disruptive sleeping and eating patterns, comments that communicate hopelessness or being a perceived burden on others, self-injury, giving away valued items, etc.). These can provide you clues and perhaps be a good way to open up the conversation about seeking help.
Once a patient has been diagnosed and treated for severe depression, is it likely to return?
Severe depression often returns even after it has been treated successful. Everyone’s experience with depression is different. If the depression is situational, such as mourning the death of a loved one, one can be more optimistic about a full recovery. Research shows long-term depression is best treated with a combination of medication and some type of supportive psychotherapy on an ongoing basis. Reoccurrence of depressive symptoms can occur for many reasons, one of which being the removal of a supportive intervention.
What kind of treatments work for depression?
Medication on its own is often inadequate for treating depression. There are several evidence-based therapies that have shown to be effective for depression, with or without medication. For example, Cognitive Behavioral Therapy uses techniques like behavioral activation or cognitive restructuring to get the client moving and learning how to shift maladaptive thought patterns, replacing them with more helpful ones. Behavioral activation is often the first step I take with my clients. It is the intentional planning and engagement in previously enjoyed activities with the goal of increasing productive and rewarding behaviors.
Every individual is different, and there is no one-size-fits all approach to the treatment of depression. If you think you are suffering from depression, the first step is finding a licensed professional who can evaluate you and offer appropriate treatment options.
Do antidepressants have side effects?
Antidepressants, like most medications, can have side effects. Some commonly reported side effects are loss of sex drive, emotional dullness (ex. Inability to cry,) chronic fatigue or weight fluctuations (to name a few).
The decision to take medication should only be made under the close supervision of a licensed medical professional. Patients should be seen at least once a month by their prescribing doctor for management and ongoing evaluation of symptoms and side effects. If changes need to be made, they should be discussed and reviewed with the medical professional.
If you are considering getting off of these medications, it is imperative to do so under the supervision of your prescribing doctor and not just stop, as symptoms of withdrawal can be severe and dangerous.
Can you talk about ECT and explain how it can help patients diagnosed with suicidal depression?
While I don’t personally have experience treating clients undergoing ECT, there are reported successes for treatment resistant clients with chronic depression and suicidal ideation. Its actual impact is on the brains neuro transmitter system to help create healthier neuro pathways. Beyond this, I can’t speak to the specifics, as this treatment option is highly specialized in the medical field and is supervised by a team of trained medical professional including a psychiatrist, an anesthesiologist and a nurse or physician’s assistant.
Do you believe the food that we eat can have an affect on our mental health?
Yes! Your stomach (gut) is known as “the second brain” as most of our body’s serotonin is located there. Serotonin is the “feel good” neurotransmitter and low levels are associated with mood disturbances such as anxiety and depression. A Mediterranean diet, rich in leafy vegetables, legumes, whole grains and seafood, is packed with nutrients and fiber. This promotes a diverse population of good bacteria in the gut, which has been linked to the processing of serotonin and good mood regulation.
Research on the impact of diet and mood is relatively new and has proven somewhat difficult to measure, given the complex variables that are involved with mood. However, it is clear that there is connection and a bevy of research is under way to help us understand it better.
Many people struggle with their careers and lack of meaning around their professional identities. What are some things you would explore if a client came to you with this problem?
Oftentimes, people come in and state they are “depressed” going to work. First, I assess if they are suffering from clinical depression that presents as chronic unhappiness or if they are struggling from situational job dissatisfaction.
If it’s the latter, I’ll work to explore how they experience their work environment in some of the following ways: how they feel about their day to day, how they engage with their colleagues, how their compensation or job security impacts their decision to remain in a position or motivates them to seek change and last but not least – how they envision their professional identities or purpose in the world. Perfectionism and self-imposed expectations can serve as motivation, but are just as often limiting and contribute to dissatisfaction in the work place. Especially in New York, where a person’s job is often seen as a critical part of their identity and a necessary means for maintaining a lifestyle, I explore what it would feel like to shift the focus to nurturing other areas of the individuals’ life.
I give my clients a safe space to both explore these issues and strategically move forward in ways to get to a place that they feel more aligned in their work identity.
What would you tell someone who thinks they may be suffering from anxiety but doesn’t understand what anxiety is?
The instinct to “fight, flight or freeze” helped ancient humans to react when danger was looming or they felt threatened. However, whereas in ancient times, there was real danger to react to – in modern times, the same survival mechanism can be triggered when there is no real danger present and we are sensing uncertainty, change and discomfort. At its core, anxiety is a protective response, meant to keep us safe. However, that doesn’t make the reality of it any more pleasant or hard to live with if kept unchecked!
When we start to feel very anxious, what is actually happening is that the part of our brain called the amygdala is taking over, and we are no longer able to access the frontal lobe, which is the part of the brain responsible for planning, reasoning, and understanding cause and effect. That is why when we feel very upset, we often have thoughts that feel reasonable at the time, but later, we see that they don’t make much sense.
Grounding is a simple but effective therapeutic technique to keep in mind when you start to feel overwhelmed/anxious. When you start to spiral, identifying the below can help:
- 5 things you can see
- 4 things you can touch
- 3 things you can hear
- 2 things you can smell
- 1 thing you can taste
Don’t worry about remembering the order of steps or if you forget one, the point is to orient yourself back to the “here and now” using concrete, non emotional sensory affirmations to ground yourself.
How can someone find the right therapist for them?
Here are some questions I would encourage anyone to ask (and consider) when meeting or speaking to a potential therapist for the first time:
- “What is your approach?” (Also asking yourself, are you looking for a supportive environment that allows you to explore your feelings or are you looking for someone who will give me homework and challenge me? There’s no right answer. Trial and error may be the best way to find out!)
- “Do you accept my insurance? If not, do you work on a sliding scale? “(Can you reasonably afford to work with this person without placing financial stress on yourself?)
- ”What is your availability?” (For me, this is a BIG one. I really urge clients not to say yes to a time that causes them undue stress. Sometimes I simply can’t accommodate a patient’s availability and have to refer them elsewhere. In the long run, it’s not worth it to give someone a time slot that has them ducking out of work early once a week and arriving in a state of utter anxiety).
- ”Have you worked with patients like me before? What has proven helpful?”
- ”What are your expectations for frequency?” (many therapists require 1x weekly to start, just because it helps gain momentum and build the relationship.)
I realize this may seem like a lot, but committing to therapy is a big decision. Don’t be shy to come prepared with a notebook and a list of questions. The therapist will appreciate that you are taking this important step seriously.
Often, the “right fit” will be instinctual and is based on how the person makes you feel. But coming armed with the above questions and considerations will also give you a sense of how they react to your needs— which is ultimately a major part of the therapeutic relationship.
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If you need immediate attention, please call 911 or visit the nearest emergency room in order to ensure timely and appropriate treatment.