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Neither Blame Nor Indulge

Andrew Solomon offers this brilliant paragraph in his classic, “The Noonday Demon” about the relationship between medication and therapy, when we should make Herculean efforts to break free from depression or rather lie listless on our beds as victims of a loathsome illness:

The conflict between psychodynamic therapy and medication is ultimately a conflict on moral grounds; we tend categorically to assume that if the problem is responsive to psychotherapeutic dialogue, it is a problem you should be able to overcome with simple rigor, while a problem responsive to the ingestion of chemicals is not your fault and requires no rigor of you. It is true both that very little depression is entirely the fault of the sufferer, and that almost all depression can be ameliorated with rigor. Antidepressants help those who help themselves. If you push yourself too hard, you will make yourself worse, but you must push hard enough if you really want to get out. Medication and therapy are tools to be used as necessary. Neither blame more indulge yourself.

I’m indebted to him for explaining it to me that way because I’ve always been confused by the relationship between meds and therapy, antidepressants and cognitive-behavioral techniques … how much I need of one versus the other, and wondering if we all need a different mixture, or if a standard Package #3 could cover most depressives.

6 Comments to
Neither Blame Nor Indulge

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  1. Brilliant post, Therese.

    I wish writers and scientists would share insights on the other side of the Bipolar Spectrum. Mania.

    I am very grateful for the work you are doing here. You enrich my life enormously.


  2. Love this! Sullivan’s book is really important in psychology, I think.

  3. I have been learning mindfulness for the past few years – I would like to say practicing, but for me, since I have yet to master it with more continuity, I will say that I am still learning how to be mindful. However, it has helped me immensely and I must give full credit for the mindful practices that I have participated in for my good mental health for 6 years. It does make it easier to notice when the sneaky bugger (my depression) is creeping up on me, even though I may not be at a point of being able to stop it. What I have learned from the person who leads the mindfullness group is that what ever I am experiencing at the moment is “okay”. If I feel like crap – it’s okay, I’m allowed to feel like crap and I find that I fight those crappy moments a little bit less than I used to. It has not been easy for me to accept my depression – I have always been motivated to “win” and be cured of it. I do have to work on accepting myself as I am – mindfully.

  4. Fantastic Post! Love this. Sometime it can be so confusing – I often hear the term mindfulness thrown around a lot – and its important to realize what we are capable in any given moment is key. Accepting ourselves along the journey, finding our authentic voice and knowing when one thing will not work, and when another may. Flexibility in how we approach our care. This was a great read – as always :)

  5. Mindfulness and CBT and other ‘brain exercises’ may only work if one is not ‘too far under’ the black cloud. In my grad program, I interned at a psych hospital depression treatment program which used cognitive behavioral therapy. The patients who seemed best able to think and make use of the awareness exercises were not, at the time, ‘seriously’ in the throws of depression. Eric Maisel, PhD writes about using creativity to enhance meaning, and hold depression back.

  6. Good point, Doug.



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