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Choosing Happiness
The following document is a sermon written by a recent Telos
parent regarding her family’s healing process. It was presented
at a Church service in her community. Enjoy.
One day last spring, I saw an accident happen on Museum Road. A
teen-age boy on a bicycle came across the road just as a car was
making a turn, and the car hit the bicycle and—a few cars back—I
saw the boy fly in the air like a tennis ball, up and over the
street and the cars until he disappeared. I was suddenly faint,
my heart racing, my skin clammy with fear.
This happened in the midst of a much more protracted horror at
home—our 17-year-old son’s depression. The boy on Museum Road
stood up after a minute, shaken, surely, but just a little
bloody. Our experience lasted several months, but it turned out
all right, too. We learned we learned a lot, including some
things I hope to share with you today.
It’s hard to say when Sam’s depression started. Just a year ago?
Or two? Or did it start in 3rd grade when his teacher was so
mean, or kindergarten, where the teacher said he seemed to be
“elsewhere?” Was it early childhood? Or conception, perhaps,
with the mingling of genes from two families with long histories
of depression? Was it someone’s fault? Or just the cards he’d
been dealt?
When Sam came home from school in the afternoon of March 13,
about a month before the bike accident, he was in a pretty bad
mood, disappointed with how he’d done in a tennis match. Within
three days, he was nauseous and exhausted, like with the flu. He
never went back to school. For three months, he could not
function. This was not the first time he had been depressed, but
it was the worst. The doctors called it Major Depressive
Disorder, Severe, known by the diagnostic code 296.23.
He said he was doing a lot of deep thinking, and took copious,
indecipherable notes, but he couldn’t explain what it was about.
He ate like a zombie, whole minutes lapsing while the spoon was
raised. He would wake us up at 2am to say that he wanted to
smash his head open like a watermelon and watch it explode in
red, wet pieces. He said that if he had a gun he would shoot me
and then shoot himself, and then he cried and said he was sorry.
The doctor called this suicidal ideation. He woke us at
1, and at 3 and 4 and 5. I would make tea and sit with him, and
then I’d turn off the lights and lie on the floor until he fell
asleep. Toward the end, he stayed awake all night, his weight on
small of his back while his tailbone draped over the edge of the
chair and his neck bent against the back, only his thumbs
engaged at the controls of his PS2. He’d play a game in which
his character would be killed and miraculously restored by a
little diamond thing floating above his head, over and over
again. The doctor asked him if he knew the difference between
what is real and what isn’t, this being the hallmark of
psychosis. He’d say, “Yeah?”
By Memorial Day, my son had lost 20 pounds and a quarter of his
junior year. He had been through hundreds of cups of tea, six
therapists, four medications, and the better part of a set of
golf clubs, which lay in pieces on the floor of his room along
with a broken lamp, broken chair, broken table, and fragments of
wood from his bed, which he had smashed so violently it had to
be junked. He slumped in a chair, crying in anguish, his face
covered in snot, his mouth contorted from hyperventilation, his
throat and chest bleeding where he had clawed himself with his
fingernails. The scratches showed above his T-shirt the next day
when said good-bye to him at a residential treatment center
2,000 miles from home.
We were lucky.
- Suicide is the third
leading cause of death for young Americans 15 to 24 years
old.
- In the U.S., about 15
million children ages 9 through 17 have a serious mental or
addictive disorder such as depression, anxiety, attention
deficit hyperactivity disorder, eating disorders, early
onset schizophrenia or bipolar disorder.
- Roughly three percent of
all Americans suffer from chronic depression, and 10 percent
experience clinical depression at some point in their lives.
It is hard for people who
haven’t experienced it firsthand to understand, but depression
is not essentially about being sad, or down, or blue. William
Styron, author of Sophie’s Choice, calls it “a disorder
of mood so mysteriously painful and elusive as to verge close to
being beyond description.” Like a lot of sufferers, he complains
about the inadequacy of the word depression itself.
“Melancholia”—which appears in English as early as 1303—would
still appear to be a far more apt and evocative word for the
blacker forms of the disorder, but it was usurped by a noun with
a bland tonality and lacking any magisterial presence, used
indifferently to describe an economic decline or a rut in the
ground, a true wimp of a word for such a dreadful and
raging disease.”
“The first thing that goes is happiness,” explains Andrew
Solomon, author of The Noonday Demon, who says the
opposite of depression is not happiness but
vitality.
“You cannot gain pleasure from anything. That’s famously the
cardinal symptom of major depression. But soon other emotions
follow happiness into oblivion: sadness as you had known it, the
sadness that seemed to have led you there; your sense of humor;
your belief in and capacity for love. Your mind is leached until
you seem dim-witted even to yourself. You lose the ability to
trust anyone, to be touched, to grieve. Eventually, you are
simply absent from yourself.”
Hippocrates considered depression an illness of the brain. But
in the Dark and Middle ages it was seen as a sign of God’s
disfavor, and it still carries a whiff of this stigma. When I
was struggling with how to help Sam, no one outside of this
church and my closest circle of friends spoke to me about it. I
was really hurt, but I came to realize that it was awkward and
sort of shameful, and they didn’t know what to say. The
Renaissance romanticized depression and gave us the paradigm of
the melancholic genius whose dejection was insight—and we still
have that notion, too, that artists, and especially writers, are
the hardest hit, although that may be because writers are the
ones who write about it—Virginia Woolf, Sylvia Plath, Rick
Moody, Anne Sexton. Today, our understanding is shaped by the
psychoanalytic model, although neuroscience, very recently, is
giving us some fantastically exciting new ideas about the brain
and how it works—among other things, that we are literally wired
to connect with other people—and that positive thinking and
nourishing relationships quite literally have a beneficial
impact on our health.
Someday we’ll understand all this and have specially targeted
medicines, but last spring I was alone in the house with a very
sick boy, and it was hard to know what to do. Some people said
that depression was the very essence of adolescence, and
perfectly normal. In fact, depression is often missed in
adolescents because their extreme emotions and disproportionate
suffering look so much like depression anyway. People said,
“Don’t worry, they all talk about suicide.”
But we did worry, and I think we were right to.
Let me say again that we were lucky—among other reasons, because
we live in a place and time where mental illness is recognized
at least by some people as an authentic issue; you don’t get
killed for witchcraft, or told (too often) to suck it up. We
were lucky because my husband earns a living wage and his
employer shares the burden of health insurance with us, and
because I could drop everything else and devote myself to
watching over Sam, to reading everything I could lay my hands on
and making hundreds of phone calls. Depression reaches across
all social classes, but treatment is available only to those
with the resources to find it and pay for it. We were lucky
because we didn’t have other big issues to deal with at the
time, no hurricanes, or drug addictions, or crippling family
belief systems such as shame and guilt. We were lucky, most of
all, because we didn’t lose him.
Sam did have a psychiatrist, and in this, I didn’t realize how
lucky we were. Only about 7,500 child psychiatrists are
currently practicing in the US, and every single one of them has
a waiting list. Only 300 new child and adolescent psychiatrists
complete training each year, which adds up to a pretty severe
labor shortage. But we still needed someone for Sam to talk to.
It turns out that Reading Pediatrics has child and adolescent
psychologists on staff, but honestly, it never crossed my mind.
I just started asking about psychologists in town. It’s a wonder
I didn’t go off the deep end myself.
Some of those who came highly recommended couldn’t see us for
six months. We would agree to see someone in the practice who
was, shall we say, less popular, and then we would find out why.
Some seemed depressed themselves. Others were obnoxious. One
fellow actually slapped me on the back in a crowded waiting room
and said, “So! How’s the kid today?”
It could have been worse. Andrew Solomon tells of a therapist
who had covered all her furniture with Saran Wrap to protect it
from her yapping dogs; he left when one of the dogs peed on his
shoe.
Doubtless there are competent adolescent psychologists in Berks
County, but it takes more than competence to make a good match.
We ended up talking to at least half a dozen therapists, which
is a lot of people to tell your whole life story to, and
discouraging if from the moment you walk in, you know it’s not
going to work. We also met some nice people, but rapport is the
most important factor in a patient-psychologist relationship,
and rapport we did not find.
You’re not supposed to do this, by the way; you’re supposed to
take what you can get and shut up. At one point in our search,
Sam’s psychiatrist said, “Hear this? (bang, bang) That’s
the sound of me beating my head against the wall.” I found a
wonderful therapist, finally, but not before we were turned away
three times by his office—he doesn’t see adolescents,
he’s not taking new patients, he’s out of the country. He and
the psychiatrist both told me later I was right to persevere.
There are a lot of ways to get bogged down when you’re trying to
help someone with depression, and one way is to spend a lot of
time thinking about why it happened, when the important thing is
to take action. Another way to get bogged down is to spend a lot
of time trying to choose between the so-called talking therapies
or medication. This is often posed as a moral conflict. If it’s
“chemical,” then it isn’t your fault, and it’s OK to take
medicine—but then wellness still associated not with achieving
control of the problem, but with discontinuation of medication.
People say, “I’m glad you’re feeling better, but I sure hope you
can get off those pills soon.” If it isn’t chemical, then it’s
your fault, or so the faulty thinking goes. The important thing
is treatment.
“No one has yet taken Prozac for eighty years,” says John Greden,
director of the Mental Health Research Institute at the
University of Michigan. “But I know the effects of
non-medication, or of going on and off medication, or of trying
to reduce appropriate doses to inappropriate levels—and those
effects are brain damage.”
In other words, depression, particularly repeated episodes,
ravages our neuronal tissue. Early intervention can be a
life-saver. Like snowflakes, every depression is unique, but for
most people, including Sam, what worked best was an integrated
approach involving relief of symptoms and the learning of new
behaviors to keep you out of trouble. It took our family a long
time to figure all this out. In the meantime, Sam was in bad
enough shape that a weekly session with a therapist and a few
pills wasn’t cutting it. Hospitalization would have been an
option for only a couple of weeks, thanks to insurance, and
there was reason to think it might make things worse. With the
help of a very expensive consultant, we finally found a
residential treatment program—in Utah.
Of the talking therapies, a system called Cognitive-Behavioral
Therapy, or CBT, is one of the most successful. It was developed
by Aaron Beck at the University of Pennsylvania, and is now in
used throughout the US and most of Western Europe. Its tenants
have been among the most important things my family and I have
learned this year.
Very, very simply put, CBT suggests that one’s thoughts about
oneself are frequently destructive, and that by forcing the mind
to think in certain ways one can actually change one’s
reality—some call this “learned optimism.” David Burns has done
a lot to popularize CBT as a self-help technique with his books,
Feeling Good and the Feeling Good Handbook. At $20
for the 732-page handbook, it is certainly the cheapest form of
therapy you can find, and it seems to be working for thousands
of people.
You can attribute blue moods to hormones or body chemistry, or
blame childhood events, or say that it’s realistic to feel bad
because you’ve experienced a loss, or because the world sucks.
Burns points out that all these claims are based on the notion
that our feelings are beyond our control. If you say “I just
can’t help the way I feel,” you will only make yourself a victim
of your misery—and you’ll be fooling yourself, because you
can change the way you feel.
CBT teaches that even though you might be convinced that they
are valid, most of your negative thoughts are distorted and
unrealistic. All-or-nothing thinking is a prime example, where
if something isn’t perfect, we think it’s a total failure.
Obviously this technique is no cure-all, and would not be the
first tool to bring out in response to a truly crippling
depression. It’s just one tool in the box, but it’s an amazingly
effective one. It underlies the philosophy of the residential
treatment program my husband and I chose for our son.
We arrived at Telos on Wednesday, May 31st. It’s a funny looking
brick house on a busy street, about 45 minutes south of Salt
Lake City, but on the horizon, in every direction, are mountains
that in May were still covered with snow. There were three of
us—Sam, my husband Bill and me—and none of us had had a lick of
sleep in at least 36 hours. We were a wreck, but had no real
alternative than to trust in a handful of people we had never
met and in the strength and resiliency of our son.
There are thousands of residential treatment centers in the U.S.
ranging widely in quality, size, focus, approach, and length of
stay. They are all expensive. Telos—which is Greek for “ultimate
potential”—cares for 24 boys aged 13-17 whose primary diagnosis
is anxiety and/or depression. There are boys there with drug and
alcohol problems, and boys who cut themselves, but not sexual
predators or violent offenders, although every once in a while
someone gets mad and punches out a window. It happens. The
average length of stay is 9 months.
My first question was, “is this place religious?” because there
was no way I was going to turn my son over to a bunch of
Mormons. The answer was no, and while it is true that Telos does
not preach or judge by Mormon rules, most of the leadership is
Mormon—or LDS, as I learned to say, for Latter Day Saints. A
couple of boys came to my door just the other evening—two
earnest 19-year-olds in white shirts. They were radiant, and
they said to me, “Aren’t you curious about what gives us such
joy?” and I had to admit, that yes, I was. I’m still not willing
to be a subscriber, but in the eight months since I met the
folks at Telos, I have learned to love and respect them,
especially Tony Mosier, the clinical director and Sam’s
principle therapist, and to appreciate the inner strength he
gets from his faith.
In the Telos philosophy, the cornerstones of genuine change are
love, family, spirituality, principled living, and insightful
choices.
- By
love,
they mean the truly radical therapeutic idea that the
ability to give and receive love is as important as food,
water and air. They love the boys. They don’t try not to.
- Family
means that change within the
family is needed to accommodate and support lasting
individual change.
- By
spirituality,
Telos means a person’s ability to connect to a purpose
greater than themself. I could definitely go along with this
definition.
- Principled living.
Not surprisingly, Telos does not have an “anything goes”
philosophy. They believe that certain fundamental truths
govern life and support health and happiness, and the
program helps kids and families identify and live by those
principles. I tend to get a bit squirmy when people talk
about fundamental truths, but I really got into this.
- Finally, by
insightful living,
they mean the most fundamental human freedom—to choose your
attitude. To think clearly, and to make choices about how to
live one’s life.
The first thing each of us had
to do—not just Sam, but Bill and I, too—was to make a list of at
least 10 personal life-principles or values. We had to define
them, put them in priority order, and write an essay on why our
principles were important to us—and whether or not our actions
match them. [In the order of service, behind the announcements,
you’ll find the list they gave us to choose from, and I invite
you to do the exercise yourself.] It was revealing process for
us, and very meaningful. Bill and I were stunned by the beauty
and eloquence of Sam’s choices, even just a day or two into the
program, and I was reminded all over again of why I chose Bill
as my life partner.
Further along in the program, we put together a set of family
principles. Our family worked together to come up with a set of
five, with definitions: Love, Openness, Togetherness, Generosity
and Responsibility. I’m pretty proud of our definitions.
Eventually, we built on them to form a whole system of family
rules and consequences based not on arbitrary decisions but that
flow meaningfully from the principles. We don’t always follow
the rules, but just having them gives us a clarity we didn’t
have before. We have a lot of family meetings.
The Telos program integrates several modalities. They use
medication—very carefully. The staff psychiatrist asked us a
million questions, and talked often to Sam, and over time found
a formulation that works for him. The boys do a LOT of
therapy—group therapy every day, individual therapy each week,
recreation therapy, and family therapy—mostly on the phone,
although we did spend three fairly intense days out there
camping with 24 boys and their families. Just learning to get
along at Telos is a kind of therapy. They also believe in the
power of exercise—especially daily cardio workouts—and it’s
clear that exercise at this level has a profoundly stabilizing
effect on the emotions. The boys participate in triathlons, and
Sam worked out at a gym at least 1.5 hours a day.
Sam worked really, really hard on all of it. He worked so hard
he became the first boy to complete the program in three months.
To their credit, Telos changed along with him, redesigning the
program so that it was right for him.
The rest of us worked pretty hard, too. It was always moving and
sometimes painful, but always rich, deep work. Bill and I wrote
letters to Sam describing his first week in our lives. We wrote
to him about the best and the worst things we had done as
teenagers. We described our spirituality. We studied ego defense
mechanisms, and communication techniques. We read The Art of
Happiness by the Dalai-Lama, Codependent No More, by
Melody Beattie, Man’s Search for Meaning by Viktor Frankl,
and The Feeling Good Handbook by David Burns.
In family therapy, the person who goes to the doctor is the
“identified patient,” with the rest of the family being the
unidentified patients, as it were. We’re all part of a system,
and we discovered family systems that were not healthy—cycles of
unacknowledged depression, codependency, a tendency to make it
“too comfortable” to be depressed.
When I came home that day last spring after the bike accident, I
burst into tears not just for the boy, of course, but for my own
son. Sam wrapped his skinny arms around me and said, “I’ll make
you some tea.” It was a beautiful gesture, and I’m thrilled to
have a child who can be compassionate even in pain—but at Telos
we learned how much Sam felt responsible for me. He felt he had
to be strong in our family, and had to take care of people and
make them laugh, and of course that’s too much responsibility
for anyone.
Sam came home for good on December 23rd. After Telos he went
into an affiliated transitional program where he lived in a
house with 9 other boys, and went to public school. That
presented its own set of challenges, but it served well as a
transition from the wrap-around control of an institution to the
“real world.” In a couple of weeks, he’ll start the second
semester of his senior year at Wyomissing High School, and
graduate with the kids he’s been friends with his whole life.
Right now, he’s working on his college applications—and we’ll be
ready to send him when the time comes. Six months ago we
wouldn’t have sent him around the block.
Will he ever get depressed again? Almost certainly. Will he
always know what to do? No. Does he understand himself better,
and have goals and principles and in general a pretty strong
handle on making a good life? Yes.
I could not be prouder of him. Sam is not just the boy he used
to be—or even the boy we knew he could be. He has become a more
wonderful, more compassionate and wise, more disciplined and
thoughtful, more terrific human being than I could have
imagined. He still leaves his socks everywhere, and breaks the
rules now and then, but hey, he’s 17.
I’d like to close by going back to David Foster Wallace, who I
read before the sermon, and the idea of choosing what has
meaning and what to worship.
First, I want to make one thing as clear as I can. There are
terrible, wretched, crippling depressions—and then there are the
little vexations of everyday life. They are not the same, nor
can they be treated the same way—and not in a million years
would I suggest that a little shift of perspective will help
someone who is really, desperately depressed—but I can’t help
but thinking they’re part of the same, long mind-body
continuum—along which we always have some control. Because we
get to decide what has meaning and what to worship.
Everybody worships, says Wallace.
“The only choice we get is what to worship. And an
outstanding reason for choosing some sort of God or
spiritual-type thing to worship—be it J.C. or Allah, be it
Yahweh or the Wiccan mother-goddess or the Four Noble Truths or
whatever—is that pretty much anything else you worship will eat
you alive.
If you worship money and things, then you will never have
enough.
Worship your own body and beauty and sexual allure and you will
always feel ugly, and when time and age start showing, you will
die a million deaths before they finally plant you.
Worship power, and you will feel week and afraid, and will need
ever more power over others to keep the fear at bay.
Worship your intellect, being seen as smart, and you will end up
feeling stupid, a fraud, always on the verge of being found out.
And so on.
My son Sam says that the most important thing he learned at
Telos was to take responsibility for making things the way he
wanted them to be. Not to be passive. Not to be a victim. Some
of us, and God help us, will suffer from severe depression while
others will get away with the blues. But all of us have choices
about how we think and what we worship and how we take care of
ourselves. May we choose well.
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