Case Study #1 – Josh
Depression
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Depression is a silent intruder that affects millions of people worldwide making it challenging to identify the symptoms and seek help. Many people who seem to have it all together are living with or battling depression. Although it may not feel like it – depression can be beaten. A good first step is to recognize the symptoms and then seek out the support you need to help you overcome it.
As depression can present in so many ways for so many reasons, I thought I’d give you an inside glimpse of depression by looking at the the case of Josh (pseudonym) a client of mine who was suffering from acute depression. My case studies in these posts are inspired by real client cases whose identifying and personal details have changed to protect client their confidentiality
The Case of Josh
Josh a 32 year old accomplished professional, seemed to have it all together. He had a loving family, good friend network and enjoyed a variety of activities from hiking and playing basketball to woodworking and fishing. However
lately, beneath his cheerful exterior, a persistent feeling of sadness had begun to overshadow Josh’s life.
At first, he figured he was just tired from working all the extra hours but as time went on, the intensity of his gloomy emotions increased. Josh’s friends and family had all commented that he didn’t seem himself lately. Josh would reply with the five words most of us say when someone brings something up about our mood or behaviour that we don’t want to talk about it. “I’m fine. I’m just tired”. Sound familiar?
After a few months Josh was so frustrated by his persistent dull headaches, lack of sleep, fatigue and fluctuating appetite he decided to see his family doctor just in case something was ‘
really wrong’ with him. Josh’s doctor asked him to fill out a questionnaire and evaluating his responses and some discussion Josh’s doctor diagnosed him with mild depression. The doctor prescribed Josh an antidepressant which he said would help balance his mood and in turn improve his sleep and appetite and get his energy back on track. He also suggested Josh talk to someone – a therapist or counsellor. Josh agreed even though he had no intention of talking to anyone at that time. He wasn’t “that bad” he thought to himself – he was just in a slump.
Josh left his doctor’s office feeling unhappier than before he walked in. He was not keen on taking antidepressants as he didn’t want random chemicals in his body or to get addicted to anything. Now that he knew there was nothing serious wrong, he was sure he could find the willpower to overcome this on his own. Josh put the prescription in his nightstand drawer.
As a few weeks went by Josh became increasingly discouraged that he couldn’t get himself to snap out of this funk he was in. Every morning he would wake up thinking today would be the day when he gets himself back on track. And every night he’d think about all the things he didn’t accomplish during the day and that made him feel even worse about himself.
To distract himself from his upset, Josh would pick up his phone and begin mindlessly scrolling on Instagram. What started out as a quick scroll turned into hours and Josh would look up at his clock only to realize it was now 2:30 in the morning and he had to be up in five hours for work. By the time he finally fell into a deep sleep his alarm went off telling him to get up and do it all over again.
Everyday that Josh could not pull himself out of this slump made him feel worse about himself. His mom was texting and calling almost daily to ‘check-in’ on him. His friends were getting frustrated that he would agree to plans and then cancel at the last minute. And even though he had a great team at work he was starting to feel isolated.
He was irritable for no reason and couldn’t stop his mood from spilling out in sarcastic comments, eye rolls and impatient heavy sighs. One evening when Josh got home from work he opened the door to his apartment and noticed the strong smell of staleness in his apartment. It was then he noticed the dirty dishes, piles of laundry and pizza boxes strewn around the apartment. “Enough is enough” he thought “something has got to change”. That evening Josh filled the prescription and took his first dose.
Josh was concerned the prescription would make him hyper but instead rather than feeling overly good – he just felt less bad. However with every week that passed Josh’s energy levels rose and tasks that seemed overwhelming two months ago were easy to complete now. However Josh still felt an odd disconnect from the activities he used to enjoy. He decided he would go and talk to a therapist and that is when we met.
In our first session Josh couldn’t think of anything traumatic that would have prompted his depression. In the discussion that followed I learned that Josh was concerned about potential downsizing at work. He shared that it had been hard to hang onto his apartment over Covid and going back to work had felt very stabilizing at first. However lately his supervisor was constantly talking about upcoming changes in the department and that made Josh feel that his job was no longer secure. .
In our subsequent sessions we talked about how Josh was coping with his concerns over potentially having to find another job. Josh revealed that his first strategy was to not be laid off in the first place. So in order to make sure his value stood out to his supervisor he had been working longer hours, skipping the gym and eating at the office so he was readily available whenever his supervisor needed anything.
When I asked Josh if someone had told him his job may be in jeopardy he said no. No one had mentioned lay offs to Josh. But Josh’s own assessment of the situation led him to have heightened concern, fear and helplessness about his job security.
He had planned to soon buy a house and being unemployed wasn’t part of his plan.
Let’s Stop Here and Talk About What’s Happening to Josh
First we can see that Josh is relying 100% on his assessment about his job security. Relying on inner dialogue about a situation is very common in depression. Because his plan to purchase a house was so important to Josh, his fear of being unemployed and therefore unable to purchase a house was overwhelming. It played over and over in his mind become increasingly intense each time it repeated itself.
Josh, like most people didn’t want to discuss his fears and vulnerabilities with anyone for fear of being perceived as needy, insecure, not good enough or having that fear or weakness used against them. This fear then carried on unchecked and played over and over in his mind. Ceaseless striving is the behaviour of trying to control a situation that you may not have total control of in the first place. When we play our fears repeatedly in our heads without resolution we become exhausted and immobilized. That’s when motivation drops, enjoyment in life disappears and a pervasive fatigue, headache or other physical symptoms set in.
THIS is depression. It’s not just a bad mood. It is a physical, mental and emotional experience that can be debilitating. Josh was not lazy, unmotivated, inadequate or incompetent. However he believed he was powerless in this situation a feeling which over time can lead to indifference, disinterest and loss of connection to people or activities. Depression is often a part of the flight or freeze response to fear or trauma. Your are frozen in thought and unable to take yourself out of the situation so you have a heightened sense of risk, danger or impending doom.
Finding the Root Cause of Your Depression
Before anyone can recover from depression it is important to first stabilize and manage the symptoms. Until Josh was sleeping, eating, engaging with others and able to focus trying to do deep emotional work would only exhaust him further. The first thing that I encourage with all of my clients who are depressed is to establish and maintain a routine. This is because when your brain realizes that you are calm enough and safe enough to complete routine activities it will move out of the fight-flight-freeze-fawn response and open up the blocked pathways that made sleeping, eating and socializing so difficult.
Once Josh was feeling stabilized then we could begin to talk about where this fear of being laid off originated. This is the part where it gets tricky for me as a therapist. A client will start to feel better and think that everything is resolved. Fortunately Josh continued his sessions. Eventually Josh was able to identify that owning a house was so important to him because he had moved so often during his childhood because of his parents employment never stayed anywhere long enough to make friends.
What made it worse was that as the new kid he experienced terrible bullying several times over as a child. As we worked through his issues Josh realized that he had decided as a child that as an adult he would own his own home so he would not have to constantly move and therefore would never suffer that abuse again. Now things were falling into place.
Sometimes the root cause is obvious, especially if the depression is related to a recent traumatic event such as the loss of a loved one or diagnosis of chronic illness. Past trauma can also result in depression years later through Complex Post Traumatic Stress which is harder to pinpoint. It is my firm belief that when clients determine the root cause of their issues they are able to manage them more effectively. They are able to recognize the triggers and to process them on their own or on return visits as needed.
Recovery from Depression:
Common symptoms of depression include persistent feelings of sadness or hopelessness, loss of interest in once-enjoyable activities, difficulty concentrating or making decisions, and even thoughts of self-harm or suicide. Physical symptoms, such as constant dull headaches, fatigue, changes in appetite, sleep disturbances, and unexplained body pain, can also accompany depression.
Behaviourally, some people become overly involved in activities in an effort to distract themselves from their upset. Some try to make themselves feel useful by committing to help others often at the expense of helping themselves. Others turn to substances like alcohol, prescription or non-prescription drugs. Some develop obsessive-compulsive behaviours, engage in high risk behaviours or withdraw altogether.
We all have sensitivities to certain things for certain reasons – some of which we are aware of and some of which we are not. I’ve seen so many clients who are able to mask their sadness but it almost always comes out in other ways. Wearing a false mask of happiness is not only exhausting – it can result in prolonged denial, physical illness and destructive or self-injurious behaviours.
Depression doesn’t have to be a lifelong condition. It’s normal to experience intermittent (and sometimes prolonged) episodes of depression in our life in response to many situations including loss of a loved one, relationship break-up, financial challenges, parenting challenges and even various stages of aging. It is helpful and important that you are aware of your own signs of depression, so you can employ the necessary self-care routine sooner rather than later and then seek support as needed.
So back to Josh…
What happened to Josh you ask? Well, Josh did eventually sit down with his supervisor and share his concerns about job security. What Josh learned was yes he may not have the job he has in the future but the reason for that was not that he would be laid off but rather that he would be given a new role that actually resulted in a slight salary increase. The other thing that Josh learned was that his supervisor had noticed him staying late, skipping lunch and interacting minimally with his team and she was wondering if he was okay. She told him she was glad that they had this meeting because she was beginning to be concerned about him in terms of work-life balance.
Do you see the irony here? The very behaviours Josh had been engaging in to make himself seem more valuable were in fact having the opposite effect! It’s now been two years since Josh first came to see me. He keeps his three month check-in appointments and at the last one told me he was now off the antidepressants and coping well.
There is NO SHAME in being depressed. However when your sadness becomes prolonged and begins to take over your life it is important to get help sooner than later. By recognizing the signs, seeking help, and unmasking the root cause of your depression you can take control of your mental well-being.. Reaching out for support is not a sign of weakness but rather a courageous step towards a happier and healthier life
If you or someone you know i struggling with depression please reach out to your family doctor and connect with a therapist who can help you work through the recovery process.
