When Someone You Love is Depressed and Demented
by Sheryl Karas M.A.
All of the dementing illnesses — Alzheimer's Disease, Parkinson's Disease, stroke, MS, etc. — are correlated with high levels of depression. So, even if you are not depressed yourself (most caregivers are), chances are you are living with someone who is.
Living with depression is a little talked about problem that needs to be addressed because depression is contagious. Anyone who lives with or spends a lot of time with depressed people is significantly more likely to get depressed themselves. And some psychologists think that the divorce rate is nine times higher among couples when one of the partners is seriously depressed.
Most of my clients have latched onto the idea that depression is a disease resulting from a chemical imbalance in the brain. This seems to help people cope with the behaviors they experience on a daily basis. However, while it is true that depression is associated with chemical changes in the brain; it is far from clear whether this brain chemistry issue develops as a result of long-time habits and belief systems or is the cause of those patterns. Most people in the field of psychiatry agree that there's much more to this condition than simple biology.
From my perspective, it appears that depression most often stems from being unsuccessful in situations where we are forced to respond to challenges beyond our capability or experience. This is often the case in childhood when the people we depended on for our physical or emotional well-being had a problem with alcohol, temper control, or severe depression themselves. It could also come from having been repeatedly told throughout childhood that we were stupid or incapable or that what we wanted most was frivolous or somehow unattainable. Or, as adults, we might find ourselves in situations where we are so thwarted in meeting our needs and desires that we come to believe we are powerless. Coping with a progressive, currently incurable, illness like Alzheimer's or Parkinson's Disease can do this very thing.
People who are depressed feel hopeless. "Nothing ever changes," we hear at the workplace. "No matter what I do to make things better around here, I always get the same response." From my sister at home I hear, "Dad will never change. We might as well give up on getting Mom out of the house for a respite break because he'll throw a fit and it won't be worth it." Caregivers who have lived a long time in situations where they feel they have no control are the most depressed people I meet.
Unfortunately, we can't always control what happens. But we CAN learn better ways to respond. What works?
I love watching the Olympics because so many of the people who are achieving the highest level of physical achievement do so in the process of overcoming some of the worst situations a human can experience. There is always the story of the street- smart orphan from the ghetto who goes on to track star greatness or the gymnastics wonder kid who grew up in an abusive home. There are people who come back from horrific injuries and others who prevail in the wake of the kind of tragedy that would send the most happy, well-adjusted of us into a tailspin. I saw an interview with one of these athletes who was asked how he was dealing with such and such a controversy in his life. His response was telling: "I find my peace between the white lines on the gymnastics mat." He didn't waste time focussing on what he couldn't control. He focused on what he could do, on what he loved, and he put his full attention on doing it to the best of his ability.
Depressed people say "What's the use? It takes too much effort. I won't succeed anyway. I'd only be disappointed if I try." Then they beat themselves up for their lack of success. Successful people aren't always happy but they tend to have more joy and satisfaction because they focus on what they CAN do and what really matters.
In order to, first, know what you love to do and, second, have the time and space to do it you have to learn to set limits and boundaries. Take a break from the depressed environment you are in. Literally, hire or arrange respite care and go away for at least a weekend if not longer or arrange for your care receiver to be somewhere else for that period of time. And then...this is the MOST important thing... don't do anything you don't want to do for the period of that holiday. This is not the time to do errands that have been piling up or to clean the house unless those are activities you really want to do. Set a limit on your own behavior - I will only do what I feel like doing - and see what comes up.
You might find yourself staring at the wall for a half hour. That's okay. You might find that you don't want to get out of bed, make dinner or wash your hair. No problem. Eventually, you may get tired of eating Cheez-its and reading books in bed and naturally add something else...or maybe you won't.
Pay attention to everything you chose to do or not do during your enforced period of only doing what you want. Did you go for a walk, get together with friends or reacquaint yourself with a favorite hobby? Did you have an impulse to start a special project or a whole new life direction? How often do you get time to do these things in a normal week? To avoid depression, making time and space for these activities (or lack of activity) has to become your highest priority. This will take discipline. You will need to set limits. You will have to deliberately set aside time for yourself and tell people you are no longer available for caregiving, work or even unwanted social interaction during those days or hours. This will also mean setting limits on your own behavior. Is the time it takes to make sure your house is spotless really worth it if it means the difference between winning your own personal gold medal or succumbing to hopelessness?
Furthermore, you need to have social contact with people outside of your depressed family situation. Find some respite care so you can get out of the house and make dates with friends, join a club or take a class. When you look at the world through the eyes of depression everything looks grey. But when you are with people who are actively engaged in something they enjoy their enthusiasm can inspire your own.
If you can't shake the blues even under these conditions, ask for help. Most of us can't get enough perspective outside a depression shared between two people by ourselves. Call a therapist and make an appointment, join a support group, and/or check into whether a mild anti-depressant might help shift the balance.
Last but not least, you might also ask if there are activities and/or medications that could alleviate depression in the person you care for. It makes a big difference to decide to help a person you love have a better quality of life. Many successful caregivers take this on as their special project and get great joy and fulfillment from that role. But a person with depression can be like a cup with a crack in the bottom. The water you feed in just keeps running out and if you don't replenish your own cup, your reserves can go dry. Go for the gold with your loved ones but know that you can't base your own happiness and well-being on winning that race. Your demented relative can't be depended upon to fill your cup. You have to do that yourself.
Caregiving Articles
A new version of this article can be found in Sheryl’s latest book The Spiritual Journey of Family Caregiving.
Caregiving Articles
© Copyright 2007 Sheryl Karas & Paul Hood