Dr. Boris Vytautas Bakunas unpacks signs of depression that, if left unaddressed, can lead to tragic consequences.
© DELFI / Mindaugas Ažušilis

“I have no family, no friends, little food, and no chance of finding a job. What’s the point of living if I’m a failure? Maybe I should just drive to the woods, feed the car exhaust into the car, and take some sleeping pills. I’m scared.” Suicide note, Ignas, age 53.

Have you ever had suicidal thoughts like those of Ignas? If you answered yes, then you know first-hand the loneliness, sense of personal loss, and hopelessness that are the hallmarks of severe depression. Many studies have shown that the vast majority of people who consider suicide suffer from depression.

Scary though such thoughts are, I strongly urge you: “Do not give in to them.” As dire and hopeless as your situation may seem, you are not alone - and help is available.

Millions of people around the world have suicidal thoughts every day. Some of the world’s most successful and renowned people, including British Prime Minister Winston Churchill, actress Audrey Hepburn, and famed Japanese filmmaker Akira Kurosama have faced severe depressive episodes, conquered them, and emerged stronger and more emotionally resilient than before.

Understanding Depression

Nearly two thousand years ago, the Greek philosopher Epictetus said: “We are not disturbed by what happens to us, but by our thoughts about what happens to us.”

Epictetus’ ancient words of wisdom have been cited as the philosophical foundation of a highly-effective new way of treating depression called cognitive behavior therapy.

Cognitive behavior therapy is based on the observation that the minds of people who suffer from depression and other forms of emotional distress are flooded with unrealistic negative thoughts, which on inspection, prove to be illogical and distorted representations of reality. Cognitive behavior therapy also maintains that these negative thoughts, or cognitive distortions, are a major contributing cause of most depressive episodes.

To understand the role distorted cognitions play in the development of depression, let’s look at the four major themes expressed in Ignas’ suicide note.

Theme One: Social Isolation

Recall that in his suicide note, Ignas wrote “I have no family, no friends… I feel alone.”

Psychologists have long known that social isolation is one of the major risk factors for the onset of severe depression. Even people with family and friends can feel socially isolated. A sense of social isolation often occurs after a negative life event in people who fail to share their experience with someone they trust.

For most of human history, people lived together in tightly-knit groups and communities where they spent much of their time inter-acting with family members and close friends. Even in cities, three generations of a family often lived under one roof or in close proximity to each other.

In recent years, particularly in advanced industrialized countries, the social support network provided by family and friends has witnessed a sharp decline.

Outside of work, we now spend most of our time in homes and apartments rich in electronic gadgets, but poor in social interaction. Many people work insufferably long hours, coming home after a long commute so exhausted that they lapse into a stupor in front of the television or spend hours surfing the internet.

As a consequence, we have far fewer opportunities to share our sorrows and joys with those we love. There are fewer people who can give us a listening ear or a helping hand. Finding a friend has become one of the biggest challenges of our time, particularly as people age.

With this in mind, Ignas’ assertion that he lacks family and friends is likely to be a realistic description of his situation. Anyone who claims that depressed and suicidal people never face hardships and adversities is being naïve. All of us have suffered from financial, relational, and health problems that try our inner resources. Many of us have endured periods when we went without the emotional support of family or friends.

But the fact is that people can and do cope with the hardships life flings their way without lapsing into depression or resorting to suicide if they seek help and marshal their inner resources to cope.

So what does lie behind Ignas’ extreme dejection? The answer resides in the implicit assumptions suggested in his suicide note:

a) that his social isolation is permanent and unendurable.
b) that his situation is hopeless, and he is powerless to change it, and
c) that without family, friends, or a job, his life has no meaning.

Thus, it is not the grim facts of his life that are the chief cause of Ignas’ depressive thoughts and suicidal impulse, but as Epictetus asserted and as research in the effectiveness of cognitive behavior therapy has shown, it is Ignas’ interpretation of his situation that is the crucial factor. His thoughts about his situation have escalated what people with resilient character traits would experience as regret over a highly undesirable situation into a severe depressive episode.

Theme Number Two: Hopelessness

“I have…no chance of finding a job.”

Losing a job can have an extremely destructive impact on people. This especially true for those who base their sense of self-worth on their job status. But it’s important to remember that the loss of a job by itself cannot hurl anyone into a dark pit of despair. Some people who lose their jobs rally and double their efforts to find work, even if it means taking a job at a lower salary.

When depressed, we often confuse feelings with facts. Worse yet, feelings of despair and hopelessness trigger our minds to generate additional negative predictions about the future that discourage us from taking action or seeking help. In this way, a vicious circle of negative thoughts, feelings, and inactivity is created.

How could Ignas have used cognitive behavior therapy to rid himself of hopelessness?

One method that could have helped is described and illustrated in a book called Feeling Good: The New Mood Therapy written by psychiatrist Dr. David D. Burns. In a survey of mental health professionals, Feeling Good was cited as the most frequently recommended self-help book on depression. One of the many techniques that Dr. Burns teaches people to use in order to overcome depression is to follow a three-step procedure: a) record in writing the stream of negative thoughts that flood the mind, b) evaluate each negative thought in light of common cognitive distortions that underlie emotional distress, and c) challenge each unrealistic negative thought and replace it with a rational response.

You can find a list of cognitive distortions with examples illustrating each in Dr. Burns’ book or you can google the key words “cognitive distortions.”

It is crucial that this procedure be done in writing. Writing down our unrealistic negative thoughts allows us to examine them in a much more objective fashion than we would if we tried to do this just in our heads.

Using Ignas’ suicide letter, we can make an informed conjecture about how he could have analyzed and disputed his depressive thought that finding another job was impossible.

As a first step, Ignas could have written his negative thought down on paper.

“I have no chance of finding a job.”

Next, after perusing the list of common cognitive distortions, Ignas could have identified at least one that matched what he told himself:

“By telling myself that I have no chance of finding a job, I am committing The Fortune Teller Error!” The Fortune Teller Error consists of confusing a prediction with an established fact and assuming that things will always turn out badly no matter what we do.

The third step in getting rid of a cognitive distortion is to refute the unrealistic negative thought that has been written down and to replace it with a more accurate and realistic appraisal. Here is what Ignas could have written as a rational response:

“Finding a job during hard economic times may be difficult, but it is far from impossible. Also, economic conditions change, so there is a good possibility that my prospects for employment may improve in time. Even though being over fifty years of age makes finding a job difficult, my age also shows that I am a mature person who has much work experience to offer. Finally, I have been able to find work before, so why am I assuming that I won’t be able to again? Now what things can do to improve my chances of finding a job now?”

By ending his rational response with a question that focuses his mind on the practical problem he needs to solve, Ignas would shift his focus of attention from the harmful depressive thoughts that impair his ability to solve his practical problems. He would also prompt his mind to come up with some practical steps he could take to find work and then try them out.

Theme Number Three: Self-condemnation

“…I’m a failure.”

According to the principles of cognitive behavior therapy, Ignas’ evaluation of himself as a failure represents two cognitive distortions: all-or-nothing thinking and global labelling.

Alll-or-nothing thinking encourages us to look at events and at ourselves in terms of black-and-white categories, with no middle ground in between. If our performance fails to meet our standards, we see ourselves as total failures.

Global rating, an extreme form of overgeneralization, results in attributing a negative life event to a permanent character flaw and judging an entire lifetime on the basis a single failure or event.

Instead of calling himself “a failure,” Ignas could have expressed himself more accurately by writing: “How does failing to find work make me a total failure? A total failure is somebody who has never succeeded at anything in the past and will never succeed at anything in the future. I have succeeded at many things in my life. Is labelling myself a failure helping me solve my problem of finding a job? No! It is only discouraging me from trying. Now what things can I do that will increase the likelihood of solving my problem – and finding a job?”

Theme Number Four: Meaninglessness

“What’s the point of living…?”

I find the pointlessness that Ignas assigned to his life the saddest part of his suicide note. To me and many people I have spoken to, a strong sense of personal meaning plays a crucial role in leading a fulfilling life.

In our increasingly materialistic society, personal meaning is associated with such visible badges of worldly success as job status, income, and fame. During periods of economic crisis, people who experience a change in income or status as measured by current cultural standards often feel a loss of meaning or purpose.

While cognitive behavior therapy can help people renew their sense of purpose, I believe that the problem of finding meaning requires a more philosophical and spiritual approach. Do our lives matter? That is an existential question that strikes at the very heart of what it means to be a human being.

Shortly after World War II, an Auschwitz death camp survivor, psychiatrist Dr. Victor Frankl, wrote a remarkable book called Man’s Search for Meaning. As a result of his experiences in Auschwitz, Dr. Frankl concluded that the fundamental problem of human life was to discover meaning, even In the midst of great suffering.

One of the stories Dr. Frankl told to illustrate his message was about a medical doctor who came to see him in the hope of alleviating the deep depression he felt after his wife’s death two years earlier.

Instead of proceeding with a typical psychiatric interview, Dr. Frankl asked the visiting physician one question.

“What would have happened, Doctor, if you had died first, and your wife would have had to survive you?”

“Oh, for her this would have been terrible; how she would have suffered!”

“You see, Doctor, such suffering has been spared her, and it was you who have spared her this suffering—to be sure, at the price that now you have to survive and mourn her.”

On hearing this, the visiting doctor’s entire demeanor changed. He didn’t say a word. He just shook Dr. Frankl’s hand and calmly walked out of the office.

In a the June 2004 issue of the Journal of Psychopathology and Behavioral Assessment, a study appeared entitled “Purpose in Life, Satisfaction with Life, and Suicide Ideation in a Clinical Sample.” The researchers who conducted the study found that a sense of purpose in life was an important factor in accounting for differences in suicide rate beyond other known negative psychological factors.

With all respect to Dr. Victor Frankl’s insight, I believe that meaning in life is not something we find, but something we create.

All of us have core values that we cherish and try to live our lives by. Some of us value character traits like courage or integrity. Some of us value nature. Others value beauty or health.

By bringing more of what we value into the world, we can create lives filled with meaning.

Thus, those of us who value courage can see life’s adversities as tests of fortitude and opportunities to enhance our courage. Aristotle wrote that the only way we can acquire and cultivate a virtue is through practice.

Those of us who value nature can cultivate gardens. Research has shown that the well-being and survival of elderly nursing home residents were significantly increased when each was given a plant to care for.

Those of us who value art can create works of art, or share our appreciation of art with others.

Even as simple an act as bringing a smile on the face of another person will add to the happiness that is present in the world.

By bringing more of what we value into existence, we become actual participants in the unceasing act of creation. Expressed in religious or spiritual terms, we fulfill ourselves as the instruments of God, Brahma, or what theologian Paul Tillich has called the Ground of Being. We can do this every day through everything we do.

Even in our final moment on this earth, we can create meaning. One of my neighbors who is a nurse told me she has seen many people die. Some left this world in fear, whining about the unfairness of death and begging for just a few more moments of life. Many died with courage and grace, leaving an example of fortitude for others to follow.

As I think about Ignas and his suicide letter, I cannot help but wonder what his life would have been like had he only sought help.

IMPORTANT: Anyone suffering from persistent depression or suicidal thoughts should seek help immediately from a mental health professional or by calling a suicide hotline (see below for suicide hotlines around the world listed in alphabetical order by country). If no other help is available, go to a hospital emergency room.

To learn more:

Feeling Good: The New Mood Therapy by David D. Burns, M.D. (HarperCollins, 1999).

Man’s Search for Meaning by Victor Frankl, M.D. (Beacon Press, 2006).

Youtube: Feeling good/David Burns/TEDxReno.

Suicide.org.

Dr. Boris Vytautas Bakunas is an educational psychologist with twenty years of experience in teaching emotional self-management graduate-level professional development courses. He has been a full member of the American Psychological Association since 1994.

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