It’s a vicious cycle: hopelessness feeds depression, and depression causes hopelessness. To break the cycle, focus on inspiration and support.
Studies show that hope can speed recovery from depression. But how do you maintain hope in the midst of despair?
The support of family, friends or a therapist can shine light in a dark time.
Happy memories can keep you looking forward. Life was good once, so there is every reason to believe it will improve again.
Goal-setting—identifying achievable goals and working toward them incrementally—is also crucial to restoring hope.
The relationship between hopelessness and depression has been studied extensively. However, researchers are just beginning to understand the role hope plays in the prevention of, and recovery from, depression.
One challenge is how to assess and measure hope.
“Hope means a lot of different things to different people,” says Murray Enns, MD, a professor and head of psychiatry at the University of Manitoba. “At the same time, mental health consumers and their families all get it—how important hope is.”
Power of hope
There is no doubt that hope is a powerful emotion. In fact, it can literally save lives.
“There are quite a lot of studies that show that hopelessness is a very important predictor of having future thoughts of [taking your life] …,” says Enns. “Why? In the absence of hope, life doesn’t feel worth living. The striking thing is that the degree of hopelessness is a stronger predictor [of suicidal thinking] than the depression itself. No one is sure why, but it reflects that you have to have hope, or you can’t see yourself in the future.”
Hope may even help us come to terms with our mortality. Researchers at the University of Alberta, Canada, surveyed elderly psychiatric patients to examine the link between depression, hope and one’s sense of accomplishment and fulfillment over a lifetime. They found that the group who did not suffer from depression had a “greater sense of purpose and higher levels of hope” than the group with depression.
“Often people who have not achieved in life may feel depressed and hopeless as a result,” says Cheryl Nekolaichuk, associate professor in the division of palliative care medicine at the University of Alberta and a co-author of the 2003 pilot study. “By treating the depression, we may be able to lessen their sense of despair and help them find meaning.”
To each his (or her) own
For Wayne C. of Toronto, the emotions of hope and love are intertwined. Wayne, 35, says the love of strangers fueled his hopefulness, enabling him to complete a year-long run across Canada. The purpose of the trip was to raise public awareness about anxiety and depression and help “erase the stigma of mental illness, in general.”
At the end of each day, Wayne, who traveled alone, had to find a way to return to the day’s starting point to fetch his car. “I would go to a gas station, or talk to people on the side of the road about anxiety and depression, and they would give me a ride back to the car, sometimes going 50 miles out of their way,” says Wayne. “I didn’t have any money to give them. They did it out of love. That’s the kind of thing that gets me going.”
When his marriage ended, Wayne temporarily moved back in with his family. Their support gave him strength to rebuild his life.
“A lot of times I get depressed, thinking that I’m suffering alone, that people don’t care,” says Wayne, who is diagnosed with general anxiety disorder, but also suffers periodic depression. “But I have a family who loves me and friends who care about me. When I think about all the love I get from these people, I become more hopeful.”
Wendy Aron, author of Hide & Seek: How I Laughed at Depression, Conquered My Fears and Found Happiness (Kunati, 2008.), defines hope as “the antithesis of depression.”
“Depression is looking backward at mistakes you’ve made, while hope is looking forward to the future,” she says. “That’s what you have to do to get over depression.”
Setting goals
In 2008, researchers at the Medical University of Vienna reviewed more than 40 studies examining the connection between hope and mental health. They concluded that hope is a shifting, changing emotion that enables us to set positive goals we believe are achievable.
Goal-setting helped Aron recalibrate after her career dead-ended. “I was living in Los Angeles trying to break in as a sitcom writer. I sold an episode of Family Ties, but then I didn’t get another assignment for several years,” she recalls. “I became very depressed about it.”
Aron eventually returned home to New York City for family support and to receive treatment for her depression. Having decided it was time for a new career path, she began looking for work in publishing.
“Once I had hope there was a future, it made it much easier to get back to functioning,” she says. “You don’t have to go out and conquer the world—you have to take a step in the right direction and give yourself credit for it.”
Aron is now a copywriter for a Web-based company and has begun work on a second book. “You need a reason to get up in the morning and start doing things, whatever that might be,” she says.
While setting goals is integral to recovery, it’s important to keep your goals realistic, says James Aikens, PhD, a clinical psychologist and associate professor of family medicine at University of Michigan Medical School. “You can make someone feel even worse if you encourage him to make plans that he doesn’t have the energy to see through, or if he doesn’t have a plan to carry it out.”
Grasp a lifeline
Friends and family can hold out hope when you cannot. An effective caregiver is someone who is reliable, trustworthy and can keep you connected to the world, says Enns. “You need a non-blaming, supportive caregiver who understands the nature of depression, including the feelings of hopelessness that may accompany it,” he adds.
Carol A. Kivler, a businesswoman and mental health advocate, has endured four hospitalizations for depression—the first in 1990—and more than 50 electroshock treatments. She knows as well as anyone that recovery isn’t a solitary pursuit.
“Sometimes the only thing that gets us through the day is [the thought] that others are holding out hope for us,” says Kivler, 58, of Lawrenceville, New Jersey. “If our loved ones and health care providers are courageous and hopeful for us, we cling on to that.”
Kivler is president of Kivler Communications, a corporate training company, and founder of Courageous Recovery, a nonprofit dedicated to “dispelling the myths and stigma surrounding mental illness.” She tells her story of hope and depression to audiences of health care professionals, consumers and families. She also reaches out one-on-one to those knocked low by depression.
“I tell people, ‘I know you can’t see through this right now, but there is a brighter tomorrow.’”
Turning to a higher power
To keep centered, Kivler reads devotionals every morning. “I’m big on positive affirmations,” she says.
Studies show that the faithful generally experience a better outcome from depression, says Enns. “Religious beliefs provide hope for a better future. This hope can allow people to persevere with their treatment,” he explains. “Religious practices provide a variety of social connections, and social supports are important for people to sustain hope. Finally, religion can provide meaning, and meaningfulness is a powerful remedy to feelings of hopelessness.”
On the days that Jean D.’s depression was so severe she couldn’t muster the concentration to read, she would turn to the Christian music radio station. “All I could do was listen to the music,” she says. “It was calming and soothing and gave me hope.”
Jean, 48, says she has made peace with her suffering because it has brought her closer to God. “It is in your weakness that the strength of God is on you,” says Jean, of Omaha, Nebraska.
Debbie Johnson of Nevada, Iowa, doesn’t attend church regularly or believe there is a God up in heaven, but she does feel there is some greater force to turn to. “When something comes up and it’s got me depressed, first I accept there is a problem, then I ask my spiritual God for help,” says Johnson, 46. “Then I list all the things I’m grateful for and write down things I can do to take care of the problem.”
Make an effort
For many, medication can reverse feelings of hopelessness. Cognitive behavioral therapy is extremely effective, too, says Enns. “With the therapist’s help, you identify hopeless thoughts, understand how they connect to one another and then challenge them one by one,” he says. Depression sufferers also report yoga, meditation, aerobic exercise and doing for others can be healing.
For some consumers, however, the symptoms of depression linger despite their and others’ best efforts. There comes a time during a lengthy depression when it may be necessary to realign your goals, says Enns. For example, you may be able to return to work, but in a less stressful setting. The trick, he says, is to face your illness realistically, without abandoning hope.
“You always want to start with the goal of remission of symptoms, but there is a point in treatment where you need to switch to plan B,” he says. “We can continue to work on total recovery, but in the meantime, you have to focus on how you are going to live, given the amount of depression you have; to rebuild your life, notwithstanding the ongoing symptoms.”
When the pain of depression is ever-present, the smallest steps to recovery can be momentous. “After a two-month episode of severe depression and isolation, I set a simple goal of making my bed every morning,” Robert V. of San Francisco says by email. “Once my bed was made, I did not allow myself to crawl back into it. This created the need to leave my room and take a shower, brush my teeth and carry on through the day. At the end of the day, I could always climb into my nicely made bed.”
Scott H., a 46-year-old pharmacist who lives in Tucson, lost his job and was out of work eight months due to depression. Thoughts of returning to work and the loyalty of friends gave him the courage to begin again.
“It was a gradual process,” he says. “In the very beginning, I didn’t even want to eat. As I moved along, I pushed myself to go for a walk with a friend. I pushed myself back to work, even though I didn’t feel like it. It was a conscious effort.”
Printed as “HOPE”, Summer 2009
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