Papercut and colored pencil art by Sheryl Aronson X 5

Tuesday, May 24, 2011

Plan Ahead for a Crisis

What do you do when nothing works?  This is one of the biggest dilemmas in medicine.  In a group I was leading (on the hospital psych inpatient unit) the other day on leisure, a couple of patients said they had lost interest in everything, others said they just had no motivation to do anything.  These are typical feelings with depression.  A few months ago, a patient said she knew she could and should pick up the phone and call someone when she is thinking about suicide, but at that point, that was not what she wanted to do.
There are no foolproof answers to these situations. Motivation and interest can't be conjured up if they aren't there, and if someone really feels they are better off dead, why would they call someone to stop them?  Research has shown that usually a combination of medication and talk therapy works best to treat most depression.  When people get to the point of the patients described above, medication is the first line of attack. When they start to feel better, they can better make use of other options.  It takes alot of strength to pull out of real depression without medicine.
The groups I teach are a sort of talk therapy, but I don't see patients on an ongoing basis.  Each group I lead is separate, the patients choose to come or not, and only while they are inpatients on the psych units at our hospital.  With these constraints, I try to make each group have an impact on how the patients think about themselves and/or their illness.
One of the things I talk to my patients about is having a plan in place before a crisis.  Keep phone numbers handy  or on speed dial for close friends or relatives who are supportive, their doctor/therapist/counselor/case manager/sponsor, and the crisis and suicide hotlines.  When a person is depressed, thinking clearly can be very difficult.  Having a clear plan ready can save their life.
I talk to them about getting familiar with their symptoms so they can learn to catch things before they get to the crisis level.   Experiment with a variety of coping techniques to learn what is most helpful in different circumstances, and have the materials readily accessible.  We brainstorm coping techniques they have tried or heard about, including relaxation techniques, distraction, reframing, etc.
These ideas are helpful not only for depression, but for physical illness and pain, as well.  Think about yourself- What triggers a flare for you?  How do you know you are going downhill?  What has helped you in the past?  By planning ahead, you may be able to prevent a crisis, or at least minimize its impact.


  1. Sheryl, I want to thank you for writing this blog. I read what you write and didn't realize the affect that it has had on me until this past week.
    I had never used words like "thankful" or "grateful" before. This week when I started having problems with the electric in my house and some things worked and others didn't, I started to notice that I have a new way of looking at things.
    I had no hot water but I was "grateful" for the fact that I still had water. I am "thankful" for each lightbulb that is still working.
    My Dad, who is my main support emotionaly, is the one that noticed the change and pointed it out to me.
    He asked me if I was OK because just last year something like this would have knocked me down very hard. He is right.
    I would have fallen into a deep and very dark hole of depression. I would have been very upset, crying and saying things like "This life is not worth living" and "Why does God hate me?"
    I'm not saying that I doin't still have problems dealing with things but, because of reading your blog, I have developed a new way of looking at things and I didn't even realize it.
    I know that I still have a long way to go but I just wanted to thank you for being a positive influence in my life just by the words that you write. I know that I can't be the only one that you have gotten through to, because it can be very hard to get things through my thick skull. So I just wanted to let you know and to say THANK YOU and please never stop being the kind of person that you are.
    Your husband is my doctor and I believe that the two of you are a great team and I am truely "GRATEFUL" and "THANKFUL" that our lives have crossed paths.

  2. Thank you for such positive feedback. I really appreciate hearing that my blog posts have been helpful in changing your thinking. Living with chronic pain and/or illness is hard enough, but we Humans tend to make it worse by how we think and react. Stuff happens in life that we have no control of, our only control is within ourselves. Being able to be grateful for the positives when the negatives are jumping up and down fighting for our attention is truly a great skill to have.
    I hope you have gotten your electricity straightened out.