Pills Aren’t Always the Answer / Go Ahead and Judge

Dear Dr. Hurd,

My friends tell me I’m depressed. I don’t even know what that means. I admit I’ve been sort of quiet and perhaps even a bit withdrawn lately, but I don’t think I need pills for what seems to be just a mild psychological malaise. Are my friends right?

Dr. Hurd replies:

It’s time to get rid of the word “depressed.” It started out as a term used by psychiatry to designate a clinical syndrome or condition. In other words, it was supposed to describe the abnormal, the unusual, or the not-to-be-expected. Nowadays, however, everyone and his brother, his sister, her daughter and first cousin are all depressed. Lost your job? Depressed. Not enough sun during the winter? Depressed. There’s such a wide array of precipitating events and emotions to which we attribute the malady of depression that the term has become meaningless with no sense of rational distinction. Since virtually everything is depression, nothing is depression.

The alternative to this confusion is to speak in concrete and specific terms. Given the lack of distinction and the need for clarity, there’s nowhere to go but up. When you think or speak about your emotions, try to be more specific. Try to take some responsibility for your thinking processes and recognize that your emotions arise from particular ideas or beliefs you hold. You seem to assume that the only answer is medication, but that’s not true. One option is that you can talk to a therapist. It might or might not help, but it could be more useful than you expect. Though a qualified therapist might or might not suggest medication for your mood, it is my experience that a good one will not rush to suggest a prescription without engaging in a bit of counseling first. And of course, you don’t ever have to take medication if you don’t want to. I won’t say that pills can never be a part of the solution, but it doesn’t have to be your first option.

However well-intentioned they may be, ignore your friends’ diagnoses. They are basically saying, “You’re not yourself. We want you to be the way that we’re used to you being.” That’s all very nice and might even be a compliment, but it’s not a diagnosis. Professional counseling can provide you with the tools and an objective sounding board to help you figure this out on your own.

Dear Dr. Hurd,

I moved to the beach about 12 years ago and started my own business. I have noticed a consistent pattern here where people say they are going to do things—and then don’t. I’ve even had people offer to help out in certain situations, but when the time comes there is always an excuse, or the even more insipid, “Oops, my bad! Sorry.” This is usually accompanied by a silly grin. Is it so important to some people to appear “helpful” that they are OK with being branded a flake when the chips are down? (My partner tells me that everyone does this everywhere, and that I just notice it more because this is a small town.)

Dr. Hurd replies,

Yes, we live in a small town. Interestingly, you’d think that in a small town people would be more concerned about their reputation and the fact that their word means something. After all, that should be part of rationally self-interested relationships no matter where you live.

Sometimes, however, the small town principle can work in reverse. People often feel they can get away with more, and opt to bask in the short-term reward of agreeing to do something, while refusing to consider the long-term benefit of actually following through. When they do this in a big impersonal city, they won’t have to face the consequences with people they might never encounter again. In a small town, it’s a different dynamic. If someone wishes to break his or her word, the unspoken assumption might be, “They’ll still be nice to me. They have to. It’s a small town.”

People who happily agree to everything and then do nothing are counting on you not to judge, i.e., not to say anything about what they failed to do. After all, that’s the “nice” thing to do. So, when your “niceness” is rewarded with more flakiness, do you make it easier for this person to get away with not keeping his or her word? They’re counting on today’s world where there are no absolutes, except for one: Never judge. And thus, the very people who should be judged get away with all kinds of things. So much for “nice.”

Of course, the pat answer is, “But I can’t be mean!” Who said anything about being mean? I’m talking about being honest. I’m talking about calmly and politely saying, “You told me that you would do such-and-such, but it never happened. Can you tell me why?”

Avoid an argument. You really don’t need to do anything beyond making a comment that will be your way of saying, “I know that you didn’t do what you said you’d do, and I’m not going to pretend otherwise.”

Michael J. Hurd, Ph.D., LCSW is a psychotherapist and author. His office can be reached at 302-227-2829. Email questions or comments to Dr. Hurd.