Depression Is Contagious How the Most Common Mood

Disorder Is Spreading Around the World and How to Stop It

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 Also by Michael D. Yapko, Ph.D.

BOOKS

Hypnosis and Treating Depression:

Applications in Clinical Practice (Editor)
Trancework:
An Introduction to the Practice of Clinical Hypnosis (3rd edition)
Treating Depression with Hypnosis:
Integrating Cognitive-Behavioral and Strategic Approaches

Keys to Understanding Depression

Hand-Me-Down Blues:
How to Stop Depression from Spreading in Families

Breaking the Patterns of Depression

Essentials of Hypnosis
Suggestions of Abuse:
True and False Memories of Childhood Sexual Trauma
Hypnosis and the Treatment of Depressions:
Strategies for Change

Free Yourself from Depression

Brief Therapy Approaches to Treating Anxiety and Depression (Editor)

When Living Hurts:
Directives for Treating Depression
Hypnotic and Strategic Interventions:
Principles and Practice (Editor)

AUDIO CD PROGRAMS

Focusing on Feeling Good:

 Self-Help for Depression
Calm Down! Self-Help for Anxiety

Sleeping Soundly

Managing Pain with Hypnosis

 Depression Is Contagious

How the Most Common Mood Disorder

Is Spreading Around the World
and How to Stop It

Michael D. Yapko, Ph.D.

 AUTHOR’S NOTE
The examples, anecdotes, and characters appearing in case vignettes in this
book are composites drawn from my clinical work, research, and life
experience. I have changed all names and other identifying characteristics
throughout the book. This book is not meant to be a substitute for personal
treatment, including evaluation, diagnosis, and intervention by a qualified
mental health professional.

Free Press
A Division of Simon & Schuster, Inc.
1230 Avenue of the Americas
New York, NY 10020
www.SimonandSchuster.com

Copyright © 2009 by Michael D. Yapko, Ph.D.

Foreword copyright © 2009 by Erving Polster

All rights reserved, including the right to reproduce this book or portions
thereof in any form whatsoever. For information address Free Press
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NY 10020

First Free Press hardcover edition September 2009

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ISBN: 978-1-4165-9074-3
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 To Diane,
whose effortless ability to light up a room
just by entering it highlights that love is contagious, too
 Contents
Foreword by Dr. Erving Polster
Introduction
1. Depression Doesn’t Arise in a Social Vacuum: The Social Foundation
of Depression
2. Other People Are NOT Just Like You: Frames of Reference,
Flexibility, and Acceptance
3. Expectations and Relationship Satisfaction: Learn to Assess Others
Realistically
4. Thinking Too Much and Too Deeply: Learn to Take Action
5. Don’t Bring Others Down with You: Learn to “Lighten Up”
6. Self-Deception and Seeking the Truth: Learn to Test Your Beliefs
7. Drawing the Lines: Protect Your Personal Boundaries
8. Marriage Can Save Your Life: How to Keep Yours Healthy
9. Hand-Me-Down Blues: Learn to Reduce Your Child’s “Depression
Inheritance”
10. Afterword
Notes
Appendix A: Exercises to Pause and Reflect and Learn by Doing
Appendix B: Self-Help Materials
Appendix C: Websites of Note
Acknowledgments
Index
 Foreword
Familiar adages appear over and over again because they teach us simple,
but important, life lessons. One of these—“the more things change, the
more they stay the same”—particularly applies to the pharmaceutical
revolution which has misled people to believe that pills can magically
replace healthy relationships, make them happy, and cure depression. Forget
about it, because that’s not going to happen now or ever. Notwithstanding
our modern technological society, we people are basically what we have
always been. Advances made by people are advances made by people; they
don’t replace people.
In fact, people-to-people connectedness can outdo pharmaceuticals in
treating depression. To broadcast that news, which is supported by many
scientific studies, we need this powerful new book by Dr. Michael Yapko. It
will be the tipping point against the present pharmaceutical domination. Dr.
Yapko presents a compelling case that the popular pharmaceutical solution
is overly simplistic and that we need to look to each other for the
antidepressant merits of good relationships.
Dr. Yapko recognizes human relationships as key designers of
psychological well-being. In clear terms, citing incontrovertible research
described with no-nonsense directness, he brings our attention to the rising
rates of depression, a social catastrophe in progress not just in the United
States but around the world. Then, most importantly, he identifies human
solutions and teaches essential skills for building positive, healthy
relationships, framed to reduce the pain and isolation of depression.
The scenarios Dr. Yapko presents rarely reach the therapy office simply
because most depressed people don’t seek help; paralyzing helplessness and
hopelessness define the disorder. But the consequences of depression
undoubtedly reach into the hearts of family, friends, fellow workers,
employers, customers, and others. The lives he describes are fraught with a
variety of dangers, misunderstandings, faulty expectations, guilty self-
appraisal, and many other common sources of malaise. But Dr. Yapko
provides a professional acumen and sensible guidance with the practical
exercises he has developed that give perspective and direction to all people
concerned with combating depression.
The study of how relationships affect physical and mental health has a
long, rich history. More than a century ago, when psychotherapy first came
along, it introduced a stunningly new kind of relationship between doctor
and patient. Called a “transference,” this special therapy relationship
encompassed a lifetime of personal experience, giving it an electrifying
intensity of feeling and meaning. The therapeutic effects showed more
clearly than ever the impact of a well-designed relationship. This discovery
was at least as captivating then as the pharmaceutical revolution is today.
Today, however, we require a larger cultural healing process, one that
transforms the therapy that works for the few into a social expansion that
works for the many. There is a growing awareness that no one’s misery
exists alone. Dr. Yapko provides extensive data that give substance to the
all-important point that depression is both formed and healed in the world
of people. Psychotherapists have always known this but only now have they
begun to embrace the paradoxical implication: the culture that hurt their
patients is also the very culture that could heal them. This dual potential
effect of the culture—its toxic force and its healing antidote—is accentuated
in Dr. Yapko’s extensive, detailed exploration of the role of social
engagements in the recovery from depression.
He also offers another paradoxical observation: Yes, we humans are
biochemical organisms, as pharmaceuticals dramatize, but we are humanly
biochemical. Dr. Yapko makes the case that a physical and metaphorical
“chemistry” is created in person-to-person relationships. To think of the
biochemical as only limited to a pill, as if it is external to our personhood,
obscures the chemistry of human response. If you get angry with me or
smile at me, you are creating a chemical synthesis that affects both you and
me. Dr. Yapko makes this simple point by highlighting the latest brain
research and showing that, in objectively measurable neurological terms,
“chemistry” between people is more accurate a description than we could
have ever imagined!
Antidepressant medication, though beneficial to many people, is proving
to be too narrow a solution to a pervasive problem. With massive profits at
stake, the pharmaceutical industry has sidestepped the relational foundation
of psychological well-being in order to relentlessly sell its product. As it has
flooded the public with oversold claims implying that pills can mimic basic
human function, a public too trusting of presumed authority has succumbed
to the temptation to believe that “a pill a day will keep the depression
away.” A countermovement to chemical solutions is now emerging,
however, and people are on the threshold of awakening to their need for
community and a feeling of belonging.
The work of a new generation of neuropsychiatrists reinforces the
scientific finding that relationships not only heal hearts and souls, they heal
brains as well (Siegel, 1999). People in a relationship experience a
neurological resonance, a “harmony” between brains, that fosters feelings
of connection and belonging, often beneath the surface of awareness; its
effect may be tiny or highly significant, depending on the individual.
Dr. Yapko’s many skill-building exercises throughout this book keep the
brain’s interpersonal circuits “open.” They are ways to enhance resonance
with relational alternatives to medical prescription. With specific,
comprehensive instructions and real-life stories, he helps you understand
and address dilemmas of workplace, family, and friends. Dr. Yapko shows
how to maximize opportunities for healthful communication and connection
and how to rise beyond depressive resignation. Our society now breeds
loneliness and despair, but here is how it can offer a guiding light on the
road to healthful living—by bringing its members together.
Even in a society that emphasizes individuality, we can attain a
communal mutuality because, underneath it all, human beings are
communal creatures. Even though we all differ from one another, we are
also all in the same boat in important respects. We all need love, security,
and guidance in solving problems.
As a teacher of psychotherapy, I have seen communal effects of
demonstrations I have given over the years at seminars and conventions.
When I conduct these demonstrations, on the surface it seems as though I
am engaging with just one person while the audience is “only” observing
the session. However, the audience is doing more than merely observing—
they drink in the experience, often telling me later how the demonstration
with one person resonated with their own experience and helped transform
them in some meaningful way. Whether you call that contagion or mutuality
or empathy or synchronicity, it points to our commonality as human beings,
our indivisible connection to one another, and the ubiquitous energy
transformations that keep us alive (Polster, 1987, 2006).
By capitalizing on our desire for a full life without depression,
pharmaceutical companies have aroused our hopes for an easy cure for
depression. Dr. Yapko documents these exaggerations and shows that
medicalizing depression has been damaging when it does not get to the real
point of people’s misery, when their misery is rooted in painful
relationships and dashed hopes. He cites compelling research which reveals
that the favorable results of taking pills have been illusory. And he
demonstrates that building social connections is pivotal for everyone,
particularly those who are isolated and depressed, in order to achieve that
full life to which we aspire.
Dr. Yapko’s vision for a relational treatment of depression contains two
key contributions. First, he sets the stage with his pointedly professional
activism. In directly confronting the rising rate of depression as a product of
social forces, he challenges us to define the problem as more social than
medical. Second, he offers practical hope that a healing connectedness can
be restored by first emphasizing people over pills and then developing the
skills essential to living well in a world filled with others. In so doing, he
joins with a growing number of psychotherapists who are recognizing ever
more clearly the social components of every person’s healing process. In
the face of the pharmacological juggernaut, he illuminates the powerful
human resources available to undo the depressive isolation too many people
experience.
Erving Polster, Ph.D.
Author of Uncommon Ground
 Introduction
The rate of depression is rising. According to the World Health
Organization, the international watchdog of health issues around the world,
depression is currently the fourth greatest cause of human suffering and
disability around the world. That observation alone tells us how serious and
pervasive the problem of depression already is. Even worse, however, is the
World Health Organization prediction that by the year 2020, depression will
have risen to become the second greatest cause of human suffering and
disability. This unprecedented rapid growth rate is strong evidence that
biology is less a factor in its spread and social forces the greater factor.
Is depression really on the rise, or are people just more tuned into
depression as a general topic of interest? The best evidence we have
suggests strongly that depression is increasing in prevalence not only in the
United States but around the world. This is not simply because more people
are seeking help for depression or because wary clinicians are diagnosing it
more frequently. Rather, the increase appears to be the product of more and
more people manifesting the signs and symptoms of depression.

People Can Spread Depression

What we do to each other can too easily become the source of great hurt in
our lives and can result in an enduring way of thinking, feeling, and relating
to others. But, we are relearning something of vital importance that has
been too often overlooked in recent years: Just as people can be a source of
pain, they can also be a source of comfort and happiness and a way out of
pain. In light of new research, being the strong, self-sufficient “go it alone”
type no longer seems the most effective route to personal fulfillment.
Instead, science is confirming what we have probably always known in our
hearts: We are built to be in positive, meaningful relationships with others in
order to feel good. Yet, today, our relationships are damaged and suffering
in unprecedented ways.
As relationships face more challenges, whether in love, family, business,
or friendship, depression is on the rise. Depression spreads in part through
troubled relationships and, in this sense, is socially contagious. You can’t
catch depression in the same way you catch a cold, but the latest research in
neuroscience, social psychology, epidemiology, and genetics provides
overwhelming support that moods spread through social conditions. Our
social lives directly shape our brain chemistry and powerfully affect the
way we think and feel. With modern scanning technologies, we now have
evidence that our brains change with positive life experiences. In fact,
brains can change as much with social circumstances as with medication.
Drugs may address some of depression’s symptoms, but they cannot change
the social factors that cause and perpetuate it.

The Skills for Living Well

What makes for healthy, strong, happy people? Why do some people face
stressful and challenging events in life and seem to rise above them, while
other people implode in the face of what seem like routine stressors? These
questions provide the foundation for much of what I will talk about in this
book. The vast majority of research into depression has focused on the
pathologies within people that presumably give rise to the disorder, such as
character defects, anger-turned-inward, and chemical imbalances in the
brain. Only recently has there emerged a different paradigm for thinking
about human experience. Known as positive psychology, its focus is on
what is right with people rather than on what is wrong. Instead of studying
people who suffer, positive psychologists study people who have overcome
adversity and thrived, who are happy, competent, and fulfilled. By striving
to identify people’s strengths, psychologists hope to help those who are
suffering.
One of the first tasks positive psychologists attempted was to develop a
new manual that would catalogue and define many of the best aspects of
human experience. Unlike the well-known psychiatric manual listing
various forms of psychopathology (the Diagnostic and Statistical Manual,
now in its revised fourth edition, DSM-IV-R) used by mental health
professionals to diagnose patients, a new manual called Character Strengths
and Virtues was developed by psychologists Chris Peterson and Martin
Seligman to identify and describe some of the best human attributes. These
include the courage to speak the truth, kindness, love, fairness, leadership,
teamwork, forgiveness, modesty, gratitude, and many other such positive
characteristics. If you reread that list of attributes, you cannot help but
notice that they are wonderful human potentials that can only be expressed
in the context of human relationships. Simply put, how people develop their
best selves is largely, though not entirely, achieved in the context of positive
relationships with other people.
At a time when we are learning how vitally important it is to have
positive and healthy relationships, we are seeing such relationships on the
general decline. Even a cursory review of recent U.S. Census data shows us
the warning signs: More people are living alone than ever before, people
wait longer to marry, on average, yet the national divorce rate remains
slightly over 50 percent for first marriages, and even higher (about 70
percent) for second marriages. The number of births outside of marriage has
risen sharply, and single parents who must work and are thereby too often
unavailable to their kids experience and transmit stresses that are widely
cited as a reason why children are often struggling emotionally. Millions of
children are currently on antidepressant medication, as well as other
psychoactive medications for their social and behavioral problems.
As families struggle and marriages wobble, large studies of the
prevalence of various disorders in the general population show rates of
depression nearly four times higher than a generation ago and nearly ten
times as high as two generations ago. Social skills have declined and
relationships have become less rewarding and effective. As a result, the
vulnerability to depression has increased.
For over half a century, researchers have known that good relationships
serve as a buffer against illnesses of all sorts. The evidence is clear, for
example, that when you are happy in your primary relationships, you suffer
less depression. Furthermore, people who enjoy close friendships and the
support of others are happier and more productive. They also suffer fewer
illnesses and, on average, live longer. We will explore the health and mood
benefits of good relationships with others in the first chapter. What most of
this book will be about, then, is how to develop the kinds of relationships
that can help you overcome depression, and perhaps even prevent it.

Depression Rises as Relationships Fall

Mental health experts have generally treated depression by giving their
patients drugs and shock treatments and other newer brain stimulation
treatments, or by talking with them about their childhoods. Yet the social
conditions that give rise to depression continue unabated, allowing the rate
of depression to continue to rise at an alarming rate. New research makes it
clear that depression is not just about the suffering of one individual, as if
he or she lived in total isolation. Rather, depression occurs in a social
context; it occurs within people, and also arises from the hurts that take
place in relationships between people.
The pains of rejection, humiliation, the loss of a loved one through a
breakup or death, the betrayal of trust, the trauma of violence and abuse,
and the many other ways people can wound each other are all reliable
pathways into depression. Simply put, depression can be and often is a
direct consequence of relationships that are, well, depressing.
Depression doesn’t just affect individuals, although it’s easy to focus on
the person with the symptoms. For every depressed person who gets
treatment, at least four more don’t. For every depressed person who doesn’t
get treatment, his or her depression affects the lives of at least three others.
For every depressed parent who goes without treatment, his or her child is
at least three times more likely to become depressed than the child of a
nondepressed parent. Relationships can spread depression as surely as
germs can spread illness. Depression is contagious.
More and better drugs will not solve the problem. People who suffer
depression, and the people who love them who suffer right alongside them,
must also avoid overthinking the symbolic meaning of the depressive
experience. Depressed people are usually already quite good at isolating
themselves and thinking too deeply about themselves. Instead of examining
them even more closely under the microscope, analyzing ever smaller
pieces of their psyche, as if depression is just their individual problem, the
solution lies in a broader view. We need a macroscope. We need to see
depression in its larger social context, see it for what it is when the world
gets more dangerously crowded while people are literally dying of
loneliness.

Depression Gets a Lot of Attention … but Not Nearly Enough

Few mental health problems have received as much attention as the
problem of depression. There are many reasons: (1) Depression has a huge
financial impact on our society because of the exorbitant economic costs
associated with it; these are measured in terms of lowered productivity,
more employee sick days, and diminished job performance. Current
estimates indicate depression is costing the U.S. economy at least $70
billion per year. (2) Depression’s cost in terms of health care expenses is
huge since it is so closely associated with cardiovascular disease, diabetes,
smoking, drug addiction, and many other costly health related problems. (3)
Depression exacts a heavy toll on individual lives, causing high levels of
suffering, anguish, unhappiness, and even the ultimate loss of life when
people in despair kill themselves. (4) Depression is terribly destructive on
the social level. Depressed people are often unable to establish and maintain
healthy family environments and constructive working relationships with
others, or to build loving and positive relationships with others. Some
depressed people even destroy and sabotage important social bonds and
harm society through antisocial acts.
The power of depression to damage and destroy lives cannot be
overstated. We in the mental health professions have worked especially hard
to better understand and treat depression and, over the last two decades, our
understanding of depression has increased dramatically. In fact, depression
has gone from being one of the least understood to one of the best
understood disorders that clinicians treat.

A Multidimensional View of Depression: Multiple Paths into

Harm’s Way
Many things cause depression. Some factors are biological, some are
psychological, and some are social. Hence, a biopsychosocial model of
depression dominates the field.
The biology of depression is an extraordinarily complex arena of
research. A young field called affective neuroscience is striving to
understand the brain mechanisms underlying moods and mood-related
disorders like depression. Geneticists are investigating the role of genetics
in vulnerability to depression. Psychopharmacologists are striving to
understand the role of neurochemistry in mood states in order to better