Disaster and trauma studies often focus on identifying the incidence of PTSD as the sequel to traumatic events.

Early interventions with those affected after a disaster or traumatic event increasingly utilize psycho-education to clarify and normalize common post-traumatic stress reactions and coping strategies.

While mentioned as a possible response, the high incidence of depression after trauma is less delineated and often goes unrecognized by those suffering.

Depression Occurs after Trauma:

• A Rand corporation study reports that nearly 20 percent of military service members who have returned from Iraq and Afghanistan – 300,000 in all – report symptoms of Post-Traumatic Stress Disorder or major depression.
• In the first long-term study of the health impacts of the World Trade Center (WTC) collapse on September 11, 2001, findings indicate that seven percent of police officers were diagnosed with depression, nine percent with PTSD and eight percent with panic disorder. Twenty eight percent of other rescue and recovery workers had symptoms of depression.
• A survey of survivors from the Oklahoma City bombing showed that 23% had depression after the bombing.
• Depression affects approximately 15 percent to 25 percent of cancer patients.
• After a myocardial infarction, the incidence of major depression is from 15 percent to 20 percent, and an additional 27 percent of patients develop minor depression.

Both major depression and Post-Traumatic Stress Disorder (PTSD) occur frequently following traumatic exposure, both as separate disorders and concurrently.

Depression is the most common disorder suffered in conjunction with Post-Traumatic Stress Disorder.

Depression is nearly three to five times more likely in those with PTSD than those without PTSD.

Well beyond the necessities and somewhere between collecting and hoarding…we all have ‘stuff.’

Be it the toy truck, the pasta bowl, the piano, the silver earrings or the old books, we all have stuff because psychologically we need stuff.

Sartre holds that “to have” (along with “to do” and “to be”) is one of the three categories of human existence…

Wired for Stuff

Famous psychologist, Donald Winnicott, tells us that long before we could verbalize the need, we transitioned from merged oneness with mother to “transitional objects,” the favorite blanket, pacifier, stuffed animal, or a piece of cloth that was attributed a special value as a means of making the shift from mother to genuine object relationships.

That said, our relationship with objects, “our stuff” never stops. It unfolds throughout our life; reflecting who we are, where we are, whom we are connected with and what we need to be ourselves.

One of the reasons we find it easier to ask others rather than ourselves, “Do you really need this stuff?” is that the actual value of anything is primarily a function of our investment in it and/or our interaction with it. We give “stuff” value and meaning.

Almost everyone has some experience with hope: We hope for the best. We hang on to hope. We despair when we lose hope.

It would seem that hope, which is broadly defined as an emotional state that promotes the belief in a positive outcome, is in inherent in human nature.

Reflections of the importance of hope are found in early mythology, religion, philosophy and literature.

Pandora, although forbidden, opened the box given to her by Zeus, and in a moment, all the curses were released into the world and all the blessing escaped and were lost- except one: hope.

“To have faith is to be sure of the things we hope for, to be certain of the things we cannot see.” ― The King James Version of the Bible

“Hope is a waking dream.” –Aristotle

“Where there is no hope, it is incumbent on us to invent it.” -Albert Camus

“Hope is that thing with feathers that perches in the soul and sings the tune without the words and never stops — at all.” -Emily Dickinson

Clearly we need hope, but even as we embrace it we often wonder – Does hope really make a difference? Is it myth, fiction, collective denial?

There is actually increasing scientific evidence that hope changes us psychologically and physiologically – that it makes a difference.

Many people face a traumatic event in adult life. Be it a serious car accident, combat, rape, a natural disaster or the loss of a child, people are often confronted with a horrific event that threatens death or serious injury to themselves or someone else, or involves the traumatic loss of a friend or loved one.

While such trauma is in itself physically and emotionally assaultive, trauma theorist Robert Stolorow proposes that beyond the actual event, it is the emotions suffered after the event that become the unbearable emotional pain of trauma.

• Difficult to articulate and unrecognized by many, the emotional aftermath of adult trauma often goes unvalidated and unhealed.
• Drawing upon his own traumatic loss of a young wife, Stolorow reports that in the unreal time that stretches slowly after a trauma, there is an “excruciating sense” of being outside normal life, alone with feelings that no one else can understand.

Stolorow’s contribution to the field is his articulation of these feelings in a way that becomes an invaluable resource for validation.

In this era of advanced medical detection and intervention, the medical care of patients and the reduction of mortality for life threatening illness has never been greater.  Against this backdrop of success, however, what is often overlooked by professionals, family, even patients, is the experience of medical illness as psychological trauma.

• While some efforts like the emerging field of Psycho-oncology are starting to address the totality of the patient and the American Psychiatric Association now officially considers “ being diagnosed with a life –threatening illness” a potentially traumatic event, it is perhaps most important that patients and families understand why and how medical illness often brings with it- anxiety, anger, depression, panic and post-traumatic stress symptoms.
• Understanding, normalizing and validating common stress reactions can demystify and lower anxiety at a time when so much feels beyond understanding or out of control.
• Given that the experience of trauma is a function of many variables including age, nature of trauma, duration and personal meaning, people will differ in their psychological response to medical illness.
• Some may experience a few symptoms which abate within months, others will deal with a delay in the experience of depression or anxiety until well after the medical crisis, and for others the persistence of emotional distress may warrant professional help.

Given that there are now 81 million baby boomers in this country ranging from ages 46 to 66, there are many people navigating the transitions of midlife. When you add to that the fact that 80% of the male boomers and 77% of the females are married the journey gets more complicated.

Amazon lists over 2,000 books dealing with midlife with titles as different as Awakening at Midlife, Midlife Meltdown, Thinking about Tomorrow: Re-inventing Yourself at Midlife, How to Survive Your Husband’s Midlife Crisis, Midlife Crisis For Men: Male Menopause, My Favorite Midlife Crisis etc. The message is that against the backdrop of mortality and a story half told, men and women navigate their midlife passage in different ways with different challenges and different needs. When married, the impact they have on each other is inevitable.

Suicide ranks as the eleventh leading cause of death in the United States. We have lost loved ones across the generations.

• Older Americans are disproportionately likely to die by suicide. Although they comprise only 12 percent of the U.S. population, people age 65 and older accounted for 16 percent of suicide deaths in 2004.
• Suicide is the second leading cause of death in college students and the third leading cause of death in adolescents.  Every day 14 teens take their own lives.
•  According to the Centers for Disease Control and Prevention, for the second year in a row, middle -aged adults have the highest suicide rate in the country, surpassing even older Americans.

While there are many factors that contribute to suicide, an important new study identifies two factors that have been associated with increased risk for suicidal thought and behavior across the lifespan – hopelessness and lack of connectedness to others.

Numerous studies have identified exercise as a key factor in reducing depression symptoms. A recent study heightens the argument by finding that as compared to age, race, gender, body mass index cholesterol, blood pressure and diabetes, it was the sedentary lifestyle of a depressed person that alone accounted for about 25% of the risk of heart-related deaths. The message is that we need to move because our lives depend on it!

The problem is that when you are depressed often the last thing you want to do is exercise.

Given the despair, lethargy, self-doubt, exhaustion, disinterest in activities and shame experienced with depression, the suggestion to exercise feels like adding insult to injury. “I’m not exercising because I’m depressed.”

Knowing exercise could help, but feeling unable to do so often adds to the self-recriminations and low self-esteem of depression.  In one case, the more the young woman watched other family members exercise – the less possible it felt.

Depression’s Landscape.

Given the recent discussion of the pros and cons of medications and treatments for depression, it seems clear that people need to have information and treatment options. It also seems important to stack the deck toward feeling better with anything that might work for you. If you have wanted to exercise but find it impossible – here are some suggestions.