Starting a Group

At this point there is no organized national effort to provide self help for people with depression.  There is no AA and no group like CancerVive (for victims of cancer) or Red Hot Mamas (menopause).  There are some good books available, both in the inspirational/codependency line and in the disease/cognitive framework (see Further Reading).  Many mental health centers and hospitals either have professionally-led depression groups or lend space to self help groups.  There are local groups:  in the New York area, I can highly recommend the New York Mood Disorders Support Group, .  And there are specialized programs, like Daniel Lukasik’s Lawyers with Depression

Without a specific self-help program for depression, many depressed people find tremendous help in groups that are not specifically about depression, such as AA, Al-Anon, sexual abuse victims, or gender issues groups.

The fact that there is no organized self-help movement for depression is really quite remarkable in these days when you can find self-help groups for everyone from victims of Satanic ritual abuse to the death of a pet.  The fact that more and more people are only getting minimal psychotherapy, or medication prescribed by their general practitioner, certainly makes it seem as if the need is there.  Perhaps the nature of the illness makes it difficult to believe that much help can come from other sufferers.  For several years I used the principles described in this book in a group in my clinic in which I was both a member and the convenor.  I took responsibility for presenting some helpful material in every meeting but it’s not group therapy.  The same responsibility could be shared by other group members.  The same type of group could be run in other settings, without professional help, or with only a professional advisor for backup.

We’ve found that the experience of dealing with depression in a self-help context is very positive.  We’ve also found that the model and structure of AA is very useful for depression.  Depression is a disease like alcoholism is a disease–recovery comes only from a change in behavior.  But alcoholics know that mere abstinence is not the cure; the cure comes from “living the program”–applying the principles of the AA philosophy consciously and deliberately.  Alcoholics know that drinking–and the habits of denial, rationalization, and manipulation that accompany drinking–changes their personality.  But they also know that they can change themselves again by living the program.

Depression also changes us.  The skills that we develop with depression in a vain effort to save ourselves pain–skills like emotional control, isolation, putting others first, being overresponsible–prevent our recovery.  Our group meetings start with sharing; each of us having been depressed, we know the power of words to heal and to hurt, and we practice acceptance and support.  At the same time, we know that we have to integrate the principles of recovery from depression; so we encourage each other to experience feelings, to practice assertive behavior, to pursue self-expression and creativity, and to challenge depressogenic assumptions.

A dry drunk is someone who has stopped drinking but still thinks and acts like an alcoholic.  They live in constant fear because their sobriety is shaky and they’re just going through the motions of life.  There are a lot of people with depression who have been helped a little bit by medication or psychotherapy, but they still think, act, and feel like a depressive.  They too are always in danger of relapse and always anxious because they know they don’t know how to live.  This book doesn’t teach people how to live any more than AA does, but it presents a program that will help them discover it for themselves.

Starting a self-help group for depression is really not as intimidating as it sounds.  Churches will donate space, mental health centers will help spread the word.  All you really have to do is distribute some flyers and make up the agenda for the first meeting.  After the first meeting, group members should come up with their own agenda, which might include some time for sharing problems and experiences, educational programs on topics of interest, sharing of activities, and advocacy.  Basic rules should include respect for members’ confidentiality, a prohibition against criticism, an encouragement but not a requirement to share.  The group should encourage members to exercise, treat themselves well, and practice mindfulness meditation.  Other useful resources are The Depression Workbook, by Mary Ellen Copeland, and The Feeling Good Handbook, by David Burns.  Both have many exercises helpful in recovery which can easily be adapted to serve as exercises for a group.