Tami Simon: You're listening to Insights at the Edge. Today, my guest is Dr. Jim Gordon. Jim is the founder and director of The Center for Mind Body Medicine and a clinical professor at the Georgetown University School of Medicine. He has authored several books, including the most recent, Unstuck: Your Guide to the Seven-Stage Journey Out of Depression. He's a leading authority on stress management and mind-body medicine, and has trained thousands of professionals and patients on how to incorporate stress management and other self-care techniques into their lives. With Sounds True, Jim has created a six-session audio program called Freedom from Depression: A Practical Guide for the Journey, in which he offers practical tools, meditations, guided exercises, and an entire map for how to restore joy and balance to your life when you find yourself in a state of depression.

In this episode of Insights at the Edge, Jim and I spoke about the actual research on antidepressants and their effectiveness. We also spoke about the most important mind-body approaches that can help people with severe depression. We also talked about how to get started with a mind-body program when you feel too hopeless and helpless to begin anything. And finally, we talked about the importance of breaking the silence—the taboo—around talking about our suicidal thoughts and fantasies. Here's my very helpful and empowering conversation with Jim Gordon.

Jim, I think many people think of depression through a "disease model." You know, "I have this 'depression disease' that I've inherited from my family, or for whatever reason. And therefore, I have to approach curing it through some kind of medicinal approach, like it was a disease." But you don't seem to be very fond of the disease model. Tell me why.

James Gordon: [Laughs] Well, that's a nice way to say it. I think the disease model is just inappropriate. I don't mind the disease model; I just don't see it applying to depression. The analogy that's often used in the medical community and in popular literature is, if you had insulin-dependent diabetes, you would have to take insulin. And similarly, if you are depressed, you have to take antidepressant drugs.

But [that] analogy is a totally false one, because with insulin-dependent diabetes, there [are] clear anatomical, biological, and physiological changes that are quite consistent, and there's actually something that's a very good remedy for the condition, which is insulin. In depression—“major depression” is what psychiatrists call it when you've had a whole series of symptoms for several weeks or more—there is no consistent biological change. There's no consistent anatomical change. You know, when you autopsy people who have diabetes, at the end of their lives, you can see the changes, in the organs and the blood vessels. It's nothing like that for people who are depressed. There's no consistent physiological change. Sometimes people have higher levels of stress hormones, sometimes they have lower levels, sometimes their levels are normal.

So the analogy is inappropriate, and even more important, the remedy that is these prescription, the latest of which are the so-called SSRIs—Selective Serotonin Reuptake Inhibitors—which means they are drugs that stop the serotonin from being taken out of circulation and cause there to be more serotonin between the nerve cells. Those drugs just don't work very well. For a long time, pretty much everybody [thought]—and I have to confess, even though I didn't like the effects or the side effects of the drugs, I thought, "Well, at least they relieve symptoms of depression”—but that was based on literature that was completely skewed by the drug companies.

Essentially, the drug companies published all of the positive studies and very few of the negative studies. And over the last 10 or 12 years, many of us—and I am one of those earlier people, but other people have done it more thoroughly since then—have looked at all of the studies that had to be registered to the Food and Drug Administration but were never published. When you put them all together, what you find is that antidepressant drugs are little, if any, better than sugar pills for treating the symptoms of depression. Plus, they have lots of very, very nasty and sometimes quite debilitating side effects as well.

TS: That's a very strong statement, Jim, that they're no more effective than sugar pills. That's a very, very strong statement.

JG: That's right. It is a strong statement, but it's a statement that's been made not just by me but has been made in the New England Journal of Medicine and a review of these studies in the Journal of the American Medical Association, and a very important online journal called PLoS Medicine. Three different groups exhumed the studies that were sitting around the FDA, The Food and Drug Administration, from the Freedom of Information Act.

And they looked at those studies. One group says, “Well, for severe depression, it looks like they're a little bit better than sugar pills.” A little bit. But one of the other studies actually suggests they're worse than the sugar pills for severe depression. So what this means is not that people don't sometimes feel better when they take antidepressants, but that they should be very much a last resort and not the treatment of choice. It just doesn't make sense because the evidence is not there. The analogy's a false analogy, and the level of side effects—70 or 80 percent of the people who take antidepressants have one or another kind of at least unpleasant side effect. So why use them unless other, far less harmful [and] in fact beneficial treatments don't work?

TS: OK, a couple of questions here. I can think of several people, as you're speaking, who are friends of mine, who are on these "sugar pills," are on antidepressants, and report that it really helps them. What do you think they're experiencing if it might not be the benefit is actually coming from the antidepressant?

JG: Well, I wouldn't even say that. I'd say there may be people for whom that particular pill is useful. I don't deny that, and I don't say to people, "You have to get off them." What I say is, "Let's look and see if there are other ways." Now, what many people report is, "I don't feel so depressed, but I don't feel so much of anything anymore. It kind of evens me out. I don't have the lows, but I don't really have the kinds of highs that I used to have either."

So they seem to do that. They do act, for some people, as a kind of tranquilizer. They do raise the levels of serotonin, which may improve mood in some people, but you can also raise the levels of serotonin with physical exercise, you can raise it with meditation, you can raise it with yoga. It's not that I’m saying they may not help people, either directly through their action on biology, or perhaps through the placebo effect—which is enormously powerful. If you believe something is going to help you, it's likely going to help you.

So the issue is not, do they help some people or don't they help some people, but, is that what you should be doing preferentially? Is that what you should be doing first, the way most doctors advise their patients, or should you only do that if all these other approaches—that enhance our biology and enhance our psychology, and enhance our connection to ourselves and others—if they don't work? So it's really turning it upside down. It's not throwing out the antidepressants, but it's putting them in a very different perspective.

TS: Now, you mentioned that the general public may not be aware of some of the studies that show the negative effects of antidepressants, or certain antidepressants. Can you tell me what some of those negative studies are, as I probably am not aware of them?

JG: Well, anybody who's taking them is pretty much aware of them. But you're right, the rest of the public may not know because even though they’re mentioned, they're really not emphasized. So about 60 or 70 percent of people who are on this group of SSRIs, like Paxil, Prozac, Zoloft, and others, they have some kind of digestive disturbance. It may be small; it may be great. Sometimes people put on a lot of weight. That's one that a lot of people don't like. Sometimes there are headaches, sexual dysfunction. In one series of what they call a "meta-analysis,” where a researcher looks at a whole bunch of studies on side effects, it showed up that 70 percent of people who were on antidepressants had some alteration in sexual functioning—less libido, less desire, more difficulty being aroused, less interest in sex, generally.

So these are important side effects. Some people become more agitated when they take them. That's one of the reasons why there's a warning on antidepressants. Particularly [this happens with] young people in the first week or two of taking them. They're depressed to begin with, they begin taking the antidepressants, [and] a certain number of them become more depressed, more agitated, and much more suicidal. That's a very serious side effect.

Then there are a number of papers that have been published about people who take antidepressants for a long time and show major neurological changes—tremors and twitches and other significant neurological side effects that may or may not be reversible. They're called Selective Serotonin Reuptake Inhibitors, as if they only work on that one chemical in the brain—serotonin. But in fact, they change the whole balance of brain chemicals and neurotransmitters in such a way that it can produce many side effects, some of which are these neurological side effects.

The literature is there. We've known about this for 20 years. But I think that doctors in general feel, "Well, yes, there are side effects, but the benefits outweigh the side effects." But what I would suggest to people who are interested is that they check it out for themselves. You know, they can listen to the audiotapes, and read my book, and look at the references, or look on Google at the references. And they'll see that there really has been a shift.

The problem is the doctors, unfortunately, don't always pay attention to the science. Unfortunately, like many of us, they continue what they've been doing because it looks to them like it works. So they say, "Well, yes, the papers show that, but..." And, unfortunately, a lot of people suffer from being on these drugs and don't get the kind of benefit they're looking for. And more and more people are on these drugs. There are 30 million Americans who are on antidepressants, which is a huge number.

TS: OK. So if the disease model is not an appropriate model for depression, what is, in your view?

JG: You know, the way I look at it, the depression certainly signals an imbalance. So on the one hand, it's a wake up call. If you're depressed—or for that matter, if you're anxious—[your body is] letting you know that there's something going on that's not right. Something [is] going on in your body, in your mind, in your life, the way you're relating to other people, that's out of balance. When we're depressed, it lets us know, we've got to pay attention.

So, hopefully, what that realization does is it prompts us to take a look at the different aspects of our lives. For example, it's been known for several thousand years that loss is the major cause of depression. I mean, the Greeks knew that. In The Anatomy of Melancholy, Robert Burton wrote about loss as the major factor, and modern psychiatry knows that. So something simple to look at is, what have I lost? What am I having difficulty letting go of? What am I mourning right now? Is it the loss of a relationship? Is it the loss of love? Is it the loss of position? Is it the loss of my sense of myself? And then, beyond that, what else in my life might not be working?

So rather than look to medicate the symptom, look for the cause. And the cause may be an imbalance in our psychological life—which is what I've been describing—the loss of another, for example. The imbalance may be there in our bodies. There are deficiencies of certain nutrients, for example, chromium, being one, vitamin B12, vitamin B6, vitamin C in some people, selenium (which is a mineral), in others. Vitamin D. All of those may contribute to or cause depression. It may be that we're physically inactive. Our genetic programming comes from hundreds of thousands of years ago, or at least a hundred thousand years ago, and our genetic programming is designed for people who move around, pretty much all of the time. So if you're sitting at a desk all day long, you're going against your genetic programming.

Similarly, the food we eat: We're genetically programmed to eat a diet that is mostly plant-based diet, with really not much grain, and the meat that we're designed to eat is a very different kind of meat; it's wild game, very different from the meat we eat that's raised on factory farms. And so we're not getting the nutrients we need, and we're getting a whole lot of things that may be toxic to our system. A simple example is aspartame, which is a sweetener that's in a lot of diet food of various kinds. In some people—not in all people, but in some people—aspartame can cause depression. So you have to look at what are you eating.

And then [there’s] food sensitivities. We're eating all kinds of food that our bodies are simply not designed to easily accommodate. Some of us can deal with any kind of food, but others become sensitive to foods because our intestines have become permeable, become leaky, because maybe we've had infections in our intestines. Or maybe we've been on certain drugs that have caused the gut to be more permeable. So the molecules that are not supposed to enter the blood stream cross the intestinal barrier and enter the blood stream, causing allergic reactions, and sometimes those allergic reactions cause depression.

Another area which contributes significantly to depression is the way we live—or don't live—with others. Again, if you look at our history as a species, we tended to live in significant-sized groups with other people—to have lots of people around all of the time. And many of us don't have that kind of social support. You know, there's always going to be somebody around. I think that's why in many indigenous societies that I've visited, it's not that depression is unknown, but you don't have the same numbers of people who become depressed, even with very significant trauma or loss, because there are so many other people around to whom you can go for support, love, and caring—just people who will be there to hang out with. So that's another issue.

And then, finally, I think a lot of people become depressed because there's no longer—or perhaps there never was—a sense of meaning and purpose in their lives. A very common example would be parents whose kids leave home, "empty nest syndrome." Their purpose was, in their minds, to raise the children, now they don't have a purpose. So why take a pill? Why not find something meaningful in your life that will give you that sense of purpose, that will give you a reason to be alive?

TS: Now, Jim, I know you've worked with hundreds of people who have come to you with depression, and you've worked with them as their mind-body physician. What do you do when somebody comes to you and they say, "Look, these are great recommendations. I know I need to exercise. I know I need to change my diet, but I'm depressed. I'm lethargic. I'm stuck. I don't have the energy for all of this change. That's the problem"?

JG: That's right. You're giving a very good example of what it's like when you're depressed. And I have been depressed, so I know it from the inside as well as the outside. You help people begin where they can. So I can't go to the gym five times a week, but maybe you can walk around the block and begin that way. "I can't do all of the assignments because I am so down. I'm so depressed, I can't do anything." Well, can you clean off your desk? Can you clean up the dishes in the sink? Can you do something?

So part of it is helping people to make small changes. And that becomes the basis for making larger changes. It also gives us—if we make a small change, the message is very clearly, "I can do something. And maybe if I can do this, I can do something else." I begin with people often by teaching them (which I do on the audiotapes) a slow deep breathing technique, which just about anybody can do. And people feel a little relaxed. I'm breathing in through my nose, out through my mouth. My belly is soft. I do that with somebody in my office, or on the tape for five minutes or so. And about 80 or 90 percent—and I'm talking depressed people and very seriously traumatized people, as well as the professionals I train—feel the difference.

And feeling that difference, you not only see that you can do something to help yourself, the idea comes in, "Well, maybe it can all change." Because the hallmarks of depression are helplessness and hopelessness. You described them very well. So if you can give people some things they can do to help themselves, they already have an antidote to the helplessness, and it gives them some hope that something else is possible. Now, not everyone. There may be some people [who it won’t work for], but there are very few who won't see some kind of change. And as a clinician, or as a writer, or somebody talking with people, I'm looking for, "Where's that possibility of change? What can I work with?"

The other thing that it's important for people to start looking at is, "What are you depressed about?" "Oh, I'm just depressed." I work with medical students quite a bit. "I'm a medical student! Why shouldn't I be depressed? Why shouldn't I be stressed out?" And I said, “No, no, no, no. Why are you depressed and stressed out?” And each one has a different reason. "My roommate's smarter than I am.” “My boyfriend is 100 miles away.” “I'm worried about my mother's health." So it's helping people to get out of that kind of reflex state in which, "I'm depressed, I need a pill." Now, slow down a little bit. Let's see what we can do.

TS: Now, you offered this description of a five-minute breathing practice. Sounds very simple. Sounds like anybody could do it. I'm curious, do you ever, in your practice, meet somebody who has so much resistance, or, you could say, self-hatred, that they won't even do that?

JG: I don't. If they are really not interested—

TS: That's a very good answer! [Laughs]

JG: There's a mistake in medicine in which we insist everybody's got to do what we think they should do, regardless of whether it's a pill or deep breathing. So I say, "Look, if you're not interested, that's OK. If you want to take a pill, I'll refer you to somebody who will do that with you. If at any point you get interested in what I have to offer, please come back." And what I've found is that, interestingly, some of those people do. Not everyone. Because sometimes, you know, we've all had this experience—we know what we want. We know what's right for us, and we have to do it. We have to go far.

In Alcoholics Anonymous they talk about "hitting bottom." It's not just about hitting bottom, it's if you feel you need to do something, you should do it. The poet, William Blake, has this wonderful line, which is, "If the fool would persist in his folly, he would become wise." And it took me a long while to understand exactly what he meant. But I think that's what he means, that if you're caught up in an idea in your head about what you should do, you've got to do it. And only if it works great. If it doesn't work, then maybe some other idea, some other possibility will come, and you'll be open to it. But you can't be forced to do it.

TS: Now, you compare the journey through depression to a hero's journey, to Joseph Campbell's work in mapping the hero's journey. Do you think it's like that? Do you think it's heroic to move through depression?

JG: It sure was for me when I was depressed. [Laughs] It felt heroic. The people I work with, it feels—first of all, it's a dignified way to look at what we're doing. And I look at human life that way. When they're talking about heroes, they're not just talking about Odysseus or Hercules, or somebody like that. We're all heroes or heroines. We're all people who are, as Dante wrote, on our life's journey.

When Dante wrote, he was writing about every human being. You come to a certain point in your life, and you've got to figure out, where am I going? What's it about? And it is a heroic journey. It's a journey of self-discovery. It's a journey of taking certain kinds of chances to realize things that you had either been ignorant of or had not wanted to see before. It’s a matter of going into new territory. Whether the new territory is a new territory of exercise, or diet, or reaching out to other human beings, or meditation, or self-reflection, it's very much a hero's journey, and there are certain stages that most of us have on that journey. And if we look at those stages, we can understand where we are on the journey, and we can be prepared, and we can use each part of the journey as a step toward becoming whole, and healthy, and having more fulfilled lives.

So really, I see it that way. I encourage my patients, I encourage The Center for Mind-Body Medicine—we train clinicians in this model, we train educators in this model. And people get it. Once you open yourself to this possibility, the metaphor of the hero's journey becomes a reality—for most people, not for everyone.

TS: Why do you think some people seem to be more prone to depression, and other people don't? You know how some people are like, "You know, I just never get depressed. That's just to my thing. It doesn't happen to me.”

JG: That's a really good question. We all come into the world with different qualities, different attributes, different kinds of personalities. It's funny, when I was originally in psychiatric training early on, I focused almost exclusively on the effect of parents and the effect of the environment. As I began to know infants, patients, my own children, I began to see [laughs] there are certain things you come into the world with. And certain people are more—I don't know if they're more likely to be depressed, [but] they're certainly more sensitive to stress, they're more sensitive to loss, they're more sensitive to certain kinds of challenges than others. And some people are more optimistic. There are certain people who just bounce through life.

Now some of those people, when something really disrupts them, they can get very, very depressed as well, but you look at a group of kids and you can see that some kids are happier than others, much more resilient than others. So some of it is in our biology. I think that that's important, but it's not the major factor. I think that we can work with that biology. So everybody has their own—just like some people are more artistically talented, some people are more inclined perhaps toward spiritual experience, they're more touched with that realm from an early age. So there may be some people who are more vulnerable, and the challenge is to help them deal with that vulnerability. Not to have them see that they're victims of a disease, but to look at what's going on, to look at the strengths.

One of the things that I like to emphasize is that we all have certain strengths. And we should both admit and accept our vulnerability, which is really important. One of the reasons people get in trouble including becoming depressed is because they think they always have to have it together. So admit your vulnerability, but then also use your strengths. For example, if you like to write and get some pleasure out of that, then when you're depressed, write down what's going on. It could make a big difference. If you like to be with other people, then use that; reach out to other people. Use whatever is an actual or potential strength to help you heal what the weaknesses are. And don't be afraid of the weaknesses. Accept them.

TS: Now, you don't seem to give that much credence to biologically inherited depression. I hear people say, "Depression runs in my family. My grandmother was depressed, blah, blah, blah.” But you don't seem to think that that's that major a factor.

JG: Well, the research doesn't show it's a major factor. It's a factor, but it's not a major factor in depression. In other conditions, sure. For example, in bipolar disorder, it is much more of a factor. It's a much stronger factor. But in either case, it's just a predisposing factor. It's not your destiny. You may be more vulnerable to it, biologically. You also may be more vulnerable to it psychologically because, you know, you look just like Aunt Sadie, and she was always depressed, so you're getting that message from early on.

But you can change biology. You can change biology without drugs. The approaches that I use with people that we're talking about change biology. They change biology in a generally predictable and healthy way without the negative side effects of drugs. And you can see this on brain scans of meditators, for example. You shift the functioning in the brain, the high levels of functioning from areas that are associated with pessimism to areas that are associated with optimism and well-being.

With physical exercise, you can actually create new brain cells. There's an area of the brain called the hippocampus, which is in the emotional part of the brain, which is called the limbic system. In the hippocampus, in people who have been depressed for a long time, or people who have been seriously traumatized by war, or by beating, or by abuse—especially when they're young—they lose cells in the hippocampus. Physical exercise cannot only create new connections among existing cells, it can create the growth of new brain cells in the hippocampus and also in the part of the brain called the frontal cortex.

So we can change biology. It's not immutable. It's not fixed.

TS: I'm curious, Jim, you briefly mentioned that in your own life, you went through a period of depression, and I am curious why do you think, you, as a professional, have chosen for this to be one of your areas of expertise, working with depressed people and helping them on this journey?

JG: Well, I’m sure some of it had to do with my own experience. I think one of the ways that we become interested in whatever we're interested in is through, hopefully, our own experience. So finding my own way, with help, out of depression, was a very important event in my life, and certainly made me feel more compassionate toward other people who were depressed. So that's one piece of it.

The other is that depression is perhaps the disorder of our time. Eighteen million people a year are diagnosed with major depressive disorder in the United States, or would be diagnosed according to the epidemiological studies. That's a huge number of people. We spend about 12 billion dollars a year on antidepressant drugs. And as I said, 30 billion people are on antidepressant drugs. A bunch of them don't have the diagnoses of major depression, but they're [still] on the drugs because they don't feel well or because they have premenstrual syndrome, or they have some pain syndrome. So depression is a major issue. Depression is a major contributor to heart disease, to pain syndrome, to diabetes, and perhaps contributes—perhaps, we don't know for sure—to cancer as well. It certainly lowers immune functioning. So it's not good for your health.

And I'm a psychiatrist, so I'm going to want to work with a condition that is so widespread. If I can help people find a better way, then that's my job. [Laughs] The reason I began to focus some on depression, whether it's through the book or through the audiotapes, is because so many people have said to me, "I'm depressed. I don't have any money. I can't see a therapist.” Or, “There's no therapist who thinks the way you do,” because they'd read something I'd written. “What do I do? My doctor just wants to give me pills."

So I want to respond to those people. Those are the people who tend to write me. And those are the people who come and see me. I feel a sense of fellow feeling, of compassion, with them. I want to provide them the tools that they need to help themselves. And I also know that if they help themselves with depression—depression is the major cause of disability in the world. You’d think maybe it's AIDS or maybe it's cancer or heart disease. No, depression sidelines people, gets their lives messed up makes them nonfunctional, far more than any other condition. It's kind of amazing. I'm interested in helping lots of people. To say it fancy, I'm interested in public health. But I'm [also] interested in helping people on a large scale to help themselves.

TS: You know, what's interesting in talking to you is you make depression sound so workable. Often when I talk to people that I love who are depressed, it feels so unworkable. But in talking to you, it's exercise, meditation, deep breathing, an antidepressive diet. I mean, it just seems like, "Yes. OK." It seems very workable.

JG: Yes, it is. But the nature of depression is to believe it's not workable. So that's where you start off. So it's very important that there are people who have had the experience themselves, like me—the experience of using an approach that works. So I bring that sense of possibility—of hard-earned, I would add, sense of possibility—and of hope to people. I'm not saying it's easy. Not easy when you're really feeling down, you're feeling worthless, "My life doesn't mean anything." It's not easy. It's perhaps the hardest thing of all. People who have been depressed that have [also had] cancer say, “Depression is much worse than cancer, for me.”

So I appreciate how painful and how difficult it is to see the possibility. But I know, at least for me and for many of the people with whom I've worked, it is possible to come through it, to learn from this challenging time of psychological, physical, social, and spiritual imbalance, and to come to a place of feeling greater wholeness. So that's what I bring. I bring that earned experience to people and share it with them. I never trivialize depression. Depression is very serious, very painful, very difficult. But it's workable. For almost everybody, I would say.

TS: One of the interesting parts of your work that I want to highlight and that I'd like to hear you talk about is, in this journey, which you describe as a seven-stage journey, one of the stages—the fourth stage—you describe is, "dealing with demons." And you talk about demons as being things like procrastination or self-aggression, that kind of thing. I wonder if you can talk about that. Specifically, you say that underneath the demon is what you call a “daimon.”

JG: Sure. Well, the word "demon" comes from that Greek word "daemon" or "daimon." Some of you may remember that Socrates used to consult, when he was in trouble, his daimon. He would consult this inner voice, the voice of his own intuition, his own unconscious, his own deep psycho-spiritual authority, and he would look for answers there. Now, what's happened in the two-and-a-half-thousand years since then is, over a period of time, that sense of the power of that inner voice, that sort of mysterious inner voice, has metamorphosed and really has been shrunken to the word "demon." So in Judeo-Christian theology, you see these demons—these things that are terrible and threatening. And we've lost sight of the daimon. We've lost sight of that internal power, and all we see is what's threatening. And what I'm saying is that if we look at our demons and we try to understand why they're there, that they become our greatest teachers.

Resentment in one of the most terrible, I find, of all the demons we have, because it just festers and sticks around and just keeps us miserable. Not only are we feeling miserable about a particular person, or a particular situation, but then our whole life becomes miserable. So we have to look at, what is this resentment about? Why are we stuck—to use a word that I like to use so much—in this feeling? How is it serving us, and more particularly, how is it getting in our way? And as we look at it, and perhaps we attempt to either get angry—resentment is a kind of festering, mean-spiritedness—if we can bring that up into anger, then it may go after a bit. Anger can come out, it can be expressed, it can go.

Or we may want to look at the possibility that the resentment has colored our whole life. And we may need to bring in a process of forgiveness—I teach many forgiveness meditations—to help us explore, perhaps little by little. We may not in the beginning be able to feel forgiveness for the person we resent the most, but perhaps we can feel forgiveness for somebody else who we just feel angry at, or slightly resentful.

So we start looking at the demon. And as we learn to deal with the demon, then perhaps forgiveness can emerge. Perhaps that's the daimon under the resentment. Or, perhaps the daimon is a capacity to a freedom of expressing emotions, willingness to express emotions, where the resentment just keeps festering rather than expressing and finishing with the emotions. Resentment is a kind of obsessiveness. And maybe it's relaxation that we need. So these are all the potential daimons that we may discover as we work with the demon “resentment.” And we can work with it with dialogues, we can work with it with meditation, we can work with drawings, all of the different techniques that I teach.

TS: Now, let's take one other example you mentioned, procrastination. Because I could imagine someone listening who says, "Yes. Of course, I know that exercise would help me feel a lot better. I'll do that—not tomorrow, well, the day after tomorrow," you know? That kind of thing. How do you help people work with procrastination?

JG: That’s a good one. That's a hard one, especially for somebody who's a writer. [Laughs] Writers know about that one very well. I think what I suggest is something very simple, like, do something that resembles the thing you can't do as a start. So if I'm a writer, I procrastinate sometimes. I'm writing a book or I'm writing an article; what I do is I write an email. So I'm doing a task that's similar—not the one I'm procrastinating. And then, maybe I write another email or I write in my journal. And it begins to loosen up the function that is so shut down and so stuck.

At a certain point, effort is required. Or, let's say, procrastinate a little more. Go out and do something, go out for a walk, go out and buy something, go do something. Instead of sitting around and staring at your computer, go out and do something else. And often, the overwhelming spell of procrastination will be broken by going to the grocery store, or getting a pair of shoes, or going for a walk, or playing with your dog, or whatever it might be. Sometimes, that frees you up from that kind of stalled confrontation with the task.

TS: Now, Jim, before we end our conversation, I want to bring up what I think is a delicate topic. And it's something that you address in your work with getting unstuck from depression, which is how we can, first of all, admit, and then work successfully with suicidal thoughts. And what I mean by "successfully with suicidal thoughts," is try to understand the message that they contain versus, obviously, killing ourselves.

I know this is a very sensitive topic to bring up, and I want to take the risk to talk about it because I think often, [even] when you just say something like, "I've been having suicidal fantasies"—you know, not even to the point of suicidal thoughts, or planning a suicide—it completely freaks everybody out. You know, you can't talk about that kind of thing. It's completely not allowed to be spoken. And yet, it seems to me that it's probably very common, and maybe even just part of the human journey to consider such a thing.

JG: You said it. I agree with you completely. Those thought come up—not in everyone, but in a majority of people at one point or another—the suicidal thoughts, "Why am I here? It doesn't make any sense. I can't stand it, and maybe I should die." And your bringing it up is exactly what needs to happen. We need to be able to talk about these thoughts. And there is such a taboo against talking about them. Physicians often will turn away.

I've heard again and again, "As soon as I talked to my doctor about this, he said, ‘Here are some pills,’ or, ‘I want you to see a psychiatrist.’” That's exactly the opposite of the appropriate response. The appropriate response is, "What's going on? Tell me about it." Because one has elected to tell those thoughts to somebody for a reason. So the crucial thing for people who are suicidal is to have somebody who is there with them and for them, who they can trust, who will take what they're saying very seriously, but will not freak out or rush to do something inappropriate. And that requires a certain steadiness of character and a certain understanding. But that's really, really important.

I would say that if people are feeling suicidal and despairing, that it is something that may be a perfectly understandable part of the psychological journey that they're on. And it is very important to have somebody there with you. If you don't have a therapist, or somebody you trust to be there with you, you may want to call a suicide hotline. I used to work with a hotline that did wonderful, wonderful work with suicidal people. And there is a national suicide hotline with laypeople—who are supervised by professionals—who are there for you.

So at the beginning, it is exactly what you're saying. You say, "OK, I am feeling this." If it's a thought that just comes every once in a blue moon, just watch it come and watch it go. But if it's something that's there, and you're thinking about it, you really do need to talk to someone. You need to find somebody whom you trust, ideally somebody you can talk with in person. If that's not possible, at least in the beginning, then find somebody on a hotline that you can talk to. And then, once you have made that contact, it's easier to explore what's going on in [your] life. Because you're really—forgive the pun—you're kind of at a dead end. “I don't know what to do. I don't think I can do it myself. I don't think I can make a difference. What's the point?”

So what does that mean? What brought you there? What are you missing? And that's the beginning of the exploration that might help you to find something that's crucial, not only to staying alive, but to really finding your path in this life. Many people come to a fuller understanding of who they are and why they're here on this planet, and what they're meant to do, and who they're meant to love and care for and be with, only after they've been through this kind of crisis. So we have to honor it as something that potentially has healing in it, at the same time [make sure] that we're extremely careful and that we take care of people who are going through it.

TS: You know, I think that one of the challenges, of course, in anybody sharing that they've had suicidal fantasies or thoughts is that, "Oh my God, you're going to lock me up or you're going to call the police, or you're going to take this radical action, and that's not what I need. I just need to talk. But who can I talk to who understands that?”

JG: That's right. Occasionally, there are really people who are saying, "Lock me up, I need it." That happens. But you're right. For most people, it's really saying, "I need somebody to talk with." And we need to become educated as a society. We need our professionals need to be educated to not be so terrified. I work in a lot of crisis places around the world where there are wars and natural disasters. And I work back here at home with US military, many of whom are going through that. That's very hard for them to talk about, [but] it's absolutely essential. It's the beginning of them being able to heal themselves and not act on those thoughts, not act on those feelings, but really find another way.

So yes, you're right. We need to understand that. We're a society that’s scared of depression! You know, the average time it takes for a primary care doctor to write a prescription, from the time that he or she hears anything that sounds or looks like depression, is between two and three minutes. And the message—whatever we've talked about, that antidepressants generally don't so that much good, if any good—that's not even the most serious thing. The most serious problem is that the doctor is essentially saying, "I don't want to talk to you. I'm just going to write a prescription for you." And it's because they're scared. They don't want to deal with depression. They don't know how to deal with it. It gets them uneasy, perhaps touches on their own fears—their own tendency towards depression. And suicide is much, much more so. There's so much fear of talking about it, of dealing with it, of helping people to understand what's going on. But we have to change that.

TS: Now, Jim, just as a final question, you mentioned that earlier in your life you went through a depressive period, and that your work in this field is hard-earned. I'm curious: if you found yourself in a depression again, do you have a sense of what approach you would take, knowing everything you know now?

JG: Well, like many human beings, I've gone through difficult crises in my life: loses, pain, confusion. And I have used all of the approaches I've described. I've worked with meditation, with physical exercise, I do drawings, I shake my body and dance, I cry, I yell, I work with my demons, I reach out to other people, I look for what's out of balance, and where I should be headed. I do all of these things, and therefore, I don't think I could be diagnosed with clinical depression. It's not that I wasn't miserable. It's that I move through it in a different way now.

So yes, I have bad times—maybe difficulty sleeping, when something has come up—and I am unhappy. But I am able, it seems, to learn from it and move through it, and to sometimes, with the help others—often with the help of others, could be professional help, or could be friends, colleagues—I'm able to move through those times and learn from them. So each of these episodes that comes up has been one that's part of my life. It's not something separate and apart. It's something that—they're really intense, often painful periods of learning. It's not like I want to keep on having them, but if they come, I better look at what's going on, because if I look at what's going on, look at what's out of balance, begin to use all of these approaches that I'm teaching others, use those approaches, then I can come through them.

TS: Wonderful. I've been speaking with Dr. James Gordon. He's created a new six-session audio learning series from Sounds True called, Freedom from Depression: A Practical Guide for the Journey. It includes meditation, guided exercises, practices, advice, and a complete description of the seven-stage journey through depression that he teaches in his work.

Jim, thank you so much. Thanks for being really brilliant, helpful, and so clear and empowering. It's really wonderful. Thank you so much.

JG: Well, thank you. It's a pleasure.

TS: Sounds True.com. Many voices, one journey. Thanks for listening.