On Executive Function
I have a longtime friend, whom I will not name, who suffers from depression, sometimes severe depression. In times past, he has been hospitalized to prevent suicide. We talk often. In times of crisis, he sometimes calls me three or four times a day. In the months since his release from hospital he calls at least two or three times a week—usually more. I think our friendship has played a significant role in his survival and progress against depression.
Let me be clear. I’m his friend, not his psychiatrist. I don’t do therapy; I supply friendship. As a friend, I have consistently urged him to trust and work with his psychiatrist. When he called from the hospital, I urged him to trust nurses and other staff; I opposed his often-stated beliefs that staff persons didn’t care about him.
I am not the doctor, not the professional, not the paid helper—and therefore I can be pretty directive. Many times I have baldly contradicted things my friend said. “That’s not true,” I have said. “You need to base your thinking on truth.” Depression and other mental disorders cloud our minds.
“I’m never going to get better,” my friend said. “I’ll never get out of here (the hospital). If I do get out, I’ll die homeless on the streets.”
Over and over, I said “That’s not true. You will get better. You are not going to become homeless. In fact, given the resources you have, you will be a small-scale philanthropist for the rest of your life. Part of your task in life is to manage your inheritance and give away significant amounts of money.”
My friend has made progress in the last few months. He takes the medications prescribed by his psychiatrist, and I’m sure that helps. He’s back in his apartment, back at work, and he has begun attending worship services at a church. All these things help.
But getting better is hard work. Very often my friend does not want to do the things that will lead to improvement. Depression saps its victims of energy and the will to fight. Depression creates a self-reinforcing cycle: negative beliefs (I’ll never succeed) produce self-defeating behaviors (Skip therapy), which magnify depressed feelings (I hate myself), which lead to more negative beliefs (No one cares).
No wonder that people say: Depression hurts. Many times I have acknowledged the reality of my friend’s feelings. “I know it feels that way, and your feelings are real. But your feelings are not based on truth. You will not be homeless. You do useful work in your job. Other people (such as I, your friend, and so-and-so, your supervisor at work) recognize and appreciate your abilities. And beyond all these things, God loves you.”
Very often, my friend says, of some suggestion: “That’s hard.” I have nagged him to make a list of possible activities that might enrich his life after retirement. “That’s hard.” I urged him to call his accountant to make sure certain tax forms are filed. “That’s hard.” When he was in hospital, I told him to go to group therapy. “That’s hard.” There are many other examples.
My friend is telling the truth. Doing these things is hard, and much harder when one is depressed. And yet, bit by bit, my friend has done hard things. He has chosen to act in ways that will probably help him feel better. I never promise him that doing something will certainly help him feel better. Every move must be truth based.
Choosing to act on the basis of truth is an executive function. It’s hard for me, and it’s especially hard for someone who is depressed. Loving relationships—in families, in friendship, with therapists—help move us, but in the end the person must exhibit agency. It is hard, extremely hard, for my friend to take charge of his life. Depression would wrap its tentacles around his emotions, beliefs and will. By the grace of God and the intervention of a good doctor, my friend decides, bit by bit, to do the hard things. As a friend, I encourage and nag.
