My seven ways to respond to depression
My previous post about my impending depression, and a possible spiral (Sometimes the universe shouts, I just don’t know what it’s saying), garnered a lot of positive supportive messages,and I’m grateful for them. Lots of people asked if there was anything they could do to help, and mostly the answer is “no” beyond the offers themselves. It’s an internal problem for me, not an external one, and I’ve been here before, so I already know most of my options.
The post itself probably identifies the strength of the depression, at least as it was that day. Feeling lost or hopeless against the universe’s fortunes. I have been losing interest in certain hobbies, although the astronomy one was not so much losing interest as losing hope I would overcome the setbacks. My sleeping is screwed up, and both before and afterwards, feeling exhausted. Restlessness. Difficulty making decisions. Even some physical manifestations. Check, check, double check, check check check. Lots of symptoms in there.
I also know that my focus on weightloss is making me especially susceptible to mood swings and depression since my energy levels have been depleted while I’ve been focusing on that, without much success at the moment. I also know that HOW I respond will determine a lot of HOW MUCH I am affected, a key tenet of trauma therapy (and heavily noted in Jeffrey Kottler’s book “Change” (Change: What Really Leads to Lasting Personal Transformation by Jeffrey A. Kottler (BR00118)).
The illusion and reality of choice
There’s a bit of a dangerous nuance in the idea that depression is a choice. Most of the time, it isn’t. The chemical effects of the brain, a limited set of economic and social situations, the lack of a suitable support network can all limit not only the likelihood of a healthy response but also drive the initial condition in the first place. I know that most people don’t “choose” to be depressed, although sometimes people need to or want to embrace it as a response. And it is one of the choices available to me now that I’ve entered the realm. But, fortunately, my thinking is still clear enough to know that I have other choices. A total of 7, in fact, that I’ve used and experienced before.
1. Embracing the depression
That sounds ridiculous, I know. But sometimes it feels like a great way to move through it faster. Almost like, “Okay, world, kick my ass, give me an excuse for a month, and then I’ll be all good.” A often-false belief in it being a simple on/off switch that allows you to wallow for a set duration of time. To me, grief is a good example of that, and the most common delusion. The idea that if you try to force yourself through the stages of grief, you can somehow manage your grief “better” or “faster”. It doesn’t work that way, but the illusion of control is appealing — that depression isn’t happening TO you, but rather something you control. Not an option.
2. Setting goals
This has been my most heavily-used technique over the years. It gives me momentum, and some illusion of control over my life. Not necessarily over depression itself, but rather preventing some of the triggers of possible depression. The idea that a well-planned life that is constantly moving forward on one front or several fronts will keep depression at bay.
And it works, most of the time anyway. The feeling of accomplishment is more a reality check against feeling that things are out of control, to maintain perspective. The feeling that “Okay, THAT area of my life is sucking right now” but not letting it define you or trick you into thinking all of your life is going that way. In a way, it’s not about the goals themselves so much as just conscious comprehensive mindfulness of all the different aspects of your life.
It’s also a seductive mistress of deception. “Oh, look, my life doesn’t suck because I am doing really well in area X”. Except you never stop to ask yourself about weighting of areas…If “X” is organizing your sock drawer, that may not matter much if your relationship with your parents sucks the big one.
And, as someone asked in response to my last post, does having multiple goals make me happy? The short answer is no, but it isn’t really meant to. That’s a bit hard to nuance, though I’ll try. I guess the simplest explanation is that overall, I feel like developing multiple areas of life gives me a better chance at a well-rounded life, that I’m not “missing” something I’ll regret later. I hate the term work/life balance, but it is a good example of people who have focused all their energies on work and later felt like they missed out on life. I responded, somewhat flippantly perhaps, that I’m not sure happy is in the cards for me, and that’s a pretty big #TruthBomb to drop that is reflective of my depression. The truth is that I feel more like my mental makeup takes me more towards “contentment” or “satisfaction” than towards saying “I’m happy”. There’s too much in my makeup of “what’s next” rather than taking victory laps or enjoying a moment. Yet, to the extent that I can say what makes me happy, I feel like there are moments in all of the areas where I am setting goals and moving ahead where I feel like I’m not just “content” or “satisfied” but have transcended that into a small feeling of euphoria. Maybe it’s what others simply call happiness, but for me it is more mindfulness — that in that moment, I am not thinking about anything else. I’m just “enjoying” what is in that moment.
About ten days ago, I had that experience with my astronomy. AstroLog 2019.002.1 Best. Viewing. Night. Ever. was my summary of that night, where for once, all of my challenges with astronomy virtually went away. And I was just “living” in the moment. Obviously, it’s not like the joy of holding a child or getting married, it’s more cerebral rather than pure emotion, but it’s still pretty powerful.
I feel it sometimes in writing too. The perfect phrase that sums up a feeling exactly as I am feeling it at that moment. Or trying to dance about architecture — you know the phrase? Talking about love is like dancing about architecture? Sometimes, I’m trying to use words to describe something I’ve seen or experienced and I know I’m going to fail. The moment in a show like Almost Famous where Kate Hudson turns to ask, “What kind of beer?” after hearing devastating news. Or a scene in a TV show like Republic of Doyle where he’s kissing his new love interest for the first time, her phone rings, and she says she should get it, it’s HER HUSBAND! A small twist, a small scene, but so beautifully done that it sparkles in my mind. A feeling like I’ve momentarily seen writing genius on display in the midst of otherwise ordinary fare. And yet describing it in words is like dancing about architecture.
In the end, setting goals is comforting to me. I feel like it keeps a wide array of activities open to me that I might otherwise ignore and risk missing out on such sparkles. Alternatively, I could say it is a way of ensuring that I have the broadest possible foundation upon which to find and build happiness, rather than the goals themselves or the process itself making me happy.
The approach resonates with me and helps me keep a broad perspective. As a tool to mitigate depression, it has worked pretty well for me over the years compared to earlier times when I didn’t do it.
3. Focusing on one single thing
By contrast, lots of people respond like they were watching City Slickers and have found their “one thing” that makes them happy (perhaps picture Jack Palance holding up his one finger to Billy Crystal and you might get the reference better).
I sort of did that when I dropped all my other goals to focus on weight loss, but that’s not really the same thing. The “one thing” approach is about finding your passion — writing, singing, playing music, painting, yoga, working out, cooking, whatever that “one thing” is that makes you happy.
Kind of an emotional Marie Kondo technique to eliminating everything else that doesn’t give you as much joy as that one true thing.
The short problem with that is you have to KNOW what that one thing is. Writing comes closest for me, but I’m not going to drop everything else in my life to do that 100% of the time. Part of that is financial, part of that is risk adversity, sure. But the main reason is that writing is NOT my one true thing. It is close. Maybe the closest. But photography, astronomy, web stuff, it all comes close too. As does reading, although most people don’t think of that as a viable option. Yet I could easily read for extended periods of days for weeks on end if given the chance. But that is more distraction from reality than reality to me.
Maybe I haven’t found my one true thing; maybe it doesn’t exist; maybe the concept is an illusion. But it’s not a viable solution for me. I think I just get bored too easily. For me, it is more about doing multiple things I enjoy, rather than one thing.
A friend posted an image on FB last week as a reminder for all of us of options for self-care. I found a copy of it over on http://www.blessingmanifesting.com and while I can’t speak to the aim or content of the site, the graphic is decent.
The benefit of the list is that many of the items are not only preventative, they can also be healing. Exercise, forgiveness, social supports, knowing yourself, organized space, money management, and work boundaries are frequently the ones that people turn to as almost cure-alls. Why? Because the reverse of them is often flagged as triggers — being unhealthy, self-criticisms, isolation, emotional dissonance, chaos, financial problems, or poor work/life balance. Treat the trigger, save the patient.
I’m not dismissing them, they are important techniques. But they are, to me at least, more preventative than cure-alls. They should be / need to be part of whatever treatment or coping plan you come up with, but there are two in there that are at a different level so I’m separating those out.
5. Time alone / social connection
While it is perhaps odd to put those together since they are polar opposites, I feel it is more the flip sides of the same coin. I also don’t have any empirical evidence to justify my conclusion towards them, but I feel intuitively that they are more suited to specific types of people — introverts and extroverts.
An introvert tends to be stressed and drained by social activities. A bit simplistic, or perhaps over-simplification, but time alone re-energizes them. It does me. And so taking time out to be by myself, to turn inward, to meditate, to journal, to think…it all helps me heal. And gives me the energy to carry on, even perhaps to pull myself out of the funk I’m in. Some of that is just stress reduction … the isolation removes demands on me, I’m not dealing with anxiety, or other people’s expectations, or reactions to what other people say or do. It’s a controlled environment. A way to hunker down, stick to the knitting, do what I need to do and nothing more, and just be me.
Often this also goes along with a focus on routine. Pundits and pop psych articles often describe routine as a coping mechanism to prevent slippage, the idea that if you make positive change part of your routine, it will make it part of your life. That’s true, but that isn’t the way routine works when dealing with depression. It isn’t to prevent slippage, it is to pre-decide certain decisions so your brain doesn’t have to think about them. If, for example, you have trouble making decisions when you first wake up, perhaps because you’re formally depressed or just because you’re exhausted all the time, ready-made breakfasts that you decide at the start of the week can take the planning and decision-making out of the equation. On Sunday night, for example, you decide what your breakfasts are for the week. You have everything organized, efficiently in one process, and it’s gone from your week. If you’ve never fully experienced depression, you don’t know how tiring it can be making decisions. Let alone group decision-making, if you have to do things with others. Routine and time alone simply takes the pressure off.
When I was at law school, and having a depression outbreak one summer, I was coming home late to a lonely apartment and I had zero interest in spending time deciding on or making dinner. So I would often stop at the same restaurant. Sit in the same section, preferably at the same table where there was low cross-traffic. Order the same dinner (chicken fingers and fries) that I knew they couldn’t screw up and was fuel more than flavour. And I would read. Occasionally I would chat with the waitresses, but even then, I gravitated towards sitting in the one waitress’ section who was the least interactive, the least burdensome to my experience. I didn’t have to do much other than say hello, tell her the usual order, eat my food, pay, and leave. Few social requirements, low stress, almost time alone, and predecision about all of it before I even got off the bus near the restaurant on the way home, one stop earlier than I would normally. Even now, if I’ve had a long day, don’t feel like dealing with anyone, I can stop at some place like Swiss Chalet, I don’t need a menu, I know what I’m ordering before I even walk in the door. Fuel, time alone. Not to the extent of becoming a hermit, you still need a social connection somewhere, of course.
An extrovert that I know is the complete opposite. For her, spending time with others pulls her out of herself and stops the potential for wallowing. It’s a distraction, of sorts, a break from her own thoughts, and the interactions literally act as battery surges to re-energize her. The comparative chaos of spontaneity and random decisions, new things to try give her a mental boost. Staying connected to friends, family, pets, helping others, all of them help immensely.
Both approaches can take you to your comfort zone, whichever that comfort zone is, and allow you to be you.
6. Cognitive behavioural therapy
I confess that I am going to diverge a bit from the classic CBT definitions, partly as I am not a psychologist and partly as I just think it is easier to understand them separately. For me, both are about finding ways to challenge negative thoughts or alter negative thinking that is causing your depression.
For the first part, i.e. the “cognitive”, generally most of the techniques fall into reframing the conversation. Some people describe it as having a more balanced perspective, giving it a reality check, blah blah blah. For me, it is more about simply changing the story you’re telling yourself. And for me, there are three ways to do that.
- Education — learning about the way your self-diagnosis and self-conversation works, and how the way you speak to yourself determines some of the outcomes you experience. Equally, it could involve talk therapy, or simply just reading a lot about emotional intelligence, getting to know yourself, etc.;
- Counting your blessings — sure, it’s a pedestrian phrase, but it ties in well with my goal-setting, by reinforcing that one area of your life might be sucking right now, but other areas are doing well. Some techniques involve keeping a gratitude journal, so that when you do have lows, you can read it and remember some of the highs too; or,
- Expressing yourself — for many, this is about journaling (or talking to a therapist or friends) to “get it out”, to talk through it, to give voice to your feelings rather than hiding it inside.
Some view it as just combating pessimism, but obviously it is way more than that. For example, the real target is the myriad of different negative ways of thinking that frame conversations often into “rock and a hard place” dichotomies that guarantee whichever way you go, you’ll fail, because you set up the parameters wrong. For example, here are some common unrealistic ways of thinking:
Black and white categories — most of the world’s problems are spectrums of gray in between the polar extremes, but depression’s triggers and depression’s behaviour often frames things as the all or nothing outcomes (total success or complete failure), just as people hold themselves to impossible standards like “shoulds” vs. “should nots”, and therefore categorizing yourself as terrible if you do something that wasn’t the “should” choice…I do this for personal standards. I believe very strongly in not only doing the right things but for the right reasons, and sometimes I will avoid doing anything, even what I think is right, if I think I’m doing it for the wrong reason. I’ve even passed on good opportunities for myself if I thought it was badly motivated on my part, or even if I just couldn’t be sure it was properly motivated. Similarly for labeling — if you label everything as “winner” or “loser”, and you didn’t “win”, there’s only one other category to choose.
Hyper focus — if you ignore positive outcomes, and only focus on the negative ones, or pick one event as endemic of your whole life’s experiences, not surprisingly, you’re going to see things in an unrealistic light…my previous post feels a lot like it could be in that category, and I admit there is some element of that. Mostly because I didn’t include the things where I am making progress. Which isn’t to say I don’t know them, or really think that the universe is conspiring against me, just that I’m struggling to maintain momentum right now as I see a number of areas where I am hitting walls, and finding it hard to find ways to stay motivated or dodge the walls.
Assuming the worst — often it feels “safe” and “protective” to just assume things won’t work out with something, partly as it excuses you from having to try and manages your expectations…why cling to hope, which takes energy, if you expect to fail…yep, it’s in there. My wife thinks it is pessimism; most pessimists view it as realism and that optimists are merely naive. I don’t feel I’m doing that, in part because I’ve seen it when my brother and mother used to do it. One thing wrong and assuming that someone is out to screw you. But, if you consistently have your hopes dashed, it is very hard to remain blindly optimistic. Hope hurts if it feels like it is never realized. For my big post, it may even read like I’m assuming the worst. That’s not entirely accurate. I would nuance it differently at least … that I’m not optimistic that my current approaches are going to work out for me. I need to do something different. And I’m not entirely optimistic that I know how to “fix” my approaches to get the outcomes I desire in the timelines I want. Yep, a lot of caveats in there. What it comes down to is a feeling that I am not invincible anymore, nor do I have infinite energy resources. I’m tired, which hurts the reasoning process.
Effect and cause reasoning — people often assume causes based on effects. For example, if you feel unworthy, you assume / reason that the reason you feel that way is because you ARE unworthy, simply because the logic works the other way i.e. if you were unworthy, you might feel unworthy. But if you assume the reverse, it’s the same faulty logical reasoning they teach you in practical philosophy…An apple is a fruit, but if you have a fruit, it doesn’t mean you can assume it’s an apple…there are lots of other types of fruit besides apples, just as there are lots of other reasons why you might feel unworthy (bad advice from dysfunctional or abusive people, faulty reasoning due to the depression, brain chemistry, etc.);
The second part, i.e. the “behavioural”, the goal is more around combating your current situation or inertia through some form of resolution or movement. In short, it’s the “let’s solve a problem” approach to fixing your depression. While it also includes talk therapy, some of it simply breaking down a problem into several component bits, and then developing a step-by-step process to resolve it.
If you are depressed because of your finances, what is a detailed step-by-step process to fix your finances?
If you are having trouble motivating yourself to do something, what sort of step-by-step process could you use, such as routines / goal monitoring / rewards, to help spur you to doing it in smaller chunks?
If you are having trouble with a relationship, including a past one or grieving a loss, what steps can you do or think about to help fix your triggers that are making you think the way you are? If, for example, you frequently get into fights with your family at Xmas with everyone in the same house for several days, can you stay at a hotel or only go for a short visit so that those triggers aren’t as likely to occur in shorter durations? If alcohol is involved, can you leave it out of that year’s equation or time your visit for the morning when they’re likely not to be drinking yet? If everyone fights at Xmas dinner, can you go for an afternoon visit and avoid the slugfest?
For me, this area isn’t that useful in a therapeutic sense. I don’t need help figuring out steps to reduce trigger occurence or even to find ways to solve problems. I can break large problems into small problems, small problems into action items, action items into activities, blah blah blah.
But I do have problems staying motivated on long lists of dominoes. If there are too many dominoes, it’s hard to overcome the first stage. Which is odd. Because the whole point of the behavioural is not really about the action plan or even the implementation, but simply to give you back an illusion of control. You often feel helpless to solve the problem, it’s too big, too out of your control, to solve. Yet, the behavioural part, helps you get there, feel like you are capable of some control, and thus reduce the symptoms.
Except the trick doesn’t work on me. I can’t “fake” belief in an action plan to give me control over a huge problem. It gives me a way to cope, it doesn’t give me a way to really solve it. Or rather, it doesn’t give me a NEW way, just ways I already knew. And when I see too many large dominoes, getting started on the first one seems like a waste of time if it isn’t related. Kind of like deciding that the problem is that you don’t have a house and living in an apt doesn’t work for you. So you decide you need to find a house. But first you need to have a better job to pay for a house. And fix your finances in other ways. And go to school to finish your degree. And stop wasting money on alcohol. Five GIANT things to do before you get to the house you want. Might not be the best domino example, but if you have a bunch like that, breaking all the big pieces into smaller chunks still feels overwhelming because the first four are really not about what you WANT to be fixing, and thus your true motivation is unrelated.
7. Aggressive medical intervention
Sure, I know that there are options out there like electro-convulsive therapy. Would I consider it? Well, let me see…hook some electrodes to my brain and see if lighting me up like a Xmas tree will help my mood. Hmm…that’s a tough one. I’m going to go with no. Maybe there is sound medical research on its efficacy for certain types of disorders. But it isn’t one I could ever see myself opting for. Pass.
Medications are often painted in extreme categories…extremely bad on one end leading to dependencies, psychotic breaks or feeling dead inside vs. extremely good on the other end to take you out of a haze, clear your thinking, stop the spirals before they get too bad, and keep you on an even keel.
Some meds help with extreme anxiety disorders for example. In pop culture, if anyone has watched The Big Bang Theory in the early days, you saw a relatively unhealthy version of this…Raj couldn’t talk to women, too nervous, unless he was drunk. So, he would have a drink before going on a date so he could talk to them. It was played for humour, of course, but it wasn’t that far off the mark from some therapeutic approaches. Usually they use prescription meds, but similar effect in some cases. There are even some therapists who experimented with alcohol, weed, and other relaxants.
Anyway, I’m digressing a bit. What I’m merely referencing is that all meds are neutral by themselves…the only real thing is how they work for you. A few years ago, a brother was on meds and it worked rather well for him. Normally a negative thinker, he was commenting on a situation and he said words that would seem common place for most people but unheard of for him…”…but there’s nothing I can really do about that right now, so I’m working on what I can control.” Wow. What a difference the meds made. Yet he had tried other meds and they just made him sleep all the time, dead inside. Finding the right dose and med was huge.
And I don’t feel any stigma towards them. I’m on other meds for lots of other health things, so that doesn’t stop me from taking them.
But for me, it gets a bit sticky. I have very high standards for myself (as noted above). I also have pretty good self-awareness (as evidenced by lots of my posts)…I can still delude myself, but I am well-versed in the lingo and decently talented at self-analysis for day-to-day problems (grief was a new area for me and needed more help). And I like to do things for the right reasons. Yet the single greatest challenge is my own arrogance.
I can certainly admit that I have a problem. I can even ask for help. That’s not the problem. It’s that when I self-assess my strengths and weaknesses, my single greatest strength, the part of me that makes me me, is my mind. Not my heart, not my soul, not my body, not my social network. I live in my mind. My mind is me.
And anything that messes with my mind artificially scares the fuck out of me. People think I don’t drink or do drugs because it is more moralistic. There’s probably an element of that for drugs, but for alcohol it is more levels and effect than a yes/no world. Happy go lucky drinkers (i.e. not my family experience) who drink in moderation and aren’t addicted don’t pose any problems for me, and generally I don’t care if someone drinks, so long as they don’t turn into assholes and want to hang out with me when they are drunk. Not my issue, not my problem.
I don’t generally drink though because I don’t trust myself to remain me. To do not only the right things but to keep doing them for the right reasons. When I drink, both of those standards get watered down. Not enough that I’m doing shocking disgusting things, just that I’m not entirely happy with myself afterwards. Drinking makes me less vigilant about my behaviour. And my fear of many meds is the same.
I haven’t tried many, and my pharmacist sister-in-law could help identify ones that are more benign than others if I was seeing a psychiatrist with a prescription pad. But my experience in the past has not been promising. One made me almost manic, another made me almost explosive.
And one thing that scares me is my temper. I have it, it’s there, I just never let it out of its box. It gives me strength, like leeching from a distant battery, but I’m always afraid that if my “control” is weakened by a medication, then my temper is more likely to be released. Yet if there is one thing that would destroy me, one thing that would push me over the edge for mental illness and into free fall, it is losing my temper. I get snippy, surly, irritable, sure. But my temper stays in its box. If I’m in a situation where my temper is likely to be triggered, I run away. It’s my safe space.
So I am terrified of playing with meds. I am afraid that I will “gain perspective”, get on an even keel, but without realizing it, also weaken the bonds that hold my temper in check.
I don’t disagree that it is the right REASONS to take it — I just am not sure it is the right THING too. For me, at least.
I simply don’t trust myself if I’m not me. Even depressive me holds my temper in check.
And if I have to choose depressed, untreated, unhappy, yet no-temper me vs. happy, medicated, possibly temper me, I will choose the first one everytime.
Yet to be clear, I am not doing this as some “martyr” complex that I’m afraid of being angry with someone and hurting them verbally or physically. For me, it is an act of self-creation — I don’t ever want to be that person, the one who says the really hurtful thing to someone. I choose not to be that person, whenever I can. At almost any cost.
Medications represent too high of a risk for me and my (possibly delusional) view of my mind and self. I just won’t risk it.
So where does that leave me now?
Most of the time, I am using a bunch of the above techniques as preventative. Now that I’m in more healing and recovery mode, the choices become more acute. And that would normally result in me choosing a “withdraw and heal” approach.
The approach is relatively risk-free, has a decent efficacy rate, and is moderately effective at getting me back to the starting point. Not too high, not too low, even-Stephen.
Yet I don’t want even-Stephen. I want to break through the walls and smash the crap out of them as I go. Which means I have another option. It is high-risk. Zero efficacy or effectiveness ratings since I’ve never fully tried it. And if I fail? I’ll take a REALLY long time to recover, if at all. But part of me wants to try it. To hope, to live, to sleep, perchance even to dream.
I know these crossroads, I have been here before. And each time, I have followed conventional psychological wisdom and chosen the safe path.
I just have to decide if I will make the same decision again.