Let me introduce myself: I twice failed at taking a shower. I got out of bed—no small feat for me—and soaked myself, but then also got scared and tired and crawled back into bed without lathering up. I don’t suppose any idea how this could happen occurs to the healthy person, the mentally whole.
Sometimes my life is so embarrassing to me that it seems I’m the only naked person in the whole world, and the act of breathing is the act of desperately trying to pull on some clothes, and there is never enough air to mask my private parts.
During my lowest periods of depression, no matter how I may seem to others, I’m never thinking what you think I’m thinking, unless you think I’m thinking “God damn me” over and over.
I have been hospitalized once for a manic episode (but that’s another article entirely) and twice for severe depression. I simply wasn’t functioning: I never got out of bed, not to shower, not to eat. I wasn’t watching TV or scrolling through Facebook; I just laid in bed and regretted my choices. The only time I wasn’t playing my mistakes over and over in my head, I was praying for respite, for intervention.
I took an entire bottle of sleeping pills and was simply and straightforwardly angry when I woke up. It’s beyond my ability as a writer to describe depression.
Let me share with you what I learned during my stays in a mental hospital. These observations are taken out of a notebook I kept with me at all times, scribbling things that came to me in group sessions, in the middle of the night, and, as we spent most of our time, while simply sitting and waiting for some change, however small and to others imperceptible. We mostly sat waiting more or less patiently for a lifting of the inexplicable heaviness of our limbs, any answer to the paradoxical numb desperation attested to by various blank stares and bandages around wrists.
Let me also say that none of this is easy. You probably won’t conquer any one step once and for all. There will be a whole lot of backsliding and plain, simple, out-and-out failures, but my experience is that if even for a moment you can practice one of these principles, you’ll feel better, and even the smallest respite goes a long, long way in fighting a chronic disability like depression.
1. Replace Guilt with Gratitude
If you are depressed, then chances good that the bedrock of your self-image is guilt—guilt and anger at yourself. Transform this guilt into an admission that you have within you a kind of momentum, even though depression feels like your self is at a complete standstill.
Consider that all this guilt takes energy. Remember that you do have energy even though you feel completely drained.
Once you’ve recognized how much energy it takes to sustain the guilt and blame you’re constantly throwing at yourself, try transferring that energy into gratitude for what you have, for what hasn’t happened, for the things you do like about yourself (there’s something you like about yourself).
For me, this means replacing the immense guilt I have over not finishing my graduate program with gratitude for the experience I did have. In my life, the most enjoyable experiences and highest levels of confidence I’ve reached emerged from the classroom. What’s that place for you?
In my case, the constant thought of “I ruined my life when I dropped out of grad school” has to morph into “I had the opportunity to go to grad school.” Find some sentence of gratitude and turn it into a mantra. Repeat that mantra when you find yourself stuck in the marathon loop of self-blame.
2. Replace Regret with Focus on Goals
A similar process as my first point, using regret as motivation can be very helpful. Of course, it’s a bit more intensive in that you have to have goals toward which to apply any motivation. Make some goals, but make them small (more on this later). Just setting goals is an admission that things could get better, which during depression seems inconceivable.
Do you regret gaining all that weight (even if primarily the result of necessary medication) and tear yourself down every time you look in the mirror? I do.
I look like a completely different person than before the depression slid past tropical storm into hurricane magnitude. I live deep in the black heart of body hatred territory. Looking at photos of my current self whisks me away to the Swamps of Sadness in “The NeverEnding Story” where Artax gave into despair and sank. How to be Atreyu instead of Artax, and crawl out of that mire?
Work toward some small goal. Every time you start obsessing over what went wrong in your life, shift into obsession over achieving this (again, small) goal.
For me it was running again. It sucked, because getting back into shape is painful and sucky, but every morning I run chips away at the number of times throughout the day that I regret my weight gain, because I’m doing something about it.
I used to run marathons; I now focus on running one mile most mornings. I’m a hundred times more proud of the last 5k I did than my first marathon.
Write your goals down, and put them somewhere you see them every day. (Don’t skip this step because it seems corny and embarrassing.) And as you work toward your goal, remember: you have a disability. Treat yourself like you’d treat a loved one. Would you point fingers at the fat gained by a dear friend who went through a major life trauma? No? Then stop doing it to yourself.
3. Act as if Your Former Self Can See You Now
This one can be crushing. In one group session in the hospital, we wrote letters to ourselves at age 18. I didn’t make it through reading mine aloud without crying in front of everyone. I’m so angry at squandering all the promise of my young self.
At 18, I was fearless. I was also a jerk. I took my family for granted, ignored my parents, failed my friends. If my 18-year-old self could see the physical circumstances of my life now, she’d be beyond disappointed. But, if she could see my interactions with other people, the humility and patience that’s been bored into me by my disability, she’d see how much I’ve grown. I think she’d be proud.
What does present you have to teach past you? Aren’t you proud of that?
What would you do, knowing what you do now, but being 18 again? Find something feasible that applies, and do that.
4. Choose Fight over Flight
Avoid Avoiding. This is the hardest piece of advice for me myself to follow. Avoidance is my way of life. If climbing back into bed and giving up on the day were an Olympic sport, I’d be swimming in commercial endorsement deals.
One reason I avoid so much is that I see my situation as fundamentally unfair, so refusing to participate seems almost moral to me. No doubt you can see how fundamentally stupid this is, but, in my hospital notebook, I transcribed one sentence from a Dialectical Behavior Therapy group session leader that rings particularly true for me: “meet the needs of the situation you’re in, not the one that is just, or comfortable, or that you wish you were in.”
It was drilled into us in the hospital that distress tolerance is about distraction, and distraction means doing. Two habits have helped me do: the one-minute rule and the twenty/ten interval. Both have to do with breaking time into manageable parts.
In The Happiness Project, Gretchen Rubin cites the one-minute rule: just do any task that can be finished in one minute. It isn’t difficult to follow, but it makes a big difference toward cutting clutter out of your life.
Unfuck Your Habitat lays out the twenty/ten interval: clean for 20 minutes, then rest for ten, then clean for another twenty. The assumption is that you can do anything for twenty minutes. If you’re depressed, then chances are good that you’ve let your environment become depressing. Change it. You can buy the Unfuck Your Habitat app which includes a 20/10 timer for $0.99.
If you don’t think you can clean for twenty minutes, then set a timer for ten minutes.
If you need more rest, then rest for twenty minutes.
Chances are good that you’ll get carried away by the task, keep going, and distract yourself while doing something healthy: twice the benefit.
5. Embrace the Interplay of Acceptance and Change
It’s demonstrably true that acceptance of pain decreases suffering. Suffering, or the anticipation of it, has a tendency to stifle and suppress us (the “freeze response”), and the reason depressed people often wear that deer-in-the-headlights stare.
Acceptance can help us choose fight over flight and just do, because acceptance actually decreases suffering, freeing you to change your response to it.
By “acceptance of pain”, I don’t mean merely recognizing your diagnosis and owning it, as important as this step is. Acceptance of pain must entail a mindful embrace of one’s suffering.Feel it.
Mindfulness is one of the greatest tools at our disposal. Mindfulness is, as Sam Harris describes it, “clear, nonjudgmental, and undistracted attention to the contents of consciousness, whether pleasant or unpleasant.”
Acceptance leads to change; change leads to acceptance. The very process of acceptance changes your circumstances, and changing your circumstances makes them easier to accept.
6. If Your Expectations Don’t Fit with Reality, Then Change Your Expectations
Are you still expecting yourself to function normally? Stop, and change your expectations of yourself.
Shift your focus from all the things you can’t do to what you can, and judge those things with compassion. Don’t belittle them. That twenty minutes of cleaning, or making that phone call you’ve been putting off, or walking, or taking a bath (it can be a pleasurable distraction, as well as doing unpleasant tasks) or whatever it is that you find to distract yourself, is a win and should be treated as such.
Ask clearly for what you want, and say no clearly. This goes for your conversations with yourself, as well as with others. Make your goals specific, and throw away the ones you simply can’t accomplish.
It sounds childish, but I collected a bunch of old magazines and made two collages, one on each side of a manila folder. One represents all the things accomplishing my goal will bring. It’s made up of pictures that communicate clearly what my habit of running will give me: better health, more confidence, communion with nature, management of my symptoms, etc.
The other collage is comprised of pictures that stand for things I have right at this moment that I’m grateful for. In my case these include my relationships, my memories of good times, my dog, my favorite books. These are not things I want, or things I’ll get if I accomplish my goals; I can access them to make me feel better right now.
In the evening, I prop up the manila folder in front of my alarm clock, the side with my running goal facing the bed, so I have to look at it first thing in the morning, and right before I hit snooze. I’m more likely to get up and run that way.
After my run, I turn the page over to the gratitude collage. When I’m feeling panicky, I grab it and actually hold it in my hands as I stare at the pictures. I pick something off the board to think about. Which leads me to my next point: your mood is dictated by what you’re thinking about.
7. Whatever Your Attention is On, That’s What Life Is for You at This Moment
Most of us intuitively know this, yet we don’t monitor our thoughts accordingly. If you want to change your mood, then shift your attention. I know this can be frustrating if you consider that at times, such as when you’re at work, your task at hand isn’t necessarily a matter of choice.
It doesn’t have to be a vast, sweeping transformation of heart. As with so many of the strategies I mention, go small if you need to. At almost any given time, you can focus on your breath. (Sometimes I clutch this focus for dear life.) You can feel the air on your skin, or the touch of the fabric of your clothes, you can conjure up a pleasant memory or a place you’d like to visit. Mentally grab any happy or at least neutral thing to first distract yourself and secondly, shift the focus of your attention.
8. Small Steps, Small Steps. Small Steps.
Let me tell you how I first “started running.” I would set my alarm, which would wake me up—and then, I’d go back to sleep. After a week or so, my body had adjusted to waking up early, and I’d get up on my own.
Then I would put on my running clothes and go outside—and just sit there for a while, and go back to bed. This went on longer than I care to admit.
One day, I got up and went outside, and told myself I could just walk; I didn’t have to run. After about twenty minutes of walking, I wanted to run. I actually wanted to run—something I decidedly didn’t want while lying in bed. Eventually—and I mean months later—I wanted to be running at almost any given time.
I hope some of this is helpful to those of us struggling with depression. I realize it’s not the most uplifting read. Ultimately, talking about depression isn’t depressing. On the contrary, it can be a transformative and uplifting experience for those who grapple with depression silently. It brings you closer to the support system of people who are crucial to your recovery.
It’s also important both for society at large and the individual to make space for a discussion of the experience of clinical depression. The stigma against mental illness is still very real, and many of us with this disability have internalized it. As part of that conversation, I can honestly say I’ve seen improvement of my symptoms and experience more quality of life as a result of these eight realizations.
Along the road to recovery lies the fact that the way we think about our emotions determines them. If you regard your disability as a shameful weakness, then you’ll feel guilty and frail. A nonjudgmental stance toward your mental condition and its symptoms is one of the best gifts you can give yourself, because, ultimately, your mind and body are all you really have.