Recovery from Depression: the Power of Expectation

Tears: Young Woman in Window

Recovery from depression depends in part on what you believe is possible for the future. If you are to recover at all, you have to take action at some point. It could be a series of small steps about your daily routine – eating breakfast, walking out the door to get fresh air and natural light, making a point of talking to someone each day.

Or it could be much larger, like going to a psychiatrist and starting treatment, regularly meditating, exercising frequently, taking long walks. Whatever it is, you need to feel motivated to overcome the inertia, to stop the loss of warming energy to the cold stillness of depression.

To feel motivation, you need to believe, however tentatively, that you can change for the better, to expect recovery from the worst symptoms. You’re likely to hit a lot of barriers, though, that make it hard to keep up positive expectations.

When you expect to fail, it often happens that you stop taking action to help yourself recover. The deeply ingrained habits of depressive thinking and belief can quickly take over. You might start making rules and setting goals.

If recovery is not total and permanent, it’s not recovery. Treatments can’t fail, relapse can’t happen. You can’t be recovered if you’re still on medication. You have to get better in six months or a year, or some fixed period of time.

Of course, the rules and goals are entirely your invention, but they’re part of the expectations you feel in your gut. If you can’t meet them, the disappointment confirms your deepest conviction that you can never succeed.

Depression wins again. You believe recovery can’t happen for you and stop taking action, stop trying at all.

Does that sound familiar? It’s one of the many problems I ran into. I stumbled around for a long time, expecting either too much or too little. Many of my expectations were purely self-defeating, no matter how optimistic I felt at the outset.

For a time, I expected that recovery would happen quickly when I started taking medication. The first antidepressant I tried actually did restore me almost immediately. I felt a wonderful energy. I was back to my old self again. But that lasted only a couple of months. Thereafter I spent years moving from one antidepressant to another, perhaps feeling a little better, usually getting no relief at all.

So the hope for fast recovery was disappointed and gave way to a desperate feeling that there was no treatment out there that could possibly help. I expected that recovery would come to me from outside. I would be rescued.

For every other treatment I tried, I had the same expectation. An effective treatment should turn me around in a short time. None of them did. None of the forms of psychotherapy I tried, none of the mental or physical workouts I put myself through.

My belief had an all-or-nothing quality about it. That’s not surprising since thinking in those terms is one of the hallmarks of depression. But I couldn’t see the expectation itself as a symptom. I repeated that same cycle many times. Unrealistic hope gave way to unrealistic despair.

I thought that learning as much as I could about depression would lay the groundwork for recovery, and I thought that talk therapy would rid me of the destructive influence of the past. Both did a lot of good, but depression has a way of poisoning any expectation of positive change.

At first, learning about depression was a great help. I could identify many symptoms that I had never linked to depression and see that the pattern of the illness often matched my experience. This knowledge was a relief and provided hope because I knew I wasn’t alone and that many certainties I used to have about myself turned out to be common effects of depression.

But the more I learned about the extent of depression’s impact, the more I came to expect that the severe, recurrent form of the illness I had was irreversible. Changes in the size and activity of key brain structures and the self-sustaining nature of the illness after years of recurrence seemed to doom me.

Then there were the increased risks and probabilities of dying sooner from a variety of illnesses. Those of us with this type of depression were at greater risk to develop heart disease, lose bone mass and suffer stroke. We have more pain, and our immune systems are compromised.

We’re at the worst risk for all this if depression started in childhood and was not treated until recurrence had become well established. We also lived in dysfunctional families of origin and had family histories of depression.

I fit the profile perfectly! Another nosedive. I could see myself only as a statistic, not as the person I am. Increased risk, no matter how small, became certainty in my mind.

For a while, psychotherapy had a similar effect. I came to feel doomed by my past. Depression had come back so many times that I felt resigned to its never-ending recurrence. Talk therapy helped at first by pushing me to many breakthrough insights about the influence of my childhood on my life as a grown man. I could see the source of patterns of behavior and ways of thinking about myself that had been self-protecting strategies when I was a kid but had now become self-defeating.

Despite the benefit of understanding these links, depression kept returning. Doomed again.

Resigning to a lifetime of depression became my new self-protecting strategy. Expecting nothing meant taking no risks and never feeling the crush of disappointment.

A number of things helped turn me around, but better than any illustration from my life is a powerful anecdote that Michael Yapko tells in his book, Breaking the Patterns of Depression.

One day, a woman guided her husband into his office. The man was so depressed that he wouldn’t even open his eyes. He had sunk into a deep depression following heart surgery. Despite the success of the operation, he believed that he was going to die. No reasoning by the cardiologist or psychiatrist could shake this expectation.

He knew what he knew, and any effort to do anything would only hasten his death. So he avoided any chance of activity or engagement by keeping his eyes shut and not saying a word all day every day. His wife had to care for his every need and even call to him from wherever she was in the house just to see if he was still OK. She answered the therapists questions for him.

Yapko decided to drop any effort to reason with him and instead castigated him for putting such an unfair burden on his wife. The man protested at that but agreed to a homework assignment. Instead of forcing his wife to call out to see if he was alive, he agreed to use a timer and call out to her every fifteen minutes that he was still there.

So every fifteen minutes, day after day, he faithfully called out to her: “I’m still alive.”

The constant repetition of those three words gradually influenced his perception of himself and his expectation about the future. He started doing things to help himself, and that proved to be the turning point.

My story and yours are different from his, but this anecdote moved me to tears. Something like this happened to me, not through a single method, but more gradually until the hopelessness came to an end. I started believing – cautiously – that recovery was not only possible but already underway.

That’s why I attach such importance to the power of expectation. The shift in perception and belief made all the difference in convincing me that I could do something to turn my life around.

What do you expect for the future? Have you found a way to imagine and believe that you can have a better life no longer dominated by depression?

Image by Έλενα Λαγαρία at Flickr

21 Responses to “Recovery from Depression: the Power of Expectation”

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  1. Donna says:

    Just one more comment, to anyone searching for “the cure,” John Folk-Williams has written the best series of articles to get you underway. I have read all kinds of research studies, medication reviews, philosophical wanderings, listened to podcasts and audiobooks on the subject, seen YouTube videos, and tried to reason it out on my own. Plus, of course, tried all sorts of medications, ECT, psychotherapy, meditation, talking to people I didn’t even know in craft stores and insurance offices! And more.

    No one has “the cure.” You have to find what works best for you, as John states in this very article. And that may change over time. Go with what leads you toward your personal values; discard what leads you away from your goals and values. And remember depression is just one of the many facets of You. It may feel like it is all you are, and it may feel like it has robbed you of anything else you might have been. But stand back and take inventory. I think we all tend to focus on that one thing that seems screwed up about us. When I color my hair and it ends up a hideous brassy red instead of ash brown (which happened to me yesterday) I think that’s all people can see. I poured my energies into finding a “fix” until I realized there’s a lot more to me than brassy red hair. You can pour all your energies into finding a “fix” or cure for depression, but realize there’s a lot more to you than just that. Find other things into which you can pour whatever-energy-you-can-scrape-together even if it’s just sitting in the sun and feeling warm while you fantasize about what you want in life. Dig in the dirt. Take a drive. Re-watch your favorite crime series or silly romance or write a poem about your feelings. Anything. Get up and go sit in a different chair. Shift just the littlest thing. Then you will have done something , and you never know which thing will throw the depression off balance. But when you do, write it down. Remember it to try the next time.

    • Thank you for these kind words. You know, if all your comments on dealing with depression and related ills were gathered together in some form they would comprise one of the best resources on the internet. Something to think about?

      • Donna says:

        Oh yes, that would be the most rewarding thing ever. Thanks for your encouragement. I have found there are a lot of barriers to the sharing of information. Someone might get sued. Another demands a PhD as a qualification. No one talks about saving lives, they talk instead about protecting business interests. But no one can stop me from writing a blog, right? Or from starting my own website.

  2. Donna says:

    That first comment on July 26, 2011 was mine. I am going back and rereading your blog and am surprised to see my own comments there! In that comment of mine, it sounds like I have found and pressed that button that led to my untimely survival (ha). What I know now is I must take the good times and fly with them. Whether it is luck, a biological shift, a phrase that I come across in someone else’s blog, something I wrote in an old journal, a medication, a relationship — whatever. Whatever brings about relief like bursting into pure oxygen after being held underwater till you’re almost dead, fly with it. Gulp in the air and start moving toward land again. Or realize you can stand up and breath right where you are even if the water is till up to your chin.
    I used to hate the cyclical nature of my depression. Now, I am so grateful for it. Not for the down side, but for the knowing there will be an up.
    Right now, my “trick” for finding that needed pocket of air is Doing the Little Things. Do the dishes, make the bed, go to the grocery store, watch the news. If I can’t be creative or go visit a friend, if I can’t find any spiritual meaning, if I can’t stand another audiobook to keep me company and I’ve already walked my aging legs into a cramp, I Do the Little Things. If it turns out I do the little things wrong (I colored my hair on a lark this morning and it turned out an awful brassy reddish brown), I laugh at myself. Then I go on and boil the eggs and water the plants. Tomorrow I hope I can be creative and visit a friend. It will come.

  3. Alex says:

    Going to a psychiatrist and starting treatment, regularly meditating, exercising frequently, taking long walks… This is the way to go. See drugs as the last possible option!

  4. Joan says:

    Hello John,
    I’ve been reading your articles for years. I’ve also read “A Mind for Life”. Todays article about expectations told my story. A lifelong illness of depression, trying every med on the the market, years of therapy, alternate therapies that either didn’t work or didn’t last, have left me without hope of recovery. I just finished 66 sessions of Transcranial Magnetic Stimulation. it helped the anxiety but not the depression. I am resigned to living with this monster illness. But reading your articles always lift me up a little. I am so grateful to you for sharing your thoughts. There are not many people who are willing or able to talk, or listen, to this kind of pain. Thank you.
    Gratefully,
    Joan

    • Thank you for writing, Joan –
      I’m glad some of the writing has been helpful to you. I’ve often wondered about TMS. In fact, when it was new and all over the news, I dreamed that this at last would be the answer and solve all my problems. Talking to a friend who had experience with it quickly disabused me of that dream, but I’m glad to hear that it did help you with anxiety. I haven’t written enough about how crippling anxiety was in my life – it took me so long to acknowledge its power!
      All my best to you –
      John

  5. Jenni says:

    Your post is really helpful for those people, who want to recover from Depression Or Anxiety disordered. Thanks so much for sharing the valuable post.

  6. Lyn says:

    Thank you for expressing everything that I had hoped to be true about recovery from depression and had thought would be conveyed to me by my psychiatrist and therapist. I wasn’t able to express these ideas as articulately as you but desperately tried to make them understand that as I recover from depression I often feel out of control and fearful, and subconsciously feel that retreating to my old way of existence would be a wiser/ safer choice. Partially due to my sensitivity and also based on their reactions I felt even more out of control rather than comforted. I feel exhausted, hopeful, strong yet weak, and am realizing that this is to be expected after coming out of a depression that has been a part of me for over 40 years. I’ll be retuning to this site daily as a try a new way of living. Thank you again.☺️

  7. caroline says:

    Hi,
    Reading your post has taken taken the edge of this horrible hole I seem to be in, I, too believe that recovery is not for me – I have had 2 breakdown and in the midst of the second – which is a lot worse than the first – I was so hopeful first time round and went to pyschotherapy, took meds etc. This time round, even though I am going to therapy and taking meds it feels like I am going through the motions. I feel so lost and hopeless. This also is combined with friend telling me that ” may be it is just our cross to bear”

  8. stephanie says:

    i just found this. this fits me well since i am going through the stage of being resigned to a terrible future right now. it’s difficult doing things everyday and currently right now, i just want to give up. part of your post made me feel like i was not alone though, that i’m not crazy for thinking the way that i think.

    i am currently in the ‘something external will save me phase’. i still have a lot of expectations about things so not sure what to do.

    thank you for sharing.

  9. Someone says:

    I’ve been in the midst of a deep, severe depression for 21 years now. It is hell. And it isn’t US who put those expectations on ourselves: no way. It is preached by society, and then we internalise them because they are the norm. Ie you must shower once a day, you must pay your bills on time, you must sleep for 8 hours, you must be well within x days/months/years. None of that we just dream up on our own – it is the health sector that propagates these “expectations”. Nobody would shower, nobody would do any of this BS if we weren’t taught to do that by society. So as a result, you can’t just drop all those expectations in the blink of an eye, since they have been drilled into us from age 4 until adulthood. It’s like telling a rape victim who has PTSD in adulthood to just “cut the crap” and drop all his/her ptsd symptoms in the blink of an eye. Not even MacGuyver could pull that one off.

  10. Donna-1 says:

    Mo, I have pinned my hopes to medication also. Although I responded poorly to antidepressants for several years, something finally kicked in and my mental state shifted from dark and airless to a kind of dawning peace. Then one medication in particular made all the difference in the world — I saw an improvement almost immediately (within 3 days) and my life turned around in ways I never thought possible. So I do have faith in medication, although I know it’s far from being the whole answer. At least it gave me some traction to climb up and out.

  11. mo says:

    I tend to pin too much hope on Big Pharma. I think they’re always just around the corner from producing a better drug, and then a better drug after that. I don’t hold out much hope for talk therapy, as I seem to keep landing in the offices of therapists who claim to use cognitive-behavioral therapy, but who in fact are just run-of-the-mill psychotherapists.

    • John Folk-Williams says:

      Hi, mo –

      If the meds help you, that’s great. The repeated failure of so many I’ve taken to do me any good finally made me look into the nature of the meds, the neurotransmitter issues etc. I suppose I’m more confused than ever but do agree with folks like John Grohol – a psychologist rather than psychiatrist – that the biochemistry is not the “cause” of depression. But I know what you mean about looking for the next and better drug. After I ran through the drugs, I had that attitude about other forms of treatment – like TMS. Hoping for the silver bullet, however, turned out to be pretty illusory.

      Thanks for your comment.

      John

  12. Judy says:

    Hi, John – again, you hit the nail on the head! I could identify with everything you said, especially about expecting nothing to avoid disappointment and taking no risks. And, yet, expecting the best can backfire, as well. For myself, I tend to think of it more as hope – hope that my life will be the best possible, while recognizing that there are always going to be disappointment and loss that alternate with, and sometimes accompany, delight and grace.

    I, too, no longer have the expectation that I will never recover from depression because the process of healing has taught me that there IS hope – but I can’t stop trying, just because I have hope. I want to get beyond my “normal” of being nearly numb because I’ve experienced deep emotions enough to know that I don’t want a life without them. And that means exposing myself to situations where I might get angry or sad – and yes, even happy! Most of my life, it didn’t even feel safe to feel happy because I KNEW (expected!) something would come along to take it away. But I know now that our emotions are meant to come and go, that grief will pass, as will elation.

    Thanks for writing this thoughtful piece!

  13. Evan says:

    I think it will usually be possible for a person to identify ways in which they do affect their experience, though perhaps not when in the deepest depression. If they can identify this then the motivation should be easier to obtain.

  14. Donna-1 says:

    I guess basically, I never lost hope that I could get better. I don’t know that I expected to recover completely, because I was not even sure what that would be. But I just kept doggedly trying every single angle — every self-help book, every combination of exercise and nutrition, every spiritual avenue, every medication, every website, until that indefinable something took hold.

    A biggie for me was learning that I could say “no” and still survive…and thrive. Also learning that sometimes it was okay to meet my own needs first instead of looking out for everyone else. Combining the two to finally move out on my own was, I believe, a giant step in the right direction. I needed to be where I could stick to a regular schedule of sleep and wakefulness and not be bombarded by the daily habits and rituals of others.

    • John Folk-Williams says:

      Hi, Donna –

      If I’m reading you right, your experience sounds like mine in at least one way. When you get out of living or working situations that are especially stressful and succeed in reducing the stress that your own way of behaving and thinking generates, then a deeper healing can take place. The role of stress – of many kinds – is so central to all this, I wonder how serious depression would be without it.

      Thanks for your comments.

      John

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