For some time I have been working with the idea of accepting depression rather than trying to fight it. That’s an approach to therapy based on mindfulness and an attempt to broaden the range of experience you can live with comfortably. Although I haven’t worked with a therapist trained in any of the acceptance and mindfulness therapies, some of the principles I’ve been learning about remind me of things I have been doing for some time.
Skills for Recovery
Granted I have developed these skills while holding to the very mindset about depression that these therapies counsel against. I’ve tried to fight, control, avoid and eliminate it. The alternative view is to start with the idea of accepting depression while living the life you want. Despite coming at them from the opposite direction, I’ve developed a few skills and beliefs that make the paradigm shift a little less drastic than it sounds at first.
I have learned to:
- Become active and committed to recovery instead of being the passive patient
- Redefine recovery as living well rather than eliminating symptoms
- Use mindfulness meditation and cognitive therapy to stop identifying with depression
These have helped me recover enough to live mostly untroubled by depression despite the recurrence of various symptoms. That’s a big accomplishment. It’s the sort of recovery I had hoped for, but depression remains on my mind.
Depression Is Under Control?
I spend a lot of time trying to control the problems that do come back – especially the thinking that reminds me what a mess I am. I’m very good at turning off that noise, but it keeps coming back, along with other symptoms. At times, I’m listless or irritable or feel rage returning or stare blankly into space or get anxious about seeing anyone.
I catch myself in the midst of these tendencies, and the simple act of recognizing them keeps them at a distance. I don’t get overwhelmed. I don’t feel like I’m having a recurrence of depression. They don’t last long or keep me from doing what I want to do. These are shadows of their former selves, but controlling and getting away from them keeps drawing my attention back in their direction. I feel distracted too often from getting on with the positive side of my life. I spend more time than I like pushing them away.
Could this be why strategies designed to support recovery could wind up derailing it?
Fear of Depression
It’s hard to be honest with myself about this. I have a lot invested in the idea that I am recovered, that I have depression under control, that it no longer dominates my life. But there remains a nagging anxiety about something that I can’t quite identify. It feels like a holdover from the depressive belief that I’m putting up a false front to cover my inner emptiness.
My first reaction is to deny that I could be slipping back, but then the nervousness creeps in. My sense of self-esteem seems shaken again, and I know I could so easily slip back into fearing the return of depression. That would mean the half-recovery of managing depression while constantly looking over my shoulder, cautious that I might make a wrong move and lose myself.
That’s exactly the state of mind that results from seeing depression as an illness that I have to control, that focuses on the danger of recurrence, that captures everything suggested by the idea of avoidance.
I like Tom Wootton’s way of putting it in The Depression Advantage. Depression isn’t fully in my comfort zone. I have yet to be able to live the difficult moments of depression with a balanced awareness instead of anxiety.
I have a long way to go before I can genuinely accept the full range of depressive experiences without hitting the fear trip-wire. I’ve always thought of recovery as a process, and acceptance seems to be the next step.
Learning from Exposure Therapy
It’s easy to get fooled by the words when acceptance and avoidance are paired as opposites. That makes it sound like moving from one to another takes place in a single leap. On an emotional level, you need to work gradually toward the change, first by learning new skills.
The promise as well as the difficulty of this process of learning became clear to me when I started watching the TV series, Obsessed. I’ve described this before, but it’s well worth coming back to. Each episode captures the dramatic moments of change as people with obsessive compulsive disorder work with therapists to confront their worst fears.
There couldn’t be more powerful examples of lives dominated by avoidance. OCD itself is a set of detailed actions to wall out the panic that seems to follow inevitably from triggering events. The story of one woman had an especially powerful effect on me.
She had developed severe OCD after several traumatic events that had culminated in the death of her father in a terrible freeway accident. She kept the torn and bloodied clothing he’d been wearing at his death and periodically felt compelled to wear the shredded garments. Driving provoked deep anxiety, and the thought of using the freeway set off panic. These were only the worst of many obsessive behaviors that had drastically limited her life.
A cognitive behavioral therapist taught her cognitive skills to cope with the ideas and feelings at the heart of her problem. His main concern was to use that training as preparation for guiding her to do the things she most feared. She needed to expose herself to dreaded situations in order to defuse and accept them as part of normal living.
After she learned to handle smaller behavior changes, she had to confront her worst nightmare and drive through the freeway section where her father had died. Despite her resistance and intense anxiety, she passed the spot where her father’s car crashed. She gradually relaxed as she realized she had done it and survived. There was no nightmare.
Is Depression Something I Do?
Could the same thing happen with depression? It’s been hard to turn my thinking around and work toward the approach based on heading into the apparent nightmare rather than blocking it out.
The first thing I’ve had to do is to shift from the idea that depression was something I had and see it as something I did. If I could understand everything I was doing that kept depression alive, even in a weakened form, then perhaps I could take the step beyond recovery that Tom Wooton describes. I could live with depression inside my comfort zone.
In the next post of this series, I’ll describe how my behavior could still be supporting depression, even in the midst of recovery.