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In thinking about how I managed to rid myself of depression, I’ve realized the importance of getting ready to recover. This idea never occurred to me during many failed attempts to find a way out of the underworld of living. I had hoped there would be a quick, linear pathway to feeling fully alive again, but there was never going to be such a simple solution.

I mentioned in a post on patterns of recovery that I really could have used the sort of roadmap that writers on PTSD have developed. Having a sense of what lies ahead and what to expect would have been great, but even more basic would have been an understanding of the inner skills I would need to keep going.

In saying that, I don’t want to suggest that it’s possible to approach recovery in a linear way. You can’t say to yourself: Well, I’m depressed, and I want to recover. So I need to learn these skills first, then create a master plan covering all the bases and then get started. That doesn’t happen – except in books about the latest sure-fire way to cure yourself of depression.

Learning to Observe, Becoming Aware

I can illustrate what I mean about learning skills by backing up to that first idea: I’m depressed. The ability to recognize that I had a condition called depression was my first breakthrough. As obvious as it seems, it takes a lot of mental muscle power to get to this basic awareness.

Until I could do that, I was simply lost in a kind of whirlwind. I had no idea that I was experiencing anything but my own nature. This was my life, a swirling mass of moods and drives and ideas about myself that were indistinct. My behavior was driven by those forces and influences, and I made sense of it all by believing I was a bad or stupid or worthless person.

I needed the ability to stand back from those drives and begin to separate one from another. I started to do that when I sought help from psychiatrists at the height of two crises that occurred during my twenties. Those crises passed as soon as I could identify something like a cause – an association with family history or a habit of thinking that was distorting my experience.

Those moments of insight and the self-exploration that led to them were like basic training. They helped me develop the ability to look at my experience more as an observer than a driven victim.

Becoming an observer of dominating feelings and thoughts is what meditation teaches as well. That is a powerful way of building the skill, but it’s not the only way of achieving some level of emotional detachment.

Every form of therapy helps you learn how to step back from experience and emotions that feel overwhelming. For me, writing about what I was going through also helped. That’s another way of learning how to sort things out and name the many different influences that add to inner pain and confusion.

The Fear of Changing

But awareness only goes so far. It was one thing to wish to feel better. It was much harder to want recovery so deeply that I could take action to get started and then keep going. What prevented me from doing anything for a long time was fear. Fear had stopped me from pursuing therapy after those early crises, even though I knew it was helping. In each case, I got to a key insight, felt better and then got out of there.

The skill of being able to experience the fear as an observer helped me get past it – but only after so many times when the fear was strong enough to dominate my behavior. For me, it was fear of change, fear of launching into daily life without having the certainty, however grim, that depression provided. As I’ve written elsewhere, it set the habits I used to get through everyday life, though, of course, they were terribly self-defeating.

I could readily imagine feeling good again, feeling “like myself” but that self had been conditioned to live with depression since childhood. Fantasizing about a great life ahead was one thing, but changing what I did from day to day evoked a deep resistance. The truth was that I had only lived without depression for isolated periods. It was the life I knew best.

So making a consistent, determined effort to stay with any form of therapy became hard. There would always come a point where I’d slow down, back off, or give up out of a sense of failure. Those were the moments when fear took over, though I’d convince myself there was another reason – the treatment didn’t work, the therapist wasn’t any good, I didn’t have time to do it right. I could always come up with some excuse other than plain old fear.

The ability to explore this fear as an observer – not avoiding it but letting myself feel it – finally helped me to set it aside. But this also happened only after a lot of failed attempts and a lot of fear. It never feels good to do – or avoid doing – anything out of fear. I felt great when I got to the point of believing: I can do this, and I’m going to get it done.

What has been the biggest obstacle for you to start and then stay with your attempts to recover from depression?

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My new post at Health Central describes some of the alternative treatments the military is now experimenting with – all of them aiming at short-term alleviation of major symptoms. I’ve contrasted that approach with the long-term treatment aiming at complete recovery as detailed in Jonathan Shay’s Odysseus in America: Combat Trauma and the Trials of Homecoming. The pattern of recovery presented by Shay begins with the model originated by Judith Herman and summarized in her highly influential book of 1992 (new edition in 1997), Trauma and Recovery.

I owe the idea of this contrast between quick-turnaround “curing” of specific symptoms and a comprehensive approach of “healing” to the blogger at the excellent site, Healing Combat Trauma. In her words,

“Health,” [Meriam-Webster defines] as “the condition of being sound in body, mind or spirit”; … “freedom from disease or pain”; and a “flourishing condition.” Great.

“Healing,” by extension, would be returning someone TO that condition. “Curing” would be reversing a disease process. …

… Healing was a better metric than curing; because “curing” implied a single event, a toggle switch that could be flipped between “sick” one day and “well” the next. Healing, on the other hand, was a progression. A whole continuum between being very sick…and being relatively healthy. And any point along that path.

The military is experimenting with treatments that go far beyond its standard approach of medication combined with limited counseling or therapy. Given the hundreds of thousands of Iraq and Afghanistan veterans returning with PTSD – and an attendant rise in the suicide rate – expanding treatment has become a top priority. Even though the treatments focus on rapid curing rather than full recovery, this level of attention to a mental and emotional problem is unprecedented for the military.

I hope you’ll take a look at the Health Central post. It occurred to me while writing it that there are important parallels between the patterns of recovery for PTSD and depression. I’m working on a post about that and will publish it here soon.

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What is it about depression that draws people to search for the benefits it brings to its lucky victims? Since I’ve been writing this blog, many writers have had great success with books and articles describing its positive role in life – giving people a creative edge, helping them figure out their lives or simply serving as a healthy and normal response to misfortune. The problem with each of these essays is that they invite confusion between mild depression, or limited periods of deeper mood changes caused by life events, and the much more severe depressive disorders.

The latest contribution in this vein is Jonah Lehrer’s New York Times article, Depression’s Upside. It’s about a theory that takes depression’s virtues to a much higher plane than that of individual insight. Depression, it turns out, evolved as part of our genetic makeup because it enhanced the human capability for analytical thinking and problem-solving. In short, depression has helped the human race survive.

This isn’t his idea. He’s summarizing the conclusions of a scientific paper by J. Anderson Thomson, a psychiatrist, and Paul Andrews, an evolutionary psychologist, but he adds a lot of additional material to support the notion that depression has its brighter side.

The concept is that depression improves the mind’s ability to focus attention on “complex social problems” (failing marriage, loss of job) through the process of rumination – the repetitive analyzing of a single problem. (Hence, the theory is called the analytic-rumination hypothesis or ARH.) Rumination fires up the area of the brain that specializes in analytical thinking, making it easier to break apart the elements of a problem that might otherwise seem overwhelming and so make it easier to find a solution.

Isolation from the rest of the world supports this tight mental focus and keeps the mind from being distracted, as does – I presume – loss of interest in sex, food, human relationships and fresh air. Since all these symptoms are coordinated so nicely to help with problem-solving, the authors contend that they must represent an evolutionary adaptation rather than a malfunction.

If this is true, I’ve really bungled the gift of my genetic inheritance. In all the decades of dealing with severe depression I never solved a single complex social problem. Amazingly enough, my mind was infinitely distractible, incapable of clear decisions and subject to aimless drift into a cloud of nothingness. At other times, I obsessed about my failings and worthlessness in prolonged self-torture and often thought of suicide. Perhaps, though unaware of it, I did sharpen my analytical abilities while sleeping all the time. However, my isolation from my family, if you can believe it, seemed to create problems rather than solve them. Clearly, I’ve given evolution a setback, especially since I’ve likely passed on this my distorted version of this gift to our three sons.

But quite possibly, it’s not true at all – at least when you untangle the confused use of the word depression. Lehrer has taken a lot of heat for failing to do that. The psychiatrist Ronald Pies, for example, writes in his Psych Central post, The Myth of Depression’s Upside that Lehrer ignores many studies that reach the opposite conclusions about the effects of depression on thinking, relating both to mental function and the level of activity in the brain. He offers this anecdote:

The notion that severe depression may bring forth good things reminds me of a lecture I once attended on “fire safety” in the hospital setting. We were shown a movie of a house that had burned down in such ferocious heat that a package of frozen muffin dough had been completely baked. “So, the house wasn’t a total loss!” quipped one of the world-weary attendees. Yes, of course—people can learn from their severe depressive episodes, but often at the cost of emotional and spiritual conflagration.

Edward Champion at Reluctant Habits attacks Lehrer’s interpretations of the experiences of Charles Darwin, Kay Redfield Jamison and David Foster Wallace.
Peter Kramer also has little patience for the idea. That’s not surprising since Kramer produced a very convincing study, Against Depression, that attacked a long-standing tendency in our culture to glorify depression.

Prior to Lehrer’s article, Jerry A. Coyne, a Professor in the Department of Ecology and Evolution at the University of Chicago wrote a devastating two-part critique of the Thomson-Andrews paper itself. He’s an expert on evolution and author of the highly praised Why Evolution Is True. He methodically takes apart the speculative reasoning and “paper-thin evidence” supporting the conclusions of Thomson and Andrews about the evolutionary benefits of depression. He looks at the original research papers cited by them and brings out the way in which their interpretations distort the actual findings of the studies.

So what’s going on? Why have there been so many claims about depression as a boon to human life, and why has there been a strong positive response from the public (excluding, of course, the hundreds of thousands of us who’ve lost so many years to the effects of this illness)?

I think part of it has to do with the confusion about what “depression” means. The same word is used to refer both to feelings of sadness or dejection in everyday life and to a set of clinically defined illnesses. Unfortunately, the psychiatric profession, however much it hopes to dispel this confusion with the Diagnostic and Statistical Manual (DSM), only reinforces it.

By setting the bar so low for a diagnosis of a major depressive episode (experiencing five out of nine listed symptoms for at least two weeks), the DSM invites psychiatrists and physicians to prescribe treatment for even isolated occurrences. To add to the prevalence of a depression diagnosis is the startling fact, reported in a recent study, that a quarter of psychiatrists and two-thirds of non-psychiatric physicians do not bother to use the loose DSM criteria when making a diagnosis.

Even when studies or popular books and articles do make the distinction between severe and mild depression, they tend to drop the qualifiers after that caveat, rely on the single word and make much more sweeping claims about depression’s beneficial impacts on life. The influence of drug industry advertising also encourages the idea that people shouldn’t put up with sadness but rather take the latest medication to restore a happy outlook on life. (But that’s a long story for another day.)

Many people do value depression as a factor that gives them a distinctive outlook on life, and they don’t want to sacrifice this dimension of mental experience to a drug-induced “cure.” I have no quarrel with that and respect whatever adaptation to depression people need to make. But individual experience and choices are one thing. Speculative theories about the brighter side of depression from psychiatric researchers are another. They have real-world consequences and need a lot of rigorous testing before put into practice. Unfortunately, that usually happens, if at all, long after the idea has gotten wide publicity and influenced attitudes of public and providers alike.

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A friend recently asked me if I could help him understand the change for the better I’ve experienced in the last couple of years. At the same time, a reader here asked if I could elaborate on what I mean by taking charge or putting myself at the center of my own recovery – an idea I first discussed soon after starting this blog. Both are closely tied together, and I thought I’d summarize a few thoughts I’ve had so far on how to account for what I’ve been through.

As I’ve written earlier, I don’t really know what turned me around. I doubt that the experience can ever be explained in the sense of cause and effect. It’s something that comes from the wholeness of a person, not the cut-away sections that are analyzed in isolation from all the others.

Here are some of the actions I’ve taken in the recent past that have helped get rid of depression – not the more conventional treatments. I’ve taken medication for most of the past 18 years, but it has never had a lasting effect or come close to ending the problem. I’ve also had many types of therapy over several decades. While many of those experiences have been powerful in terms of personal growth, they’ve never changed the overall dominance of depression. The reason for bringing them up in this list is to discuss the mindset that these treatments tend to encourage.

1. Writing. First, I started writing Storied Mind. I’d written journals off and on for years, and these were full of ideas and descriptions of depression. Mostly they recorded the raw experience and the frustration I felt at not being able to get better for very long. There were also several periods when I was too depressed and mentally blocked to sustain writing. The blog has been quite different because I’ve written more consistently and looked at many more dimensions of the illness than ever before. Writing is the way I discover things, and it also has an important healing effect. This has helped me stay with the revitalizing energy that creative activity brings with it.

2. Online Community. The people I’ve gotten to know as a result of getting active online are a treasured resource in healing. Reading about the experiences of so many others, exchanging ideas with them, receiving and offering support – all have had an enduring impact. This community has been a source of insight and encouragement throughout the past two years. What I’ve learned has helped change permanently some of my basic attitudes about depression.

3. Running out of Medical Options. A couple of years ago, I was quite nervous about running out of medical options since none of them worked for very long. At the time, I was putting my hopes on TMS – transcranial magnetic stimulation – and followed its progress in working toward FDA approval. I’d heard a lot of positive reports since I knew someone who had worked on one of the major studies of its effectiveness. However, the evidence submitted to FDA didn’t show much advantage over placebo. Medical treatment seemed less and less likely to offer any hope.

4. Challenging the Mindset of Treatment. So I stopped waiting for something to cure me and relied more on internal work of my own, bolstered by the help of the online community. I was starting to question the whole concept of the medical model of treatment that focused narrowly on a few key neurobiological processes. The medications based on that model didn’t work in my case. Health providers tended to blame me, in effect, by attaching the label of treatment resistant. That was no help at all.

   I realized I had to stop expecting cures within the limitations of that model. Before then, I had understood – based on my experience with cancer – that I had to become an active partner with the medical providers. My energetic determination to get better had made a big difference in the speed of recovery at that time. Now I had to push farther in that direction. Taking charge of my recovery from depression meant changing the basic expectation that someone or something outside myself was going to cure me. That approach didn’t work, so I had to come up with a different strategy – and there was no one to do that but me.

5. Rethinking Depression. I found inspiration in reading Reynolds Price’s memoir (A Whole New Life) of his experience in stopping the extreme pain of spinal cancer that permanently severed nerve connections to his legs. Nothing helped him until he did hypnosis. That started his ability to rethink the pain so as to end its debilitating effect. One of the interesting things about this was that the pain itself was pure phantom – it came from his legs where he had no nerve sensation at all. That got me thinking that such concepts as pain or depression are powerful mental constructs that respond to sense perceptions and chemical changes in the body. They assume a life of their own and influence the expectations and assumptions we have about their permanence. If Price could disempower “pain” in his experience, could I do the same with “depression?”

6. New Assumptions. Somehow, I internalized this idea and felt new hope. Combined with the healing effect of writing the blog and all the support I had from the online community, this new idea helped me to change long-held assumptions. I stopped assuming, for example, that depression was a permanent condition that would always reassert itself. I stopped assuming that it was a single overwhelming force and broke it down into the separate symptoms that were more manageable. I challenged more effectively the inner voice that was always telling me I had no hope, had no self-worth, had never done anything right. Most important, I assumed that depression had no more power over me than I gave it – however unconsciously. I didn’t have to be its victim. That was a hard one since it contradicted all my earlier ideas.

7. All that was exciting and hopeful, but there was still something missing. I’d often had breakthroughs and new awareness of possible recovery in the past, but those never resulted in real change because they never touched my basic beliefs about myself. Those beliefs had been completely negative, and depression had been their perfect mate. The eroding emotional and mental effects of the illness seemed the natural outcome of my lack of self-worth. The belief that I deserved only a life of depression had to change, and somehow it did. That was a great gift, a sudden realization that I was fine, that depression was a nuisance rather than my fate, that I could live a full life again.

All these factors, and others, must have had a cumulative effect in helping me get to that shift in belief. I can list, narrate and speculate about all this, but that’s about as close as I can get to explaining the outcome. Of course, changing for the better is a process, not a one-time achievement, and it takes a lot of attention and quick response each day to make sure I’m staying on the right track.

I’ll keep on writing about it and always seek insight from the online community. So I hope you’ll share some of your experience in making progress, however halting or incomplete it may seem. Every step counts, even the backward ones.