Storied Mind» Recovery

At Health Central: Recovery and Denial of Feelings

john — Fri, 19 Feb 2010 20:58:48 +0000

Just a note to point you to this new post at Health Central.

I hope you’ll drop by and leave a comment.

Reflections in Mind: Sherwin Nuland’s Recovery from Depression

john — Fri, 05 Feb 2010 18:59:25 +0000

Some Rights Reserved by onkel_wart at Flickr

An important part of my recovery has been exploring emotional memory when I respond so deeply to a story or song or even just a moment in a film that somehow reaches right inside. A feeling long held back flows out freely, even though broken away from the memory that stirred it. So I have to stop and ask – what is this, where is it coming from? The emotion is often grief over loss – and there have been plenty of those through decades of depression – but it can also be a happier surge of recognition, powerful reminder of a breakthrough in recovery.

Sherwin Nuland’s 2001 Ted Talk video about his recovery from depression provoked just such a response. It affected me so deeply that I started looking for a written version. I found it in the opening pages of his memoir about his father, Lost in America: A Journey with My Father.

Nuland grew up in the South Bronx in the 1930s and 40s, one of two sons of Russian Jewish immigrant parents. Quite apart from the personal meaning I found in that opening chapter, the memoir is a moving, beautifully written story of life in a close-knit family dominated by an overbearing father – who also played a part in his depression.

Nuland’s recovery story parallels the experience of many who’ve been through this nightmare. He captures so well those powerful moments – the terrible ones that led him into a mental hospital and the thrilling, even funny ones that brought him back. There are several that resonate for me.

In the video, he describes the gradual collapse of his work life. Even while struggling each day to get out of bed and consumed by obsessions, fears and feelings of worthlessness, he tried to keep up the pretense of his surgical practice at a university hospital. But his condition was no secret, and fewer and fewer cases were referred to him. As he said in his talk, “I couldn’t work…I had no more patients,” I felt keenly for him since I had gone through a similar and humiliating decline that I had been helpless to stop.

Even at the worst moments of this years-long catastrophe, he remained determined to will himself out of depression. Despite many failed attempts to pull himself out of the depths, he could always “retain an image of my inner ogre as it looked when I could distance myself from it.” I know that glimmer of survival that persists in spite of endless frustration and defeat – it’s the one reminder that you’re not completely lost.

The voice of the young psychiatrist who attended him during his hospitalization proved to be an enduring source of guidance and strength, especially when he felt some recurrence of depression in later years. This was the doctor who saved him from a lobotomy that would have destroyed him. He alone on the medical staff was convinced Nuland could be brought round with electroconvulsive therapy. And the treatment worked but only at the twentieth session.

The way in which this treatment helped him captured exactly my own sense of the function of any treatment. It brought back enough of his mental and emotional strength and clarity that he could finally push himself to recovery. As he puts it, “the act of will that had seemed impossible now came within reach, and finally in a single surge of determination, I made it happen.”

What he then describes sends a thrill right through me since it captures almost exactly what I experienced. It makes me laugh and cry at the same time to think of it.

One Sunday morning in January 1974, I was standing alone in the little kitchen of the residence unit where I lived with some fifteen other patients, thinking very calmly – analytically, in fact – about the content of the galaxy of pathological ideations. It crossed my mind that it was no longer necessary to give in to them each time one or another would flash into consciousness. Why not figuratively turn away and refuse to succumb? Why not respond to their pernicious urgings with some dismissive formula, like “Ah, fuck it?”

Then and there I resolved to abandon my pathological limitations in a single determined stroke.

When at last it became possible to shrug off the demons that had pursued me for so long, the experience seemed at once simple and triumphant. I shouted out that big No with vast relief in a thrilling, giddy, crying, laughing instant. And it’s the words I used then that I repeat – as Nuland does – like a magic spell when ghosts of depression try to take over again. A monster of such power, suddenly weak and overwhelmed, looks so ludicrous. These days I tip it over with a finger push.

But there is always more to do. Nuland told his story of recovery at the beginning of this memoir in order to introduce the power that his father had over him. During depression, he felt that influence so strongly that his posture stooped to resemble that of the older man in his illness. He was becoming his father, the man who had held him back all his life.

Nuland writes of a haunting memory that symbolizes the relationship. His father had so much trouble walking that he had to lean of his son’s arm to get down a street. The life-long fight to free himself is captured in those moments when Nuland felt the tight grip of his father’s hand pulling him back to match his own halting pace. The force of this pull never left him, even after recovering from his disastrous depression, even long after his father’s death.

I find this story, in both its video and written versions, a recurring source of hope and encouragement for sustaining recovery and starting life over. Is there a story of recovery that you’ve found to be a support and guide?

Trying to Explain Recovery from Depression

john — Fri, 04 Dec 2009 21:48:42 +0000

Some Rights Reserved by spettacolopuro at Flickr

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.

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.
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.
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.
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.
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?”
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.
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.