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.
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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.
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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.
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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.
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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.
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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?”
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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.
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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.
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John, this is deeply moving and inspiring to me. It warms my heart to recognize many of the same emotions and phases I have gone through. Count me as a new fan of your blog!
Thank you, Eva –
It’s always great to know when someone connects with a post. I look forward to seeing you here – and I’ll check out your blog.
John
I live in USA and I suffer from anxiety a few years ago and I can not stop taking xanax since it helps me a lot to be able to relax and calm my impulses.
Hello, James –
I’m glad you’ve found a medication that helps with anxiety. It’s always been a big problem for me and seems to go hand in hand with depression. When you say “can not stop taking,” though, that’s a bit worrisome. Xanax is one of a class of drugs that are known to be addictive – so I hope that doesn’t become an issue.
Thank you for commenting.
John
In my lifelong enduring depression, I’ve been able to manage it although I still feel its pain nearly every day. In the early 80s I came across Martin Seligman’s first book on helplessness and decided to do even the smallest things to put me in charge. I took over the family finances, made our vacation travel arrangements, returned things to the store when they weren’t right, etc. I got up, got dressed, and went to work every day. My depression would have been much worse if I had not made myself persist in that.
When Prozac came out and I read Peter Kramer’s book, Listening to Prozac, I began to think medication might help. One of my sisters started with it before I did. I also went into a deep crash, due to a lot of factors, and went to my doctor to ask for a referral to a psychiatrist, over the objections of my husband. She said she could prescribe Prozac for me, and I didn’t need to go to a psychiatrist. That turned out to be a big mistake. I also went into therapy. I kept waiting to get better, but seemed to get worse. After about 9 months of this, as I read everything I could find on depression and grief, I found a book with just a few paragraphs on bipolar disorder. Besides the symptoms of extreme manic-depressive illness, which I didn’t have, it talked about bipolar II. That sounded much like what I experienced. I fired my doctor and started seeing a psychiatrist and getting medication combos. He didn’t seem to hear me when I mentioned bipolar. I didn’t let that go on for long, and saw my company’s employee referral program rep who seemed surprised that I still felt so bad after such a long time in treatment. She referred me to a new psychiatrist and therapist. At the same time, I said to myself that I lived within shouting distance of some of the two best medical schools in the country, and also looked in a “top docs” list and got the names of the best people there. I took both avenues, the referred psych and an appointment, not with the top doc at U of Michigan, but with another one. Independently, they concurred that I did have bipolar disorder. I was shocked to learn that the SSRIs triggered cycling, and I had spent a year on a medication making me sicker, because a family physician thought herself qualified to treat a psychiatric illness. I was furious about that, and the first quack psychiatrist I saw. My therapist claimed that she had encouraged me to see the psychiatrist sooner, but I didn’t really remember her doing so.
Taking charge of my illness, especially choosing to see the best qualified people–not whoever mediocre practitioner was close–was a critical step. A lot of people with our illnesses say that the day they got the right diagnosis was the most important day of their lives. I asked one, “So I’m not just making this up?” and he said, “I have no doubt” that I had a real medical condition.
There have been years of more ups and downs in the story, but the next most important thing I found–through an online depression chat room–was David Burns’s book, “Feeling Good,” which is a guide to do-it-yourself cognitive therapy. Everything he says about detailed rethinking of your assumptions and depressing thoughts can be put into practice and gradually make a significant improvement. This is what I call, “doing the work.” Whether you’re using medication or not, you have to keep doing the work, rebutting the thoughts that make you feel helpless and worthless. I’m surviving, functioning well-enough, and still need to do the work every day.
Until research finds a better medical model for bipolar illness, and I expect they will find several distinct and different kinds of it, that’s what I have to do. I still work with my current psychiatrist to continue to retune my medication combination, and she agrees that the cognitive work is essential.
Hi, Karen –
Good for you in creating your own strategy and getting so active. Taking charge of treatment has helped me enormously. Unfortunately, a lot of people wait far longer than you did before making changes – and some are just too consumed with self-doubt and the rest of the debilitating symptoms ever to do it. I went along for most of my life in and out of depression – I don’t know if the high periods could be described as BP II or not – and in and out of therapy of all kinds. Medication was never prescribed (except in one emergency), I’m convinced, because so many psychiatrists, according to Kramer, thought depression was useful in getting someone to probe their lives more deeply for the “real” causes. They hardly mentioned the word and never explained symptoms. (Of course, that was mostly before the turning point in diagnosis with DSM III.) The trends in diagnosis and models of treatment are just that, they come and go. If we don’t take charge, we’re at the mercy of the latest model – which never captures the full scope of what’s going on.
Thanks for that great story.
John
John, thank you 🙂
Two of your statements stand out:
~ your “energetic determination to get better” … Yes, determination … so important … I find that depression has a volitional aspect to it — a volitional injury, a wound to the will. Basic energy and chosen determination … so challenging to cultivate when nullility has been a long habit … but so worth working for!
~ that you “stopped assuming that [depression] was a single overwhelming force”. I too have made efforts to perceive and deal with singular symptoms — “chunking it all down to bite-size proportions,” a friend of mine calls the process.
Lately I have taken a perspective that understands (my) depression as a metabolic event. I was so weakened by this latest relapse (going on two years now) that all the basic metabolic functions and checks-and-balances were badly disturbed –> appetite, sleep, body temperature, libido, etc. I have been needing to take a very “physical” and somatic approach to my own treatment. Regulating sleep cycles, appetite, food and fluid intake; maintaining body warmth; making sure to move every day … very basic stuff, but it underscores everything else. If the body’s not adequately fed, rested, and animated with fuel/energy, how can we hope to moderate our thoughts, emotions, and actions?
I see my approach at present as being quite different from the medical model –> medicine tends to start with the behavioural symptoms and to regulate them through neurochemical intervention. I’m being very body-based, but presently am less concerned with my thoughts and emotions than with the basic functions that allow my brain to operate with more strength and ease.
If the body’s malnourished, exhausted and stagnant, how can we expect our brain and mind to function well?
“Back to the basics … back to the basics,” one of my mentors always says … “Everything comes from the basics.”
Hi, Jaliya –
“a wound to the will” – that’s a great phrase & exactly right! I didn’t realize that this was taking such a physical toll on you. Back to basics for sure. Depression has so many physical effects that people ignore – as well as compromising the immune system and increasing the risk of such things as heart disease and bone loss. I have an easier time with food, exercise and other essentials because my wife is such a strong model. Hate to think what a physical mess I would have been on my own.
All my best to you —
John
John, thank you. My story is not so unusual but to me crucial. I too need to lift a general lethargicness and tendency to gloomy thoughts by learing to like and value myself more.
I am glad you say that medication is not generally the answer. I too trid that and was not ruling it out as I am at a low point again. Just reading what you have said confirmed my beliefs that that is not the answer. I dont want ai intrusive chemical change.
I too read and learn
I still have a way to go
Take care
Chris
Hi, Chris –
I hope that your progress takes place a lot faster than mine did (decades!). There are many sides to the medication issue. In my case, all but the last one really did little or nothing for depression while adding bad side effects. I still take some of that last one but it’s effect has only been temporary, and I’ll be completely off it soon. It all depends on how your body reacts. But the general point is that I stopped depending on them to solve the underlying condition and relied on me to get over the biggest hurdle.
All my best to you —
John
Hi John,
This is inspiring as always. I like the way you highlight the power of your own belief system in making this wonderful shift.
I’m still in the midst of depression and PTSD symptoms, but I believe I’m less depressed than in the past, and when I get down I bounce back more quickly than I once did. Part of that for me is maturing and also being in better external circumstances than in the past.
Right now I’ve started a therapy that I’m not sure whether it is going to help me or not. I may be wasting my money. But it is so hard to know what to do at the time, until later, when with hindsight I’m sure I’ll know what I should have done.
take care
Thank you, Ellen –
I’m sorry the symptoms are with you, but it’s great to hear of your progress. Changing the external circumstances took away a huge burden of stress, and that has made life in general much easier to deal with.
Good luck with the new therapy. Wisdom in hindsight is better than nothing, but how I share your wish that it arrive a lot sooner!
My best —
John
Thanks John, this is great: raises lots of great questions I think. Especially about the medical model marginalising people’s agency (ability to choose and co-operate).
Thanks, Evan –
I working up to a serious rant about “medication resistance” but I need to finish some research first.
I’m sorry for the lateness of this reply – I’m juggling quite a bit of online writing just now as well as working on new directions for this blog.
Hope you’re well –
John
Thank you John. Your thoughts have given me a deeper understanding. As I am not afflicted with depression, as you know, I have a ex/partner who is and battles it each and every day. I will forward this blog to him and hopefully, it will allow him to gain some insight that may be helpful to him. Right now, he is relying on medication and primarily therapy to help him cope. His nutritional diet is an up and down roller coaster ride as is a few other things that are not good for anyone. I love him tremendously and just wish he can find the path to peace, calm, joy and happiness…with or without me.
Hello, Liz –
I’m so glad you find the post helpful, and I hope your husband does too. Of course, my experience isn’t going to be the same for most people, but I hope some parts of it make sense to others, especially men.
With all hope for his improvement —
John
Thanks for sharing this part of your story. You asked us to share things that helped us move toward recovery. I would say that building a life I CAN handle instead of living I life I CAN’T handle has helped. I have eliminated a lot of activities, and people, which drain me. This way, when depression DOES rear its ugly head, I do not have to pay much attention to actual circumstances but instead to thought patterns. I try as much as I can to do self-talk, speaking back to my incorrect thoughts and setting myself strait on my irrational thoughts. I HAVE to work on these sorts of things because I am medication resisitent more often than not. The med which I am presently taking helps to a degree, but there are side effects that come with it that ADD to depression instead of decreasing it. What’s a girl to do? The biggest thing though that I do is that I DON’T GIVE UP! Last night, for instance, I spent two wonderful hours in a bookstore going over books on Bipolar Disorder, with a pen and notebook in hand, reviewing, and learning a few new things that I have yet to try, such as vitamin D and the omega vitamins. It makes me feel less like a victim of this thing, and more like a manager of it. We need to claim back our power from an illness that can often leave us feeling powerless.
Hi, Wendy –
I couldn’t agree more with the need for being a manager rather than a victim. That’s made all the difference to me, as has turning around the idea that I’m medication resistant. If a drug doesn’t work and adds to the problem, I tell the doctor it doesn’t work and that I won’t take it anymore. I discussed my own experience with antidepressants in the post called Feeling Fine on Prozac. I believe there’s a lot of curative power in the things you do for yourself as well as the determination not to give up. You’re doing many of things that I do, and I hope they keep on working for you.
My very best —
John