Is it possible to learn to live well using an acceptance approach to depression rather than the strategy of trying to suppress or avoid it? That’s the question I’ve been exploring.
Most of the treatments for depression I’ve used have been based on avoidance. Reduce stress, overcome depression, control anxiety, conquer anger. Get rid of them with medication, psychotherapy, ECT or any of the other available methods that help you stop the pain.
What else can you do but try to root out such disabling disorders and all their destructive allies? If you can’t stop them completely and avoid all the life-breaking pain they bring, at least you can manage them with careful monitoring and ongoing treatment.
Everything I read, every therapist and psychiatrist I worked with, all supported this view. Even though this approach never worked very well for most of my life, I kept on with it, hitting my head against the same wall over and over again. That was treatment as I knew it.
Learning about Acceptance
What was I to make, then, of a newer set of therapies that advised just the opposite. Don’t try to avoid depression. Accept it, live with it “mindfully,” learn from it, take it into the comfort zone of your life.
At first, these ideas sounded bizarre, even insulting. I lumped their advocates in with the condescending “depression is a choice” crowd or hopelessly naive new-agers who weren’t really talking about depressive disorder at all but some spiritual unease. Gradually I dropped the resistance and tried to understand what acceptance was all about.
I’ve described my change of heart about these approaches in recent posts on Buddhist psychology, mindfulness, hypnotherapy, Tom Wooton’s idea of the depression advantage and others.
For one thing, they recognize their limits. Each of these approaches stops short of the extreme of suicidal depression that demands fast treatment, including medication, hospitalization and whatever other treatment is necessary to help a person regain a basic hold on reality.
Most of the lives of those of us with recurring depression demand that we deal with less extreme conditions, but they still lead to the collapse of our ability to function. This is where the therapies based on mindful acceptance can be effective.
Understanding Recovery
At first, I looked to these approaches primarily to figure out how I had achieved my own recovery of the past several years. I couldn’t understand what had caused the change after all those decades of muddling through, all the downtime lost to depression – despite the use of every therapy and medication I could try.
Getting more deeply into mindfulness helped me see how some of the changes might have occurred, but now I want to go much further in exploring these approaches. I want to work with them actively to see if I can accept and learn from the experience of depression, letting it guide me to a different sense of my life.
That’s a radical shift from thinking of depression only as a destructive illness to be ended as quickly as possible. I’ve had a lot of experience avoiding painful experience in my life generally as well as in the treatment of depression.
Avoidance as a Way of Life
I had lived by avoiding fear and shame-triggering events from my childhood on. The practice became deeply embedded in my way of doing things. I even made life-changing decisions rather than take on these dangerous situations.
No matter how much I might accomplish or how much I was praised, I ran from possible careers at the first important rejection. Those experiences wiped out everything that had gone before. I was filled with shame, convinced I would never be any good at that kind of work. Rejection was proof that all the worst things I believed about myself were true. Get out now!
It was easy to adopt the same approach when anxiety, depression and stress became much worse. When overwhelmed with the severe feelings that seemed to paralyze me, I started avoiding any situation that brought on the symptoms.
Refuge from Depression
There were many of those. I canceled meetings when I was so depressed I could hardly string two ideas or words together. I fled huge parties with dozens of strangers. I put off difficult phone calls, presentations and face-to-face conversations. I cut off close relationships out of fear of rejection.
There was safety in retreat, a chance to recuperate before taking on the world again. It was a great strategy for immediate relief, almost addictive, certainly habit forming. But the relief never lasted long. The reality was that the solitude I sought for rest soon became the isolation that deepened depression.
I felt ashamed that I couldn’t handle things. I learned nothing about coping with the inevitable next time when I would not be able to avoid or put off what I didn’t want to face. Fear and anxiety would build up again as I thought about the upcoming encounter.
I learned the hard way that avoidance came with a high price.
Avoidance as Treatment for Depression
When it came to dealing with depression, the strategy of avoiding its symptoms promised the return of a decent life rather than continued loss. I know it’s not customary to use the word “avoidance” in connection with treatment. But the word fits.
As I’ve often mentioned in these posts, the strategy of stopping depression and avoiding its effects never worked. My attitude about recovery became pessimistic. Since I couldn’t get rid of it, I felt that depression had become the ever-present background of my life.
After I realized that major episodes usually began without any triggering events, I felt I had to adapt to the inevitable. The best I could do was try to prepare for a hard impact as the illness followed its own rhythm.
With the help of medication and therapy, I tried to cut the deepest part of the cycle, but those methods were only half-effective at best.
A Deeper Recovery
After decades of this, I was suddenly surprised to feel a much deeper shift and came to believe that depression was behind me. It wasn’t a matter of the symptoms disappearing but rather of my living with them in a different way.
This is the outcome I want to explore more deeply. With the help of the therapies based on mindful acceptance of the experience of depression, I want to see what further changes in my way of living I can learn.
That’s what I will be writing about in this occasional series of post, and I’d like to get your ideas and reactions every step of the way.
Acceptance…what a concept! When you finally realize that you are fairly powerless in this whole process acceptance can be a huge relief. Just as I can not “will” myself into a depressive state, neither can I “will” myself out of one. No matter how hard I work at maintaining mindfulness in my life, there are some of those “out of the blue” depressions that hit despite my best efforts. The last one was a couple of months ago…and it was more discouraging because I thought that I had all the tools in place to fight it…but nothing helped. That was the first time my therapist has ever said to me that maybe I just need to “sit” with the depression a bit…knowing that it will pass. Accepting that this is part of who I am. Don’t fight it. Have confidence that it will pass. It always does. I hate it, though… But accepting that it is basically out of my control has lifted some of the guilt I feel about not being able to fight it or fix it…and that feels good right now.
And yes, I am looking forward to this series of thoughts. Thanks for being so willing to share…
Hi, Shelly –
I’m glad it feels good now to take it in as a part of who you are. Isn’t strange how you and I can know so well that we can’t will ourselves out of depression yet at the same time feel guilty and inadequate for not being able to will ourselves out of depression? The hard thing about acceptance is cultivating the mindful attention that helps you detach from all the bad stuff you’d really rather not have to accept. You have to get beyond the stage of just tolerating depression to the point of living in it, learning from it, etc – even though every instinct and urge tells you to shut it off fast. What I like about the new therapies like ACT is the focus on the skills you need to get to that point of acceptance.
John
I wholehearted agree, John, and look forward to reading your series. It is interesting to see depression as analogous to the weather – you can go out in it, stay in it, leave it alone, complain about it, celebrate it, wait for it to pass…the list is endless. This is liberating because it’s not about what you should do or what it would be best to do. It’s just about what you can do if you want to. This at least takes away some of the suffering and confusion and self recrimination that goes with depression and frees the way for its passing, like the weather, in it’s own time.
Hi, Ann –
Weather is an interesting comparison as something undeniably in your life that you can try to shut out and ignore or walk into and welcome. What intrigues me most about the acceptance approach of some interpreters is the idea that depression can become a valuable period of insight and inspiration. That’s a view that Peter Kramer wrote a fine book to debunk, but I think, despite his great insight and wisdom, that maybe he’s missed something in his absolute judgment.
Thanks for commenting.
John
I’m looking forward to hearing more on this topic. I’m in the middle of reading David Karp’s “Speaking of Sadness,” which seems to lean toward this type of mindset, accepting the inevitable recurrences of depression. It’s so interesting to read about how other people view their depression and how that view can change over time, especially once they begin to understand that there may not be a “cure.” It is rather depressing to think about, but reality nevertheless. Most of us are going to continue having to deal with this, over and over. Maybe it would be better if mental health professionals would just level with people that have this pattern, rather than leading them to believe that somewhere around the next corner is a cure. This is probably a fairly new concept, really, so probably not their fault, plus I think there is value in understanding the possible roots of our depression, wherever that makes sense. Maybe for some there is no “answer,” per se, which is really frustrating. It seems we need to have answers. But answers aren’t always available to us, so then we have to figure out how to deal with what we have. This really makes sense to me.
Hi, Judy –
Karp’s book is one of my favorites, and I’ve often written about its insights in these posts. Most people seem to get to a point of acceptance of depression as part of their lives, but it can go in opposite directions. One is resigning to your fate in a defeatist way – giving up in the face of a victorious enemy. The other seems to be finding special value and insight – even spiritual fulfillment from living with it for so long. I think you and I are fortunate in coming out on the more upbeat side.
John
This is a great start and a battle that I can relate to, for myself and (I think) for my partner. There is no doubt in my mind that acceptance is key to self-forgiveness, etc. And I too have struggled with whether ‘avoidance’ and isolation can be a healing thing or makes things worse.
Lately I have identified ‘safe’ activities and friends – that is, simple/inexpensive things I can do and people to hang out with that just feel healthy, even if they don’t magically make me ‘happier’. This means not drinking (excessively), talking with close friends who I feel emotionally safe with, mild exercise and fresh air, going to a coffee shop to write. Generally these bring a bit of emotional balance, especially when I’m feeling trapped and isolated.
(with mild-moderate depression), I think that true acceptance can lighten the load and clear you up enough to recognize how simple activities can help you through.
Hi Renee –
I think you’re right that starting with simple things works best. One of the traps for me has been having wild expectations about rapid change when starting a new therapy or program. You also mention forgiveness, and that’s another powerful part of the changes I’ve been through. I’m glad this approach is working for you – and I appreciate your adding mild-moderate depression. Really severe forms of depression require different methods altogether.
John
It’s like the fable of the reed and the oak tree. Bend to the storm of depression and you’ll survive. Fight it and you’ll break.
Depression is only a symptom. Underneath is are feelings of sadness, worthlessness, hopelessness, ‘what’s the use?’ etc. The dialectic of healing is that you have to go deeper into those feelings to resolve them. You come out the other side with relief and renewed understanding.
Hi Bruce –
That’s a great fable for acceptance vs avoidance. It sounds like you’ve come through – perhaps you’ll share some of your experiences here.
Thanks for your comment.
John
I can’t wait to see the other posts
I have been struggling with depression and anxiety. I tried ti be anxiety free, but it did not connected me back to life, to be in touch with pleasure and new goals.
When i take the time to be in touch with my feelings, altough they dont seem positive at 1st, I feel more connected, more in touch with what goes on in my life.
Your avoidance track really makes sense to me. Thanks for sharing your thaughts, always usefull.
Thanks David –
Feeling more connected does seem to be the key. We’re pretty social beings, and even talk about connecting to ourselves as if we were a group of people who wanted to know each other better.
Thanks for commenting.
John
Well, you have got my attention! I am with you all the way on this one. Can’t wait for the next post.
I too have tried everything and the only thing that brings relief from symptoms is avoidance. So I avoid a long list of activities. Not a very interesting life I might say. But it does work. I do not experience long periods of deep, dark depression anymore. But neither do I experience much of anything because living a full life tires me and being tired makes me depressed.
And so I will be reading eagerly and considering how I might change my own approach.
Keep up the good work!
Hi, Wendy –
This is new for me too, in some ways. It was strange to find that methods I stumbled into by dumb luck have been built into therapies based on sophisticated models and backed by experimental studies. I have a lot to learn and apply, so it will be a gradual process to see if the methods that work for me will continue to hold up.
John
Take a look at Acceptance & Commitment Therapy. For books I recommend Russ Harris’ “The Happiness Trap”.
I can attest that it has worked on my anxiety and I am positive it can help on depression as well.
If you have 30 minutes to spare watch this interview with Russ Harris:
http://www.youtube.com/watch?v=S5UWEgC0A4c
Thanks for the link, Thomas. I was looking for videos as I wrote this post and will check out this one with Russ Harris.
John