Stories about the struggle to recover from depression tell of repeated efforts to find a way to live well despite the recurring burden of illness. For me the key lesson is that each person in these stories keeps trying, despite repeated setbacks.
I recently came across a research study that says the same thing in more formal language:
“[S]tudy findings suggest that constant effort aimed at positive transformation and growth may underlie the whole process of recovery.” (Recovering from recurrent mental health problems: giving up and fighting to get better by Yulia Kartalova-O’Doherty, M.A., M.Sc. and Donna Tedstone Doherty, Ph.D. – Int J Ment Health Nurs. 2010 Feb; 19(1): 3–15.)
The study is a small one but is based on interviews with people living with depression, bipolar or schizophrenia, all of them long-term, recurring conditions. The constant effort participants in the study described turned on each of them finding motivation within themselves, while also drawing on all the support they could find from friends, family and professional helpers.
The turning point was their own decision to get better or, in their words, to fight rather than to give up.
The choice became clear to them over time. They would either fight to recover and live independently, or resign themselves to chronic illness under the permanent care of professionals.
Two Views of Recovery
Recovery meant both getting rid of the symptoms and feeling positively about themselves and life generally. Most mental health professionals have focused on the first and considered recovery as living symptom-free.
But when researchers have asked people with depression about their views, they’ve generally found that people think of recovery as feeling good about themselves and having a satisfying and productive life. It’s a much more expansive idea than the medical goal of cutting down the number and severity of symptoms.
Even if their symptoms are reduced to the point that they no longer meet the criteria for diagnosis, most people still don’t feel recovered unless they have regained a sense of vitality and capability at managing their lives.
This study helps relate the two views of what recovery means by suggesting that focusing on inner motivation and a fighting spirit can foster the ability to reduce the symptoms.
There is a parallel to this in research on cancer patients. Those who met their diagnosis with a sense of resistance and optimism about getting better recovered more quickly and lived far longer without recurrence than those who accepted the diagnosis as a settled fate and didn’t try to resist it. (This rings true with me, since it was my own experience of fighting cancer that helped me understand how to deal with depression.)
The people interviewed for this mental health study had decided at some point to fight their illnesses. They challenged the idea that they would never fully recover and be able to live independent lives. They believed that they could minimize the effect of depression, anxiety and panic attacks and also regain the positive side of life.
To do that, they had to keep fighting every day or risk having depression take over completely. At some point, they had made a conscious decision to get better and found something or someone to fight for. Their lives, though, were not all about struggle and fighting.
They were looking for peace of mind, a sense of belonging and self-acceptance. They simply wanted to feel that they were in control of their lives,. They wanted to help others, work in good occupations and feel happy.
They characterized the alternative to fighting as giving up and accepting the idea that they were chronic mental patients. The positive side of giving up was feeling comforted by the idea of being taken care of and looked after. But that would also mean resigning themselves to being able to do less in life.
It would mean probably never recovering to the point where they could hold the kind of jobs they wanted and live a full life in the community.
For many the question about their futures went back to their original diagnosis. Most of them had been told that they had a condition that would require treatment for the rest of their lives.
Giving up meant accepting that assessment. Fighting meant confronting it.
Why Fighting Helps
Motivation can have a lot to do with depression. Martin Seligman, a founder of positive psychology, discovered a link between a sense of helplessness and the development of depressive symptoms. He also demonstrated that cognitive behavioral techniques could help people regain an inner motivation and sense of effectiveness.
If a person can make the personal decision to fight back, that can become the energizing basis for initiating change in behavior.
Each of the participants in this study described a turning point that helped them make that decision. Sometimes, it was the experience of being listened to and accepted, rather than talked at as a passive patient.
For others it was the ability to verbalize and explore traumatic experiences. By various methods, they were able to get a different sense of themselves and how they could deal with their illness.
Recovery in Small Steps
Talking about fighting and motivation can seem impossible when you’re in the middle of depression. But the participants in this study, like most people with depression, weren’t referring to anything earthshaking. As one put it:
“You’re not looking to move mountains, you know, you just want peace in your mind, have no more anxiety, no more depression, to be able to cope with the normal stresses of life.”
For another, a turning point came when she could take the most basic step of all:
“Actually my first big step towards recovery was, believe it or not, getting myself out of bed, talking myself out of bed. Now that sounds like a small step but it really was a major step for me, actually just to get out of bed.”
Sometimes living with depression is like that. You feel the pressure or weight of the illness holding you on one side of a line. You need to push hard to get to the other side of that line, where life goes on. On the inside, the effort to push against the illness feels like a titanic struggle, but on the outside it might look like the most ordinary event, one most people take for granted. Look at that – I got out of bed!
I think there can be a lot of fight and heroism in even the smallest steps of survival.
I’m a positive kinda person but depression is something really not so easy to conquer. Great article guys.
Nice article, this is powerful and I thank you for sharing this with us. Depression can become an addiction in a way, and balancing out the neurotransmitters can be difficult without the proper mental motivation. You are right, it is a choice and once you decide you don’t choose it anymore, true recovery can begin. I like to recommend an integrative approach to help my clients get to a point where they are strong enough to find the motivation to implement change and do the things they need to do to overcome their symptoms. I also believe in the power of micronutrients to help heal and restore the natural balance of neurotransmitters. It isn’t just the brain’s chemistry that needs to be balanced, but that of the gut as well. We have more neurotransmitters in our stomachs than we do in our brains, believe it or not. Micronutrients are now being researched and used for their healing properties as it pertains to various mental disorders such as depression, anxiety, bipolar disorders, etc. Here’s some research for those of you who are interested in learning more. Clinical Guide As always, pairing these methods with therapy and the will to decide to change is the best line of defense. 🙂
Here is a link to some of the research I have come across all together on one site for those of you who are interested: http://bit.ly/2wavcCU
This year my depression and anxiety symptoms (originally rooted in childhood trauma) hit a high after the loss of a loved one and end of a 7 year relationship. I didn’t think I would ever feel better. I decided to try micronutrients, as antidepressants and antianxiety medications never gave me the relief I sought, and the side effects were dangerous and worse than my initial symptoms. Anyway, I’ve only been taking them for a few days, and I feel amazing. I mean, I haven’t felt this happy since I was a very young child playing on the beach at my grandmother’s house in the summer. It’s unbelievable. I just wanted to share this with everyone. I want everyone suffering to feel as good as I do right now. <3
It’s hard to be both the one bleeding by the side of the road and the Good Samaritan. But just as life is not always fair, neither does life always send the Good Samaritan. It sends priests, therapists, medication, psychiatrists, family and friends that seem to walk by on the other side of the road willing to avert their eyes. If you’re going to get help, you’re going to have to get up off the road and put one foot in front of the other and keep stumbling forward…and do the best you can to help yourself.
Michael Platania says
I started a 60 day feel good challenge, where I am writing each day as part of my recovery from depression. Yesterday I wrote about fighting. I realized it’s not how many times depression has knocked me down, it’s how many times I’ve gotten back up and as long as I always get up one more time than the number of times I’ve been knocked down, I am still fighting. Thanks for helping reinforce this.
John Folk-Williams says
Hi, Michael –
I was surprised to find that writing turns out to be a recognized form of therapy if done as you are doing it. Congratulations – good for you to keep getting back up on your feet.
I think this can be a tricky conversation to pick our way through. And this comment might be raining on the parade.
I think ‘giving up’ may be a positive if it means accepting where you are. Pursuing an ideal of health may be draining and just lead to chronic disappointment and hopelessness.
Perhaps this could be regarded as beginning to engage in the fight – taking the first step.
The language gets tricky I think.
Michael Platania says
Evan, I think you are exactly right on target. There was a point where I realized I needed to learn to live with depression, instead of constantly fighting to get away from it. It was as you say “accepting where you are” and it was a first step in a long road of many struggles, but I have never forgotten that lesson of acceptance.
John Folk-Williams says
Hi, Evan –
Yes, it is a matter of engaging your condition rather than letting it control your life. The way you deal with it is described as fighting vs giving up in this study, but the authors, I think, bring out the subtleties. I commend them for wading into such a qualitative issue that many researchers avoid in favor of things that are easier to measure. The wording is always tricky, but I think the example I gave at the end gets at the underlying problem. Do you get out of bed or not? If you adapt to depression in the way Tom Wooton or Andy Behrman have done, then lying in bed with depression may be something you’ve learned to be comfortable with. But if you feel like your life is being destroyed because you can’t get out of bed, then you have to act to change the experience. Most do it by “fighting” to get back to the earlier life they had always known where staying in bed depressed was not what they wanted. Everyone has to decide what health means to them. I agree that a goal of health can be illusory and has to grow out of who you are as a person. Thanks for bringing this up – it’s important to think it through carefully.