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.