Recovery should aim at restoring psychological well-being as well as ending the symptoms of depression. Naturally, you get into treatment to stop the pain of those symptoms. It’s a huge achievement if the treatment works, and you can keep depression from ruining your life. But so many people relapse after initially getting better that full recovery has to mean more than focusing on what’s wrong. It should also move you toward a goal of wellness.
Psychological well-being is not just feeling “like yourself again.” When you’re severely depressed, it’s easy to idealize what your “normal” self was like. You believe that if you can stop feeling so down and worthless, you’ll be fine.
In reality, your old self was prone to depression, and relapse could be just a matter of time. Unfortunately, relapse is becoming the norm for a huge number of people who appear to have gotten over most of their symptoms. Conventional treatment is falling short.
There are forms of therapy that emphasize well-being and describe in detail what that means. They guide you through a process of recovery that builds on your strengths to help you become more capable of living a fulfilling and well-rounded life.
Well-Being Therapy is one of the newer treatments that frames recovery in this way. Instead of starting with everything that’s wrong, it starts with everything that’s right.
The therapy tries to strengthen six closely interwoven dimensions of psychological well-being and a capable self: a sense of mastery of your environment, personal growth, purpose if life, autonomy, self-acceptance and personal relationships. Rather than focus primarily on ending static symptoms, it moves you from the negative to the positive ends of a continuous spectrum for each of these key life skills.
When I read through the positive side of each one, I see a portrait of the emotional balance and self-concept I want to have. But in looking at the negative side of the spectrum, I see the reflection of who I was during long years of depression.
Here’s the positive side of the six dimensions.
- Environmental Mastery: You feel competent in managing everyday life and can take advantage of new opportunities. You can organize your life, work and home situations to match your needs and values.
- Personal Growth: You see yourself as growing and improving over time and feel you’re realizing your potential. You’re open to new experiences and feel that you’re continually developing as you respond to them.
- Purpose in Life: You have goals for your life and a sense of direction in working toward them. You have beliefs that support a sense of purpose in your own life and life generally.
- Autonomy: You’re independent and self-motivated. You decide what you want according to your own standards rather than by reacting to social pressure.
- Self-acceptance: You feel good about who you are and accepting of both strengths and weaknesses. You feel positive about your life thus far.
- Positive relationships: You’re able to form warm and trusting relationships, and you’re capable of empathy, affection and intimacy. You understand the give and take of human relationships.
If all that describes you, you’re an exceptionally well-balanced, grounded person, and I hope you’ll tell us how you manage to stay so psychologically fit. If you’re dealing with depression, you probably have trouble with most of these great qualities. Some of them have stumped me for long periods of my life.
So here’s the other side, the negative end of the spectrum. Depression can lead you to believe that if you’re not at the top of the chart, you must be at the bottom. That classic all-or-nothing thinking supports the inner belief that change is not possible. Recovery, however, is all about seeing yourself more realistically as somewhere between perfection and misery.
- Environmental mastery: You feel overwhelmed by the circumstances of your life and unable to control them. When you succeed at something, you explain away the accomplishment as a fluke and focus only on what you failed to achieve. When the chance for something good comes along, you feel unable to take advantage and then regret you’ve missed the opportunity.
- Personal growth: You may have goals for improving your life but always believe you’re falling short and will probably never meet them. Instead of growing, you feel like you’re stagnating. Perhaps you lose interest in trying to change and can’t seem to get out of the rut you’re in.
- Purpose in life: The idea that your life has any meaning disappears, and there doesn’t seem to be any point in working toward a better future. You may find a short-term purpose in trying a therapy for getting over depression, but it’s hard to sustain a sense of direction. Any setback is taken as confirming that the effort is pointless.
- Autonomy: Far from feeling inner direction, you’re likely to depend on others for approval. That often means trying to please everyone by hiding your own opinions and needs. You can become passive and unassertive rather than risk disapproval, but that behavior can come across as dishonest and lead to conflict anyway. You can wind up feeling frustrated and dissatisfied most of the time.
- Self-acceptance: You don’t accept who you are and feel ashamed, perhaps uncomfortable in your own skin. You feel you can’t do anything right and can reinforce the sense of failure by setting impossible goals. If you’re anxious and paralyzed in social settings, you may believe that the only measure of improvement is to be the star of the show, dazzling everyone with wit and social ease. Anything less feels like failure that confirms your belief that you can’t succeed.
- Positive relationships: All these problems in your sense of yourself make it almost impossible to form close relationships. Feeling shame about who you are can lead you to project faults and inadequacies on someone you’re trying to be intimate with. You may look to that person as making up for your own failings and winning for you the approval of others. By the same token, behavior in your partner you feel is inadequate causes you anguish, as if it were your own failing. In depression, you may feel incapable of engaging emotionally because you feel so indifferent about everything in your life. You may have set unrealistic goals for a perfect relationship and feel deep frustration when it doesn’t work out that way.
When you feel OK about your life and things are going well, these six dimensions of well-being support one another. They can’t be separated neatly since they’re woven together as the overall sense of who you are and how you handle experience. When you’re depressed, they work in disharmony to sustain your illness.
The question is how can recovery proceed in a realistic manner when depression seems to block every way forward. The downside of each dimension reinforces standing still, isolating and setting yourself up for failure.
In the next post in this series, I’ll look at the methods used in Well-Being Therapy to build resilience and the inner belief that recovery is possible.
Where do you find yourself along the spectrum of these six dimensions of psychological well-being? Do you feel you’re making progress or just standing still? Are the therapies and tools you’re using to get better helping you focus on achieving psychological well-being or on controlling symptoms?
Image by Seldom Scene at Flickr
I have read your article “When a Depressed Partner Falls Out of Love” and I feel everything that you said in that article like when you said “I believed that the relationship was holding me back. It had become hollow, empty of the intensity I longed for.” I have felt this way for about 2 months but I don’t want to break up with my girlfriend. I just don’t know how to get out of it. I still love her.
It is interesting to see how many comments are written to each of your blog posts. The one about anger got around 250. This one gets 10. Yet both are important and worth deep personal thought. People tend to jump on anger and hang onto it because it is REAL emotion. And depression can be so numbing any real emotion is a keeper. Even anger. Then maybe they pass on a read about well-being.
I liked the part about starting with what is right instead of what is wrong. Even if you were talking about the particular philosophy and not what often happens in the therapist’s office. It is so easy to get up every morning pinpointing exactly why it is going to be a bad day. Not enough sleep. Too much fatigue. Not enough energy. Too much time lost. A whole life lost. And believe it or not, it can tumble even further downhill after that.
Self-acceptance is a good place for me to start picking myself up, propping myself up, in the mornings. It is so tempting to say to myself, “If I could only get my life back to normal.” But whose normal? This IS my normal! Self-acceptance to me is not feeding myself feel-good champagne and ice cream comments, it is saying here I am. Ready or not. Like it or not. And this is where I start. With what I have. My two feet on the ground. My apartment that I pay for with my disability money. My car that gets me to my feel-good places like the library and art museum. My mistakes, my spikey anger, my tendency to laugh uproariously in the least appropriate settings. Me. Just like I am.
Being in the moment with all I have at the moment. No more, no less.
I am replying to myself. Because I keep looking for more kindling to set myself on fire to do the work. It isn’t going to happen that way, is it. Either I start right here with my butt in this uncomfortable chair, feeling angry, unable to sleep and it’s past midnight, only one poor excuse for a friend, and unable to remember anything good in my past — or it isn’t going to happen. I can’t wait for a great day full of energy and resolve. I can’t back away when I wake up in the morning feeling nauseated by my own appearance in the mirror. I have to start with my 64 years, my sour stomach, my flabby thighs, my decades of trying to find the right medication, my restless agitation, and do it. I have to start right where I hate myself, where I can’t even remember basic chunks of my history, where I have nothing to return to, like that person who has been in prison for over 50 yrs and has just been pardoned. Cheap suit and $10 in my pocket and a cold cruel world out there. Nowhere to run or hide. Literally: do or die.
Thank you John for devoting so much time to building this site and keeping it going. I have returned here again and again to draw strength from you. Now it is time to find just enough strength in myself to open my eyes and stand my ground and start shuffling forward.
I love the holistic perspective of this recovery approach. I went through some major depressive episodes and what has reconnected me to my “true self” (that which is changing and growing) was not praising myself for simple tasks like getting out of bed and making it through the day, but rather getting back on that bike, getting close to my licensure in clinical social work, and reconnecting with my family. I want others to know that life can get even better after depression. You don’t have to limit yourself to be all or even more than you ever imagined you can be.
I think it’s extremely helpful to look at recovery in this way. It’s very concrete and gives a picture of what well-being really looks like. In fact, I feel a lot better after reading this because I realize how far I’ve come and what I still need to focus on. The self-acceptance part is still hard but considering that my opinion of myself was initially formed and drummed into me by others, it’s not surprising. I also can see, from reading this, how my work environment made it impossible for me to recover to any greater degree than I did when it just kept reinforcing what I already believed of myself. Now that I’m retired, the freedom from that sometimes feels almost exhilarating! And that’s a word I seldom use! I sincerely empathize with anyone who feels stuck in a soul-killing job, just trying to exist one day at a time, for years on end. Who wouldn’t feel depressed??? I wish I would have tried harder to get out of that position but ironically, depression kept me believing that it was hopeless and the people around me just added to that belief. Resiliency is difficult when there’s nothing flexible enough from which to bounce back up.
Hi, Judy –
It’s been a great help to me too to look at what a vital life consists of. Breaking out the dimensions this way is useful – even though they’re so closely bound up with each other – because I can see the persistent traits of mine that have made it so easy to stay depressed. It’s a rueful inventory but encouraging, as you say, to see how far I’ve come from where I spent so many years. Feeling you’re in the wrong job is really deadly – that alone produced enough grinding and sustained stress to give me a depression Cadillac.
John
I find it horribly difficult to try anything new, even the things I would like to do. For instance, taking a continuing education (non-credit) college course in photography. No telling how many times I have pored over the course brochures making note of which classes I want to take, but I can’t get past my fear of stepping into the unknown. It just doesn’t feel “safe.” But I have let depression define my “safe” boundaries, and once set, they are difficult to expand or move beyond. CBT might help, yes, but my CBT therapist seems to have no grasp of this barrier even when I try to explain it. It it like, “Just do this and this and this and everything will fall into place.” It’s not that easy, is it?
I think this is a very intriguing post and I printed it out so I can take it into the bedroom and read it while lying in bed, listening to music. I want to think about it a while before making any further comment.
Hi, Donna –
CBT can help, but no, it’s not easy, and it doesn’t begin to deal with problems like that of boundaries. I’m working on a post for Storied Mind on psychological flexibility that takes a different approach than CBT does. The idea is that energy spent on trying to regulate your thoughts and feelings into a desired state pushes you to a goal of static happiness or positive living. The problem is that you never reach the goal and so waste a lot of energy trying. The reality of well-being calls for adaptability to changing situations that call for different levels of positive and negative feelings and thoughts. Remaining flexible in this sense is a more accurate indicator of well-being than struggling to displace one kind of thought with another. I’m still trying to understand how this idea words, but on the face of it I responsiveness idea as opposed to aiming for static happiness.
John
I flip-flop on the “dimensions of a capable self” and “dimensions of a miserable self.” At any one time, I can feel I am achieving the first while at the same time feeding the second. But maybe that is a good thing. At least I can see the areas where I have improved while still being aware of areas in which I need improvement. Part of this is probably the perfectionist ideal: I sometimes see perfection as my goal and never fully experience it. But as you say, it is a matter of balance — somewhere between perfection and misery.
I guess you have to determine to start your path in the midst of confusion. Because right now I don’t understand any of this, even though I have studied it for a lifetime. I always want my ducks in a row, all my intellectual understanding behind whatever I want to do before I start. So I guess I can try something different. Go on even though my map doesn’t have all the coordinates penciled in yet. Go even though I don’t have an ETA or a clear destination. Even though some of it is in another language. I think I know the good part of who I am, and just want to claim that and hold onto it. And come to inhabit it daily.
I think this is a promising way to overcome the problem of those who were abused early not having a sense of (what for the rest of us is) normal. Looking forward to the next post.
Hi, Evan –
I think a great many of the conditions we call disorders start in early childhood and give you a distorted sense of how life works. You feel like an outsider and have a hard time handling situations that others breeze through with no trouble. So looking at well-being can be a revelation.
John