One of the strange things about recovering from depression is that the condition is so pervasive getting better can feel like learning how to live all over again.
There’s a lot of disagreement about what recovery means and whether that is even the right word to capture the changes you undergo. Because there is so much variety in the ways of healing and the goals of wellness, I’m finding it harder than I had thought to get my ideas about recovery into the form of an ebook.
It’s always tempting to summarize my own experience as universal in some ways. There are commonalities in life dominated by depression and in some of the phases most of us go through as we learn what it is and how we can deal with it. But I want to make sure I can capture the range of differences too.
It’s not just that I keep exploring approaches that others have used. I also keep rethinking what I’m going through as I learn about new therapies and ways of looking at depression.
The best way I can organize the changes in my own approach is to summarize the different mindsets I’ve had about depression and my life generally. One thing I notice in doing this is how the words I’ve used have changed to reflect changes in understanding and greater levels of openness to what I feel.
Recognizing the Need for Help
Like everyone else, I had first to figure out what was happening to me. That process took many years, partly because when I first sought treatment in the 1960s, psychiatrists had a very different response to depression than they do now.
Unless you were in a state of collapse or suicidal, depression wasn’t treated as such. The focus was on an examination of causes for distress buried deep in your family history and personality. Getting rid of the “surface” symptoms would only keep you from getting at the real issues that were disturbing your life. The symptoms were the clues that helped you get access to the past.
So the early recognition of depression was restricted to identifying low mood, low energy and low motivation. At times, I would just float with it, letting myself soak in its darkness. I guess you could call that mindless acceptance, but the only effect was to get a feeling of comfort in my immobility. That didn’t help me very much.
I never used the word “recovery” or thought of myself as ill. I was just trying to figure out my screwed up life. Unfortunately, my idea of depression didn’t include damage to self-esteem and obsessive negative thinking, so those continued to shape my idea of who I was.
Redefining Depression as Disease
Much later I learned that depression influenced me more extensively than I had ever imagined. I learned the contemporary ideas about neurobiology, cognitive dysfunction, comorbid physical illnesses and the pervasive influence of stress. I connected with the larger world, the millions of people with depression and the array of medical treatments I had had little experience of before that time.
Learning that I had a “brain disease,” a medical illness rather than a vaguely psychological and emotional “problem” was a huge relief. I eagerly embraced the medications and newer versions of psychotherapy.
It was a period of new hope and energy in dealing with depression. I was “sick” with illness like someone with cancer, not “sick” with a defective personality and less than fully human nature. Finally, there were medicines that promised to help me feel good without putting me into a stupor.
Unfortunately, the strange optimism about having a disease turned to hopelessness when I found that medical treatments didn’t work. Even though I was the energized and highly motivated partner in treatment, I was in the passive position of waiting for the latest medication or procedure that, maybe, this time, would bring recovery to my doorstep.
I put my hope in transcranial magnetic stimulation and followed the trials and FDA approval process. Unfortunately, it was an expensive treatment that required out of state travel at the time. As further discouragement, I met a friend – treatment resistant like me – who had tried it with only minimal results.
He also had a vagus nerve implant (a pacemaker-like device inserted under the skin that sends a pulse of electricity into a major nerve), and that wasn’t helping him at all. When he undertook electro-convulsive therapy, lost short-term memory and his usual fluency in putting sentences together – but was still depressed, I was scared away from trying that approach as well.
Independence and Taking Charge
In the next shift of mindset, I decided that I needed a more comprehensive approach to recovery. I went back to the starting point. I tracked my daily existence to identify all the depressive habits and symptoms that I felt were restricting me and limiting what I could do.
I wanted to dispense with the general list of depressive symptoms familiar from the diagnostic manual and self-help books and see exactly what my version of depression was like. That process helped me match specific therapies to each set of problems I wanted to deal with.
I was full of purpose to feel good about living again. I understood that I had to be as active as possible and to accept relapse as part of the process. I had a lift in mood from medication for a while, learned the techniques of cognitive therapy, drastically reduced persistent sources of work-related stress, found my way back to writing as an important guiding purpose, and opened myself more to relationships and doing things with my family.
All this and more helped me to a state of stable recovery in which any legacy symptoms of depression felt like brief diversions. Surely that was it. I had recovered, task accomplished. But that’s not the whole story of living well.
Learning to Keep on Learning
I’m in a different stage now, but I don’t know what to call it. Others refer to this as transformation or self-mastery. Those words are helpful. Instead of feeling like I’m successfully coping with an illness, I’m changing the way I think about depression and how it fits into my life.
I’m seeing the good and bad dimensions of my experience as a single whole, each aspect of which has its opportunities for discovery and fulfillment.
One way to think of it is that I’ve reinterpreted symptoms as experiences. The attitude is more open, accepting, even welcoming of what happens. Maybe it comes down to the simplicity of feeling I have my feet on the ground and of being open to exploring the terrain rather than afraid of what I’ll run into.
Talking about this flow of living and discovering in terms of stages or mindsets is, of course, misleading. There aren’t very clear boundaries where one ends and a new one picks up. But I can separate out different beliefs and expectations that influenced how I responded to depression, to myself and to the people in my life. There is as much continuity in who I am as change in awareness, and there are no endpoints to anything.
This latest mindset is still forming, and it will doubtless be followed by others. Perhaps the key thing is that I have kept responding to depression as an essential part of who I am. Whether I’ve thought of it as disease and disability or opportunity for discovery, I have had to grapple with forces and energies within me that I will never fully understand or master.
You can see why it’s so hard to put all this into ebook format. I keep wanting to feel like I’m finished, that I’ve done it and can help others do it too. I’m so used to talking about life having purpose, structure, direction, values, goals, processes, as if it were something I could build and shape, reach out and touch. But I can’t.
What do you think are the attitudes and mindsets that keep you going as you deal with depression?
This is an updated post from the archives.