I’ve been wondering: How could it be that I have recovered from depression but still deal with symptoms almost every day? Can both things be true? Recently I’ve come across new ways of thinking about well-being and psychological flexibility that help explain this paradox. Finding these ideas couldn’t be more timely because doubts about recovery have been more frequent than ever.
It’s discouraging to have to keep dealing with the inner voice of depressive thinking, downshifts in mood or a tendency to withdraw into isolation. I do have the skills now, the new habits of living, that enable me to knock these out as soon as they pop up. Perhaps the doubt itself is a residual symptom of depression, one aspect of low self-esteem. The doubt makes me ask:
Could I be kidding myself about recovery? There are many ways to do that.
- Denial. Am I falling back into a pattern of denying there’s anything seriously wrong? I doubt that. I’ve been around the world with denial and know it pretty well. Besides, I’m keenly aware of each symptom, and I react as soon as I recognize one coming back. Another big indicator is that I don’t get angry if my wife tells me there’s something wrong. I know what she’s picking up, and I know she’s right. When I denied depression, I’d always get angry at any mention of the idea that I had a problem.
- Meds. Has recovery depended entirely on medications that have lost their effectiveness? No, recovery goes beyond the drugs, and, yes, I think the added lift I used to get from the current med combination is gone. I want to wean myself off the medications entirely. They served the purpose of helping me feel good enough that I could do the rest of the work of recovery on my own.
- Ego. Would I be too embarrassed to admit that I was depressed again after talking so much about recovery? I have to pause over this possibility because I’ve done that before with other problems. Sometimes, my ego gets so invested in seeing myself a certain way that I shut out all the evidence that goes against me. The thing is, I’m actively considering that evidence, and I’m looking for a way to explain it. So, I doubt I’m clinging to a false belief.
Traditional Measurements of Recovery
If I’m not kidding myself, and recovery is real, what’s the difference between having depression and having symptoms of depression? I’m definitely not talking about the questionnaires and scales the researchers use to measure your response to therapy. Those instruments look for remission of symptoms, not recovery in the sense of getting your life back.
On these symptom inventories, like the Hamilton or Beck scales, a score of 18.2 might mean you have a depressive disorder, but a score of 14.8 might mean you’re good to go, even if the only change is that you’re sleeping better. The people answering those questionnaires aren’t interested in symptom scoring. They’re interested in how they feel and how they’re getting through each day. Same here.
New approaches to therapy that focus on well-being instead of symptoms help remove my doubts about the extent of recovery. The key has been to turn my thinking around. The life skills I’ve mastered to deal with depression are more important to look at than any lingering problems. They’re what recovery is all about, not the absence of symptoms.
Focus on Well-Being
The focus on what’s right instead of what’s wrong is new to the mental health professions. For decades, psychologists and psychiatrists have studied disorders and everything that can go wrong with the human mind. The therapies that have emerged from traditional studies have reflected that same view. They dwell on the problems and try to fix them. Fair enough. After all, people go to therapists to stop the pain. The problem is that the therapies don’t work for everyone.
Relapse has become a big problem in depression treatment, and the new therapies have tried to deal with that problem specifically. These are the treatments that tend to emphasize wellness rather than illness. These are Mindfulness-Based Cognitive Behavioral Therapy and Well-Being Therapy.
Since these approaches are complicated, Here’s a brief summary of the the main ideas as I understand them.
Dimensions of Well-Being
Well-Being Therapy breaks out six inter-related dimensions of well-being and helps strengthen you in each one. They concern your adaptability to the conditions of your life, your ability to grow personally, your sense of purpose and direction, your personal independence and self-guidance, a positive attitude toward yourself and the ability to form close relationships with others.
This way of looking at well-being gives me specific ways of measuring my progress in recovery, rather than relying entirely on the general sense of inner balance and vitality.
Flexibility instead of Happiness
The concept of psychological flexibility pulls together a number of characteristics of well-being in a different way. (Here’s the link for downloading a theoretical paper about the idea.) Briefly, it describes the ability to adapt to changing circumstances to meet your life purposes.
It contrasts with the goal of therapies designed to help you regulate your thinking and feeling to achieve a beneficial but static state of mind and behavior. Cognitive Behavioral Therapy, for example, trains you to avoid negative thoughts and replace them with positive or optimistic thinking that, in turn, leads to positive feelings. Other forms of psychotherapy help you identify destructive life patterns so you can avoid those and practice more helpful ones.
The originators of the psychological flexibility concept go a lot farther than I would in rejecting these approaches. They believe that avoiding certain conditions in order to achieve happiness, however defined by each therapy, is a waste of time as well as the limited energy of someone who is ill. They believe that it’s far more helpful to work within the setting of both good and bad experiences to learn the skills of adapting your thinking and behavior to fit each one.
Acceptance and Commitment Therapy (ACT) is closely related to this idea. ACT emphasizes that avoiding painful feelings and situations is the source of problems rather than the solution. Its methods train you to go straight for the pain but with a deepened sense of awareness and mindfulness of your responses to each difficult experience. In this way, you develop the adaptability that enables you to live a full and rewarding life.
While I don’t agree entirely with this approach, these ideas about well-being and psychological flexibility do help me explain how it is that I’m still dealing with depression symptoms while also feeling so deeply recovered.
I’ve escaped the rigidities of depression that fix you in a self-destructive condition. Everything reflects your worthlessness, everything is pointless, everything is negative, now and forever. It’s exactly the opposite of the flexibility of a healthy mind and the engagement in life that helps strengthen the skills you need to have a satisfying way of living.
It’s the life skills I’ve been practicing that reinforce the feeling and energy of recovery. Seeing progress in the various dimensions of well-being and feeling the ability to engage people and situations I used to fear and avoid give me confidence that any remaining symptoms of depression won’t change the basic direction of my life.
I’ll never get rid of the doubts. I’ll have a lot of days when I feel so bad I’ll wonder why I think I’m recovered. But these ideas about well-being give me more specific standards to come back to. They’re reminders of what recovery is all about.
Image by digitalpimp at Flickr
I find the wellbeing approach far more attractive than the fix the problem approaches.
It is especially good I think that the wellbeing approach has a way of acknowledging that having some bad feelings doesn’t mean that you have a problem.
John Folk-Williams says
Hi, Evan –
I like that aspect too. Depression makes you focus on nothing but the bad – and of course you see everything about yourself as wrong, even when good feelings try to get through. So reinforcement of positive feelings and actions forces a big shift in attention. There’s very little research to back up the idea, but I can’t help but think that enhancing well-being is as powerful as any other approach in dispelling mood disorders.