When I started learning about Acceptance and Commitment Therapy (ACT), the idea that I was doing depression rather than having it as an illness didn’t make a lot of sense to me. I could understand that avoiding painful situations could worsen depression and that I often acted in self-defeating ways. But weren’t those the effects or symptoms of an underlying illness?
Knowing that I had an illness called depression explained so much of my experience that I found it hard to suspend that way of thinking and consider an alternative. I had enough awareness, though, about the habits of depressive thinking that I could take another step backward to look at my assumptions about illness.
Before getting into this, however, I want to make it clear that I’m not suddenly abandoning the idea that depression is an illness. Nor am I going to rewrite every post on this blog that starts from that assumption. Thinking of depression as an illness was an enormous step up from identifying and blaming myself as an inadequate or crazy person. It helped me gain a distance from depression that marked the beginning of recovery.
This series is an experiment in changing perspective radically to see if it will help me move further toward the fulfilling life I want to live. I’m not recommending that this will work for everyone. I’m not even sure it will work for me. But it’s exciting to try something new, and anything that keeps me active in learning how to live well is worth the effort. So, back to the story.
I’ve relied in the past on tracking depressive symptoms in order to map out a plan for recovery, so I started by revisiting this method to get into the ACT approach. This time, instead of looking at symptoms and triggering events, I looked at my actions and what followed from them. Since I’ve gotten better in recent years, I mostly looked to the past when I felt completely locked into depression.
This became an inventory of the habits that had guided my life for many years. As soon as I thought of these patterns as a way of doing depression, I wondered how I could have missed it. Many of the problems that I had thought of as symptoms or impacts of an illness could also be seen in this different light. It was more than the act of avoidance, or not doing something. I could see that I had actively done things that made my life more painful, and I had repeated them over and over again.
Work:
At different periods in my life, I felt that the stress of my work was killing me, and I came to dread showing up. I realized I was handling assignments less and less effectively, even though I knew how to do the job well and had succeeded many times in the past.
I assumed that symptoms of depression were undermining my skills and acted to end the symptoms. But I did more than that. I convinced myself that because of depression, I could not make a living doing anything else. I stayed in the same line of work, even though I grew more and more anxious and panicky about doing it. I not only stayed with it, I acted with great persistence to drum up more clients so that I would have even more work to do.
There was also a strange undercurrent that I paid less attention to. It was a background feeling of resentment at being trapped. As a result, I was refusing to act effectively. I know that sounds bizarre, but there it was, like a kid’s reaction to being forced by his parents to do something he didn’t want to do.
Deep down, I’d be feeling: I don’t want to be here, so why I should I do anything for these people. Afterward, I’d take all the blame for a failed job and be plunged more deeply into depression. I berated myself for failing and spend hours in anguish and shame. I resolved that next time I would to do all the things I knew how to do instead of holding back. Then I would go out and do the same thing all over again.
Writing:
In the meantime, I knew what I really wanted to do. More than anything, I wanted to write. That was the work I valued most, but I convinced myself that two things made it impossible. Depression as an illness was at the heart of both.
Because of limitations caused by the symptoms, I wouldn’t be able to earn enough money in this way. Even more fundamentally, I had a block about writing itself. When I made time to write, I would be depressed and deeply anxious. My mind blanked out and often shut down in sleep. So I would busy myself with taking notes and other tasks but avoid the act of creative work as much as possible. I stopped trying to write because of the fear, even panic it aroused.
Then I would go through the same process all over again, feeling trapped, trying to write, convinced I couldn’t, getting panicky, stopping in frustration, blaming depression. Yet every step of the way, I was making decisions and acting on them without changing the strategy in any way.
Treatment
When it came to treating depression, I looked only to the elimination of symptoms and never thought about trying to act differently. I took medication, and I did psychotherapy with the goal of feeling better. Neither method was very effective.
I remained depressed, with occasional periods of relief, but this was the same cycle I had always lived with. The change seemed to be that periods of depression became longer and the symptoms more dominant. Yet I kept treating depression in the same way because I was afraid that things would get worse if I stopped.
I could extend this list to include most aspects of my life, but the pattern was similar. In ACT terms, as I understand them, that pattern goes like this:
- I fused with my thoughts and mental rules about myself, about depression and about the choices I had. The thoughts owned me, and my mind was purely reactive to them.
- I tried to control depression by avoiding problems, sometimes even cutting myself off emotionally and mentally from a situation while in the midst of it.
- I knew what I valued in life but believed I could not act on those values. So I acted on different values that were not mine.
- I tried to get out of the trap I was in by acting in ways that kept me in the trap.
No, this doesn’t make much sense, but the ACT experts help you see how little awareness you have when you’re struggling with depression. There are a lot of rules you learn and apply in the belief that you’re helping yourself. But I do have to ask: how many times do you have to knock your head against the same wall before you get the idea that it hurts?
Have you looked at your experience of depression as a pattern of actions rather than a set of symptoms? It’s not easy because you have to suspend judgment and many of your assumptions. You could think of it as a thought experiment. Do you find yourself doing depression?
I’ve been doing some introspection lately about why I keep ending up depressed. I’ve found that by writing it out, it helps a bit (you can read what I wrote at http://soluble-fiber.com/2015/08/08/when-depression-sets-in/ ). Maybe it’s just the fact that writing forces you to slow down your thinking, but I found it helped me see what I needed to do to carry on.
Hello, Thank for such an interesting and inspiring blog. I am 69 years old, and have suffered from depression since I was 22 years old. Throught the years, I have survived -but I also have had very good years. Last year in the month of August, I started again with a very deep depression, the antidepressants are not helping me. I started reading about ACT three months ago, I have been applying some of your methods. I have been able to understand depression more. I wonder if I can do it on my own, or does it work better if I do it with a therapist. I live in San Francisco, CA.
I would really appreciate if you could respond.
Thanks a lot,
Victoria
Dear Victoria, given your life story with depression as you tell it, I recommend you to start therapy as soon as possible with an ACT therapist. You have lived almost your entire life battling with depression, and I can’t even imagine how that’s like, but it’s never too late to get better. Self-help books are good, but seeking help from a professional therapist will make things much easier for you, and also faster.
I’m a clinical psychologist and I use ACT with my clients, and the results are really good. I live in Argentina so I can’t offer myself as therapist, but I can give you orientation if you need it. Feel free to write me al my email adress: nataliavrodriguez@gmail.com
Best of luck for you, and don’t give up! Change is just around the corner!
Let me tell you that I completely love your blog. I’m a clinical psychologist from Argentina, and I often find enlightening reading blogs like yours, where people tell how they managed to cope with mental and emotional suffering, what worked for them and what didn’t, etc.
I’m iniciating myself as an ACT therapist; there aren’t many in my country as here this is still a very new approach that most people don’t know. I’m starting a blog myself, in spanish, with articles of interest for both colleagues and general public who want to know more about psychology, and I was wondering if you wouldn’t mind if I traslated this article from your blog and submit it to mine, with due credits and links to the original of course. I really enjoyed reading it and I think it’s a shame more people can’t because they don’t speak english! Anyway, if you agree I’ll be most thankful!
Also, I’d like you to tell me how ACT has worked out for you. I really hope you’ve found your own path to a meaningful, fulfilling life, and that your depression has receded (though that’s not really the goal of ACT, but often a very welcome bonus!) Best wishes for you, and I’ll be waiting for your response!
Lic. Natalia Rodriguez – Clinical Psychologist – MN 55.888
Mr. Williams,
Thank you for your enlightening post.
I’m an avid follower of Stephen Hayes’ “Get out of Your Mind and Into Your Life”. I have been depressed for over 15 years, but ever since picking up Mr. Hayes’ book, I have begun to see a slight change for the better in my life. Your timing could not have been better–I was on the road to returning to pre-Hayes level of depression again, when your insightful comments make me reflect on what I have been doing, and I realized my mistake on time.
Long story short: I was depressed because for 15 years, having moved from China to US, I cannot assimilate into U.S. society, which are exacerbated by my lack of dating prospects. This depression caused me to drop out of college. Recently, I have been studying again and working out intensely, which brings out feelings of: longing for intimacy, increased sexual desires, loneliness, and failure in concentration.
Unconsciously, I began to rely on online pornography stories to combat my increased sexual drives, to my own detriment–these stories are often written by people more cruel, more attractive, more experienced than I. Had I not came upon this post, I would have simply dismissed reading porn stories as “natural”–they are not! They bring out the worst fears, memories, and sensations within me!
Thanks for the reminder again about the usefulness of mindfulness again. I know Prof. Hayes really tries, but he tends to bash it in my skull so many times when I’m feeling the most pain, it’s hard not to feel resentful sometimes.
Hiroki
John,
This is an old thread but I hope you’re still responding to it.
You’ve described me to a T. I am stuck in work I detest because I have invested so much experience in it, I don’t know what else to do. The irony is that I’m a writer and I love writing, but I’m a technical writer and my subject matter is often dry and uninteresting. The client I work for is deadline driven and the pressure to produce is immense. The work pays well but it is stressful and exhausting.
My recurrent depression keeps me locked into thinking that there’s no alternative; I must do this because of the money, because of the time I’ve invested in it; because it’s the only type of writing that pays well, because, because, because….
It only takes a glance at my non-depressed freelance writer colleagues to see that there are many alternatives. They seem to move easily towards the type of paid writing that turns them on, makes them passionate, etc. Of course that takes marketing, vision and a “go for it” attitude. Depression is like a cognitive prison; it forbids hope and freedom; all doors are seemingly closed; all escape routes cut off, and all energy is sapped. The prison chains tighten and each day is like going to a torture chamber for another bout of suffering. I need to find a way out of this before I get really sick.
It’s time for me to go back on medication, even though I know it provides only partial relief. I need to learn more about ACT. Can you recommend any books or websites?
Your site is a great resource for depressed people; you give us all hope.
BW
Hi, BW –
With your level of self-awareness about how depression is affecting you, I think it’s a great time to move beyond medication alone and also work with a therapist. ACT is a good approach to explore because it can help you turn what you know intellectually into action. The leading website for ACT is at this web address: http://contextualpsychology.org/act – they have a world-wide directory of ACT therapists. There are many books out now, but I find that it’s easy to get stuck on the concepts and theories if you just read about it. Steven Hayes’ Get Our of Your Mind and Into Your Life is the best introduction. Also good are The Mindfulness and Acceptance Workbook for Depression by Strosahl and Robinson and ACT Made Simple by Russ Harris.
I can especially empathize with your situation as a writer, since I spent years using my writing skills on reports, memos and technical books and had the same hesitations about making a change. The internet has made a huge difference in creating a whole new medium for writers. I wish you all the best!
John
i am not sure all depressions are the same. as i am not sure anyone person can experience anything the same as another.
however, i have long held the veiwpoint,
(that has until now found no validation anywhere (THANK YOU :)),
that depression can be a defense against the fears, anxieties, pain, and anger that lurk within just as avoidance or denial or cognitive dissonance or any of the standard defenses. sometimes the depression can set in after the guilt and “i am so bad and wrong” feelings come or it can be there to justify not acting to keep something we want or to keep pain we think we dont want. depression is HUGE in its ability to encompass ALL the other mechanisms that could be used singly or at least not with so many other factors and the web or downward spiral one gets trapped in with this type of depression is enormous and so damaging to the well being and relationships of the depressed person that it can be impossible to pull out of given the fact that so much must be faced then.
how do we encourage and yet hold in some way accountable the one who is doing depression?
i do not believe that “doing” is a choice but i do see it as something learned before choices existed and thus also potentially unlearned. but what work and commitment that would take! i will re-read you many times john…am i seeking an excuse to not leave the one who has hurt me so often for so long? or am i truly able to help?
i dont know, but i see truth here. and i see the patterns and the inabilities reasons. does that mean i could stay with this in my life? i dont know.
Hi John,
John,
This is a terrific post to which I kept saying as I read down the page, “Me too, Me too, Yep, just like me.” I went through all the maladroit efforts to fight depression that you recount. Far from not making sense, it makes all the sense in the world. I myself was very slow in learning from my failures and begin acting and thinking differently. The beginning, as I recall, was to stop fighting depression. When I accepted it as a part of my life, I was then able to learn from it. One thing I have learned over time is not to overprotect myself. Depression makes me want to crawl in a hole while assuming that any interactions with people will only worsen my condition. This has proven to be untrue so even when depressed I try to push through with my normal and scheduled activities.
I am familiar with at least 25 websites on depression but just stumbled across Storied Minds and love it.
Thanks, John.
Hi, Galen –
Thanks for all your comments – you have a lot of insight after your long years with depression. Like you, I’ve learned to do many things to control depression, but the approach of ACT has been a revelation. I’m convinced that the words we use to describe experience and the overall context in which we encounter it – like being told we have an illness by a doctor – limits our expectations in certain ways. Something like ACT has a great effect by turning the old concepts around. If you can think in terms opposite to those you’ve become accustomed to, it’s possible to feel a great energy and sense of hope as well as healing. The theory behind ACt goes into this quite deeply, and I’m starting to look at that aspect of it. This is not a matter of intellectual curiosity but seems rather another dimension of the healing process.
John
I have had episodes of what used to be called clinical or biological depression for 30 years. I have no doubt that for me depression is an illness, partly because it has no continuity with my experience of “normal” life. They are two different worlds. In addition, I have responded to some medications in a way that only makes sense on the assumption that there is something awry in my brain, whether a scarcity of neurotransmitters or something else.
But at the same time, depression can be significantly affected by life situations, my thought processes and my behaviors. Over the years and very gradually I have learned about the best ways to move through episodes. I am still learning. I think that I can also moderate an episode when I see it coming. But my best defense is a way of life that integrates a number of elements. In this way depression is similar to other illnesses like heart disease and diabetes.
I am very glad to have found this site.
John, again, you’ve given me something new to think about. This concept of “doing” depression does make a lot of sense. To me, it feels like the doing of it is so enmeshed with the symptoms, especially the thought processes, that it’s hard sometimes to know where one stops and the other starts. I know I’ve spent a lot of time kind of waiting around for the symptoms to go away and feeling like it didn’t much matter what I DID, that somehow, once I got it all figured out, THEN I would act differently. It kind of reminds me of the phenomenon of wanting to lose weight – after I lose the weight, THEN I’ll exercise more, buy clothes, etc., etc. And we all know how well that works.
I’ve wondered sometimes if I actually am afraid of not being depressed. It’s like it’s so much a part of my personality, maybe a piece of me will be gone if it disappears! Now, that would be a line of thought that could certainly evolve into blame and shame, but I think there may be some truth to it. Is there a “depressive personality disorder?” Would that mean I’m inventing the symptoms? That’s kind of a pathetic thought.
I also could identify so well with your description of trying to work when depressed and developing this rather hostile attitude about it. During the worst of it, for me, I would sit by myself in the cafeteria at lunch and as people walked out, fantasize about shooting them if they looked happy. There were so many things that were wrong and it wasn’t 100% my depression, but the depression kept me feeling powerless and, yes, so trapped.
I’m looking forward to learning more about this. Thanks.
Hi, Judy –
You remind me of a post I did a long time ago asking if there was comfort in depression. I think there can be, in the sense that depression answers all your questions and settles you into a familiar pattern of living – however terrible it can be. Getting better is a hope, but it also means a lot of change. In depression, of course, change – anything requiring energy, seems so remote and impossible. I sometimes felt like sitting back as if in a drugged state and resting as the busy world went by. It was a form of escape. I think everyone with depression at some point feels like they’re making up symptoms – a fraud who’s just evading everything. Thinking of depression as an illness and that type of thinking as a symptom was extremely important. Whether it “really” is an illness or not matters less now than doing life.
John
Hi John–
It sounds like you’ve got ACT pretty well pegged. As for whether depression is an illness or not, I see that as merely a semantic question, and it can have different answers depending on one’s stage in dealing with the problem. If ‘illness’ means a condition that feels unpleasant and limits life, then yes, depression can be (and usually starts out as) an illness. But if it means a definable brain disease that can be treated with specific medications, one can only say that at this point there is little evidence to support that view. I’ve followed this research for years and have yet to see any findings that solidly (or even plausibly) demonstrate organic pathology. For every suggestive piece of evidence one can find powerful refuting arguments.
Although the disease concept helps relieve us of shame and so can be helpful early on, eventually we want more than escape from blame. We want better living. ACT offers an approach to achieving that. I am personally glad that I came to ACT after working with psychodynamics, CBT and many other methods. Those earlier educations taught me a lot about how my history affects me and how my thoughts can be highly inaccurate. But now I am ready to let most of that material go and just focus on what works. And what works is living life with purpose without so much emphasis on how I feel or what I think.
This doesn’t mean I need to drive myself in occupations that don’t suit me. It doesn’t mean I can’t listen to my intuition or think about options. It simply means that I have more flexibility in my responses. I no longer react reflexively out of fear, anxiety, insecurity, or negative self-talk. As I’ve begun to live a richer life despite my frequent feelings of sadness, regret, and fear, I’ve started to see that the ‘illness’ concept no longer serves me as it did earlier. But in the end, it’s just a word that people can use or not use according to their situation and preference.
Thank you for sharing your thoughts as you explore ACT. I especially appreciate how you remain observant, resist blind acceptance, and honor the value of earlier work. We need to approach healing paths empirically. The Buddha often cautioned followers to test his ideas in their own lives rather than embrace his concepts without question. I think that’s always good advice.
Hi WillSpirit,
We know that depression is not a “definable” brain disease, assuming that definable means identifying specific areas and neuro-processes that account for it. The disease issue may also depend on what is meant by depression. People often use the term to indicate a bad mood or feeling down. That’s fine, but severe depression–depression that incapacitates is an entirely different beast. That at least is my experience and accords with numerous accounts of depression I have read. My own depression was a brain dysfunction; it responded to no number or variety of therapy sessions. At present I take medication that seems to prevent the worst depression. But I have breakthroughs that can be mighty unpleasant. To live in a way that minimizes these episodes or prevents them from being more severe or prolonged I marshal numerous strategies. I do this imperfectly and am sure that there are other things I can be doing. So I look forward to getting acquainted with ACT.
Hi, Will –
Like you, I’ve worked my way through many types of therapy, and each was helpful, though not the cure-all that I expected or wanted at the time. I’m still not sure why but a few years back the idea of being sick with depression went away. Living – and working – with a sense of purpose is the main concern and with that has come a sense of excitement. I don’t want to think of myself as ill any longer, but I’m so conditioned to thinking that way after all these years that it’s easy to think first of what’s wrong rather than what’s right. I guess the hardest thing is just to let myself be and stop imagining that there is some far off goal of well-being that I need to reach.
Thanks for your insights, as always,
John
I think depression can be an “all of the above” experience. Something is going wrong in the brain and body — an illness — causing symptoms. Medical treatment can be applied to this. Symptoms are affecting thoughts, which affect behavior. Behavior and symptoms are jumbling the mind to create disadvantageous rules and beliefs. Illness and symptoms make it difficult to overrule the beliefs and act in ways other than what the “rules” say. Changing behavior, going toward the fear rather than away, changes beliefs and rules, which change symptoms, which can modify the brain. The root cause, the illness, may go away (or into remission) long before the symptoms caused by the feelings, beliefs, and rules can change. Making the effort, acting “as if,” and walking through the veil of fear are all required. Even if you can’t do it all the time with every fear.
I credit Dr. Claire Weekes with some of these ideas. Her books (“Hope and Help for your Nerves”) came out decades ago but are very common sense and full of wisdom. Also Dr. David Burns (“Feeling Good”) and his mentor Aaron Beck. I’m liking “You are not your Brain.” I had a hard time getting into the book I bought on ACT. I have also had some good therapists getting me through the tough times, and my wonderful psychiatrist.
John, good luck with the ACT. It sounds like it’s the right thing at the right time for you. We all go through our passages and I appreciate the network of helpful people you’ve drawn to your blog.
Hi, Karen –
I’ll have to find Clare Weekes’ books – thanks for alerting me to another writer I haven’t met before. It’s easy to go around in circles trying to figure out what is influencing what when it comes to depression. I’ve dropped any hope of understanding cause and effect – there isn’t any clarity at all about the causes of depression. Nor do I get help from a given therapy because it goes more accurately to causes than other models do. You’re right – there is a time in your life and your history of depression when certain approaches resonate and work and others don’t. It’s an endless learning process for me, but in recent years one full of insight and a feeling that I’m getting somewhere.
John
As I read this post I kept nodding. I feel that your words captured my experience of working and living as a lawyer these past 25 years. Doing alot of work that my heart isn’t in, stressing out about not doing (being?) enough despite success, blaming/shaming myself for my depression, etc. Like you, I also love writing. I also want to be a writer – I guess I am because I blog. However, my job only allows me small pockets of time to write. Work has been tough lately and I’ve felt very alone with my depression. Your post really helped me feel less lonely today. Thanks for this gift John.
Dan, you’ve given so much to depressed lawyers (so we don’t feel alone, or like we’re totally defective). Give yourself some kindness and compassion from the appreciative lawyer community. You were probably the first writer and blogger to help me understand that I wasn’t alone and there were work-culture forces (as I’d suspected, though everyone else seemed so gung-ho….) making my struggle harder. Thank YOU too.
Hi, Dan –
I’m glad you found a little help in reading this post. One of the problems I’ve found in trying to follow a certain type of work is that the investment in expertise can become the reason for staying with something you no longer want to do. There are all the practical constraints as well that make it hard to change. I found ultimately that the stress of my professional work was literally killing me, and the relief I felt after letting it go so precious. Maybe the hardest thing is accepting – or imagining you can cope with the sacrifice of income, standing – whatever benefits of the job have been deeply entwined in your way of living.
John
John,
Thank you for the ideas about leaving stressful work in this comment. I just had a 3 day weekend and felt like a human being for the first time in a long time – back in the office I am becoming increasingly convinced that I’ve actually already died but just haven’t fallen down yet. And it is the investment in skills, the fact that I’ve already had loans and paid them off and, most of all, the fact that within family my professional degree and career have always been treated as the proof of my worth (even though I do NOT want to do them) that conspire to keep me stuck. I can imagine the relief in leaving – will have to do this soon for myself.
Hi, MJ –
I hope you can find something that is more satisfying to you. You may well have a lot more options than might occur to you when feeling stuck. The fear of changing your work has its practical side, to be sure, but much of it is also the depression talking.
John
Hi John, the problem as an illness thing is interesting.
It is often criticised because it disempowers the sufferer. But this needn’t be the case. Often, as you found, it is a way of responding with – well, I need to deal with it then. The reality of depression (or whatever) is accepted and responded to. So that the diagnosis encourages action not passivity.
Once we see that we are part of our experience and what we do shapes our experience we have the possibility of a better experience.
Thanks as always for your insight.
Thanks, Evan –
The idea of illness can be helpful or not. I think it depends at least initially on how a diagnosis is communicated by a doctor and how awed you might be by the voice of medical authority. Depressed people can be so vulnerable since they often have little self-esteem. It’s easy to become passive, especially when doctors encourage you to think that your health depends primarily on a medical procedure or prescription. I don’t have any problem thinking of depression as an illness if that refers to the experience of feeling certain kinds of pain rather than an objectively verifiable disease process in the body. But so much depends on the words and symbols surrounding an experience that a new set of concepts can shift your attitude about what you can do for yourself.
John