The Depression Notebook – continued

In the morning she scuffed her way to the kitchen and sat down with a fresh cup of coffee. It took a while for her to feel awake enough to look around, to survey the disaster. Somehow she’d cleaned up the sink full of dishes yesterday. Finally. It looked nicer. Her memory of the day was hazy, as usual. Brain fog, or something, she said under her breath.
She glanced at the table and saw the notebook, still sitting there under the damp towel. Only then did she remember — she’d written that list, the “what’s wrong?” list, the day before. What a slog through my collection of hells, she thought. She did not want to read it through, or think about the problems for a while.
She sipped the coffee and stared off into the distance. All the things going wrong…quite a list. Seemed a bit — just a bit — more manageable, at least, after doing that brain dump.
Then she remembered, there was another question. One was about what was wrong. What was the other one?
She refilled her coffee mug and sat back down. She opened the notebook to a new page. A fresh start. And again, as if a voice within whispered the words, she wrote at the top of the clean sheet, “What’s going well?”
She stared at the sheet for a long time. This was harder. Finally she wrote, “well, the coffee is hot.”
Smiled a bit. That was stupid.
“…and the dishes are done. The kitchen looks a bit cleaner.”
She sat a while longer, nothing else coming to mind. Then something did. Just a little thing. She wrote it down.
And another came to mind.
After a while she stopped. She’d filled half the page. There was a list there, which came from…somewhere. Things going well.
The stupid smile came back to her face. She decided to get up and shower and finish the cleaning. Something felt a bit better, anyway. Maybe not hugely better. But a bit.

Getting the mind out of the depressive track
Depression tends to involve a cycle of thinking and mood symptoms. They tend to fuel each other, much like a cat chasing, but then catching and biting on his own tail.
When you are depressed, you tend to filter out the good stuff. You are less able to remember the positives, the pleasant experiences. It’s harder to remember the many things that are going right, because you get so focused on what is going wrong.
It’s a form of tunnel vision. Only focusing on the bad parts.
I like to think of this as a sort of survival reflex gone rogue. In primitive times, we probably needed a way to cope with emergencies that involved laser-like focus on whatever was going wrong. You want to survive in a stone-age environment, you need to be aware of the falling tree, the attacking animal, the noise in the bushes. Everything else should be put on hold.
Which is fine for coping with an immediate, short-term emergency. It keeps you alive.
The problem is that in most of our lives, the sources of danger are not short term, and not physical threats that require an immediate response. Rather, they are simmering problems: a relationship under strain. A bill that you can’t pay this month. A chronic physical condition. Loneliness. Loss of a love.
Those problems are not acute, fix-it-this-second-or-die emergencies. Yet our brains treat them as if they were.
Meaning, we automatically focus only on these negative things. And so we forget about the rest of life. The good parts.
In short, our conscious awareness gets stuck in a toxic groove. All we see is the negative.
This in turn triggers our biology, and nasty things happen. Stress hormones, brain chemistry, a cascade of ick.
The advantage of making yourself shift focus
Several decades of research in depression has confirmed what some of the ancient philosophers taught about the healing effects of shifting your focus away from the ick. Often, the simple act of listing what is going well, of writing down things you are thinkful for, or even just forcing yourself to smile, can actually, believe it or now, help you feel better.
In effect, what you think and what you do to feel less depressed can be as effective (or even more effective) than taking a pill to treat your depression. These things literally do change your brain chemistry as effectively at times as antidepressants.

Thoughts and acts are medicine

Try this exercise a few times. It’s one of many ways of doing this. Just do it and see if it helps at all:

Write down a list of “things going right in my life today.”

Little things count. The coffee you like. Someone smiled at you. The sun came up.
Just see what happens. Not promising it will work. Just worth a try.

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Putting Pen to Paper

A woman sits alone in a quiet room, weighted down by a sadness that has come over her like a heavy, smothering wet blanket. She feels alone, hopeless, has no energy. She cries often. She has had bad things happen to her, feels like a failure, sees nothing but the dark days of winter and cold and isolation and shame ahead.
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Almost by accident, as if a force inside her was gently encouraging her to do it, she picks up a pen and opens an old notebook. Maybe one that her child abandoned when she moved away, maybe an old sheaf of paper. And for a time she merely doodles. Tries to draw, tries to focus her mind.
Finally, she writes, “What’s wrong?” on the paper. She starts listing all her faults. Her failings. Her losses, in love, in comfort. She nearly writes about some bad, horrible memories she may have…but at the last second her thoughts veer away.
After a time she puts down the pen. It’s enough. She may feel…just tired after that. She sleeps, even though it is the middle of the day. Later she wakes up and makes tea and stares out the window.
Or perhaps she does feel better. Just a bit. She glances at her list of faults and problems. Shrugs, and then decides she should make her bed. Maybe change the sheets. Feed the cat.

The complexity of depression
Many people with depression have had similar experiences. Sometimes a feeling of being overwhelmed, sometimes the near-opposite, a sense of flatness, numbness, emptiness. It is often the case that depression is mingled with other bad feelings and thoughts: anxiety, panic, fear. Old traumas that never seem to fade are often the distant cause of current depression, confusion, endless-seeming pain. The body is often affected in myriad ways as well, whether through chronic pain, cravings for toxic substances, headaches, fibromyalgia. Or just a constant fatigue, a need to sleep, an inability to sleep.
Depression’s complications are many — it is not simply a matter of a down mood or a few simple-to-identify bad thoughts or mental habits. It’s like a ball of yarn that’s been dragged out into the yard and forgotten for a season. It’s tangled, messy, dirty, knotted, and it smells bad.
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It is important to respect, and not to ignore, how complicated and tangled depressions usually are. They are like a tangle of yarn from four or five or ten different sources, mingled together. It is in fact the very complexity, the many many things that both cause and then result from depression, that makes it, often, so overwhelming.

Untangling the mess
I’m going to suggest a lot of things that might help you to feel better if you’re depressed. They will include very simple things you can do or think, and also some that, to work, will require that you learn a simple set of skills. (Nothing too hard, but probably things nobody taught you to do at home or in school.) In fact, my book will list over fifty things you can do to manage, or even eliminate, depression.
But one simple thing, one that many people do find helpful, is to write down the answers to two questions.
The first question is, “what’s wrong?”

From “What’s wrong with me?” to something else…

When we’re depressed, our first impulse when asking ourselves this question is to ask “what’s wrong with me? We tend to want to blame ourselves. This can, sometimes, lead to a litany of self-blaming statements that only sink us deeper into the blackness of our moods… much like struggling to pull your feet out of quicksand will only sink you deeper into it.
I would suggest a slight change in what you write. Just write the question this way:
What’s wrong in my life? What’s going on that is bothering me?

Then jot down anything that is troubling you. Be messy. If there are “external” problems like money or relationship worries, write them out — shorthand, or even drawings, can be enough. List names, list situations, list the sink full of dishes, the backache, the unpaid bills.

The point in writing out your problems this way is not to fuel more ruminating about them. The point is to clear your mind.

That’s all it’s for. For now, having things a bit out there, may be enough.

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When I was learning to be a therapist my favorite supervisor, Paul, explained something to me about doing a first interview with a patient. It has always stuck with me.
He advised me to start my intake interviews with one question: “What brings you in?” Then to just listen. Give the client the space to talk about it. All of it. All of the many things that are troubling them. And don’t start jumping in with a hundred questions and suggestions.
Paul said that you wait for the moment when the person has talked it out. The moment when they have listed, explained, talked about all the things that are troubling them. It might be one thing, or two, or fifty. But a moment wil come when they finally stop. They may audibly sigh. They relax.
It’s all out there. Finally.
Write until you get to that point. Until it’s all out there.
Maybe you cry. Or maybe it seems clearer now.
Then rest. Take a nap. Sip some tea.
That may be enough for now.

About that notebook…

Yesterday I talked about the importance of taking that first step to deal with feelings of depression. And how that can be difficult.

It’s actually difficult in many areas of life to take a “first step”to solve a problem or get something done — it’s not just something that happens when you’re depressed. Starting in on a little or a big project can be hard for lots of reasons. Even writing this post, I found that there were a bunch of reasons it was hard to get started, including:

  • It was the end of a long day at work and I hadn’t gotten any free time to work on it when I was fresher during the day… so I’m trying to do it when I’m tired (apologies in advance for mistakes)…
  • It seemed easier to tell myself that I can “get up early and do it tomorrow” (meaning now I also have to overcome the demon of procrastination)…
  • I didn’t have a clear outline or idea what to say. That’s especially true because what I need to explain seems kind of complicated, and so I want to get it right. (Even though it’s harder, I think, to explain than to actually do once you get it.)

Notice that none of these reasons for it being hard to start this post have anything to do with “depression.” I’m actually not feeling depressed this evening. Just tired and uninspired.

But depression brings its own special challenges. If I were feeling depressed, it would be like dealing with the three reasons for not writing above, plus all the reasons that tend to flow from depression. Such as self-doubt, pessimistic thoughts along the lines of “this will suck,” fears of things like failing, being embarrassed, “looking stupid,” making someone angry at me.. and a zillion other things.

See? It all adds up. “Regular” reasons for not getting started are there for most of us. “Depression-based” reasons just pile more, heavier weights on top of our minds.  The formula, if you like math, might be something like:

Regular problems starting + Depression based problems = MASSIVE problems getting started dealing with the problem

What to do, then? How can we ever hope to overcome depression?

Okay. Here I admit, I must pause and admit to some hesitation in starting to answer the question, because even to me, what I’m going to suggest may frankly sound overly simple. It would sound this way to anyone, with or without depression. But if you’re depressed, it’s really likely to sound simplistic. Stupid. Or even (here you can plug in your own favorite expletive…)

But so here goes: You take small steps…

Yeah. It sounds like “baby steps.” (“He said it! He actually said ‘baby steps.'”) Which no doubt reminds you of a certain movie, right?

But here’s the thing: there actually are some pretty well researched and effective approaches to dealing with depression. There’s actually a whole technology for treating depression. And most “technologies” really do amount to a bunch of “baby steps” — but “baby steps” that are organized. 

“Baby steps,” organized, become a technology.

They become a plan. And they turn into something that can be big and powerful.

And knowing how to do that, how to start, how to take one small step, then another, can lead to the solutions to major problems. In fact, it is almost always the case that the solutions to really big problems come about by a sequence of small steps.

So about that notebook…

Let’s assume that you went off to see a really good therapist. That you went to see them once a week for, maybe, several months. Or maybe even for a year. If you are like most people, you’re likely to find it helpful.

This can be for a lot of reasons, and it’s often due to a combination of reasons, actually. Just having someone to talk to, whom you learn to trust, who seems to have empathy or to understand you, is a big part of it. And hey, one bit of the “secret sauce” of therapists is that they also know that most depressions actually just go away by themselves over time. (We take credit, of course. But sometimes, people just start to feel better.)

But it’s also the case that very often, at the end of the therapy when you look back at all your discussions, you’ll find that there are probably just a few little things that you learned, that you discussed, or maybe that the therapist suggested, that really seemed major. Out of a hundred suggestions or questions the therapist might have asked you, the odds are that there will be a few that really stand out as helpful.

And on the last session, when your therapist asks if anything was particularly helpful, that you remember, you will probably cite that one thing. The thing you learned to do. The suggestion, or reminder, or vision, or mantra that has stuck with you.

That happens, in my experience, much of the time in treatment. A lot of things a therapist suggests may help you a bit, some won’t help a lot at all. But a few will be really a great fit for you. And years later, if someone asked, you’ll say “this is what helps me…”

So one of the reasons I suggest finding a notebook (or keeping some kind of notes on your laptop or phone, or carve them into the bark of a nearby tree), is as a kind of “lab notebook.” Someplace that you can start to learn about your moods, to take some organized notes, and to write out some thoughts and exercises that you may find helpful. Even though right now, it may sound like those stupid “baby steps.” Even though you have nothing in particular to write.

Especially if you are depressed, you are actually not likely to remember what ideas, insights, or little experiments helped you to feel better. (And I will have lots of experiments to suggest.) I’ll talk more about this, the memory problems of depression, in a bit.

But for now… here’s an example I already shared of one famous (and really, quite realistic) fictional use of a notebook for coping with depression.

Next… How to do a little experiment and see if it helps your mood.

 

Taking the First Step

Replying to yesterday’s post, Valory sent in a comment:

“Taking that first small step, i.e., thinking about how to do something to feel better, rather than thinking about all the reasons you don’t feel “good/OK/happy/content,” is the most important and, sometimes , the most difficult step.”

I agree!

Very often, first steps can be the most difficult and even scary. Especially when depression is involved.

When we are depressed we may even feel paralyzed, unable to do literally anything to change our situation. In fact, the feeling that “there is nothing I can do that will make me feel better” is actually one of the primary symptoms of depression.

That is often why people with depression tend to look for solutions that require almost no effort on their parts. Because well, if “nothing I can do will help,” the only help seems like it has to come from somewhere else, right?

I even think that a lot of the popularity of antidepressant meds, both with patients and doctors, comes from their shared (yeah, doctors feel  it too!) assumption that there is nothing that the patient can do on their own that will matter. Under those conditions, taking a pill often seems like the only way to get some relief.

Now, it is often true that the meds may help people. But it can be a big mistake to assume that medications are the only, or even the best approach. Many research studies have shown that this is not true. There is a lot that a person can do on their own that may help.

I have learned a lot from my clients over the years (well, ahem, decades) of being a psychologist about ways people often learn to manage their own moods. Very often, people discover that they can at least feel a bit better by doing some fairly simple things to cope with a depression.

In future posts and my book, I’m going to list a number of things that often help people manage their moods. But the first, biggest step is often deciding that one is willing to give something a try. To experiment.

Different things work better, in different amounts, for different people. What helps me might not help you, but you might find that something you do that I’d find unhelpful, for you is actually a life-changing idea.

My first suggestion, then, is to get a notebook. Or find some way to keep some notes. I’ll tell you why soon.

How to do psychological first-aid on a desert island

You’ve probably never had it THIS bad. Nearly killed in a shipwreck, stranded alone on an island, no hope of rescue. The temptation to give in to despair must have been nearly overwhelming. Many would have become immobilized, maybe even considered taking a long, cold walk back into the ocean to end it all.

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But Robinson Crusoe didn’t. And the reason he didn’t, the psychological “first aid” that he rendered unto himself, still stands nearly 300 years later as perhaps one of the simplest, yet best example of what would later be called “cognitive behavior therapy.”

How Crusoe did it

Here’s the key passage* from Daniel Defoe’s 1719 classic:

I now began to consider seriously my condition, and the circumstances I was reduced to; and I drew up the state of my affairs in writing, not so much to leave them to any that were to come after me—for I was likely to have but few heirs—as to deliver my thoughts from daily poring over them, and afflicting my mind; and as my reason began now to master my despondency, I began to comfort myself as well as I could, and to set the good against the evil, that I might have something to distinguish my case from worse; and I stated very impartially, like debtor and creditor, the comforts I enjoyed against the miseries I suffered, thus:—

At that, Crusoe write down a list of negatives in one column, and responses in the other:

             _Evil_.                             _Good_.
I am cast upon a horrible,          But I am alive; and not drowned,
desolate island, void of all hope   as all my ship’s company were.
of recovery.

I am singled out and separated,     But I am singled out, too, from
as it were, from all the world,     all the ship’s crew, to be spared
to be miserable.                    from death; and He that
                                    miraculously saved me from death
                                    can deliver me from this
                                    condition.

I am divided from mankind—a         But I am not starved, and
solitaire; one banished from        perishing on a barren place,
human society.                      affording no sustenance.

I have no clothes to cover me.      But I am in a hot climate, where,
                                    if I had clothes, I could hardly
                                    wear them.

I am without any defence, or        But I am cast on an island where
means to resist any violence of     I see no wild beasts to hurt me,
man or beast.                       as I saw on the coast of Africa;
                                    and what if I had been
                                    shipwrecked there?

I have no soul to speak to or       But God wonderfully sent the ship
relieve me.                         in near enough to the shore, that
                                    I have got out as many necessary
                                    things as will either supply my
                                    wants or enable me to supply
                                    myself, even as long as I live.

His conclusion from the exercise:

Upon the whole, here was an undoubted testimony that there was scarce any condition in the world so miserable but there was something negative or something positive to be thankful for in it; and let this stand as a direction from the experience of the most miserable of all conditions in this world: that we may always find in it something to comfort ourselves from, and to set, in the description of good and evil, on the credit side of the account.

Useful lessons from a shipwrecked man

Reading the above passage, there are a few really good examples of effective self-treatment for depression or despair.  You can probably see how effective this exercise might have been in reducing some of the despair and fear he was feeling.

Here are a few of the most notable things Crusoe does:

1. Writes his concerns down

First, Crusoe makes the point that it’s better to not let your concerns just rattle around loose in your head:

“I drew up the state of my affairs in writing…to deliver my thoughts from daily poring over them, and afflicting my mind.”

Continuously “poring over”,  ruminating about your worries, overthinking things, is a sure way to go crazy — at every turn, these things will pop up and nag at you.

“Free range terrors,” left to run amok in your mind, are the most damaging. Tweet this

You’ll often see this key principle of writing things down happening if and when you talk to a therapist. Forget your troubles for a second and just watch how they work, and how this works for you:

Generally, they start jotting down the sixteen things you rattle off that are bothering you. And at the end of their high-priced session, they look up over their spectacles, smile, and in that kindly and wise seeming way, say, “so… it seems to me that your main worries are…” and they glance down at their pad, and like a genius, they read back to you the three or four main “worry clumps” that pretty much summarize your last hour’s worth of fretting and whining. Then they sit back, let that soak in, and send you a bill.

It seems too simple. But odds are, you’ll feel like your head is a bit clearer, things seem less chaotic, just for having had your concerns summarized back to you. This kind of summary lets us get a bit of psychological distance from things, and that seems to help.

Like Crusoe, stuck on an island that has no managed care clinic nearby, you can jot down your worries and fears yourself, pick out the main “themes,” and get about $150 dollars’ worth of therapeutic help from that simple step. (Plus, write down one more in the “Good” column: you will have saved $150.) Writing your concerns down tends to give you a bit of psychological “distance” from them. Seeing  beasts on the ground from helicopter height, instead of down on the ground where the big scary rhino is breathing in your face, you tend to feel a bit more able to think clearly about things.

2. Examines his thoughts and asks critical questions

The second thing Crusoe does, is to start coming up with responses to his fears. This is almost exactly the same process that later became the hallmark of “Rational Emotive Therapy” founder Albert Ellis, and still later, the “Cognitive Therapy” of Aaron Beck.

It’s not a hard thing to master. Having written his worst fears down, Crusoe then has a bit of psychological “breathing room” in which he can think logically about these concerns. He is then able to think of a specific, focused responses to each concern, a sort of “on the other hand” response.

It’s important to notice that this is not a vague, overly general “always look on the bright side of life” cure. He is not just staring up at the blue sky and whispering “everything is peachy keen today!” Because that would not work. It would not deal with the very real, and very specific, raging fears and concerns that are tormenting him.

Rather, he gets each individual concern down on paper. He then comes up with a SPECIFIC “on the other hand” kind of response to each concern.

The standard Cognitive Therapy way to work with such a list would involve taking  each concern on your list, and asking yourself a few simple questions:

– Is this concern valid? How do I know? (Could I be misinterpreting the evidence? Am I being selective in what I am paying attention to, filtering out the good news and only paying attention to the scary clues? Was that scary bump a burglar, or just the cat…again?)

– Are there other ways of thinking about this that might be more helpful, or calming? (e.g., the response to “God must hate me to have stranded me” can be countered with, “Well, but he DROWNED all the other guys and kept me alive! Maybe I’m the favorite!”)

– So what? So what if this is true? What’s the worst that can happen? How, specifically, can I manage if this fear is true? What, for instance, might be the realistic, long term results of this situation? (e.g.: “I’ll just live and learn.” “Pay the fine and move on.” “I’ll make sure my next brownies aren’t burned.” “I’ll make sure my next husband isn’t such a jerk.”)

This kind of thing takes a bit of practice, and I would imagine that Defoe had to struggle a bit, tapping his head with his inky quill, to get this nifty example down on parchment. It will take you a bit of time to learn, as well. But we know from decades of psychological research in treatments such as cognitive-behavior therapy, that when you learn this technique, it practically becomes your superpower. Your mind, and your life, will thank you for learning it.

3. He gets busy

Crusoe finishes the exercise thus:

Having now brought my mind a little to relish my condition, and given over looking out to sea, to see if I could spy a ship—I say, giving over these things, I began to apply myself to arrange my way of living, and to make things as easy to me as I could.

When we are depressed and scared, we tend to be paralyzed. We may be agitated, tired, unable to get moving. Breaking out of the worried, ruminative state tends to release a great deal of physical and mental energy. Crusoe felt better and so his energy was freed up to get busy, building his island home.

Another advantage of getting going, doing things, is that you can start to deal with the “real world” situations that have been triggering all that worry. After Crusoe spends some time and effort getting his situation organized, he’s going to be in a much better position to cope with the disaster that has occurred. He may still be stuck on an island, but he will at least have managed to find safety, food, water, shelter, and protection for himself. The only way he could have done all that, was by shaking off the paralyzing depression and fear that threatened to overwhelm him.

Practice exercise

Sit down and write out three of your current concerns or worries. Do a Robinson Crusoe on them: next to each one, try to come up with a different, less catastrophic way of thinking about the situation. If it’s not easy at first, remember that you will get better at this kind of thing with practice. Devoting a bit of time to mastering this skill will change your life.

___

* Excerpt from Robinson Crusoe, a public domain book, courtesy of Project Gutenberg. You can find the whole book here.