Don’t let them put the wrong brain in your head!

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Over the last few posts I’ve been sharing some ideas about ways to help yourself overcome depression. I’m going to share a lot more of these ideas. They are based on decades of research on effective treatments of depression and related conditions, as well as on many years of experience as both a psychologist and an explorer of my own moods, mind, and behavior. (They will eventually be the basis of my forthcoming book, The Five Stroke Depression Cure.)

But before going on, this might be a good time to discuss a what we might call a “commercial break.”

“Commercial breaks”

TV shows are often interrupted by commercial breaks, those few minutes (or many, many, many minutes!) of advertisements that you are expected to watch as the price of seeing the show.

Commercials are annoying, but they are also powerful. They influence us more than we realize.

Marketing researchers know that the mere fact of frequent exposure to a product, even if the ads annoy you, makes you more likely to think of, and buy, that product when you are in the store or shopping online.

More insidiously, commercials are powerful ways of convincing us of “what’s real.” Commercials are used during political campaigns to get us to accept fictional models of “reality,” to believe that perfectly nice leaders are “crooks,” that tyrants and idiots are the geniuses we’ve been waiting for, and to convince whole nations to go to war or vote against their own interests. We come to believe in the worlds presented in commercials, especially if we see the same messages over and over and over again.

The main concern I want to address is what I might call commercialized “breaks” or really, mental breakdowns. The media are full of ads that try to convince you that, to be frank, you are having a mental breakdown, that you are suffering from the dreaded “chemical imbalance” of depression.

Of course, if your unhappiness, anger, fatigue, and desire to strangle your cat is really due to such a “chemical imbalance,” it stands to reason that the only way to help you with this is to “ask your doctor” to give you some kind of medication.

Big Pharma spends millions every year to insert this “abnormal brain” idea into your head. To convince you that your brain is, in effect, something it isn’t. To convince you that your brain is “abnormal.”

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These are not entirely honest commercials. Depression is a complicated condition. Many things contribute to a depression — it is usually not a condition with a simple physical cause. Thinking habits and attitudes, childhood messages about your worth, as well as things such as traumas, losses, and fatigue, can contribute to a feeling that may or may even be a true clinical depression.

When we are depressed, we feel helpless. The very definition of depression, according to researcher Martin Seligman, was once described as the belief that “nothing I can do will make a difference.” Letting the multibillion dollar drug industry insert an image of a certain sort of “brain problem” into your head can be harmful. It may add to your feelings that you are helpless. You may become dependent, docile, believing that you are nothing without the meds they have. That you can’t make it on your own. What a great way to control you! (When you think about it, it’s the same technique that some abusive partners use.)

Big Pharma knows that depressed persons can be the easiest people to take advantage of. If they can convince you that you have an unbalanced, “abnormal” brain, you will be scared. Which will mean that if I’m selling you overpriced pharmaceuticals, I’ve got you right where I want you.

Because you will be desperate for my cure.

As a specialist in psychological disability, I’ve seen many people whose main psychological problem is sometimes that they have created an image of themselves as helpless. They don’t even try things to feel better anymore, don’t try to find a therapist, to change their lifestyle or exercise or read self-help books to feel better. They have settled into the slow death of passively waiting for others to provide the magical solutions to their malaise (via pills, illegal drugs, dependent relationships with parents or spouses, fairy godmothers, or disability payments).

A mental experiment

Just for fun, try to imagine the following paragraph being read out during a TV commercial for an antidepressant. Imagine it being read in that deep, serious, “caring” professional voice that always reads the drug side effects during drug ads:

Side effects of this medication may include believing that the only treatment for your condition is this medication. Other side effects can include a loss of confidence in your ability to recover on your own, a loss of motivation to try to help yourself, failure to make major life changes that you know are really overdue, and a tendency to see yourself as a permanently “sick” person or “mental patient.” All of which may cause depression to last longer and cut deeper into your soul.

What if there is a better way?

A way to learn to control your own moods, to write your own story? To have control of your own, perfectly normal and lovely and talented and creative brain?

Research has shown that medications are only a part (and not always a necessary part) of effective mental health treatment. Decades of research have shown that psychological treatments may be as effective or more effective.

As usual in this blog, this may be a decision you need to discuss with a doctor or therapist or loved one. But when you do so, discuss concerns and reservations honestly, and as assertively as you can. And remember to include in that discussion the fact that there are lots of things that you can do to manage depressions. Including dozens that I am virtually certain you don’t know about (nobody advertises “journaling” on prime time!)

Simple techniques such as the notebook tools I have just shared, can be powerful ways to treat a mood disorder. Psychotherapy, exercise, mindfulness meditation techniques, yoga, and healthy diets may also contribute a great deal toward your mental well-being. Solving “real life” problems such as stressful job situations, chronic exposure to abusive relationships, isolation, or a failure to express your truest values in your life, may also be effective.

As a last resort, watching less TV and even, in some cases, firing your doctor and finding a better one, may be more useful steps toward cure.

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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.

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.