In my last post, I gave an overview of my symptomatic experiences of clinical depression. Following on from feedback given by readers, I would like to stress that this series of articles relates to my personal experiences of the illness: readers who suffer from depression may find that it manifests quite differently in them. As such, these articles are not intended as ‘gospel’, but are merely a reflection of how the malady has manifested itself in my own psyche. Any constructive criticism or other feedback is always welcome; all I seek to do is to raise awareness and heighten understanding of mental illness by contributing my own perspective.
As I said in my previous post, I do not yet know if severe clinical depression can be comprehensively beaten, or merely contained and attenuated (that is to say, made less potent and malignant). What I do know is that certain things work and certain things don’t; moreover, that some things work only if applied in conjunction with other activities.
One of the things that depressives are often told to do is to keep busy: to distract the mind so as not to allow negative feelings of depression to overwhelm us. This is a core example of something that doesn’t work if applied on its own. Yes, by all means, those suffering from depression should get out and do things as often as possible, and not succumb to the paralysis of despair. However, the fact remains that if like me you suffer from chronic depression, that persistent negative inner voice will not be silenced until it is confronted and challenged head on. Whilst keeping busy with external and social activities is an essential part of the recovering depressive’s daily routine, applied exclusively it amounts to a kind of running away; you simply can’t stay busy all the time, that would be to court burnout and further mental stress, and at some point you will need to rest. And that is precisely when depression is most likely to rear its ugly head and strike.
Another common suggestion given to depressives, based around the cognitive behavioural therapy (CBT) method of treating depression, anxiety and obsessive thinking, is to ‘accept the intrusive or unpleasant thoughts’. Now, this piece of advice is very tricky, because whilst it does carry considerable merit it can also be misapplied and wind up doing more harm than good. To draw on my own experiences, I spent several months trying to follow this advice, and the result? I allowed the negative, depressed side of my thinking free rein, and my psyche took an almighty battering as a result. This mistake, along with a relapse into alcohol dependency, cost me my last relationship, a loss I am still mourning.
So let’s clarify what is really meant by ‘accepting’ the negative thoughts. Accepting negative thinking does NOT mean allowing your inner demons to run rough-shod over your conscious mind without putting up a struggle; accepting negative thoughts means accepting they are there in the first place and then acting to oppose them. You cannot block out a negative thought, however painful it may be; once it has manifested, it is there. But you can bloody well challenge it. What I have found so useful in recent months – and full credit must go to a good friend of mine who also suffers from depression for suggesting it in the first place – was to write down all the positive, rational thoughts produced by my conscious mind at times when I wasn’t under depression and therefore thinking clearly.
And now the hard work begins – because if, like me, you have suffered from unchecked depressive thinking for a number of years, the chances are your negative subconscious has been firing intrusive, negative and untrue thoughts at the naturally happy conscious you for years. That’s a lot of territory to reclaim, and the only way to do that is to wage war – and I will return to this combative metaphor time and again – on the negative part of your mind that has turned on you so virulently. As such, once you have written down whatever coping statements you’ve come up with when thinking more clearly – repeat, repeat, repeat. Read them back to yourself several times a day, every day, for months or even years if necessary. Sounds too much like hard work? Sounds like auto-brainwashing? Believe me, depression has been working very hard every day for years to brainwash you into thinking you are worthless, that your life’s achievements are nil, that your life itself and everyone and everything in it is null and void. If your demons can work so hard to poison your thought processes, why can’t the conscious, rational you do just the same to reverse the damage?
Because I repeat folks, you are at war here, whether you like it or not. You are in a dogfight for your mind, and be assured that severe clinical depression will fight you for its possession down to the last stray synapse. Accepting the need to go to war is not the same as accepting the presence of an enemy and passively turning the other cheek. If peace of mind is worth having then it is absolutely worth fighting for – every day, for the rest of your life if need be.
If this combative approach still seems a little contrived to you – and yes, I initially thought so too – try looking at it from this perspective: an anorexic looks in the mirror and is convinced that she is overweight. Any healthy person around her can quickly see how deluded she is, but the anorexic does not. Accepting your negative inner voice without countering its statements is like accepting the notion that you need to lose weight; in both cases you are in fact suffering from a delusional form of mental illness that has distorted your thinking and perception and resulting emotional responses. Just as anorexics must have their self-destructive ideas about not eating challenged, so depressives (and those suffering from anxiety and OCD-type disorders) must have their self-destructive ideas about themselves, their surroundings and their very lives challenged.
To fight this war you need more than one kind of soldier, just as in a real-life war different types of fighting unit – sappers, air strikes, infantry, what have you – serve different functions but cooperate towards a single ultimate goal of victory. I’ve already touched on challenging the demonic inner voice with statements of rationality, strength and positivity (I won’t suggest specifics, as each of us suffers from our own personal demons – you’ll need to figure out your own coping statements, which will be an essential part of your arsenal against clinical depression). Now let’s look at some of your support activities, your auxiliaries if you will.
These are in themselves based around simple common sense and are things that would be recommended to healthy minded people as well, namely: good diet, regular sleep, proper exercise (as a recovering alcoholic and former slob I cannot recommend this highly enough) and meditation (yes, meditation – as well as working for Buddhists for thousands of years, it is now scientifically proven to help against depression/anxiety and is part of NHS core recommendations for treating mental illness). To torture the cliche – healthy body, healthy mind. But REMEMBER, this is only one part of your treatment – eating and sleeping well and getting regular exercise might be enough in themselves to beat mild depression, but severe and moderate depression will require that you do more. In other words, eating and sleeping well plus regular exercise and meditation is simply your base: the foundation on which you will construct your fortress.
Now the real fun begins: we already have the coping statements, what I like to call my ‘mantras’, which you will repeat to yourself every day, several times a day if necessary. That’s one key building block for your fortress. Another is prescription medication accompanied by a total (yes total) abstinence from alcohol and other recreational drugs. Oh, I’m sorry, does the latter part offend you? Fair enough: play it the way I did for three years, and drink on your medication. I ended up having a psychotic episode during which I repeatedly lacerated myself with a kitchen knife and lost about a pint of blood. I drove my partner away, and nearly drove my poor mother into a nervous breakdown of her own, and I now know what the insides of both a psychiatric ward and a police cell look like. That’s what happens when severe depressives mix booze and medication – and believe me it wasn’t much fun.
Severe clinical depression is no joke – you wouldn’t expect soldiers to fight a war under the influence would you? No. So… Put. The. Bottle. Down. For those of you who also have alcohol dependency issues, I’ll talk at greater length about addressing these in another post.
Even without alcohol and other drugs interfering, prescription medication will not work by itself: severe clinical depressives cannot expect a pill a day to chase their blues away, and meds must be applied in conjunction with other treatment methods. One study I read says that only a third of depressives can expect medication alone to ‘cure’ them, while another third experience no improvement in their mood at all. I personally believe I belong to the middle third: medication helps but other methods of tackling depression must also be applied. One of those most often touted is therapy. Again this is tricky as different kinds of therapy work for different types of people and depressives. I personally found CBT to be a useful front-line soldier – think of it as a kind of shock trooper – but not enough on its own to beat severe long-term depression. If, like me, you are the sort of person who needs an answer to things, to understand why you are thinking the way you do when depressed or in a state of anxiety or obsessiveness, you will need to combine it with psychotherapy or psychodynamic therapy, methods that tend to explore your personal history and do not focus exclusively on the here and now as CBT does.
As a personal aside, if you are in the least bit suicidal or prone to obsessive, negative and harmful ruminative thinking, I would avoid psychoanalysis like the plague. This assertion is of course based on my personal experiences, but I found it did more harm than good – psychoanalysis fails to take into account that many of our inner thoughts are irrational and untrue, and tends to follow the erroneous line of thinking that what you think must always be valid. This is patently absurd and, in a severe depressive, a very dangerous and toxic idea. As observed above in our example of the anorexic’s thoughts about her weight, clearly much of what you think when under depression is not true; and an essential tool to beating depression lies in realising this and learning to discern the untrue depressed thinker from the more rational, balanced thinker; the naturally happy you that existed before life events and chemical imbalance conspired to give rise to the depression now assaulting your psyche.
Choosing a therapist and type of therapy is a potential minefield, and I’m afraid constitutes a whole battle all of itself. My recommendation is to try several different types until you find a practitioner you absolutely trust (by this I mean you should feel able to tell them anything, your darkest secret, worst fears, etc, without fear of being judged or misunderstood). I have personally seen at least half a dozen different therapists in my life, and I’m sure there are other clinical depressives out there who’ve seen more. Above all, take your time and be patient – your illness may require more than one approach to tackle it, as mine has done, so the sooner you accept that you are engaged in a time-consuming business and in for the long haul, the sooner you will find some peace of mind.
To recap then, atop our foundation of exercise, diet, sleep and meditation, we have our fortress, so far constructed of therapy, medication and personalised coping statements or mantras. Another building block we can add to that is staying active – hopefully you should now begin to see how keeping busy works, but only in the context of a wider patchwork of different treatments. So yes by all means, get off the bed and get out of the house. Find things to do that you like. I’m fortunate in one respect in that I am an accomplished musician – so out comes the guitar and off we go to play on the streets or at an open mic night or any old place that will have me. But you don’t need to have talent to find things you like doing – go to the cinema, walk in the park, visit a market, wander the fucking streets looking at people if that’s what it takes. Just try and engage with the wider world as much as you can. Easily said, less easily done, I know – but trust me, if a formerly suicidal depressive like me can manage to do this, anyone can. And if you can repeat your mantras to yourself while out and about, so much the better. That will prove a doubly good use of your time.
Next building block: friends. Be very careful here. Some of my good friends I have had to avoid of late simply because they drink too much and while sympathetic to my condition have no understanding of what it means to be clinically depressed (lucky them). This has led to unfortunate situations where close friends have ended up inadvertantly saying things that made me feel ten times worse when in their cups (‘How can you think stuff like that?’ and ‘If you don’t stop thinking that way, you will never get over it’ are two of my personal favourites). I’m sorry to have to report that clinical depression can be a very lonely illness; drinking buddies and close friends from the good old days may be people you now need to start avoiding. Sorry, I never said it would be easy. Fighting depression is a tough business, and a key part of it is learning to stand alone when necessary.
So choose your friends carefully – people who have suffered from some form of depression themselves are ideal as they will have a much better idea of what you are going through. Failing that they will need to be very understanding and analytical enough to at least grasp in theory what you are dealing with – sympathy alone is not enough. And obviously, pity is out, out, OUT. Anyone who pities you is no friend; both pity and self-pity are toxic to the depressive. Compassion is subtly but crucially different; friends exercising compassion, understanding and tolerance are gold dust and should be treasured accordingly. Also, remember: seeing friends can be helpful, but don’t overdo it! As I said already, learning to stand alone is of paramount importance. At some point you need to be able to be alone with your thoughts, and that’s why I am placing so much emphasis on the mantras – you will find yourself in single combat with the darker side of your mind periodically, and that is a fight you will need to get used to fighting.
But what happens when the depression is so overwhelming, so potent, that none of the above works and your carefully constructed fortress crumbles? As a severe clinical depressive you will inevitably have those days. This is when it is crucial to remember the war metaphor – you may lose a battle, but that DOES NOT mean you have lost the war. A good general doesn’t waste time mourning the loss of his troops in battle; a good general thinks about the next battle in the campaign and prepares accordingly; a good general does not give in to despair as a result of one setback. And so it is with the war on depression.
Yes, sometimes you will find yourself, as I have, lying on your bed or curled up on the sofa, your mind churning with anxious and troubled thoughts, or simply overwhelmed by a feeling of hopelessness and despair. It is at these times that the doctrine of acceptance must be, well, accepted: you are at a low ebb but this will pass. Just as soldiers in a real-life war must be sacrificed, so those minutes and hours must be given up as lost; sometimes it is stronger to accept times of weakness and weather them than fight yourself to no avail. Because remember, fighting your demons is one thing; beating yourself up over losing a battle you cannot win is quite another. The key to attaining eventual victory is to not give up hope altogether – feelings of hopelessness must be ridden out and regarded as fundamentally impermanent. Believe me, you will emerge from these rough patches, and through learning to accept the pain of a lost battle you will gradually grow stronger.
For it is strength you need to pursue – not happiness. Focus on the pursuit of happiness and you will come unstuck, as I did. For years I chased happiness in all its gilded forms: career, money, success, recognition, travel, sex, relationships, drink, drugs, socialising, the list goes on. And I ended up miserable, despite having all of the above at various different times in my life. The lesson I have learned has been a costly and painful one, but it is salutary nonetheless. Chase happiness and you are chasing a chimera, the proverbial pot of gold at the end of the rainbow.
Pursue strength on the other hand, and you have something much less fleeting and far more dependable within your grasp. To court strength is to secure the ability to stand alone, friendless and single if need be, on your own two feet, and not be destroyed by the world or your perception of it. The strength to look your weaknesses in the eye, without recourse to alcohol or other mind-altering substances, and change them wherever possible or accept them where not; the strength to feel completely overwhelmed by despair one day and yet come back fighting again the next; the strength to have nothing and still feel you are worth something; the strength to realise that inner peace means far more than mere happiness; the strength to embrace all your emotional pain, your neuroses and your heartache and your frustration and disappointment unflinchingly and without complaint.
Because, my fellow depressives, you may not ever be happy, but each and every one of you has it in you to realise this inner strength, and in so doing lead a life that promises little joy but is also free of fear. Let go of the desire to be happy, and you will see how quickly your fears vanish. I do not believe we fear death for its own sake; we fear it for the absence of happiness-pursuit it inevitably must bring. This is why depressives so often turn suicidal – they simply give up believing that life can offer them any joy, so why not embrace death? But put happiness aside as your primary goal, and court strength instead, and you will find the need to destroy yourself suddenly becomes much less acute. This, I believe, is the state of mind that sustained our ancestors in less pampered, privileged times, and it is one am working towards, every day.
I am a long way from winning my war, but just over three weeks after giving up drinking and taking up regular physical exercise – the final missing pieces in my own fortress construction – and four months on from being a suicidal emotional wreck, I can safely say this: I have never felt stronger, or more real, than I do now. I may be less happy than I was in former times, but I am undoubtedly also less weak. My bouts of depression have lessened in frequency over the past fortnight, and are less long-lasting and intense when they do occur; my obsessive thoughts seem far less potent and real than they did last year; and my feelings of anxiety, once so crippling, are now virtually non-existent.
I am, in short, becoming a new person, someone I have never been before.
I trade on results, and these are results. I will continue to build my fortress of medication, therapy, friends, activity and mantras on its foundation of exercise, meditation, diet and sleep. I will build and build and build, as many times as this disease can knock over the things I make, I will build and rebuild. And hopefully one day, when my demons have grown tired of smashing themselves to pieces against the defences I have so diligently and meticulously maintained, I will take back possession of my mind.
And if and when that day comes, I will know inner peace.
Take whatever you will from this article. Feel free to disagree with any of it if you wish. All I seek to do is give others the benefit of my experience as well as inform loved ones as to where I am at in my struggle with clinical depression. If you are reading this and know anyone who suffers from an anxiety/depressive disorder, please feel free to share this with them. My biggest mistake in hindsight was a failure of recognition; I failed to realise that my mind had grown diseased, that alcohol dependency and unchecked neurotic thinking had poisoned it. This eventual recognition, that my mind has been overrun by depression and that a prolonged fight is now necessary to take it back, has brought me from the brink. But I had to fall very low first; I paid a high price for self-knowledge – I lost two great partners, several friends, and very nearly my life. Though at liberty I now have a criminal record, and had I continued in the same vein said liberty would almost certainly have been lost, to the prison system or a psychiatric ward.
Learn from my mistakes: the sooner you accept that your mind is ill and that you are at war with whatever demonic thoughts afflict you, the sooner you put pursuit of happiness aside as a luxury and start to pursue strength instead, the sooner you will know some measure of inner peace. And who knows, it may just turn out that, paradoxically, happiness will come to you as a result of having that strength and inner peace. But the key point here is, it won’t matter even if it doesn’t.
Because you will have become strong enough to live without happiness.