Although I like to cling to the promise that my depression will get better — since it always has in the past — there are long, painful periods when it seems as though I’m going to have to live with these symptoms forever.
In the past, there was a time when I had been struggling with death thoughts for what seemed like forever. One afternoon, I panicked when I surmised that they might always be with me. I embraced the wisdom of Toni Bernhard, who wrote a brilliant handbook for all of us living with chronic illness, How to Be Sick. While reading her words, I mourned the life I once had and made room to live with symptoms of depression indefinitely.
The death thoughts did eventually disappear, but I’m always mindful of my depression. Every decision I make in a 24-hour period, from what I eat for breakfast to what time I go to bed, is driven by an effort to protect my mental health.
When I hit a painful stretch that feels like forever, I return to Bernhard’s insights and to my own strategies that have helped me persevere through rough patches along the way.
Here are some of them:
1. Revisit the Past
When we’re depressed, our perspective of the past is colored by melancholy, and we don’t see things accurately. For example, if I’m in a low mood, I look back on those years when I experienced death thoughts and think that I felt nothing but depression for more than 1,000 days. It’s helpful to peak at my mood journals from that period to see that I did have some good days and good times scattered throughout the painful stretches, which means I will have good hours and days in coming hard periods as well.
I also look at photo albums that bring me back to moments of joy sprinkled in amidst the sadness; these give me hope that even though I’m still struggling, it’s possible to contribute a nice memory to my album.
2. Remember that Pain Isn’t Solid
Going through mood journals is also a good way to remind myself that pain isn’t solid. I may start the morning with excruciating anxiety, but by lunch I might be able to enjoy a nice reprieve. At night I may even be capable of laughing at a movie with the kids.
Bernhard compares the painful symptoms of her illness to the weather. “Weather practice is a powerful reminder of the fleeting nature of experience: how each moment arises and passes as quickly as a weather pattern,” she writes.
I like to think of my panic and depression as labor pains. I breathe through the anguish, trusting that the intensity will eventually fade. Hanging on to the concept of impermanence gives me consolation and relief in the midst of distress — that the emotions and thoughts and feelings I’m experiencing aren’t solid.
3. Maximize Periods of Wellness
Most people who have lived with treatment-resistant depression or another chronic illness have learned how to maximize their good moments. During painful stretches, I consider these moments to be the rest periods I need between contractions. I soak them in as much as humanly possible and let them carry me through the difficult hours ahead.
4. Act As If
Author and artist Vivian Greene has written, “Life isn’t about waiting for the storm to pass … It’s about learning to dance in the rain.”
That sums up living with a chronic illness. There’s a fine line between pushing yourself too hard and not challenging yourself enough, but most of the time, I find that I feel better by “acting as if” I’m feeling okay.
So I sign up for a paddle-boarding club even though I don’t want to; I have lunch with a friend even though I have no appetite; I show up to swim practice with tinted goggles in case I cry. I tell myself “do it anyway” and operate like I’m not depressed.
5. Embrace Uncertainty
Not until I read Bernhard’s book did I realize that much of my suffering comes from my desire for certainty and predictability. I want to know when my anxiety will abate, which medications will work, and when I’ll be able to sleep eight hours again. I’m wrestling for control over the steering wheel, and the fact that I don’t have it is killing me.
The flip side, though, is that if I can inch toward an acceptance of uncertainty and unpredictability, then I can lessen my suffering. Bernhard writes:
Just seeing the suffering in that desire loosens its hold on me, whether it’s wanting so badly to be at a family gathering or clinging to the hope for positive results from a medication or desiring for a doctor not to disappoint me. Once I see the [suffering] in the mind, I can begin to let go a little.
6. Stop Your Inner Meanie and Remember Self-Compassion
Like so many others who battle depression, I talk to myself in ways I wouldn’t even address an enemy. I call myself lazy, stupid, unmotivated, and deserving of suffering. The self-denigrating tapes are so automatic that I often don’t catch how harmful the dialogue is until I’m saying the words out loud to a friend or doctor.
We can relieve some of our suffering by addressing ourselves with the same compassion that we would offer a friend or a daughter. Lately, I’m trying to catch my inner meanie and instead offer myself kindness and gentleness.
7. Attach Yourself to a Purpose
Friedrich Nietzsche said, “He who has a why to live can bear almost any how.”
When my depression gets to be unbearable, I picture my two kids and my husband, and I tell myself that I have to stick around for them. It’s fine if I never wear one of those “Life Is Good” T-shirts. I have a higher purpose that I must complete, like a soldier in a battle. I must see my mission through to the end. Dedicating your life to a cause can keep you alive and give you the much-needed fuel to keep going.
8. Stay in the Present
If we can manage to stay in the present moment and focus only on the thing that is right in front of us, we eliminate much of our angst because it’s almost always rooted in the past and in the future.
When I’m in a painful stretch, one day at a time is too long. I have to break it down into 15-minute periods. I tell myself that for the next 15 minutes, my only job is to do the thing in front of me, whether that’s helping my daughter with homework, doing the dishes, or writing a column. When 15 minutes are up, I commit to another 15 minutes. That way, I patch several days together, and before long, one of those days contains some joy.