Wednesday, 21 November 2012

The Bottom Of The Well
Today's National Health Blog Post Month prompt is to write about mental health.

For many people, myself included, depression just goes with chronic illness.  We have bodies that aren't working properly anyway, and endless drugs which can mess with mood, and we have things to legitimately be unhappy about.  It all adds up.

Upfront, let me say, I do take antidepressants. There's no shame in taking them if you need them. Mental illnesses like depression are no different from physical illnesses. If your brain chemistry is such that prescription drugs are going to help, then it's worth taking the doctor's advice and taking the pills.

But I also work on my thinking processes, trying to look at things in different ways, so that I'm not getting depressed in reaction to events in my life.

It's called cognitive therapy.  It can be done in therapy with a group or with a therapist, but mostly, it's about learning personal skills in dealing with our reactions to events.

I'm not saying I don't get upset, I do.  But then I work at looking at things from another angle.

For example, the day before yesterday, I posted about my need to move home.  When I wrote that, I was in shock, and quite overwhelmed.  Yesterday, I didn't post on this blog at all. Not because I was in a fit of depression, but because I had to get groceries, and that left me too exhausted to do anything else.

But in that time, I also started to deal with my situation.  I started to list things I could do - make my appointment with the Housing Department, contact the institution I have my car loan with to see if they can reduce the payments and increase the time to pay, list things I can sell that will make me a little money and cut down on what I will have to move, start to give away some of the things I won't be able to take with me. I've given the first couple of bags of books from my theological library to another minister - who was delighted, and is looking forward to me culling more books. I've started talking with my daughter about what things she wants to take with her when she moves out.  And I've been thinking about the little flat I lived in many years ago, when I first moved out of home, and realising how much I miss the simplicity of living like that.

That initial starting to look at the situation from another angle can be a challenge.  But if it's not done as soon as possible after the shock, it gets much harder.  Depression is like being at the bottom of a well, it's so dark down there that you can't even see the daylight at the top. It takes a lot to claw your way out of that.

When I get a big shock, I'm effectively hanging off the side of the well. I can either do the work then to pull myself out, or I can let go and fall to the bottom of the well and have a much more difficult (and much longer) challenge to climb out.

So let's talk about cognitive therapy. It's a psychological approach that tells us that feelings don't exist on their own.  What we feel is a reaction to what we think.  Often, the way we think about things is faulty, this is called "cognitive distortion."

Here's a list of the basic cognitive distortions, taken from David Burns' book Feeling Good.

  1. All-or-nothing thinking: You see things in black-and-white categories. If your performance falls short of perfect, you see yourself as a total failure.
  2. Over generalisation: You see a single negative event as a never-ending pattern of defeat.
  3. Mental filter: You pick out a single negative detail and dwell on it exclusively so that your vision of all reality becomes darkened, like the drop of ink that discolours the entire beaker of water.
  4. Disqualifying the positive: You reject positive experiences by insisting they "don't count" for some reason or another. In this way you can maintain a negative belief that is contradicted by your everyday experiences.
  5. Jumping to conclusions: You make negative interpretation even though there are no definite facts that convincingly support your conclusion.  
  6. Mind reading. You arbitrarily conclude that someone is reacting negatively to you, and you don't bother to check this out.
  7. The fortune teller error: You anticipate that things will turn out badly, and you feel convinced that your prediction is an already-established fact.
  8. Magnification (catastrophising) or minimisation: You exaggerate the importance of things (such as your goof-up or someone else's achievement), or you inappropriately shrink things until they appear tiny (your own desirable qualities or the other fellow's imperfections). This is also called the "binocular trick." 
  9. Emotional reasoning: You assume that your negative emotions necessarily reflect the way things really are: "I feel it, therefore it must  if be true."
  10. Should statements: You try to motivate yourself with shoulds and shouldn'ts as if you had to be whipped and punished before you could be expected to do anything. "Musts" and "oughts" are also offenders. The emotional consequence is guilt. When you direct should statements towards others, you feel anger, frustration and resentment.
  11. Labelling and mislabelling: This is an extreme form of over generalisation. Instead of describing your error, you attach a negative label to yourself: "I'm a loser." When someone else's behaviour rubs you the wrong way, you attach a negative label to him: "He's a goddam louse." Mislabelling involves describing an event with language that is highly coloured and emotionally loaded.
  12. Personalisation: You see yourself as the cause of some negative external event which in fact you were not primarily responsible for.

The idea of cognitive therapy is to be on the lookout for these cognitive distortions, and to challenge them and address them with reality when they appear.

Apart from cognitive therapy, there is another tool I personally use to deal with distressing, potentially depressing, situations.  It's faith.  If you look at the psalms of lament in the Bible - those ones where people complained about how difficult their situation is, you notice that after they pour out all their troubles, they then describe how God has been faithful to them in the past, how God has got them through tough times.  Because God has been faithful in the past, they then decide to trust God for the future as well.

I have a number of wonderful memories of times when I thought there was no solution to a problem, and then God presented one from an unexpected source.  A special one for me was when I was in theological college. My then husband was full-time carer for our children, and money was very scarce.  I had just finished writing in my journal about how hard it was to trust in God's provision when the kids needed new shoes, and there was no money for them, when there was a knock at the door. It was the husband of my son's Sunday School teacher - their daughter had been throwing out shoes her children had outgrown and the Sunday School teacher realised they would be suitable for my kids.  The bag of shoes had so many in them, I had shoes for both my kids in the sizes they needed then and the next two sizes up for each of them, and the same for the two children next door to us.

Events like that one help remind me that a crisis is not necessarily a disaster, and that God will always help me deal with anything.

Reference: David D. Burns, MD Feeling Good, the New Mood Therapy

This post is part of Wego Health's National Health Blog Post Month.


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