Saturday, 20 April 2013

Lassie, Get Help

Let's talk about a serious issue today.

Depression is a pretty common experience for people with chronic illnesses.

I've heard there's a difference between clinical depression - caused by unbalanced brain chemicals, and reactive depression - caused by a reaction to overwhelming circumstances.  From experience, I think it's probably usually a bit of both.

There is an element of "this is the circumstance I'm in, and if I look at it in another way and use CBT (cognitive behavioural therapy) skills, I can work my way out of it."  But there's also, for me at least, often a need for the medication as well.  I know there was once a stigma about taking anti-depressant medication, but honestly, I can't see depression as all that different from any of my other symptoms and I take medication for them, so why not this one as well?

For me, depression is something I can visualise as like being at the bottom of a deep pit or well. There's daylight up there, but it's just so far away. (And the worse things seem, the further away it is. ) When I'm in the bottom of the pit, I can understand how some people can give up and decide it's all too much.

I can't give up. Too many people would be hurt if I did.

So, I have to climb, no matter how hard it is, to drag myself out of the pit.

The tools I use are prayer, medication, and cognitive therapy.

Cognitive therapy works on the idea that how we think about a thing affects how we feel about it. Sometimes we have to look at our thoughts and assumptions and realise that they're faulty, before we can feel better about them.  One of the best resources I have found for an introduction to cognitive therapy is Dr David Burns' book Feeling Good: The New Mood Therapy.

Here's a quick summary of the kinds of faulty thinking that lead to depression:

  1. All or nothing thinking.  This is the thought that if I'm not perfect, I'm no good at all. Or one bad thing happened today so the whole day is a disaster. I messed up on my diet at lunchtime, so I may as well just chuck it in for the whole day, week, month, for ever....  It's faulty thinking because the real world isn't usually black and white. It's shades of grey.  And close enough is very often  good enough.
  2. Overgeneralization. This is the thought that this one little example is the whole of everything. An example might be: the cat is always puking on my bed.  In reality, he's seven years old, and he's done it probably three or four times. If I'm going to look at the reality of the situation, that's far from "always" happening. This is the thought process that takes one person saying something mean to me and turns it into "everybody hates me".  If you step back and look at it, it's obviously not true. In the real world, one little thing (or even one big thing), is just that one thing, it's not everything.
  3. Mental filter.  It's possible to get into the mindset of just seeing everything as bad, or that something not living up to your expectations is a disaster. Take the student who usually gets High Distinctions, who discovers they have a Distinction on a subject.  For a person with a mental filter which says if they are smart they will always get High Distinctions, that is a disaster and they are dumb.  For the student who always gets by on Passes, that Distinction is an amazing thing to be coveted. Sometimes, we can't see the truth because of our filters. In the real world, we sometimes have to ask ourselves if this really is the way we're seeing it, or if we're applying some unrealistic filter.
  4. Disqualifying the positive.  This is the faulty thinking that says none of the good stuff matters because this bad thing happened. For an example I'd like to tell you about a small boy I babysat recently.  He had been in trouble for some naughtiness just before I took over, and was crying about it. When I asked him what good things had happened that day he said, "Nothing good happened. Mum yelled at me."  Then I asked about specific things I knew his family had done. He agreed that he'd gone to the playground and had a great time, and had lunch at McDonalds and enjoyed that, and then been for a ride on his scooter, etc, etc.  He'd had a great day. But until he was specifically asked about it, all he could think of was the one bad thing that happened. In the real world, if what happens to us is 90% good and 10% bad, we're doing pretty well. 
  5. Jumping to conclusions. There's two parts to this: Mind reading and Fortune telling. Mind reading is when someone does something and I think this is about me. You can identify mind reading when you find yourself thinking "they're doing this to me".  Most of the time, they're actually just doing what suits them and may not even have any knowledge or interest in how their actions affect me.  In the real world, I am not so important to other people that all their actions are designed specifically to affect me. Fortune telling is when we decide we can predict the future. (In depression, we predict the worst possible). Fortune telling will say something like this: this flare is going to go on for ever and never get any better, I'm just going to get sicker and sicker and more and more miserable. It ignores that flares are unpredictable, and decides the worst possible scenario is what will happen.  In the real world, we don't know what tomorrow brings. Things, both good and bad, can happen unexpectedly. 
  6. Magnification and minimization. In a depressed mindset, it's easier to make bad things bigger than they are and good things smaller than they are, especially things about ourselves. Magnification is when your own faults or fears are bigger than anyone else's and they overpower everything else, it's when I don't deserve friends because I let one down and couldn't go out because I was sick. Minimisation is when we make our good qualities small and unimportant, it's when I spend days working on something for someone, but it's no big deal, it's not like it was anything special. In the real world, most of us are no better or worse than anyone else. We have good qualities and bad, and unless we're serial killers or something like that, we're probably more good than bad.
  7. Emotional reasoning.  This is the thinking that goes "I feel therefore I am..." I feel embarrassed, therefore I've done something wrong and the whole world must be watching me and judging me.  I feel guilty, therefore I must have done a really bad thing. I feel like a failure, therefore I am a failure.  In the real world, feelings aren't the best evidence of reality, especially when we're depressed to start with. 
  8. Should statements. Another chaplain I used to work with used to often say, "Don't should on yourself." When we give ourselves a list of shoulds: I should lose weight, I should get the dishes done, I should be more efficient, etc, we end up just feeling frustrated at all the things we should be and do and just never quite get there with the whole list. This leads to us feeling guilty and resenting all the things we "should" do, and often means none of it gets done.  When we apply "should" to someone else, we usually find other people aren't perfect and end up angry or resentful that they don't do everything they should do.  In the real world, human beings aren't perfect. We won't always meet our own, or others' expectations. We need to allow room for people (including ourselves) to fail once in a while, without that being a failure of everything.
  9. Labelling and mislabelling. Labelling is great in the kitchen when we want to know the difference between the plain flour and self raising flour canisters. It's not such a good idea when we apply labels to ourselves or each other.  If I call myself a "loser" or a "failure", that's how I'm going to come to see myself. In the real world, if I make a mistake, I made a mistake, I'm not a "failure".  I am more than the things I do right or wrong. And everyone else is more than the things they do right or wrong as well.
  10. Personalisation. This is when everything is about me. It's all my fault (even if I had no actual control over any of it.) My son missed the bus because I didn't wake him up (even though he's now an adult, he has an alarm and has been waking himself up for years). Personalisation leads to heaps of unnecessary and inappropriate guilt.  In the real world I am not omnipotent, and I don't control everything. I'm not responsible for all those things that are beyond my control.

A lot of depression can be tracked back to these faulty thought patterns. Sometimes, just doing the work of thinking through all the things that have happened lately and how I have thought about them and how that has led me to how I am feeling, can be all I need to do to climb out of the pit.

Sometimes, I realise that the "depression" isn't really "depression" at all. I'm just "feeling lousy" because I'm physically in a lupus flare, and the best thing to do about it is to go back to bed until I feel better. That happens in the real world, too.

Reference: BURNS, David MD.  Feeling Good: The New Mood Therapy. HarperCollins e-books.

Depressed? Need someone to talk to?  From anywhere in Australia call Lifeline on 131114.

This post written as part of Wego Health's Health Activist Writers' Month Challenge.


  1. I didn't know there was two kind of depression.... Very interesting post : cognitive therapy can indeed offer very effective results to who is able to apply it.

  2. I'm a little late to this article, but I've just started reading your blog and love it :). I just wanted to say that I'm so glad you've written this post. It honestly helps me a lot to read this. All these things are things that happen to me and go through my head ALL the time. It's so hard to get other people to understand what's going through my head when I'm feeling "depressed," or just down. What you've posted has reminded me I need to take each thing step by step and think rationally on things, before I go assuming things like being a failure, people deliberately trying to hurt me, etc., etc. Keep up the wonderful posts, you're so inspirational!

    1. Thanks Kayleigh. You're definitely not alone. It's very hard to step back and say, "Is this really what's happening, or just what I'm telling myself?" Those of us with chronic illness seem to have battles to fight on all fronts.


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