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Jun 26 2014

Depression, and Mental Health as a Balance Beam Over a Pit

Content note: Depression. Obviously. (Also note that this post has a somewhat different comment policy than usual: it’s at the end of the post.)

There’s this analogy I’ve been using lately to think about my depression and my mental health care. I’m finding it useful, so I thought I’d share it with the rest of the class.

I’m not the first person to describe depression as feeling like being in a pit. And as my depression has been getting better (in the classic “two steps forward, one step back” fits and starts), I’m not the first person to describe that process as feeling like clawing my way out of the pit. But there’s another stage of mental health recovery, the stage I’m in now, that feels somewhat different.

feet on balance beamI feel like I’m out of the pit. But I feel like the ground I’m standing on is very narrow. I feel like I’m walking on a balance beam that’s suspended over the pit.

For some months now, I’ve felt more or less okay most of the time. But that okayness has felt somewhat shaky. Easily disturbed. Fairly small things make me feel bad out of all proportion to the badness; large things, or even medium-to-large things, can trigger a recurrence of the depression, or of some of the depressive symptoms.

And my mental health care has to be very carefully managed; my mental state rigorously monitored, my self-care precisely titrated. I need exactly the right amount of rest and sleep — not so much that I get torpid, not so little that I get exhausted. I need exactly the right amount of socializing — not so much that I get exhausted, not so little that I feel isolated. I need exactly the right amount of alone time — not so much that I feel isolated, not so little that I get overwhelmed. I need to spend exactly the right amount of time on work, exercise, meditation, pleasure, so I feel calm and engaged rather than overwhelmed, or aimless, or both. Small excesses in any direction have to be adjusted for immediately, or they can easily push me into the bad place.

This is not what I’m like most of the time. Of course I’m made happy or sad by external events; of course I try to keep work and pleasure and rest in a healthy balance. But when I’m not in the middle of (or recovering from) a serious depressive episode, I’m generally on a pretty even emotional keel. My basic outlook on life is not only steady, but is largely self-generated. And I can have stretches where my work and pleasure and rest, my time alone and my social time, are temporarily out of whack. I want them to balance out in the long run, but I can have longish stretches where I’m busting my ass to finish a project, or am running around being a social butterfly, or am lying around being lazy, without it risking my mental health.

It hasn’t felt like that lately. I feel like every step I take has to be small, and careful, and intensely conscious. And I feel like even if my steps are small and careful, I could easily be knocked off balance by a stiff breeze. I feel like I’m walking on a balance beam that’s suspended over the pit.

A few weeks ago, a couple of crises arose. (That’s generally what triggers a depressive episode: I can usually handle one bad thing in my life, but multiple serious stressors are what knock me into the pit.) So a few weeks ago, a couple of crises arose — and it felt like I’d been knocked off the balance beam. It didn’t feel like I’d fallen back into the pit, exactly. But it felt like I was clutching onto the balance beam with my fingertips, dangling over the pit, scrambling to pull myself back up. I got back on the beam again — but I felt wobbly, and my footing was shaky. And then another crisis came along, and I got knocked over again. I’m just now hoisting myself back up, and am trying to regain my footing.

catwalk FEMA_Mitigation_Team_Inspects_Raw_Water_Intake_TowerSo when it comes to mental health care, I feel like my job now… well, right now, today, my job is to hoist myself back onto the beam. But once I’m back on the beam, and my footing is steady and I’m not wobbling or flailing, I feel like my job is to widen the balance beam — so it’s more like a catwalk, or a bridge, or a platform. I’m doing carefully managed, rigorously monitored, precisely titrated self-care, partly because in the short run it keeps me on the balance beam, but also because in the long run it widens the balance beam, and makes it more stable.

I want to get to a place, not just where I don’t feel depressed, but where I can get bad news or have a bad day without it making me depressed. I want to get to a place where I’m not being knocked about by every gust of wind that comes along; where my mood isn’t totally shaped by whether the last thing I saw on Facebook was happy or sad. I want to get to a place where my mood is shaped by my fundamental optimism and empathy and high energy and general good nature, as much as (or more than) it is by the crisis of the week. I want to get to a place where I’m not constantly thinking, “What would be best for my depression now? Would it be better to finish that blog post? To go to the gym? To go to the cafe? To masturbate? To meditate?” I want to get to a place where I don’t have to drop everything and do self-care the moment I feel inspired to, because I don’t know when that window is going to open again.

The pit is always going to be there. That’s what it means to have chronic depression, even with infrequent episodes. I’ll never be able to ignore it entirely; I’ll always have to do some degree of mental health self-care to keep from falling into it. But I want to get back to a place where I don’t have to devote rigorous attention every waking minute to my mental health care, and can just get on with my life.

Comment policy for this post: It sucks that I should have to spell this out, but past experience has taught me that I do: Please do not give unsolicited amateur medical advice, to me or to anyone else with mental illness, in the comments. Or anywhere, for that matter. Talk about your own experiences until the cows come home; ask questions until you’re blue in the face (except for douchy passive-aggressive question like “Why don’t you understand that psych meds are poison?” or “Will you read this article explaining why psych meds are poison?”). If you need this spelled out in more detail, please read Why You Really, Seriously, No Fooling, Should Not Give Unsolicited Amateur Medical Advice to People with Mental Illness (Or to Anyone, Really), Episode 563,305. Thanks.

Related post:
On Being on Anti-Depressants Indefinitely, Very Likely for the Rest of My Life

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  1. 1
    AMM

    I’m in a little different position from you, because I’ve never had “fundamental optimism and empathy and high energy and general good nature.” As far back as I can remember, I’ve had a background level of depression (the usual feeling worthless, hating myself, etc.) that goes up and down over a long timescale (months or even years.) But I also find that some (but not all) bad events can knock me way down. It’s sort of like Dante’s hell, which is a big pit pockmarked with little pits (“bolgie”)
    .
    Self-care: I’ve learned that I have to structure my life. Regular getting-up times, bedtimes, regular exercise, regular social events, all of which I have to make myself do even if I really, really don’t want to. There’s nothing like dragging yourself off to a dance when you feel like hell, because I know 90% of the time the “feeling like hell” is my depression’s way of getting me to stay in my dungeon cell.
    .
    Anti-depressants: I’m on them for the second time in my life. The first time was something like 10 years, this time it’s been about 6 months with no end in sight. I really don’t like being on them, because (in my experience) it doesn’t make the depression go away, it just makes me not care about it, so I can go on about my life. (Reminds me of the description of opiates: I’m told they don’t make the pain go away, they just make you not care about it.) I just feel anaesthetized and alienated from my feelings. But if I don’t take them, I keep having situations where I can’t do what I obviously need to do in the moment (e.g., getting up from the couch to make dinner or go to bed.) Whether to take meds is mainly a question of which kind of zombie I want to be.

  2. 2
    Mary Ann Ryan

    Thank you for this essay Greta.

    I’ve recently come across you and your work as I’ve gotten more involved in the atheist/secular community in Washington, DC, where I see you’ll be coming soon to talk about your new book. I can’t be there but thank you for coming (and coming out!). I’m a very out atheist too and I love the conversations I have because of this. I’m an atheist and I’m kind! What is this cognitive dissonance?!

    I digress…

    I’ve been depressive my entire life (the worst of it between 20 – 34). Now at 42 I can finally, FINALLY, say after years of therapy, medication, ADHD education and writing my own ADHD blog, that I feel sturdy, resilient (RESILIENT!!!) and excited for my future.

    Every depression is different so I think the most we can share with each other is our experience. For me to truly be on the other side and be the one who feels strong and stable is amazing to me on a level I can’t quite verbalize yet. Like the song says, “trouble me with your cares and your worries… my back is steady and strong.”

    I have no doubt you will build that strong and steady plank again for yourself.

    Mary Ann Ryan
    Twitter: @maryannryanwdc

  3. 3
    keelychaisson

    It would probably be more accurate to describe my own experiences with mental illness as a pit of depression with a beam over it, as well as at a few intervals part way down, with at most rickety rope ladders in between the levels. On the bright side, this means sometimes when I fall off a higher beam, I can catch myself part way down and stabilize at a point of low-level misery instead of completely crippling depression (antidepressants seem to help with this, as do various cognitive coping skills such as mindfulness). On the negative side, sometimes it feels foolish to try and climb from my place of relative stability up to a higher level–I WANT to be happier, but what if I fall trying to make the climb, or work my ass off to get there just to fall back down?

    As always, great post Greta. I will be sharing and thinking about the metaphor some more.

  4. 4
    badgersdaughter

    In my personal experience… coming out of depression is like a balance beam over a well, but also like draining the well, surprisingly. I fall, yes. I can fall hard. But the water at the bottom isn’t over my head anymore.

  5. 5
    badgersdaughter

    I think it’s also important to note, for any people reading this and struggling with depression, that we are all talking (so far) about having the experience of recovery, to one extent or another. That’s not something that would have occurred to me while I was struggling, myself. Recovery is possible.

  6. 6
    Larry

    But I want to get back to a place where I don’t have to devote rigorous attention every waking minute to my mental health care, and can just get on with my life.

    I may have commented about a similar experience on an earlier FB post – my analogy was hiking an icy trail along the side of a hill. Same thing about watching every step to avoid sliding down.

    It took a period of years, but I have to say I no longer feel the same degree of diligence I did during my first year on medication (and I’m 20 years in at this point). I don’t recall how long it took before I wasn’t thinking about it constantly – it was a gradual transition, which also involved fine-tuning my meds, waiting a few months, rinse and repeat. It never goes away completely, but it’s relatively minor nowadays. Only when I notice myself going a week or so “under the weather” do I check in and make sure I’m not feeling negatively toward every single aspect of my life, and even then I have to be careful to rule out illness like the flu.

    So here’s one data point that says yes, it does get better/easier, albeit gradually in my case. Hang in there!

  7. 7
    johnthedrunkard

    Hmm. I’ve been off the SSRIs for a bit over a year. Simultaneously living through some really dreadful shit, emotional, medical, financial etc.

    I’m finding that my ‘feelings/outlook,’ or maybe ‘affect/mood,’ can be at polar opposites. I can feel robust and cheerful WHILE having hopeless gloom over work/romance. At another instance, I can be ready to demand a neurology consult for the heaviness I feel physically while I’m chatting and laughing with friends.

    I know I’m in better shape than when I started the meds. That comparison can be made subjectively with no special effort. In the present though, I seem to muddle along with more than one scale to measure at the same time.

  8. 8
    geocatherder

    I’m so glad to find someone else who sees the state of not-depressed-but-fragile with similar imagery to mine. In my mind I walk a very narrow path at the edge of a cliff, and it won’t take much perturbing to push me off the edge. I’ve lived in that state quite a bit over the last few years. Right at the moment I’m several paces away from the cliff edge, but I discovered recently that a big enough push can still send me tumbling down the cliff. Fortunately the depression episode didn’t last too long… this time.

  9. 9
    geekgirlsrule

    I had a hard time recognizing my latest depressive episode as exactly that. I’m a year into a fantastic job that treats me really, really well, after 8 years working for a micro-manager with zero people skills and an emotionally abusive shithead who took out his marital problems on me. So, when the depression hit like a constant grey fuzziness leeching all the colors out of my world and feelings, I didn’t quite know what to do with it, or what it was. I had gotten used to depressive episodes that involved me sobbing in a fetal curl for two or more days, and popping clonazepam to try to kill the anxiety enough to deal with the depression.

    I finally figured it out, “Oh, yeah, this was what it looked like when I didn’t hate my life constantly and wish for the sweet release of death because at least then my partner would get my life insurance.” Honestly, the greys are almost worse. The deep dark sobbing depression would really bottom me out for a day or two, but I’d bounce back into my usual state of anxiety-generated hypervigilance and awareness. It took me so long to realize what I was doing, and what was going on with the grey, that I kind of didn’t know how to cope.

    I’m finally pulling myself out of it, and having to have a bunch of conversations with friends who don’t get why I suddenly disappeared for three months: “It’s not that I hate you when I’m like that. I hate me, and I don’t understand why anyone would want to hang out with me.”
    They invariably say, “You can call me when you feel like that.”
    “Yeah, if I were capable of doing more than looking at all the numbers in my phone and feeling like you’re all just nice to me out of politeness, and that I shouldn’t burden anyone else with my problems.” (thanks mom)

  10. 10
    Peter the Mediocre

    Your blog entry and some of what’s in the comments is eerily familiar–to the point that I could have written it myself (except that much of it was written better than I probably would have). In particular:

    “Yeah, if I were capable of doing more than looking at all the numbers in my phone and feeling like you’re all just nice to me out of politeness, and that I shouldn’t burden anyone else with my problems.” (thanks mom)

    hit me like a hammer. A big one, not some wimpy little tack hammer.
    Thanks for talking about something that’s hard to talk about. I suspect a lot of people are benefiting from it.

  11. 11
    geekgirlsrule

    Peter, virtual hugs if you want them.

  12. 12
    Onamission5

    I have described some of my own bouts of depression as The Doldrums, because that is what it feels like to me. Long periods where time seems to stretch out behind and in front of me indefinitely, there is no movement, only waiting for the end of seemingly infinite stasis. When I sense that I am approaching The Doldrums, I describe that as the looming abyss and when I am exiting, that’s me crawling out of the rabbit hole.

    It’s only been recently– the past few years– that I have started to really come to terms with naming all that imagery for what it is, with one single word. I still can’t quite get all the way to calling it depression, but it’s less scary to me now to give it a name than it used to be. Doldrums. Depression. They both start with D at least?

    @geekgirlsrule #9:

    Your last couple lines. Oof.

  13. 13
    Greta Christina

    They invariably say, “You can call me when you feel like that.”
    “Yeah, if I were capable of doing more than looking at all the numbers in my phone and feeling like you’re all just nice to me out of politeness, and that I shouldn’t burden anyone else with my problems.” (thanks mom)

    geekgirlsrule @ #9: That is absolutely the #1 thing I hate most about depression: the 857,304,961 ways that the illness itself gets in the way of taking steps to make it better. I don’t have that particular one, but I have plenty of my own. It’s as if one of the symptoms of diabetes was that it made it harder for you to take insulin.

    And virtual hugs to anyone in this thread, or reading this thread, who needs and wants them.

  14. 14
    Usernames are smart

    the 857,304,961 ways that the illness itself gets in the way of taking steps to make it better.
    — Greta Christina (#13)

    Add to it the frustration of being at the mercy of the f’d-up FDA and corrupt drug companies. I was caught up in the “Generic Wellbutrin Scam” whereby Bupropion (the generic) wasn’t tested by the FDA and let on the market. It turned out Bupropion had a lack of efficacy and/or increased side effects compared to the brand-name.

    When my pharmacy “helpfully” switched me to the generic, I started getting DTs.

    Once my Doc and I figured out what had changed, and gotten me back to the proper meds, the symptoms all but went away.

    (Speaking for myself, as always) I’ve never understood the stigma about taking psycho-meds. I eat food every day to live. I take medicine every day to remain well. The end. Someone wants to laugh at me or ridicule me because I eat food take medicine, then they’re the f’d-up ones, not me.

  15. 15
    fullyladenswallow

    @Greta Christina 13:

    “That is absolutely the #1 thing I hate most about depression: the 857,304,961 ways that the illness itself gets in the way of taking steps to make it better.”

    I heard an author being interviewed on the radio one time about his new book on Prozac. He described depression this way (paraphrasing): “It’s as if you had just broken your leg and while knowing this, also knowing you had to walk to the doctor to get it fixed- the very thing you’re suffering from is preventing you from getting better.”
    For me, depression doesn’t feel to be that much of a balancing act with the pit below. It feels more like some sort of emotional weight where hopelessness and negativity can rule the moment at will and any sort of positive expectancy is snuffed. And although I’ve been on meds for a long time, it’s seems I’ve always been this way. I think with the meds, I don’t sink as far, but by the same token, I don’t rise much above an occasional feeling of contentment. Oh, for a week or so of uninterrupted contentment. I’m in a room with a fairly low ceiling. I dare not jump to high lest I bang me head. I think the thing I would like to have most right now is some clarity.

  16. 16
    Lyrandar

    … I need to stop ignoring content warnings for depression. That always seems to end with me crying for reasons I can’t quite spell out.

    I don’t even know if I’ve ever been in the pit in the first place, but I can certainly sympathize with this metaphor. I feel generally okay most of the time, but every so often, I get a problem or combination of problems that hits me wrong, and then I’m feeling terribly useless and hopeless for the next hour or two (at least) while I regain my stability (and, usually, cry myself out). Almost every time I start feeling that way, the stressor that triggered it is rather minor (if I even can pick out one specific stressor that did it, as opposed to a collection of minor difficulties).

    I think it’s mostly because I tend to recall everything else that’s gone wrong recently when I get in a bad enough mood… which makes my mood worse and results in me dredging more crap up… and then by the time I’m berating myself for my lack of self-control, I interrupt it and find something to distract myself with until I’m in a better mood. I occasionally manage to interrupt it earlier, if I was already engaged in a sufficiently compelling activity or if I find something I want to do quicker than usual… that feels less common, though.

    And it’s difficult, at best, to talk about, because if it’s not people wondering why I would be so strongly affected by little things, it’s people wondering why I would subject myself to the feedback loop I described, and the best I can say is that I don’t know either. Although to be fair to the (very few) people I have tried to talk to, I don’t think I’ve ever been comfortable explaining this in any more detail than vague generalities.

  17. 17
    Trebuchet

    Greta, that’s a superb analogy. If I can extend it a little, it’s sort of like walking on a line in a parking lot. You can do it all day with no problem at all. But if there’s a precipice to either side, it becomes much more difficult. It’s not physically different but knowing that drop is there….

    I had a bit of an episode over the winter because pumpkin hurling season was over and I’d stopped doing the exercises I needed to do for some previous injuries, resulting in pain. Not to mention SAD. I’m doing better now, got some PT and more light and am building a new catapult, but it was SO easy to slip into that last winter. I’ve got to really watch it this year.

  1. 18
    Depression Sucks | Polimicks

    […] This is a response I made to a post at Greta Christina’s blog: […]

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