Depression, and the “Throw Everything Against the Wall” Method of Care


Please note: I am not a doctor. I am not a therapist. I am not a mental health care professional, or indeed a health care professional of any kind. I’m just talking about myself here, and my own experiences. Also, please note that while the self-care techniques I’m talking about here can be an effective part of a treatment plan for depression, none of them is treatment all by itself, and none of them is a substitute for therapy, medication, or other medical care.

I wish I had something to say about Robin Williams’ apparent suicide. I don’t — nothing other than “Fuck, that’s awful, that’s so sad,” nothing that hasn’t been said by many other people better than I could say it. But a lot of people have been talking about depression in the last couple of days, and I have some stuff I’ve been wanting to write about that, so that’s where I’ll go.

partly open windowI’ve written before about one of the smartest pieces of advice I ever got about depression, one that’s become a cornerstone of my depression self-care — both when I’m in a depressive episode, and when I’m not and am working to stabilize and improve my mental health. I was talking with a friend about the horrible self-perpetuating nature of depression, and how the depression itself saps my motivation to do the things I need to do to take care of my depression, and what a fucked-up vicious circle this was. The advice I got was this: If I ever have a window in which I feel any motivation at all to do any form of self-care, I should do it. When I’m in the middle of a bad episode, those windows don’t open very often, so I should walk through them when they do. And even when I’m not having a bad episode, I don’t always feel motivated to do mental health self-care — but doing it whenever I do have the motivation makes my mental health more robust, and makes a relapse less likely.

Now, if you asked me which form of mental health care was most important, and which I would do first if one of those windows opened up, I could probably give you a roughly prioritized list. But a more accurate and honest answer to “which form of mental health care is most important?” would probably be: All of them. What works best for me is to do every form of effective mental health care I know of, as much as I have time and energy and money for. What works best for me is to throw everything I have against the wall, and hope that some of it sticks.

There’s a couple of reasons this works for me. For one thing, when a motivation window opens up, it’s often very specific. I don’t always get a general jolt of motivation to do anything at all that will alleviate my depression. Instead, I get a specific glimmer of motivation to meditate; to masturbate; to get dressed and go to the cafe; to take a long walk outside. So even though exercise is one of the highest priorities on my mental health care checklist, if I have a sudden glimmer of motivation to meditate, then I meditate. (I was actually at the gym the other day, feeling irritable and unfocused and spending as much time staring out the window as I was working out — so I quit my workout, and found a quiet-ish corner, and meditated instead. Totally the right decision. My brain needed the self-care that day more than my muscles did.)

paint splatter 2Throwing everything at the wall also gives me more options when I have more than one window of motivation. If I’m doing better, and I have a fair amount of motivation to do a fair amount of mental health care… well, I’m not going to meditate three times a day, or go to the gym three times a day. But I might meditate, and go to the gym, and go out to the cafe. And doing all three gets more care into my system.

And maybe most importantly: Throwing everything at the wall just makes my mental health recovery more robust, and more resilient. It gives it a broader, more solid foundation. I don’t always know what’s going to make me feel better, either immediately or in the longer term. But if I’m doing all of it, or as much of it as I can do, I’m playing the odds. I’m increasing my chances that one or more of the things will have an effect. If I throw everything I have at the wall, there’s a better chance that at least something will stick.

So here’s what I’m throwing against the wall.

Meds. I never blow this off. I take my meds every day.

Talk therapy. I never blow this off unless I’m sick. I sometimes have to schedule my therapy around my travel schedule, but if I have a therapy appointment in my calendar, I go unless I’m so sick I can’t think or talk.

(Note: According to what I’ve read, research shows that therapy plus meds is more effective on depression than either therapy alone or meds alone. Can anyone with more familiarity with the current research confirm or deny that?)

dumb-bellExercise. I try to take at least a 20 minute walk every day. I don’t always succeed, but I wind up doing this about 4-5 days a week. I also try to make my exercise more vigorous — going to the gym, dancing, taking a longer walk, something — 2-3 days a week. I don’t always succeed, but when I aim for this, I get more exercise than when I don’t.

Socializing. When I’m in the middle of a bad episode, or am teetering on the brink of one or pulling out of one, one thing I do if I can is make specific plans to see people. If I don’t have anything in my calendar, it’s all too easy to just stay home and stew in my own juices — but if I have a lunch date in my calendar, I almost never blow it off. And I know that seeing other people is one of the most important and powerful anti-depressants in my repertoire.

Leaving the house. When I’m in the middle of a bad episode, or am teetering on the brink of one or pulling out of one, I make it a priority to leave the house at least once every day. As a writer, it’s easy to just stay home in my bathrobe all day, and when I’m not having trouble with depression, that’s fine. But when I am having trouble, I make getting out of the house a priority. If for no other reason, it kills two birds with one stone: it gets me into the sunlight, and it gets me interacting with other people, even if it’s just a five-minute conversation with the barrista at the cafe. And working in a cafe, even if I’m just sitting alone at a table and not talking with anyone except to order more coffee, still feels less isolating than working at home alone.

Time outdoors, especially in the daytime. See above, re: leaving the house.

Meditating in urban environmentMeditating. My goal is to meditate every day. The reality is that I meditate about 5-6 days a week. It helps enormously.

Getting the right amount of sleep: not too much, not too little.

Sensual pleasures. Sex, masturbating, eating delicious healthy food, taking a long bath with bath scrubs, getting a manicure, getting a massage, taking the time to put together an outfit I enjoy… you get the drill. I try to do at least one of these every day. That’s a larger and somewhat complicated topic — there’s something weird about treating pleasure as medicine — but it helps, so I do it.

Writing. This is weirdly tricky: when my depression is bad, lots of extended time on the computer isn’t good for me. And when my depression is bad, it’s easy for writing time to turn into “dicking around for hours reading just one more thing on Facebook” time. But writing is activity, and writing gives my life purpose and meaning and forward direction, and writing gives my experience shape and cohesion, and writing makes me feel connected, and writing makes my brain feel better in ways and for reasons I can’t explain and don’t entirely understand.

That’s my mental health care toolkit. That’s what I’m throwing at the wall. What about you? If you experience depression, or have in the past — what’s in your mental health care toolkit? Do you have priorities among your tools, or do you prioritize whatever it is you have the motivation to do?



Coming Out Atheist Bendingwhy are you atheists so angryGreta Christina’s books, Coming Out Atheist: How to Do It, How to Help Each Other, and Why and Why Are You Atheists So Angry? 99 Things That Piss Off the Godless, are available in print, ebook, and audiobook. Bending: Dirty Kinky Stories About Pain, Power, Religion, Unicorns, & More is available in ebook and audiobook.

Comments

  1. ceesays says

    I’m going to stop reading this right this instant, go have a run or a bike ride, I don’t know which, and then come back and finish reading this. it’s exactly the advice I needed to hear at the right moment.

    BRB

  2. Great American Satan says

    I don’t want to be a pest, so I hope this just comes off as an alternate point of view rather than naysaying. Your suggestions work for you and I’m sure they’d work for many others. But I know anecdotally that some of these items work very badly for some people. The person I know who feels terrible most of the time (possibly not depression or bipolar in the usual clinical sense, but suicidal ideation aplenty) has found a few of the items on this list to be extreeeemely bad for his style of problem:

    Exercise) Something as mild as a walk can be OK if motivation is available. Doing anything that burns serious calories can cause catastrophic mood crashes and lasting depression. I feel like this possibility – even if it’s not very common – should generally be included as a caveat for any suggestion of exercise to help depression.

    I’ve definitely found other people with this issue or variations on it. And if you have body image issues, you will have the added bonus of feeling guilty that exercise makes you feel bad, since everyone everywhere has nothing but good things to say about it.

    Leaving the house) Yes and no. Lots of body image and social anxiety issues just to get through the door. You have to fight through that sometimes, but might not a good idea when you’re already down, and have those issues. I like this one in principle. I think humans compartmentalize our consciousness in such a way that a change of scenery can change our whole outlook sometimes. And the reverse principle has been true for him – going home making a briefly forgotten depression come back.

    Time outdoors, especially in the daytime) unless like me, you can’t stand heat. I spend summer with a hair trigger temper and a frown on my face like the Geto Boys. Right now, I am very uncomfortable, with no relief in sight. I will go to sleep cranky and wake up sweaty, stiff, and cranky.

    Sensual Pleasures) Would be nice, but he can’t afford a large enough bathtub. They seem to max out at four feet in apartmentland. Other stuff works a bit sometimes. Food can’t be sensual because of anorexia soundtrack in brainz.

    Writing) The single worst thing possible for him is journaling or free writing. It opens a floodgate to the worst self-hate talk. I’m neurotypical and when I was a teenager I remember the same experience: I had two high school classes which involved journaling, and they ended up being tomes of swears and laments. (Bad home life, I got better as soon as it was far enough in the dust.)

    He has found escapism is the single best route to feeling better, but it has to be something that engages the mind. He calls this consuming “active” media or entertainment, rather than “passive.” For some reason, TV, books, and movies don’t do it for him. But video games and sometimes pen&paper RPGs can work, as does throwing himself into a big art project while listening to brainy audio on unrelated topics – if motivation is available.

  3. Great American Satan says

    Oh, and meditation) Some people have great difficulty with autohypnosis-type things. I can’t make meditation work. And people looking into it have to watch out for woomeisters, but I feel like you’ve covered that subject before and well. Not sure off the top of my domepiece.

  4. says

    For me, it’s reading. Reading has always been immensely healing for me. I grew up in a small desert town and went to a really small school. I was bullied and didn’t really have any friends. I lost myself in books.

    Sometimes, as an adult, I forget how healing it is to read.

    I find it most comforting when I am at a comfortable diner or even a fast food joint, with lots of noise and hustle about me, and I can just sit and enjoy my food or my coffee and read.

    I also like to walk, and I often walk without music going, because I like the noise of life around me.

    I am in a new state, now, a new city, and it’s so cool at night here during the summer!! I have found solace in sitting on the porch, with my Kindle. Or going out for nightly, cool walks — because in Phoenix, in the middle of summer, it was often too hot to even go for walks at night. There’s something about a lovely, quiet night walk that I enjoy.

    I don’t have a car, and I am happier because of it. I am forced to walk, a lot, and I am forced to spend time outside, and I am forced to figure out where I am and how to get places, and I find that a challenge like that, even if sometimes frustrating, is also very rewarding.

    I am almost looking forward to winter. It’s hard to be depressed when you’re faced with such a tough challenge. A desert gal now living in New England without a car. It’s going to be fucking hysterical.

  5. says

    Right now, it’s “take care of the cat”.

    I gotta keep her fed, and she needs pets and loves and interaction. She gave me a scare last night, though. I couldn’t find her — I was out there shaking the treat bag and calling her at 3:00 am. I did get to visit with the skittish neighbor cat, which was a real treat, because he’s a one-person cat and never rarely leaves his yard.

  6. Lea says

    Playing a musical instrument. When I was younger, my guitar-playing helped keep me going many times. Other creative activities like drawing or painting might also apply.

  7. cameradragon says

    Two things I lean pretty heavily on are art and good nutrition.

    I suppose art could be considered a form of meditation, but there is also something theraputic about creating, building and making, that isn’t always addressed by other ways of focusing and calming whirling thoughts.

    When i find myself starting to swing off balance I also tend to look at my eating habits. Chances are I have been either skipping meals or loading up on stuff with little actual nutrition. Keeping an eye on getting decent meals in me from time to time makes a difference.

  8. Kevin Kehres says

    I did a little work in major depression and bipolar disorder (separately, they’re different diseases) a few years back.

    You’re right that the clinical trial data show that the best results with depressive disorder are seen with a combination of medication and “talk” therapy. This is from memory, but I think “cognitive behavioral therapy” and maybe its cousin “brief cognitive behavioral therapy” were most effective with medication.

    One of the major stumbling blocks in effectively treating bipolar disorder is that patients most often are diagnosed when they are in a depressive episode and are wrongly given anti-depressants, which tends to make things worse — even leading to rapid cycling, which is a “very bad thing”. So, I’d recommend that people suffering from mood disorders not rely on their primary care doc giving them a prescription for Wellbutrin. See a psychiatrist and get a full work-up. It’s one of the major benefits of Obamacare — so USE it.

    Frankly, I’m shocked-shocked-shocked that Robin Williams wasn’t diagnosed as being bipolar. If he didn’t have a history of manic episodes, he did a damned good job of recreating them on TV.

  9. DysgraphicProgrammer says

    Frankly, I’m shocked-shocked-shocked that Robin Williams wasn’t diagnosed as being bipolar. If he didn’t have a history of manic episodes, he did a damned good job of recreating them on TV.

    Actually, I am given to understand that that was not so much “manic episodes” as “loads and loads of cocaine”.

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