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.
I’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.)
Throwing 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?)
Exercise. 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. 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?
Greta 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.