What’s working for you regarding your mental health? Do you have a mental health regimen? What behaviors or strategies do you want others to know about or practice more often?
I want to know!
As a therapist, I am insatiably curious about people’s mental health efforts and what works for them–as well as what doesn’t.
Do you swear by self-help books? A particular workout? A gratitude practice? A satisfying hobby? Is there a daily routine that keeps you stable? Maybe your progress has been made up of many smaller steps and changes that have added up to a more joyful, meaningful life.
Sometimes, the little things are the big things. Maybe most of the time they are.
Do you have inner peace? Have you learned to truly like and be proud of yourself, like the self-help books and influencers are always telling us to do?
Are you … happy?
Your story can encourage and inspire others. Share with us!
I am currently looking for true mental health success stories, either previously published or unpublished. As an alternative, I can conduct a brief one-email interview with you with five or six questions regarding your story. I encourage you to share links to your blog, website or other writings with my readers as well. We can also exchange stories for each other’s sites if that interests you.
Mental health is hard. Your story is important–even if it doesn’t seem particularly exciting or dramatic.
I look forward to hearing from you in the comments.
This is an excerpt from a memoir I’m currently writing, Thirty Cures in Thirty Years: A Depression Survival Story. It is a lighthearted book about the heavy work of mental health.For updates and availability info, subscribe to the right.
***
“What can I say? I’m depressed. You gotta do what you gotta do.” This was the first joke I made about my depression. It was also the first time that I self-identified, out loud, as a person with this disorder, and if doing so wasn’t actually a treatment attempt, it was at least one step closer to one.
I made the comment on a Saturday afternoon during the eighth grade after bringing a large stack of Peanuts comic books home from the library. Comics weren’t usually my thing, but recently, I’d branched out. While stacking the books next to the bath, preparing for a bit of escapism, my mother commented good-naturedly on my odd reading selection. Feeling a bit defensive, I spontaneously divulged this painful fact of my inner experience.
For the first time, I told someone I was depressed.
Recalling her reaction now, it seems a bit … inadequate. She laughed. Not a mean laugh, just a shoulder-shrugging kind. And there was something else, too, in her reaction that day. Was it helplessness? Or fear? Maybe, too–yes, definitely–there was relief.
Of course, looking back, I see that she could have done more for me that day than to simply acknowledge and reinforce my acceptance of the pain I was experiencing. Some follow-up, at least, would have been helpful, but alas, this was not to be. Due in part to her spiritual beliefs, and in part to her make-do small-town upbringing, she didn’t believe in counseling or medication; she believed in God’s power to heal, and in our power to believe harder and do better.
Mom wasn’t skilled at confrontation or open dialogue, either–any uncomfortable conversation was almost palpably painful for her. She embarrassed easily and passed on this trait. Which is why I sensed that my newfound ability to joke about my problem brought her some relief.
She wouldn’t have to be the one to say it first.
Her laugh told me something else, too: she already knew what I was going through. How long had she known? Who can say? But one thing is certain: the fact of my depression did not surprise her that day. Only my admission of it did.
So now, I knew that Mom knew I was depressed, and she knew that I knew that she knew. The knowing didn’t help, though; it contained no hint at next steps for either of us. Maybe she talked to a friend.
Maybe she prayed.
I never felt resentment of my mom for her seeming helplessness in this difficult parenting situation, though. During my bath that day, I even noticed some relief of my own. A joke. A joke helped. Note to self: this isn’t a disaster. Mom’s laugh told me that she understood, at least.
And that was something.
***
“Remember that you are an actor in a play, of such a kind as the playwright chooses … If it be his pleasure to have you act a poor man, a cripple, a ruler, a private citizen, play it naturally.” Epictetus.
“Many a true word hath been spoken in jest.” William Shakespeare.
This is an excerpt from a memoir I’m currently writing, Thirty Cures in Thirty Years: A Depression Survival Story. It is a lighthearted book about the heavy work of mental health.For updates and availability info, subscribe to the right.
***
On a fair-weather day towards the end of my seventh grade year, I sat alone on the schoolyard bleachers as Freya and the other girls in our class huddled nearby. Though it was our second week of softball P.E., not much softball was being played; the games we preferred were more subtle.
Suddenly, one of the huddling girls, Janice, walked over to me. The action jarred me out of my boredom and mental fog.
Why is she coming over here? I wondered. Is she going to talk to me? And what’s that in her step and in her jaw? Defiance?
“No, thanks,” I said. I returned her defiance, but mine was topped with embarrassment instead of friendliness. Still, there was power here, I told myself. It wasn’t often I got to reject others before they rejected me first.
“Do you want to join us?” Janice asked. It wasn’t a peace offering; it was an accusation. Albeit with a thick layer of hearty good cheer over top. I felt the sound of a ball connecting with a bat, but I didn’t hear it. The kids on the field were just standing around.
Besides, what choice did I have? I had to tell her no. I’d taken my stand against the clique long ago. Changing my mind now would be impossible; the script had already been written. They were Them, and I was just me.
But Janice didn’t leave it there: “What do you have against us, anyway?” she asked. “We never did anything to you. You just think you’re better than us.”
It was a fair assessment. I did think I was better than them. This war had never been theirs. It was mine alone.
I glanced at the nearby huddle. Every girl was staring at us. My accuser waited a moment for a reply that never came, then rejoined her friends. And then there was a moment that I didn’t appreciate at the time: Freya’s voice reached me. She said, loudly, “Don’t bother her, Janice.”
Maybe Freya wasn’t so terrible after all.
Maybe Freya was just popular because she was cool–not because of some deep character flaw. Later, she would compliment me on my beautiful, thick brown hair during a classroom exercise about self-esteem. But on the sidelines of the softball field, I didn’t–couldn’t–reach any of these mitigating truths.
I merely sat alone, humiliated.
Murmurings and glances from the direction of the group flowed over me, and as was my habit, I focused on simply getting through the next few minutes, one minute at a time. Not long afterward, we were called back inside to class, and I walked alone, trailing further behind the others than usual.
The anger that followed lasted several days at least. I might’ve called it “righteous indignation,” but it was wasn’t; it was powerless rage. I catalogued every possible rationale for my dislike of these prepubescent ladies. They were sinful. They were shallow. They’d rejected me, too.
In time, though, I found my way to the truth of the situation. They were right; I was the problem. I was the one who aggressed first, and what’s worse, I wasn’t good at this. When they finally returned fire, my line quickly caved.
Self-awareness, however, brings consolation prizes. Mine was a moment of clarity that happened not long after this incident.
***
Memories are strange. In some, sensory details feature prominently, while in others, only disembodied, timeless thought remains. One of my most meaningful recollections is of the latter type. It happened sometime during my middle school years.
There is no setting. No plot, really, either. I was probably in my bedroom when it occurred–but which one? I do remember the rough sequence, though–the thought that led to the next thought and then the one after that, till finally culminating in a momentous life decision.
Thought one: I’m a sinful person. I knew that one was true; I hadn’t been going to church all those years for nothing. Besides, there was the way I treated the other kids at school. I hadn’t been quite fair to them, had I?
I had my flaws. But according to The Way Things Were, flawed people could never be happy. That, then, was my second thought: Sin causes guilt. Which was followed by thought three: Guilt causes depression. Or maybe, Guilt causes God to withdraw His presence and favor, leading to deep and abiding dissatisfaction. Something like that.
It was that thought–that third one–that everything hinged on. It felt so true–so immutable–at the time. Looking back, I want to kick myself, or haul myself off my bed and through a window, then into some other life, just for thinking it.
Guilt. It was my Achilles’ heel. For many years, it caused me to suffer. And, as it turned out, unnecessarily. Until I let go of the idea that I was perpetually guilty of something (something …), my ability to discover helpful solutions was nearly nil.
You can’t find a solution when you have the wrong problem.
It led, logically, to thought four: If I want to be happy, I have to be perfect.
Then, thought five: I cannot be perfect.
What was the way out of this predicament? As I remember middle-school Mollie’s sadness about the inevitable and ongoing pain of life due to humanity’s sinful nature, I see that it was desperation that led to the next steps of my thought ladder.
Thought six: I can, at least, be more perfect than I am now.
Thought seven: But how? I have to be honest with myself about my failings.No matter what. If I don’t know what my sins are, I won’t be able to repent and change.
And there it was: the turning point. The first thought on this long train of thoughts that hinted at a solution, a way through. I couldn’t be perfect. But I could improve. And the first step to improving was brutal honesty.
Thought eight: It’s difficult, being honest with yourself. Admitting that you’re the one who messed up. But if I do this one thing, and do it consistently, I at least have a chance of someday feeling good.
Thought ten: I won’t always do the right thing. But I will always tell myself the truth.
It wasn’t a casual decision. It was a solemn pact. Brutal honesty would be the first guiding principle of my life. The idea was a sequoia of wisdom on a landscape otherwise barren of thriving, solid ideas. It showed that I trusted myself to not crack under the pressure of self-knowledge.
It showed that I knew I could do hard things.
***
“Be strict with yourself and forgiving with others.” Seneca.
“Everybody has to lie. But you pick out somebody you never lie to.” Ernest Hemingway.
This is an excerpt from a memoir I’m currently writing, Thirty Cures in Thirty Years: A Depression Survival Story. It is a lighthearted book about the heavy work of mental health.For updates and availability info, subscribe to the right.
***
Throughout my school years, while physically in school, I deftly maintained my loner status. In other places, though, things were changing.
When I was in the sixth grade, our family switched churches, and Lulu and I started attending a youth group. To our great and lasting relief, we became instant friends with the small cohort of fundamentalist Christians who were around our age, including the mature, well-spoken Judith who was a year older than me and became my best friend. We talked about everything–finally, I got to really talk–and since youth group met on Wednesdays, we saw each other and the rest of the group twice a week. After years of loneliness, my sister and I finally had kids to invite to our birthday parties, to go camping with in the summer, and to pass notes with during church.
We had friends.
It was the best thing that had happened to me in a long time. Religion wasn’t all bad for my mental health, then.
But it wasn’t all good, either.
***
Though still managing my depression with food, books and baths, I now had access to more potent potential cures: spirituality and friendship. Church gave me hope. But there were strings attached. My religious community provided me with a place where I could be my best, most confident, most outgoing self, but it also gave me a … problematic … worldview.
With an increased focus on religion came an increased feeling of guilt: I feared the wrath of God if I listened to non-Christian music or had a crush on a boy. Everything, it seemed, was sinful. The good news: if I could just stop sinning forever, I would likely be happy.
***
The church was a confidence booster for me, and my mom must have felt the same way. Along with providing her with new connections, the community strengthened a central part of her identity. She was a prophet, she declared soon after we attended our first service. And we believed her. And maybe she was.
One day, when I was eleven or twelve years old, she told my sister, brother and I that she’d had a vision of our new home in the country. First, though, we had to build it. But no worries: God would provide. She wasted no time getting the project underway.
As she researched land, contractors and blueprints, she also sold our childhood home. Then, the summer before my eighth grade year, after some months of living in friends’ basements and extra spaces, we bought an intermediate house in a different part of town. The house wasn’t as nice as the one we’d grown up in, but no one complained: it was located less than a block away from my best friend Judith and her younger sister Anne.
For the several years that we lived in that house, the four of us girls were inseparable. We baked cookies, watched scary movies, jumped on the trampoline, shared secrets–all of the things I always wanted to do with friends. At home and at church, I genuinely liked the person I was becoming; however, school remained difficult. As I entered the building each day, I also entered a fortress of shyness and sadness.
And until 3:15 p.m., I couldn’t escape.
***
One warm afternoon during the summer before sixth grade a friend of my mom’s went on a cleaning spree. Thinking of Mom’s two preteen girls, she brought us several large boxes of discarded magazines.
“Magazines!” Lulu and I said. Lulu was just a year younger than me, and we had both arrived at the age of crushes and self-consciousness. Though normally my mother forbade us from reading teen magazines, she couldn’t resist the free gift. Lulu and I brought the boxes out to the front lawn and dug in.
It was a treasure trove. One by one, my sister and I plowed through the magazines, skimming, reading, skimming again. The older girls in the pages and their daily concerns (lipstick shades, celebrity updates) fascinated me. I wanted to be like them. Of course I did.
It might’ve been my second time through the boxes that I slowed down enough to read a different kind of article–one of those socially conscious offerings that the editors seemed obligated to include at the rate of one per issue. It was about a girl who had been diagnosed with depression and was now receiving counseling and other support. In large print, there was a callout highlighting her moment of truth: “While riding on a bus one day, out of the blue, I burst into tears. And that’s when I realized I was depressed.”
My first thought: Ha! Crying on a bus? That’s not depression. That’s just … crying. I cry all the time: on the bus, in the car. Sometimes, secretly, I cry during class. She did it once, and suddenly she has a serious mental disorder?You’re not selling me on this, folks.
Depression wasn’t crying. Depression was not getting out of bed. It was losing a job, or attempting suicide, or becoming institutionalized. Anything less than this seemed a bit … dramatic. Anything less was just the pain of life.
Then I read the article.
Thank you, mental health educators.
The realization came slowly and by degrees. Isn’t it like that sometimes? At first, I filed the article in my head under “teen magazine’s weak attempt at a public service announcement, the one most girls skip on their way to the advice column.” Later, my internal dialogue shifted: If she has depression, then I definitely do. But clearly, that’s ridiculous. Then (how long did it take?), eventually, there was another quarter-turn: Oh. Maybe I do have depression. That would explain a lot, actually.
Maybe I have depression.
I have depression.
I wasn’t a martyr or a tragic figure. I wasn’t destined by God to suffer. I was a normal person whose emotional needs weren’t being met. The understanding that eventually dawned did little to solve the problem. But knowing was at least a starting point.
***
My first purposeful attempt to treat my depression was … inadequate, to say the least. It took place on Thanksgiving day of my seventh-grade year and was inspired by, of all things, a long bath. Even at that young age, I had begun seeking comfort in baths on a regular basis, outlasting the water’s heat in an attempt to remain in that place of comfort as long as possible. When I recall the experience, it’s not the tongue-in-cheek remedy that I drafted that stands out the most; rather, it’s that I remember the occasion at all.
I have only thirty or so clear, specific memories of my childhood home, and most of them deserve to be remembered: nighttime fears. Christmases. Punishments. The day I discovered my grandmother “acting funny” on her favorite chair in the family room in the midst of her fatal heart attack.
I remember my first phone call, made on our wall phone in the hallway nook. It was to Sydney after she moved away. I asked if her favorite color was still our favorite, purple, and she told me that she’d switched to blue. I also remember particularly enjoyable afternoons with my sister, playing post office and coming up with dance routines.
But why do I remember this experience–this simple bath? I remember it because it was important. That bath was the first time I purposely and knowingly considered how to manage my depression, and without the benefit of the internet, grownup involvement and proper mental health care, options were limited. Which is why my plan involved turkey.
The day of the bath I soaked for a long time, and after getting out, I lay on the bed. The familiar, welcome smell of my mother’s turkey dinner–now nearly done–came over me, and I realized something: I felt pretty good.
I feel … good, I thought. Better than I had in recent memory. Elevated to humor, I decided, half-jokingly, to create a recipe for treating my depression right then and there. I might have even written it down.
This was that plan: Step one: Get a turkey. On a day off from school, put it in the oven. Step two: Once the smell of the turkey starts to fill the house, draw a bath. Step three: Get in the bath, and stay in it for two hours. Then drain the bath fully while you’re still in it. Listen to the water as it slowly leaves the tub, and notice your state of complete relaxation. Step four: Get out of the tub and lay on a comfortable bed until dinner is ready. Step five: Eat the turkey.
It wasn’t a Turkish bath. But it was a bath with turkey. Maybe it was just crazy enough to work.
It wasn’t. But other crazy things were. And though I didn’t find out about them till much later, at least now I was taking action. I wasn’t just accepting my lot in life as I had for most of my childhood.
I was starting to make plans.
It was an inconvenient strategy, but it was important. It was my first.
I had no idea how many more strategies–both successful and not–were to come.
***
“The man who moves a mountain begins by carrying away small stones.” Confucius.
“He who controls others may be powerful, but he who has mastered himself is mightier still.” Lao Tzu.
Recently, while reading various reactions to Elizabeth Gilbert’s latest (super controversial) book, All the Way to the River, I came across a post that subtly disregarded her readership as “fed up middle-aged women.” It was a throwaway comment and one that I hear regularly. Middle-aged women are, apparently, quite unhappy.
I am forty-seven now, and though I can’t speak for all of us in this age bracket, I can say that this has not been my experience.
Has it ever been the middle-aged experience? Not for men, seemingly: a “middle-aged man” is often thought of as stable and successful, while a “middle-aged woman” is, well, past her prime.
Someday, I will be past my prime, and I’m okay with that. But that day has not yet come.
We are the new middle-aged women. We go to therapy. We inform ourselves about politics. We eat free-range chicken and recently, we’ve learned how to compost. Some of us read self-help books, and some of these books are corny. But we don’t read them because we’re sad, desperate and lonely—we read them because we are, more and more, becoming the emotionally regulated, fiscally responsible, work-life-balancing person we’ve always wanted to be.
Which of the women you know are financially and relationally thriving? I’d be willing to bet they’re past thirty-five, and likely well past it. But if this is true, why do we often dismiss them?
Middle-aged women are—cliché alert—the glue of society. We’re the thread that holds the pieces of the quilt together. We consistently (often daily) reach back to the younger generation and forward to the older, ensuring that all the pieces stay together. We’re the supervisors, the employers, the caregivers, the best friends, the supportive partners, the bus drivers, the volunteers, the full-time parents, the teachers and the bosses—and many of us are several of these things at once.
We handle the bulk of the day-to-day tasks that are most necessary for the survival of the human race.
We have boundaries. We have good friends. We have long walks in the woods and spaces in which we can be ourselves. We are as busy as women have always been, but we remind each other to pace ourselves. We have gathered enough life experiences to fuel a fulfilling life, and we’re better at making hard choices.
There’s something in literature called the “sagging middle,” and it doesn’t require much explanation. Writers, understandably, work for months or years on their openings, and give their endings a lot of elbow grease, too, but let their middle sections remain unpolished. The solution is to make sure the drama/action/conflict/challenges increase with every scene, without relenting, until the climax.
And somewhere along the line, we middle-aged women have figured out how to do this.
When I was in my twenties, I wondered when my growth would slow down—when I would start getting complacent. When I was in my thirties, some external life circumstances stabilized … but my internal growth actually gathered steam.
This surprised me.
When I was thirty-nine, I unexpectedly changed careers, going back to grad school to become a mental health counselor. When I was forty-one, I came out as a lesbian and ended my marriage of ten years. Neither of these were goals that I consciously pursued. Instead, they were the natural result of personal growth. And things like this just keep happening.
I’m forty-seven and since I plan to live till at least ninety (one can hope), I’m currently smack dab in my sagging middle. But … it’s not sagging. And my friends aren’t sagging, either. They’re building healthy relationships and maintaining enjoyable hobbies and learning new things. They’re going to therapy, focusing on self-care and improving their mental health. Some of them read corny self-help books and some of them do not. The ones that don’t, don’t need to.
They already know.
It’s true that middle age tempts many of us—men and women alike—into complacency. But some complacency is healthy, right? It’s stability. It’s accepting yourself, and understanding your limits, and realizing you will never have it all and that no, you can’t save the world, actually.
The new middle-aged woman isn’t trying to save the world. She’s picking her battles and doing the good she can do. She is responsible, reliable, conscientious and accountable for her actions. She’s being the change she wants to see in the world … to the best of her current ability and considering her current life circumstances.
We are the new middle-aged women. We read self-help books like All the Way to the River and Untamed by Glennon Doyle and, well, everything Oprah recommends. But we do this not because we’re miserable and on the verge of giving up.
We do it because we’re stronger than ever.
And though we can at times feel fed up, the phrase is no longer an accurate description of us, if it ever was.
This is an excerpt from a memoir I’m currently writing, Thirty Cures in Thirty Years: A Depression Survival Story. It is a lighthearted book about the heavy work of mental health. For updates and availability info, subscribe to the right.
***
When I was in the fifth grade, I checked out the same book every month for the entire school year. Some months I read it little by little during free reading hour, but other months I just kept it in my desk, comforted by its presence and pretending it was mine. When I did read it, I scratched the edges of the pages compulsively—a comforting habit. As I did this, some of the paper would flake off under my fingernails, and I would flick it to the floor, then start scratching again on the next page. By the end of the year, the book was in a sorry state of repair.
The book was called The Bears’ House–Marilyn Sachs was the author–and it was the first great book I ever read. Years later, I discovered that I hadn’t understood the book; clearly, the mother was severely depressed and the children were severely neglected. Sachs’ masterly subtlety and her use of the first person limited point of view meant that she never used those words. Instead, she perfectly captured the loneliness of a child who had no friends and who ran home from school every day at lunchtime to feed her baby sister Kool-aid from a bottle as her mother slept through the child’s cries.
But it didn’t matter that the subtler aspects of the book’s substance escaped me. I didn’t read it because of the plot; I read it because it was sad, and because I liked the main character. Her name was Fran Ellen, and she was always alone, and it didn’t seem strange to her to be that way.
Somehow, that made me feel less strange, too.
By the end of that school year, when I had to turn the book in for the last time, much worse for my having loved it, The Bears’ House was more than a book to me.
It was an education, and a friend.
***
That year, I gave up on going to the playground where my aloneness might draw attention. Did I reject them first, or did they reject me? Maybe it was a little of both. At recess and at lunch, I would wander the halls or apply lip gloss in the girl’s bathroom, killing time by sitting on the white-painted radiator by the obscured-glass window that would have offered a view of the playground and the other kids.
Other times, I would sit on the concrete steps on the side of the school building, around the corner from the schoolyard. They were comfortingly solid and hidden and I don’t remember anyone ever finding me there. And other than a few moments of sudden joy, or satisfaction, or a spontaneous feeling of confidence brought on by some special circumstance, that is who I was back then: the girl sitting on the back steps, alone.
***
One afternoon that year, I returned from recess and joined the line at the drinking fountain. Standing there, waiting my turn, I started crying. No precursor. No inciting incident. I was just … crying. No one in line behind me said anything.
Soon, Natasha walked by. Natasha, my almost-friend–the only person in school I suspected might like me. She was different, too, but in a different way. She was a confident tomboy with an attitude. Seeing my tears that day, she had the decency to stop abruptly and ask me if I was okay.
I appreciated that. Someone noticed. I existed. But when I didn’t respond, she added something to her query: “What’s wrong? Is it … the drinking fountain?”
The drinking fountain? Natasha. Don’t you see that my problem is bigger than that? I’m not a little kid, crying because she’s thirsty and the fountain doesn’t work. I’m suffering here.
I didn’t say any of this to her, though. I didn’t know how to say it, and she wouldn’t have understood. I simply shook my head in defeat, and she walked away. Her comment incited enough shock and embarrassment in me that I was able to suppress my tears, drink some water, and return to the classroom with the rest of the kids.
I went on with my day as if nothing had happened, but something had happened: I’d been confronted with a hard truth. People didn’t feel the way I felt about life. They didn’t see the despair in it all. My perspective wasn’t understood, and I wasn’t, either.
Maybe I never would be. Maybe I was a tragic figure, like people in books. Maybe I was destined by God for suffering.
But that wasn’t all bad, was it? At least I was special. I had depth. That much I knew. I had hoped that Natasha saw it, too, but it seemed she didn’t. “What’s wrong?” she had asked. Didn’t she know that everything was wrong?
The whole world is wrong, Natasha. The other kids. The grownups. The unfairness. The bleakness. The suffering. The drinking fountain, Natasha, had absolutely nothing to do with anything, but if it did, it probably sucked, too.
Natasha doesn’t cry like this, ever, does she? Not ever. Only I feel this way.
Why didn’t a teacher see me cry that day? Or another day–one of the many? Why didn’t they notice I had stopping going to the playground, that I spent every recess hiding in the bathroom or on the side steps? Why didn’t my mom wonder why I never asked to bring a friend home from school?
I will never know.
***
My fifth grade teacher was a kind and insightful one, and looking back I see her efforts towards me were more effective than I then appreciated. She made small talk with me–even confided in me about small things–and tried to make sure I felt included. For group projects, I was placed with the weird kids, including Natasha, and every once in a while I found myself accidentally feeling confident.
For the first few months of the new school year, Natasha and I were buddies. We passed notes during class and occasionally I would even join her on the playground at recess. She and I and another girl, Sandy, knew each other from the year prior, and the other girls in our combined fifth/sixth grade classroom were a year older (our struggling Catholic school had only a handful of students per grade). And so, it seemed natural for us to attach ourselves to each other–at least, it did for a time.
It wasn’t long before the beautiful Sandy was drawn into the older girls’ clique, though. It was hard to watch, but I’d expected it. The leader of the sixth graders was the school’s most popular girl and child model, Freya. She collected admirers. No one was safe. As I made no attempt to ingratiate myself with her (I knew a losing battle when I saw one, and besides, she was an asshole), she went after everyone around me instead.
Now it was just Natasha and I, and I began to wonder how long she’d hold out. We hadn’t experienced the gravitational force that was popularity yet. Could we just ignore it, much like we ignored the boys?
Already imbued with the hubris of religion, I saw the rivalry as good against evil. Which is why it was so hard losing Natasha to the other side.
***
It happened quickly. One day, in the girls’ bathroom, as I sat on the radiator, killing time, Natasha made a dramatic entrance.
“I’ve been looking for you,” she said.
“You have?”
“Yeah. I wanted to play. Have you been in here the whole recess?”
I nodded my head.
Looking for me, I knew, was Natasha’s way of siding with me–at least temporarily. Lately, things had been coming to a head. So rather than joining her, pretending I was okay, I gave expression to what had been on both our minds.
“You can’t go back and forth,” I said with the conviction of the utterly wrong. “You can’t just hang out with them and then me and then them again. You have to choose.”
It was kid logic. So of course, Natasha saw its sense immediately. She agreed to choose, but said she’d have to think about it first.
Towards the end of that day, during a short break between lessons, Natasha came up to me and abruptly said, “Hey, Mollie. I choose you.”
“Really?” I asked.
She nodded, businesslike. I sensed that she had convinced herself it was the right thing to do.
I smiled, and till the end of that day, we were best friends. Then, the next day, Natasha spent recess with Freya and the others.
Later than day, she found me again. With a touch of defiance, she said, “I just wanted to let you know, in case you haven’t already figured it out, that I changed my mind.”
I nodded sadly, but I understood. This was never going to go my way.
I was no fun.
***
With my support system at school pared down to one person–my teacher–I needed additional ways to prop myself up. The good-versus-evil story that had given me legs in my conflict with the popular kids was a great candidate, with handy evidence: these people weren’t even real Christians. I was good, and they clearly were not, and so it was just as well that we didn’t hang out.
I didn’t want to be friends with them, anyway.
“They’re bad influences,” my mom told me. “Don’t cast your pearls before swine.”
It was scripture.
And so, by the time I got to the sixth grade, I wasn’t just a loner.
I’m reblogging this post today since it’s so relevant to the theme of my blog … and so well-written, too! It’s also a great reminder to take with us into the new year.
In addition, I’m looking for true personal success stories about depression management and mental health improvement, so if you have a story to share and would like to be featured on my blog, let me know!
This is an excerpt from a memoir I’m currently writing, Thirty Cures in Thirty Years: A Depression Survival Story. It is a lighthearted book about the heavy work of mental health.For updates and availability info, subscribe to the right.
***
When I was in the first grade, I had a best friend. Of course, there wasn’t much competition for the title. My other friend, Joanne, had, in an act of great disloyalty and performed with great indifference, moved away several years prior.
Sydney was petite, blonde and unarguably pretty, made prettier next to my less graceful figure and plain face. I was shy—terribly shy—and she was … well, normal. We wouldn’t have been friends in school.
She was my neighbor, and our 1980s-era parents didn’t drive around to playdates, so in a way, she was stuck with me. In summers especially, we played together nearly every day, even though it was clear that at times, I annoyed her terribly.
I followed her around. I copied her, as kids do. She was the alpha to my beta. Yet, in those simple days void of personal reflection, the strategy worked pretty well. Most of the time we had fun together, choreographing backyard dance routines and teaching ourselves how to do cartwheels. We remained close, until one day in the summer before the second grade, she announced she’d be moving—in a week.
Other than events whose significance I wasn’t aware of at the time of their occurrence, this was my first defining life moment.
Our last playdate came. We spent it in my backyard. I don’t remember what we did, but there was a swing set and, if I recall correctly, clear open skies. Maybe we swung side by side, noticing the beauty of the day without noticing we were noticing. Kids do that, too. Before her parents arrived to pick her up and whisk her off to their new city, we discussed how we would say goodbye.
“Will we cry?” we wondered. “Will we kiss? What will we say?” But when, all too soon, her parents beckoned her to the car, the moment wasn’t as sad as it was awkward. Not knowing how to express our sadness, we quickly hugged and said goodbye, and after she left, it wasn’t sweet sorrow. It was just sorrow.
My best friend, my only friend, was gone.
***
A few weeks after the move, I got an unexpected letter. It was from my summer camp counselor who had heard that I wouldn’t be attending camp that year.
When my mother came to read it to me, I was in the backyard on our swing. I wasn’t swinging now, though. I was staring down at the ground, noticing how the gentle movement of my feet traced lines in the dirt.
The first thing I noticed when my mother interrupted my thoughts that afternoon was the uncharacteristic timidity of her voice. Was she … embarrassed? Why is she embarrassed about a letter? I wondered. This must be a pretty big deal.
It was from Mrs. White, she said. She gave me the already opened letter.
“I know it’s sad when a friend moves away,” I read silently. “But I hope you’ll change your mind and come to camp anyway. We want you here.”
The letter was nice. But my mom’s awkwardness as she handed it to me made me wonder. Did Mom feel sorry for me? Did she think I was sad or something? Had she discussed my feelings with other people?
Am I sad? I don’t know. I hadn’t thought about it till then.
“So what do you think, Mollie?” Mom asked gently. “What should I tell her? Do you want to go?”
I looked back down at the ground, missive still in hand. “No,” I told her. “It’s not that much fun anyway.”
Mom didn’t press the issue, and I was glad for that. She returned to the house and I returned to my thoughts.
I am sad, I realized. I’m not crying. I’m not physically hurt. But I am sad, and people can tell. And it’s not just right now.
I’m sad a lot.
It was true. And to me, it was a significant realization.
I was sad, and other people could see it. They knew.
***
When my father, who suffered from depression much of his life, would describe me as a baby, he’d say that I often had a “worried, thoughtful expression” on my face.
“There was a little wrinkle between your eyebrows,” he’d tell me. “You were so cute.” Maybe to my father, my seriousness was a sign of intelligence. Or maybe he appreciated that I took after him.
Either way, I wonder: did I already understand what I was getting myself into?
I was a serious kid. Maybe … a bit too serious? In pictures from young childhood, I see genuine smiles, but I also see contemplation, confusion, chronic boredom and unanswered questions.
My mom called me “sensitive,” but I knew the label covered up something else–something bigger. I’d been lonely for a long time, and now my one friend was gone. There would be no one to fill in the gap that she left–not for a long time.
***
One afternoon before I was yet school age I sat in our living room, re-reading the handful of children’s books we owned. Where was Mom? She might’ve been on the phone. For hours on end, she would gossip with her friends from church and Avon (a Mary Kay-style multilevel marketing company) while my older brother, younger sister and I would watch television and play outside. In later years, as her own depression grew, she gave up all three pursuits: makeup, church, and friends. For both of us, our social lives were a reflection of our sense of well-being.
On our eighties-chic light blue carpet, I spread out the books and studied them, one by one. Then, bored of the activity, I lay quietly and thought. Recalling saying goodbye to my brother that morning as he caught the bus for school and wishing for someone to play with, I had a strange thought: Is something wrong with me? What if I’m … retarded? That was the word we used then for people with Down Syndrome. I tried on the idea, slowly turning it in my mind. What if I’m retarded and no one wants to tell me because they’re afraid it will hurt my feelings? It was my first thought experiment.
After considering the evidence, I assured myself it couldn’t be true–my mom always told me I was smart and praised me for teaching myself to read at age three. So why did I feel so different? And why didn’t I feel good and smile a lot like the other kids? And what was I feeling, anyway? I had so few answers, and so many questions, most of which I didn’t even know how to ask.
And who would I have asked, anyway? What would I have said? Throughout childhood, the idea of confiding in someone about a serious personal difficulty just never occurred to me. I was different, I figured. I’d always be this way.
No sense in making a big deal about it.
***
Other early memories corroborate the narrative of myself as a fundamentally lonely, withdrawn child: The time I relieved my bladder at my desk because I was too shy to raise my hand and ask to use the bathroom. The times I excitedly reorganized my bedroom and carefully planned my outfit for the rare playdate my mom set up for my sister and I with the kids of one of her friends. How many of these were there altogether? Four? five?
One day at recess (was I in the second grade?) a boy pointed to my feet and said, “Don’t you need new shoes?” He was right: the soles had completely worn through and one of them flapped a bit, separating from the fabric uppers, as I walked. I liked those shoes. I was comfortable with them, and I hadn’t even thought to ask my mom for another pair.
One Christmas, I received the present I’d been hoping for–a talking spelling computer. When I tried to use it and realized that, right out of the box, it was broken, my mother told me she would replace it as soon as she could. I nodded a reply, but somehow I knew she never would, and she never did.
One day in the third grade I cried in class, devastated, after being scolded by the German nun who had taught that grade at our small Catholic school for as long as anyone could remember. I had reversed the i and e in the word “friend,” and the teacher’s severity was not only embarrassing–it was a betrayal. Though the kids didn’t like me, the teachers always did, and being humiliated by her felt like losing an ally.
Often, basic tasks of self-care went undone. There’s a memory of my mother frantically insisting that my sister, brother and I brush our teeth before a rare dentist appointment. I was a bit annoyed by this, and also a shade doubtful: Why are we brushing them now? It’s too late, Mom. He’ll figure it out.
I didn’t brush my hair regularly, either. When finally my mother decided things had gone too far, she wet my hair with No More Tears shampoo (a splurge of a purchase that she showed me proudly) and worked through the knots one by one.
To her disappointment, there were tears.
***
The last time I remember being truly happy during my youngest years was when, a year or two after her move, Sydney came to town and visited for an afternoon. We played in the living room, hanging various important documents all over the walls of our “office.” But what I remember the most is the pit-of-the-stomach sadness I experienced when her mom finally said she had to go.
Sydney and I begged for ten more minutes.
“Ten more minutes,” her mom told us. All too soon, she came back. Then Sydney left, and it was over.
I didn’t know when I’d play with a friend again, but I guessed it would be a long time.
I guessed right.
In that moment, something inside me broke, and though it healed, I was never quite the same. From that moment on, I was no longer a child.
I no longer believed everything would be okay.
***
I wasn’t right about that, exactly; eventually, I would be okay. But it would take a long time to get there. In the years to come, I’d try numerous remedies for my lifelong chronic depression, and though they wouldn’t all work, some would.
Have I tried thirty cures in as many years? Or have there been more than that? Either way, for me, self-improvement has been a lifelong job. Fortunately, it’s a job that I have since figured out how to do–most of the time. And it’s a job that I like most of the time, too.
Anyway, mental health, I’ve learned, isn’t free for anyone–even for people who are naturally cheerful.
It’s always earned.
There are no exceptions.
***
As an undergrad, I majored in English and History, specializing in ancient Greece and Rome. A few years ago, I revisited some of the authors I might not have fully appreciated as a twenty-something. This included works of stoic philosophy like The Trial and Death of Socrates (the trio of dialogues individually known as The Apology, Crito, and Phaedo),Meditations by Marcus Aurelius and Letters from a Stoic by Seneca. Other authors I read or reread around this time echoed some of their themes: Ralph Waldo Emerson. Henry David Thoreau. Augusten Burroughs. A guy named Mark Manson wrote a book called The Subtle Art of Not Giving a F*ck, and it was every bit as profound as the title suggests.
By this time, I’d been a self-help writer for about fifteen years and a mental health counselor for about five. Many of my books and stories coalesced around the themes of depression treatment and of the mental fortitude such a disorder calls for. What do I most want to say? I’d often ask myself, as all writers do. What is the one thing I want everyone to know?
Inspired by my recent reading, the answer came easily: I want to help people see themselves as survivors, not victims. To take responsibility for their mental health–to see it as a job.
And here, now, was Socrates: “He who is not contented with what he has, would not be contented with what he would like to have.”
And here, now, was Seneca: “Difficulties strengthen the mind, as labor does the body.”
And here, now, was Marcus Aurelius: “You have power over your mind—not outside events. Realize this, and you will find strength.”
I’m a stoic, I realized. I just didn’t know it till now.
And so, this is a book about depression–my depression, specifically.
This is chapter one of my book, Fights You’ll Have After Having a Baby: A Self-help Story. Previously available at Amazon, Barnes and Noble and other online retailers, it is now available at Walmart as well. Get your copy today and don’t forget to leave a review.
***
Everyone told me it was normal to be nervous. More than nervous—freaked out. Insecure. You’re going to let us take her home now? By ourselves? they remembered thinking before leaving the hospital. Are you sure that’s such a good idea?
And actually, it was pretty weird. The nurses taught me how to latch the baby, how to change a diaper, how to adjust the straps on the car seat. They helped Matt and I get the swaddle neat and tight. But they didn’t say a word about, well, parenting. Crib or bed? Feeding schedule or no? Go back to work or stay at home? All of the hard decisions were saved for another day, not this day, the day Poppy was born.
I labored at the hospital, Matthew there and gone again, making trips between the delivery room, various eating establishments and home. While he distracted himself with errands, I distracted myself with an audio book, trying not to wish he was nearby. Thing was, I didn’t want him there. I really didn’t. I didn’t want to have to have a conversation. But if he would have held me–just that, and nothing more–that might have been all right.
It took two hours for the pitocin to kick in, and in late afternoon the real labor came. For this, Matthew did hold me, both my head and my hand, offering his body as leverage. When the midwife told me to curl, Matthew pushed my legs to my head, and laughed at how hard I pushed back. Lots of pushes. Lots. So many. So many. Then the head was visible, and the midwife asked if I wanted a mirror.
“Yes!” I said.
“No,” said Matt at the same time. Then: “You do, Hon? Are you sure?”
“Yes,” I said. “Of course I do. Don’t you?”
The midwife positioned it for me, and I saw my baby for the first time.
It didn’t look like a baby.
Three more pushes. Hard pushes. Long ones. Then: relief. The head was out, and with a last push for the body, Matthew and I became parents.
Matthew looked at the baby, then at me. “It’s a girl,” he announced.
“We know that already,” I said, laughing.
“She’s beautiful,” he said.
“But we knew that, too.”
“Of course we did. She is perfect.”
The midwife put Poppy, now crying heavily, on my chest. As I smooshed my breast against her mouth, Matthew put his hand on her soft hair.
“There she is.”
“There she is. She is ours.”
* * *
Late that night. Matthew gone again. He didn’t want to sleep on the pull-out. And as I soon learned, it was just as well. No, not just as well; it was better.
I got to spend the whole night with just her.
No sharing. No small talk. No deciding. No details. No normal life stuff. Just life. Just the room, the dark, except the street lamps below the half-drawn blinds, and a simple light behind the bed dimmed to almost nothing.
So this is motherhood, I thought as I stared at Poppy’s face. This is who I am now. Strange that I’m not scared. Everyone says you’ll be scared. But I feel good. I feel confident. It feels simple.
Here’s this little alive thing, sort of like a plant, except that I am her air and sunlight, her photosynthesis. She needs me completely, and I accept the challenge. That is the way this thing works.
It’s the most straightforward relationship I’ve ever had.
Honestly, that was it. That was my conclusion. I would be the giver, she’d be the taker—and I was fine with that. It was when I expected something, when I needed someone to behave a certain way—that was the situation I worried about.
Which is why lying in bed that night, there was only one thing I was worried about, and it had nothing to do with the baby.
It was Matthew.
What’s he going to be like, now that we have a kid? I wondered. Will he be the same person? For that matter, will I? Will being parents affect the way we treat each other? How we are together?
How will our relationship change?
And as it turned out, I was right to be nervous. Because while that first year with Poppy was one of the best of my life, it was the worst for me and Matt.
* * *
The following day, the hospital. Only that room in the hospital, and the bathroom adjoining it. Nothing more. Matthew came and went, bringing meals, bringing news. We opened a few presents, saw doctors, did paperwork. I slept a bit, too, Poppy next to me on the bed, though the nurse had advised against it. When I had to change my pad, the nurses helped me to the bathroom. They changed all of Poppy’s diapers and held her when she cried. It was the first time in my life I’d been waited on so thoroughly, and I relished it. I didn’t want to leave.
The following morning, Matthew arrived at 9 a.m. to take me home, and I delayed the departure as long as possible. When the time finally came—it was close to noon—I took a long last look at the room.
Maybe it was nostalgia. Sentimentality. Hormones. Or maybe—just maybe—it was more than that. Maybe it was the inkling I’d had the night before about Matthew.
Maybe I was sensing the learning curve ahead.
Yes, that was it. Just hours after giving birth, I had the mom thing figured out. I didn’t know how to do anything—not even change a diaper—but I knew how to be alone with my child. But four years into my marriage, I still didn’t know what Matthew expected of me, what he didn’t expect of me, and, most important, what to expect of myself. When it was just Matthew and I, this oversight didn’t matter. I compensated for not understanding what he really needed by giving him more of what he wanted, which worked fine. But now—now I had a second relationship to consider. My usual coping strategies wouldn’t work.
Even before Matthew and I arrived home the tension between us had begun. Matthew wasn’t himself. He was irritable. Hurried. Though whether due to jealousy, neglect or just impatience, I’ll never know.
He tried to hide his annoyance with humor. “Should’ve had a home birth.”
I responded with a tight smile and forced laugh. “I liked it there,” I said.
“Yeah, I noticed. Thought you were going to sprain an ankle so you could stay.”
“Don’t begrudge me my reward,” I told him, smiling again. “Besides, I thought about it. Wouldn’t’ve worked.”
The things I didn’t say: “Why do I have to bring up the pain of childbirth this soon?” “Why aren’t you happier?” “Why aren’t we celebrating?” I wanted the day we left the hospital to be special, an occasion. Instead, I just felt sad to go home.
Maybe it was too much to expect him to know how I felt, how I wanted him to support me on that day. But a small gesture made in that tender time would’ve gone a long way towards lessening my fears. He could’ve held my hand. He could’ve told me how proud he was of me. He could’ve just asked me what I needed. It would’ve taken so little, almost nothing—but instead, he chose jokes and I chose smiles.
The first two weeks after the baby was born, I cried nearly every night before sleep. A few times, Matthew heard me; he came to the bedroom and asked what was wrong. Each time I told him the same thing.
“It’s just hormones, Hon. I’ll be okay.”
I was working too hard. That was part of the problem. I always had and didn’t want to stop. Baby in the chest carrier, I cooked, cleaned and, my favorite, organized. There’s never an end of things to organize.
Part of me realized the emotions were normal, and that I wasn’t taking good enough care of myself. Another part of me, though, blamed Matthew.
He wasn’t helping enough. That’s the truth, unvarnished. He didn’t seem to know how to, really. While my life had changed completely—no more day job, constant sleep interruptions—he was quickly back to his usual routine. Work. Eat. Play. Sleep. Weekends: basketball, projects. Which is why, during those first few weeks with Poppy, I felt all the good stuff you’re supposed to feel— gratitude and love—I felt a lot of bad stuff, too. I was scared. I was angry. But mostly, I was sad. Sad that things weren’t right with me and Matt.
*
Fights You’ll Have After Having a Baby is my favorite thing I’ve ever written. Previously available at Amazon, Barnes and Noble and other online retailers, it is now available at Walmart as well. Get your copy today and don’t forget to leave a review.
This is an excerpt from a book I recently completed called Get We Get Better: 48 Treatment Options for Chronic Depression. Following the mental health journey of depression survivor Ruth, it offers numerous practical, evidence-based strategies for improving your physical, behavioral, vocational, relational, cognitive and emotional health. For updates and availability info, subscribe for free to the right.I post two or three articles per month, mostly on the topic of depression.
The hippies were onto something: when properly taken, psychedelics–ketamine, magic mushrooms, LSD, MDMA and others–can provide significant (and fast) relief from depression for many people. They are especially recommended for people with severe, treatment-resistant depression.
The effectiveness of these substances comes from their ability to quickly and dramatically alter the user’s neural pathways. When taken in a carefully crafted therapeutic environment that includes professional assessment, planning, oversight, and counseling, they can help people replace unhelpful stories and perspectives with new, vastly different ones. History is rewritten.
According to current studies and Michael Pollan’s excellent, comprehensive book How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence, psychedelics are not addictive and have a low risk of physical harm. However, mental harm such as paranoia or psychosis can occur, and people with bipolar disorder, schizophrenia and certain other mental disorders should not take them. Consult with your mental health provider on legal and safe use.
Ketamine is a legal psychedelic commonly used for starting and maintaining anesthesia during medical procedures. Recently, anesthesiologists across the U.S. have set up clinics to administer ketamine off-label for mood disorders. Other medical providers specially trained in psychedelic-assisted therapy are offering ketamine treatment in smaller, private settings. These treatments can be expensive, and are rarely or never covered by insurance at the time of this writing. However, like other psychedelics, ketamine’s effect on depression is reportedly swift and significant. In clinics, it is administered intravenously.
Esketamine is a legal psychedelic that is almost identical to ketamine on a molecular level. It is approved for use in the U.S. as an antidepressant when prescribed by a properly credentialed psychiatrist, and it is not as expensive as ketamine. It is administered in the form of nasal spray.
Psilocybin is the active ingredient found in magic mushrooms and magic truffles. Research on psilocybin for depression is in its early stages, but is quite promising.
Though MDMA is shown to have similar efficacy as that of other psychedelics, it is often sold as ecstasy or molly, and these drugs are unsafe. They sometimes contain methamphetamine, a highly addictive substance. In addition, some research has shown that repeated use of MDMA can lower one’s baseline mood, though this finding is controversial. Finally, it is known for creating a next-day hangover effect in some people, in which users experience depression, irritability and lack of motivation for a day or more following their use. Still, psychedelic advocates are currently seeking the legalization of MDMA and other psychedelics in addition to ketamine.
Before trying a psychedelic, read about its possible long-term effects, which for some might include psychosis and suicidal thoughts. Do not purchase these substances illegally, and carefully follow your prescriber’s recommendations regarding dosage, substance interactions and more.
If desired, add “consider psychedelic therapy” to your depression treatment plan. Then decide on next steps, such as finding a provider, and write them on your short-term and/or long-term to-do list.
This is an excerpt from my This is an excerpt from a book I recently completed called Get We Get Better: 48 Treatment Options for Chronic Depression. Following the mental health journey of depression survivor Ruth, it offers numerous practical, evidence-based strategies for improving your physical, behavioral, vocational, relational, cognitive and emotional health. For updates and availability info, subscribe for free to the right.I post two or three articles per month, mostly on the topic of depression. book, We Get Better: 48 Treatment Options for Chronic Depression.
***
Treatment option 11: Undergoing Eye Movement Desensitization and Reprocessing (EMDR) or another form of trauma therapy
EMDR is a surprising therapy. The most surprising part: it works. Studies show that this unique technique, which involves making side-to-side eye movements while a therapist helps you process your trauma stories, reduces some trauma symptoms with relative rapidity. If you suffer from PTSD, or you think that your personal history might be contributing to your depression, you might want to consider this treatment option.
To locate an EMDR-trained therapist, a good place to start is PsychologyToday.com. This website is the most-used referral site for counselors, psychologists, psychiatrists and other mental health professionals and the search function seems to work fairly well.
Once you have identified providers, ask them about their EMDR training, experience and credentials; the practitioner’s skill level is a significant factor in its effectiveness. Your counselor should have experience with other forms of trauma therapy as well, as EMDR is contraindicated for some people.
When undergoing any form of trauma therapy, carefully consider your level of tolerance. Plan for possible lingering emotional effects and choose the environment and timing that is right for you. Practice your preferred emotional coping skills before and after therapy and provide feedback to your counselor about what you feel able to handle on any given day.
If desired, add “try EMDR” to your depression treatment plan. Then decide on next steps, such as finding a medication provider, and write them on your short-term and/or long-term to-do list.
This is an excerpt from a book I recently completed called Get We Get Better: 48 Treatment Options for Chronic Depression. Following the mental health journey of depression survivor Ruth, it offers numerous practical, evidence-based strategies for improving your physical, behavioral, vocational, relational, cognitive and emotional health. For updates and availability info, subscribe for free to the right.I post two or three articles per month, mostly on the topic of depression.
***
Treatment option 9: Taking antidepressants
Though the exact mechanisms by which antidepressants work is as yet unknown, and studies are complicated by the placebo effect, evidence of their effectiveness is mounting. Most psychiatric professionals recommend them and see good results, and their patients do, too. It is a basic tenet of the therapeutic process to trust your client, and enough of my clients report significant benefits of antidepressants to convince me of their effectiveness.
The people who feel stuck and unable to make the kinds of changes that lead to an improved mood, as well as the people who have made many positive changes but still see no improvement, are the people that could benefit most from medication. In many cases, the advantages far outweigh the risks and side effects.
There are many reasons clients choose not to take medication for their anxiety and depression, though, and the choice is a highly personal one. In general, I recommend that people base their decision on side effects, effectiveness and other medical considerations, and not on social, moral or idealist considerations. Taking medication for a mental health condition is not inherently wrong or right, healthy or unhealthy. Listen to your body.
If you’ve been prescribed an antidepressant by a primary care physician (PCP) and it doesn’t seem to be working well, find a psychiatrist or psychiatric nurse practitioner (PNP) instead. While psychiatrists are medical doctors, PNPs are nurses, and many of my clients tell me that PNPs spend more time with them and ask more questions.
Go to your first appointment prepared with information on your options as well any questions you might have. Tell your story honestly and don’t be afraid to inquire about all possible treatments in case your first line of treatment doesn’t work out. You are allowed to be your own advocate. You are also allowed to say no.
When taking antidepressants, it is important to follow your medical professional’s advice concerning use, including guidelines around length of use, dosage and (if needed) discontinuation. Antidepressants are believed to work less well in successive rounds, so cycling medications is highly discouraged. Also, at least half of the people who try medication need to try more than one before finding one that works for them, so don’t give up after your first attempt, and follow your prescriber’s advice around increasing dosage until an effective level is found.
For general information and discussion on the topic of medication, read the relevant sections in Andrew Solomon’s excellent and thorough book, The Noonday Demon: An Atlas of Depression. For more specific information, consult your doctor or mental health professional.
If desired, add “consider taking antidepressants” to your depression treatment plan. Then decide on next steps, such as finding a medication provider, and write them on your short-term and/or long-term to-do list.
This is an excerpt from a book I recently completed called Get We Get Better: 48 Treatment Options for Chronic Depression. Following the mental health journey of depression survivor Ruth, it offers numerous practical, evidence-based strategies for improving your physical, behavioral, vocational, relational, cognitive and emotional health.For updates and availability info, subscribe for free to the right.I post two or three articles per month, mostly on the topic of depression.
***
Treatment option 8: Using nature and light therapy
Many people with and without depression report that their moods are affected by the presence or absence of natural light. And when you get that natural light outside, you might also receive the benefits of fresh air, open skies and exercise–no small extras.
Spending time out-of-doors, especially in natural environments, mentally separates us from our usual tasks and routines, helping to clear our heads. Even a short walk or quiet moment free of our four walls can interrupt an anxious or despondent moment by bringing our mental focus away from the emotional centers of our brain (the limbic system) and into the sensory centers instead.
In the book Lost Connections: Uncovering the Real Causes of Depression–and the Unexpected Solutions, Johann Hari describes the various ways modern life creates disconnections that can lead to mood disorders. One of the most significant of these, he says, is our disconnection from nature. At least in part, spending more time outdoors might reduce depression by offering perspective: wide open spaces make us feel smaller, which helps our problems feel smaller, too. It’s a mental shift that happens almost without our noticing.
Light therapy can also be accomplished indoors with man-made lights designed for this purpose, including tanning beds at licensed professional tanning salons; however, your results may vary.
If desired, add “spending time in nature” and/or “using light therapy” to your depression treatment plan. Then set specific related goals and write them on your ongoing to-do list.
This is an excerpt from a book I recently completed called Get We Get Better: 48 Treatment Options for Chronic Depression. Following the mental health journey of depression survivor Ruth, it offers numerous practical, evidence-based strategies for improving your physical, behavioral, vocational, relational, cognitive and emotional health. For updates and availability info, subscribe for free to the right.I post two or three articles per month, mostly on the topic of depression.
***
Treatment option 7: Eating well
No judgment here, and no specific advice: when it comes to your diet, do what works for you. Consider whether or not your eating habits affect your mood, and if so, what changes might help. Undereating can cause depression, and overeating can, too. Avoid perfectionism and choose goals that are realistic and doable.
Of course, when it comes to food, it’s not just about physical health, but about mental health, too. Do your food-related thoughts, choices and plans help you feel more emotionally stable and healthy, or less? Answering this question can provide helpful information when assessing whether or not you’ve established habits that work for you.
If you suspect that you could benefit from a rigorously scientific perspective on nutrition, try How to Eat: All Your Food and Diet Questions Answered by Mark Bittman and David Katz. Everything by Michael Pollan is also great.
Finally, if you suspect that you might have an eating disorder, take a moment to fill out a confidential screening or start the search for help at nationaleatingdisorders.org. Food is a big part of life, and it’s hard not to be depressed or anxious if this area of functioning isn’t going well.
If desired, add “eating well” to your depression treatment plan. Then set specific food-related goals and write them on your ongoing to-do list.
This is an excerpt from a book I recently completed called Get We Get Better: 48 Treatment Options for Chronic Depression. Following the mental health journey of depression survivor Ruth, it offers numerous practical, evidence-based strategies for improving your physical, behavioral, vocational, relational, cognitive and emotional health. For updates and availability info, subscribe for free to the right.I post two or three articles per month, mostly on the topic of depression.
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Treatment option 6: Improving your sleep
A complete sleep might be longer than what you’re used to, but you know when you’ve had it: you feel fully able to get out of bed and start the day’s tasks. Increased energy can increase motivation, which often increases productivity. Productivity, in turn, produces confidence and optimism. In addition, emotional energy–patience, distress tolerance, etc.–can be enhanced through proper rest. In people who are chronically tired, increased sleep might be the most effective mood booster available. It might also increase the effectiveness of other depression treatments.
Cognitive behavioral therapy for insomnia (CBT-I) is the behavioral modification therapy of choice for sleep problems. If you think you might need professional help for this issue, find a mental health counselor trained in this modality. Different people benefit from different CBT-I interventions. Briefly, CBT-I practices include:
Adjusting your sleep schedule as closely as possible to your natural circadian rhythms;
Going to bed at around the same time every night, and getting up at (as nearly as possible) the same time every morning–even on the weekends;
Using various techniques to reduce sleep anxiety;
Staying busy during the day and refraining from napping;
If needed, reducing your time in bed and/or getting out of bed during wakeful night hours to reset; and
Tracking your sleep patterns in a sleep journal.
Substance and caffeine use can significantly impact sleep, reducing the length of your phase three deep sleep and increasing the length of your less restorative REM sleep.
Finally, if you are consistently sleeping poorly even while maintaining good habits, consider setting up a consultation with a sleep specialist. You might be suffering with a sleep disorder like sleep apnea without knowing it.
If desired, add “improving my sleep” to your depression treatment plan. Then set specific sleep-related goals and write them on your ongoing to-do list.
This is an excerpt from a book I recently completed called Get We Get Better: 48 Treatment Options for Chronic Depression. Following the mental health journey of depression survivor Ruth, it offers numerous practical, evidence-based strategies for improving your physical, behavioral, vocational, relational, cognitive and emotional health. For updates and availability info, subscribe for free to the right.I post two or three articles per month, mostly on the topic of depression.
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Treatment option 5: Exercising regularly
When I talk with clients about exercise, I always feel a bit redundant. Most of us know that it’s one of the best non-pharmaceutical mood enhancers available. We also know that the long-term benefits–better physical health, better sleep–will likely increase our quality of life overall.
While some people report feeling a “runner’s high” after a good workout, others don’t seem to receive this benefit. If you are in the latter category, you still might notice a milder, yet significant, sense of well-being. In addition, for many people, exercise is associated with a sense of self-efficacy–even empowerment.
As discussed previously, don’t wait to feel motivated to take a long walk outside, or to follow along with a yoga YouTube video in your apartment. That feeling might never come. Unfortunately, the human mind isn’t as logical as we tend to believe: it knows the relevant facts, but it doesn’t vote for them. Instead, it votes for what’s comfortable.
Veto the vote for comfortable. If you’re not quite ready to start your new routine, consider a soft entry. Choose your days and times to exercise and put your exercise shoes or clothes on at those times every week, even if you don’t leave the house. Gradually, add small amounts of exercise (a walk around the block?) to this routine. Habit is what matters most.
From a mental health perspective, being consistent is the most important part of exercise–much more important than time spent, frequency, difficulty and other factors. Anytime you follow through with your exercise goals you have made progress–even on the days or weeks you don’t increase difficulty or see changes in your body. Your body has built or at least maintained its fitness levels that day, and more significantly, your mind has strengthened its relevant neuropathways.
After around twenty-five years of consistent exercise, it’s almost impossible for me to imagine discontinuing the habit. Over time, movement becomes more than a healthy self-care practice–it is part of your identity. You can take breaks, but it soon pulls you back; when you don’t do it, something feels missing.
That’s a good feeling.
If desired, add “exercising regularly” to your depression treatment plan. Then set specific exercise goals and add them to your ongoing to-do list.
This is an excerpt from a book I recently completed called Get We Get Better: 48 Treatment Options for Chronic Depression. Following the mental health journey of depression survivor Ruth, it offers numerous practical, evidence-based strategies for improving your physical, behavioral, vocational, relational, cognitive and emotional health. For updates and availability info, subscribe for free to the right.I post two or three articles per month, mostly on the topic of depression.
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Treatment option 4: Setting long- and short-term goals
Researchers in the field of positive psychology have made their careers discussing what constitutes the good life. Many of their findings are included in this book, and high on the list: pursuing meaningful goals. Though mindfulness research has shown that living in the present moment is a helpful habit to cultivate, we also benefit emotionally from some amount of future planning. Achieving goals–both daily tasks as well as major milestones–gives us the satisfaction of accomplishment, which can increase a sense of self-worth and self-efficacy.
When considering what you would like to work towards both in the short- and long-term, it might be helpful to follow the SMART framework. Try to identify goals that are specific (clear and well-defined); measurable (how will you know when you’ve reached it?); achievable (can you really do this?); relevant (does it get you closer to a larger goal?); and time-bound (yes, there’s a deadline).
Of course, people with depression often struggle with motivation. There’s a catch-22 at work here: you know you’ll feel better after you get started on the day’s tasks, but you don’t always have the emotional bandwidth to do so. For many people, though, motivation isn’t motivation. Instead, motivation is a reward pathway that follows the initial action. That’s right: motivation is a misnomer. It’s the feeling of satisfaction that comes as a response to completing a task, not the excitement that spurs us to get started. Some people do experience a feeling of motivation before doing their first task of the day, but that might be because their brains have learned over time that task completion satisfaction follows action.
Habit is key here. The more often you complete tasks on your to-do lists, the more your mind will anticipate the pleasure of doing so. Jeff Haden writes about this concept in The Motivation Myth: How High Achievers Really Set Themselves Up to Win, as does Daniel Pink in his popular book Drive: The Surprising Truth about What Motivates Us.
When thinking through ways to get more done, consider the following strategies:
Keep to-do lists and use them daily.
Start the day with a relatively easy task–an initial win to get your motivational ignition lighted. Then move on to the more challenging stuff.
When feeling unable to start a difficult task, tell yourself you’ll spend just a minute on it (even thirty seconds if that works better for you). Often, you’ll find that getting started is the hardest part and after the minute passes, you’ll want to keep going.
Ask a friend to be physically present with you while you catch up on time-consuming needs like laundry, organizing and the like.
Create time blocks of a predetermined length during which you focus on work alone: no texting, emailing, scrolling, etc.
Get more sleep. (More on this later.)
In What Makes Your Brain Happy and Why You Should Do the Opposite, author David Di Salvo has some additional advice. Get fast feedback, he says–even if you have to ask a friend to congratulate you on a task well done. When accomplishment and encouragement happen close together in time, your brain is more likely to associate the two. Also, keep in mind that some people are motivated more by achievement and some are motivated more by enjoyment. In one study, achievement-motivated people presented with a word puzzle that was described by researchers as “fun” didn’t do as well as when it was described as “a challenge;” for enjoyment-motivated individuals, the opposite was true. If you’re the fun-motivated type, find the fun in your to-dos. If you’re the achievement-motivated type, find the challenge. This framing might also be relevant if you decide to reward yourself for following through on an important goal. Would an enjoyable activity or indulgence work best? Or would it be more effective to track your progress in a phone app?
Though more focused on organizational change, the book Switch: How to Change Things When Change is Hard by Chip and Dan Heath might be worth a read as well. Research- and evidence-based, it discusses ways to increase your emotional desire to change, how to build new habits by “shrinking the change” and “tweaking the environment,” and more.
Finally, if you suspect you might have attention-deficit hyperactivity disorder (ADHD), consider seeing a specialist.
In your treatment plan notebook, on your phone or in another handy location, create a long-term to-do list, a short-term to-do list, and an ongoing to-do list. Add tasks that relate to your treatment plan as well as other work and life tasks that need to be done. Check the lists daily and get in the habit of accomplishing at least a few items every day. Update the lists frequently.
This is an excerpt from a book I recently completed called Get We Get Better: 48 Treatment Options for Chronic Depression. Following the mental health journey of depression survivor Ruth, it offers numerous practical, evidence-based strategies for improving your physical, behavioral, vocational, relational, cognitive and emotional health. For updates and availability info, subscribe for free to the right.I post two or three articles per month, mostly on the topic of depression.
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Treatment option 3: Keeping a daily mood log
Rating and recording your mood two or three times daily and tracking it over time is a treatment option that is often overlooked. This might be because–let’s face it–the follow-through can be a bit of a pain. If there weren’t so many good reasons to use this strategy, I wouldn’t waste your time. But there really are so many good reasons.
The first reason I like mood logs is that they provide additional data when assessing the value of a particular treatment or set of treatments. Sometimes, it’s hard to know what’s working and what isn’t; tracking your results supports this goal significantly.
The second reason to use a mood log is that doing so allows for much-needed moments of introspection throughout the day. How am I doing? What do I need right now? Is there an emotion here that I need to address? Becoming more aware of your mood states and cycles can help you plan activities accordingly.
Finally, and possibly most important, the mood log provides evidence that, contrary to what you might feel during especially difficult times, depression is not a constant state. Instead, there are times of contentment and even joy mixed in with times of loneliness, sadness or worry. For some people, this knowledge alone is revelatory, as depression’s refrain is that sadness is permanent (unending), pervasive (carrying through every part of life), and personal (part of who you are).
The first rule of the mood log is: be as consistent as you can be. The second rule is: be as honest as you can be. It’s important that you trust the accuracy of your entries; otherwise, you won’t be motivated to apply the data to your treatment plan choices and to believe that you really are making progress.
If desired, in your treatment plan notebook, start a mood log. Check in on your emotional state either twice a day at about 10am and 6pm or three times a day–morning, afternoon and evening. Assign a number from one to ten that best represents your mood, with ten being blissfully elated; five being even-keeled, without either depression or elation; and one being deeply depressed. Be as accurate as possible without overthinking it.
In the weeks to come, periodically review your mood log. Notice any patterns that emerge. Certain activities and times of day might trigger certain emotional states on a fairly reliable basis. Note this information, and use it to inform your daily schedule and your depression treatment plan.
At least once a month, calculate your average mood score. Reflect on whether or not your mood seems to be stabilizing over time and possible reasons for this. Again, use this information to inform your depression treatment plan and make changes as needed.
This is an excerpt from a book I recently completed called Get We Get Better: 48 Treatment Options for Chronic Depression. Following the mental health journey of depression survivor Ruth, it offers numerous practical, evidence-based strategies for improving your physical, behavioral, vocational, relational, cognitive and emotional health. For updates and availability info, subscribe for free to the right.I post two or three articles per month, mostly on the topic of depression.
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Treatment option 2: Creating your individualized treatment plan
Many books on depression management are incredibly helpful. But often, they’re limited in scope. They focus on one intervention, such as meditation, exercise or cognitive therapy, and attempt to convince us that it’s all we need. However, most people who experience chronic depression know that it’s more complicated than that. While depression responds well to many individual treatments, over time, a more well-rounded, comprehensive approach is usually needed.
For this reason, I invite readers who suffer from some form of depression to create an individualized treatment plan that meets their personal needs and preferences. It might be helpful to seek the support of a psychiatrist, licensed mental health counselor or another mental health professional in this endeavor. My hope is that by taking a whole-person approach, rather than identifying one treatment at a time, depression sufferers will experience sustainable, long-term symptom reduction.
Four dozen treatment options is a lot to take in. Keep in mind that perfection is never the goal. As you work through these pages, try to remain a bit lighthearted about the whole thing. It can be fun to make optimistic plans. Later, you can revise your expectations and your goals, adjusting them to the reality of daily life.
One more important point here: though all of the treatments included in this book work some of the time for some of the people with depression, six options are backed by more research than are the others. I call them the Big Six, and they are: maintaining healthy relationships and a sense of community; sleeping well; taking antidepressants as directed and at an adequate dose; exercising regularly; going to therapy; and doing written cognitive therapy exercises. Spending time in nature is also surprisingly effective (see Lost Connections by Johann Hari for more on this). Psychotherapy’s high rates of effectiveness are enhanced when the client connects emotionally with the counselor and when therapy is used as a meta-strategy that includes and encourages other changes. I should also note two other less accessible heavy hitters for treatment-resistant depression: taking psychedelics in a therapeutic setting and undergoing transcranial magnetic stimulation (TMS). More on all of these to come.
Strongly consider each of these when creating your treatment plan.
Grab a journal or a notebook (or even just some loose leaf paper) and start your individualized treatment plan. This can look however you want it to look, but my suggestion is to keep it simple: write “Depression Treatment Plan” at the top of the first page, and write “Emotional Coping Skills” at the top of the second page. That’s all for now; as you work your way through this book, you will write down the treatment options you would like to try on these lists. More specific tasks related to your treatment plan can go on your to-do lists or elsewhere in the notebook.
This is an excerpt from a book I recently completed called Get We Get Better: 48 Treatment Options for Chronic Depression. Following the mental health journey of depression survivor Ruth, it offers numerous practical, evidence-based strategies for improving your physical, behavioral, vocational, relational, cognitive and emotional health. For updates and availability info, subscribe for free to the right.I post two or three articles per month, mostly on the topic of depression.
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Treatment option 1: Making your decision to get better
Ancient hunters, it is said, didn’t always run to catch their prey. Often, they walked over long distances using a technique called “persistence hunting.” Humans weren’t the fastest or the strongest animal in the wild, but our stamina made up for that shortcoming. In the immortal words of the long-running show Survivor, we were able to “outwit, outplay, outlast.”
The people who successfully manage or overcome their depression are those that have the qualities of a survivor: persistence, determination and grit. They use these qualities to pursue relevant knowledge and take action in spite of any internal resistance that might be present.
They do what it takes to survive.
For many of us, maintaining our mental health is a lifelong project that encompasses almost every area of our lives. Before exploring available treatment options, then, take some time to consider whether or not you are fully ready for this commitment.
Ask yourself this question: Am I willing to do whatever it takes to manage my depression in a healthy way? This could include introspection and honesty, putting aside old habits, forming new habits, consistently working toward goals, questioning long-held unhelpful beliefs and much more.
Take as long as needed with this task: minutes, hours, days, weeks or even longer. Only you know what you are able to commit to and when.