Warning: This article talks about depression and mentions being hospitalized for suicidal ideation.
I was depressed for about three decades. I recall being eight years old and feeling existential weight, malaise, fatigue, and sadness, emptiness, insecurity – feelings like I wanted to disappear (or worse). I was periodically suicidal in my 20s and 30s. In each episode, I voluntarily went to a hospital before anything serious happened. Mental illness is present in other family members: obsessive compulsive, bipolar, anxiety and depression. There are most likely other Autistic relatives as well, but that’s not talked about much. I was diagnosed with autism at the age of 32 years old, and while that’s late in the scheme of things, in the 1980s there was no diagnosis that I would have fit, being female and verbal and behaviorally compliant. Depression was one symptom of how my needs were not recognized or supported. I don’t blame anyone for that – it was the era I was in.
In the 80s, everyone was concerned with “self-esteem.” High self-esteem seemed to be the holy grail, and as a quirky, awkward, sensitive girl, I grew convinced I would never achieve it. Confidence was an elusive wellspring that I didn’t possess and couldn’t generate. Kids teased me for being skinny and bookish, and I struggled with undiagnosed Central Auditory Processing Disorder which made the world hard to process.
I was depressed and felt invisible, disposable, unremarkable, or unworthy. I tried harder and harder to perform some role or identity and then felt like no one really saw me for who I was. I didn’t want people to see me. I took on identities that may have been real, but didn’t satisfy my deep craving to be seen. In my most depressed stages, I rejected opportunities to be with other people in a real community or making connections and forming meaningful relationships. I gravitated towards other depressed people and relationships that reinforced my low self worth.
It’s becoming more clear that depression is not merely a chemical imbalance. I used to subscribe to the idea that it was, and I think it kept me stuck because I’d imagined that this imbalance state was my default. That meant either I’d have to take medications forever, or that the weight pressing down was inevitable, and ultimately out of my control. So I’ve found it helpful in my journey to be less attached to this explanation. In some sense, the depressed mind relies on helplessness to reinforce itself.
The depressed mind craves isolation (or even punishment), because it’s like confirmation that the world is a dark, unsafe place that is unsurvivable. I now recognize this mindset as a distortion, and I figured out how to combat this distortion by practicing three things:
- Find supportive environments and people for my daily life,
- Eliminate unsupportive environments and people from my daily life, and
- Cultivate a kinder, more positive, empowered internal state
Those three things didn’t happen in order, where #1 had to be completed before 2 or 3. They also are never completed, and they are never perfect. They are also not easy, and I don’t wish for the depressed reader to come away feeling hopeless because it seems like getting from there to here doesn’t take a ton of work. But I do want to emphasize that it’s possible.
Over time, doing these three things helped me understand how much depression reinforces itself, and can be affected by internal and external factors. This is so much more empowering and doesn’t require being “cured” so much as building skills of discernment and self-advocacy.
Discernment is an important word. I labored for years under the fear of being a judgmental person, of being unkind if I rejected people who were suffering (regardless of how cruel they were to me), or of not being liked. This kept me stuck in relationships, job situations, living situations, and even dangerous encounters for longer than I should have. The more this happened, the less I could trust myself.
Discerning which environments are healthy, supportive, and positive informed my path out of depression. It took me until my mid-thirties to really figure this out. At first it is a small difference: instead of resisting my tears or my bad feelings, they allowed them (and me) to be.
It was hard to take in that kind of experience, because when I was depressed, I wanted to be validated (for things like feeling unworthy of such attention or care). Ironically I felt invalidated when people said things like, “But you’re so smart and talented!” In essence, invalidation is an experience of not being seen. I think depressed people need others who recognize our suffering, and engage with it in a way that doesn’t minimize or avoid it. It is also impossible to get out of this without consistently, slowly, working out of it through support and real success. A person has to shift the dialog within, but also the conditions on the outside. These things have to align. Otherwise it’s too easy to reject support, praise, or success.
As I allowed in the experience of being supported, I noticed how bad it felt to be around people who didn’t treat me well. I stopped contact with relationships that didn’t feel like they were working. I made room for more positive interactions with people who reinforced positive cycles of thinking in my own mind. But there was a person I couldn’t really remove from my life, and with whom I spend the most time: myself.
The Clouds Inside
I don’t call it “my depression.” I do not own or claim depression as an identity – I used to, and when I look back on it, this was detrimental to my well-being. In fact all the depressive thinking, I don’t think of it as Me. I also don’t think of my positive thoughts and feelings in this way, either. If I identify too much with my feelings or thoughts then I may be attached to them and be stuck. It’s counterintuitive perhaps to do this with positive feelings too, but being stuck to happy feelings can make it painful when those feelings don’t last. Because none of it is permanent, I can be more free.
I rave about Dialectic Behavioral Therapy (DBT), especially for anyone like me who has tried Cognitive Behavioral Therapy (CBT) and didn’t find it helpful. In DBT we learn emotion regulation, and skills to tolerate distress as well as navigate relationships and conflict differently. I did more than one “round” of this over the years, and it’s helped me cultivate a kinder, more positive, empowered internal state.
I also have done a lot of yoga and meditation. I used to encounter a saying: “Honey, if yoga and meditation cured your depression then it wasn’t depression.” I would say that like DBT, yoga and meditation have taught me skills. I’ve learned through them to detach from my thoughts, to understand how momentary feelings really are, and to breathe better. Breathing is a key to the whole nervous system, and neurotransmitters are part of that nervous system. Eating well and moving have been keys to feeling better.
I don’t negate the benefit of pharmaceuticals for some, but even when they are needed I see them as tools to enable better skills. At times of distress, sometimes I opted to keep medications the same, and focus on therapeutic strategies. I didn’t want my cognitive abilities to be affected by higher doses of medication, or to confuse the issue with changes to medications. This is not psychiatric advice. I took medications for ten years. As I built skills, I needed less medication. I’ve been off meds for seven years. I’m imperfect at managing stress, but I’m okay with that.
Cultivating an inner world of self-acceptance has been more powerful for helping with depression than any concept of “self-esteem.” Esteem is another word for respect. If I don’t accept myself, I can’t respect myself.
How did I accept myself? Acceptance isn’t willful, and doesn’t say, “I’m fine just the way I am and I never have to change!” It’s almost cliche to say that you can’t change something you don’t accept. But if you don’t accept something, you deny it. Denial is a stance of escape. The “do it anyway” advice that is sometimes offered to depressed people is a bit like denial. It’s not about pretending. To accept is to recognize reality.
Right now, I live a happy, supported, and meaningful life. I have a spouse, a great job, and a home in the quiet countryside of New Hampshire. Sometimes the old feelings pass over like a cloud, and I worry that perhaps the cloud is here to stay. But I’ve become accustomed to seeing, alongside the chill and the dullness of the shadow, what still remains of beauty, light, and joy.
To clear the clouds of depression, I figured out how to move in the rain. Believe me, you don’t need to dance.
Karen Lean has sat on the Board of Directors and various committees, has given numerous keynotes, panel appearances, and led workshops for AANE. Her writing appears in the book of essays, “Sincerely, Your Autistic Child.” Originally from Canada, she lives with her husband in New Hampshire where she works in Healthcare IT.
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