what will you do if your hopes are lost, gone, destroyed, destructed? create another one, brick by brick: an overarching purpose of life
hope & purpose of life
systems of survival
reinventing hope & purpose in life
finding an overarching purpose
what will you do if your hopes are lost, gone, destroyed, destructed? create another one, brick by brick: an overarching purpose of life
Recovery, Purpose and Nests
by John Folk-Williams
There is a link, though it’s a stretch, between recovery and the building of nests that occurs to me on this fine spring day, and I’ll get there in a moment. Right now, life is blossoming out everywhere. The stunning medleys of the mockingbirds are in the air, and there’s much courting behavior among all the birds: the strutting, chest puffing and singing of males, the coy approaches and retreats of females. And of equal importance, they’re building nests for their future young.
I saw a crow sail up to a high spot in our neighbor’s spruce tree, not far from the towering line of eucalyptus where his kind usually hang out, a hundred feet above us. This crow carried a single thin, flexible twig much longer than his body. I wondered if that one strand was the first for weaving the nest. How do they begin – what holds the first piece in place? How long does it take to pick out and carry back all the twigs of just the right type – one strand at a time – until the whole structure is woven together? The crows know by instinct the intricate pattern to follow, exactly the materials to be used and the right shape and depth of the final product. The purpose it serves is just as clear.
I may lack the instinct, but I’ve been learning to put together the pattern, the structure to support a new life. And there’s my homely analogy. I’ve been weaving a nest for recovery, one strand at a time. Getting started and having that first piece stay in place has always been the hardest part. I’ve learned all sorts of methods, patterns and step by step pathways to get out of depression. Time after time, the whole thing unraveled, no matter how strong it appeared to be.
The problem of the various treatments I used was the way they handicapped my thinking from the outset. They were telling me how to stop something, to end addiction, to overcome depression, to reduce stress and anxiety. That’s aiming for a negative, and, as important as it has been to stop those plagues, I need to see the positive side too.
Recovering means coming back from a loss, regaining lost ground. It is an activity, surely as hard as they come, which will support the future, but it is not that future itself. I don’t want recovery to become a constant. If I assume I won’t ever be free of depression and that I am always threatened by its return, I will have to apply the techniques of recovery as long as I live. But I don’t want to think or live that way. I can’t accept recovery as a life sentence, anymore than I can accept depression.
I don’t want to understate or downplay the importance of recovery itself. It is a tremendous accomplishment. It has taken everything I had to keep going after so many failed attempts. I always knew there was a different self inside me that could live differently, however dim the memory of that person might be. Only a deep instinct to survive, a will to live, kept me going through so many years of depression.
I celebrate that will and can never forget all I’ve had to do to get this far. For the recovery to last, however, as the earlier ones did not, I have to break out of the mindset that recovery as a life of constant vigilance is as good as it gets. As long as I think that way, depression continues its dominance as the condition I am always trying to control. I have to turn my mind and feelings toward a life with new purpose, not just a life in recovery.
For one last shot at my metaphor, those birds don’t go about building their nests as part of therapy. They are building the means to nurture new life, to extend the species into the future. They are born with that simple and compelling drive.
The instinct in people to live is just as basic – though for us it can be warped into its opposite by a mind estranged from its own nature. But we also need more, an inner meaning to guide the spirit to fulfillment. And that is what I’m moving toward now.
March 23, 2009 at 11:50 pm
I pay tribute to that wonderful will for life.
I think it is possible to build the new within the old. Even while dealing with the old.
March 24, 2009 at 8:13 pm
Evan – I haven’t thought of it that way, but you’re right – how could it be otherwise. The new is still me – a different potential that I’m now bringing to the forefront. That reminds me of an observation of a Jungian psychiatrist I once worked with – that in later life you move to a different point on the psychological type dimensions – more the feeling type than the thinking. So the whole of what you are gets full expression.
All my best – John
Recovery, Well-Being and Purpose
by John Folk-Williams
It occurs to me that recovery is past, well-being is now and purpose is the future. Let me explain.
Recently, I wrote about recovery as a concept I no longer wanted to apply to what I’ve been going through. The word carried a set of assumptions that kept me within an illness frame of mind. It meant getting over depression or perhaps managing it well enough to function more effectively. The focus was on what I had been through in the past and could not completely escape in the present or the future. My life was stuck in time. Recovery would never end because depression would never fully disappear.
But why did I have to start with that idea? Well-being, mental health, emotional balance, whatever you may call it – that’s what I was experiencing at the present moment. Why was I assuming that depression was the strong, well-being the weak force?
There was an alternative that could start from the fact that I’m excited, full of energy, feeling good right now. I can stay with that and assume that this is my normal state – that I’m well. Every time a depressive thought or symptom comes up, I can refuse to go there. Think it, say it: I’m not going there. If it should get bad, ok – it’s like being sick with the flu, or if it’s a lot worse – like pneumonia. Treat it, get rid of it, then get back to the norm of feeling good.
So I made a list of the assumptions I had carried around for so long. These are some of the big ones:
* I have had a condition diagnosed as major depression for most of my life
* Major depression is a chronic and self-sustaining
* I am treatment resistant and will probably have this condition all my life
* I hope for recovery, but none of the treatments work
* Though I will have good periods, depression will always return
* Medications aren’t very effective, but if I stop taking them, I’ll be much worse
Once I had set the assumptions down and saw them staring back at me, they lost their power to guide my thinking, feeling, expectations about the future and the sense of who I was. Recovery has been taking place for a long time, and the assumptions had to change. They didn’t make sense anymore, and I could suddenly sweep them out of my brain. Recovery was about the past – living and well-being are the rich present.
And what about purpose and the future?
I kept thinking of Viktor Frankl and the story he tells in his classic Man’s Search for Meaning about internment in a Nazi concentration camp. Thrown into the midst of the worst torture and suffering imaginable, subject to arbitrary “selection” for death, living through the grueling work details and lack of food only by mastery of the small tricks of survival, he learned the lesson that would shape his later life and career.
Without a sense of purpose, no one could live for long in those camps. He saw the truth that starkly. Those who could believe in a positive future, or even a single event like liberation from the camp, and who could sustain the will to achieve it, lived. Those who lacked that inner sense of purpose and meaning died. Those who held such an idea in mind could live as long as it lasted. Once it was lost or given up, they died. Learning the art of survival was not enough; there had to be a vision of what came next that transcended all the suffering.
Frankl developed the basis of his psychiatric practice from such extreme experience. He believed – and I share that belief – that all of us need a sense of meaning and purpose not just for bare survival but for fulfillment as human beings. Since I have survived, that sense of meaning and the hope it engenders must have been much stronger than I imagined.
Getting beyond survival, beyond the goal of recovery – that’s where I am now, shaping a new future while trying to make the most of the life that fills and surrounds me.
What sense do you have of the role of will and purpose in getting past depression?
May 3, 2010 at 1:12 pm
I am currently in the survival mode of depression. I am trying to get through the day and night without giving in to my despair. I have an insightful positive feeling for a short time followed by more despair, exhaustion etc.
I am still trying to accept depression as a real illness, not something I can will myself out of. I am still blaming myself for not trying hard enough. But the truth is that I have tried hard all my life.
I know my beliefs need to change in order for me to recover. I just don’t know how to do that…I want to have a career or at least be able to support myself in a meaningful way. I am so scared that I won’t be able to do that. That thought keeps my depression going. I need help to let go of that.
Anyway, that’s all for now. Thank you for this blog, and for all of your insights.
May 7, 2010 at 9:00 pm
Hi, Minu -
I know how hard it is to keep going through a time of feeling discouraged and fearful about getting better. It really is true that depression is an illness and that there’s a lot more to you than that. It’s hard to find the methods that work – I’ve tried just about everything except sending electricity through my brain. In the end, I think it’s all helped – I urge you to look at the Sherwin Nuland video on his recovery (which did require ECT). It’s another moving testament about recovery from a man who almost lost everything to depression.
My very best to you.
April 9, 2009 at 9:58 am
Ironic, this last week I’ve been looking at the different phases I’ve gone through with mindsets of ‘diagnosed’, ‘maintenance’, ‘recovery’…now I’m on ‘living’.
The cool thing for me is knowing now where I was years ago, months, and even weeks ago compared to now. Making better choices than I ever have in my life, and knowing that I’m healthy and living to make ones for greater tomorrows, today and then.
Again, another wonderful post.
April 9, 2009 at 3:33 pm
Thank you – that’s so encouraging to hear you’re doing well. It amazes me how the words and concepts can frame our whole outlook. Congratulations on great progress!
Thanks for coming by.
Merely Me says:
April 7, 2009 at 5:25 pm
This post reminds me to re-read this book. It reaffirms so many things for me.
The way that I have always survived my moods is to think that there is a meaning and purpose to my life. Suffering is part of this meaning. I no longer resist suffering so much because of this. Not that I allow myself to become disabled by my moods but more so that I accept that these dark times are a part of my existence as a human being.
I think nowadays the emphasis is upon eradicating any form of sadness. I am not advocating some romantic version of depression but being happy all the time is not my goal. Instead it is to find joy. There is a difference.
Well I could go on and on but I will stop here.
You always get me to thinking. Great post as usual.
Was wondering if you could stop by to give your insights on a tongue and cheek post I have written about the history of depression “treatments.” Imagine using leeches to cure your melancholy!
April 7, 2009 at 8:57 pm
Hi, Diane -
Accepting suffering and pain as part of being human is hard, but I think that gets at it. You show incredible resilience, given the number of issues you have to deal with – and you remain a highly motivated writer despite the pain. Happiness, I agree, is not the way to think of what to aim for. Frankl is great on this. He deplores the idea that people should seek a happy equilibrium – what he emphasizes is both purpose and action in the world, a dynamic state full of change and surprises – not the same anodyne existence all the time. (I’m actually working on a post about that now.) I’d be interested to know more about how you distinguish between happiness and joy.
Thanks so much for your insights – they always get me thinking.
I’ll check out your post on treatments – and others, since I’ve been remiss in visiting my favorite blogs. I’m spending a lot of time on my new blog and other online ideas. Fortunately, I have the time now to focus just on this kind of work.
All love to you – John
April 6, 2009 at 4:06 pm
I’m not sure this is in keeping with what you’re saying or not, but I simply don’t pathologize my feelings anymore. I’m okay however I feel…and the feelings pass through more quickly…like a rain cloud or some weather…or a burst of sunshine…etc…
I don’t use clinical terms at all to describe my experience anymore and I don’t think in those terms either. This has been profoundly liberating.
April 6, 2009 at 9:53 pm
This is exactly what I mean – getting away from the illness words and assumptions. What you say so beautifully about feelings passing through quickly is a wonderful quality about well-being. Unfortunately, I’ve always had a way of pinning the feelings up on a wall to stop them for review – I wind up holding onto them and they whip up a storm trying to get out.
Thanks for this comment!
All my best – John
April 6, 2009 at 2:35 am
Echoing the thanks, I’ve arrived at a similar place myself, making the transition from living just for recovery to some kind of new purpose. I hear the word ‘reinvention’ a lot, not only from my therapist, but even from people in business who are trying to cope with the external turmoil of the economy climate.
To your question about the role of will and purpose, I believe that a certain amount of recovery has to take place before the will can function meaningfully.
Depression robs me of the ability to do the things that I need to do to get better. There have been times when I was a puddle. No amount of exertion of will, belief in the future, or anything could bring me out of it. I required treatment in the form of meds, ECT, hospitalization, and therapy, along with tremendous and loving support from family and friends, to get my head above water.
This varies widely from person to person, just as responses to crises, infections, or pollutants differ. My father, a welder, worked with asbestos all of his life, wrapping himself in asbestos blankets while welding inside boiler tanks. He lived to 93 with clear lungs at the time of his death. Another friend had a brief exposure to asbestos and died of lung cancer a few years later. It was, IMO, about genetics, not about will.
Again, thanks for your good insights.
April 6, 2009 at 9:04 am
Thanks for this interesting comment. It’s true, of course, that recovery has to take place and requires much of what you’ve worked with (I hope the ECT had benefit – friends of mine who’ve had it suffered serious cognitive loss for some time afterward). I discussed that more in the earlier post I cited in this one. I spent years in that condition of not being able to will anything, so what you hear from me now only comes after that long struggle for basic survival.
There is evidence about the genetic basis for the disposition to get depression, provided the later life experience triggers it. But it isn’t the whole story, as it probably is with other diseases. However, no one really knows the whole story from a medical and research perspective, and each of us has to figure out what works and make the most of it.
I wish you well with finding out where you go from here.
My best to you – John
April 6, 2009 at 12:45 am
I love this post. Getting beyond the “survival” of recovery is something I have explicitly talked about with friends of mine also in recovery. There is more to life than survival, and sometimes, that gets lost in the bare bones scramble to hold on of recovery. Survival is necessary for living, but surviving is no way to live. It’s what reaches beyond survival that makes life worthwhile.
April 6, 2009 at 8:53 am
Hi, Katherine -
I love that line – survival is necessary for living, but surviving is no way to live. Great tag line for a blog! I’m starting to explore different approaches to therapy that emphasize this idea. Frankl does, and there is one I hadn’t heard of before called ACT – just trying to find out what its principles are. I’ll probably write about those and others by way of follow-up.
Thanks for taking the time to comment.
My best to you – John
April 5, 2009 at 7:48 pm
As usual, I couldn’t agree with you more. I think psychologists have done us a disservice by keeping those with histories of depression, alcoholism, or drug abuse “in recovery” for the rest of their lives. There is something better beyond recovery. Recovery is like getting a C. We need to strive for a B, or an A. The human spirit and will are stronger than any antidepressant. People can continue to function with severed limbs and other massive injuries when they need to. Active treatment of depression (planning a future, interacting, moving, talking, exercising) works better than passive (only taking meds). Depression looks back, anxiety looks around, happy looks forward. Yet the whole theory of depression today keeps focusing on neurobiology that we supposedly can’t control except with expensive drugs. I believe that human will is stronger than that, and by encouraging and expecting more out of those with a diagnosis of depression, we ultimately serve them better.
April 5, 2009 at 9:02 pm
That’s beautifully put, and you’re so right that “human will is stronger than that.” Looking back on all the treatments I’ve tried, it’s strange that not one therapist, psychiatrist or anyone else ever spoke about human will or my will to live without depression. There was always the principle that making progress was up to me – but that usually meant achieving catharsis and acceptance about the losses of the past – or achieving a state of tranquility and equilibrium. It’s definitely time to get a higher grade than a C!
All my best to you – John
April 5, 2009 at 5:20 pm
“You don’t have to be sick to get better” – Fritz Perls, one of the founders of gestalt psychotherapy.
I once tried the thought experiment of doing away with the concept ‘therapy’, it had interesting results: e.g. ideas like a celebratory approach to life (including suffering). I don’t mean this to sound like I trivialise very real pain.
Looking forward to hearing how you shape your life.
April 5, 2009 at 8:52 pm
I love that quote! That’s an interesting thought experiment – there are so many things we just go along with that it’s refreshing to try turning them upside down from time to time. Something new always appears.
All my best – John
April 5, 2009 at 3:47 pm
A very impressive post, thanks. I thinnk it’s always important to write about positive personal developments to encourage others to do the same.
April 5, 2009 at 8:49 pm
Thank you so much! There is something to be said for writing about the down side of things – mostly for the catharsis. But writing out of hope and good feelings is one of the ways I stay well.
Thanks for coming by.
Does Finding Purpose in Life Help You Overcome Depression?
by John Folk-Williams
Finding purpose in life that goes beyond your personal needs is often mentioned as a major step in overcoming depression. That’s a hard thing to imagine, though, when you’re in the middle of a severe relapse, and survival is the only goal in sight.
Yet, one of the hallmarks of depression is loss of motivation to do anything because you feel that your life is meaningless. You are meaningless, empty, worthless, bad, nothing but a burden. There’s no sense of future, no purpose to give you hope and help pull you back to an active life.
A sense of purpose goes along with building hope for the future, hope for recovering from depression and getting your life back. Even though you can’t focus on it when you’re struggling, hope and purpose are pretty basic for regaining a sense of who you are.
The Long-Term Threat of Relapse
Let’s say that medication, therapy, and whatever else you might do to get well, succeed in getting you back to a level of basic functionality. Is it enough to be able to sleep normally, feel more energetic, get your work done?
Many would say: You’re damn straight it is! They’d be thrilled to recover that much, to stop the symptoms, even partially. But if you look to the longer term, there is no medication and no form of psychotherapy that can prevent relapse. The high rate of relapse is becoming one of the major concerns about dealing with this illness.
Continuation of even minor symptoms greatly increases the likelihood that the illness will return. Something more is needed to help you keep depression at bay.
Finding that larger purpose may not be enough either, but many stories of recovery – including those of Donna, Tony Giordano and I on this blog – describe it as a critical step.
It’s not the first one. The first step is always to get control of the worst symptoms. After a while you need more to get to the next stage of living well, and a larger purpose may be part of the answer.
What is “Larger Meaning” All About?
Many of the most widely read books on recovering from depression emphasize the need to immerse yourself in activities that serve purposes beyond your own immediate needs. Richard O’Connor (Overcoming Depression), Martin Seligman (Learned Optimism) and Michael Yapko (Breaking the Patterns of Depression) are among the influential psychologists who urge this as a necessary part of recovery.
Seligman says that the emphasis on individualism has replaced values that once focused on community, religion, family and a sense of social cohesion. The private good is more important for most than the public good, and as a consequence many of us seek fulfillment for ourselves as if we were independent of a greater social context.
He believes that an excess of individualism is a social contributor to the vast increase in depression. His solution is to explore a role in community life that serves others as well as yourself.
Victor Frankl, in Man’s Search for Ultimate Meaning (my emphasis), goes even farther. He says that the fundamental drive in human existence is the need to find meaning in life in general, not just in your life. He calls this transcendent meaning, one that includes us in a greater whole.
Many find this greater meaning and purpose in God and spirituality or service to country or activism for social good. Frankl believes that a sense of purpose in your own life and self-fulfillment are the by-products of attempting to fulfill such a larger meaning.
Putting yourself into an activity that goes beyond you – like Donna’s volunteer work, Tony’s new career in teaching, my own writing on depression – can make the difference between getting by and feeling fully alive again.
Avoiding a Common Trap
There is a potential trap here. Depressive thinking can twist the most fulfilling activities into more excuses for self-condemnation. That can happen if you start imagining that you’re not worth anything unless you have this larger purpose and unless you’re really good at the work you do to fulfill it.
Your worth is not proportional to what you achieve in life. Part of depressive thinking and your inner critical voice keeps telling you that it is and that you always fall short. This is a classic example of all or nothing thinking, and it’s an ever-present danger for the battered self-esteem that is usually part of the illness.
Cognitive therapy techniques can be effective in keeping you out of this trap. They enable you to assess each setback in realistic terms rather than as indicators of your worth as a person.
How Do You Rediscover Purpose?
How to you find this larger purpose if you feel you don’t have one? Starting at any level is important, and support groups build on your own need for help. You may look at them only as a means to feel better yourself. But what you’re doing is sharing with others. You’re helping them as much as they are helping you.
I’ve rarely found it easy or comfortable to become active in face-to-face support groups because I get so anxious and self-conscious. It’s hard to be myself, harder still to trust others enough to open up. But I did find a place in one group that make a big difference in my life.
What drew me into it was the concerned and non-judgmental response I got the first time I spoke up about my problems with depression. As the group continued to meet over time, we would share the good feeling when one of us made progress and empathize with anyone having a tough time. We had all had similar experiences, and that helped us talk freely.
This may not sound like finding a meaning in life. That phrase suggests a great epiphany, a call from on high to some noble duty. But the reality is down to earth. You start at a level that feels good and supportive and see where you go from there.
Alcoholics Anonymous has always understood the power of one addict helping another. Both are supported and both are doing something that goes beyond their immediate personal need. That’s why service became one of the three pillars of recovery from AA’s earliest days.
I doubt you can live without a belief that there is some purpose to your life. It’s so common to hear people say that they want to make a difference. They want recognition, but they also want a sense that they’re doing something that will help others as well.
This may be the farthest thing from your mind when you’re absorbed in a depression nightmare. But I feel it’s one of those anchor points I need so that I can look ahead with a little hope.
Does this idea make sense in your work to get rid of depression? Have you been able to find a meaning and purpose that helps you keep your bearings at the worst moments?
November 23, 2013 at 11:57 am
“There is a potential trap here. Depressive thinking can twist the most fulfilling activities into more excuses for self-condemnation. That can happen if you start imagining that you’re not worth anything unless you have this larger purpose and unless you’re really good at the work you do to fulfill it.”
Yes. Guilty. Another avenue to self-condemnation is denying yourself the chance to simply live free of depression, once you reach recovery or stability. That is a part of what you are saying, I think. Sometimes I feel I need to make up for lost time. All those decades I was not able to “contribute” to society. All the chances I missed to have relationships, to enjoy my family, to go for a walk and see something besides the tops of my shoes.
There are times I sit and watch TV all day now, the rare afternoon I take a long nap, having fun following boards on Pinterest, even the fascination of realizing, “Hey, I’m not fighting for my life anymore.” I feel like I just got back from military deployment. I’m home, but still in shell shock. Still learning how to filter my feelings and my senses. Things don’t feel quite right, but I’m hoping they will soon.
Voices are hammering at me from the past and present. “When are you going to get a job? When are you going to save for your retirement like your brother? Don’t you want to own your own home? At least you are are well enough now you could move in with your mother and take care of her. Why do you have all these great ideas and never follow through?” But if I listen to those voices, I’m right back on the battlefield. Getting no sleep. Anxiety attacks. Sliding down that slippery slope.
My inner voice tells me recovery is not fully attained when the depression ends. There is maintenance. Keeping things in order. A very slow adjustment period. I need this time to acclimate, to rehabilitate my thoughts. Right now, this is more important to me than anything else. I just have to keep reminding myself.
July 6, 2013 at 11:45 pm
One thing that gives my life meaning is my daughter. She’s 7 now. I’ve been through a couple debilitating bouts with depression but she was wonderful through it all. I don’t know how much she understood but she is the most accepting person in my life. I remember coming out of the most recent dark time and for the first time in months I was able to make her laugh so hard she got the hiccups. That was an amazing feeling and I imagine it was for her, too. At this point I never expect to recover from my depression and I’m trying to learn how to manage it and live with it. I carefully guard my energy because I know I don’t have much. But even if I’m sitting on the steps with my daughter and I play catch, there’s a feeling of contentment. In other areas, it’s a lack of energy and motivation which seems to be preventing me from working at creating meaning in my life. I have moments when I feel that I’ve been called to something higher than myself but I can’t quite find it. The passion is not there. But maybe I need to be more proactive and fuel the passion? I don’t know – it just sounds like a lot of hard work to me :-)
January 1, 2014 at 8:09 pm
This is exactly the point I am at. I just feel so emotionally void, and yes, it sounds like a lot of work. I’d rather take a nap.
September 24, 2012 at 10:08 pm
I remember hearing that Robin Wright Penn was credited for stating: “There is no sense of future” in describing what the world was feeling in
the throws of this global economic melt-down but, true to my nature I had to make sure that I had remembered correctly who said it so googled what I felt perfectly summed up the world’s emotions as a whole. And I found your site. Lucky me! Just when I needed you most! Thank you all for reaching out to others as you have, it is the very essence of humanity.
Laura Eckard says:
September 9, 2012 at 5:50 pm
I am currently working on getting my life back (again…) from depression and just happened across your blog and articles. I am finding them inspirational and thought provoking; I appreciate the comments and it is refreshing to read some truly supportive and insightful commentaries… Shared experiences can be so powerful. At times, knowing that I was not alone was the ONLY thing that got me through.
Joanna Z. Weston says:
August 17, 2012 at 3:49 pm
When I first began to struggle with depression I was convinced that it was a spiritual crisis, and that if I could only figure out my life purpose, I would be fine. This was overly optimistic, but not totally off the mark. While I had to go through therapy and medication to reach a basic equilibrium, I didn’t start to really throw off the shackles of depression until I started working towards a life purpose. Not that I will ever be 100% free of it, but working towards something bigger than myself has allowed me to become much more free than I was before.
John Folk-Williams says:
August 20, 2012 at 8:57 pm
Hi, Johanna -
I agree that most therapy and medication can help stabilize you and limit the impact of depression, but it takes a lot more to find your life again. Sometimes, it not so much recovering life as entering it more fully for the first time. Purpose and meaning are essential – “much more free” is a good way to put it.
Alex @ Raw Recovery says:
April 25, 2012 at 4:18 am
I actually just wrote and finished my senior thesis on Depression and Free Will, using Frankl as one of my primary sources. This is a great site and I’m so glad to have found it. I’m recovering from depression as well as other disorders and I believe we have a mental health crisis on our hands. It’s great to find others who are engaging in discussion about what is often taboo. Great job!
John Folk-Williams says:
April 27, 2012 at 8:25 am
Thanks, Alex -
I wish you well with your recovery and look forward to reading your website. Thanks for commenting.
March 4, 2012 at 11:14 pm
Great article. Abraham Lincoln probably is the most well known example of someone who transcended his depression by finding an overarching purpose.
John Folk-Williams says:
March 6, 2012 at 12:25 pm
Thanks, Sriram -
I’m waiting to get hold of Nassir Ghaemi’s recent book (A First-Rate Madness) on other great leaders who also used depression to their advantage. Ghaemi is a psychiatrist with a lot of interesting ideas – this is his first book for a general audience.
Do You Have to Lower Your Expectations of Life to Recover?
by John Folk-Williams
Donna-1 recently asked me this question in a comment at Recover Life from Depression. It’s an important one to think about. I’ve often mentioned how crucial it has been to my recovery that I made basic changes in my work and way of living as a whole.
Did I have to give up on hopes for what I could accomplish and settle for less in life in order to get better? My answer is No.
But if you had asked me before I made the switch, I would probably have said, Yes. Leaving the work I had done for so long seemed like giving up on myself – and I didn’t want to do that. I had been feeling bad enough without wrecking the last bit of self-esteem and hope for the future that I had left.
That’s the way I thought about the prospect back then.
But since making those changes I haven’t felt at all that I’ve lowered expectations or given up on myself. Just the opposite. I feel I’ve gained a new life.
I do sometimes look back with regret, but it’s not about giving up that high-stress life. It’s about having held onto it for so long despite its terrible cost to my well-being.
There were strong reasons for resisting change, but they had more to do with what I thought I should do rather than what I wanted to do. There was a long history behind that way of thinking – all the way back to childhood. Early on, I started assuming that something was wrong with me, that I wasn’t a real person.
I had to make up for that by trying to be first in every project I undertook. I felt instinctively that doing what I wanted to do was dangerous even destructive. I could only justify myself by working on what seemed to be more socially useful – by taking on a purpose that was not my own.
For years I accepted this flawed belief about what I could and should do. I knew I was good at certain things and bad at others. I wanted to be a writer but believed I could never be good enough to make a go of it.
As if to prove that, I kept trying to write in my spare time but soon hit a wall of fear that I couldn’t break through. My mind stopped working, and I felt only confirmation of the belief that I simply couldn’t do it.
That was the real defeat, the lowering of expectations, the giving up.
Donna also pointed me to a post at PsychCentral by Shannon Cutts that gets at these beliefs from a different angle. She refers to the story you tell yourself about what you can and cannot do. You relive this story with each choice you make that follows its assumptions. You fix yourself into it every time you tell your story to someone else. You don’t imagine that you can rewrite it, and so you avoid anything new.
Jane Chin recently wrote two posts I find helpful in thinking about living in a trap like this. One talks about Why Failure is Good. If you always avoid the possibility of falling short, you will never learn that failures are survivable and can teach resilience.
The other is I Don’t Know What I Want to Be When I Grow Up. If you’re preoccupied, even well into life, with the question of what you want to be, you can avoid exploring any new interest because it couldn’t possibly be the final answer.
Both strategies can lock you into a narrow view of who you are.
Add severe depression and a collapse of will and motivation, and you’re locked in even more. Anything new feels so impossible. What’s the point? I can’t do anything well. The only prospect is more defeat, more failure.
It’s hard to follow the twisted logic because you’re hardly conscious of it most of the time. I lived that way for so long because I was often filled with drive and energy, but only when I felt secure that I was meeting someone else’s needs, not my own.
In my (hypomanic??) periods, I’d spin out ambitious goals and stay high with them through the first years. Each was a career that felt like the real thing.
After a while, depression would set in, and I’d start falling short in meeting the expectations I had set – and that others counted on. Especially over the last ten years, the illness got worse and worse, and it was clear to everyone that I was falling apart. No one is going to hire a person so depressed that he can hardly function – especially when they don’t know that depression is the cause. So when the possibility of retirement came up, it was the obvious choice.
But right after getting out, I felt the kind of relief from stress, the lightness, that made clear how much I had been fighting myself. I felt deeply energized and vital once again. Changing my life in this way was decisive in getting me out of depression.
There is, though, no instant cure for the illness. Recovery has to be supported every day, and that means, among other things, keeping the level of stress low. But that doesn’t mean cutting down my expectations of life. There are two kinds of stress. One bears down on you with the force of life that feels out of your control, a constant threat. That’s the one you have to watch.
The other comes from the excitement you feel when pouring yourself into what you love to do. That’s the kind of stress you can live with.
So, no, I have no feeling of expecting less of life. I’m finally doing the writing full-time that I’ve always wanted to do. Working hard in that way improves my life, and my wife’s as well, since depression has taken its toll on both of us.
How do you feel about making big changes in your life in order to get better? Does it seem like you have to lower expectations? Do you dismiss the idea as impossible to do, even if you wanted to?
January 23, 2014 at 7:53 pm
I have little to say except “Thank you for writing this.”
May 15, 2011 at 2:03 pm
Wonderful post and site. You have provided me with the inspiration to start a blog that deals with my recovery from depression. Thank you.
I too have stepped back and allowed others to care for me and make decisions. I have been afraid to expect more from life, but I am working hard to make a better life.
May 12, 2011 at 4:53 am
These are very instructive and useful comments to a well-written post. I am wondering…without discounting the genetic predisposition aspect of depression…do you think that, in any sense, depression can be a result (or one of the results) of abdicating personal responsibility for our own lives, our own choices, and making others responsible for our moods? I can see very clearly that I have done this. But now I am making it a “priority” as Ms. Chin said, to treat myself and my opinion with respect and to pursue wellness on all levels. I can see where I have “used” my moods, even my psychosis, to manipulate others into taking care of me in the past. It honestly felt good to let others take control and make decisions for me. It is very difficult to climb up and out of that way of thinking. But I have a “kick butt” therapist who is helping me!
Jane Chin says:
May 9, 2011 at 3:28 pm
Excellent post, John, thanks for including 2 articles I wrote to help others frame some questions around their life and work choices.
I was thinking about this question the other day about “can medication ever replace psychotherapy” and my immediate answer was “no”. Because “normal” people get depressed too! Granted, their depression is situational and short lived and they usually climb out of it barring any genetic disposition to the illness.
It got me thinking about the dramatic impact of our environmental signals and external stimuli that we allow to affect us on a daily, consistent basis. This coupled with a disposition for depression guarantees symptoms.
The way that I see the equation, it’s not about settling for less in order to get better: the true statement is, “it is exactly because I know I deserve better, that I’m prioritizing getting better, from now on.” If I didn’t take care of myself and focus on healing first, there would have been no way (NO WAY) I’d ever imagine coming to where I am today.
John Folk-Williams says:
May 11, 2011 at 11:14 pm
Hi, Jane -
I like the way you frame the idea – knowing you deserve better and so prioritizing healing. For me, though, and several others I’ve heard from, it takes a while to develop an attitude that positive. The starting point is often a collapse at work because of depression. Many don’t realize that depression is the problem and just feel like failures – a belief in keeping with low self-esteem during depressive episodes. Even if you do understand that depression is the problem, it can seem like you’re being defeated by the illness and have to do something “less” stressful or demanding or “less” than full-time – the feeling is negative. I got over that pretty fast because I really wanted to do something different with my life anyway. But if you love what you’re doing and find you can’t do it anymore because of depression, it’s a very human, understandable idea that you’re losing something rather than taking time off to heal so that you can have the better life you deserve. Therapy is helpful in turning around the negative framing. As you come out of depression, of course, you’ll naturally think more positively about the future. I have to say, though, that I’ve worked overtime on the idea that I deserve better, since my self-esteem was surviving on deficit spending. I “know” I deserve better, but I don’t always believe it.
I’m not sure I’m making sense here – but you’ve got me rethinking the question. And that means I have to write more about it!
Thanks for coming by.
Mapping Recovery-1: The Big Picture of Depression Symptoms
by John Folk-Williams
This post is the first in a series about how you can help yourself begin recovery. Depression can be a powerhouse of misery that leaves you feeling helpless, but it’s not one massive force, whatever it may feel like.
Depression is a combination of several conditions, and there are effective ways to deal with each one. It takes a lot of trial and error to find the best treatments, but the steps described in these posts might help you get on the right path a little sooner. Here’s the basic approach:
1. Get the big picture of depression symptoms and the dimensions of life they distort.
2. Track the symptoms that most disrupt your life and the specific impacts they have.
3. Choose the treatments and lifestyle changes that focus on those problems.
Once you have this map in mind, the challenge then is working with it every day, despite setbacks. None of this is easy, or follows a simple logic, but it helps to have a guiding idea of what to do. You may well lose sight of it during the worst episodes, but it’s something to come back to when you’re out of those depths.
Getting Beyond Helplessness
What does your depression feel like? Most people I know answer this by trying to find words to capture the overwhelming nature of the illness. You’re under a cloud or a huge weight or drowning or flattened or feeling dead or living in a fog. You use some powerful image to get across the totality of the experience.
You can’t do anything, don’t want to see anyone, and barely manage to drag yourself through the workday. Depression is a vast force you feel powerless to change. It seems hopeless, you feel helpless, you don’t know what to do.
During my worst episodes, I felt exactly like that and for years couldn’t imagine anything else. That began to change, however, as I learned more about the full scope of the illness. There were not only a lot of symptoms that I had never linked to depression. There were also ways to group them so that I could see how they reinforced each other.
This was no intellectual exercise. I had lived with the disappointment of ineffective treatment for a long time and knew I had to do more on my own. As I learned more, depression felt less like an overwhelming force and more like a complicated problem I could do something about.
Learning the Full Scope of Depression Symptoms
There are a lot of explanations and paradigms of depression symptoms, but most group them as disrupting the healthy processes of your body, thinking, feeling, behavior and relationships. A grouping of this type helps you form of picture of what your depression is like, but you can’t stop there. You also need to know how the symptoms interact, reinforce each other and sustain the illness over time. That’s the dynamic process of depression.
To start with the lists, the best known one covers the nine criteria for identifying an episode of major depression. These symptoms are based on clinical practice as the most reliable ones for differentiating depression from other conditions. They’re not the only ones, but they comprise the crucial indicators that moves you toward a formal diagnosis.
I won’t go into the details of diagnosing different types of depression – that would take several posts. As far as grouping symptoms is concerned, they’re broken out into two lists. The first group includes the two defining characteristics of depression. A diagnosis requires that you have one or the other.
1. depressed mood much of the time or
2. lack of interest, enjoyment or feeling for anything
There are seven more, and the screening requires that you have at least five of them:
1. significant changes in weight or appetite
2. sleep disturbance nearly every day
3. physical agitation or slowing
4. fatigue or loss of energy
5. feelings of worthlessness or excessive or inappropriate guilt
6. diminished ability to think, concentrate or make decisions
7. recurring thoughts of death and suicide or plans or attempts to commit suicide
This is the list you’re most likely to have encountered. You find it in every book about depression and on every mental health information website, along with screening tests that use these criteria. But the list is too short to capture the full scope of the illness. There are many more symptoms you might experience that are shared by countless others.
Getting the Big Picture
I’ve put together a more extensive list here, though you may find it still doesn’t capture everything you’re living with. I realize many of these symptoms don’t define depression exclusively since they could also indicate a different condition. However, all of them can and often do accompany depression.
You may find it as helpful as I did to be able to link all these to the illness. It can be reassuring to know that a problem you thought was part of who you were turns out to be a treatable symptom. But there is a downside to long lists of symptoms.
If you only count them up one by one, you might become more convinced than ever that depression is too overwhelming to deal with. That’s why it’s important to go beyond a bare list. Many symptoms are closely related and act together to intensify their impact. So it helps to group them, and many experts do that according to their effects on the basic dimensions of your life that I’ve mentioned: what they do to your body, thinking, feeling, behavior and relationships.
That’s the way I’ve organized them here.
* sleep disturbance
* significant weight loss or gain
* fatigue or loss of energy
* physical agitation or slowing down of movement and speech
* unexplained pain
* diminished ability to think, concentrate or make decisions
* ruminating, obsessive thinking
* recurrent thoughts or death or suicide
* impaired memory
* negative thinking
Mood and Feelings:
* depressed mood
* lack of interest or enjoyment in anything
* irritability and anger
* feeling helpless
* feeling worthless or guilty
* self-defeating behavior
* lack of motivation
* crying for no apparent reason
* blaming and angry outbursts
* attempts at suicide
* substance abuse
* social isolation
* loss of empathy
* unwillingness to communicate
* emotional withdrawal
* social anxiety
You may divide up the symptoms differently, but breaking them out like this can give you a starting point for making choices about treatment. Before you can get to treatment, however, you need to profile your own depression in as much detail as possible. Making a list of all the symptoms you experience shows you how pervasive the illness is, but you probably don’t experience all the symptoms at the same time or always with the same intensity.
It’s important to track them over time while looking also at what else is going on in your life. This is the way to get a sense of the overall patterns that sustain depression.
I’ll explain how you might develop a profile and track depression in the next post.
In the meantime, it would be useful to hear how you’ve thought about your experience with depression. Have you already put together the big picture of your illness? Is that a helpful approach, or does something else work better? Has learning more about depression in this way helped you take a more active role in your treatment?
Do I have depression says:
July 6, 2014 at 10:13 pm
It takes mee about 5 seconds to be aware of how I feel and to realize that I need
to respond to the messenger. Feelings, behaviours, thoughts and physical responses on your journey.It is surprising hoow soothing and
therapeutic that simple little thing is.
May 28, 2013 at 5:00 am
After about 20 years of enduring a ‘colourful personality’ over which I seem to have no control, I’m trying to figure out if I’m mentally ill. My motivation for this is my two young children. Nothing is more important than being a stable, warm, loving and engaged mum to them. And at the moment, I’m not.
For years I’ve experienced what I’m now calling ‘episodes’. When they kick in, I get angry really easily – at a loud noise, at one of my kids accidently bumping me etc, and I’m constantly managing irritability. I lose interest in things and lack motivation (housework, personal projects, work etc). I self medicate – alcohol, valium where I can get it. I get very negative, ruminating on things constantly, thinking about people close to me in a negative way. I think about death a lot. Not suicide, but I see the date on the paper in the morning and get the sense that it’s ominous, that today’s the day. I see a truck driving towards me and think ‘this is it!’. I think about what would happen if my partner died, I touch wood constantly, fearing the worst for my kids. I hide behind my hands constantly, sometimes I pretend I’m rubbing my eyes – other times when people are talking to me, I literally just cover my face with my hands. I often burst into tears for no good reason. I don’t want to leave my house, and I don’t want my partner to go either. I want us all to just stay home – but then I don’t want to be around them when we are. I probably have about a dozen ‘mental health’ days off work each year – the ones where I make up some excuse (gastro, food poisoning, the flu) because I just can’t face the world. During these times it takes me ages to return calls, and I dread talking to anyone – I avoid filling the car up with petrol because I can’t face the small talk. I dodge familiar faces in the supermarket if I’m not feeling ‘on’. I can’t concentrate, my memory is absolutely shocking – everything you have listed above basically. And I wrote all this down a few weeks ago.
I’m currently trying St John’s Wort. It’s ok, but not arresting the lows, just making me a bit more lucid during the non-lows.
I’ve tried 3 or 4 psychologists over the years in response to two major traumas I experienced – they didn’t work, in fact they seemed to make it worse.
I did an online test on the Black Dog Institute website, and scored really highly on the ‘probability’ spectrum for bipolar disorder (but I don’t see how because I don’t get the extreme highs they talk of..).
I’ve tried exercise and it makes me realllllly happy for a few hours immediately afterwards, and pretty grumpy for a day or two afterwards.
Thanks to your website I’m now going to monitor my moods more frequently using the Optimism App.
I’m also considering going to a psychiatrist and asking for a diagnosis and meds.
I’m not sure why I’m telling you all this – why would you care!? I guess it’s to say thank you for your blog. It is reasoned, and unprejudiced. The hardest thing about this whole process is the secrecy, the inability to use the ‘d’ word, the judgement, the being bounced around by well-meaing NGOs, GPs and the broader public health system that doesn’t seem to know what to do with a non-suicidal-but-still-not-coping-very-well-case.
June 9, 2011 at 10:13 am
1.Get the big picture of depression symptoms and the dimensions of life they distort.
2.Track the symptoms that most disrupt your life and the specific impacts they have.
3.Choose the treatments and lifestyle changes that focus on those problems.
Yes, I believe that all three of these are absolutely necessary in recovering life. And not just re-covering but at times re-building from the foundation up. Many of us have had symptoms of depression since an early age, so the history is there, the disruptions and impact are there and are usually quite obvious. But that #3, choosing changes that focus on the problem areas, that’s where I’m afraid most of us fail. I’m eager to see what you have to say about that. In my own life, my relationship with my aging and frail mother has come to the forefront not only now, in midlife, but at many times in the past. So I am focusing on therapy and lifestyle changes that will aid in dealing with the Consuming All-Mother…if you know what I mean. I am instituting changes that will restrict the flow of information from me to her while leaving open the reverse flow. Being available for her is important, but letting her live her life vicariously through me by seeing her input lived out – that soon to be a thing of the past. At age 52, it is necessary to make these changes to deal with her eventual death as well as to put right the excesses and exigencies of the past. To re-cover and re-build.
John Folk-Williams says:
June 13, 2011 at 10:01 pm
That must be a highly stressful way to live, and I’m glad you’re working on changing the way you handle the relationship with your mother. I’ve found that changing life conditions to reduce stress has been a crucial part of my recovery. The effect of stress on depression – and vice versa – is one of those problems I was completely unaware of until a few years ago. There were other connections with depression – such as the connection with anger – that I never made, despite the fact that I’d dealt with depression since childhood and had extensive psychotherapy over several periods of my life. Perhaps I worked more with earlier generation psychiatrists who focused on probing the past in detail and the way it’s reflected in the present but who weren’t so concerned about attaching everything to a DSM label. Today there’s so much publicity about depression that it’s hard to miss the symptom lists – though the standard one is terribly incomplete. Nevertheless, most people who turn out to have depression go to their doctors complaining only of physical pain. Apparently, there are a great many people who need to learn much more about the wide range of depression symptoms.
Thank you for commenting. I’ll get to the treatment part of this series next week.
Mapping Recovery-2: Tracking Your Symptoms
by John Folk-Williams
Tracking your symptoms as part of mapping recovery might sound like one of those good ideas you’ll do for a while but eventually drop. It could be like all those computer programs for organizing your work into projects, goals and actions. The method itself becomes a big project and takes so much time that you can’t get anything else done.
Or it feels like another of those pointless prescriptions for getting well that you hear all the time. Like the Otis Redding song: so many people telling me what to do, that I think I’ll remain the same. You know how rotten you feel so what’s the point of jotting it down?
I used to think that way, and you may have the same impatience with the whole idea. But there are a lot of good reasons to do it.
1. Why Track?
Tracking is only a tool for learning more about your illness. And learning is a form of change, a waking up to awareness of the habits of depression. You’re learning to turn off the auto-pilot of living.
It’s like feeling lost when you’re driving in an unfamiliar place. The first thing you do is turn down the volume of the radio or CD because you need to concentrate all your attention and awareness on your surroundings. You look more closely to find some marker to guide you.
As you start recovery, your attention shifts from the voice of depression to your close observation of where you are. You’re turning down the volume of a voice that wants all your awareness all the time. That voice is your guide to staying lost.
Tracking takes back the power of awareness to tell you where you are. You’re listening to your own voice instead of depression’s droning.
Learning in general about the scope of depression symptoms is important. New knowledge helps you connect depression with dimensions of your life you may have thought were unaffected by the illness. That sharpens your awareness of what to look for but doesn’t fill in the details of your version of depression.
That’s what tracking is for. It helps you see more clearly each of the problems you have to deal with. You can compare the effects of the symptoms you follow: how severe each one is, how long it lasts, how badly it damages your life.
Getting active in your own treatment is itself a big step toward recovery. Depression is all about inaction, inability to move, to make decisions or use your brain for much of anything. Whatever you can do, however small a step it seems, can help break that spell of paralysis.
Improve your Treatment:
Tracking gives you something to share with a therapist. It’s more reliable than your memory and provides a good starting point for discussion.
2. What to Track
There’s a lot more to learn about your depression than you might think. You can track a huge amount of information if you’re up for it. But if you’re like me, you might want to start more slowly and get used to tracking a few key things rather than take on everything at once.
The first form of tracking I tried, at the suggestion of a therapist, was simply to jot down each day what sort of mood I was in. I used a scale of 1-10 so all I put down was a number. That was good start because I got in the habit of paying attention to the ups and downs of my moods from week to week and month to month.
Before long, I added mood levels for morning, afternoon and night. The tracking gave me – and the therapist – more detail to help explore what I was going through.
That’s about as far as I got with tracking at that time, but it helped make therapy sessions more meaningful. Now I had a lot more specifics to work with.
His questions about specific events and feelings opened my thinking to other possibilities for tracking. During each session, he’d ask me to be clear about what I was feeling as I recalled some incident, whether my body was tensing up, what thoughts were going through my mind, what I had done and said as that event had unfolded.
Those were the details that brought the mood numbers to life. Not surprisingly, his questions centered on feelings, thoughts, bodily sensations, behavior and relationships – the five broad categories of symptoms that are so commonly referred to in discussions of depression.
Although I didn’t consistently track all these dimensions, I started writing down a few phrases about them alongside the mood numbers.
Before then, I’d often arrive at a therapist’s office and wonder what I was going to talk about. I couldn’t remember very clearly what had happened – unless it was something earthshaking – and tended to act as if I felt better than I really did. Now I was beginning to feel more like a partner in treatment. I went to the therapist actively thinking about what had happened the week before. I was no longer depending on him to wake me up to my own experience.
Tracking All Your Symptoms
Building on the kind of tracking I did, you could get into following the specific symptoms of your depression profile, such as sleep disturbance, pain, loss of energy; level of concentration, memory, negative thinking – whichever problems are causing the most trouble.
You could also add notes about triggering events and memories and how you reacted to each one.
You don’t have to limit yourself to what’s wrong. If you try to take care of yourself each day, you can track the wellness activities and compare the timing of those with the ups and downs of depression. You decide exactly what to follow and how much detail to record.
3. Next Steps.
By doing this, you’re becoming much more active in your own healing process, and I believe that makes a big difference in how effective treatment can be. Whether you use a simple system with pen and paper or an elaborate computer program, you’re taking a step back from depression.
How you go about tracking is an important decision because the wrong choice can turn you off to the whole idea. Since it’s essential to find the tools you’re most comfortable with, I’ll review several in the next post.
June 14, 2011 at 10:41 am
On May 21, I started tracking my moods and some startling truths have already emerged. For instance, I knew I usually felt better in the morning. But every single day since I’ve been tracking, I have felt alert and calm and in a fairly good mood early, then as the day progresses I feel worse and worse till at night I am a basket case. I still haven’t gotten far enough to figure out if there is something I can do about this, or if it is just my own body’s emotional rhythm. But I’ve been writing down what I ate before a big mood shift, too, and it appears that a lot of carbs at once lifts my mood. I guess that is not such a stretch seeing as how carbs provide almost instant energy. But as this progresses I may find that I am able to stretch carbs out over the course of the day to my advantage. Nutrition seems to be a big key for my recovery.
John Folk-Williams says:
June 14, 2011 at 1:55 pm
Hi, Donna -
That’s the sort of discovery that has led me to start tracking again. I’ve decided to pay most attention to the problems I haven’t focused on in detail in the past. As you’re finding with nutrition, I’ve been linking anxiety and stress to depression for some time now, but I haven’t looked at how those two play off each other in day to day living. I had one of those no-duh moments when I realized that.
As far as simple carbs go, I’ve always thought of them as comfort food. I’ve read that depressed folks do reach for those foods exactly for the mood boost. Years ago, when I was dealing with cancer, I made big changes in diet so it’s been whole grains and complex carbs for me. Anything with much sugar tends to drag me down, strangely enough, but food is definitely my drug of choice. Now there are exceptions to the sugar drag effect (intensified by lots of oils and fats) and guess what that is.
I’m not giving up my daily 3 oz dose of bittersweet chocolate – which has obvious health benefits, especially with almonds.
Keep on tracking – I’ll report on my findings soon.
Mapping Recovery-3: Reviews of 4 Web Apps for Tracking Depression
by John Folk-Williams ·
The best way to understand depression is to track your symptoms and triggering events each day. The question is: How to do it. To start with, you might use a written diary, or just a list on note paper. But the more symptoms and triggering events you follow and the longer you keep up with it, the harder it is to reorganize the information to get a good picture of patterns and connections.
That’s why I’m focusing on software in this post, especially online applications, or web apps, that you can access with a browser from anywhere.
A good online mood tracker preserves all the data you enter over time, presents it visually in a chart or graph and allows you to print and/or download the results. You get a useful report instantly and can look at it in different views. Many web apps have mobile versions that you can use on a smart phone.
But they’re not all created equal, and after testing a number of online mood trackers, I’ve picked out four to review here.
Any software that’s new to you, whether online or on your desktop, can have a discouraging learning curve. The web apps, however, are designed to be simple and readily useful to visitors with little computer experience. After all, they aren’t written for geeks but for people with an urgent need to learn more about their illness.
These four apps are quite different, so I won’t compare them to each other. They’re all good at what they do, and you’ll need to decide which one best fits your goals and style of working.
Optimism Web App
Optimism, available in desktop and mobile as well as online versions, enables you to track a large number of symptoms and many other dimensions of your illness and treatment. James Bishop, its author, recently made this a free application in all its forms. It was well worth the price at the time I bought it. Now that it’s free, there’s no barrier to trying it out.
The opening screen is the first of five, as indicated by the five tabs across the top, shown in the two images I’ve included.
That first screen is for recording several aspects of your condition. Though it might look a bit overwhelming at first glance, the use of sliding scales and check boxes makes entering information fast and efficient. The top section covers the basics of mood, coping, sleep, exercise and medication use. After that are sections for stay-well strategies, triggers and symptoms.
You can change any of these or add new items. You decide how many are relevant for your tracking. The flexibility of the application means that you can adapt it for any other mood or physical disorder you may be dealing with. Here’s a screen shot of that form.
Optimism Data Entry Screen
Second is a chart for visualizing progress for a time period of your choosing. This summarizes the same data categories you’ve been recording. The third tab gives you a text version of the information that can be downloaded as well as emailed to a doctor or therapist.
A fourth tab lets you isolate and make notes about individual items you’re tracking. The last tab brings up a screen for planning wellness strategies and treatments you want to follow.
Tracking this much information fits my needs perfectly, but it may well be overkill if you’re just starting to follow your symptoms. The next three web apps are much simpler, as well as being free. All you have to do is register at each site to get access to the mood tracker, and you can do that anonymously.
Bear in mind that there are a great many more mood trackers online. Several of the big health sites have them, but most prefer to emphasize symptom screening, rather than tracking, to help you figure out if you have a depressive disorder. I’ve chosen just three of the mood trackers that I find helpful and easy to use, but you may find others that fit your needs better. If you do, please let us know in the comments.
MedHelp offers a good set of tracking tools with multiple views of your results. The starting mood entry chart enables you to track seven mood levels throughout the day, every hour if you want to. For whatever frequency you use, you can indicate levels of as many as 30 different symptoms. Another tracking section lets you record whether or not you’ve followed treatment each day, and a fourth provides space for five conditions that might contribute to mood, such as family or work issues.
The visualized result consists of five sections stacked on top of one another. (For space reasons, the image shows only part of the full report.) There is a vertical bar chart for each day’s mood level, a graph showing the average mood over time, a chart showing the levels of as many as 30 symptoms, a section for treatment, and a final one for triggering conditions.
Another thing you might consider about this web app is that MedHelp also provides trackers for many other health problems – like chronic pain. You may have an illness concurrently with depression, and you may want to follow that as well.
I like MedHelp’s detailing of symptoms and the variety of ways for visualizing progress. As is often true on big health sites, navigation and instructions for using the tracker could be clearer, but on the whole this can be an effective system for monitoring your illness.
PsychCentral is one of the oldest and most respected mental health sites and has amassed a wealth of information since the 90s. Its mood tracker is far simpler than the one at MedHelp, but simplicity can work well in capturing the essentials. The tracker helps you put together a basic portrait of the trend of your moods. You need to register on the site to use it, then, once logged in, you find the mood tracker under Quizzes in the menu bar.
You enter data by using a sliding scale to describe your level of agreement or disagreement with 10 statements about how you’re feeling. There 2 more asking you to fill in blanks about the quality and amount of sleep. Here’s the list of all 12 – but without the lines for your responses.
1. I feel sad, blue or unhappy.
2. I feel full of energy, hard to slow down, or have been more active than usual.
3. I feel my future is hopeless, or that I’m worthless and am a failure.
4. I’d describe my sleeping recently as:
5. My attention keeps jumping from one idea to another, or I have so many plans and new ideas that it is hard for me to work.
6. I feel irritable or restless.
7. I feel nervous, nauseous, my heart pounding, dizzy, or have had shortness of breath.
8. I have lost interest in things that used to be important to me.
9. I have difficulty relaxing or sleeping.
10. I have had periods of tearfulness and crying and other times when I laugh and joke excessively, or my self-confidence ranges from great self-doubt to equally great overconfidence.
11. I have periods of mental dullness and other periods of very creative thinking, or there have been great variations in the quantity or quality of my work.
12. Average hours of sleep I’ve had per night over the past week:
There is also a space for notes where you can add anything else you’d like, such as triggering events or treatments used that day.
This information yields a numerical score for depression, anxiety, mania and sleep, with an indication of which ones might be cause for concern. A chart is also provided which organizes the information on a slightly different scale, with columns showing whether you’re above or below a norm. There is also a graph that shows the trends of mood and sleep over the period you have tracked thus far and a section showing all your saved data. The charts can be printed, sent by email or downloaded in PDF format.
The charts and summaries are good, but the navigation is a problem. You have to go to three different locations to find all three versions of your data, and I missed one of them the first time I used the site. If you’re new to PsychCentral, this could be quite frustrating.
HealthyPlace is another big website covering many health conditions and including numerous community features. Once registered, you can find the tracker under Tools in the menu bar under the header on each page. Once at the tracker, you’ll find a clear setup that lets you record basic data quickly. You use dropdown menus to answer the key questions. Here’s the full list of measures in the questionnaire.
1. Select your Mood – You indicate your basic mood (elevated/manic, normal or depressed). Then you can choose the level of that mood.
2. Your Anxiety – You can choose a level for anxiety and then one for irritability.
3. Your Hours Slept – How many hours did you sleep in the last 24 hours?
4. Your Weight – Enter your weight in pounds.
5. Your Medication – You can add multiple medications and doses.
6. Your Daily Notes – You can write a brief diary entry on triggering events, and as you continue using the form, you can look for patterns.
You can print out a daily chart and a graph covering a date range you select. The program also generates a 30 day report. HealthyPlace has a prominent disclaimer and caution about using the tracker without consulting a mental health provider. To make it easier to relay information to your doctor, they include an optional alert form you can use to send a direct email, fax or SMS message.
Although the information tracked is limited, the ease of use in filling out the form and seeing immediate results would probably help you use the tracker every day. That’s a big advantage since the charts aren’t very useful if you don’t add the data consistently over a long period of time.
Using web apps is only one way to track depression, but after a lot of experiments I’ve settled on this solution. Whatever level of detail you want to follow, the most important thing is to track consistently – and to be honest with yourself with what you put down.
Please use the comments to let us know what method you use and what you’ve learned from the practice.
April 24, 2012 at 5:57 pm
I just visited optimism online and found that they no longer charge for their online service.
John Folk-Williams says:
April 27, 2012 at 7:56 am
Thanks, Al -
I’ve updated the post to indicate the change. It’s great news. Optimism is state of the art for this kind of software.
Mapping Recovery-4: Matching Therapies to Your Symptoms
by John Folk-Williams
If you’ve been tracking your symptoms for at least a month, you should have a fairly detailed picture of your particular variety of depression. You understand the full range of symptoms, when they occur, what other conditions in your life accompany them and which ones you’ve got to deal with first.
Now comes the hard part – figuring out how to control the symptoms as soon as possible and, hopefully, get rid of them forever. You may hit the mark with the first treatment you try, but there’s a good chance you won’t.
The search is likely to be a tough test of your patience and hope, and those qualities are in short supply when you’re in the midst of this illness.
Focus on Learning Skills
I lived through years of discouraging relapse and failed treatment, constantly looking for the right therapy that would at last undo depression. Finally I realized that I was looking for the wrong thing. This was the wake-up call:
You don’t need therapies, you need skills. You need to drive your own treatment. Psychiatrists and therapists can be thought of as guides who teach you the skills you need.
Focusing on learning skills is more helpful than focusing on finding the right therapist or treatment. Those choices are important, but they’re the means to the end of training yourself to get rid of depression.
You can evaluate the usefulness of a form of treatment by looking at the practical skills each one teaches you. Some therapies depend on professional guidance while others can be mastered on your own, with the aid of recorded lectures and exercises, workbooks and support groups. However you learn about them, you have to practice the skills over and over.
When you need them most, you won’t have the time or clarity of mind to recall how they work. They need to become habits you can automatically use.
Most therapists draw on a variety of techniques to respond to your needs. If you want to go further with one approach, they can guide you to resources and contacts. In this way, you can learn new skills even without the benefit of working with a specialist in each treatment model.
Types of Therapy and the Skills They Teach
There are hundreds of books and studies about each therapy, and each has its promoters and detractors. It’s easy to get caught up in the endless debates about which therapy is best, which has the strongest evidence behind it, whether its claims are true or fraudulent. But all that is beside the point.
It’s not a question of which therapies are right or wrong. If you’re focused on skills, you need to zero in on the ones you can learn from each form of treatment.
To do that, I’ve found it helpful to relate therapies to the basic areas that depression affects: thinking, emotion, behavior, relationships and body systems.
For example, Cognitive Behavioral Therapy (CBT) and its many spinoffs, like Positive Psychology and Well-Being Therapy, teach you methods for changing the distorted patterns of thinking that reinforce depression. I don’t buy the underlying concept that your thoughts determine your feelings, but that doesn’t matter. The cognitive skills this approach has taught me have been invaluable for dealing with negative thinking.
Mindfulness-based therapies use meditation as a way of combining impacts at cognitive and emotional levels. Acceptance and Commitment Therapy or ACT combines cognitive techniques with skills to identify and change patterns of behavior that support depression.
Psychoanalytically-based psychotherapies build awareness of patterns of behavior, feeling and thinking that are self-defeating. Dozens of therapies, like exercise, nutrition and yoga, teach you ways of influencing mood and brain health through the body.
This sort of grouping can help you link therapies to the skills most relevant to your symptoms. Over time, you need to put together a variety of skills to deal with all the dimensions of depression you live with.
There is one skill that I’ve found essential in order to benefit from any form of treatment, and that is awareness. It’s important in a couple of ways. If you’re not alert to all the changes that depression brings with it, you probably won’t use the therapies – or develop the skills – needed to deal with them.
As a result, you may make some progress with the treatments you’re using but still feel that something is missing. You’re not completely well, and those remaining symptoms, even if they seem minor, are often the predictors of future relapse.
Awareness is possible when you’re able to step back a bit from your symptoms. You can observe what they are and recognize them as dimensions of depression rather than unchangeable parts of your identity. Without that skill, I wouldn’t have gotten far with recovery.
Meditation, writing therapy, peer support groups and many other methods can help you cultivate a level of awareness that keeps you alert to warning signs of depression. It’s one of the most important skills you can learn.
As you follow your depression, you’ll probably notice that certain symptoms feed off each other in a vicious cycle.
I find that looking at these clusters of symptoms gets me away from formal labels and closer to what I’m actually living through. Labels for symptoms are pretty abstract, and there’s limited value in trying to understand the technical meanings assigned to each one.
When I’m depressed, I tear myself apart and feel like a worthless creep. In terms of symptom labels, I can call that a cluster of low self-esteem, feelings of worthlessness and negative thinking. In my life, they’re three sides of one terrible problem, and I know how to fight them with a certain set of skills that I’ve learned from cognitive behavioral therapy, among others.
That’s how I think about matching therapies to symptoms. I apply internalized skills to counteract painful experience.
June 26, 2011 at 10:30 am
CBT helped me because it wasn’t all talk on my part and all listening on the therapist’s part. Believe me, I went through 5 years of meaningless, fruitless therapy where I just talked and someone else just listened. I began to wonder just what kind of training she had received…then I began to wonder what I kept seeing her, so I stopped for a long, long time. Now, I am seeing a cognitive-behavioral therapist who speaks her mind and gives me assignments when I get stuck. I never wonder what her training tells her about what I’m saying, because she lets me know. I really do appreciate that. But early-on, before the “listening only” therapist, I had tried CBT and it was a total washout. I think a lot of what a particular type of therapy can do for you depends on where you are in the wellness process and what you’re ready and willing to do to move forward.
John Folk-Williams says:
June 28, 2011 at 12:33 pm
Hi, Donna -
I agree that therapy’s value does depend on where you are in the process – are you really ready to deal with things yet. But it’s also the therapist – a good person will draw you into the process even if you’re only partly with it. You can trust the current one because you know what she’s thinking and how she’s responding – and that she is responding. I went through two periods of therapy with psychiatrists who said nothing – apparently their interpretation of Freudian methods. I guess they were too young to have gotten more flexible. Two older psychiatrists with similar training were as open and responsive as could be, and I got much more from them.
I’m interested to hear about your CBT therapist – I think there’s the same variety in therapists of every persuasion. Some use the methods mechanically, others bring it to life and make it deeply meaningful – they really see you as a person.
Mapping Recovery-5: Does Your Life Support Depression?
by John Folk-Williams
Mapping the full scope of your depression requires a searching look beyond symptoms to include the way you’re living your life as a whole. When tracking symptoms, the focus is on what’s wrong, what you can no longer do. Following daily life means focusing on what you do, the specific actions you take in response to the situations you run into.
By following your daily actions, it’s easier to spot the patterns of depression’s impact on the way you’re living. You can see more clearly when the illness seems to drive everything you do and when you feel have some room to maneuver. Those are the openings for change that let you begin a recovery process.
Learning the Habits of Depression
You know too well the pervasive impact of depression in undermining your capabilities, vitality, sense of self-worth and the will to take action. One of the most damaging effects on daily life hits the expectations you have about your future. You come to expect that things will work out badly no matter what you try.
As this happens internally, you start acting almost by habit in ways that reflect all the negatives that now fill your mind. The worst experiences and the pain they cause become the standard guiding daily behavior.
You may be afraid that if you try to take on these difficult problems, even when feeling better, you will provoke a collapse. You come to expect that you won’t be able to handle them and avoidance becomes almost habitual, often triggered outside your awareness, like a reflex action.
I’ve found that tracking and mapping out what I do help me build the awareness I need to move forward. Here’s how I used the method and what I was able to learn.
Becoming Aware by Suspending Judgment
The first step is becoming aware of what I do and how that behavior is shaped by depression. Then I can start to ask questions. Why do I always act that way? Do I feel better as a result? Does it feel like a healing step or one I’m forced to do because of depression? Trying to answer at least gives me a starting point to work from.
To do this, I realized that I had to suspend judgment. I needed to stop blaming myself and listening to mental tapes of self-condemnation. Instead, I had to pause the obsessive thinking about all my shortcomings and failures – and simply look at what I did each day and the situations I had to deal with.
Patterns of Avoiding
Avoiding the dangers of a depression crisis was for years the most common element guiding my actions in daily life. It’s probably the best example I can give about how the mapping process works for me.
I put up many defenses to protect myself from depression, but most of them turned out to be self-defeating. I believed quite deeply at the time, however, that my best strategy for defending myself was to avoid the situations I couldn’t handle.
Finding the patterns of avoidance – and the variety of methods for doing it – was the eye-opener.
There were so many activities that triggered deep anxiety and the fear that they would overwhelm me. I’d tell myself: I just know that I can’t handle this right now. I’m exhausted or not up to it or incapable of responding. Often the trigger was an unfamiliar social situation, an unexpected demand at work, a difficult meeting.
Whatever it might be, all the depressive beliefs and symptoms came to the fore: the cloudy thinking, the anxiety, the expectation that I couldn’t do it, my lack of ability, the certainty of failure, the loss of short-term memory, my slowed-down thinking and speaking, the droning inner voice telling me no, no, no in a dozen different ways..
I felt I had to get away, to rest and recoup, find a way to deal with this – on my own, alone, safe. If I couldn’t get away, then I would disappear in place, hiding in plain site, saying nothing, feeling completely detached and uninvolved.
Being passive was another strategy, leaving it to someone else to take the initiative, constantly deferring, not daring to impose my own point of view. I felt fear about my own emotions, that any feeling would be dangerous to release.
I tried to avoid facing anger from anyone because I was dependent on what others thought of me. My own self concept sank so low that facing anger was unbearable, confirming my worst beliefs about being worthless. I avoided those situations as much as I could by trying to please everyone and preventing conflict.
Asking Hard Questions
These are a few of the patterns of avoidance that emerged. Only by recording what I did could I take a more detached view of what was happening. I tried to put down what I had done, what I was reacting to and what was driving me to act in that way.
I could then start to ask questions. They sound simple, but it was hard to answer them honestly since I so often wanted to say I had no control over what I did. That wasn’t always true.
Did it help to get away, to be alone? In a few cases, the answer was yes. There are times when severe depression leaves you no choice and you have to get help. You’ve got to get away. The isolation may not cure anything, but it’s one way you try to help yourself.
Most often, though, avoiding hard situations plunged me deeper into depression. I felt like a failure. Stress and anxiety increased as I battered myself and sank into hopelessness.
On balance, I realized that avoiding difficult situations usually cost me more than it gave. I was acting on fear most of the time, and I felt terrible living that way.
Instead of giving me strength and time to get some energy back, it only increased the stress I was generating. I could feel myself frying in it.
What stood out from the mapping was the way I was narrowing down the scope of my life. Trying to stay safe meant defending myself within a constantly shrinking perimeter.
So long as I kept myself confined and alone, I excluded any opportunity for breaking out of depression. Mapping what I did provided no answers or solutions, but by adding a new level of awareness it helped me find a place to begin to change.
July 2, 2011 at 3:19 pm
The area of avoidance I deal with most often is in regard to intimacy and even casual friendships. I will open up to someone too fast because I am starving for a relationship with someone, often anyone. And then I pull back in horror upon review (isn’t this “review” a part of the guilt and self-blame?) Then I quickly backpedal and get out of the relationship. I’m sure it leaves the other person totally baffled as to what happened, and leaves me feeling even more guilty because it seems I have betrayed the budding relationship.
John Folk-Williams says:
July 3, 2011 at 7:49 pm
Hi, Donna -
That definitely qualifies as a life trap sort of avoidance. But at least, you’re reaching out to someone – trying to broaden instead of narrowing your life. The “review” is puzzling – or is it a gut reaction? It’s reasonable to worry about jumping in too fast – everyone probably has a story about a nightmarish misreading of another person. The reaction I often had in that kind of situation was a shame attack, not believing that anyone could really want to have a relationship with me. I guess I started to get around that when I explained to the would-be friend that I had this weird problem about getting to know people. That made a huge difference.