As a long-time sufferer with depression, I can unreservedly say that helping care for a loved one in acute depression challenges everything you know and have come to understand and believe about the illness. Above all, I find my thoughts coming back to the same things.
Depression is not a boogeyman. It’s ghastly, and the awful mind tricks it plays on a person with depression are devastating. You see this in dramatic relief when it’s not going on in your own head, but is happening to someone you love. You see it for what it is when you are not the one experiencing the ravages of depression in your own mind. It’s not a phantom or a monster. It’s a real physical illness.
Public perceptions are all wrong. When people see someone’s body being ravaged by cancer or ALS or some other degenerative illness, they are rightly outraged and demand effective treatments to combat these physical illnesses. For some reason, when the disease is above someone’s shoulders, we no longer consider the very real chemical and physical nature of the illness. It’s almost too easy for people to dismiss it as a personal or spiritual weakness. We should collectively be outraged that depression and other very real physical illnesses (that are conveniently lumped under the tenuous category of mental illness) are not being researched as aggressively for the cure. Depression is as unacceptable as cancer.
Doctors and other medical professionals are not objective about depression. As a society, we rely on doctors to be objective about our own health issues, and the health issues of all members of our society. Why is it that most medical professionals are, dare I say it, as superstitious and/or dismissive about depression and mental health as the general public? Or about any other invisible health issue for that matter? I see and hear regularly about doctors ignoring the real suffering of people with real physical illnesses. Is it because they have never experienced it, they can’t see it, they’re too exhausted, or they just don’t care? I’d love to believe it’s not the latter, but honestly, when I see people at death’s door due to cancer or depression, receiving the minimum of care, I really wonder. If someone is suicidal, you surely can’t say take a pill and call me in two weeks. You surely can’t say, you have to manage, because our wards are full and we’ve run out of major tranquilizers to keep all the crazies quiet. It’s not good enough!
When someone is depressed, the world disappears. I experienced this throughout my life, but particularly during the years when I was consistently suicidally depressed. I see the same thing now when my loved one is suffering. Family, friends and acquaintances who were in abundant supply during the summer of light, joy and abundance go missing when it becomes a winter of darkness, depression and lack. It’s hard to be with someone who is suicidal, but it’s harder to be that person. You don’t have to be that person’s primary care team. However, show up, and show that you care. I know from my own experiences and from being a devastated and unwilling participant at a few end-of-life services, that it’s so much better to put in that hour every week to just show up in the person’s life and listen. Take them places. Show them beautiful things and life and give them hope without lecturing them. Just show them. Just listen. Just be there. Don’t disappear.
When you are depressed, or you are caring for someone who is, these things are important (and I didn’t realize it when it was me, but I realize it now):
– Rest. Even if you need chemical help to have a good sleep, you need your sleep. Without regeneration of your physical self, the depression is so much worse.
– Food. The brain is a physical/chemical engine. It need good nutrition to work. Feed it well. In our home, we all deal with various challenges. We’ve made a deal to take turns cooking and it’s both a pleasure and a relief to know that every night we can have a healthy meal without doing all the work. Is there a friend or two nearby that you can enlist into a cooking exchange? Reach out and eat lots of fish and colourful fruits and veges!
– Movement. I deliberately replaced ‘Exercise’ with ‘Movement’. I hate exercise, but not movement. Movement is important. Movement is a beautiful thing because it begins with the simplest thing: breathing. Check in with yourself now. Are you taking great breaths of air into your diaphram, or are they short little gasps into your upper chest? It’s okay if it’s the latter. Become aware of the movement of your lungs as often as you can. Breathe. Practice breathing a little deeper. Draw in air and feel the oxygenated blood begin to heal you a little. It’s okay if you forget. I forget a lot too, especially when pain takes over. This fundamental movement is a beginning. From there we can move to stretching and wiggling our fingers and toes. Get up if you can. Go to the window or door and breathe in a deep breath of real outside air. Inside air is never the same. If you can go for a walk, do so. Don’t worry if you can’t manage a triathlon. We’ll leave that to the athletes. Just move. Just breathe.
– Structure. I hate this word. I rebel against it. I always have. However, you need a treatment plan to deal with depression, and part of that plan is structure. If you know where you’re going and what you’re doing, even if it’s two hours to prepare a meal, an hour to wash your socks, and two hours to walk to the corner to buy milk (even if you don’t need it) because you need to get out and get fresh air, you need to do it. Even if you’re bed-bound, you can’t afford to do nothing. Read, watch an educational documentary, listen to music that moves you (physically as well as spiritually). Throw in a tacky bestseller or popular movie for fun. We need fun. If your plan doesn’t work, modify it, as often as needed. Mix it up, and embrace new experiences. The worst thing for a brain that’s depressed is boredom and time to think about how awful you feel.
– Companionship. Maybe you have lots of friends, and this isn’t an issue. That’s great. Maybe you got depressed and many people stopped talking to you. That’s okay too (that reflects on them, by the way, not you). The one or two that always check up on you are your real friends. They are the ones that count. They are the people with whom you need to check in every day, even if just to say hi. For many years, experts and professional opinionated strangers have told us that friendships built on the internet weren’t real. Bullshit. I happen to be married to one of my internet friends, and have been in love for 13 years. Some of my best friends are people I have never met, but that I talk to daily. If you have trouble talking to others, which is particularly so when you are depressed, you may find it easier to connect through written words, and build your connections. I can vouch for the fact that you look forward to messages from loved heart friends throughout your day. If you’re able to follow the age-old advice to go out and join social or interest clubs, then please go forth and make friends.
– Beauty. Have you ever seen a sunrise or a scene that was so achingly beautiful that it made you cry? A movie with nuanced emotions about beauty, truth, freedom and love? (P.S. Try Moulin Rouge) More than ever, when you are severely depressed, you need reminders that there are so many beautiful things in the world, and so many beautiful things yet to see. I’ve seen so many of them, the Twelve Apostles, the Grand Canyon, Disneyworld, and even the C-beams that glitter in the dark near the Tannhauser Gate (okay, I imagined the last one thanks to the movie, Blade Runner). The point is, these beautiful things are your medicine. Did you know that you can go on Google maps’ Street View and walk the streets of Paris, and even see inside a gallery of the Musee D’Orsay? I didn’t know that until two weeks ago. You don’t need money, fame, good looks or even a travelling companion to do these things. All you need is imagination.
– Imagination. This perhaps should come first in my list, but let’s leave it here. Do you remember as a child getting lost in fantasy and imagination in the confines of that same roughly 1100 cubic centimetres that’s causing you so much misery now? Then your parents or guardians, teachers, pastors, and even contemporaries came and lambasted you for that imagination? They dragged you out of those glorious spaces and into the world, which may or may not have looked anything like the Grand Canyon. They didn’t do you any favours. As much as you need food, clothes, shelter, safety, warmth, sleep, sex and love, you need imagination. Before my depression ultimately took hold, I spent years in blissful imagination, writing stories, storyboarding and building character developments in my head. As I walked to class or did the ironing, I pretended I was that character and worked out what they would do or say and how they would react to a particular circumstance. Sometimes I worked out how they would survive something life and death like, oh say, the crisis of depression. Imagination is a muscle of intellect, as much as reading the encylopedia is, or learning advanced calculus. Einstein’s thought experiments were all about intellect and they changed the face of physics and the world as we understood it. Even he said: “Reality is merely an illusion albeit a very persistent one”. If your present reality needs improvement, the key could lie in your imagination. If you could live in a utopia where your depression would be cured, what elements of that utopia would be the doorway to recovery? Really use your imagination: don’t just imagine a little blue pill that fixes everything!
– Expression. I believe this is the most important of all. Through the internet, I have come to connect with a group of loving and compassionate people that share many of my common struggles: pain, isolation, depression, fear and even anger. Without this outlet, we would all be suffering individually and internally, and that would lead to more suffering. You can express anything you like. It doesn’t have to be about illness. It can be about anything you feel passionate about. I find that for me, writing and creating art helps me to express many of the themes associated with living with an invisible illness and indeed, being a marginalized person. It also helps me to develop and set out thoughts like these. Through expression and mutual sharing, we develop support networks and strategies that help us to improve the quality of our lives. The key word is connection. When illnesses like depression arise, they encourage us to withdraw from the mainstream. No one seems to see the dark struggles of the world that we see. Through expression, we learn to share our experiences, while hearing other viewpoints and ending our self-imposed isolation. It’s not a cure, but whether we express ourselves through writing, art, cooking, or any other creative pursuit, we take the first steps to claiming mastery over the aspects of illness that diminish our quality of life. We take the first steps of sharing our experiences, and begin to learn that other people share them too. We are not alone.
– Compassion. Above all, we must view ourselves and our lives through the lens of self-compassion and kindness. We must turn on ourselves the light of love that we share so readily with others, and learn to believe that we too deserve it with all our hearts.