change the world
daily survival plan in hell
My definition of a man is this: a being who can get used
What do I mean by hell? I define it as "relentless physical
or emotional pain that appears to have no end."
What follows is a brief outline of my daily survival plan. I have rewritten
it in the second person so that you can adapt it to your individual
needs. Remember, the goal is to identify coping strategies that will
keep you safe and get you through each day until the pattern of the
In chronicling his own depressive episode, novelist Andrew Solomon
wrote: Recovery depends enormously on support. The depressives I've
met who have done the best were cushioned with love. Nothing taught
me more about the love of my father and my friends than my own depression.
- EXERCISE Research has shown that regular exercise can improve mood in cases of mild to moderate depression. Exercise is one of the best ways to elevate and stabilize mood as well as improve overall physical health. Pick an activity that you might enjoy, even if it is as simple as walking around the block, and engage in it as often as you can (three to four times a week is ideal).
- DIET + NUTRITION Eat a diet that is high in complex carbohydrates and protein, avoiding foods such as simple sugars that can cause emotional ups and downs. Try to stay away from foods that have chemical additives or preservatives that may create ups and downs for chemically sensitive individuals.
- SLEEP Adopt a regular sleep schedule to get your body into a routine. If you have trouble getting to sleep or suffer from insomnia, there are behavioral techniques as well as medication that can help you to sleep. The book No More Sleepless Nights by Peter Hauri is a good resource.
- HOMEOPATHIC MEDICATION Take your medication as prescribed. Check with your homeopath or health care professional. Be patient.
Switching from negative to positive self-talk
is a process that may have to practiced once, twice, sometimes ten times
a day. Since the depressed brain tends to see life through dark-colored
glasses, monitoring one's inner dialogue provides a lifeline to healing.
I also used the mood diary to record daily thoughts and feelings.
... the universe will help you in your time of need ...
Because of the disabling nature of depression, you may not be able to implement all of the strategies that I have presented. That is okay. Just do the best you can. Do not underestimate the power of intention.
Your earnest desire to get well is a powerful force that can draw unexpected
help and support to you.
mind is its own place, and in itself can make a Heav'n of Hell or a
Hell of Heav'n.
To one who has not experienced the torment
of a clinical depression, it is hard to put this pain into words. It
cannot be described as stabbing, shooting, or burning; neither can its
sensations be localized to any one part of the body.
"But reduce the pain?" I thought incredulously. "How
am I going to find relief from an agony this extreme?"
After a time, however, the pain
and the longing would let up, perhaps for a day or two. Yet, invariably
the heartache would return and begin the cycle all over again - pain
turning into relief, which turned into more pain and then more relief,
"The key to reducing your perception of pain," Teresa continued dispassionately, "is to uncouple the sensations in your body from the thoughts about them."
"What does that mean?"
"There are two levels of pain that you are feeling. The first level is physiological - the raw pain in your body. The second layer (and this is where you have some control) consists of how you interpret your experience. Perhaps you may be thinking, 'This torment is killing me,' or 'This will last forever,' or 'There is nothing I can do about it.' Each of these despairing thoughts creates a neurochemical reaction in the brain that creates even more distress. If you can learn to detach yourself from these judgments, much of the pain that arises from them will diminish."
"How do I do this?"
"Think of your anxiety or depression as a large wave that is approaching you. As the wave makes contact, see if you can ride the wave by focusing upon your breath. Breathe through the sensations, breathing in and out while attending to the sound of your breathing. Don't fight against the pain - that will only make it worse. Just breathe. It's not even about getting through the day; it's about getting through each breath."
When I had worked as a salesperson in the corporate world, I learned the skill of breaking large goals into manageable parts. Now I discovered that one could also divide pain into manageable parts.
If I couldn't handle getting through the day, I would
try to make it through the next hour; if an hour seemed too long, I
set my sights on the next minute or second. Teresa showed me another
powerful technique to use when my pain became intense. Calling her on
the phone I would say, "My pain is unbearable."
What Teresa was teaching me was the practice of mindfulness, the spiritual practice of staying focused on the present moment.
In traditional meditation, when the mind wanders, one gently brings it back to a central focus (the breath, a candle, etc.).
Teresa challenged me to do the same in response to intense emotional pain, especially when I projected my present condition into the future using catastrophic self-talk that led to suicidal thinking - e.g. "If I have to put with this pain for 30 years, I might as well end my life now."
"Just refocus on the present moment," Teresa would say. "Over a period of time you can learn to relate differently to your pain. You can work with the pain and live around the corners of pain and develop your life around it. Eventually the turbulent emotional waters will become calm again. In the meantime, you can find inner stillness and peace right within the most difficult life situations."
As a way to keep me safe, Teresa and I devised a simple but powerful three-step technique for responding to my catastrophic and despairing self-talk. I have rewritten these steps in a prescriptive fashion so that they can be used by others.
I cannot recall how many times this simple process allowed me to endure a day, an hour, or a minute of intense pain. In giving me a way to manage my catastrophic (and potentially dangerous) thinking, this technique kept me alive while I waited for the pattern of my illness to shift.
In his classic book, Man's Search for Meaning, Victor Frank, while imprisoned in a Nazi concentration camp, discovered that "everything can be taken from a man but one thing - the ability to choose one's attitude in any given set of circumstances."
While we cannot always avoid the pain of depression, we can direct
our thoughts about it, and thereby modify our experience of the pain
at the level of perception. While the subsequent pain-reduction may
be subtle, it can be enough to make the suffering "barely bearable".
Copyright 2002 Douglas Bloch
sitting with depression
Depressed people think they know themselves, but maybe they only know depression.
By Mark Epstein
A woman named Sally called me not long ago seeking advice. I had seen her for a single session in consultation months before, and we had talked about a variety of therapeutic and spiritual issues.
Like many people with an interest in spirituality, she was suspicious of the role of psychiatric medications in today's culture. It seemed like the mark of some kind of Brave New World to have mood-altering drugs so readily available. But like many others, Sally wondered if there might be a medicine that could help her.
She had been plagued with chronic feelings of anxiety and depression for much of her adult life, and despite a healthy investment in psychotherapy, she still felt that there was something the matter with her.
When I spoke with Sally the second time, she had been taking a small dose of an antidepressant for several weeks, 25 milligrams of Zoloft, and she was finding that she felt calmer, less irritable, and, dare she say, happier. She was going on a two-week meditation retreat later that month. Something about taking her medication while on retreat made Sally uncomfortable, and that was the reason for her call.
"Perhaps I should go more deeply into my problems while I'm away," she said. She worried that the antidepressant would impede that process by making her problems less accessible to her. "What do you think?" she asked.
Let me be clear right from the start that there is no universal answer in a situation like this. Some people notice when they take drugs like Prozac, Paxil, or Zoloft, antidepressants of the SSRI (selective serotonin re-uptake inhibitor) variety, that they feel cut-off from themselves as a result.
They don't feel their feelings quite so acutely and sometimes report feeling numb. Some, both men and women, find that the drugs interfere with their ability to reach orgasm.
Many others find that the damping down of their feelings is more subtle. One of my patients notices she no longer cries in movies, for example, but she is willing to accept this because she also no longer worries to the point of exhaustion about things she can do nothing about. I was relieved to hear that Sally was feeling better.
People who respond well to these antidepressants often have none of the side effects mentioned above. Instead they feel restored, healed of the depressive symptoms that they were expending so much of their energy trying to fend off. Less preoccupied with their internal states, they are freer to participate in their own lives, yet they often wonder if they are cheating. "This isn't the real me," they protest. "I'm the tired, cranky, no-good one you remember from a couple of weeks ago."
As a psychiatrist, I am often in the position to encourage people to question those identifications. Depressed people think they know themselves, but maybe they only know depression. Sally's question was interesting not only because of the drug issue but because of her assumptions about the nature of spiritual work.
The notion that we need to go more deeply into our problems in order to be healed is a prevalent one, and one that, as a therapist, I am sympathetic toward.
Certainly, ignoring the shadow side of our personalities can only lead to what Freud once called the "return of the repressed." Yet it struck me that there was a remnant of American Puritanism implicit in Sally's perspective, or at least a Judeo-Christian tendency to divide the Self into lower and higher, or better and worse.
When people believe that they are their problems, there is often a desire to pick away at the Self. People think that if they could just admit the awful truth about themselves they would start to feel better. But going more deeply into our problems can be just another variant on trying to get rid of our problems altogether to return to a state of original purity like the Garden of Eden.
While most therapists would probably deny a religious influence on their thinking, many collude unconsciously with this mode of thought. Going more deeply into one's problems is the standard approach of most therapies, and it can lead to a kind of sober honesty and humility that gives people a quiet strength of character.
But to go more deeply into our problems is sometimes to go only into what we already know. I was sure that Sally did not have to go looking for problems on her retreat. Retreats are difficult enough even for people who are not depressed.
Sally's unresolved issues would come rushing in to fill every space whether she took her antidepressant or not, but she might have more success in not being sucked in by them with the medicine inside of her.
I told her that at this point I felt she needed to come out of her problems, not go into them more deeply, and that the antidepressant should not get in her way in that regard. To be overwhelmed while on retreat would not be useful.
As a therapist influenced by the wisdom of the East, I am confident that there is another direction in which to move in such situations: away from the problems and into the unknown.
If we stay with the fear this often induces, we have a special opportunity to see our own egos at work, defending against the unknown while hiding out in the very problems we claim to want freedom from.
The Buddhist writer and translator Stephen Batchelor, in his austere new book on the teachings of a third-century Indian philosopher-monk named Nagarjuna, Verses from the Center: A Buddhist Vision of the Sublime (Riverhead Books), eloquently describes how the mind can be set free of all constraints in meditation.
He tells of how the eighth-century Indian monk Shantideva, author of A Guide to the Bodhisattva's Way of Life, was liberated upon uttering the following words: "When neither something nor nothing/Remains to be known,/There is no alternative left/But complete non-referential ease."
Rather than going more deeply into his problems, Shantideva learned how to disentangle his mind from them. This is an approach that Western therapy has little experience with, but it is the foundation of Eastern wisdom.
The contents of the mental stream are not as important as the consciousness that knows them. The mind softens in meditation through the assumption of a particular mental posture called "bare attention," in which impartial, nonjudgmental awareness is trained on whatever there is to observe.
Problems are not distinguished from solutions; the mind learns how to be with ambiguity.
The imagery that describes this transformation in classical Asian cultures is revealing.
When nourished with meditative awareness, the mind unfolds like a lotus, symbol of the primordial Buddha-nature that is obscured by our identifications with our problems.
Buddhas themselves sit upon a lotus throne, symbol of a mind that contains everything but holds nothing. The lotus is another way of evoking the womblike nature of emptiness or sunyata, whose translation is literally "pregnant void."
In Batchelor's book he describes how the understanding of emptiness "eases fixations," another way of talking about freeing the mind from an obsession with "problems."
A translation of the Sanskrit prapanaca, "fixations" take root when we turn fleeting and ephemeral pleasures or displeasures into objects that we then try to hold on to. They are evidence of a kind of psychological materialism that holds us as much as we would like to hold it.
Sally felt that she should go more deeply into her problems, not to understand their empty nature, but to admit the awful truth about herself.
But this sort of truth-seeking masked a continuing attachment to the kind of person she thought she should be: a person without problems.
Mark Epstein, M.D., is a psychiatrist in New York and author of Thoughts without a Thinker: Psychotherapy from a Buddhist Perspective (Basic Books, 1996) and Going to Pieces without Falling Apart (Broadway Books, 1999). He's been a student of Buddhist meditation for 25 years.
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Guilt or embarrassment may be blocking an honest
expression of your feelings, so unblock the guilt. You'll get there.
Inch by inch, and everything's a cinch.
YOU ARE NOT YOUR DEPRESSION.
Even so, the boards are an important and immediate link to the outside world, which you may well need until you find a strong, stable and positive influence in your life, such as a local spiritual/religious group or a non-directive therapist or counsellor (preferably familiar with the works of Alice Miller) who believes in listening and not merely in prescribing.
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