daily survival plan in hell

My definition of a man is this: a being who can get used to anything.
- Dostoyevsky

What do I mean by hell? I define it as "relentless physical or emotional pain that appears to have no end."

This was my experience of living with chronic, unremitting anxiety and depression. I found that the best way to cope with such intense discomfort was to live my life one day at a time.

Whenever I contemplated the prospect of dealing with my pain over the long term, I became overwhelmed. But if I could reduce my life to a single 24-hour segment of time - that was something I could handle. If I could tread water (or, being in hell, tread fire) each day, then perhaps I could survive my ordeal.

Working together, my therapist and I created what I called "my daily survival plan for living in hell." The central idea was simple-to develop coping strategies that would get me through the day, hour by hour, minute by minute.

Because I was fighting a war on two fronts, I had to devise and employ techniques that would deal with both the depression and the anxiety. I used my coping strategies to create four categories of support, which I have summarized.

These categories are:

- physical support;

- mental / emotional support;

- spiritual support; and, most importantly,

- people support.

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 depression shifts.

1. people support

Social support is a key ingredient in dealing with emotional pain. Find a way to structure your daily routine so that you will be around people much of the time. If there is a day treatment program in your area, some form of group therapy, or depression support groups at your local hospital, attend them.

Don't be embarrassed about asking for help from family members or friends. You are suffering from an illness, not a personal weakness or defect in character. My own sense of connection with people gave me a reason not to harm myself.

I did not want to afflict my friends and family with the anguish that would result from my self-imposed departure. A lifeguard at the pool where I swam agreed with my thinking. "Other people are a good reason to stay alive," she affirmed.

Support is critical in helping people to cope with all kinds of extreme circumstances.

Survivor researcher Julius Siegal emphasizes that communication among prisoners of war provides a lifeline for their survival. And for those who are prisoners of their inner wars, support is equally crucial.

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.

2. physical support

The second aspect of your daily survival plan consists of finding ways to nurture your physical body. Here are some suggestions:

- 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.

3. mental/emotional support

Every thought and feeling produces a neurochemical change in your brain. Although you may not always be able to control the painful symptoms of depression and anxiety, you can influence the way you think and feel about those symptoms.

monitoring self-talk

Monitoring one's self-talk is an integral strategy of cognitive-behavioral therapy, a talk therapy widely used in treating depression. You may wish to work with a therapist who specializes in cognitive therapy. He or she can help you to replace thoughts of catastrophe and doom with affirmations that encourage you to apply present-moment coping strategies.

For example, the statement "My depression will never get better" can be replaced by the affirmation "Nothing stays the same forever", or "This, too, will pass."

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.

keep a mood diary

One of the survival techniques I used to stay alive in my hell was to keep track of my anxiety and depression on a day-to-day basis. To this end, I created a daily mood scale. Somehow, the simple act of observing and recording moods gave me a sense of control over them.

I also used the mood diary to record daily thoughts and feelings.

be compassionate with yourself

Once again you can turn to the affirmation process. Whenever you start to judge yourself for being depressed you can repeat, "It's not my fault that I am unwell. I am actually a powerful person residing inside a very sick body. I am taking good care of myself and will continue to do so until I get well."

focus on the little things

In the middle of my episode I asked my therapist, "If all I am doing is trying to survive from day to day, how do I find any quality to my life?"

"The quality is in the little things," she replied.

Whether it is a kind word from a friend, a sunny day, a beautiful sunset, or an unexpected break from the pain, see if you can take in and appreciate these small moments of grace.

Having such moments is akin to making deposits into an "emotional bank account." When the dark periods return, you can draw upon these stored memories and affirm that life can still be beautiful, if only for an instant.

Above all, no matter how bad things seem, remember that nothing stays the same forever. Change is the only constant in the universe. One of the most powerful thoughts you can hold is the simple affirmation "This too, will pass."

4. spiritual support

If you believe in God, a Higher Power, or any benevolent spiritual presence, now is the time to make use of your faith. Attending a form of worship with other people can bring both spiritual and social support. If you have a spiritual advisor (rabbi, priest, minister, etc.), talk with that person as often as possible.

Put your name on any prayer support list(s) you know of. Don't be bashful about asking others to pray for you. (A list of twenty-four hour telephone prayer ministries in provided for you in my section on prayer.)

... 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.

bearing the (seemingly) unbearable

The mind is its own place, and in itself can make a Heav'n of Hell or a Hell of Heav'n.

- John Milton

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.

It is an all-encompassing malignancy - a crucifying pain that slowly permeates every fiber of one's being. Falling prey to a depression is not like being gored by a bull; it is more akin to being eaten alive by an army of starving termites.

In the midst of my depressive episode, coping with such unbearable pain became my central task, especially when the pain became so overwhelming that my thoughts turned to suicide.

"But reduce the pain?" I thought incredulously. "How am I going to find relief from an agony this extreme?"

I remembered what author William Styron had told his daughter on the eve of his hospitalization - "I would rather have a limb amputated without anesthesia than to suffer the kind of pain I am feeling right now."

It was at this point that an old college friend of mine serendipitously reentered my life. Teresa Keane was a registered nurse who worked at the Oregon Health Sciences University Medical School where she taught stress reduction to patients with chronic pain.

Her classes were based on the groundbreaking work of Jon Kabat Zinn, a meditation teacher featured in Bill Moyer's 1996 PBS documentary, Healing and the Mind. Kabat Zinn teaches the Buddhist practice of "mindful meditation" to patients suffering from intractable physical pain. Through employing his techniques, patients alleviate not only their physical discomfort, but the accompanying emotional distress as well.

I met up with Teresa in her office at OHSU where I described the nature of my torment. "Facing pain is a learned skill," Teresa responded. "When you are in a lot of pain, whether it is a migraine headache or suicidal torment, the pain dominates all of your awareness and becomes-all encompassing. It's hard to remember a time when the pain was absent, and it's hard to believe that it will ever go away. It's as if both past and present are blotted out, and you are left stranded in your present misery."

"At least you understand," I remarked.

"However," Teresa continued, "If you can release your judgment about pain and just observe it, you will notice a very important fact about the nature of pain-pain comes in waves!"

Upon hearing these words, I remembered my experience of grief after my separation from my wife, Joan. There were days when I was so overwhelmed by sorrow and loss that I could barely function.

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, etc.

"This is the body-mind's built-in protective mechanism." Teresa explained. "If the pain were truly nonstop, you wouldn't survive. And so you are granted a few gaps in between the intense sensations while you stop and catch your breath."

"But it feels like the pain is unrelenting," I protested. "If you were clinically depressed, you would understand."

"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."

"It is barely bearable," she replied. "Can you feel the subtle difference between those two sentences?"

"The pain is barely bearable," I repeated to myself.

There was a shift and I felt it. In another session I screamed, "I can't take it anymore!"

"You can barely take it," she responded.

"I can barely take it," I replied.

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.
  1. Notice what is happening Become aware that your mind is dwelling on thoughts of catastrophe and doom. Identify the catastrophic thought - e.g., "This pain will never stop. The only way out is suicide."
  2. Realize that these fearful thoughts are describing not the present but the future Since the future has yet to occur, it cannot harm you.
  3. Refocus onto the present moment through positive self-talk and constructive action For example, you might replace the statement, "I'll never get better" with, "Right now I am going to choose a self-care strategy to get me through this period [e.g., calling a friend, going for a swim, etc.]." Then, put your strategy into action.

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

Buy When Going Through Hell Don't Stop! A Survivor's Guide to Depression!

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.

Buddhism is very clear about how important it is to move in such a direction.

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.

Copyright 2001. Yoga Journal, LLC.

Alice Miller
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Find your own North Star

WARNING The creators of this site do not believe depression to be an "illness" but a critical message that you must change your way of living, thinking or behaving.

Depression is an important opportunity to reevaluate your priorities, and not a "disease" to be smothered or feared; depression is inverted anger, nothing more, so take the time to discover that with which you are angry.

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.

The following message boards and chatroom are extremely useful for immediate help but not recommended for long-term use as some of the users do not seem to be interested in working through depression - rather, they hold onto it as if it were a prized possession.


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.

Live depression chatrooms - NOW!
Depression message boards (these usually get fast replies) - NOW!
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Find Your Happiness message boards - NOW!

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Depression and anxiety message board - NOW!
Receive inspiring daily stories
If you are suicidal, email all these new friends now
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Depression and anxiety message board - NOW!
Receive inspiring daily stories
If you are suicidal, email all these new friends now
Free guided audio online relaxation exercises