Checking In With Yourself

When you’re feeling really depressed, upset, or anxious, it can be hard to come up with ways to understand what is happening with yourself, let alone what to do about it. Even the most basic self-care can be hard to remember when your executive functioning is down.

This is a very helpful list to have handy for those times when you are unable to generate the energy to remember how to support yourself:

 

Depression Part 3: Nurture Yourself Back to Life

Part 1

Part 2

Part 3: Physical Aspects–Sleep and Nutrition

It can be very hard to take care of yourself even at the best of times, especially if you have a trauma history. And when you’re depressed, it can be even harder to take care of yourself. You might feel too drained, sad, and even unworthy of care. But this is exactly when it is most important to take care of yourself, even if you can only do a little bit.

Just do the little bit that you can. And keep doing it.

First, stabilize your physical aspect as best you can. The four most crucial mental health needs of your body are sleep, nutrition, exercise, and social interaction. You may also be considering medication.

Sleep: regular sleep is probably the single most important thing your body needs to maintain mental health. If you have been skimping on sleep in order to get things done, you may need to let a lot more tasks go in order to recover. The purpose of sleep is to release toxins from your brain cells. If you are not getting enough sleep, then you are intoxicated, and not in a fun way–your brain is poisoned. Start developing a sleep routine that is as regular as you can make it, close to the same time every night.

If you are struggling with insomnia, the insomnia needs to be addressed so you can get the sleep you need. It’s not uncommon for depression or anxiety to remit simply by getting your sleep stabilized. Don’t use alcohol as a sleep aid: alcohol is not only a depressant, but it also interferes with sleep cycles, so it can worsen sleep problems.

If depression is causing you to sleep too much, it may be most useful to first address other physical aspects of depression before trying to cut down on sleep. Besides, is it actually “too much”? You may need extra sleep for the time being. If it feels like you are convalescing from an illness, that is because you are.

Nutrition: Your body needs fuel in order to operate physically and mentally. Your mood will be worsened by hunger, even if you are not feeling the hunger. At least get a bit of  protein and some complex carbohydrates. If your appetite has dropped and you are having trouble eating, or caring about eating, then try having something like Ensure, or chocolate milk, or kefir on hand – it can be easier to drink something. If you can eat a little something a few times a day, even if not your usual meals, it will help you not to sink further into depression.

When you’re feeling up to it, treat yourself nicely when you eat. It can be comforting. It may be you’re just eating condensed soup sitting on the couch, but see if you can eat it from your favorite bowl. Or try eating something that reminds you of childhood in a pleasant way.

When you have regained enough energy to attend better to your meals, you can get back to what you would normally eat, but for now it’s okay to just eat something.

If you are suddenly eating a lot more than you normally would, try to be gentle with yourself. There is a reason you are doing this–you feel bad!–and it’s not worth harshly criticizing yourself. Indeed, you will make yourself feel worse and it might compound the issue. Remember the important thing is to fuel yourself and restore your balance overall, and do so gently. The goal is not to sternly restrict. That may backfire.

 

Next: Physical Aspects–Basic Exercise, Social Interaction, Medication

Depression Part 2: When You’re Depressed

Part 1

Part 2:

Recognize Depression: Depression often creeps up gradually and may affect you for a while before you realize what is happening. What effects do you usually experience? Are your symptoms usually physical, emotional, or cognitive, or a combination? Exhaustion, achiness, overwhelm, lack of motivation, negative thoughts, suicidality? (See Part 1.) If you have a better idea of your own symptom profile, you will be able to catch a depressive episode sooner when it occurs.

It is often a great relief simply to realize why you’ve been feeling bad. Also, it can be encouraging to remember that most depressive episodes remit within two weeks even without intervention!

Accept Depression: Depression can be tricky because we often have a belief that if we recognize what’s going on, we should be able to “snap out of it” by some act of will. While it’s good to try some things you think might help you feel better, the process is healing rather than fixing. You are an organism, not a mechanical device. It may take some time to get through the healing process.

Most people feel impatient about this, because depression interrupts whatever else you’re trying to do with your life. That’s the part most people have a hard time accepting. But depression is a real thing that really affects people on many levels, so work on accepting how your feelings and your functioning are affected. Then you can better decide how to address it.

Beating yourself up for “feeling bad for no reason” or “not getting enough done” will only make things worse! It may be that during some depressive episodes you will  feel bad “for no reason” or that you may not get as much done as you want to. That’s what happens during depression. You can do many things to support your healing, but you can’t just decide to not have depression.

Most people experiencing depression–even severe depression–are mostly functional in some life areas, which can lead to denial or minimization. “They must not be very seriously depressed, I just saw them laughing and joking at a party,” or “I can’t have severe depression since I’m able to work 12-hour shifts on a busy floor.”

Functionality varies from situation to situation and from day to day. You can be functional in one or more life area, or appear “okay” to others. That doesn’t mean the depression isn’t real or isn’t serious.

 

Depression Part 3: Nurturing Yourself Back to Life

 

Depression Part 1: Depression and Functioning

Because we often think of depression as “lying on the couch crying,” many people don’t recognize what they’re experiencing as depression, especially if they’re high-functioning or have “smiling” depression.

But the most prominent and common symptom of depression I see is a lack of motivation. It can be anything from “I don’t care about anything and I don’t want to do anything” to “I’m too exhausted to do even the smallest thing” to “I want to do this one thing and somehow I just…don’t.” It’s also very common to function well at work, only to “fall apart” off the clock.

While actual proportions vary from person to person, few if any depressed people look like the “just sad” stereotype. A graphic in an article by Anna Borges depicts the discrepancy:

 

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It makes sense if you think of what “depress” means: to push down. Depression pushes down your physical, emotional, and/or cognitive functioning, in any combination.

If your physical functioning is depressed, you may feel exhausted and achey or move and speak more slowly than usual (often without realizing it). You may experience sleep difficulties.

If your emotional functioning is depressed, you may feel low, sad, hopeless, pessimistic, guilty, or even strangely flat, empty, and detached.

If your cognitive functioning is depressed, you may have difficulty concentrating, planning and implementing anything, or trouble with memory. The “planning and implementing” piece is the brain’s executive function. This is where the motivation problems come in, and why a person experiencing depression can’t simply “snap out of it” and “motivate.”

Also in terms of cognitive functioning, you may generate a lot of irrationally negative thoughts (and you may believe them uncritically), or have thoughts of death or suicide. It’s especially important to recognize that suicidal thoughts, while scary, are a symptom of depression and usually diminish when depression improves, so seeking help with depression is important.

 

Next:

Part 2: When You’re Depressed

You Are Not “Lazy”

“I’m not getting enough done, I’m so lazy.” “I ended up hardly doing anything Sunday and I felt so lazy.” “I need to get this one task done, but I keep being lazy about it.” “After work I’m just too lazy to work out.” “I’m too lazy to keep track of things.”

In fact, I have never met a lazy person.

I’ve met people who are: overworked, exhausted, sleep-deprived, in chronic pain, ill, mired in depressive episodes, struggling with anxiety, stuck in intolerable situations, and having attention difficulties, but I’ve never met a lazy person.

“Lazy” doesn’t really mean anything clinically. It’s a “folk” term, and it is primarily used as a pejorative towards self or others. One patient summed it up as “not doing what you think you ‘should‘,” and I think that’s a good all-around summation.

Calling yourself “lazy” is usually an internalized message from caregivers in your formative years. It could have been directed towards you or towards others. The message is “You are unacceptable unless you do what I want, regardless of your ability, wishes, or how you are feeling.”

If you are injured, walk it off! If you are tired, too bad! If you are sick, it can’t be that bad since you’re not actually in an ambulance on the way to the hospital! Just because you don’t want to do something is no reason not to do it! You’re just “lazy”! In other words, how you feel and what you want do not matter. Ignore your own feelings and your wishes.

“Lazy” has also been used (and still is) as a way to demean racial minorities, those with disabilities, the poor, and women. Please be especially careful not to re-enact racism, ableism, classism, and sexism on yourself by calling yourself lazy!

The implication is that if you would just “will” yourself to do whatever it is, then you would be acceptable and worthy. If not, then you must just be a bad, unworthy person and you must deserve bad treatment.

The fact is, you are already acceptable and worthy, without doing anything to “earn” that worth. Now, you might feel better or happier if you were doing certain things, and they are certainly worth trying, to see if that is the case. But telling yourself you are “lazy” is not helpful.

Feeling awful about yourself is not a good motivator for anyone. And it is in no way helpful in mitigating situational factors, such as poverty or prejudice. In fact, it is likely to worsen your exhaustion, depression, anxiety, insomnia, and concentration, which will make it even harder to do whatever it is you would like to be doing.

Instead of calling yourself lazy when you did not do something you intended to, try paying attention to your feelings. Are you tired? Has it been weeks since you had a good night’s sleep? Have you been working 60 hours at three different jobs? Do you have an infant or a toddler? Are you taking care of others’ needs? Are you sick? Are you getting sick? Are you going through an exhausting life transition? Are you grieving? Are you experiencing chronic pain or illness? Are you in a depressive episode? Are you experiencing anxiety/phobia about certain tasks? Do you have PTSD? Are there systemic barriers to your tasks that make them much harder than they are for others? Have you been paying attention to self-care?

It may be that you have internalized some unrealistic expectations for what you “should” be able to do. It may be that some others can do the thing you want to do. It may be that on “good” days you have been able to do twenty times as much as you are doing today. But where are you, just you, today, right here, right now? Maybe you’re doing the best you can with what you have at your disposal right now. Maybe that is enough.

Another day, you may be able to do something more or something different. But accepting yourself right now is even more important than doing the thing. And that does not make anyone “lazy.”