Sunday, September 13, 2015

Depression and free time

When people are fairly depressed, they have no energy.  They would say they have no "motivation", which only means there is nothing they actually want to do.  In spite of that feeling, they can continue to do things that they don't particularly want to do; such as jobs or tasks of various kinds, even going to the dentist or other relatively unpleasant task. They "feel paralyzed", that they "can do nothing", but that's simply not true.  Many people use the word "motivation" to denote some positive feeling toward action. When you're depressed, there are few positive feelings.   However, it is  possible to have purely intellectual motivation, a form that does not depend on how you feel but rather how you think.

The very worst thing for depressed people is to have nothing to do.  We instinctively want to lie down in a quiet and relatively dark place and hibernate when we're depressed.  But that gives us lots of time, time to think about things.  Usually the things we think about when we're depressed are pretty negative, which further increases our depression and inertia.  We disapprove of our own inertia and "laziness", which makes us feel more worthless. We get caught in a vicious circle with plenty of time to deepen the spiral.

To fight  the depression with activity is counter-intuitive.  There is a great deal of experimental evidence that supports the idea that activity of any kind, including exercise, will gradually improve the depression over a several month-long period.  In fact, the improvement is about as fast as the improvement one expects from an anti-depressant medication, but the long-range effects of exercise are clearly a lot better.  It's just that the hardest part, that of actually starting exercising, comes at the very time when the depressed person least feels like exercising.  Of course, that's where medication comes in: a short-range "jump-start" to get going with.  And it's easier to take a pill than to work out.

Having nothing to do but think while you're depressed is really the pits. So how do depressed people get started?  Well, mostly they don't.  To exercise while depressed is like going to the dentist to have a tooth drilled.  To do that we have to understand that "motivation" is neither available or necessary;  it's a luxury which depressed people have to do without for a while.  It does come back eventually, but it takes at least several months for that to begin.  For some of us (including me) exercise always has to be done without emotional motivation.  But so many things are never going to be based on "wanting to".  The world is full of unpleasant and distasteful tasks. Actually we're used to doing things we don't want to do.  Saying we "aren't motivated" is like going back to be an adolescent rebel again.

I have also noticed how many depressed patients I see who lead empty and fun-free lives, and did so for years prior to their depression.  How easy is it to get up to face a day with nothing pleasurable in it?  Why wouldn't we think "What's the use?"  It doesn't occur to us that arranging pleasurable events and experiences on an everyday basis is necessary for mental health.  Taking an anti-depressant does not provide a substitute for an interesting or enjoyable life.

"Motivation" is an award earned only by play.

Sunday, September 06, 2015

Letting Go

Some ideas that seem useless when you are young get more relevant as you age.  An idea of that sort  is  "letting go".

We hold on to our "stuff", things we have accumulated over our lives.  At the time we get these things we think they are important and necessary.  As time  passes, however, we find taking care of all our stuff gets  more and more difficult and tedious.  At the same time we begin to recognize how little of it we actually use or need. 

Some times we see this even in the short run, such as after birthdays or Christmas.  Even the new car that seemed the epitome of our dreams becomes a thing to get rid of and a pain to take care of.  We see it more clearly when we move from one house to another.  Getting rid of stuff...  what a nightmare!

Our relatives (even the ones we love) die and we must let  them  go. Our friends for a lifetime die as well.  As we age, and if we live long enough, we will lose all the  long-term friends.  Letting them go becomes a frequent and painful job, but we have to learn to do it.

When someone dies with whom we have a difficult or conflictful relationship, letting go is more problematic.  We feel there is "unfinished business".  We experience the burden of the things left unsaid and the questions left unanswered.  Learning to let this go as well is much more difficult and sometimes we simply don't know how to do that.  (This is one of the things psychotherapists spend a lot of time doing).

Finally we have to let go of negative feelings on a daily basis.  We carry anger and resentment far too long,  hurting ourselves but not the person who is the target of our anger.  We carry anxiety about unlikely catastrophes to the point we can't manage the crises of everyday life.  We carry sadness in our hearts for relationships that are long over.  We hate saying "goodbye".

Old age seems to be the time for me and others of my age to focus on the skill of "letting go",  I have to do a lot of it, it seems.  In fact, I would say that the most important skill for the aged is the skill of letting things go, of accepting your losses, and also accepting the peculiar freedom that results.