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 13, 2015
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.
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.
Sunday, August 23, 2015
Taxes and Benefits: The Great Disconnect
The morning papers have the same complaints and demands, year after year. Everybody wants the government to do more for them. The same people complain about paying taxes. Last year about tax time we were having a staff meeting. You should be aware that our staff are social workers for the most part, and well-educated ones at that, with a Master's degree and years of experience. The complaint heard around the room was how once again the Department of Mental Health was taking cuts in budget, as we had for a number of years, on the grounds that tax revenues had again fallen and there simply wasn't enough money.
During a lull in the complaining I stood and asked the following question: How many of you would be willing to pay a five percent increase in your state income taxes if the money were earmarked for mental health?
Not one single hand went up. I then asked for suggestions as to how the money could be found without raising taxes. There were a number of suggestions, some obscene or at least impractical.
These included "stop the graft", without specifying exactly which graft was being referred to; another suggestion included taking it from the roads budget, although our roads are among the worst in the US. It was clear that as a group we did not see the direct connection between taxation and budget. The money should come from the same place we expected it to come from when we were unemployed teenagers: the Great Daddy, who now apparently resides in Washington.
As a people we need to reconnect our expenditures with our income. I have a suggestion, clearly impractical since it makes sense. We should vote on budget issues online. Each budget expenditure should be associated with the exact amount of cost, paid by taxes, for each person's bracket. We need to own what we choose to pay for. Oklahoma highway bridges? X Million total, for you personally $437.44 of your income tax. No items can be approved unless enough people vote for the expenditure out of their pockets. Not enough voted? The item cannot be paid for and we can't have it. Just like our personal budgets.
I can think of many possible variations on this idea. It might be disastrous for a few years, but eventually people will see the truth, that they are paying for everything the government spends out of their own individual pockets. I suspect legislator salaries and benefits would be among the early casualties of this plan, but if I can think of that, so will the legislators, and they will never allow that to happen as long as they vote for their own pay.
Such a plan was not practical, or even possible, in the early days of the republic. Distances and difficult communication were huge obstacles. But with the internet those problems can be solved and there is no practical reason why the general public should not have a direct voice in allocation of tax moneys and expenditures.
During a lull in the complaining I stood and asked the following question: How many of you would be willing to pay a five percent increase in your state income taxes if the money were earmarked for mental health?
Not one single hand went up. I then asked for suggestions as to how the money could be found without raising taxes. There were a number of suggestions, some obscene or at least impractical.
These included "stop the graft", without specifying exactly which graft was being referred to; another suggestion included taking it from the roads budget, although our roads are among the worst in the US. It was clear that as a group we did not see the direct connection between taxation and budget. The money should come from the same place we expected it to come from when we were unemployed teenagers: the Great Daddy, who now apparently resides in Washington.
As a people we need to reconnect our expenditures with our income. I have a suggestion, clearly impractical since it makes sense. We should vote on budget issues online. Each budget expenditure should be associated with the exact amount of cost, paid by taxes, for each person's bracket. We need to own what we choose to pay for. Oklahoma highway bridges? X Million total, for you personally $437.44 of your income tax. No items can be approved unless enough people vote for the expenditure out of their pockets. Not enough voted? The item cannot be paid for and we can't have it. Just like our personal budgets.
I can think of many possible variations on this idea. It might be disastrous for a few years, but eventually people will see the truth, that they are paying for everything the government spends out of their own individual pockets. I suspect legislator salaries and benefits would be among the early casualties of this plan, but if I can think of that, so will the legislators, and they will never allow that to happen as long as they vote for their own pay.
Such a plan was not practical, or even possible, in the early days of the republic. Distances and difficult communication were huge obstacles. But with the internet those problems can be solved and there is no practical reason why the general public should not have a direct voice in allocation of tax moneys and expenditures.
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