Receiving advice without beating yourself up

This woman’s story is heartbreaking and enraging. But I don’t have anything useful to say about women’s body images or abusive relationships, so I’ll leave those parts of the thread alone.  Rather, I’m linking to it because a peripheral issue came up in the discussion about which I do have something to say. Respondent:

Lastly, try to get outside of yourself a little bit. Volunteer at a nursing home or some place where you can give of yourself. I find that’s the best way to feel good about yourself – to give. After all, we are what we do, ya know? So bringing a smile or a warm touch to someone’s day makes you a thousand times more beautiful than crunches or miles on the treadmill ever could.

Well said, well-intentioned, and of course, exactly right.  But check the OP’s response:

and I know how shallow and idiotic I am. I know I should adopt kittens or feed orphans in Sudan instead of being so wrapped up in my own shit but I’m so numb, and just feel worse for *not* fostering kittens and orphans.

Classic. I’ve been down this mental road so many times myself. The relevant background here is that I started feeling shitty around 7th grade and I’ve been a bit screwed up in some way or another ever since. And thousands of times have I heard that I could just make myself feel better by going out and doing X, Y, and Z. And a similar number of times has such advice only made me feel worse.

Here’s what I think about why “how to feel better” advice has seldom worked for me.

First, consider the disease model of depression. Certainly I think that the shift to thinking about mental health issues medically has lead to a lot of good—and it always rankles when I hear people complain about the possible overmedicalization of depression in this country, as if that’s really one of our major problems—but at the same time I think there have been times when thinking about what’s wrong with me as a disease has led to an underestimation of my power in the situation. Diseases (generally) fall upon us for mysterious reasons. We tend to think of most of them as being “not our fault.” We tend to seek out specialists, trained in a medical science that is inaccessible to the laity, to make us better. This way of doing things can be freeing, as we are liberated from the stress of being responsible for our betterment, and because the disease is viewed not our fault, we receive from others pity and understanding rather than blame.

I think that when the depressed receive (well-intentioned, and usually good) advice on how to feel better, they often rush to dismiss it because it threatens the protections offered by the disease model. Suddenly, your unhappiness might actually be your fault. And the thing is, depressed people are really good at finding novel ways to feel bad. And the possibility that you might be responsible for your own bad feelings happens to be a fantastic reason to feel bad. And in the quotes I pulled above, we see one of the classic examples of this. Volunteerism might very well make the OP happier, but it’s so easy to just feel bad about not volunteering rather than to actually do something. “I suck. I’m so selfish.”

So this has personal relevance because I’ve been down this spiral of defensiveness followed by bad feelings about being selfish so many times. And dear Lord, it has taken a long fucking time, but I think I’m finally getting to a point where I’m no longer threatened by the idea that there are things I can do to make myself feel better. In fact, these days, rather than denying that are actions that will change my feelings, or feeling guilty about not carrying out those actions, I am actually sometimes somewhat empowered by the knowledge that they exist. It’s not, “See, I knew I was horrible! I’m not volunteering!” it’s “There are things I can do to get out of this funk! Awesome!” One of thoughts is that I should use this blog to help myself by keeping track of things that make myself feel better, so that I can have a ready reference when I’m in needed. And learn more about the cause-effect relationships

How did this change in perspective happen? I wish I knew, so that I could provide an instruction manual to others who are going down roads similar to mine. AFAIK it’s some crazy intersection of finally starting psychotherapy and life in general, and how the two play off each other. The meds are a necessary component, too, I think I learned last year when I tried to taper off them.

I’ll note that there is still a part of me that feels like I have certain emotional tendencies that no actions will change, however. I’m far from being in complete control.

But I no longer cling to the “depressed” label. It’s pretty clear I’m not DSM-certifiable major depressed anymore, for one thing. The code that my therapist puts on the bills is for “Major Depression-remission,” or something like that. But mostly I don’t cling to the diagnosis anymore because I don’t think it’s very useful for me to think about things that way. It just seems too narrow. Saying the MDD is over makes it sound like it’s entirely gone, when really parts of it are still there, because it’s a part of my past that continues into my present in the same way that all parts of our self travel forward with us while being processed by a filter that leads to some continuity and some change. I prefer to think of what’s going on in these terms: “I’ve been screwed up for awhile. I probably didn’t really develop properly. I think I’ve been getting better but I still have a ways to go.” Therapy has led me to a more holistic way of thinking about this stuff (I wish I had a better way of describing it), and I think that’s been entirely the right way to go.