In writing about retirement in The Summerhouse Years.com I had always intended that this blog should be a combination of the amusant and the serieux, not to mention the pretentious. You know the way life is. This blog is intended as a serious one. My hope is that it may be helpful. It is about the ‘d’ word I referred to in my last blog. I shall use the word sparingly but for the sake of a little clarity I’m talking about that, much abused, concept – depression.
Depression is not unique to retirement, the number of pupils in our schools who are given the label is an unfortunate indicator of this. In my view the mental ‘state’ that is labelled depression, is often (always?) about control or lack of it. Retirement is a period of our lives when we feel we have less control for the, apparently paradoxical, reason that we have less to do, less structure. We feel disoriented, lost and as a result often unhappy. I know this sounds a bit odd but then it is not the purpose of this blog, despite the title, to explore in depth, depression unique to retirement. The purpose is to express my concern about the concept of the term ‘depression’ and the industry it has generated at a more generic level.
An article in The Guardian (10th August) by Giles Fraser sets the context for this blog and describes the nature of my concern better than I can. He said “by calling it (the way we feel – my italics) depression is already to classify a particular kind of experience as something quasi-medical thus leading one to think in terms of medical treatment.” He goes on to say that the history of depression is based on the premise that the drug companies already had drugs for other purposes – to treat infections – and they were found to have mood-altering side effects so “instead of developing a drug to fit an abnormality, an abnormality was postulated to fit a drug.” Fraser suggests that “unhappiness is a perfectly proper response to the state of the world – happiness is not compulsory.” Nor the industry that underpins it (just look at the bookshelves of any bookshop (if you can find one), train station or airport. The place is full of them. I digress.
As a psychologist I always avoided any kind of labelling. In my professional view a label doubles the problem rather than reduces it. A label is a false friend. It was often difficult to avoid this trap when talking to a parent who often, quite understandably, sought some explanation for their child’s behaviour, but a trap it was as they found to their, and the child’s, cost. No longer a person but now a label. Sometimes these were their first words – he’s got ADHD, OCD, ODD, ASC etc. etc. that’s what their child had become a stereotype. And there the ‘good news’ (irony intended) stopped because, other than drugs of highly dubious nature – read about the side effects of Ritalin, for example – there was / is no unique treatment that went with the label. Other than medication the label was a dead end, in fact worse than that the failed expectation of help left a person in a more damaged place than before.
And so I believe is the case with depression. Yes, there are associated treatments that are not drug dependent and I will return to these in a moment. Overall, however, I believe that label induces a feeling of helplessness rather than empowerment. A feeling that only an expert can help me now, rather than, with a bit of support I can work this out myself. The psychiatric industry thrives on this state. Because they (psychiatrists) are trained as doctors and to think like doctors they add up the symptoms (on their checklists, mental or otherwise) and with a given (read arbitrary) score, you’ve got the chosen condition. I don’t believe that mental health works like this but dependency does.
One of my heroes (which may imply a degree of bias) in the profession of psychology (very different from psychiatry) is Steve de Shazer. An American psychologist who, with a number of others, has developed an approach to ‘therapy’ (another word I don’t like but nobody’s perfect) called Solutions Focused or Brief Therapy. This is not the place to describe this approach in detail, suffice it to say that I believe it has much to offer those who feel they are depressed. It is in direct opposition to the ‘I’ve got depression and /it’s not my fault/ it’s to do with my brain / I need help / I need medication to cure me/ approach.
OK, having said what I don’t think is helpful to people ‘with depression’ let me say what I do think is supportive. I’m going to continue this blog, with some ‘advice’. And of course I’m not saying that people ‘with depression’ don’t feel bad, sometimes very very bad. Some of it may seem rather trivial for a condition (another loaded word) that people describe as a mind-numbing, all encompassing, incapacitating blanket of blackness, helplessness, misery. The (in)famous ‘black dog’ of Churchill’s world. Boy, what words, just using them makes you feel bad. So am I wary of trivialising depression? No, not in the least, in my view that’s what depression needs, more triviality and less pomp. So here’s my top tips, in no particular order, for combating the ‘d’ word:
Think small and go slow. If you can’t get off the sofa, can’t even go to the toilet I feel so depressed, see if you can put your foot on the floor (that may be the easy bit) then the hard part – notice that you did it, just notice and take interest in how you did it, no big hurrah for doing it, just, hmm, I did that (omit the ‘ great job, well done’, it just builds expectations you may not be able to meet. Self-acclaim can come later).
As in Solutions Focused Therapy (SFT) work notice those times when you feel slightly better, politely enquire of yourself why that might be. The thing is when you’re ‘d’ed’ you notice only events that confirm the hypothesis that you’re depressed. Lots of good or at least slightly better stuff goes by when you have this mind-set. You cannot afford to miss the good stuff, those times when you feel a little lighter, no matter how small and apparently insignificant, they might (appear) to be.
Another strategy that I first came across in SFT although it’s probably been around much longer is scaling. Give yourself (without thinking about it – first number that comes into your head) a score out of 10 for how you’re feeling right now. Anything above 1 ask yourself, what made it 1? How come it wasn’t zero? Focus on that positive but perhaps more importantly ask yourself – what would it take to move 1 point up the scale, or even half a quarter of a point. That’s your goal then. By the way goal setting is an art in itself but too big a topic for this blog.
Tease them (your problems) apart. This little mantra has guided me through many a stormy, dark night (the last one a couple of night’s ago). It’s from Thomas Harris who wrote the ‘best seller’ I’m OK, You’re OK:
A winner takes a big problem and separates it into smaller parts
So that it can be more easily manipulated
A loser takes a lot of little problems and rolls them together
Until they are insolvable
So don’t role your problems together and ‘awfulize’ (i.e. tell yourself that everything is terrible). Oh, and one favourite bit of advice for my clients – write it down, write down all the problems, you need to get them out of your head. By externalising them you make it easier to tease them apart, then look at each and decided – action / no action (i.e. just live with it, what cannot be cured must be endured). If the problem is in the action column then take steps to work out what action is required. I have other techniques for doing this and I may write about them later.
Watch your thoughts. A very popular (and linked to this last point) form of ‘therapy’ for depression is Cognitive Behaviour Therapy (CBT). Did I say popular? God, it’s even recommended by the government which could be enough to put you off. I have to say, despite this, that I’m a fan. CBT encourages you to look at your thinking (cognitions). This isn’t the place to go into the types of thinking people who are prone to depression ‘specialise‘ in. As somebody (a psychologist named Dreikurs, I think) said –there’s no such things as facts, just the interpretation we put upon them. One example – generalisation – “I was mugged by a young kid – all young kids are thugs”. This and other forms of faulty thinking as CBT would have it make life a lot more difficult for the person that thinks this way. Bad thinking, makes you feel bad and behave bad.
And, as an addendum to the last point, and this may be the most important bit of advice contained in this blog – watch your language – the way in which you speak to yourself and others about how you’re feeling, what you’re thinking is vital in determining whether you feel empowered or disabled. I hate to keep saying this but again the topic for another post.
Exercise. I don’t pretend to understand the chemistry but I’m impressed. I know it’s a bit predictable, take exercise, get out of the house, but it’s right and, if you can walk with another person and have a bit of a chat at the same time, that’s all to the good. In fact having the right kind of person to talk is an obvious big help generally. The right kind? – a possible topic of yet another blog. Stay away, on your walk, from deep examination of why you’re depressed, that’s just digging a deeper and deeper hole for yourself. Try a focus on the type of thinking – one thing that would make me feel better – for example. There are other questions that help you out of the hole rather than dig you deeper into it – collect them – I do. Again I may write about these questions later.
Finally, and, in a way, most trivial of all – humour. It was Howard Jacobsen who I first read who said ‘humour is just tragedy plus time’. Obviously time is something we can’t artificially add, or can we (again, sorry, another possible serious topic for later). I have always said to teachers who were having a bad time in the classroom that when I was a teacher in a special school – a battleground if ever there was one – that the terrible stories made for a great source of fun in the pub later. Nobody wants to hear how well you did. Make bad things funny. It’s possible more often than you might think, especially with a little time. Everything can be funny – ask Mel Brooks, Springtime for Hitler and Germany! Wow. It’s mind over matter – if you don’t mind, it don’t matter.
In her novel ‘The Mystery of Mercy Close’, Marion Keyes (a writer who knows more than most about depression) wrote :
“There was no such thing as depression. We all had days when we felt fat and cold and poor and tired, when the world seemed hostile and rough-edged and when it seemed safer to simply stay in bed. But that was life. It was no reason to take tablets or get time off work or go to St Teresa’s for a while. Muffins, that was the answer.”*
Sound trivial? Good!
*By page 244 she’d got the diagnosis and was desperate for the tablets, couldn’t move off the rug without them. But maybe the point is that Marion writes with great humour and I’m guessing that this helps her with her own depression.
Of course if your life really is shit, well, fair enough. Maybe you’ve earned the right to wallow a bit, but, sooner or later, you probably need to get on with it. And, yes, I am in danger of trivialising a crippling mental ‘condition’ but in my view there’s enough of the deadly serious, the weighty, the academic, this blog just aims to add a little lightness to the depression industry. Take it out of the hands of experts, therapists, drug companies, etc. etc. and put in back in the domain of the individual. Is this blog a contradiction in those terms? A ‘sort of expert’ writing for others. I don’t know, you decide.
So as I said at the beginning, depression is by no means unique to retired people, but there are certain conditions that make it an increased possibility – changing sense of identity, lack of self esteem or sense of purpose, change in financial situation and so on. My own experience, anecdotal evidence and media reports all attest to the fact that retirement can be tough, you need to keep your wits about you.