Hardcore Self Help: F**k Depression

by Robert Duff

  Sure, being late and causing some sort of disruption is upsetting. It is probably your own damn fault, and you should feel bad about it. How bad, though? This is where that 0-100 scale comes in. Does anything about your lateness indicate that you won’t be able to do good things with the rest of your day? Have you been late before and been able to salvage your day just fine? The other day, I was late to a treatment team meeting. I blamed traffic (external control fallacy) when it was probably my fault, and I did cause a bit of disruption. The members of the team were gracious and didn’t make any comments while they shifted around to make room for me. In that moment, my brain was trying to convince me that I screwed up the meeting and probably my whole day. Taking a step back, I used this 0-100 scale based on how smooth the rest of the meeting went and my ability to contribute useful information. Absolutely it was my fault and I felt like an idiot, but I really only hit a 20 on the fuck up scale. In my own silly brain, that allowed me to only feel 20% like shit. That’s the trick. I don’t want you to think magical pixie dust thoughts and hope that you can do whatever you want without consequence just because you think positively. You still need to handle your stuff. However, you can be more realistic and try to work toward having emotional reactions that are appropriate to the situation instead of using that deadly combination of emotional reasoning and all-or-nothing thinking to drive you straight into Depressionville every time you might the slightest mistake.

  Using the “fuck up scale” instead of defaulting to all-or-nothing thinking patterns takes some practice. Your depressed brain is in the habit of blowing things out of proportion, so when you first start trying out this technique, your ratings might be inflated. That’s another place where those people who you recruited as your logical barometers can come in handy. You can explain the circumstances and ask them how they would rate it on the 0-100 scale. Then, you can compare your rating to theirs. After a while, you will get the hang of more realistically appraising your own fuck ups, so just stick with it.

  Another valuable tool that you can use to fight back against your brain’s lazy shortcuts is related to that labelling distortion we talked about before. That is the one where you apply mean labels to yourself instead of just describing what you did or didn’t do in that particular instance. The trick that you can use here is also one that we use in the world of science. You can define your terms. When you are doing a science experiment and you want to look at a given construct like happiness, relationship strength, or effectiveness of a drug, you need to come up with something called an operational definition. This means that you need to find a very specific way to describe and define that construct so that we know exactly how it is measured and someone else across the globe can also investigate the same thing.

  In the same way, you can push yourself to specifically define the labels that you find yourself using. When you call yourself a failure, an idiot, a bad spouse, a bad child, or a loner, what exactly do you mean by that? What are the specific traits that an idiot possesses? What sorts of actions do they take? Who can you think of that certainly exemplifies those specific traits? Are you just the same as them? In what ways are you different from that person? I know those were a lot of questions in a row, but ideally that’s what your pattern of thinking should start to look like. Use some Socratic questioning to poke holes in your distorted thinking and your global labelling. It’s alright if there are some aspects about you as a person or about what you have done that fit with the specific label that you have defined. You can do idiotic things sometimes without being an idiot.

  Here’s another personal example: I consider myself to be a pretty nice person overall. I care about humans and don’t ever mean to intentionally put someone down. My own personal golden rule is “just don’t be an asshole”. Well, that works out well most of the time for me, but believe it or not, I’m not perfect (GASP!) and sometimes I slip up and say something that I instantly regret. I don’t remember the exact conversation, but I was chatting with my wife over dinner and said something that I thought was very casual and playful, but to her it was a pretty sharp attack on her character. At first, I had no idea why I started getting the silent treatment. Once I probed a bit, I saw how what I said could definitely be taken as criticism. Even though I apologized, it was clear that the damage was done and there was no taking it back. Now, I don’t want you to think that this was some catastrophic event in my marriage. It wasn’t. Just one of the normal misunderstandings that happen among spouses. However, I really needed to catch myself in that moment. What I said is certainly something that an asshole might say, but that does not mean that I am an asshole.

  If I were a depressed person, I would not be so easily convinced that I was not an asshole. I would have to get specific about what exactly qualifies someone as an asshole. Well, I can think of a few people that I will not name that fit the bill. They tend to have traits like not caring about anyone else and seeming to enjoy making other people upset. Do these apply to me? Hell no. I HATE making other people upset over something that I did… probably to a fault. I can’t let it go until I feel like I’ve fixed it. In this previous example, I may have communicated through my actions that I don’t care, but the fact that it is eating me up so much inside indicates that I actually do. I am still allowed to feel a bit shitty about it. I messed up, but going through this sort of self-analysis and being more specific and investigative about labels helps that be a temporary feeling of ickiness that goes away instead of serving as just another log on the depressive fire.

  The other thing to consider, when it comes to labels, is that they always have a flip-side. Sometimes, it can be useful to examine the other side of the coin. Even though the immediate label that you give yourself such as “greedy”, “asshole”, “idiot”, or “failure” may have a clear negative weight to them, you can also ask yourself whether there are some positive qualities in there as well. For example, if you are dealing with the asshole label, you might be able to look at the other side of the coin by breaking it down a little more. What are some positive aspects of assholeness? Maybe you are a skeptical person. That’s definitely an admirable quality which can enable you to think critically and get to the heart of important issues. Maybe you are assertive. That’s also great in a lot of ways. Many people never learn how to stand up for themselves and instead get stepped on by other people every day. With this example, you are not throwing out the label entirely, you are just recognizing that there are some nuances to it. You can own both the good and the bad. You can notice that you screwed up overall, but, in some ways, it was just a case of admirable qualities getting out of hand. That is much easier to learn from. You can adjust your behavior with information like that.

  I’ve made a lot of references to scientists in this chapter. I really want you to internalize that idea. Create a mental picture of yourself in a silly white lab coat with protective glasses or whatever image really screams scientist to you. Adopt this little mental alter ego when you find yourself engaging in these unhelpful patterns of thinking. You don’t have to walk around all day, analyzing and questioning everything (unless that’s already your personality), but you can switch into this mode when you need to examine the evidence that your silly brain tries to immediately pass off as fact. Of course, any good scientist knows the importance of documenting your findings. That’s why your grade school science teachers made you write down every detail in those little composition books during lab. It is exceptionally hard to see yourself changing on a day to day basis. If you’ve ever trained physically for something, you know that this is true. If you are trying to gain muscle definition, lose weight, or complete your race faster, you really can’t see much difference from one day to the next. However, when you keep track of your progress through pictures, or logging your performance in a paper or digital log, it becomes much easier to see change across weeks or months. Fighting back against depression can be much the same way. Remember; your brain is currently trained to tell you, “See? That did noth
ing. The same shit happened again, just like always. This book is useless and you are not getting any better.” When that happens, you can whip out your log and determine whether that is true or not. You can say, “Well let’s slow down here. Sure I made the same mistake that I did yesterday, but it looks like overall the number of times that I am engaging in distorted thinking has gone down by 20% over the past month. That’s the difference between a D and an F in just 30 days. Pretty badass if you ask me!”

  It’s also important to admit that sometimes the things we try are not hitting the mark and making a big difference for us. There is nothing wrong with that. Part of being a good scientist is being open to the null hypothesis that no change has occurred after trying something new. Learning that a particular strategy just isn’t your thing is also really valuable information. By continuously documenting and logging your progress, you can notice when things aren’t quite working for you and make the choice to change course. Maybe it’s a slight adjustment to the strategies that you are using, or maybe you need to do a radical overhaul of your approach. No matter what, you will never know that it is time to shift your approach if you don’t take the time to analyze your own progress and check in with yourself. Documenting makes it that much easier to take an objective look at your progress and make those decisions. Eventually, you will become amazing at fine tuning and tweaking your approach to really work for you.

  Ch. 4 A Chapter About Suicide

  Time to be straight up. I want to talk about suicide. That’s right, I said it. Suicide. Some people seem to think that suicide is like Voldemort and we should never utter the name out loud, or that it’s like Beetlejuice and if we say it three times, suddenly someone will decide to kill themselves. That’s not how it works. In fact, I think that a lot of people kill themselves because it isn’t talked about. In this chapter I’m going to talk about it. I would say “trigger warning,” but I wouldn’t mean it. It’s something that we need to talk about and something that we need to stand up to.

  Suicidality is a spectrum. Most of us have had the passing thought about what things would be like if we were gone or what it would feel like to die. Probably fewer of us have made a game plan and identified the method and circumstances that we would use to kill ourselves if we felt the need to. I think that we all lie somewhere on this continuum. Yes, being on the extreme end of it is dangerous, but just because you may fall farther to one side of this spectrum than the other does not mean that you are crazy or that you are hopeless.

  We have to get into a few terms here because I think that they get thrown around pretty casually, and I want to make sure that you understand them. The first one that I want to clarify is “suicidal ideation.” The term sounds scary and intimidating, but it’s not too bad. Suicidal ideation just means that you are thinking of suicide. On the lower end of this spectrum, it crosses your mind every once in a while and on the high end of spectrum, you are virtually obsessed with the idea of killing yourself. A word with a very different tone is “suicidal intent.” The word intent is a little scarier because it refers to the degree to which you plan to kill yourself at some point. Finally, it is important to understand the term means. This references the method that you might use to kill yourself (gun, bridge, knife etc.). Let me use a hypothetical example here to illustrate how these terms are used in a practical way.

  So, let’s say that we are trying to understand Sally, who is a 23 year old recent college graduate who just suffered the loss of her mother and has been unemployed for the past 6 months like many others in her cohort. She certainly has a lot going on, but where does she fit on the suicidality spectrum? Sally has had fleeting thoughts about death during the rough patches throughout her life, but she currently can’t seem to get the thought of it out of her head. No matter how hard she tries to shake them off, thoughts of death seem to creep into every empty space in her brain. Her little internal voice tells her that this is all just too much to deal with. She envisions herself taking every medication in her bathroom cabinet and falling asleep in a hot bath. This scares the shit out of her. She really does not want to die. In fact, she feels like she has to live for the rest of her family … it’s just so damn scary having these thoughts. For now, she feels very confident that she will not try to kill herself and she wants it to stay that way.

  Okay, sorry if that was a little intense. I just wanted to give you a realistic scenario to wrap your head around. In this case, Sally definitely has suicidal ideation that is at least moderate if not severe. She is really preoccupied with the thought of dying. However, her fear of death and desire to find a way to live indicates that her intent is actually pretty low. Even though her intent is low at the moment, her level of ideation is definitely worthy of concern. For that reason, we want to be careful about her means of killing herself. She identified one for us, which was taking the pills in her cabinet. In this scenario, it might be a good idea to enlist some help to make sure that she is able to maintain her safety as well as she wants to.

  I’m going to ask you to do something pretty damn brave for me here. You can do it. I want you to compare yourself to Sally. Right now, in this moment, where do you lie in the dimensions of suicidal ideation, intent, and means? There is no wrong answer here, but it is important for you to know. If your intent is high and you have a means that comes to mind immediately, I want you to seriously consider putting this book down right now and getting help. If you are in the United States, you can call 1-800-273-8255. This is the national suicide prevention hotline where people are trained to help you stay safe. If you live in another country, you can google “suicide hotline” and find some options near you. Depending on the country, you might need to adjust the words slightly. For instance, in some countries the translation for “suicide” is closer to “self-murder”, so play around with the terminology until you find what you are looking for. If you don’t want to deal with a hotline and would rather just get the hell out of dodge, you can call 911 or your country’s equivalent emergency services number. If you tell them that you are worried about killing yourself, they will come out and do an assessment with you and, if necessary, take you to a hospital where you will be kept safe. I know this doesn’t sound fun (and it probably isn’t), but this is not the time to think about convenience. We are talking about the permanent destruction of your life here. As far as I’m concerned, that’s the most pure example of a medical emergency there is.

  I want you to live. Suicidality that comes from depression is often a symptom that stems from the hopelessness that we talked about earlier. Your asshole of a brain in tricking you into thinking that there is no way out of your situation and no point in hoping for anything different in the future. The old saying still definitely rings true: suicide is a permanent solution to a temporary situation. Don’t make that mistake, my friend. Things can change, even if your douchebrain won’t let you believe that right now.

  If you aren’t quite on the crisis/emergency side of the suicidality spectrum, there are some other things that you can do to help yourself cope. My first advice would be not keeping it a secret. I know that talking about suicide is scary as hell, and it should be. It’s a frightening prospect. However, keeping it a secret only gives it more power. Take the power back, my friend. Drawing suicidality out into the open can be one of the most protective things that you can do. I don’t mean getting on Facebook and shouting it from the rooftops (unless that is really your style). I mean that you should tell your family, your significant other, your closest friends, or your doctor.

  One of the terrifying things about bringing up the topic of suicide is the prospect of people overreacting. I think some people imagine that as soon as they utter the word suicide, a Special Forces group will breach their wall or rappel down from helicopters and violently extract them straight to a mental hospital. That’s not going to happen. Your family might react strongly for sure, but that’s because you are important to them. It may also be a big shock to them to hear this from you, because you a
re better at hiding these thoughts than you realize. Of course this is personally loaded. We don’t all have good families, but I hope you see the point that I’m trying to make. If the people that you tell about your suicidal thoughts overreact, educate them about where you lie on those spectrums we talked about, and help them understand what your level of intent is at the moment. If you aren’t looking to kill yourself in the immediate future, let them know, and also tell them that it is something that you are struggling with. Tell them that you need them to be on your team while you find your way out of these scary and confusing feelings. I know that it can be very difficult to find the right words to say in situations like this. Just try your best. The words don’t need to come out right. They just need to come out.

  So, you tell people that you have been thinking about killing yourself. Groovy. What now? Well, there are a few things that they can do to help. All of this comes down to the level of severity that you are experiencing with your suicidality. (It is a little bit difficult to write in generalities, so please pardon anything that doesn’t directly apply to you here.) One thing that most families or friends would be happy to do is limit your access to the likely means of killing yourself. The scenario that I described with Sally earlier is actually quite common. Pills are an easily accessible, non-violent means of ending a life. If you are on a prescription medication or have access to drugs that have overdose potential, such as Xanax or strong pain killers, consider buying a tiny safe for the storage of those pills and giving the key to someone that you trust. You can keep a small amount for treatment or emergency, but not enough on hand that you could possibly hurt yourself. If you need to access the whole bottle for any reason, you must go through that trusted person. The point of this strategy isn’t just to take away your autonomy. In fact, if you live alone and have no access to trusted people to help out, I would still encourage you to try out the safe method. The trick here is giving yourself intermediate steps. When you are in crisis, your brain tries to trick you into jumping from point A to point Z. Crisis states are temporary. If you include things designed to put more time between the impulse to kill yourself and your means of doing it, you will give yourself more opportunities to make a different, non-fatal choice.