The comment policy for this post is different from my usual one. It’s at the end of the post. Content note: depression, obviously.
How — specifically, in a practical sense — do I live with the understanding that I have chronic recurrent mental illness?
I have chronic episodic depression, and probably will for the rest of my life. I’m getting better now, I’ve been better for a few months; but I accept that this is a chronic illness and I could get depressed again at any time. A few days ago, I wrote a piece about What All This Means: it was useful for me to write (a lot of my writing about depression is as much for myself as for anyone else), but it was a little philosophical, a little abstract and meta. So I’m writing this practical guide to how I plan to live as a currently healthy person who has a chronic recurring mental illness.
None of this is intended to tell anyone else with depression what’s right for them. This is entirely an account of what I think is right for me, written largely so that I can refer back to it later if I need to. If you find any of this useful, please take what you need and leave the rest.
Continuing to do self-care. I’m going to continue to eat a reasonably healthy diet, get enough sleep, drink enough water, exercise, spend time outside, spend time with other people (even if it’s just quiet time in cafes), meditate, do hobbies, limit my TV watching, write, take breaks from writing. I want to do those things anyway: I enjoy them and they make me happy and healthy. But I’m also doing this because when the next bad depressive episode hits, I want to be ready. Being in better health will make it easier to weather the storm — and if I’m already in the habits of doing self-care, it’ll be easier to stick with them when the next depression hits.
Asking people close to me to keep an eye on me. Depression lies, and one of the biggest lies it tells is, “You’re not depressed — this is just how the world is.” So I’m asking Ingrid, and my closest friends who see me pretty often, to let me know if they’re worried that my depression is coming back. In particular, I’m going to ask this of my friends who themselves deal with depression and know first-hand what it looks like.
When stressful or traumatic things happen, dial up my vigilance, and consider taking action. I know that hyper-vigilance about my mental health is itself not healthy. Trying to find the right balance — monitoring myself just enough but not too much — is going to be tricky. But I also know that my depressive episodes tend to be triggered by major stressful or traumatic events, usually when two or more happen at once.
So when life is ticking along reasonably well, I’m going to relax more. If I’m wondering whether a low, pessimistic mood is incipient depression or just human sadness; whether fogginess and difficulty focusing are coming from depression or whether I’m just coming down with a cold; whether a stretch of tired inactivity is depressed amotivation or just my body and brain needing a break — I’ll err on the side of, “I’m just tired and sick and sad.” I’ll keep doing self-care (see above), but if life or laziness interferes and I let it slide for a few days, I’ll cut myself slack.
But when life gets harder, I’ll get more vigilant. I’ll pay closer attention to my mental and emotional state. And if I am experiencing things that might or might not be depression, I’ll err on the side of assuming that it’s probably depression. I’ll get more rigorous about self-care; I’ll talk with my doctor about dialing my meds dosage back up; I’ll ask the people keeping an eye on me to keep a closer eye; I’ll look at getting back into talk therapy. Heck, if life gets seriously traumatic or I can see serious trauma coming, I’ll just get back into therapy, even if I don’t feel depressed. When my dad was dying in 2012, I got into therapy before he died — which meant that when the Armageddon of 2012 hit, I didn’t have to add “find a therapist” to my list of “shit I have to deal with when my life is already upside-down and my brain is hiding in a bunker and pulling the blankets over its head.”
Doing a mental health check-in routine. I want to avoid hyper-vigilance about my mental health, but I also want to avoid… well, avoidance. I don’t want to forget that I have chronic episodic depression, or go into denial about it. So I’m going to set up a regular check-in routine, probably once or twice a week, where I take stock of my mental health and see how I’m doing. Meditation may play a role in this. One of my meditation techniques is to focus my attention on my mental and emotional state, to just sit with my thoughts and feelings and observe them without trying to change them — so I’m going to start incorporating that technique into my meditation routine more often.
But when the next set of bad traumas hit, I want to have the meds already in my system. I don’t want to wait four to six weeks for them to kick in, and I don’t want to go through the crappy adjustment period. So I’m staying on them; at a lower dose, but very likely for life.
Finally, and very importantly:
Thinking of my next episode as “when” instead of “if.” I’ve had depressive episodes off and on throughout my adult life, maybe even starting in adolescence. They’ve mostly been off — I’ve been not-depressed more than I’ve been depressed — but they’ve been frequent enough that I have to assume this is a chronic condition. This means I’m likely to have them again. No — strike that. I’m almost certainly going to have them again.
So I can’t let myself think, “Oh, it’s been a few years since my last episode, maybe I’m all better now.” I can’t let up on my self-care and self-monitoring, and if the people I’ve asked to keep an eye on me say they’re worried, I have to listen. I can’t indulge in wishful thinking. I have to remember. I have chronic episodic depression. I need to act like it.
That’s what I’m doing. What are you doing? Other people with mental illness that comes and goes — how do you cope?
Comment policy: If you yourself have depression or other mental illness, I welcome suggestions and perspectives on managing it as a chronic lifelong illness — but please frame them as what works for you, not as prescriptions for me or anyone else. If you don’t have mental illness, please don’t give advice of any kind. Thanks.
Wellbutrin_SR_tablets_150mg image by SergeSF, licensed under Creative Commons, found at Wikimedia Commons.