43. The Paradoxes of Depression

18 Dec 2017

As I sit here in IMH, waiting for my medical appointment, I keep mulling over what I see as the Paradoxes of depression. I’ve managed to come up with an acronym! I’m still so chuffed about that.

To understand depression, you have to understand these paradoxes. 5 are internal – meaning they are internal struggles that need proper counselling and medication to help with. 4 are external, meaning if you know someone who has depression, chances are you can help with these paradoxes to some extent. Note that no two people have the same experience of depression, but yet as general paradoxes, these hold true to some extent for most sufferers of depression.

I’ve labelled these paradoxes as the SHELF-GULA paradoxes.

Internal paradoxes, are the Self, Hope, Effort, Life and Feeling paradoxes.

External paradoxes are the Guilt, Understanding, Loneliness and Assistance paradoxes.

Paradoxes that are largely internal struggles

Self

At the heart of every depression, is the self. The paradox that we struggle with, is that we find our selves useless and even worthless. We struggle to find ourselves, and we struggle to make sense of what we stand for, or who we really are. So while we find our selves unimportant, we also put our selves at the center of our introspection. Our questions don’t stray far from the self, but we also don’t want the focus to be on us. This paradox becomes a very frustrating key to depression because if we can solve the problem of self, we can focus less on ourselves, and more on the world around us. Usually this requires some form of talk therapy.

Hope

Who doesn’t want hope? A depression sufferer hungers for hope. Hope that life can go on. Hope that the pain will end. Hope that we can live as normal people. Hope to stop the medication. Yet while we hunger for hope, we feel that hope is impossible. We refuse to let ourselves dream of the future, unless it is a dark one. We refrain from hope because we feel burnt and disappointed in ourselves. We want to have hope, and at the same time we don’t dare to hope. Some days we wake up and feel that we might be able to hope and dream. Some days, we wake up in a nightmare. Doctors and therapists help us to have hope by pointing to the overall upward trend of our condition, if there is one. But generally, our hopes and dreams are internal, and we struggle with wanting to have them – and yet not wanting to be let down by our selves.

Effort

When energy is at a premium, effort is at a premium. At what cost do we do something? When we meet someone, how much energy will be expended? Will it be worth the effort expended? The paradox occurs especially when we consider our efforts at recovery. Exercise, a healthy diet, and low level social engagement are all recommended for recovery. But putting in too much effort into these activities cause us to crash after, and the crash never feels good. Crashes risk our safety as well, as we are not well able to think after. Work is an even scarier paradox when it comes to effort. Do we go all in, and do our best at work, and put in all that effort, and find ourselves floating when we return home in a haze of mess?

So do we put in effort, or don’t we? How much is too much? How much is the effort that we must put in to be accountable to ourselves?

Life

One key issue with depression that makes it so vitally important a condition to be treated, is the issue of life itself. To a depressive, life is painful, and the self is worth so little. Why live? Why keep up the struggle? Sometimes the pain gets too much and life is actually not an option. There is simply nothing left inside to fight the battle. But the paradox occurs because there still is an innate sense of wanting to live. It could be that we don’t want to let our loved ones down. Or abandon our dependants. Or just a stubborn will to live. Promises we have made. Things left unsettled. So we fight to stay afloat even as we want to give up and let the whirlpool just suck us in. This paradox is the one that locks my muscles down during an episode so that I can’t harm myself. For some, it leans more towards self harm, while for others, it leans more towards living.

Feeling

Whenever depression is an issue, you will hear people ask – so how are you feeling today? Sometimes the feelings get too overwhelming. Whether it is happiness or sadness, we struggle to regulate our emotions, and we struggle sometimes to even face them. Medication can help to moderate this sometimes, but we run the risk of anhedonia, where nothing is felt, not even pleasure. But that may not be a bad thing if the feelings threaten to overwhelm. But yet, not feeling anything feels… dead, to some extent. So should we feel? Should we not? Usually the answer lies somewhere in between, and therapists can equip us to learn to handle our emotions better, but this is another difficult paradox which is a daily struggle. How to be in control of our emotions, and not be controlled by our emotions, at the worst possible times.

Paradoxes that can be influenced externally

Guilt

Depression sufferers experience guilt at some level, most of the time. Guilt that we are sick, guilt that we can’t do more, guilt that we are sick with an illness that isn’t visible, guilt for overreacting to stimuli, guilt for being worthless. But yet at some level, we know that we are sick and need help, and shouldn’t feel guilty for that. Enter the best paradox ever – we feel guilty for feeling guilty!

At least this paradox can be influenced externally. Seek to reassure the sufferer when they are feeling guilty about something. Remind them concretely why they shouldn’t feel guilty. Repeat yourself gently if you have to. If accidents occur, help them not to blame themselves by reassuring them that it was an accident.

Understanding

The paradox of understanding lies in this – a sufferer would understand the pain of another sufferer easily, but would struggle to admit that any comfort or solution that applies to another sufferer would apply to him or herself. The sufferer, in effect, can help someone else, but cannot see the way to help him or herself. This ties to the uselessness / worthlessness / self paradox, and can get tiring to work around.

One simple way to help a sufferer caught in this paradox is to gently remind the sufferer that he or she would have helped or spoken to someone else with depression in the same circumstances the same way. When confronted with fact, usually the sufferer will take it in – even if it’s just for an hour or two.

Loneliness

When you feel like you’re worthless, or that you don’t deserve anything good, or when you feel that no one should trouble themselves over you, what would be the natural reaction? Depression sufferers tend to shut themselves off to avoid causing trouble, or to avoid having to deal with emotional roller coasters, or simply because they’re tired. But this is a self fulfilling prophecy – the more we feel we don’t deserve good relationships, the more we shut ourselves off, and the more lonely we feel. But depression is by nature a lonely illness, and so by withdrawing, the situation can get worse. We feel we don’t deserve the support, but we crave that support to at least know that we are still valued by someone.

How to help in this case? Simply drop notes of care. Invite the sufferer along, but don’t guilt them into joining you. Let them know you care. Little gifts. Make sure you don’t cross over into pressuring them though, as this can lead to even more guilt or too much energy expenditure that could make things not as good as before.

Assistance

The final paradox has to do with helping someone who’s having depression. Depression sufferers generally feel that they are beyond help. Or that they’re not worth helping. Or pride can be an issue – I used to be able to help myself, and I don’t need your help to get better!

But yet in the dark stretches of depression, we know that we are helpless, and that we need to be aided along in our recovery. How then, can you help? Be there. Listen to us, first, before you seek to help. Offer concrete help in areas that you know are needed, financially or otherwise. And don’t be offended if the person is angry. Instead, take the chance to tell them that you want to hear them out. That you care, no matter how much the sufferer thinks they’re not worth your time. Show that they are worth your time and love. It draws us out of the darkness into the light, even if we’re kicking and screaming about it!

Understanding the paradoxes

Understanding these paradoxes don’t necessarily solve the problems involved. But by understanding them, you may be able to see better why a depression sufferer struggles to make sense of the world, starting with him or herself. You will also be able to see why advice, unsolicited, doesn’t help a sufferer. In effect, these paradoxes rule sufferers, and anything that causes the paradoxes to kick in even more, hinders rather than helps.

If you are a sufferer, understand these paradoxes, and see them for the half-truths they all inherently carry. This will help you to separate reality from the feelings that the paradoxes bring about, and will aid you to struggle through these dark times.

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