Doubts about Recovery - Can it Last?

Patient Expert

I've been thinking about a question that Donna asked in a comment on this post about recovery.

"Can "I am recovered" include the feeling that the old mental problems are just waiting for me around the corner?   How do you abandon that feeling -- what do you tell yourself in order to stop it?"

This is just one comment by Donna, who writes so insightfully and powerfully about her own experience. (Here's her most recent post, another must-read.)

The question she posed last month is a tough one, and it goes right to the heart of what I've gone through in preventing a relapse.

There will always be ups and downs in anyone's ability to manage symptoms. I think of this as breaking old habits. You can't drop them immediately because you're so used to thinking and feeling in terms of depression. But in recovery you're learning to stay alert and act as quickly as you can to replace an old habit with a new way of behaving.

Simply reacting, and quickly, when a feeling of doubt arises, is essential for me. Being active - doing something - is one of the opposites of depression. Each time I act to help myself deal with depressed thinking and worries, I'm strengthening my skills of recovery.

I'm reminding myself that I don't have to sit still and let my mind slowly drift toward hopelessness or a sense of inevitability about the return of depression. I have new skills and need to get busy using them.

One of those skills is interrupting thoughts and experiences that can lead me in the wrong direction. It's especially important to catch the little things. For example, if I start imagining that depression is waiting for me around the corner, I remind myself that depression is not a person, not even a monster.

It doesn't lurk, wait, hide, create clever and insidious traps for me, pounce on, overwhelm, strangle, choke, smother or drown me. Nor is it a mountain, cloud, swamp, bottomless pit, dark hole, black dog, fog, storm, body of water or even a shapeless ghostly mass that will cover and weigh me down into paralysis.

Catching myself in small things like that strengthens the habit of thinking in a way that's more open to reality, rather than one still lost in fear of slipping backward.

I also keep reminding myself that these moments can happen anytime - and, in fact, I experience many each day. That's no reason to start judging or evaluating how well I'm doing at feeling good. That's another trap, thinking - "Oh, I'm not doing this right, I guess I've messed up yet again," etc, etc.

It took a long time to get to the point where I could regularly catch myself in this way. That's because I used to have a more passive idea about recovery. I thought it meant that I'd stop feeling so low and lethargic, that I'd get my energy back. Makes sense, right? But there was a problem.

Most depressive episodes do end eventually - all by themselves. So - at least for a person like me who goes through up and down cycles - I often had that experience of regaining the feeling that I was back and could do things again after a long deadness. The problem was that I hadn't learned any skills to help end the episode. Since feeling good was a sort of gift, I was convinced it would be taken away again - and it was. Depression always returned.

That's the familiar problem of living out your own expectations. Imagining and believing that I would remain a passenger on this roller-coaster, going around and around the same self-contained route, helped maintain the cycle.

With years of that kind of expectation behind me, my number one reminder has become: Don't wait for anything. Never be passive, never assume the worst is inevitable or that recovery depends completely on the latest medication or anything else that is done to you. I can't expect to change course if I'm always the passenger. I have to be the driver.

I recently found an article called How Recovery Happens that takes you inside the mind and feelings of someone grappling with this problem of preventing a recurrence. It's well worth quoting:

[People in recovery] describe a moment of choice an opportunity to choose a new way to respond. They describe a brief, unfamiliar mind-space in which they see a glimpse of themselves from a new perspective, not reacting in familiar ways to external and internal stimuli. The moment they describe is the moment immediately preceding a trigger or symptom. In that moment, there is a split second when they can either surrender to the symptom, reacting in habitual ways, or they can choose a new path leading to further recovery.

[One of the authors of the article described her own experience:]

There have been times when I haven't been able to stay in that moment and have found myself so overwhelmed by a symptom that I didn't have any choice but to surrender to it. When I have been able to stay in that moment, I've been able to choose other options that have helped me grow and learn new ways of moving ahead". There is something seductive about symptoms they are familiar ground, they give definition to who we are and what we're experiencing, and they usually cause others to either excuse us, or try to help us. So when we don't surrender to them, we're on new ground unfamiliar, undefined, and while it feels unreal, in fact, it is what's really real. With it comes a feeling of being free from the mind-prisons that previously limited our ability to respond in new ways and recover.

I know those moments well. They are at the heart of the process of recovery, not just an abstract description of methods. The fact that I come out on the helpful side of many of those each day has given me confidence that I have really gotten somewhere after all the therapies and medications over many years.

Constant attention is part of it. Learning awareness and mindfulness is a means strengthens the ability to stay alert throughout the day.

The writer points to another problem, though, and that's the strange comfort of the old ways of depression. After all, for many years I didn't have to be so alert. All my questions about what to do and feel were taken care of. Sure the answers were always the same - no point in trying, you can't do it anyway, just sink into hopeless inactivity, etc. But at least I knew what that was like and didn't have to take a chance on something new.

There's a risk in recovery, and it can be hard to take that risk. Only with new skills was I able to gain enough confidence to stop the old pattern and do things differently.

After a long time learning about all this, something finally clicked - and I can't explain it. I started to think differently about myself. The belief changed. Now it's like this: I'm a whole person who feels down from time to time, but that's part of living. I had depression. I don't have it anymore, and I don't think of myself as inevitably depressed. It's the adage - I'm more than depression. It doesn't define me.