The Only Way Forward is to Go Back

So much of Springtime is about looking and moving forward. The very earth itself seems bursting with anticipation, and in fact a few green shoots that couldn't wait for proper warm weather have already sprung out and now stand trembling and shivering in the chilly wind in our yard.  It is a time for growth, and change.

For me that change, and Spring itself, is psychologically punctuated by important anniversaries. In March, I celebrated the four year anniversary of my discharge from inpatient hospitalization and physical therapy. It wasn't the victorious homecoming I had envisioned, since I still couldn't walk, was still using a catheter and diapers, and required more care and assistance than I'd ever imagined needing prior to being, oh, say, about 100 years old.  But it was a glorious homecoming all the same, because it marked the end of almost six months of emotionally devastating separation from my family, lack of privacy, dearth of dietary choices, and all the other trials of lengthy hospital stays.

March also brought the anniversary of my friendship with a dear, funny man who died much too soon of a disease that made us share many disability tribulations and humorous fiascos. Of the many legacies he left behind - like friends who only know each other because of him, precious memories, ongoing joke memes - the one I try hardest to honor is to find humor in things, to let myself laugh (especially at myself) and try to get others to join me, and to give myself permission to rage against the horror and frustration of all of this sometimes; to feel ALL the things that having cancer and disabilities makes me feel and really acknowledge them without shame the way my friend used to do, the way he taught me.  Anger is okay. Joy is okay. Gratitude is okay. Outrage is okay. Depression is okay. Anxiety is okay.  Crying is okay. Laughter is okay.

Ever since I started going to counseling sessions with my onco-psychologist, I've resumed my old habit of journaling. Writing was a major factor in my first recovery from depression, almost twenty years ago, so I feel a lot of deja vu now when I sit in some public or private space and scribble in my little journal, simultaneously immersed in and separated from the scene surrounding me. Now, as then, the notes help me remember the moments that define each day, good or bad, that depression chemicals would try to erase from my mind shortly after they happen.  When you have a great moment, depression makes you forget about it, makes it short-lived. When you have a terrible moment but you survive it and carry on with your day, depression makes you forget that you were strong and that you coped.  But a journal remembers, so you can congratulate yourself later for those little victories, or allow yourself to acknowledge that something difficult was going on, that you felt pain or sadness or panic and that it was real and valid.

So even though it's Springtime and like everything else I want to move forward, it seems like the best way to do that is to go back, to the tools and the habits that worked before, like counseling and writing and sharing with others. To remember that I've beaten depression once, that anxiety is manageable, that my support network is strong and constantly present, and that I will see the other side of all of this eventually.

Impossible

At the new year's beginning is a natural time to do a little goal-setting in our lives. But even if it weren't January, I would still have been thinking about goals lately because my psychologist asked me to try to develop several concrete, specific goals for our therapy sessions. It was a daunting task, though it sounds simple at first, because with depression it is often much easier to define and measure what is NOT happening than what actually is. Many patients will describe their symptoms in these negatives: 

• I'm not as interested in what is happening around me.
• I'm not as good at rolling with the punches or adapting to situations as I feel I should be.
• I don't feel cheerful as often or have my usual energy levels.
• I can't recover my good mood quickly or easily after experiencing something sad or upsetting.

We describe depression as a sort of vague absence: of happiness, of cheer; an emptiness where enjoyment of life should be.  With evaluative tools like those, how do we measure progress towards mental health? I considered this a great deal over the holidays. How could I set goals for getting better?  What do I think being less depressed would look like?  So initially my goals were sort of weak and searching for direction. I would like to cry less often. I want to have fewer days where I'm overwhelmed, by sadness or anxiety or both. I want to dwell on cancer less, give less of my time to that disease in the form of worry and fear for those I care about.  It's not that I want to stop caring for the fates of others, far from it, I just need to be careful not to dwell on those worries and cares too much.

But I had a feeling I didn't quite get it yet, that I had not grasped what my therapist was trying to teach me. So I kept mulling it over. I started to think about when I had been recovering from depression in the past, and how sometimes to feel better, one had to do the things one used to do while well, even if one didn't feel like doing them, and the act of going through the motions brought about change in the brain. The chemicals would flow even if your heart wasn't totally in it. And little by little you could start to change your brain chemistry by acting out the life of a healthy you. I thought about the things I would be doing if I wasn't letting depression demotivate me, and I thought about how successful I usually am at setting physical goals.

So as my next therapy appointment approached I started thinking of other goals, things that I could sit back and look at and say, "Hey, if I accomplished that, then I must be feeling more motivated lately, I must be starting to get better." I set a goal related to walking distance, and a goal for getting my family outside and more active. I set a goal to spend more time with my face-to-face and online friends, replacing some of the time I spend feeling alone or isolated. As an introvert I highly value alone time, but there can definitely be too much of a good thing, especially when you're struggling with depression. 

When I met with my therapist he was pleased with the level of thought and care I had taken to evaluate his request, and in some respects that was the whole point: to invest energy in discovering what I define as a healthier, recovering self, and find ways that we could measure progress towards that state. So many people struggle to realize that anything is being accomplished by their depression treatment methods because they haven't yet defined what success will look like, and are easily discouraged when it feels like nothing is changing. Now we have eliminated that hurdle, and I felt really positive about the direction this therapy is going.

During this introspective period, I had occasion to think about impossibility a few times. It's very easy to negative self-talk yourself into thinking that something is impossible. Certainly this challenge of coming up with measurable goals for mental health seemed almost impossible at first, and I also recall my kids complaining that this or that task was impossible recently, too. There is a quote by Lewis Carroll about impossible things: 

Alice laughed. 'There's no use trying,' she said. 'One can't believe impossible things.'
'I daresay you haven't had much practice,' said the Queen. 'When I was your age, I always did it for half-an-hour a day. Why, sometimes I've believed as many as six impossible things before breakfast.'

When I was talking to my children about it I twisted the quote a bit to fit the situation. "Impossible is all in your head, it's a matter of perspective. I do three impossible things everyday before breakfast!" Of course they were confused and thought I was tricking them, until I explained that at one time, it was the professional, medical opinion that I would never stand or walk again. It was impossible. Yet every morning I stand up, use a regular toilet without help, and walk across the house to get breakfast. 

As much as it was a good lesson for the kids, it was also a good reminder for me. Depression makes you feel overwhelmed, despondent, fatigued, and sometimes anxious, and facing all of that you can start to think that recovery is impossible, that healthiness and happiness are impossible. Take a moment to remember the last impossible thing YOU did, and maybe you'll recapture some of your own fire, your motivation to keep fighting. Then sit down and figure out what your life as a recovered patient will look like, (be specific!) and use that to set goals you can actually measure your progress by. Planning what the changed you will be doing and feeling is a huge part of accomplishing the change.