When you’re depressed, there are many things going on. I know…that’s an understatement, but bear with me. People who are depressed show many symptoms in common, among them a depressed or sad mood that lasts for a prolonged period of time, lack of energy, difficulty concentrating, changes in appetite or sleep patterns, and a whole host of other little things that make it really tough to get out of bed in the morning, much less function well during the day.

Our brains are affected, our social interactions are affected, and our ability to sometimes even recognize depression is affected. I remember reading a passage once in a book written by a teenage girl, that depression was a monster creeping up on you. First, you have a bad day – but everybody has a bad day once in a while, right? Well…ok, you have some more bad days, but again that happens to a lot of people – you’re basically ok. Then, there are more and more bad days, but it’s easy to push those away, because everybody DOES have bad times, right? Then…you realize that you’re having bad days most of the time, and that you don’t remember your good days. That’s when you realize that you may be clinically depressed. The illustration that went along with the description showed a girl trying to walk away from a monster that was chained to her leg, a lot like a ball and chain. That’s what chronic depression feels like – you may get a little further away from the chained beast, but it’s always there, and you never know when it’s going to catch up to you. Honestly…chronic depression stinks, and that’s putting it mildly. (And if anyone knows the name of the book or the author of this analogy – let me know. I’d love to credit her AND get the book.)

Luckily, we have medications that help – but that’s not what this post is about. In my opinion, one of the msot insidious symptoms of depression is the sense of paralysis that accompanies it. This sense of paralysis goes beyond the negative and depressed thinking like, “This is never going to end, and nothing will ever change.” It goes beyond feeling unmotivated or unhappy. This type of paralysis is affected by all these things – and made worse by them – but is more a sense of not being able to have any effect whatsoever to even deal with these symptoms. It’s the sense that not only will things not change, but there’s not a damn thing you can do about it, because you don’t know how, aren’t able to muster up the energy to move, or are afraid that anything you do will backfire or end up not working. When I talk about emotional paralysis, I mean paralysis. It feels like you are stuck in your thinking and your doing.

Ok, now that I’ve got everyone feeling lousy…(hopefully not) What do you do? Well, first – if this has gone on for a while, please see your doctor. Medications help, they are not addictive, and you won’t get “high” on them – Clinical depression is as much biological and medical as it is psychological, and medications help with the biological aspect. Second, if you can – see a good therapist. (I know, I know…I’m biased and I say it all the time) A good therapist can help you be aware of your thought patterns and the things you do – and help you and support you as you climb out of the hole. Third – please know, you CAN climb out of the hole – it really is possible. Which brings me to my point – what can YOU do when you’re dealing with this?

First of all – realize what’s going on. I know I sound like a broken record, but being aware is huge. You can’t work on a problem you don’t see. If you wonder about experiencing this…ask yourself what it’s going to hurt to try to feel better? It’s a low risk pain for a potentially huge gain. So..work on awareness. You can do this by keeping track of your symptoms. The DBT diary card has one side devoted to mood tracking (see DBT Self-Help for a great example and printable version of the diary card: http://www.dbtselfhelp.com/html/diary_card_1.html ) On the diary card, you track the intensity of things such how suicidal you felt/feel, how much of an urge to self-harm you felt, how intense your feelings of shame, fear, anger, and sadness were. Honestly, it’s a rigorous system that requires a high level of self-honesty. You can also make your own mood charts – and add “Paralysis” as one of the categories – the point is, you want to make yourself aware of how often and how intensely you feel this.

The ironic thing is that by doing this, you are already counteracting the sense of paralysis. As I wrote in another post – one of the major things you can do to cope is move (http://theothersideofthecouch.wordpress.com/2009/05/19/coping-with-tough-times-part-1-move/ ). It sounds simple, it sounds silly – and it works. Anything you do that doesn’t hurt you or someone else will start to counteract the sense of paralysis.

The thing is, I know when you’re stuck in this that even the idea of moving is exhausting. In DBT, we talk about something called dialectics (and please note, for the record that this is NOT the same as “dianetics” – not even close). A “dialectic” exists when you have two situations that seem to be opposites yet are both true. The dialectic here is that you’re exhausted by even thinking of moving, yet by even thinking about it, you ARE moving. I know…it’s a microstep – but it IS a step. Once you realize this (awareness, remember?) it’s easier to move a little more.

Mindfulness also helps – don’t get stuck in “emotional mind” or let yourself be numbed into only “logic mind” – find your “wise mind,” balance and let yourself see things as they really are. When you’re stuck in emotional paralysis, your “emotional mind” has hijacked the process and taken over. (Review the “Mindfulness Skills” if that helps: http://theothersideofthecouch.wordpress.com/2009/05/24/coping-with-tough-times-3-dbt-skills-pt-1/ ) Also, use the skills in the Emotion Regulation and Distress Tolerance sections – they really do help.

So, you’re exhausted, numb, feeling hopeless and helpless…work with me here and try a little experiment. It’s going to sound silly…but get up, walk to the kitchen or drinking fountain and get a drink of water. Seriously – do it. I’ll wait…….

………..

………..Ok, you’re back. How did that feel, just to do that? Nothing hard, probably something you’d need to do eventually anyway, right? Here’s the thing – you MOVED. Now, I’m not going to claim that moving is going to erase all your worries, bring out the sun tomorrow, and make everything better. It will help YOU, though.

Ok – move. Check. What else? Well…when you’re dealing with emotional paralysis, another thing that’s likely to be there is fear. Fear of screwing up, fear of failing, fear of looking like or being a fool, fear of succeeding sometimes…sometimes it’s just a nameless dark blob of fear that engulfs you. Fear is a powerful emotion. Counteracting fear takes a lot of hard work. I’m going to show you what a geek I was in high school – anyone ever read “Dune” by Frank Herbert? It’s a classic in science fiction. Anyway, there is a passage where the main character is being tested with the threat of death if he does not endure excruciating pain (a metaphor for dealing with depression if I ever heard one). While he is being tested, he mentally recites something his mother taught him – the Litany Against Fear:

I must not fear.
Fear is the mind-killer.
Fear is the little-death that brings total obliteration.
I will face my fear.
I will permit it to pass over me and through me.
And when it has gone past I will turn the inner eye to see its path.
Where the fear has gone there will be nothing.
Only I will remain.

Fear is an emotion, like any other. It evolved as a way of protecting us and warning us of danger, and is one of our most intense and primitive emotions. There are many situations in which fear is appropriate, but I’ve found that in cases of depression, many times the fear (or the intensity of the fear) is overwhelming and harmful. I don’t know if any of you remember the analogy of emotions being like a wave – but it works for fear too. As the litany says, it will pass over and through you and you will remain. Counteracting the fear you feel in emotional paralysis requires not only this awareness, but the willingness and mindfulness to let it pass.  Fear is easy to hang on to – our “what ifs” are paralysing sometimes. AND, we can choose to let go, and let it wash over us. Visualing this helps, and so does doing something opposite to what the fear is telling us.

In behavioral psychology, one way we treat phobias (severe, specific fears) is by gradually exposing someone to the thing they’re afraid of. (It’s not as harsh as it sounds – really!) We do this in baby steps, until the person is able to deal with and even approach the thing they feared. Emotionally, we need to do the same thing. If you’re afraid of failing…do something along the path on which you’re afraid of failing. Here’s an example from my life – my fear is that I’m going to be a failure as a psychologist (I can’t afford the expenses of getting set up, I’m not going to get the hours for licensure, etc.) Honestly, it paralyzes me sometimes.  My “homework” was to contact one person about possibly being willing to supervise me. Long-story short, she wrote back, we met and she’s willing. It’s a step on the path. I’m still afraid – but am willing to take another step. The thing here is, set yourself up with something where you have a pretty good to really good chance of succeeding. If I chose to start by going to the bank and asking for a $10,000 loan to start a business (with no plan or setup in place), I wouldn’t stand much of a chance of succeeding. Pick something you can do – and will likely succeed at. Doing something will help, but succeeding will help more. My next step is researching insurance companies to see what they charge – no risk in checking it out, right? Again – baby steps and something that will help.

The last thing I want to mention is this (and these ideas are certainly NOT the only things you can do to counteract emotional paralysis): cope. Do everything and anything you can (that doesn’t harm you or someone else) to hang on, even if for just another minute. The minute will pass. The emotion will pass eventually, too- the wave will wash over you and you will still be there. The problems may not have gone away, and you may have to do this many times and in many ways but you will be on the path to being able to get to where you want to be. Coping – all those things I’ve talked about before with DBT skills, coping techniques, moving – helps you. Coping can also be taking care of yourself – seeing your doctor, seeing a therapist, getting exercise and eating well, doing the best you can to rest well and sleep well (not too much or too little). Coping – bottom line – is doing what it takes to keep you here. Working on wellness is another step down the road, and we’ll address that soon.

For right now, in this moment, in this place – right where you are, be aware and mindful of what you’re feeling, move (even if it’s a microstep), let the wave of emotion pass over and through you, and cope in the best way that you can without hurting yourself or others. As you work this process, you’re likely to feel less paralyzed, and hopefully a little better.

Please Note: The content on  this blog is intended for informational purposes only. This is not therapy, and if you wish to work in therapy, please contact your local mental health agency or your physician for a referral.

If you are in crisis or danger, please call 911 for immediate help. Please, again, realize that seeking out help really IS a sign of strength and not a sign of weakness. You don’t have to be alone in facing these things – there are people who care and who will help. Email me at: theothersideofthecouch@live.com

P.S. – If you haven’t noticed, I deal with my sense of emotional paralysis by writing! ;p Hang in there, take care of yourself, and I’ll see you next time on The Other Side of the Couch.