On a sad and foolish day in mid-May during which I got emotionally needy and expressed myself histrionically to a sometime-reader of this blog, he accused me of being unwilling to “take a single step” to help myself with my depression and social isolation. This criticism infuriated me not least because it was grossly untrue.
Nonetheless, his assertion got me to thinking about the whole question of self-help, and I found myself still thinking about it several weeks later. I realized I was beginning to forget some of the things I’ve done in the past eight years, since I left my husband and found my own life spiraling out of control after he died. As a way to preserve this piece of my self-history for myself and for any future counselors I have—and, I hope, to help others—I decided to list and discuss the things I’ve tried to reduce my guilt and grief over my ex-husband’s death and to alleviate the severe depression and social isolation that resulted. What helped? What didn’t? What did I not try, and why didn’t I try those things? Why did I abandon some of the things I tried?
This is an extremely long post, something of a primer on depression, isolation, and loneliness, and it’s not intended for casual readers. Rather, it’s meant in part to give some perspective and advice to fellow sufferers and those who love them. Therefore it comes with the standard disclaimers: I’m not a doctor or therapist; these are strictly my own impressions based on my own experiences; consult a professional if you suffer from depression; get help if you’re feeling suicidal. Okay? Please act in your own best interest. Variability also comes into play. Tolstoy wrote “[E]very unhappy family is unhappy in its own way.” Every depressed person, I think, is depressed in her own way. The fact that my depression has been inextricably bound up with guilt, grief, and loneliness does not mean that your depression is as well. Consequently, what this post has to say will not be of use to everyone (and maybe to no one).
I’m not taking into account here the year and a half I hung onto my job after my ex-husband’s death, or the many ways I tried to help him before he died. I’ve written about that elsewhere in this blog (“Into the Confessional“). Nor am I taking into account the endless repairs I had to coordinate for the house I bought for myself and my disabled sister, or the many ways I’ve helped her, or the work involved in selling that house after she bought her own, or my own house search and second move, or the fact that I supported an on-again/off-again boyfriend in 2014, the fourth and final year of a turbulent relationship. All those things fall under the headings of work and trauma. What I want to do here is recall the things I did to try to keep my head above water. Although most of them didn’t help me, I believe each of them could be valuable for others.
That leads me to another caveat: My depression was severe enough to keep me mostly in bed for several years, which means I have little stamina or strength. That in turn made it harder for me to help myself. This probably is not a typical situation for most people. In addition, I found out about a year ago that I have severe anemia, which is contributing to my exhaustion. It’s possible I’ve been anemic for years; there’s no way of knowing. For two or three years before I left my husband—we’re talking at least 10 years ago now—I experienced increasing trouble getting going in the morning. I’d also begun having occasional days—most often Saturdays, at the end of the work week—when I was so tired I stayed in bed all day. I attributed this development to overexercise and the (very slow) approach of menopause. It may in fact have been due to iron deficiency. My fatigue was exacerbated by depression. Without the disabling fatigue, I might have been able to keep my job, or to find fulfilling volunteer work, or to more easily take steps to counter the deconditioning I experienced from being in bed.
Anyway, let’s start with the standard therapeutic stuff.
- I attended Al-Anon meetings before my ex-husband’s death. This lasted two or three months, until I could see that Al-Anon’s philosophy had nothing to offer me. As part of this effort, I also called people from Al-Anon who volunteered conversation and advice. I should note that Al-Anon has helped many people; I just happened not to be one of them.
- Because my husband had attempted suicide and because I myself felt suicidal, I tried a suicide support group. Again, for various reasons this wasn’t a helpful group for me.
- I also tried a grief support group at my town’s Center for Independent Living. I gave up on this very quickly, because the participants spent most of the sessions talking about their efforts to gain financial stability. This was extremely important for them, so I’m not denigrating it, but it wasn’t my issue or the purpose of the group. If another grief support group had been available, it would have been a better bet.
- I tried new medications. Eventually my psychiatrist put me on a second antidepressant. I also tried an adjunct therapy, Abilify, which substantially relieved my depression…for about six weeks. Although it made me feel spacey, it worked beautifully during that short period of time. Unfortunately, it coincided with:
- My participation in what’s called an outpatient partial-hospitalization program. This particular program involved three full mornings of group therapy per week for four weeks. Thanks to the Abilify, I was temporarily (and deceptively) doing very well. The program itself, however, was unimpressive; I thought it was much too superficial to help someone with severe depression or suicidal thoughts. Similar programs offered in different parts of the country might be much more effective.
- I underwent a voluntary two-week hospitalization in November 2009 for six sessions of electroconvulsive therapy. The idea of ECT terrified me, and it took two years of desperation for me to work up enough courage to try it. I re-entered the psychiatric ward—again, voluntarily—the following month for three more treatments. ECT seemed to help a little, but not dramatically, and the effects quickly wore off. (NOTE: It remains the case that ECT is the most effective treatment for depression; it helps about 70 percent of people.) In July 2014 I checked myself into a psychiatric hospital in St. Louis, ready to do another round of ECT, but for reasons I won’t get into, I immediately negotiated an early release predicated on my agreement to undergo at least one ECT treatment. Unlike my previous treatments, this one had bothersome side effects. More worrisome to me was that it was not conducted by the psychiatrist I initially spoke to, and was not done according to the protocol we agreed upon. Given that troubling circumstance, I insisted on the early release. My sister later was in this hospital for almost a month; ECT helped her, but the shortcomings of the hospital countered her improvement.
- These stays, incidentally, opened my eyes about psychiatric wards. Much of what I assumed went on in such places does not in fact go on. For example, I assumed I’d be meeting with a therapist or psychiatrist daily. Not so; I met with one, once. I assumed that group therapy would take up much of the day and would be extremely intensive. Not so; there was a singularly nonintensive session each morning. There were no facilities for exercise, which is something proven to help many people with depression (not me, unfortunately, but many). I never imagined that time on the ward would be spent instead in kindergarten-level crafts sessions. I’ve spoken to various doctors about my experience, and I’ve observed my sister’s experience on two psychiatric wards. Unless you’re unfortunate enough to be committed to a state institution, or fortunate enough to be able to afford a long-term stay in a private hospital, the goal of hospitalization is to stabilize you and get you out of there. (Those last few words are quoted verbatim from a psychiatrist.) It’s unusual for most places to keep you more than two weeks, which simply is not long enough to assess the effects of various medications on your depression. If you’re psychotic or suicidal, hospitalization certainly has a place, and it also has a place if you can’t get ECT as an outpatient.
- I did quite a bit of online research on other treatments for depression, but these were still pretty experimental, expensive, and not covered by insurance. One of them, transcranial magnetic stimulation, does basically what ECT does (disrupts certain neuronal pathways), but less effectively. My research accords with what my psychiatrist asserts: TMS hasn’t lived up to its early billing. The other treatment, vagus nerve stimulation, involves surgery and still doesn’t have a long or especially notable track record.
- For a year and a half, I saw a grief counselor, a former faculty member who specialized in death education, among other things. Once a week after work I went to her house and talked with her for one to two hours. She did this for free, an amazingly generous effort. Although the work we did and the exercises she suggested didn’t help me, she is now one of my best friends—and as a friend she has helped me considerably. Friends help. Let me qualify that: Friends with some understanding of what you’re going through help.
- I also was seeing a conventional therapist during most of the years since my ex-husband’s death. When the first one hadn’t helped after a year or so, I switched to another one for several months. I later switched back to the first one. Perhaps I should note that in my adult life I’ve seen 14 or 15 therapists—men and women, young and old, with differing qualifications and differing approaches. Some of them I saw only two or three times. Some of them I saw for years. None of them helped me resolve any of my problems. YMMV. There was a key benefit, though: the ability to blow off steam and to direct toward the therapists some of the despair with which I would otherwise have burdened my friends.
- Did I mention that I called friends? During the worst of the depression I would be seized every afternoon or evening with an absolutely panicky need to call somebody. I tried to cycle these calls among my friends so that no one person would be overburdened, especially since much of my talking was mixed with crying and I was hard to understand. Inevitably I lost friends, though, and it’s hard to replace friends when you’re not working.
These therapy-based efforts didn’t pay off for me, but they can help others and they’re all worth considering. What helped me more were other things I tried.
- I took singing lessons for three years. There were days that I was too fatigued or depressed to get out of bed, but I hung in there. The singing lessons were good for me because I enjoyed them and they involved personal interaction.
- I volunteered for one semester at WSIU’s Reading for the Blind program (SIRIS), until it became clear that my voice couldn’t handle both this and the singing lessons. I chose to give up SIRIS because they had plenty of volunteers (there was actually a waiting list) and because it was a totally isolated activity (you’re in a room by yourself, reading into a microphone). I would like to do more volunteer work, but I haven’t yet. Why not? Without the structure of a job, my sleep schedule has turned nearly upside-down. In addition, my depression and my debilitation combine to make me an unreliable volunteer who must rule out many activities because of physical limitations. For the same reason I haven’t sought out a part-time job.
- I did, however, jury into the Visual Artists Cooperative in Cape Girardeau (I do fine-art photography), where I was a member for about two years. This involved displaying a new piece every month and participating in exhibit change-out days. When I became too debilitated to drive round-trip to Cape and also pull my weight on the change-out days, I felt I should resign, so I did.
- I set up, but never publicized, a freelance copyediting business. Why did I not go through with it? Just after I’d finished the website, but before I’d done flyers or ads or business cards, a faculty acquaintance asked me to edit some things for him. I did a job application letter for him, then his CV, then his website. Working was good for me, but at each juncture I found that I simply couldn’t charge him any money. I set aside the idea for the time being, although I may return to it.
- I took my on-again/off-again boyfriend on a trip to the Rocky Mountains, which he had never seen. It was great to travel. The flip side was that it was also demoralizing to see how much trouble I had walking, when the altitude had never bothered me before. I knew I needed to get back into shape. So:
- I met three times with a personal trainer, until it became clear that he was not equipped to help someone as debilitated as I already was. Next:
- I tried physical therapy three times a week in 2013. These sessions exhausted me, sometimes putting me in bed for days. After about three months I had to quit. However:
- I tried again for several months in 2014, this time doing two sessions a week. They still exhausted me. In retrospect I realize that I was severely anemic during both PT attempts, which undercut my efforts.
- I took a silversmithing class at the local community college. I made it through about two-thirds of the class; unfortunately, the work flared up my longstanding tendinitis, so I had to give it up. I do, however, now have a much greater appreciation of the work done by jewelry makers and the costs of their materials. It was fun while it lasted, even though I accidentally set my towel on fire once. I’d already taken most of the other community college courses that interested me, although I check the listings each semester. If I can regain stamina, I plan to apply for a community listener’s permit so that I can sit in on some courses at the local university. Right now I’m too debilitated to walk very far from the parking lots to the buildings. That sounds pathetic, but it is what it is.
- I took two solo road trips: one to Memphis and New Orleans, and one to Clarksdale, MS. These confirmed my ability to travel alone without any qualms, and I enjoyed what I did. However, I severely overextended myself in Memphis and arrived in New Orleans so fatigued that I could barely drag myself around the aquarium and to Café du Monde. Clarksdale was a more manageable trip. My fatigue level is now too high to make a trip of five or six hours comfortable; I could no longer drive from Memphis to New Orleans in one day. But if you’re physically able, I highly recommend solo road trips for reaffirming self-confidence. If you’re single and lonely, they can make you more acutely aware of your loneliness. But they’re worth it. Traveling with a companion also is a good idea. You need a change of scene.
- Depression tends to be socially isolating even for people with extended family or strong friendship networks. It can be much worse for single people, childless people, and retired people whose friends are busy with work and family. If you’re forced as I was to retire quite young because of depression, you quickly find that work constituted much of your identity and provided much of your social interaction. I use Facebook to keep in touch with friends and acquaintances. A few months ago I made a special post there explaining that I was looking for activity companions; this yielded very little. I’ve also reached out privately to a few acquaintances, both men and women, to see if they had time to do things together, but that also yielded very little. That brings us to online dating sites. When I felt ready—though I probably was not ready—I signed up for OkCupid. I’ve also subscribed to eHarmony twice; Match.com three times; OurTime once. I have met guys on these sites whom I’ve dated or just been friends with. This is a double-edged sword: Dating decreased social isolation but increased heartache. Rejection on these sites can eat at your self-esteem (which is already low if you’re depressed) and can make you feel even more lonely. Rejection is the rule for me now that I’ve gained weight, but dating sites are still the most viable place for me to meet potential partners. For people who have extended family or lots of friends where they live, or who are churchgoers, perhaps, this may not be true.
- Finally, when I’ve been able, I’ve gone by myself to movies, plays, and lectures. That too is a double-edged sword for single people: You have the activity to enjoy, but it can be depressing to see almost everyone paired up. Go anyway if you can.
- Oh, and I started this blog. It’s been intermittent, but I write when I have something to say, and I try to get out when I can to take photographs.
One of the reasons severe depression is so pernicious is that it renders a person so helpless. It’s tremendously hard even to get out of bed. Simply taking a shower can be a major achievement. Getting your groceries and pushing through the aisles of a Wal-Mart Supercenter are arduous exercises. If you live alone, you must be your own caregiver. People who haven’t experienced severe depression will be impatient with you and may, despite their good intentions, say hurtful things. You will probably lose friends; most people with severe depression do.
Given these realities, I feel pretty good about the number of things I tried, even though my results were lousy and I think I should have done better. But readers may find that things which didn’t work for me will work for them. So much depends on circumstances. For example, I suspect there’s a great variation in the effectiveness of grief support groups. For what it’s worth, I believe the best things are getting out of the house whenever you can make yourself do it, getting back to nature (I took frequent drives to a nearby wildlife refuge, and still do), engaging in creative activities, working part-time or volunteering if you’re able, and getting the hell out of town whenever you can—with a companion, if you can.
As for me, right now I’m undergoing iron infusions that I hope will give me enough energy to start an exercise program. If I can regain some stamina, more opportunities will open up for me to take some of my own advice.