If you have a mood disorder, by definition you have trouble with self-destructive behavior. It’s usually a passive form of self-destruction—staying home isolated, giving up hope, expecting the worst—though there are angry depressed people who get into fights and emotionally abuse others. You may turn to alcohol or drugs to help comfort you. Depression is usually accompanied by suicidal thoughts and impulses, and suicide is often a real risk. Impulses like driving into a bridge abutment or stepping off a high place can come out of nowhere and convince you that you are going crazy, though they’re very common with depression.
Your assumptive world changes drastically with depression, and the depressed assumptions turn into self-fulfilling prophecies that just make you feel worse. Depressed people tend to take too much responsibility for the bad things that happen in life, but feel that the good things are just accidents that they had nothing to do with and are unlikely to happen again. If you’re depressed, you are probably quite pessimistic in your thinking, assuming that everything is getting worse all the time, and there’s nothing you can do about it. You feel that you have to be in control every moment, and if you relax, things will fall apart; at the same time you don’t really believe that your efforts to control will really do any good. The glass is always half empty, good things are temporary and unreliable, bad things are permanent and pervasive, other people are always better, more attractive, more successful than you. When you know what you ought to do to feel better, but are too depressed to do it, you blame yourself for lacking will power, as if it’s a character trait that you either have or don’t have, and that adds to your low self-esteem.
Here are some of the self-destructive behaviors most commonly associated with depression:
- Overeating to comfort yourself, a consolation prize
- Social isolation because you don’t feel worthy of attention
- Substance abuse
- Procrastination—for all kinds of reasons
- A cycle of overwork and collapse
- Staying in destructive situations—letting your partner, boss, or coworkers take advantage of you
- Neglecting your health because you don’t feel you’re worth the effort
- Poor sleep—insomnia or waking at 4 AM and obsessively ruminating is a classic sign of depression
- Not exercising—you don’t have the energy and you don’t think it’ll do any good
- Won’t ask for help because you’re ashamed and guilty
- Suffering in silence—not expressing your feelings is both a cause and symptom of depression
- Depressed shopping, spending money you don’t have to buy things you hope will make you feel better
- Parasuicide—nonfatal suicide attempts, suicidal gestures
- Self mutilation
- “Wearing the victim sign”—unconsciously communicating that you can be taken advantage of
- And many more
All these things obviously interfere with recovery, but they also make your mood problems worse. Every time you try to get control over these patterns and fail, you have another experience that confirms your own shame about your illness. You blame yourself, and you become more hopeless.
If you ask depressed people to spend ten minutes thinking about their problems, they become more depressed (because of all their negative thinking patterns). If you give them another subject to spend ten minutes thinking about, they become less depressed. Pay attention to this, because it’s counterintuitive; it’s important to our worldview to believe that if we just apply mental power to our problems, we’ll find a way out. But that just backfires with depression, because the illness has so pervaded our minds that our beliefs and assumptions are twisted, and our ability to concentrate and make decisions is damaged. In fact, it’s rather obvious that if the ordinary powers of the conscious mind were able to counter depression, we wouldn’t be depressed to begin with. This is a very ironic form of self-destructive behavior, and why I refer to depression as the Catch-22 of mental illness; trying your best to figure out what’s wrong and what to do about it just makes you feel worse. But no one recognizes this without help.
That doesn’t mean there’s nothing you can do about it. I ask people to keep a log of their depressed mood shifts, what’s going on around them at the time, and what their thoughts and feelings were. They thus learn to identify their triggers, and develop some control because they can strategize how to avoid or respond differently to things that make them feel bad. At the same time, they develop some of that metacognitive awareness that accompanies mindfulness; the fact that there are explanations for their mood shifts means that they’re not crazy or out of control, and lends hope.
Dr Richard O’Connor