How to Build Resilience to Depression

I wrote this piece for the local newspaper!

As we’ve attempted to settle into post-pandemic life, the mental health crisis continues to rage. According to a review by Boston University School of Public Health, rates of depression in the United States have risen from 9 percent, pre-pandemic, to 33 percent in 2021. 

With depression affecting one in three people, odds are you know someone, or you are someone who is suffering with depression. Here are a few principles that have been shown to help build resilience to and aid recovery from depression.

Aliveness instead of happiness. Andrew Solomon wrote, “The opposite of depression is not happiness, but vitality….” Depression is a sense of internal deadening. Cultivating a sense of aliveness means building our ability to be present with the full spectrum of emotion. You can get started with this practice by thinking of the last time you felt fully alive and engaged in a moment. Maybe it was getting into the wintery ocean, or being in deep conversation with a close friend. Now think about a time when you chose to numb a feeling, maybe with food, alcohol, TV, sex or staying overly busy. For many of us, the numbing behavior is our default and aliveness must practiced.

Pay attention. However one chooses to do this (meditation, prayer, journaling, daily reflection, etc.), the act of noticing and processing the events of our day, leads to an increased sense of well-being. Regularly seeing a talk-therapist is a guided practice in paying attention. Whether you decide to seek a professional guide or start something on your own, paying attention to the experience of your life is key. 

Be curious. Curiosity, as a mindset and skill, might be the most useful tool in mental health recovery. If depression is deadening, curiosity provides an opening through which light can enter. There is a lot of pressure in our current culture to optimize every aspect of our day. But, instead of self-flagellating over missing a day of exercise or numbing with one of our vices, the practice of curiosity allows us to notice our shortcomings with compassion. Curiosity doesn’t condemn. It asks Why?, and How? and looks into our internal life with wonder.

Rebellion in the sparkling line of costume gems

When I was 17 my mom made me a prom dress.  It’s still one of my favorite pieces she has created, which is saying something because this is a woman who has spent thousands of hours behind a sewing machine.  Since before I was born, she sewed dresses for herself and my sisters and me.  For Christmas, Easter, and summer at the least, every year, she would produce four new dresses.  When we were little, the dresses for my sisters and I were matching.  As we got older we would all go the fabric store to pick out a dress pattern and material so we each got a custom frock. 

I have done a little sewing.  In my 20s I received a sewing machine for Christmas from my mother-  and father-in-law.  I was living in their basement at the time and taking prereqs for PA school.  I saved my Joann’s coupons and bought material and patterns and I began to sew garments for myself.  I got some vintage material from Grandma Hurst that was passed down from her mother, who owned a fabric store at one time.  I made shirts and skirts and dresses. 

Sewing, for me, was an interesting mix of technical ability and creativity.  At times, it was really difficult to understand the pattern instructions and inevitably I would sew a seam in the wrong place and end up picking it out.  Sometimes there were hours of unpicking seams.  Sewing is an exercise in frustration and accomplishment, devastation and creativity, and and mostly perseverance.  Sometimes it’s exhilarating and sometimes it’s intolerable. 

So knowing this, when I look at my black velvet, beautifully tailored prom dress hanging in my closet, I understand a bit of what went into its creation. 

My mom was in a moderate-to-severe depressive episode for about ten years, which covered the entirety of my adolescence.  When I think about that time, it mostly feels quiet.  It was quieter in the house without her laughter and music and the hum of her sewing machine.  There were times when she didn’t function.  Times when she disappeared for days.  Her absences felt ominous and confusing.  But most of the time she was there, doing the driving and shopping and cooking and cleaning, in a quieter way.  Most of the time it wasn’t the activity in the house, but the presence of suffering that felt different. 

I have learned, in a small way, what that might have felt like for her.  There have been nights when I have wondered how I will face the following day—how I can summon the strength to get up and do the few things that must be done.  And I’m in awe that, during this time of darkness, she found the strength and desire to create a graceful, elegant dress for me.  It was a gesture of kindness and love. I see rebellion in the sparkling line of costume gems on the bodice.  An indignant strike against the oppressive darkness.

This is what I learned from my mom: 

To keep moving alongside the fear and the dark. 

To find beauty in it.

And to create in its presence. 

That is how you find the light again. 

Evictions and invitations

After I wrote my last post I have been using, “I’m just going to dance,” as a mantra.  It’s been quite useful, but because life is what it is, it’s been a struggle to keep dancing. Just wanted to reality check that.  I’m still repeating, still working to do it.  I do feel like I’ve risen to a new level in this process I’m working in but, as I keep learning, progress does not equal comfort. 

I’ve been through a meaningful clean-out this week.  I passed on most of River’s baby items to people who could use them.  As someone who waited a long time to have a child (“long time” qualified as such by nothing but my own expectations) and is now facing the possibility that I might not have any more children, this was emotional.  I also sold my longtime companion car (read here if you missed the tribute).  It was time for the car to go and I felt ready, but the experience of selling a car on Craigslist was a little harrowing.  Nothing bad happened but I felt extremely vulnerable, standing under a streetlight in the otherwise dark, holding River, while three grown men examined my car and then haggled with me over the price.  It’s an experience I never anticipated having and I hope to not repeat.

All of this moving-on business has prompted me to think about evictions. 

When I was about 11 years old, a big shift happened in my family.  Around this time my grandpa was diagnosed with pancreatic cancer.  His prognosis was poor.  I was young so I don’t understand everything that played into this, but I know it broke something open in mom. She began spending long periods of time in her room, in bed, with the door closed.  When I came home from school, I was met with a serious expression and relative silence.  Before this time there had always been pleasant chatter and busy flow of housework, homework, errands and dinner prep. 

Glennon Doyle described this kind of experience as an eviction from your life.  It’s a point in time in which something changes in a way that makes it impossible to return to your previous existence.  Effectively you cannot go home.  You cannot return to your previous way of living because something fundamental inside or outside of you has changed.

I think my mom would identify this time period as one of her life evictions.  It was my first.  It was the first time I remember understanding that life was bigger than my childhood problems.  That the adults in my life were facing things that were bigger and more complex than I could understand.  I searched for a way to make sense of it and my role within it.  This is when I started to worry about getting good grades.  I started thinking about college.  I started to TRY to get along with my sisters.  I started to believe that if I could be and do enough good, I could control my life and, to some degree, the lives of those around me.

Eviction #2 happened about ten years later.  I was 20 years old when I got married.  Five months after the wedding, I had a septoplasty and turbinate reduction surgery. This was to help me breathe better but was mostly in response to recurrent, severe headaches that had been going on for years.  It was an outpatient procedure but I spent the entire day in the recovery room.  My blood pressure became very elevated during surgery and it took hours to bring it down.  The surgeon advised me get this checked out by my primary care doctor.  I was a BYU student at the time so I went to student health and told the doctor what had happened.  Thankfully she took it seriously.  She began ordering tests to evaluate my cardiovascular and endocrine function.  After a bunch of tests and a misread CT scan that was thankfully given a second look, a tumor was found in the back of my abdominal cavity behind my pancreas. 

I had an incredibly invasive surgery to remove the tumor, followed by another incredibly invasive surgery four months later.  This was my second eviction.  I dealt with this in a similar way to my first.  I put my head down and went to work.  I looked for things I could control to take care of the things I couldn’t.  I went on like this for 11 years. 

I was 31 when I became pregnant with R.  I waited a long time to have a child and I was so excited to be pregnant and bring this little human into existence.  I don’t think it matters what you circumstances are, having a child is an eviction from your life!  It’s something you can’t adequately prepare for, no matter what.  Having R was the best kind of eviction.  Holding my sweet boy, feeling the incredible love I felt for him and believing that God’s love for him was even more perfect than mine—that was the impetus for me.  That’s when I started to believe that God loved me and he wanted something more for me than my self-mandated, contrived existence. 

This is when I realized I couldn’t continue—I couldn’t fulfill the measure of my creation, within my marriage.  This marked the most meaningful eviction to that point.  That’s the thing about evictions.  They are uncomfortable.  They are supposed to be.  During the past two years, there have been several times when I have longed to go home.  To return to some feeling of normalcy in life.  But whenever I think about this, I try to picture what that would look like and where it would be.  And I realize, it doesn’t exist anymore.  I cannot go home.  Like those whose homes were destroyed in the terrible fires in California this past week, I could return to the lot and I would find a field of charred and scattered debris.  What was there before, only exists in my memory.

This is where the invitation comes in.  An eviction always comes with an invitation.  An invitation to rebuild, to grow, to expand, to understand, to let go, to reach.  These are invitations that I would ignore without the preceding abrupt eviction.  Life in the status quo, however comfortable or uncomfortable, is familiar and it is so hard to let go of the familiar.  I don’t think God provides these evictions.  The world and life and biology are chaotic and complicated enough to ensure that we will find our necessary breaking points.  But God is always the inviter.  God is the one that invites us to turn shit into gold.  It is up to us to accept the invitation—to “trust the inviter,” as Glennon suggests.

When have you felt this eviction/invitation?   

Today my invitation is, not to wait for the downhill stretch, but to get comfortable in the climb.  To stay open.  To love.  Namaste.

It's all delusional anyway

I am a psychiatric PA.  A lot of people get confused by that title.  I am a physician assistant specialized in psychiatry.  I do the same job as a psychiatrist for much less money, and I’d like to think with a little more style!  I diagnose and treat mental illness, primarily with medication.  I have been doing this for 6 years and for half of that time I have worked with the severely, persistently, mentally-ill population.   Most of my patients have schizophrenia, bipolar disorder, substance abuse or some combination of all three.  When I tell people this, I usually get some kind of response like, “I don’t know how you do that. That seems like a really hard group to work with.”  And it is in some ways.  My patients are often dirty and smelly.  They are often high on something or coming down from something or waking up from something.  They struggle with basic tasks.  They get angry easily.  They don’t answer my questions in straight-forward ways.  Sometimes they are violent or threatening.  Sometimes they lie.  And sometimes they are honest. 

One such patient suffers from schizophrenia.  He is usually stoic with limited eye contact when he sits down in my office, but after only a moment he will start to intensely muse about Father Time and the universe and people and places that, I’m pretty sure only exist in his mind.  I’m trying to find out how he is sleeping and whether he is thinking about suicide.  I’m thinking, “Yeah, ok, Father Time… but let’s talk about the important things.” 

And he is probably thinking, “Yeah, ok, sleep…but let’s talk about the important things!" My interviews often feel like a struggle to obtain the information I want without completely dismissing, what to me is complete gibberish, but what to my patient is his pressing reality.  I’ve learned that patients get used to this dance too.  And like me, sometimes it’s frustrating but usually we just roll with it and do our best to play our parts. 

This particular meeting was different.  He started off with a bizarre statement (not so unusual), “Did you know I have AIDS but it doesn’t register?  I have it in my spirit.” 

I think, “Okay, this is how it’s going to go.”  So I look at the report that he completed in the lobby.  It’s called a Common Ground report and it gives the patient a Likert scale to rate various symptoms.  Sometimes psychiatric patients (and really all patients) have a hard time relating their symptoms to their healthcare provider so this is meant to ease the process.  He marked that he was not doing so well at fulfilling responsibilities so I ask him about it. 

“I have trouble remembering to go on walks, wash my plate and the table cloth, and flush the toilet because I spend a lot of time nervous and confused.” The honesty of this statement strikes me.  He continues, “It’s confusing that I know how to understand what I’m going through and still be able to take the pain that I’m going through.”

Heart wrenching. 

This man stabbed himself in the arm a while back in response to some delusional belief.  It became infected but no one noticed and his arm eventually had to be amputated due to the infection.  "Is the pain physical or emotional?" I asked. 

“Emotional,” he replied.

I saw his pain in that moment.  He is living in two worlds, maybe more.  For a moment, he visited me in my reality, but there is pain there so he quickly wandered back into the land of “Mother Nature”, “Father Time” and “alternate universes.” 

This is a dramatic example—and, speaking from the front lines, mental illness is real—but we all get to choose our reality.  Life happens in the mind.  Ultimately, our experiences hold the meaning that we assign to them.  So be intentional with your narrative, friends.  You get to decide if it is a tragedy or the hero’s journey.  You choose the delusion and make it your reality…choose wisely.