Recovery should aim at restoring psychological well-being as well as ending the symptoms of depression. Naturally, you get into treatment to stop the pain of those symptoms. It’s a huge achievement if the treatment works, and you can keep depression from ruining your life. But so many people relapse after initially getting better that full recovery has to mean more than focusing on what’s wrong. It should also move you toward a goal of wellness.
Psychological well-being is not just feeling “like yourself again.” When you’re severely depressed, it’s easy to idealize what your “normal” self was like. You believe that if you can stop feeling so down and worthless, you’ll be fine.
In reality, your old self was prone to depression, and relapse could be just a matter of time. Unfortunately, relapse is becoming the norm for a huge number of people who appear to have gotten over most of their symptoms. Conventional treatment is falling short.
There are forms of therapy that emphasize well-being and describe in detail what that means. They guide you through a process of recovery that builds on your strengths to help you become more capable of living a fulfilling and well-rounded life.
Well-Being Therapy is one of the newer treatments that frames recovery in this way. Instead of starting with everything that’s wrong, it starts with everything that’s right.
The therapy tries to strengthen six closely interwoven dimensions of a capable self: a sense of mastery of your environment, personal growth, purpose if life, autonomy, self-acceptance and personal relationships. Rather than focus primarily on ending static symptoms, it moves you from the negative to the positive ends of a continuous spectrum for each of these key life skills.
When I read through the positive side of each one, I see a portrait of the emotional balance and self-concept I want to have. But in looking at the negative side of the spectrum, I see the reflection of who I was during long years of depression.
Here’s the positive side of the six dimensions.
- Environmental Mastery: You feel competent in managing everyday life and can take advantage of new opportunities. You can organize your life, work and home situations to match your needs and values.
- Personal Growth: You see yourself as growing and improving over time and feel you’re realizing your potential. You’re open to new experiences and feel that you’re continually developing as you respond to them.
- Purpose in Life: You have goals for your life and a sense of direction in working toward them. You have beliefs that support a sense of purpose in your own life and life generally.
- Autonomy: You’re independent and self-motivated. You decide what you want according to your own standards rather than by reacting to social pressure.
- Self-acceptance: You feel good about who you are and accepting of both strengths and weaknesses. You feel positive about your life thus far.
- Positive relationships: You’re able to form warm and trusting relationships, and you’re capable of empathy, affection and intimacy. You understand the give and take of human relationships.
If all that describes you, you’re an exceptionally well-balanced, grounded person, and I hope you’ll tell us how you manage to stay so psychologically fit. If you’re dealing with depression, you probably have trouble with most of these great qualities. Some of them have stumped me for long periods of my life.
So here’s the other side, the negative end of the spectrum. Depression can lead you to believe that if you’re not at the top of the chart, you must be at the bottom. That classic all-or-nothing thinking supports the inner belief that change is not possible. Recovery, however, is all about seeing yourself more realistically as somewhere between perfection and misery.
- Environmental mastery: You feel overwhelmed by the circumstances of your life and unable to control them. When you succeed at something, you explain away the accomplishment as a fluke and focus only on what you failed to achieve. When the chance for something good comes along, you feel unable to take advantage and then regret you’ve missed the opportunity.
- Personal growth: You may have goals for improving your life but always believe you’re falling short and will probably never meet them. Instead of growing, you feel like you’re stagnating. Perhaps you lose interest in trying to change and can’t seem to get out of the rut you’re in.
- Purpose in life: The idea that your life has any meaning disappears, and there doesn’t seem to be any point in working toward a better future. You may find a short-term purpose in trying a therapy for getting over depression, but it’s hard to sustain a sense of direction. Any setback is taken as confirming that the effort is pointless.
- Autonomy: Far from feeling inner direction, you’re likely to depend on others for approval. That often means trying to please everyone by hiding your own opinions and needs. You can become passive and unassertive rather than risk disapproval, but that behavior can come across as dishonest and lead to conflict anyway. You can wind up feeling frustrated and dissatisfied most of the time.
- Self-acceptance: You don’t accept who you are and feel ashamed, perhaps uncomfortable in your own skin. You feel you can’t do anything right and can reinforce the sense of failure by setting impossible goals. If you’re anxious and paralyzed in social settings, you may believe that the only measure of improvement is to be the star of the show, dazzling everyone with wit and social ease. Anything less feels like failure that confirms your belief that you can’t succeed.
- Positive relationships: All these problems in your sense of yourself make it almost impossible to form close relationships. Feeling shame about who you are can lead you to project faults and inadequacies on someone you’re trying to be intimate with. You may look to that person as making up for your own failings and winning for you the approval of others. By the same token, behavior in your partner you feel is inadequate causes you anguish, as if it were your own failing. In depression, you may feel incapable of engaging emotionally because you feel so indifferent about everything in your life. You may have set unrealistic goals for a perfect relationship and feel deep frustration when it doesn’t work out that way.
When you feel OK about your life and things are going well, these six dimensions of well-being support one another. They can’t be separated neatly since they’re woven together as the overall sense of who you are and how you handle the experience. When you’re depressed, they work in disharmony to sustain your illness.
The question is how can recovery proceed in a realistic manner when depression seems to block every way forward. The downside of each dimension reinforces standing still, isolating and setting yourself up for failure.