Depression
Depression: managing the mind
Everyone we talked to engaged in a conversation with themselves in their minds. Even when very young, some people said they thought negatively about themselves, and saw it as the truth. It was certainly a feature of depressive episodes that people talked very negatively to themselves. One young woman called this her internal “chatterbox”.
Describes how when she is depressed her thinking focuses on the negative rather than the positive.
Describes how when she is depressed her thinking focuses on the negative rather than the positive.
Negative thinking can have so much power over people that they find it difficult to see such thinking as a distortion of reality, unless it was somehow pointed out. Indeed, people could slip into the negative thinking states of depression without realising it. As people began to recover from depression, they could better glimpse their distorted thinking.
Describes how when she is depressed her thinking focuses on the negative rather than the positive.
Describes how when she is depressed her thinking focuses on the negative rather than the positive.
I seemed to be concentrating on the big things, really, almost possibly as a distraction from myself. But I felt like, again my own needs weren't that important, really. If somebody had some kind of emotional problem my attitude was probably that it's not a real problem, it's not the same problem as people starving in the Third World, and that's kind of how I felt about myself. I felt okay, I'm not enjoying life a lot, I find most of it very boring, possibly that's because I'm quite bright, and I don't have that much to fill up my time or that much stimulation. But it was a kind of gradual slide from about the age of 10, I think, into something that was depression. I was about, I was standing in a dinner queue at school once, on my own, and somebody comes up behind me and he said, 'You know, you radiate depression.' Which was, at the age of 13, was quite [laughing]' It was also a funny turn of phrase and I think I probably laughed actually, but somehow I'd picked up that something was wrong.
As part of recovering from depression, people attempt to better 'manage their minds'. One popular approach to 'managing the mind' among participants is cognitive behavioural therapy (CBT). CBT basically argues that it is our tendency to think negative thoughts that creates our unhappiness and distress, and that we can challenge these thoughts and so feel better. In recent years there have been major investments by the Department of Health in getting new professionals to offer CBT much more widely than before.
It is important to say that just as with meditation, CBT is not for everyone, and doing CBT is very difficult in the depths of depression. One man in his thirties sometimes felt more like 'giving in' to the negative thoughts in the depths of depression, and it was a real struggle to gain ground over them. Antidepressant medication could help to lift the mood and make it easier to get control of the thoughts. Supervision by a health professional is important as there can be a danger that when people get their motivation back through medication before their thinking becomes more realistic, it can increase suicidal thinking.
Describes the varying success he has had with trying to defeat the negative voice in his head. (Played by an actor)
Describes the varying success he has had with trying to defeat the negative voice in his head. (Played by an actor)
It's almost you've got this voice, and it is a voice sometimes of just' that has this incredible power of right about it. And no matter what you try and do, sometimes you just think okay I'll argue with it, that exhausts you.
Sometimes you think I'm not listening, I'm not listening, not listening, almost like you know when kids sort of put their fingers in their ears and try and pretend something that goes away'Getting better is about thinking no that's [thinking is] wrong actually, and moving on, it's not about fighting.
Fighting you have to do sometimes'. I'll tell you, there are some moments when you're depressed and you say, "Oh right, yeah, oh well I can probably live with that, you now I can live with the rest of my life being shit basically, you know that's fine, I can get on with that."
And you have this sort of' and you think' you think well that's the good times, you know you think, 'Oh yeah, okay'. But there's other times when you sit there sort of going, 'No, no, no.' And that is really hard. The thing I remember'. and it was the beginnings of getting better because you try it many, many times and it doesn't work, you have to stick with it. It's not so much that wrestling, because when you are alright of course you're not wrestling, you just go "No, actually that's wrong."
And' it never even comes to mind that's health. There's a sort of intermediate phase where they come, but you just bat them away quite easily, no great fuss'.. But I think you have to' you do have to sort of fight a bit. But it's tiring and sometimes you just want to give up you know, and just say, 'Okay have it your way, yes that's right actually.' And that's really not nice, not nice at all.
Interestingly, people frequently picked up or developed their own techniques for challenging negative thoughts, even if they had never had CBT. For instance, one man had so much experience of depressive episodes, that by the age of 75 he had become very skilled at putting a positive spin on being depressed. Some described developing a much more useful voice in their heads over time. A woman in her twenties suggested life experience partly helped her to become more positive. Clearly, people who could challenge distressing thoughts felt better for it.
Explains how he considers depression a sign he is going to get better.
Explains how he considers depression a sign he is going to get better.
There are a variety of ways to challenge negative thoughts. All methods involve (1) noticing the negative thought, and then (2) doing something about it. For instance, in noticing his state of mind, one man found that his mind would race ahead into confusing and distressing territory when depressed.
In trying to do something about it, a very simple technique a woman used involved just repeating the word 'Stop!' to herself when noticing a negative thought. Another approach involves seeing the negative voice as separate from the self, and looking for the humour in it, such as one man who characterised his negative voice as like a 'slightly cantankerous family member.'
People who had had therapy could become very skilled in their approach. Interview DP06 became aware that she could examine a social scene in order to challenge her initial negative thoughts that she was to blame for someone else's behaviour. Another woman was able to challenge the powerful feeling that she was a bad person and responsible for conflicts around her. One man was able to see the split in his thinking as “rational” and “neurotic”.
Describes how he has noticed he has a rational self (positive thought) and neurotic self (negative thoughts).
Describes how he has noticed he has a rational self (positive thought) and neurotic self (negative thoughts).
OK, so I mean I was saying that I think sometimes there are 2 [selves]. There is rational [self - participant's name] which can look at things sensibly and think, "I'm OK, I can do these things" and there's neurotic [self - participant's name] which thinks, "People don't like me, they see something in me, they recognise that there is something bad about me, that's why they don't want to go out with me, that's why they don't want to," I used to think, "that's why they don't want to give me a permanent contract". Most of the time that I had been in education I had been on temporary contracts or dodgy contracts you know, and I sort of feel that they see something in me that is not good, they recognise that. And that is my way of explaining really, being single and certainly when I had job insecurity...
And when you are not neurotic how do you explain this sort of stuff?
I don't need to explain it I just think [laughs] it's a load of rubbish. So, when I'm rational then, like here I'm sitting talking to you, I can talk about these things rationally. If I was neurotic I'd think those things were true, I would think those people really did hate me.
Last reviewed September 2017.
Last updated September 2017.
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