Reprinted from "Self-Management" issue of Visions Journal, 2003, 1 (18), pp. 15-16
I recently learned that my mental disorder (unipolar depression) will be a life-long battle. It was hard to hear, after seven years on medications and still in my mid-20s, that the reason the weaning-off process never seemed to work well for me was because I probably needed to be on meds for life. Of course, over the course of these past seven years — and the relapses and setbacks and successes along the way — I have learned a whole host of techniques and skills, and pursued various alternatives that help keep me well: from relationships with doctors, to going through counseling, to making lifestyle changes and nurturing social supports. These skills and processes for participating in my own recovery are what academics and others now call self-management. I call it ‘taking care of myself.’
Still, I sometimes feel the whole concept of self-management isn’t great for self-blaming perfectionists like me. I know it isn’t trying to suggest I can ‘fix’ my condition myself, but I do know a lot of things that can help. And that help can feel awfully powerful sometimes. But there are a few barriers that I, and many others I imagine, inevitably come across:
- Although taking some control away from this beast of a disorder inside me has been very therapeutic, not everything about my condition is within my direct control (if it were, it’s probably a sign of a transient depressed mood, not the illness of depression). So I can be maintaining a healthy lifestyle, and taking my meds faithfully and I can still crash and not prevent it. This happened recently, and it can be really hard to cope with because I feel I have failed somehow. I start to think, “well, self-management has helped prevent relapse before, why not this time? is there something I could have done? forgot to do?” After all, using self-management principles, I’ve been able to cut down my setbacks to twice a year; when I ignore those principles, I can easily have symptoms return half a dozen times a year. So self-management can be powerful medicine, but it’s not a cure-all; it has its limitations. And that’s hard to remember sometimes because it has been so helpful to me.
- The principles of self-management are often the hardest things to bring myself to do when I’m even slightly low. When I’m depressed, I feel like brooding, oversleeping and eating all the wrong foods — even though I know better! But I’m not alone here. Think about it: most North Americans know that exercising or eating lots of fruits and vegetables is good for you, but plenty of folks still sit on the couch eating potato chips. My point is that knowing is one thing; doing is quite another. There are a lot of health-promotion principles, mental illness self-management included, that make sense, sound good, feel good, and we know them intellectually to be true. But it takes something else altogether to make them resonate emotionally — and that’s where true behavioural change and motivation come from. As a counselor of mine once told me, “The trip from the head to the heart is the longest seventeen inches in the world.” Long indeed.
- Having any co-occurring conditions can make self-management that much more difficult. So imagine what happens in these two common scenarios for me:
- I have a disabling sleep disorder that is unrelated to my depressive illness. As a result of the sleep disorder that leaves me unrefreshed upon waking, I have a tendency to feel sleepy and lethargic a lot. That sleepy feeling I carry with me all day is frustrating and often depressing. It even feels like depression, which it isn’t, which, in turn, makes it harder to fight off any real symptoms of depression that do ever return.
- I have chronic allergies to a whole slew of environmental allergens, and although I get two weekly allergy shots, symptoms are still a real bother. However, I can’t take antihistamines to relieve them, because they always interact with my antidepressants and trigger a depressive episode. The ear-nose-throat congestion that goes unrelieved then bothers me during my sleep making my sleep disorder worse (see a above!) and the cycle continues. The figure below should further shed light on the complexities of self-management in my world.
Anyway, you probably get the idea. Self-management doesn’t happen in a vacuum. You can control only certain variables and have to take the rest as they come.