Wednesday, January 25, 2017

High Functioning Depression, Part Four: The Plight of Apathy and Lethargy

Originally, this post was supposed to discuss the silver linings of depression, but I received a few questions about the exact nature of the symptoms I experience when compared to "normal." There are four major symptoms I experience, including:

  • Apathy, which is manifested as "I don't CARE about anything"
  • Lethargy, which is manifested as "I do not want to DO anything."
  • Anhedonia, which is manifested as "I do not get ENJOYMENT from doing anything."
  • Irritability, which is manifested as "Everything ANNOYS me."

Let's use an example to explain the difference between normal behavior and "depressed" behavior. I'll use a trip to Walmart to buy a loaf of bread, a container of milk, and a stick of butter as an example. I never look forward to a trip to Walmart, but if I'm not in a depressed state, I'll be motivated to go as soon as I possibly can to get the chore out of the way. I'll go to the car, drive the half mile to the store, make a rough mental plan to take the most efficient path to get the three items, actually get the items, check out, and go home. During the trip, I'll often observe others out of curiosity. I'll note unique behaviors and maybe pay special attention to behaviors that might be incongruent with the situation (keeping a vigilant eye on potential dangers.) If the store is busy and the lines are long, I might entertain myself by checking Facebook on my phone or perusing a magazine. Sometimes I might strike up a conversation with someone else in line, the cashier, or even random people around the store. When driving, I'll be patient and considerate. I'll slow down to allow others to merge into my lane, wait patiently if someone doesn't hit the gas as soon as the light turns green, and ignore instances of bad driving. When I get home, I'll go back to doing whatever I was doing before.

Now the exact same trip in a depressive state. 

The very thought of going to the store makes me feel slightly annoyed, and the thought of the trip feels too overwhelming to do. But we need that loaf of bread, container of milk, and stick of butter, so skipping out isn't even an option. I'll spend ten minutes mentally overcoming the myriad of justifications I'll come up with to skip it. When I finally silence the objections, I have to force myself to stop thinking about the whole trip because it's too overwhelming. Every single one of the minute details of the trip feels like a million individual insurmountable walls. I know each one will take a shit-ton of mental energy to overcome, which starts producing low-level anxiety. I have to force myself to break the trip down into tiny, discrete steps. First things first - I need to put on some pants.

I'll sit on the couch for ten minutes mentally rehearsing the process - get up, walk to the bedroom, take off the pajama pants, put on a pair of jeans. It is so simple, but I can't will myself to do it. The worst part - I'm 100% aware of the sheer stupidity of this scenario... I literally cannot get off the couch. Every thought process and mental strategy I normally use to do anything simply doesn't work, which leads me to ponder if other people have this experience. Do other people ever analyze what they do to motivate themselves to put on god damned pants? Probably not. I might spend a minute or two ruminating about how much this situation sucks, then even more time ruminating about how utterly stupid it is. I used to get really pissed at myself at this point, but I've since learned I have to break the task down ever more.

Okay.

All I have to do is stand up. Go from sitting to standing. That's it. I don't think about what comes next... I just have to get past this one little task. I channel my ultrarunning experience. Late in long races, every fiber of your being wants to stop. The trick to keep going is to continually take one more step without thinking of the step after that. It's gotten me through many races. And I'll get my ass off the couch. "Don't think. Just do it." I'll repeat that three or four times, then finally just fucking do it. 

Yay! I'm standing! I'm already mentally fatigued, but I can't just sit back down even though I would love nothing more. Through sheer will, I resist the urge to abort the trip. Now I have to walk to the bedroom. Since I've initiated, the next step doesn't take as long, but the same basic process happens with every god damned step in this trip to Walmart. Remember, I'm fully aware at the absurdity of this. I can take the meta-cognitive viewpoint, dissociate a bit, and objectively look at the situation as if I'm viewing myself in the third person. None of this makes sense. It doesn't even seem possible that the brain can make such simple tasks so fucking impossible. But... here we are. 

Getting dressed and outside is the easy part. Once I go out in public, then I have to deal with the other drivers, pedestrians, greeters, other shoppers, the cashier, dumbasses in the parking lot, and so on. Anything that could be even remotely annoying, which I would normally either ignore or not even notice, becomes a giant neon flashing sign. The transient who wanders across the street into traffic without looking, the driver who doesn't signal when changing lanes, the person with a "Hillary" bumper sticker, the little screaming kid in the parking lot, the obese woman blocking the bread aisle, the cashier who bags the bread like an idiot, the dude soliciting petition signatures for the latest California hippie cause outside the door... all of it becomes as irritatingly grating as being trapped in an airplane with ten screaming babies on an international flight to Minsk. And I don't care about any of these people. The worst part - each one of those annoyances sticks. Can't ignore them, can't forget them. All of it making me just a little more angry.

Not even this helps.


By the time I get home, I'm mentally and sometimes physically exhausted, incredibly irritable, and angry. If this happens early in the day, I would have exhausted my "motivation" reserves for that day. Any task I have to do becomes even more difficult and taxing than the trip to the store. If I HAVE to do more shit, anxiety will start to creep in. If I have to do a lot of shit, that anxiety builds up until it's basically a panic attack, which is mentally and physically crippling. The depression itself is bad, but tolerable. The anxiety? That's pure Hell. And I'm acutely aware of how fucking ridiculous that is. But no amount of self-talk makes it go away... I've spent decades trying to find that magical solution to no avail. 

If I'm alone, I can just chill. The feelings will pass in an hour or three, but whatever. I can deal with that. If I'm not alone, though, I have to put on my husband or parent hat, attempt to bury the negativity, and go on with my life. If the kids are being irritating, it makes for a really, really rough night. To make matters worse, that normal loving feeling we feel towards our kids is seriously muted and replaced with, well, nothing. I'll still have the intellectually-understood parent/ child bond, but there's little or no feeling behind it. For a long time, I felt incredibly guilty about my inability to let that shit go and for the lack of loving regard, but I found that just makes the depressive episode stronger and makes it last longer. 

It's kind of like being lost in a forest of depression. The trip to Walmart took me deeper into the forest. If I feel guilt about that, that's just taking me deeper, which means it'll be harder to get out. If I just accept it for what it is, I stay where I'm at, which makes it easier to get out. 

Up to about 27-28 or so, this was what I experienced about half of the time. I did not understand why it happened. Since I didn't have the sadness aspect of depression, it never occurred to me that it was depression I was experiencing. I assumed I was normal and everyone experienced this to some degree. I chalked it up to procrastination or just the fact that I was a lazy fuck. That view was reinforced by most of the people in my life who often branded me as lazy, selfish, unloving, etc. In short - I believed I had a serious character flaw, and that belief was continually reinforced by the people in my life. 

The crazy part - when I'm not going through a depressive episode, I tend to be all-or-nothing when it comes to doing anything... so there are times when I'm not depressed and I experience procrastination and laziness. The difference? Those behaviors are simple to overcome. If I HAVE to do something, I just do it. There is no mental anguish. There's no need for elaborate self-talk to do the most simple of tasks. Anything and everything takes very little mental energy, I'm extremely calm and laid-back, and I rarely if ever get angry. I also have little problem accomplishing pretty big shit, whether it be taking a shit-load of college credits, organizing food drives, running 100 milers, writing books, or prepping to fight an mma fight. 

Today, it's extremely rare to have a depressive episode as strong or as frequent as described in the Walmart scenario, but it does occasionally happen. I have way more tools at my disposal to help navigate the experience, and I'm surrounded by people who are far more supportive and don't use guilt as a manipulation tactic. The depressive episodes today are mild, don't last long, and (as I'll discuss in the next post) have a benefit I could not utilize before. That's the main reason I don't perceive myself has having "depression." 

Without a doubt, the worst part of the entire experience is the awareness. It's not like depression causes you to break from reality. In fact, you become even MORE aware of reality (via something we call "depressive realism", which I'll discuss in the next post.) I know the inability to do simple tasks is illogical. I know those tiny things shouldn't annoy the fuck out of me. I know I shouldn't get that angry over irrelevant shit. I know I should just be able to let it go. 

But I can't. 

As it turns out, our brain does what our brain does, cognition be damned! This used to trouble me quite a bit despite the fact that I've studied and taught psychology for decades. Understanding that we're not in the driver's seat as much as we like to believe is kind of unsettling at first. But then you kind of accept it, which is where I was when I started to identify triggers and coping mechanisms. It also helps that we're slowly beginning to discover that there is a strong biological basis for our behaviors, like this interesting study that investigated the biological basis of this very topic - apathy. While it's a lone study, it does offer tantalizing explanations for that inability to think your way out of apathy, and helps explain why doing even simple tasks while depressed is so damn exhausting. 

Hopefully this explanation will clear up the vague descriptions I gave in the first post, which should help non-depressed readers understand that this isn't something we have voluntary control over. This is what people mean when they say they can't "just get over it" or "just cheer up." At best, we can sometimes prevent the episodes by avoiding the triggers we've identified, or we can sometimes influence if we're doing deeper or coming out of the depressive state. 

In the next post, I'll talk about the ways I use depressive episodes to my advantage. As it turns out, depression does some interesting things to our perception, which I hinted at above. I may not be able to directly control the depression through cognitive thought, but, given I'm fully aware when it occurs, I can put myself in a position to take advantage of it. It's sort of a "Fuck you, brain, I'm gonna get something positive out of this!" attitude. It goes a looooong way towards not only accepting it, but really embracing it. 

Stay tuned!

Also, if you have any questions about the experience, leave a comment. I'll answer the questions asap.



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