Depression: “I Can’t Do This”

depressionOne of the things that we spend a lot of time thinking about is the “I can’t do that” process. How it is that someone can’t get out of bed, or take a shower, or any number of other things…

It is actually a step forward often when the other person says, “I can’t do that” directly. Most of the time, when working with folks with chronic depression, the “I can’t do that” process takes place in a hidden fashion. The result is that things just don’t happen.

We have been thinking about the process this week from a number of different perspectives.

We’ve been working with the husband of a woman with chronic depression. He has been trying to be supportive, but it becomes very, very hard to remain supportive when, all of a sudden, his wife is unable to get out of bed and do even a minimal self-care.

We have also been working with a couple of clients who are (or have been) wrestling with the “I can’t do that” process themselves.

One woman, who just came out of that state, and is, for the first time in a few weeks, getting out of bed and taking showers and even beginning to do some physical activity.

There is no way for anyone on the outside to say whether the person’s statement that they can’t do something is “true” or not.

Depression has profound effects on brain metabolism, and a result, affects our ability to do things. On the other hand, it is also true that the “I can’t do that” process contributes in a very significant way to the severity of depression.

Another woman we saw had to go back to bed a couple of times, both times missing a typical morning run. A few months earlier, when she was just as depressed, she did go for a run, because she and a friend were both training for a race together and so the implication of not going was greater. Those times she went out for the run and her mood improved (slightly), this past week she did not drag herself out and her mood seemed to get slightly worse.

The “I can’t do that” process is in part driven by negative thoughts  (what cognitive therapists call self-statements) that can become uncontrollable. The person may be experiencing a level of constant self-criticism of an extreme nature,  that would be hard for someone on the outside to even imagine.

Unfortunately, the self-critical comments do not serve any kind of motivating function (which may be where they came from) and when people on the outside express their own exasperation, it can often reinforce or strengthen the self-critical thoughts.

The key intervention is really to pay attention to those thoughts and try to get them out in the open. Taking a look at those thoughts is a big step forward because “in the light of day”, when they are really visible and conscious, it often becomes clear that they are extremely unrealistic.

If not, a good cognitive therapist can help to modify the thoughts and to develop a more realistic self-appraisal.

Another part of this process that is increasingly of interest to us is the selective recall of information that fits with the person’s mood. When you’re depressed, you tend to remember all of the failures and difficulties and hard times that you’ve experienced, and that selective recall, which is unconscious, reinforces the negative voices.

It is possible to consciously try to remember other some more positive memories. It might make sense to even write down some of those positive experiences to help you recall them when you get trapped in negative memories.

We have also found that it’s often helpful to remember people who can serve as role models for success.  One of us often finds it useful to recall a cousin who is very confident and effective in his life despite great hardships and challenges.  As part of that memory, there is also the recollection of times in the past when the inspiration of his example has served to get us out of a “I can’t do this” funk.