What I Learned About Managing Depression When I Was Hospitalized

Let me share with you what I learned during my stays in a mental hospital. These observations are taken out of a notebook I kept with me at all times, scribbling things that came to me in group sessions, in the middle of the night and – as we spent most of our time – while simply sitting and waiting for some change, however small and imperceptible to others. We mostly sat waiting more or less patiently for a lifting of the inexplicable heaviness of our limbs, any answer to the paradoxical numb desperation attested to by various blank stares and bandages around wrists.

Let me also say none of this is easy. You probably won’t conquer any one step once and for all. There will be a whole lot of backsliding and plain and simple, out-and-out failures, but my experience is that if even for a moment you can practice one of these principles, you’ll feel better, and even the smallest respite goes a long, long way in fighting a chronic illness like depression.

1. Replace guilt with gratitude.

If you are depressed, then chances are good the bedrock of your self-image is guilt — guilt and anger at yourself. Consider all this guilt takes energy. Remember you do have energy even though you feel completely drained.

Once you’ve recognized how much energy it takes to sustain the guilt and blame you’re constantly throwing at yourself, try transferring that energy into gratitude for what you have, for what hasn’t happened, for the things you do like about yourself.

2. Replace regret with focus on goals.

A similar process as my first point, using regret as motivation can be very helpful. Make some goals, but make them small. Just setting goals is an admission things could get better, which during depression seems inconceivable. Write your goals down, and put them somewhere you see them every day. (Don’t skip this step because it seems corny and embarrassing.) And as you work toward your goal, remember: you have an illness. Treat yourself like you’d treat a loved one.

3. Act as if your former self can see you now.

This one can be crushing. In one group session in the hospital, we wrote letters to ourselves at age 18. I didn’t make it through reading mine aloud without crying in front of everyone. I’m so angry at squandering all the promise of my young self.

At 18, I was fearless. I was also a jerk. I took my family for granted, ignored my parents, failed my friends. If my 18-year-old self could see the physical circumstances of my life now, she’d be beyond disappointed. But, if she could see my interactions with other people, the humility and patience that’s been bored into me by my disability, she’d see how much I’ve grown. I think she’d be proud.

What does “present you” have to teach “past you”?

4. Choose “fight” over “flight.”

Avoid avoiding. This is the hardest piece of advice for me myself to follow. Avoidance is my way of life. If climbing back into bed and giving up on the day were an Olympic sport, I’d be swimming in commercial endorsement deals.

One reason I avoid so much is I see my situation as fundamentally unfair, so refusing to participate seems almost moral to me. No doubt you can see how fundamentally illogical this is, but in my hospital notebook, I transcribed one sentence from a group session leader that rings particularly true for me: “Meet the needs of the situation you’re in, not the one that is just, or comfortable or that you wish you were in.”

5. Embrace the interplay of acceptance and change.

It’s demonstrably true that acceptance of pain decreases suffering. Suffering, or the anticipation of it, has a tendency to stifle and suppress us. By “acceptance of pain,” I don’t mean merely recognizing your diagnosis and owning it (though this step is important). Acceptance of pain must entail a mindful embrace of one’s suffering. Feel it.

Mindfulness is one of the greatest tools at our disposal. Mindfulness is, as Sam Harris describes it, “clear, nonjudgmental, and undistracted attention to the contents of consciousness, whether pleasant or unpleasant.”

Acceptance leads to change. Change leads to acceptance. The very process of acceptance changes your circumstances and changing your circumstances makes them easier to accept.

6. If your expectations don’t fit with reality, change your expectations.

Are you still expecting yourself to function “normally” with depression? Stop and change your expectations of yourself.

Shift your focus from all the things you can’t do to what you can and judge those things with compassion. Don’t belittle them. That 20 minutes of cleaning, making that phone call you’ve been putting off, walking, taking a bath or whatever it is you find to distract yourself, is a win and should be treated as such.

7. Your life is whatever your attention is focused on.

Most of us intuitively know this, yet we don’t monitor our thoughts accordingly. If you want to change your mood, shift your attention. I know this can be frustrating if you consider at times your task at hand isn’t necessarily a matter of choice.

It doesn’t have to be a vast, sweeping transformation of heart. As with so many of the strategies I mention, go small if you need to. At almost any given time, you can focus on your breath (I sometimes clutch this focus for dear life.) You can feel the air on your skin or the touch of the fabric of your clothes. You can conjure up a pleasant memory or a place you’d like to visit. Mentally grab any happy or at least neutral thing to first distract yourself and secondly, shift the focus of your attention.

8. Small steps. Small steps. Small steps.

Let me tell you how I first “started running.” I would set my alarm, which would wake me up — and then, I’d go back to sleep. After a week or so, my body had adjusted to waking up early, and I’d get up on my own.

Then I would put on my running clothes and go outside — and just sit there for a while, and go back to bed. This went on longer than I care to admit.

One day, I got up and went outside and told myself I could just walk instead of run. After about 20 minutes of walking, I wanted to run. I actually wanted to run — something I decidedly didn’t want while lying in bed. Eventually — and I mean months later — I wanted to be running at almost any given time.

I hope some of this is helpful to those of us struggling with depression. Talking about depression is important because it can be a transformative and uplifting experience for those who grapple with depression silently. As part of this conversation, I can honestly say I’ve seen improvement of my symptoms and experience more quality of life as a result of these eight realizations.

If you or someone you know needs help, visit our suicide prevention resources page.

If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text “START” to 741-741.

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