Hello From The Other Side? Why It's Hard To Embrace Our Mental Health Wins
Image: This Way Up (2019)
I remember staring at the wall for about 15 minutes. I'm pretty sure I whispered to myself, "Holy Shit." This was back in June, and I had just finished a call with my doctor, where she congratulated me on going over a year without experiencing clinical depression. She brought to my attention that this was occurring during a pandemic, without medication, while experiencing significant personal changes in my life. I honestly hadn’t thought of it this way. I hadn’t even realized how long I had gone without an episode or being symptomatic.
I’ve struggled with Persistent Depressive Disorder (PDD) since around age 15, with periods of Major Depressive episodes, known as “double depression.” This past 2 years is the longest I have gone not only without a MDD episode, but without any symptoms of clinical depression. I no longer meet the criteria for PDD. Am I really on the other side of it? Am I really in recovery from depression? This is kind of a big deal. Why had it taken a conversation with my doctor for me to finally reflect on this major mental health win? And why was a part of me still hesitant to frame it this way? In my work with clients, I have witnessed how common this reluctance is. So, why is it so hard for us to embrace our mental health wins?
What do I mean when I say a mental health win? A win is something that shows we are making progress, conquering our mental illness or feeling less consumed and defined by it. It doesn't have to be recovery; many mental illnesses are chronic. It’s those little moments and signs that indicate we are winning back our lives. Or, indications of strong mental health. A win might be for 5 minutes or 5 months or 5 years.
A win could be the absence of mental illness symptoms or episodes; changes in the frequency, intensity, or duration of symptoms; being off or lowered doses of medication; less reactivity during conversations; setting boundaries; getting out of bed or showering in the morning; going 6 days without self-harm; going 6 years without drinking; staying 1 hour longer in a social setting; being more comfortable around the presence of certain people; being less triggered by certain stimuli and memories; more compassionate self-talk; asking for help; the experience of more positive emotional states. The possibilities are endless for what wins might look like. Our weeks may be filled with numerous small wins. Or, like myself, a big one might be occurring. However, we often tend to miss or downplay these signs. Below are some possible reasons why.
I Only Know That Side of Me
I was diagnosed with clinical depression when I was 15 years old. My life story and identity is inextricably tied to this. For more than half of my life, I’ve struggled with depression. We say that we “have” depression but rather it’s that depression “has us.” It disrupts our lives. I’ve either been struggling with symptoms, on alert for worsening or returning symptoms, or grieving and resenting the interruption to my life. It’s demoralizing.
I’ve often said that a major cause of my depression is my depression. There is hopelessness about the experience of hopelessness. It’s exhausting and consuming, regardless of experiencing symptoms or episodes. With an ongoing mental illness, even during times of wellness or of being asymptomatic, there is a need for constant vigilance. Sometimes the well-meaning comments about resilience seem to minimize our battle, or the slip we view is easy to happen. Sometimes we can't see any wins because the loss is so disruptive. It sometimes seems patronizing or dismissive to talk about "wins."
Sometimes we wish we could be more focused on the positive changes but we wonder if it will cause us to miss the signs into decline; that we will be caught off guard. Sometimes we are suspicious of signs that indicate progress: "There's no way this feeling is real or lasting, this soon after starting Prozac." Sometimes we minimize or deny improvement because we don't want to get our hopes up.
Honestly, it’s kind of destabilizing to live without depression. There is at least a familiarity there that comes with symptoms. There was also a built-in theory and narrative for why I was feeling a certain way. Recovery is scary and uncertain. I’m not used to not experiencing depression, or knowing it's hanging nearby, around the corner. I’m also hesitant to view myself as in recovery. I know it’s been 2 years, but I’ve had 16 years with Persistent Depressive Disorder infiltrating my life. Of course I’m going to think it’s still hovering. What if I’m lying to myself, in denial about symptoms? I’m trying to reconcile being in recovery but also aware this doesn’t mean depression is done with me. I know that I am predisposed to experiencing clinical depression. Can I really embrace this as a win if I’m so worried about losing out again?
Sometimes, we have a hard time seeing things as wins because others only know that other side of us. I know of individuals who have tried to share something that is an accomplishment, only to have it minimized by a family member or psychiatrist. To have them go, “Okay but don’t stop taking your medication now.” If others in your life don’t validate these experiences as wins, and filter everything in relation to illness, then you will have a hard time noticing and embracing them too.
What is the Other Side?
What does progress really look like? What does being in recovery mean and involve? There is no mentorship or acclamation process when you are diagnosed with a mental illness, nor when you experience recovery. I think there is where communities like Alcoholics Anonymous can be so helpful. You have people who have been there, who can say, “That urge and craving, after 6 months clean, is totally normal and does not indicate you are failing at sobriety. You are still on the right track.” You have sponsors to reach out to for ongoing normalization and support.
We don’t really have anything like that for mental illness support. Yes, hopefully you are connected with a therapist or mental health care team, depending on your situation, but ongoing peer feedback is invaluable. Treatment eventually ends, and you lose those connections with professionals. I am one of those professionals. I specialize in depression and anxiety management! And yet, I was unable to see my own positive changes without objective input. I wish there were mental illness support groups similar in accessibility and scope as AA.
Without normalization of the ups and downs of recovery and/or normal emotions, we are often left feeling bad about ourselves and our progress, and we go, “Okay, I guess I’m not doing as well as I thought I was.” This may not be an accurate assessment.
We don’t tend to talk about all the small, but ultimately huge, signs of progress or recovery or healing, or the vague but still valuable ways of measuring mental health. We do not talk about mental illness recovery as openly as we do about the experience of mental illness. We are increasing promotion of the prevalence and signs/symptoms of mental illnesses, but what about mental health? What does it look like to be mentally healthy?
One Side or the Other?
What is mental health? This is where things get tricky, because it’s complicated. There’s no clear definition. I personally think there is a lack of mental health and emotional literacy. We need more psychoeducation about the grey that is wellness, beyond the black and white categorizations of mental illness versus no mental illness, or good versus poor mental health. It's not really about sides.
Mental health is not the absence of defenses or bad moods or anxiety or strong emotions or self-loathing or self-sabotage or destructive behaviours or self-doubt. I struggled to realize that what I was experiencing over the last few years was not clinical depression but instead normal emotions and coping behaviours that anyone would experience going through what I was going through. That is part of the filtering that happens when you have a mental health diagnosis; I would assume my week of sadness and crying was just my depression. I left out the consideration of context. I left out the consideration of the normal variance of mood and loss of interest and motivation that is part of being human. (It’s also okay to be exhausted by this need for contextual assessment. The question of, “Is this depression or is this just being a human during 2020?” has drained me all year). So, to me, I assumed I was still experiencing clinical depression when in reality I was not.
That is not to minimize how awful those emotions or behaviours are to experience, it’s just to acknowledge that they weren’t part of a mental illness. I wasn't experiencing clinical depression. That big win was there, but I couldn’t see it, which is fair. Those feelings, like grief and anxiety, were still disruptive. Why would I see my experience as a win, when I was still experiencing loss of quality of life?
Absolutist thinking is also influenced by how we conceptualize treatment goals in mental health. We tend to focus on the absence of something: not drinking, not binging, not yelling, not feeling tired, or not experiencing a manic episode. This makes it hard to gauge what we are working towards, and when there are moments of that happening. When goals are about the presence of something, the instead behaviour we want to be doing, this makes it easier for us to recognize and celebrate when those things occur.
People post pictures of healthy dinners, toned stomachs, miles ran, and weight lost. People celebrate getting 8 solid hours of sleep, being in remission from cancer, and evading a diagnosis of Type-II Diabetes. We do not talk about mental health the same way. Not only is there silence about the experience of mental illness, but we do not talk about mental health wins in the same way we talk about physical health improvements. These accomplishments tend to be pushed to the side in our society.
There’s little celebration in general for accomplishments that are psychological and less tangible, like increases in emotional intelligence, saying “no” more often, intervening when you notice the signs of burnout, being successful with a new parenting strategy, or not getting back together with a toxic ex-partner. There are also changes we cannot fully articulate, like equanimity or non-reactivity.
All of these psychological accomplishments are hard! The emotional labour involved in these and mental health changes, in doing the work in therapy and on your own, all of that deserves so much respect and admiration. I love being a part of “Mental Health Twitter” and seeing people share their stories of progress or how hard they’re working; all the stories of sobriety, PTSD and eating disorder recovery, months without self-injury or manic episodes. Amazing, right? Those are big deals! I also love people sharing that they just feel like they are doing well. I may struggle doing it for myself, but I am actually very strengths-based and solution-focused in my approach with clients. I'm constantly focused on their progress and small wins.
I Don’t Want You to Know That Side of Me
I love hearing all the stories of how far people have come. But I also understand why these are not quite readily shared. I think part of this lack of disclosure may stem from embarrassment. For me to truly share how far I’ve come, I may have to paint a picture of how “bad off” I was. There’s vulnerability and shame in sharing this. There’s the worry you will see it that way or only focus on that, on how much I struggled or that I am susceptible to that again. Of course, these are all just stories I am telling myself, my thoughts are not facts, but it’s fair that people may limit acknowledging their mental health wins, not only to others but to themselves, because of mental illness stigma.
Maybe I also don’t want to share how good I’m doing because I'm worried it might sound smug or disrespectful towards others who are currently struggling. Especially if we leave out the acknowledgement of certain privileges and opportunities that have allowed for this. I think there is worry of how it comes across. When we share that we are proud of being off medication for a year, does that sound like we are implying this is the ideal scenario and best outcome? Does it sound like we are shaming others who “still need” it? We are not. We are simply sharing our own experience and personal preferences and wins, but it’s hard to phrase this in a way that is respectful and doesn’t sound like we think others are still “losing.”
We know it's okay to not be okay, but it's also okay to be okay. We should be proud of how far we’ve come and how hard we’ve worked (and continue to work) to get here. I think these stories are important for people struggling to know that there is light and hope, that recovery is possible, that fluctuations are normal. I just also understand the hesitancy to be this open.
It makes sense why I wasn’t looking at my mental health from a strengths-based perspective. Individually there are reasons why we sometimes cannot see these wins, and collectively we do not celebrate them like we really should. I want to hear more stories from people, ranging from the daily small wins that aren't small at all, to stories of recovery or less intense or consuming symptoms. I want to be proud of what I have accomplished. After 16 years, I no longer experience clinical depression. "Holy Shit" indeed. Beyond just the absence of this, I view myself as very mentally stable and healthy. Even if I still struggle with other things.
The other part of embracing the win is truly accepting my role in it. It didn’t happen by accident. I knew I was working hard to manage my depression; I just didn’t give myself time and distance from it to assess if it had worked. This one win is also the result of so many other wins. We also need to give ourselves permission to assess and embrace our wins. Acknowledging progress is what helps maintain progress. And progress and mental health wins really matter. These are important.
Mental health awareness is more than awareness of mental illness or the importance of mental health on a macro level; it’s also about the micro level, the day-to-day awareness. We do need to talk more broadly about what has worked, what success really entails, and what good mental health really is. We need to embrace and share our mental health wins, when we do feel we've made it through, to some kind of other side.
Title lyric: Hello (Adele)