Self Care: A Paradox
Disclaimer: I’m not a doctor and I’ve never even studied psychology. This is not a blanket recommendation, so much as the thoughts of another person on the internet trying to think of better ways to cope.
I’m 26 years old and I am clinically depressed. To the best of my memory the suicidal thoughts, paranoia, and self harm began with puberty, around eleven. I was and am an almost comically textbook case; you name the symptom, I have it. During an episode, I cry all the time, eat way too much, refuse to go outside, isolate myself, self-harm, and think and say to myself all of the horrific things we think and say to ourselves when we feel we either do not want or do not deserve to continue in the world.
It comes in waves, of course — at my best, I have been active in my community and in college. I completed a bachelor’s degree, and then a master’s, and embarked on a PhD. I’ve spoken at conferences, flown internationally on a regular basis and have the best, dearest friends in the world. But at my worst, I do nothing. I stay in bed for days, and go to sleep when the room gets dark instead of braving the effort of turning on the light. Standard. Two years ago, during a particularly bad downswing, I turned to the internet for help. It came in the form of ‘pro tips’ and ‘friendly reminders’; make your day a little better by treating yourself to something that brightens your mood. Make it all go away by wrapping up in a soft blanket and watching a movie from your safe, cosy childhood. I was recommended face masks, snacks, and other such forms of self care. I was inundated with simple pleasures, most of them in the form of complex carbs.
Slowly, I became aware that the information I was getting was paradoxical; the things that came recommended to me under the guise of helping me get better were just cosy, tasty ways of leaning right into the symptoms of my depression. Nevertheless, I tried it. I leaned in, and it felt great for a while. I ate like a princess and almost never had to leave the house to do so. I self-medicated (a telling euphemism) and used getting a good night’s sleep as an excuse to stay in bed until the afternoon because I still felt tired, and one of the principles of self care is to trust your body. I lavished all of these simple pleasures on myself and let the wrappers fall to the ground, where they stayed, because, as I told myself almost gleefully, I was too depressed to clean. The results of this ironically pleasurable misery were catastrophic. I entered full meltdown mode, quit my PhD, left the country, and ran myself into the ground both financially and physically. I say this not because I’m here to mope, but to tell you I’ve done it. I tried the panacea, I drank the Kool Aid, and it was piss in a bottle, and this is my response.
What I’m going to try to do is break down the reasoning behind my thinking during this period into a step-by-step argument. It may seem weird to abstract a bunch of depression chaos into such a strict format; nobody really thinks this way, especially people whose feelings are literally crippling them. But that’s exactly why it might be helpful — when your brain is sending out chemicals that make you believe irrational things and act in irrational ways, spelling it out in the most logical form can help cut through the bullshit.
This is, loosely, what was going on in my head:
- Premise: I am depressed, and it makes me feel really bad.
- Premise: A symptom of my depression is that lying in bed all day makes me feel the least bad out of every possible option.
- Premise: I should do the things within reason that make me feel the least bad.
- Conclusion: I should lie in bed all day.
If it seems weird and wrong, that’s because it is weird and wrong. The paradox here is that all of the individual premises look pretty legit when we take them out of context. The first is straightforwardly true, as is the second, and even though the third premise is shaky, it’s banal. But the conclusion is absurd, because it answers the problem of depression by peddling a harmful symptom as a possible cure. And yet, this is the advice I was given. This is the number one thing that in my experience, well-meaning, well-read people on the internet will tell you to do to combat your depression. I don’t particularly want to call out Tumblr by name, but we all know the origins of the Lush bath bomb cure-all cult.
Taking a bed day may seem like no big deal — but the problem for me, and for so many others, is that this reasoning is seductive because it often involves things that give us pleasure. And not to sound like your mom, but things that feel good aren’t always good for us in the long run. Most of the things that got me where I ended up were literally seductive; long baths, red wine, drugs, and actual sex. The problem is not that these things are bad in themselves (with the exception of certain illegal drugs), but that because of distorted thinking, we end up making the category error of taking them for legitimate coping mechanisms. This is not the case, and it is especially not the case for a group of people whose mental illnesses make them less likely to be able to perform the necessary drudgery that make luxuries like occasional takeaway and duvet days sustainable. Give in to this thinking once, not a big deal. Give in to it three times a week and you have a slippery slope to rock bottom.
A little NB here that I’m speaking mostly from the point of view of depression, which is the most common mental illness, an equally common offshoot of less common illnesses, and my own personal hell. I don’t want to go into huge detail about symptoms of mental illnesses I don’t suffer from, because I’m not an asshole and because I’d be more likely to ruin a good point by overstepping my boundaries.
A Symptom is Not a Cure
In response to this, I’ve tried to come up with a rule that will help myself and other people, maybe even one or two of you, not to fall victim to this thinking — kind of like a measuring stick you can hold your behaviour up to that will help you decide whether or not it’s actually a good idea, or just the depression talking. This is my rule of thumb:
If a behaviour can be accurately classed as a symptom of your mental illness, you cannot legitimately call it self care.
It seems obvious, but smarter people than me have died on smaller hills. Having a mental illness almost always negatively affects our perceptions of what is good for us — this is a pretty straightforward trick to get you around the kind of thinking that landed me homeless, undocumented, piss-poor, and depending wholly on someone I had only met in person once before for my continued subsistence in the world.
The rule is applicable pretty widely: for example, if not eating is a symptom of your mental illness, then refusing to eat is probably bad for you. It may feel like a good stop-gap solution for those times when your brain tells you that it is going to short circuit if you feel like you’ve gained weight, but in the long run, giving in to that thinking lets it have it have the upper hand. If you give it the upper hand too many times, it becomes a habit, and those are hard to break. Habits formed as a result of poor mental health are even harder to break than normal ones, too, because so often they result in physical symptoms that act as further impediments to recovery. Ditto eating too much, undertaking risky behaviours, avoiding human interaction, drugs, alcohol, and just about any number of things, including harmless ones like treating yourself, sleeping in, watching Netflix, comparing yourself to other people, and all manner of things. Getting takeaway may make you feel good and keep you fed in the short term, but in the long term will lead to financial and health complications that your illness probably leaves you less equipped to deal with. And the same for the fallout if something goes wrong on a night of drinking and drugs — if you’re already depressed, you’re going to feel the resulting serotonin depletion more than many. It should be your duty to your sober self not to dole out more than they can handle. Our illnesses and the way they present are as diverse as we are, so don’t make the mistake of thinking that just because something is not inherently bad does not mean that it is not bad for you, especially if it is often repeated. I’m not trying to scaremonger; I don’t want you to doubt yourself unnecessarily, but in general mental illnesses are things that are bad for us and it’s good to have a few things in our conceptual tool belt that can hammer through the bullshit. I want this to be one of them.
All it will take to implement is adding it to the little checklist in your head that you go through when deciding whether or not to do something. That’s it — if you have the time and mental energy, stop yourself just long enough to think:
Is this thing I want to do coming from me, or is it a symptom of my mental illness?
If you don’t know the answer to that, some helpful questions might be:
Will it be good or bad for me in the long run?
Do I do it when I’m feeling my best?
How many times have I done it this week?
Is it becoming a habit?
If it did become a habit, would that be okay?
Sometimes the answers will be straightforward and sometimes they will not, and even if you do figure it out it’s going to be hard to stop yourself from just ordering that takeaway anyway. No amount of conceptual re-jigging can stop you from making bad decisions sometimes, but at least it can keep you from lying to yourself.
I know, also, that there are nuances — some days you really can’t get out of bed. I’ve been there too. If accepting that today is one of those days instead of trying to ignore it and running yourself into the ground will help you cope better in the long run, then that is exactly what you should do. But even on those days where you need to lie around watching Netflix all day, Netflix is not self care. The self care part of that comes from knowing yourself well enough to define healthy limits and accept your capabilities for what they are. Part of this is also learning to separate the trappings and trimmings from the actual self care; the warm-and-fuzzies from the self-knowledge and executive function.
In the end, thinking of the symptoms of our mental illnesses as cures will trap us forever in a cycle of self-congratulatory Munchausen syndrome. If your depression makes you less likely to cook for yourself and bad at spending money wisely, then ordering takeaway is not going to be a good coping mechanism. Yes, it may relieve the clincher of finally mustering up the courage to feed yourself at midnight after three weeks spent studiously ignoring the food shop, but it isn’t the way to recovery. Bath bombs, rest time, takeaway — these things are stop-gaps until you find actual coping mechanisms that involve not just taking care of yourself, but living your life. And those things aren’t fun; food shopping, laundry, cleaning, and sorting out your life are the kind of skills it’s easy to make it into adulthood ignoring because being a teenager is like an immunosuppressant for your mental health. But they’re important because they make life possible.
If all of this seems tiring, it is. Living with a mental illness is taxing. For all of you out there ignoring your wellbeing and running yourself into the ground trying to pretend that you are well enough to do it all — and then some — this advice is not for you. You already know what I’m saying, probably too well. This is for people like me: we are sometimes too easily convinced to give it all up, pack it all in, and congratulate ourselves on a job not done, because we are sick, and good for us for trying, and don’t we all deserve nice things. There comes a point where all those little treats we get to cheer ourselves up bypass us entirely and only end up feeding the tapeworms in our bellies. For us, learning not to feed the illness is an act of resistance. It took me losing almost everything to learn it, and I’m telling you because I want nothing more than for you to win.