Depression: managing the mind

Everyone we talked to engaged in a conversation with themselves in their minds. Even when very young, some people said they thought negatively about themselves, and saw it as the truth. It was certainly a feature of depressive episodes that people talked very negatively to themselves. One young woman called this her internal ‘chatterbox’.

Describes how when she is depressed her thinking focuses on the negative rather than the positive.

Age at interview 24

Gender Female

Age at diagnosis 14

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I call, what I’ve got in my head my chatter box. Basically it is my mind, seeing things a particular way. And with depression you see it really negatively. You see everything negatively, you’ll always pull out the negative over the positive if you ever see a positive, you’ll. if for one positive you’ll give ten negatives. And that little voice in your head, that’s telling you, oh God, you know, that person doesn’t like me, or oh, I don’t look very good today, or I feel fat or, you know, all these horrible negative things that come into your mind are your chatter box telling you all these frightful things.

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Negative thinking can have so much power over people that they find it difficult to see such thinking as a distortion of reality, unless it was somehow pointed out. Indeed, people could slip into the negative thinking states of depression without realising it. As people began to recover from depression, they could better glimpse their distorted thinking.

Describes how his thinking was negative early on in life, but he only became aware of it when…

Age at interview 35

Gender Male

Age at diagnosis 17

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I seemed to be concentrating on the big things, really, almost possibly as a distraction from myself. But I felt like, again my own needs weren’t that important, really. If somebody had some kind of emotional problem my attitude was probably that it’s not a real problem, it’s not the same problem as people starving in the Third World, and that’s kind of how I felt about myself. I felt okay, I’m not enjoying life a lot, I find most of it very boring, possibly that’s because I’m quite bright, and I don’t have that much to fill up my time or that much stimulation. But it was a kind of gradual slide from about the age of 10, I think, into something that was depression. I was about, I was standing in a dinner queue at school once, on my own, and somebody comes up behind me and he said, ‘You know, you radiate depression. Which was, at the age of 13, was quite [laughing]’ It was also a funny turn of phrase and I think I probably laughed actually, but somehow I’d picked up that something was wrong.

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As part of recovering from depression, people attempt to better ‘manage their minds’. One popular approach to ‘managing the mind’ among participants is cognitive behavioural therapy (CBT). CBT basically argues that it is our tendency to think negative thoughts that creates our unhappiness and distress, and that we can challenge these thoughts and so feel better. In recent years there have been major investments by the Department of Health in getting new professionals to offer CBT much more widely than before.

It is important to say that just as with meditation, CBT is not for everyone, and doing CBT is very difficult in the depths of depression. One man in his thirties sometimes felt more like ‘giving in’ to the negative thoughts in the depths of depression, and it was a real struggle to gain ground over them. Antidepressant medication could help to lift the mood and make it easier to get control of the thoughts. Supervision by a health professional is important as there can be a danger that when people get their motivation back through medication before their thinking becomes more realistic, it can increase suicidal thinking.

Describes the varying success he has had with trying to defeat the negative voice in his head…

Age at interview 31

Gender Male

Age at diagnosis 17

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It’s almost you’ve got this voice, and it is a voice sometimes of just’ that has this incredible power of right about it. And no matter what you try and do, sometimes you just think okay I’ll argue with it, that exhausts you.

Sometimes you think I’m not listening, I’m not listening, not listening, almost like you know when kids sort of put their fingers in their ears and try and pretend something that goes away’Getting better is about thinking no that’s [thinking is] wrong actually, and moving on, it’s not about fighting.

Fighting you have to do sometimes. I’ll tell you, there are some moments when you’re depressed and you say, “Oh right, yeah, oh well I can probably live with that, you now I can live with the rest of my life being shit basically, you know that’s fine, I can get on with that.”

And you have this sort of and you think’ you think well that’s the good times, you know you think, ‘Oh yeah, okay. But theres other times when you sit there sort of going, ‘No, no, no. And that is really hard. The thing I remember. and it was the beginnings of getting better because you try it many, many times and it doesn’t work, you have to stick with it. It’s not so much that wrestling, because when you are alright of course you’re not wrestling, you just go “No, actually that’s wrong.”

And’ it never even comes to mind that’s health. Theres a sort of intermediate phase where they come, but you just bat them away quite easily, no great fuss.. But I think you have to’ you do have to sort of fight a bit. But it’s tiring and sometimes you just want to give up you know, and just say, ‘Okay have it your way, yes that’s right actually. And that’s really not nice, not nice at all.

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Explains how he became suicidal while on antidepressant medication. (Played by an actor)

Age at interview 33

Gender Male

Age at diagnosis 24

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And whilst initially (after starting antidepressant medication) I started feeling better. I then started feeling, I started feeling depressed again and I started feeling, essentially because I’d got my capacity of thought back, I started feeling introspective. In the, before then really I’d lost the capacity

I just think I was a zombie and I started feeling, I started sort of thinking again and started thinking that, Well, actually yeah the world would be a better place without me. Then, I think my family would be better off without me. You know, because of the life insurance, think of life insurance and they’ll be more secure then you know. If I did lose my job I’d be unemployed

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Interestingly, people frequently picked up or developed their own techniques for challenging negative thoughts, even if they had never had CBT. For instance, one man had so much experience of depressive episodes, that by the age of 75 he had become very skilled at putting a positive spin on being depressed. Some described developing a much more useful voice in their heads over time. A woman in her twenties suggested life experience partly helped her to become more positive. Clearly, people who could challenge distressing thoughts felt better for it.

Explains how he considers depression a sign he is going to get better.

Age at interview 75

Gender Male

Age at diagnosis 35

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It’s [pause] I always try to think that theres a sort of beneficial flip side to these problems. And I tell myself that if you don’t hit the bottom, you don’t really know what the good things are. So when I felt absolutely as if I’d hit the rock bottom, it was starting then to feel quite joyful because I knew it was going to get better, and gradually it did’

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Growing experience of depression and life has helped her to develop a more positive view of herself.

Age at interview 27

Gender Female

Age at diagnosis 16

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But I see myself as having…through experience, experiencing it myself, having got better and able to cope with it, even though if you get depressed you always still, you still really kind of believe that this is it, and it’s really bad, but at the back of your mind at least you know that it’s going to get better at some point. And I have become more positive, and I don’t know if that’s just something to do with gaining experience in life and actually doing things, and so becoming slightly, you know more confident. I mean, nowadays when I talk to people and meet people, sometimes I say, Oh, I don’t feel, I’m not very confident and whatever. And they go, Well, that’s funny because I really thought that you wer. So I’ve become a lot better, I think at presenting a better face to the world, and not kind of so obviously, like just withdrawn and introverted. And you know, partly that’s just growing up, I think and just kind of gaining in experience, and just being less, slightly less, you become less self-conscious after a while.

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There are a variety of ways to challenge negative thoughts. All methods involve first noticing the negative thought, and then doing something about it. For instance, in noticing his state of mind, one man found that his mind would race ahead into confusing and distressing territory when depressed.

Describes noticing how depression for him meant a racing and negative mind. (Played by an actor)

Age at interview 31

Gender Male

Age at diagnosis 17

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And just, I remember nights you know, I couldn’t sleep and I’d bemy mind would be really buzzing and racing. Somebody would tell me they’d been depressed and they feel sort of dead and numb. I never felt that. My depression is always about your mind zooming into miserable places, never aboutome people say to me when I’m depressed I just, I can’t feel anything. That’s not my experience, it’s just about racing. I remember lying in my bed and it would be, I can kind of see it you know [laughs] the light on the landing, and it would be getting later and later and later and I couldn’t sleep and I’d be crying and I’d be upset and then my parents would say, "Well what’s wrong?" you know, they’d take me into their bedroom and sit with me.

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In trying to do something about it, a very simple technique a woman used involved just repeating the word ‘Stop!’ to herself when noticing a negative thought. Another approach involves seeing the negative voice as separate from the self, and looking for the humour in it, such as one man who characterised his negative voice as like a ‘slightly cantankerous family member.’

People who had had therapy could become very skilled in their approach. Interview DP06 became aware that she could examine a social scene in order to challenge her initial negative thoughts that she was to blame for someone else’s behaviour. Another woman was able to challenge the powerful feeling that she was a bad person and responsible for conflicts around her. One man was able to see the split in his thinking as ‘rational’ and ‘neurotic’.

Discusses how a therapist helped her to see that she might not be at fault if an acquaintance…

Age at interview 44

Gender Female

Age at diagnosis 41

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I think one of the analogies he used first off was, if I was walking down the street and somebody came walking towards me that I knew, and I knew well, but that they looked away and walked past me, how would I feel. And I said, "Well, you know, oh my God, you know, what have I done?" Or trying to remember the last time I met them, I mean what had I said. You know, feeling guilty that it was obviously my fault. It would never have crossed my mind as he would suggest, as he suggested to think that the person might well have had things on their mind, may not actually have seen me, may have been distracted by something else…..And I, I saw for the first time, other people had other issues that were quite separate from me…..And it made me realise over a period of time that….if something happened that I felt unhappy about [pause], I only saw it from one angle.

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Describes her illogical yet powerful thoughts that she was responsible for an office argument…

Age at interview 40

Gender Female

Age at diagnosis 37

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I’ve been doing diaries about thinking, of my thoughts, and there was recently an incident at the office – just a normal day-day one for me, where there were two colleagues. I get on well with both of them, I was sitting doing my own job, and there was some altercation in another room between these two people, and I felt completely responsible for this. I had nothing to do with it, I didn’t even know what they were arguing about, but I was responsible for it, and nothing could shake my view that I had brought this about. Something about me had caused them to have this argument, and, I know that’s completely illogical. I wasn’t in the room, I still don’t, to this day know what they were arguing about, but it was my fault, because that was the most obvious thing that I could think of. If nothing else makes sense, then I have to be in the wrong, which doesn’t make any sense at all, but it does when you’rewhen you are living through it, and there are lots of situations where I do take on responsibility for things that are not my responsibility and therefore not my fault.

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Describes how he has noticed he has a rational self (positive thought) and neurotic self…

Age at interview 50

Gender Male

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OK, so I mean I was saying that I think sometimes there are 2 [selves]. There is rational [self – participant’s name] which can look at things sensibly and think, “I’m OK, I can do these things” and theres neurotic [self – participant’s name] which thinks, “People don’t like me, they see something in me, they recognise that there is something bad about me, that’s why they don’t want to go out with me, that’s why they don’t want to,” I used to think, “that’s why they don’t want to give me a permanent contract”. Most of the time that I had been in education I had been on temporary contracts or dodgy contracts you know, and I sort of feel that they see something in me that is not good, they recognise that. And that is my way of explaining really, being single and certainly when I had job insecurity…

And when you are not neurotic how do you explain this sort of stuff?

I don’t need to explain it I just think [laughs] it’s a load of rubbish. So, when I’m rational then, like here I’m sitting talking to you, I can talk about these things rationally. If I was neurotic I’d think those things were true, I would think those people really did hate me.

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