On Mental Health

Mental health and specifically depression is a tricky issue, even controversial. For some, it’s an excuse lazy people came up with to not follow through on things. It makes dealing with it that much harder. Two points to note here, before I carry on:

1. In some cases they are right. There are people in this society, who will manipulate and game the system, even weaponise good things, to gain some sort of satisfaction out of it. Sometimes because they are lazy, sometimes because they have a different mental health issue.
2. The people actually dealing with it, myself included, will have the exact same thoughts about themselves. “Just pull through it!” is the inner voice screaming. I call it my inner drill sergeant. Sorry to all drill instructors out there.

I have been asked in the past via DMs and calls, how I deal with it. So this post is partially an answer to those questions, partially catharsis for myself.

Note: Always consult with a professional. Do not just depend on what random people on the internet say about mental health. Use this article as a litmus test: if it resonates with you and you haven’t seen a professional yet, maybe it’s time to do so.

What happens, when ‘it’ happens?

This is highly individual and somewhat complex, since it’s often not a single thing. The best way to describe what happens to me is “mental paralysis”. Things competing for my attention will cancel each other out, to the point I’m not able to do anything. Some of those things will also trigger a deeper fear and my mind literally goes blank. Zilch. Zero. Nada.

Depending on what triggers it, the blankness will do a relay race with mental cinema of various past incidents that rub me the wrong way.

The whole thing is accompanied by physical symptoms. The mental cinema especially puts the cardiovascular system into overdrive, which in extreme situations will trigger spasms. It’s not just exhausting, it’s often painful. I take it by joking about the cardiovascular and muscular benefits it should have similar to a workout (and my Apple Watch agrees). I continue to feel the pain from it for hours, the muscle soreness for days. It puts a serious dent into any ambition of proper exercise.

Other physical symptoms include headaches, aching muscles and increased tinnitus among other things. It’s a true smorgasbord of unpleasantness.

For good measure, a lot of tasks fall victim to the mindset of “does it matter anyways”. Not just tasks, habits. Things that usually get done automatically without thinking about them. My structure simply falls apart.

What to do, when ‘it’ happens?

Again, highly individual. I’m still looking for the best way to deal with it, since a way that worked yesterday, may not work tomorrow, but again next week. The best way probably is multiple different ways, which kind of makes sense.

Some days, going for a walk in the woods is the answer. Other days it will utterly fail to help. Playing certain games will help as well. My brain needs to be occupied with something that is significantly different to what I did (or should do). It can’t be too hard, because my brain can’t take it in that moment, but it can’t be to simple either, because my brain will go back to the bad place.

Sometimes, though this is the most time consuming way, I just let the thoughts run their course. Consciously and actively acknowledging they are there and verbalising them will help sometimes. This will sound familiar, if you have ever tried meditation.

What I will never ever skip is writing the whole thing down: when it happened, what the symptoms were, what was the context when it happened, not just the very situation I was in, but usually everything that comes to mind even a couple of days before. Sometimes it builds up. Other times, it’s surprising. You don’t need to do a root cause analysis, but dig a bit deeper than the primary thoughts.

Note: while “active” meditation never clicked with me, i.e. doing meditation for meditation’s sake, I do engage in activities that result in meditative state. I need to “cheat” my mind to do meditation, so to speak. So if you have issues with “doing meditation” as well, maybe you also need to find your meditation activity.

How to get back on track

Now to the bit some of you desperately have been waiting for. Remember that just because it works for me, it may not work for you. Some steps might not even be feasible for you for whatever reason.

The tl;dr: re-establish structure.

Firm rules are better than hard rules

What is the difference? Firm rules are hard rules with an escape hatch that can be used in very specific and limited ways. In the end it’s a contract with yourself and you can game yourself into inertia.

You probably know some examples of firm rules: I think it’s called “never skip twice in a row” and is the concept that skipping a habit always has to be followed by doing the habit, before it can be skipped again.

A similar concept is with streaks, where it’s recommended that a break in the streak should not reset the streak entirely, but should have a recovery strategy.

You get the gist. Be firm, but not too hard on yourself! Use the firmness together with other helpers to gain back momentum.

Checklists & Routines

This is where things may sound silly to the uninitiated. Externalised structures usually help. If all else fails, I live by one or more checklists. Even for obvious or stupid things, like brushing teeth. I put everything onto checklist and bundle and stack certain checks into routines, like a morning routine and an evening routine. Then I work through them like assembly instructions.

I recommend to have an external verification for the hardest days, because as human beings we’re very effective at cheating ourselves. This needs to be a person. No app, journal, alarm, reminders or other self regulation will help when things get really bad. That’s OK!

Do at least one (specific) thing

The previous only covered the basic life structure so far. What about those one-off things that you may have to do or things you want to do, but feel guilty of doing, because of all the other things you have to do (usually at the request of another party).

The answer for me is instead of having three or more things on the todo list for today, I just have one thing. Usually one thing related to any of the big areas I have to deal with, so it is moved forward — that’s where the “specific” part comes from. That’s already plenty considering that on bad days those life structure checklists and routines will consume plenty of my energy already.

I also apply the above rule regarding firm vs. hard rules, by allowing myself to skip this one thing per day, once. Usually the day when I was triggered. In bad cases, there are one or two further days with zero things, but never in a row. There is always one day with an action in between, often even a full day of many actions, until things normalise.

Which task you may ask? Some suggest to “eat the frog” and tackle the task giving you most grieve. That may work, but for me it takes a couple of days. I have a different strategy.

Let randomness help you

In these situations everything seems important, therefore nothing is important. The old adage about priorities is truly alive and kicking when I’m struggling. I learned to embrace it.

Whenever I get back into my structure, I ignore internal and external priorities. What I want or what others want is irrelevant. I let randomness decide what this task may be and then do that (unless it’s blocked by something else of course).

Through reflection, I even noticed that having a random day every now and then, helps me to stay on track. On those days, it doesn’t matter what is already in progress, what may be important or urgent, I simply take one random task, move that forward, take the next. Now in order to understand the last sentence, you probably need to know how I organise myself on normal days, but that’s a different post. Let me know if you’re interested.

It may sound anti-structure to depend on randomness, but it really works for me to keep my structure healthy.

When you’re back on track, reflect and reframe.

When I’m back on track to a certain degree, the work is not done. Two things help me here: reflection and reframing. Both may seem obvious, because when you break it down, therapy is all about reflection and reframing (depending on the type of therapy of course).

Self reflection comes naturally for me, often to a fault. So I need to do it in a conscious manner, to not do more harm (because the self reflection can be a starting point for the mental cinema mentioned earlier). Reframing already helps here: I reframe the reflection as a curious exploration into the what happened and why, kind of a scientific investigation.

That’s why I write things down almost immediately. It’s like the black box of a plane. It allows me to draw conclusions after the fact, when I’m not in the emergency situation anymore.

During my hospital visit, I started using a tool, which in hindsight I should have used much earlier. If you know me, you will probably say “that’s so very JJ of him”. The tool is a virtual whiteboard. I put situations, symptoms, learnings (from therapy and self reflection), thoughts and other things on this board and connect related items with arrows to make their connection explicit. It helps me understand and refine my reaction to the triggers of my depression. It’s a living document of my recovery.

Combining the various inputs during the hospital visit (and after) like this, allowed me to pin-point very specific situations and how to deal with them very rationally. It also reframes “quitting”. In some situations it is not just an option, it’s the only healthy way forward. Seeing it written down or in form of a diagram on a (virtual) whiteboard is freeing. It also happens to satisfy my curious and analytical nature. My therapist loved it when she saw it the first time, because it made her job easier as well.

If you take anything from this post, take this. Put things down, connect the dots. Do it on paper or digitally. I used FigJam, but everything that can create boxes, put text into boxes and connect these boxes will do the job just fine^[1]. These days, I would probably use Excalidraw, in fact, I consider redrawing the FigJam board in it, because the “sloppy”, hand drawn style of Excalidraw is very pleasing and probably conducive in this context.

Let me know, if this helped you.