Depression and Lack of Motivation

This past week, May 5th to 12th, was Mental Health Week, which led me to reflect on my personal experience with depression, something I have struggled with multiple times throughout my life.

There is a misperception that depression is strictly an emotional or mood disorder; the truth is that depression affects every aspect of one’s life. Depression affects how one feels, how one moves, how one thinks, how one behaves. And, for me, the hardest part was how it affected my ability to set and meet goals, or to find the motivation to do more than just survive the day.

Depression robbed me of my drive, my ability to initiate activity, my ability to concentrate, retain information, and to recall words and/or thoughts. During my periods of depression I was physically, emotionally, and mentally fatigued. I was exhausted, and every movement required more energy than I could muster. The fatigue and the lack of motivation made it hard to do the simplest task. Brushing my teeth became a chore that was utterly draining. What made this even harder was people telling me I could “just snap out of it” or “get over it” if only I “tried harder”. They didn’t understand that it was taking everything out of me to exist. That I was trying as hard as I could, but that my best just wasn’t cutting it. This led to frustration, guilt, disappointment, and conversations with myself in which I continually beat myself up for not being able to get things done. And these conversations of self-abuse just led to more exhaustion, frustration, and depression.

Many of us are perfectionists, and expect more of ourselves than other people would ever expect of us. This makes the lack of motivation during depression even harder as our expectations for ourselves don’t change with the depression, but our ability to go about our daily life does dramatically alter. I had to learn to find success in lowered expectations. I had to give myself permission to lower the bar, and applaud myself for anything and everything that I was able to accomplish. I had to learn to focus on small steps and small successes. It started with getting out of bed. I would lie in bed, while a constant dialogue ran through my head, telling me to get up, knowing I should get up, but not being able to find the energy to actually get up. And, if I actually began to move out of bed, I felt like I was moving in slow motion, every movement required so much energy, and I felt drained just moving from the lying position to the sitting position. But then I learned to see this as a success. When I am not dealing with depression getting up from bed is an action that is so natural and automatic, that I give no thought to it. But when I am dealing with depression it seems equivalent to scaling a mountain. I learned to see it as a success, and to use getting out of bed as a springboard for the other daily activities I needed to achieve. I reminded myself that if I didn’t get out of bed, nothing else would be accomplished. Getting out of bed is vital to the day, it is a hard first step, and so I congratulated myself for completing that first step.

I learned to break tasks into small steps. Brushing my teeth was broken down into going to the bathroom, getting the toothbrush, putting the toothpaste on the brush (such an easy step to skip), and then properly brushing my teeth for the full two minutes. Each of these steps required enormous energy from me, and so I gave myself credit for each small step. By doing these small steps, and acknowledging the successes within them, I was able to move on to the next task.

It is extremely difficult to let a lifetime of perfectionism and high expectations slide. It is not natural, and it takes effort. But, for me, it was the main thing that helped to move from task to task, congratulating myself along the way for accomplishments that on a normal day I wouldn’t even notice doing. The depression robbed me of being at my best, and the only way I could work towards getting back to my best was to acknowledge that I was in a different situation, lower my expectations, and find success in small steps. Each day I would try to do a little more, but I would try to understand if I was unable to do something. The self-abuse of negative thinking was part of the frustration in dealing with my depression, and it exhausted me. I had to work hard to realize that I was emotionally draining myself when I beat myself up for not being at my best, for not meeting my high, and unrealistic, expectations. When I gave myself permission to focus on new, smaller, goals, I had less of the negative conversations in my head, but it wasn’t easy.

You can’t force motivation. It cannot be called upon by will. But neither is it best to wait for motivation, or one can be waiting a long time. Instead, I have found it best, in my experience, to take small steps to move towards motivation. To see success in lowered expectations. Part of depression is feeling like things are never going to get better, so when I can concentrate on small successes, I see that things can move forward by small increments, and maybe, just maybe, I can work my way out of depression. I can try to switch my focus from the fatigue and inability to do normal activities to seeing that I am accomplishing something, even if it is as seemingly simple as not sleeping all day, or sitting outside instead of inside, or only having a two hour nap instead of a four hour nap, or brushing my teeth with toothpaste.

This isn’t the case for everyone. The treatment of depression is different on a case by case basis. I have required medication and therapy, and other treatments, in addition to the work I do on myself. Success in lowered expectations and small steps is not the cure-all, but, for me, it was a vital component in my moving from a place where getting out of bed required every ounce of physical, emotional, and mental energy, to where it was so natural, I barely gave it a thought. It wasn’t a quick road from one to the other, and there were a lot of setbacks. It isn’t easy to drop being a perfectionist, but with work, time, and medical assistance, I was able to work my way back to motivation.

Tips for Interacting with People Who are Blind or Who Have a Visual Impairment

The following are some things to remember when interacting with a person who is blind or who has a visual impairment.

As you approach the person, announce your presence, as well as your name.

Speak directly to the person in your normal voice.

Do not touch the person without first asking for, and receiving, permission. Respect their personal space, and understand that touch may startle them.

If you think you can assist them, ask them first and wait for their reply. If they reply in the affirmative, let them guide you in how you can best assist them. Follow their instructions. Don’t make assumptions about what they need. If you are unsure, ask them. They will best know what they need.

If they accept your offer to guide them, offer them your elbow and walk at your normal pace. Tell them about upcoming changes in elevations, steps, or barriers.

If you move away from the person, tell them that you are leaving. They may continue to talk as if you were still there, so it is polite to let them know when you are finished with the conversation, needed elsewhere, or need to go.

Do not talk to, or touch, service animals. While it is hard to resist the urge to touch animals, it is necessary. Working animals must concentrate on the task at hand. They may not look busy to you but they are on the job, and as such should not be distracted. Some people do let others pet their service animals, but assume the majority do not, and try your best to ignore the service animal. If you are unable to resist, ask first whether you can touch the service animal, and, most importantly, respect the answer.

If you are offering directions be precise. Do not use terms such as “over there”; this does not mean anything to the person. Do not point. Be as clear and concise as possible. If you can, use distances (100 feet, 10 metres, etc.). Let them know if there are any barriers in the way that they should be aware of.

Don’t assume a person can or cannot see. Some people who are blind have no vision at all, others are legally blind and have very limited vision, others have visual impairments that can differ in severity, shape, texture, etc.

Be patient with yourself. While interacting with a person who is blind or has a visual impairment, you may feel uncomfortable, nervous, unsure, or confused; understand that this can be a normal reaction to interacting with someone who has a disability, especially when you have little or no experience. When in doubt ask the person with whom you are interacting, they will best know what they need, and  if, or how, you can help.

Treat the person as you would anyone else. A person with a disability is a person first and foremost. Their disability may require some alternations to how you interact, but it should not affect how you treat the person.

Your Pain is Real

I recently attended a talk given by Ron Coleman, from the Hearing Voices Network, an organization that is run by users, in a self-help capacity, for people who experience auditory hallucinations. This group teaches that people should explore, engage, and in some cases, negotiate with the voices they hear, as opposed to only utilizing the medical route which is to deny the voices, or to label them as delusions, and to go the drug-based route which can add damaging side-effects to a person’s life. While I listened to Coleman talk about his own experience as a person with Schizophrenia who went from living in an institution to getting involved with Hearing Voices, and now being a husband, father, and speaker who travels the world, several things really resonated with my experience as a person with disability and chronic pain. This is the second of two blogs that will explore comments made by Ron Coleman and how they really resonated with me, and, I believe, will resonate with many others who live with chronic pain and disability.

Ron Coleman lived in an institution for years. Then one day, one of his support workers suggested that he attend a meeting for the Hearing Voices Network. He was resistant at first, but following some negotiations, he agreed to attend. When he arrived at the meeting a man came up to him and asked “do you hear voices?”, Coleman answered “yes”, and what the man said next forever changed the direction of Ron’s life; he said “the voices are real”. This statement lifted a weight off Ron; this acknowledgement that the voices he experienced were real, and not delusions to be ignored, denied, or medicated into oblivion, was life changing. The impact of that simple statement really resonated with me. I ran a chronic pain support group for six years, and there was not one person who attended our meetings who hadn’t been told by someone in their life that their pain was not real, that is was imagined, made-up, or exaggerated. Then they attended one of our meetings, and they were believed, and you could see a weight being lifted by the acknowledgement of the reality of their experience.

It can be very lonely having chronic pain. Only you truly know what your body is feeling. You can do your best to explain that pain to loved ones and medical professionals, but they don’t feel it, it isn’t as real to them as it is to you. This is especially the case when there is no accompanying visual sign of something being wrong. There is doubt, on their part, that the pain is real, or as bad as a person is saying. That doubt can be very damaging to the person with chronic pain, as they know what they are feeling but they don’t know how to get others to understand.

For many people with chronic pain it takes years before a diagnosis is discovered. I, personally, did the doctor/specialist dance for six years before being given a diagnosis. During these years, people with chronic pain are constantly questioned, doubted, and told it is all in their head. They encounter medical professionals who can’t figure out the pain, so place the blame on the patient instead of admitting that they just don’t know what is happening, or how to help the patient. The person with chronic pain begins to wonder if it is all in their head, they begin to doubt their own pain. They begin to doubt their own perspective, their own experience. Chronic pain is complex. It does involve emotional and psychological components. How could it not? When one has chronic pain, one’s life is turned upside down. Many have to leave work, school, quit hobbies, sports, and change the way they do everything in their life. Chronic pain affects relationships, interactions, productivity, and most of all, a sense of self. There is no denying that people with chronic pain deal with more than just pain. But that does not mean that their pain is any less real.

Unfortunately there are people who pretend to have chronic pain, who exaggerate their pain, or who use pain as a way to gain attention and sympathy, but, like so many things in life, that group is a tiny fraction, like 5%, of the overall group. It does not represent everyone with chronic pain, and yet so often it is the stick by which others with chronic pain are measured. It can become quite difficult to remain steadfast in one’s own perception of their pain when faced with this kind of constant doubt and cynicism. So when someone with chronic pain, who is used to doubt, negativity, and people thinking it is all imagined, is asked “do you have chronic pain”, and they answer “yes”, and they are told “your pain is real”, they, like Ron Coleman, feel a weight being lifted. They are relieved that they are believed. They can be overwhelmed with emotions, because their pain is so very real to them, but often denied by others. This acknowledgement can give a person with chronic pain the strength to continue forward, fighting for a diagnosis and/or treatment, secure in knowing they are believed by someone. Hearing, from another, that their pain is real, also demonstrates that they are not alone. Like those who hear voices, people with chronic pain can easily become isolated, feeling as if they are the only person who is experiencing this. But that is not true. Just as those who hear voices are not alone, neither are those who have chronic pain. And just as those who hear voices should not deny the voices, those with chronic pain should not deny their pain. They should also not let others dictate what one feels. If you have chronic pain it is real to you, and therefore your pain is real.