Dis-ease (Mental Health)

from Philosophy for Any Life: an open-source self-help book

by Zachary G. Augustine

Editor’s Note:  This piece follows on from Zachary’s previous post.  The book is freely available to download at philosophyforanylife.com.

Anxiety
Today I escaped from anxiety. Or no, I discarded it, because it was within me, in my own perceptions – not outside.
—Marcus Aurelius^[i]

There is a real danger in focusing too much on learning about techniques as opposed to implementing them. The goal of therapy aims to break the linguistic circle of reading-and-thinking, ad infinitium, and to prompt a shift toward action.

Those who experience anxiety know unpleasantness of thinking too much. An apt description of anxiety is one of ‘rumination’. Those with social anxiety may ruminate on what could go wrong in a social interaction, or endlessly repeat inconsequential events. Those with more generalized anxiety may ruminate about nearly anything. The word itself refers to the digestion method of large grazing animals (like cattle) that ferment cellulose by holding it in a special, extra stomach for a long period of time. Cattle must sleep standing up because the slurry of grass and digestive juices would otherwise spill into their other stomachs.

Not that cattle aren’t infinitely interesting, but the point is that rumination has a negative connotation, one of referring to the lower animals. That is, while humans are distinguished in our ability to pause and think through problems (as no one has ever seen a cow ponder), we are also responsible for deciding, that is, stopping thought and resuming action at an appropriate time. Ultimately, humans are distinguished by action in combination with thought, not either alone. And action without thought is worse than ignorance, for the base form of judgment is one of blindly trusting the desires and judgments of the body. This leads to consequences that you would not otherwise accept. The opposite is also true: Thought by itself moves nothing.^[ii]

Treatment depends on honest and good judgment of oneself. A key factor is the recognition of your own anxiety-producing practices. You must find their root, which tends to be mental and verbal in origin.^[iii] Problems can seem large when they are dealt with in an excessively verbal manner – anyone who has sat in on a bureaucratic meaning can attest to the damaging powers of bloated words. Rather, you will feel relief if you can develop your own techniques to break the verbal cycle. To get outside of your own head, so to speak. The techniques themselves vary based on the situation, but fundamental to all of them is correctly identifying that your recovery is within your own control, the acceptance that it may be difficult and a willingness to try in spite of this, and a responsibility to take your recovery into your own hands. Kabat-Zinn summarizes the importance of this disposition:

“The deciding factor…is the willingness of the patient to try to do something for himself or herself to cope with some of the pain, particularly when it has not responded fully to medical treatment alone. People whose attitude is that they just want the doctor to ‘fix it’ or to ‘make it go away’ are not good candidates. They won’t understand the need to take some responsibility themselves for improving their condition. They might also take the suggestion that the mind can play a role in the control of their pain to mean that their pain is imaginary, that it is ‘all in their head’ in the first place.[iv]”

The notion that pain is real but mental is crucial to the whole effort of recovery. This is not to deny that pain feels bad or can impact our lives. But it to deny, firmly and absolutely, that we can do nothing about it. While we cannot outright ‘cure’ our mental ailments, we can minimize them to the point of nonexistence. Even more so, we can learn from them and grow into a stronger, more loving person than had we never experienced that kind of pain. In the end, any ailment ends up being an impetus to change, an opportunity for growth. But it is only an opportunity, one you have to actively take. The ailment itself is changed through this realization, just as you are changed by the ailment, and changed again by acceptance of the ailment: in all three cases, suffering ceases the moment it acquires meaning.^[v] You may find that the pain itself lessens once you stop fixating on it. (This was certainly my experience.) Instead, a positive outlook actually and physically makes your situation easier to bear. The key is to direct your energy toward other activities, almost as if you are distracting your mind, long enough to show yourself that you can think about other things besides an unpleasant situation. And once you begin to think that, it will become easier and easier to distract yourself until you no longer feel compelled to think of the pain as a hindrance.

Mental health treatment must be viewed as an ongoing process of change, not merely just a cure delivered to an otherwise static patient. As patients, we often want doctors to change our bodies in order to relieve our minds. But relief often only comes from the opposite: we must make up our minds, and then our bodies will follow. Doctor’s simply won’t say this, because it defies their job description, and the ideal we hold of them. It is a matter of shifting the locus of control from an external antidote to an internal one already contained within your mind. Realize truly what is within your control, and what is without. Here especially, be patient as you learn to accept these things. You will feel frustrated. Things you wish you could be now, ideas yet unfulfilled, shapes you can see the outlines of but never materialize, a thought you grasp for only a moment before it disappears and is replaced by the nagging pain of knowing that you’ve forgotten. This is frustration. But you can teach yourself not to accept frustration and work through it. You can cultivate the muscle of patience and understanding, through forgoing false judgments in favor of reality and all its flaws. This is because, “the value of attentiveness varies in proportion to its object. You’re better off not giving the small things more time than they deserve.”^[vi] And the pain you feel is outside of your control, and thus not something worth focusing on.[vii]

Obsession

When your mind becomes obsessed with anything, you will filter everything else out and find that thing everywhere.
—Pi^[viii]

You can’t change the fact that this obsession exists. For you, it’s real. Don’t waste energy denying that.

But you can modulate your response.

This is the problem I felt most acutely. I developed irrational fears about things that never used to bother me. I knew they were irrational but I couldn’t stop. That was the worst of all.

I became fixated on ways I might accidentally or intentionally hurt myself. I was afraid that I might hurt myself. Through that fear, I became afraid that I might want to hurt myself. This fear grew and I ended up causing myself a lot of emotional suffering. My fear of suffering directly caused my suffering, because I was stuck in certain mental feedback loops. It is illogical, ironic, and borderline insane. But through simply feeling fear, worrying about fear, and worrying about worrying about fear, I spiraled downward and watched as I let my obsessions begin to impact my daily life. (This happens to be a good litmus test for looking more objectively at the state of your own problems – to what extent do your problems impact your life on a daily and long-term basis?)

I developed an irrational fear of knives, scissors, heights, and driving. I knew it was ridiculous – I had no intention of ever hurting myself – but in spite of this knowledge I could not stop worrying that one day I might. If any of those situations presented themselves, I froze. If I was cooking in the kitchen, I was watching the knives. I would sweat constantly, my heart stuttering as I walked up a tall staircase for fear that this time I would lose control entirely, have a mental breakdown, and throw myself off.

These obsessions carried over into my personal relationships. It became difficult to drive to see my friends. I became worried about trivial matters, like small sums of money or arguments with strangers on the Internet. These were ways that I could express my desire for control, in however small a way. I was so afraid of losing control that I lost it. Now, I am at peace with the fact that much is outside of my control.

So believe me when I say even some of your own thoughts are outside of your control. That’s a horrible feeling – to lose control of yourself. But it is manageable, I promise.  Don’t get discouraged, “Don’t let your imagination be crushed by life as a whole. Don’t try to picture everything bad that could possibly happen. Stick with the situation at hand, and ask, ‘Why is this so unbearable? Why can’t I endure it?’ You’ll be embarrassed to answer.”^[ix] Take that feeling of embarrassment, and focus on that. Laugh at how strange your mind works, how silly sometimes you are. Don’t invalidate the way that you feel or the things that grab your attention. But see the humor in it, and take them for that they are worth. How things that seemed urgent a moment ago now don’t make much sense.

Depression

If you look for the light, you can often find it. But if you look for the dark, that is all you will ever see.—Iroh^[x]

Depression is the inability to imagine a future.^[xi] It is the assumption that your current mental state will continue indefinitely, and that such a continuation would be bad. Why would it be bad? Because your current mental state feels unpleasant, you don’t want it to continue. It would be bad because it is bad to have your current feeling continue indefinitely. It is a vicious feedback-loop. It is illogical. But, it is nonetheless real.

Depression can occur by itself or in tandem with other conditions. Often, more fundamental problems such as anxiety, phobias, or other chronic conditions wear you down. They may weaken your overall health, and leave you more susceptible to other things: difficulty sleeping, worsening eating habits, weakened immune system, etc. It is often in situations like this that one can begin to feel discouraged. And that is the breeding ground for depression, a capstone added on top of your health problems when your back was already strained. You didn’t ask for this, but you have to face it nonetheless. If you begin to feel depressed for other reasons, you obviously have to deal with the root problem. Learning to handle your anxiety or OCD can take the edge off of growing depression before it becomes a full-blown problem.

That said, depression can have no other illnesses exacerbating it. It may seem that there is no physical reason for it; this may be true. In that case, it is important to get help. It could be as simple as not getting enough vitamin D, or it may be an issue that needs to be talked through. The only way you can know is if you get help. But in any case, reasonable or unreasonable, physical or mental, you can construct your own sense of meaning in your life. This meaning can be anything you can think of. And having some sort of focus, even if it appears simple or is just a hobby, will always make your condition easier to bear. And before you know it, you’ll feel much better.

Chronic conditions

Nothing but what you get from first impressions. That someone has insulted you, for instance. That – but not that it’s done you any harm. The fact that my son is sick – that I can see. But ‘that he might die of it,’ no. Stick with first impressions. Don’t extrapolate. And nothing can happen to you.
—Marcus Aurelius^[xii]

It’s important to stay positive, and it is always possible to do so. Those words mean little by themselves. But behind them is a deep truth relevant to all of our lives. Living is painful, and often for no good reason. But life in itself is reason enough to keep going – it is always worth it, and it is always possible to believe as much, if you choose.

Take every step you can to improve your overall well-being. Any positive change you make will also have effects on your ailment. There is no reason for your pain; it is random, or unlucky, or unforeseeable. But there is always a reason to endure pain. It acquires meaning when you choose to endure it. For pain only becomes suffering when you cease to endure it. That word is important; it is active, it is everlasting, it is optimistic. It says that you have within you a willpower that you can always stretch further than before, and always replenish quicker than last time. It may not get better, but it will get easier.

Despite your ailment, you will wake up every day with determination, energy, and hope. It may not feel like it now, but it will. To wake up every day and face a new set of challenges is wonderful. You just happen to have more challenges than some people. But you also have less than other people, and for that you should be thankful. There was no way to know where you would end up on the random spectrum of what life has dealt us. And even now, although things may seem bad, there’s no way to know where you’ll end up. Won’t it be interesting to find out.^[xiii]

It may end as quickly as it began, or not at all. It could stop and come back. But the answer in every case is the same: do the best you can. Don’t let yourself get discouraged by a lack of external progress, for the only progress that matters is internal.

Often these kind of things are what you have to learn to live with. And when you finally feel defeated and are about to give up, you resign to the fact that this is something you will have to get used to. You will just have to deal with it, and make the best of it. Then, at that precise moment, it passes. Paradoxically, when you stop trying to get rid of it, it disappears. This is something that requires suffering to realize. You have to go through it to understand: it didn’t go away. It’s still there. Only, now, it doesn’t bother you. What you did instead was learn that it doesn’t need to bother you. You learned how to get around, despite the obstacles. Only by fully and honestly submitting to the reality of the situation can you come to live with it in the best way possible.

Recovery

Pain is neither unbearable nor unending, as long as you keep in mind its limits and don’t magnify them in your imagination.
—Marcus Aurelius^[xiv]

A positive attitude is integral to your recovery. What if what was holding you back this entire time, preventing your recovery, was your negativity? What if just by changing your mindset – which is always within your power – you can change your life? Then you have nothing left to fear. Often, paradoxically, it is our behaviors that sustain our illnesses. Like the addict who realizes his deteriorating condition and wants to change, but lacks the resolve to do so yet. Perhaps that addict is used to feeling this way. Perhaps he has come up with behaviors that no longer give him comfort, but are simply familiar. And so the addict continues, not because he enjoys it anymore, but because he’s frightened of change. As Aurelius says

Frightened of change? But what can exist without it? What’s closer to nature’s heart? Can you take a hot bath and leave the firewood as it was? Eat food without transforming it? Can any vital process take place without something being changed? Can’t you see? It’s the same with you – and just as vital to nature.^[xv]

As difficult as it may be, you need to want to change. What you want to do is suspend the doubts of your mind for long enough to act positively. Action has great positive changes on the body; this much is well known. If you change your physical state, if you achieve a basic state of physical health and activity, your mind will follow. And if you change your mental state, it will be easier to change your physical state in the future. And then you know how it works, and that it can be done, and it becomes much, much easier.

This takes time. Be patient with yourself.  There will be times when it feels hopeless, when the pain is unbearable. When it would be easier to return to your old ways. This is good! It shows that your body is resisting the changes you are trying to implement. This means that you are close to overcoming the body’s resistance. Feel the pain (don’t deny that it’s there) but don’t give into it fully. “Unendurable pain brings its own end with it. Chronic pain is always endurable: the intelligence maintains serenity by cutting itself off from the body, the mind remains undiminished. And the parts that pain affects – let them speak for themselves, if they can.”^[xvi] Maintain control of your mind despite the pain – always keep a bit of yourself pulled back a bit to watch what’s happening to yourself. Just watch.

Through this act of self-observation (metacognition) your pain will lessen as you come to understand yourself better. You will reinforce a self-imposed divide between body and mind, one that nature would rather do away with, reducing you to little more than an animal. But as anyone who can endure great pain can tell you, the body cannot rule the mind; they should never converge to the same entity.

Do not hesitate to ask for help; for your worries about appearing burdensome are a just another internal barrier you have erected to bar your own recovery. You are far more conscious of your own faults in this regard than anyone else – it is just as likely that those close to you want to help, but don’t know how or are afraid to ask. It is your responsibility to ask for help, and you will be floored by the support that you receive. The stigma surrounding mental health issues is already disappearing rapidly, and what little that remains is mostly imaginary. Your problems, however, are real, and any barrier to your recovery must be overcome. Any stigma is then useless or illusory, and can be safely ignored. Do not be afraid; everyone you could possibly encounter during your recovery wants nothing more than for you to succeed.

Do not be discouraged if progress is slow. As Hemingway says, “The world breaks everyone and afterward many are strong in the broken places. But those that will not break it kills.”^[xvii] It is okay to be broken, for you will always heal stronger. And to break in some areas and recover is infinitely better than the alternative. I want everyone to become strong at the broken places, and I hope that this book will help you in some way. But these words are no substitute for serious medical help, if that is what you require. So please, ask for help when you need it, because there are some things that are outside of your control.

In the end, you will find yourself stronger than had you never faced any difficulties. You will look at yourself and be proud of who you became. And you would do it all over again if given the chance. Because if you didn’t, you wouldn’t have learned anything. You wouldn’t be as strong as you already are now, or nearly as strong as you will become. It will all be worth it. Always.

Friends and Family

We must not force crops from rich fields, for an unbroken course of heavy crops will soon exhaust their fertility, and so also the liveliness of our minds will be destroyed by unceasing labour, but they will recover their strength after a short period of rest and relief: for continuous toil produces a sort of numbness and sluggishness.
—Seneca, On Peace of Mind

There is a constant tension between asking those close to you for help and remaining silent. You need support more than anything, but it can be impossible to communicate something you don’t fully understand or even accept yourself – so how is anyone else supposed to? And that feeling of burdening those close to you never quite goes away. But I have been on both sides of that emotional support system, and I can guarantee you that there’s nothing they would rather do than help you. So please reach out to them. It will be as relieving for them to help you as it will be for you.

If you know someone who is struggling, you must understand they are already beyond frustrated with themselves. They already feel immense lot of guilt, shame, embarrassment, and helplessness. Constantly they feel as if they are a burden. So you must take great care to not add to this weight.

Also recognize that they express this internal frustration outward, and often to those closest to them. So take any negativity they express with reservation, for surely it does not reflect upon you and your actions. Even if you treat them with nothing but kindness, you will inevitably receive responses from them that are unwarrantedly negative – from your perspective. If only they could see that things aren’t as bad as they’re making it out to be. From theirs, the world is drained of its color, and you would have to be blind to not see it. Keep that in mind.

If this happens, reflect that you have far more perspective, willpower, and patience than they do in their current state. Don’t criticize their behavior, which is a direct representation of their mental state, which they have little control over (at this moment in time). To criticize any of this – to express your frustration or empathy or pity for their sorry state – is to further degrade their already minimal self-worth. You may feel frustrated that they can’t exit their slump. But surely they feel this same frustration ten times more strongly. It’s not that they don’t see it, it’s that they feel powerless to do anything about it. It is a compulsion, a necessity. And an unfortunate byproduct of that is you will have to shoulder some unpleasant encounters, reassurance, and complicated or otherwise stressful situations. Be patient, for your patience is one thing you can do to help.

Don’t take how they treat you personally; they may feel so trapped that they likely don’t have much else they can do other than lash out at you in this way. Remember that your willpower goes ten times as far as theirs. In their state, it is almost as if they are a different person.

With your support, they will emerge stronger than they were going into the ordeal. And when they come through the other end – and they always will – they, with their newfound perspective, will be incredibly thankful for how you helped them. The previous feelings of guilt and shame will be replaced with only love. The sense of burdening one another fades, instead replaced by an image of the posts of a new foundation: what weight would crack one alone is effortlessly supported by multiple. While similar things would be crushing alone, they are that much easier to bear when we rely on each other. It will be because of you they succeeded, and they, too, will help you to succeed. That is what a meaningful relationship is, and it is perhaps the strongest thing there is.

Zachary G. Augustine is a student of philosophy and history at the University of Chicago. Besides writing, Zach does contract work and teaches as a graphic designer and is an advocate for open content, tech education, and mental health. Take a look at his work or send him an e-mail at zacharyaugustine.com. Zachary has written an open-source self-help book, based on Stoicism, which you can find at http://philosophyforanylife.com.

[i]Ibid., IX.13.
[ii]Aristotle, Nicomachean Ethics.
[iii] “There is evidence within the CBT literature that a preponderance of verbal processing in the form of rumination is associated with a range of psychological symptoms, overgeneral memory, and poor problem solving (e.g. Watkins, 2008). Conversely, the ability to flexibly integrate verbal and sensor/perceptual information may be the hallmark of more adaptive processing.” Richard. Stott, Oxford Guide to Metaphors in CBT: Building Cognitive Bridges, Oxford Guides in Cognitive Behavioural Therapy (Oxford: Oxford University Press, 2010), 19.
[iv] Kabat-Zinn, Full Catastrophe Living, 287.
[v]Frankl, Man’s Search for Meaning.
[vi]Aurelius, Meditations, 2002, IV.32.
[vii] A theme repeated often in the excellent Richard Carlson, Don’t Sweat the Small Stuff – and It’s All Small Stuff: Simple Ways to Keep the Little Things from Taking over Your Life, 1st ed. (New York: Hyperion, 1997).
[viii]Darren Aronofsky, Pi, Drama, Thriller, (1998).
[ix]Aurelius, Meditations, 2002, VIII.36.
[x]The Legend of Korra, Animation, Action, Adventure, (2012), bk. 2 Episode 10: A New Spiritual Age.
[xi]Steven Soderbergh, Side Effects, Crime, (2013), http://www.imdb.com/title/tt2053463/. This movie may be disturbing for those with mental health illnesses, but this phrase taken alone sticks with me as an accurate depiction of depression.
[xii]Aurelius, Meditations, 2002, VIII.49.
[xiii]The Legend of Korra, bk. 4 episode 2: Korra Alone.
[xiv] Aurelius, Meditations, 2002, VII.64.
[xv]Ibid., VII.18.
[xvi]Ibid., VII.33.
[xvii]Ernest Hemingway, A Farewell to Arms, 1st Scribner classics ed. (New York: Scribner Classics, 1997).