Friday, September 11, 2009

Making it through a difficult day or night

It can be hard to make it through the next hour, if you are feeling desperately unhappy, agitated, empty, worthless, or isolated, especially if you also feel disconnected from love, meaning, community, "belongingness," or relationships with others.

Such desperate places of mind can yet be familiar places, and a certain set of coping tactics may evolve. Sometimes social isolation or sleep can help the time pass; other times there can be addictive or compulsive behaviours of different sorts. These tactics may either be distractions from pain or distress, or may serve to anesthetize the symptoms in some way, to help the time pass.

Time can become an oppressive force to be battled continuously, one minute after the next.

I'd like to work on a set of ideas to help with situations like this. I realize a lot of these ideas may be things that are already very familiar, or that may seem trite or irrelevant. Maybe things that are much easier said than done. But I'd like to just sort of brainstorm here for a moment:

1) One of the most important things, I think, is to be able to hold onto something positive or good (large or small), in your mind, to focus on it, to rehearse it, to nurture its mental image, even if that good thing is not immediately present. The "good thing" could be anything -- a friend or loved one, a song, a place, a memory, a sensation, a dream, a goal, an idea. In the darkest of moments we are swept into the immediacy of suffering, and may lose touch with the internalized anchors which might help us to hold on, or to help us direct our behaviour safely through the next 24 hours.

In order to practice "holding on" I guess one would have to get over the skepticism many would have that such a tactic could actually help.

In order to address that, I would say that "covert imagery" is a well-established technique, with an evidence base in such areas as the treatment of phobias, learning new physical activities, practicing skills, even athletic training (imagining doing reps will actually strengthen muscles). The pianist Glenn Gould used covert imagery to practice the piano, and preferred to do much of his practice and rehearsal away from any keyboard; he preferred to learn new pieces entirely away from the piano. There is nothing mystical about the technique -- it is just a different way of exercising your brain, and therefore your body (which is an extension of your brain).

In order for covert imagery to work, it really does help to believe in it though (skepticism is highly demotivating).

Relationships can be "covertly imagined" as well -- and I think this is a great insight from the psychoanalysts. An internalized positive relationship can stay with us, consciously or unconsciously, even when we are physically alone. If you have not had many positive relationships, or your relationships have not been trustworthy, safe, or stable, then you may not have a positive internalized relationship to comfort you when you are in distress. You may feel comforted in the moment, if the situation is right, but when alone, you may be right back to a state of loneliness or torment.

The more trust and closeness that develops in your relationship life, the easier it will be to self-soothe, as you "internalize" these relationships.

Here are some ways to develop these ideas in practical ways:

-journaling, not just about distress, but about any healthy relationship or force in your life which helps soothe you and comfort you

-using healthy "transitional objects" which symbolize things which are soothing or comforting, without those things literally being present. These objects may serve to cue your memory, and help interrupt a cycle of depressive thinking or action.

-if there is a healthy, positive, or soothing relationship with someone in your life, imagine what that person might say to comfort or guide you in the present moment; and "save up" or "put aside" some of your immediate distress to discuss with that person when you next meet.

2) Healthy distraction.
e.g. music (listening or performing); reading (silently or aloud, or being read to); exercise (in healthy moderation); hobbies (e.g. crafts, knitting, art); baking
-consider starting a new hobby (e.g. photography)

3) Planning healthy structured activities
e.g. with community centres, organized hikes, volunteering, deliberately and consciously phoning friends

4) Creating healthy comforts
e.g. hot baths, aromatherapy, getting a massage, preparing or going out for a nice meal

5) Recognizing and blocking addictive behaviours
-there may be a lot of ambivalence about this, as the addictive behaviours may have a powerful or important role in your life; but freeing oneself from an addiction, or from recurrent harmful behaviour patterns, can be one of the most satisfying and liberating of therapeutic life changes.
An addictive process often "convinces" one that its presence is necessary and helpful, and that its absence would cause even worse distress.

6) Humour
-can anyone or anything make you laugh?
-can you make someone laugh?

7) Meditation
-takes a lot of practice, but can be a powerful tool for dealing safely with extreme pain
-could start with a few Kabat-Zinn books & tapes, or consider taking a class or seminar (might need to be patient to find a variety of meditation which suits you)

8) Being with animals (dogs, cats, horses, etc.). If you don't or can't have a pet, then volunteering with animals (e.g. at the SPCA) could be an option.

9) Caring for other living things (e.g. pets, plants, gardens)

10) Arranging for someone else to take care of you for a while (e.g. by friends, family, or in hospital if necessary)

11) Visiting psychiatry blogs
-(in moderation)

...I'm just writing this on the spur of the moment, I'll have to do some editing later, feel free to comment...


Anonymous said...


Anonymous said...

This is a good list. I find it a lot easier to do these things when I feel unhappy + a bit agitated, but I can see that there are things on the list that would be helpful even when that kind of physical agitation isn't there.

One thing that I have found helpful when I go through periods of feeling very disconnected from things is to read cookbooks, especially church or community cookbooks, or cookbooks that are for your particular culture, or cookbooks that are focused on celebrating festivals, etc. My family compiled a family cookbook many years ago, so sometimes I read that as well. I dream about this food, even if I don't make it. It is actually surprising to me how much this helps sometimes. I feel like I am a part of something, because I think about how many generations ahead of me have made these recipes...I don't know, this often works for me.

GK said...

Thank you for your comments.

I realize that it could possibly feed a cycle of frustration, guilt, or hopelessness to read a list of well-meaning suggestions--and to feel that there either isn't enough energy or motivation to do these things, or to feel that you've tried all these things many times, and don't feel any better, or to feel guilty that you aren't doing what you're "supposed to." (I guess I have to add to my list, to say "try to let go of any guilt you may have about not doing things on this list"--but I realize that this suggestion is also much more easily said than done)

So my list, or anyone else's, will always be an imperfect one. Always a work in progress.

Part of my motivation in this post was also process rather than content -- just a reminder that there are others thinking of you, that you are valued and are part of something larger than yourself.