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Making Decisions When Depressed

John Folk-Williams has lived with major depressive disorder since boyhood and finally achieved full recovery just a few years ago. As a survivor of ...Read More

I experience depression in various forms, yet each in its own way knocks out the decision control center in my mind. At times, I scramble in anxiety and can’t focus enough to pick out one among many possibilities. At other times, I don’t care about choosing – or anything else for that matter – and I let the alternatives fall where they may. Or I make all kinds of decisions, even life changing ones, but none of them seems like a choice. Each one is do-or-die. If I fail to do it, I’ll go right over the edge.

Varieties of Indecision

Depression isn’t one thing but a series of moods along a continuum from mild to severe. I used to move regularly with this perverse flow toward desperation. At the mild end, I might wake up knowing that something is wrong, feeling at once that everything is a bit off. I want and need to get a lot done, but I’ve lost my sense of where to begin and what’s most important. Then I get anxious.

There’s a steady snowfall of tasks, floating free of deadlines and priorities. I feel the anxiety and tension about getting them all done, so I pick one out of the air – yes, I’ve got to do that! Then I realize after a few minutes of continuing worry that I’ve got to do that other one in a hurry too. So I grab that and start working. And then another and another. It’s like picking snow flakes out of the air, each melting at once, a drop of moisture in my hand. I’ve got to get everything done, but I’m going crazy because I can’t grab hold of anything.

Then there are those times when I’ve felt nothing and could care less about making decisions. That’s happened most often when I’ve been on the antidepressants targeting serotonin, like Prozac . I think I’m fine because I don’t feel depressed, but then everything else, including close relationships, seemed far away and empty. I could drop them in a minute, and that might well seem to be the logical thing to do. The thinking brain can still function but cut loose from any tie to feeling. Decisions based on logic and indifference can be the most dangerous of all.

On the other end of the spectrum, where major depression waits, there is plenty of feeling, but it’s all desperation. My survival is at stake. I have to be alone and shut the door on everyone I know. I have to quit this job, or it’ll destroy my life. Seeing this therapist makes me sicker, and I’ll go off the deep end if I don’t quit. This relationship is a trap that’s ruining my life. There are only relentless drives here, and everything I do or desperately feel I need to do simply has to happen. I have no power of choice. It’s easy to argue that a decision has been made. But I can’t see it that way, any more than I would say that someone under torture makes a choice to confess and stop the unbearable pain.

What Does It Take to Decide?

The psychologist James Hillman wrote a book called Kinds of Power in which he presents an interesting take on decisions. This may sound a bit pedantic, but he looks at the root meanings of the word from a Latin verb meaning to cut or to kill. Decision/decide shares this root with words like incision and homicide. Cutting away or killing off are useful metaphors because that’s what I have to do to pick one among many possibilities.

Cut away the extraneous possibilities and narrow down to specific action that will accomplish something: here’s what to do, now do it. Choices must be made to keep life and mind moving. But to do that, I need a clear vision of what I want, confidence that I can do it and belief that I can improve my life by acting in this way. When depressed, those are exactly the qualities I know I don’t have.

Depression brings the whole world inside me. I look at people and everything around me, and I’m not seeing anything but evidence of how bad I am. I’m dancing with my own nightmares. Even if I’m only mildly depressed and feel suspended amid a thousand possibilities, no one of which I can choose, I’m assuming that whichever I might pick will not take me anywhere. I’ll move in an endless circle.

Or else I’ll feel nothing, and there is no point in wanting anything. I put on a good show, pass for happily adjusted to life but only see blankness ahead – if I take the trouble to look. And in the most desperate state of severe depression, I’m running for my life. The idea of choosing a different path doesn’t enter my mind.

What’s common to all those ways of being depressed is an all-or-nothing thinking. Nothing good can result from what I do, and so there is no vision that I can choose of my own will. Everyone else is better than I am, and each seems a powerful presence that only makes me smaller still. Whatever I do will not work and only confirms the worst. All the creative possibilities I might see when I’m healthy become so many triggers of obsessive thinking.

When I began to recover some years ago, I started with a single decision. I can’t explain how it happened when I was so close to believing that I should do the world a favor and just disappear. But something snapped. All I could hear in my mind, louder than any sound I knew, was NO, I won’t go there, and YES, I’m getting out of this. I will do it. It was more than a survival instinct, or fear of where I was headed. I had to push hard against the current that was forcing me in the wrong direction, and suddenly the strength and purpose were there. I felt in my bones that I did have a choice, and I’d better make the right one.

Most people don’t have to make a decision like that. They can take self-respect for granted and get on with living. I guess people with severe depression have to work harder to master the most basic dimensions of life, to keep going and to kill of the impulse to stop.

How does depression affect your ability to make decisions?

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