Shades of Depression: Anhedonia, Anxiety, Anger, and Alienation

            Depression has been described in many ways. Through my experiences and my reading and discussions with others, I think that while there are some common experiences, the details of each person’s experience with depression are unique, and vary even among multiple experiences of depression for the same individual. I’ve felt terrible sadness, apathy, hopelessness, helplessness, and these things I thought were all normal. Yet I’ve also had other experiences less well-associated with depression, and I’m not alone.

Anhedonia

            “Anhedonia is defined as a loss of capacity to experience pleasure. This inability to enjoy pleasurable things is associated with a number of mental health problems including depression. The word anhedonia comes from ancient Greek and means without delight. The individual who is experiencing this condition will find that their life is emotionally empty.

            “…A world without pleasure is a grey place indeed. Without this emotion, life become monotonous, and there doesn’t seem to be much point in doing anything. Day to day living becomes an endurance race, and there is no motivation to try to improve things. The inability to experience pleasure means that life can feel pointless, and that is not a satisfying form of existence. It is a particularly dangerous way to feel if people are trying to recover from an addiction.

            “…Pleasure is a vital component of the internal reward system – it helps people grow and learn. If the individual is unable to experience rewards they will fail to make any progress.” —‘Anhedonia in Recovery’

            Anhedonia sucks. It sucks away your motivation to recovery, to do anything at all. “What’s the point?” you may think.

            “I know nothing. I can do nothing. I understand nothing. I know nothing. Nothing. And all this misery does not even make me particularly unhappy.” —Gerhard Richter

            I go through the motions, but get no pleasure, and soon may not have the energy or motivation to go through the motions. I wander through a twilight fog where everything has lost its color.

            In this state, anytime I feel a glimmer of feeling for anything, I grab it, fiercely, and hold on as long as I can, until that fleeting joy is gone. I feel as though I am hopping from melting ice floe to melting ice floe over a killing-cold lake, and I wonder if they will sink, or get too far apart, or run out before I reach the other side I’m hoping is there.

            “I tend to find the ecstasy hidden in ordinary joys, because I did not expect those joys to be ordinary to me.” —Andrew Solomon

Anxiety

            “If you told me that I’d have to be depressed for the next month, I would say, “As long as I know it’ll be over in November, I can do it.” But if you said to me, you have to have acute anxiety for the next month,” I would rather slit my wrist than go through it. It was the feeling all the time like that feeling you have if you’re walking and you slip or trip and the ground is rushing up at you, but instead of lasting half a second, the way that does, it lasted for six months.” —Andrew Solomon, ‘Depression, the secret we share’ TED Talk

            Living in terror or panic for a prolonged time affects your body. Your adrenal glands wear out. You’re hypervigilant. You can’t sleep, and your body doesn’t recharge. The cortisol soup your whole system is swimming in takes its toll. Your brain rewires. Your sense of the future becomes foreshortened. Anything can trigger you to fight, flight, or freeze. It can become too much to leave the house, into a world of unknown variables and overwhelming stimulation. It can feel like having no skin.

            You develop learned helplessness when nothing you can do stops the source of fear and panic. It wears you out when you feel you have to keep this vulnerability hidden, which if you are living with someone or something that is threatening to you and more powerful than you, is highly likely. You feel small, disempowered. You are liable to lash out at the smallest trigger. It is as though the gain has been turned up on everything—a whisper is a shout, a simple word is a hammer blow.

            It is hard for me to tell, having lived with terror all my life, what is a genuine assessment of a threat, what is a childhood flashback, what is either causing or a result of depression. What I do know is, regardless of cause and effect, terror is the most debilitating of all. With anhedonia, even at its worst, I still can connect to the idea that I haven’t experienced absolutely everything, and perhaps there is something out there in which I can take pleasure. Anger, even frustrated and helpless anger, urges me to action against that which is intolerable and unjust.

            Fear chases me into a corner, binds my chest with invisible iron bands so I cannot even dare breathe or make a noise, lest someone notice I am here and take more from me when I have nothing to give, or beat down someone so beaten down by life I feel paralyzed.

            “Suicide is really more of an anxiety response than a depression solution: it is not the action of a null mind but of a tortured one. The physical symptoms of anxiety are so acute that they seem to demand a physical response: not simply the mental suicide of silence and sleep, but the physical one of self-slaughter.” —Andrew Solomon, ‘The Noonday Demon’

Anger

            “First, you are faced with an experience that seems wrong or unfair. Second, you don’t feel able to calmly correct it. And yet, in order for you to feel okay, the situation must be successfully resolved because leaving it as it is does not feel like an acceptable option (the third factor). You feel a strong desire to right a situation that seems wrong, yet you also believe that, at least for now, you are unable to do so. When this set of circumstances occurs, your normal, built-in, human response is anger.”
—Marcia Cannon, ‘The Gift of Anger’

            “A lot of painful things happened to me, and I just wanted to forget. I would wake up in the mornings and just be angry that I woke up. I felt like there wasn’t any help for me, ’cause I was just on this earth wasting space. I lived to use drugs and used drugs to live, and since drugs made me even more depressed, I just wanted to be dead.” —Sheila Hernandez

             “It’s like a hurt. It’s just like they raking your heart out your body, and it won’t stop, it’s just like somebody’s taking a knife and keep stabbing you all the time.” — Danquille Stetson

            It’s been said that depression is anger turned inward. I think depression can have in it anger both turned inward and outward. In depression what I have felt is helpless anger.

            I’ve been angry at hurt I could not prevent or defend against, angry both at the source of the hurt and at myself for my impotence or weakness.

            All this anger is exhausting and demoralizing, and without effective ways to express all this anger non-abusively and feel heard, it becomes a hopeless, angry despair. Loneliness is not just the absence of people but the absence of compassionate understanding.

            “I meet people and I know that they don’t have the level of experience that I have.” —Bill Stein

            Despite a lifetime of painful interpersonal traumas, I have come to believe there are some out there who aren’t habitually, mindlessly hurtful. Yet the absence of a flaw doesn’t indicate the presence of a virtue.

            We humans are rarely comfortable with the expression of emotions like anger and fear and shame, even when we are only bystanders. It takes awareness, effort, investment, and a willingness to learn from inevitable failures to practice empathy, compassion, validation, and humility in the face of these things; with emotional boundaries that don’t trend to self-protective insensitivity. Too often we rely on comparison and pity in the face of others’ pain; or unwanted and inappropriate judgment, advice, and humor. Intellectual understanding blocks empathy.

            “Generosity and love demand great expenditure of energy and effort and will.” —Andrew Solomon, ‘The Noonday Demon’

            Prolonged anger can also have physical health consequences—heart attacks, hardening of the arteries, strokes, hypertension, high blood pressure, heart rate and metabolism changes, muscle and respiratory problems (Dr. Herbert Benson, The Relaxation Response, 1975).

Alienation and the Struggle to Overcome it

            Depression is an alienating experience. Anhedonia, acute anxiety, and anger are alienating experiences.

            “You can’t measure in objective terms how sick people are or what their symptoms are. You can only listen to what people say and accept that that’s how it feels to them.” —Deborah Christie
 

            “There is an interaction between illness and personality; some people can tolerate symptoms that would destroy others; some people can tolerate hardly anything. Some people seem to give in to their depression; others seem to battle it. Since depression is highly demotivating, it takes a certain survivor impulse to keep going through the depression, not to cave in to it.” —Andrew Solomon, ‘The Noonday Demon’

            Compassionate understanding isn’t something we’re automatically good at, nor empathy, nor non-judgment, listening skills. Capacities for these are there, unless you’re a sociopath, but it takes mindful work and perseverance, and humility, to build and practice these skills. It’s not easy, it’s not always fun, and it requires uncomfortable self-examination and self-honesty and a willingness to fail and try again.

            Becoming a brain surgeon is hard work and you would (I hope) not presume to try brain surgery without that work. Yet many people try to offer support who have underdeveloped humility, awareness, and trustworthiness necessary to be effective. We do this because we don’t know what we don’t know. We also do this because shame shuts down genuine human connection and vulnerability (see Brené Brown’s work for more on overcoming these issues).

            I’ve been there. I’ve not only bought the t-shirt but run the t-shirt stand. But having had the experiences I’ve had, I can never return to not-knowing. Sooner or later I think most everyone is touched by tragedy or trauma, and ignorance is no longer an option. The choice is, what do you do then?

            “You cannot draw a depressed person out of his misery with love (though you can sometimes distract a depressed person). You can, sometimes, manage to join someone in the place where he resides. It is not pleasant to sit still in the darkness of another person’s mind, though it is almost worse to watch the decay of the mind from the outside. You can fret from a distance or you can come close and closer and closest. Sometimes the way to be close is to be silent, or even distant. It is not up to you, from the outside, to decide; it is up to you to discern. Depression is lonely above all else, but it can breed the opposite of loneliness. …So many people have asked me what to do for depressed friends and relatives, and my answer is actually simple: blunt their isolation. Do it with cups of tea or with long talks or by sitting in a room nearby and staying silent or in whatever way suits the circumstances, but do that. And do it willingly.” —Andrew Solomon, ‘The Noonday Demon’

            “Our needs are our greatest assets. I am able to just be there with people because of the stuff I’ve needed from people. I guess I’ve learned to give all the things I need.” —Maggie Robbins

Sources and further reading:

            ‘Anhedonia in Recovery’ article

            Hyperbole and a Half: Adventures in Depression by Allie Brosh

            Hyperbole and a Half: Depression Part Two by Allie Brosh

            ‘Depression, the secret we share’ TED Talk by Andrew Solomon

            ‘The Noonday Demon’ by Andrew Solomon

            ‘The Gift of Anger’ by Marcia Cannon

            ‘Honor Your Anger’ by Beverly Engel

            ‘Healing Through the Dark Emotions:The Wisdom of Grief, Fear, and Despair’ by Marcia Greenspan

            ‘The power of vulnerability’ TED Talk by Brené Brown

            ‘Listening to shame’ TED Talk by Brené Brown

            ‘Suicide: Read This First’ on metanoia.org

            ‘What can I do to help someone who may be suicidal?’ on metanoia.org

            Emotional Intelligence information on EQI.org

            ‘EQ for Everybody: A Practical Guide to Developing and Using One’s Emotional Intelligence’ free PDF by Steve Hein

Self-Soothing

What is Self-Soothing?

Self-soothing has to do with comforting, nurturing and being kind to yourself. One way to think of this is to think of ways of soothing each of your five senses:

• Vision—walking in a garden, visiting an art gallery, watching a visualizer or candle flame, looking at pictures
• Hearing—music, nature sounds, ambient noise
• Smell—fresh-baked bread, aromatherapy, scented candles or lotions, flowers
• Taste—savoring tea, juice, small tastes of favorite foods
• Touch—warm baths, favorite textiles or clothes, petting an animal, feeling a breeze

The movie ‘Amélie’ shows a really excellent selection of examples the characters use to self soothe, from dipping hands into sacks of grain…

…to popping bubble wrap.

We have expressions like ‘stop and smell the roses.’ Smells are powerful memory triggers; the smell of gardenias reminds me of an adolescent safe haven. Many of us have favorite music we listen to either to validate an uncomfortable emotion, or shift out of it. Some jiggle a foot while talking, pace, click a pen, play with hair or objects at hand, peel off labels, or carry around knitting. Plenty of us scribble or doodle while on the phone, and countless numbers enjoy repetitive puzzle games. We sing in the shower or the car. We dance to music.

Repetitive and sensory stimuli can not only reduce anxiety, they can also induce a light trance state. We do things that feel good, often without thinking, and often to shift our focus from stress to something more pleasurable. We can consciously develop these skills for feeling better, and coping both with daily stresses and extreme distress.

Self-Harm

Sometimes we might focus on things that harm us, such as stress eating, picking at one’s skin or scabs, pulling out hair, starving, cutting, burning, self-flagellation, inducing vomiting. These produce powerful physical sensations, flood the body with endorphins and adrenaline, can provide distraction from extreme distress or pain, ground oneself or trigger dissociation and numbing. Many people can’t fathom self-harm as a form of self-soothing, but it has an effect, and meets needs in those who engage in it. Unfortunately the consequences can be severe, and troubling both to the person and those around them.

“We should not take away what helps, even if it also causes harm, without understanding the help it provides.” —‘Over the Influence’ by Patt Denning, Jeannie Little, and Adina Glickman

“…shame is not a cure, and you can’t solve your problems by telling yourself off. If you focus on figuring out what’s wrong, what your needs are, and how you might be able to meet them, it will probably make things easier.” —‘Stimming Without Hurting Yourself’

The above article explores finding replacement activities that don’t cause harm. These will be different for everyone. We have different needs and different stimuli produce different results for each of us. Chances are there are things you do, some harmful and some not, some conscious and some not, that soothe you.

Harm reduction is a big subject and offers a lot of ideas that have helped me enormously. I’ll cover it in more depth in a later post. Meanwhile here are two keys to help shift from harmful or undesirable behaviors to more positive and supportive ones:

1. Be mindful—understand what needs are being served by harmful behaviors, notice when you feel a need or urge, notice what you’re doing and feeling, notice which substitute activities help and which don’t.
2. Practice, practice, practice making the substitutions. Notice how you feel and what happens. It can be easy to be discouraged since changing habits takes time. Be gentle with times you may be less successful than you’d like; trying is the most important ingredient to change.

What is ‘Stimming,’ and Why is it Important? 

Many people with autism self-soothe and regulate themselves by engaging in ‘stimming,’ doing repetitive things that provide sensory input. For example:

• Rocking
• Waving or flapping your hands
• Rolling a marble
• Playing with a tangle toy
• Repeating words over and over
• Ripping paper

Stimming can be really important for autistic people for several reasons. Stimming can make it possible (or easier) to think and understand what’s going on, prevent overload or help to pull someone out of overload, and express through body language. For people who automatically stim, refraining from doing so can be a drain on cognitive resources and make it difficult or impossible to do anything else. 

“If you prevent an autistic person from making repetitive motions, you’re probably also preventing them from doing things like understanding what’s going on, communicating, and learning self-control and interaction. Do not value a typical affect over learning and communication.” —‘Autism Awareness for Aides’

What About Drawing Unwanted Attention?

Body language is important. People respond to our body language. Just as in poker, having ‘tells’ can telegraph whether you’re bluffing or not to an experienced eye, self-soothing can (even if subconsciously) send a message. Sometimes it can subtly alert toxic people who are drawn to vulnerability.

“…while there are many different types of people who stand to make you miserable, they are usually all repelled or dissuaded by the very same thing — strong, unemotional, assertive energy – the calm and unshakable confidence of firm, low-key boundaries and quiet no-nonsense attitudes.”

—‘How to Use Body Language to Repel Toxic People’

The above article recommends staying still without appearing rigid, and keeping your hands calm and unoccupied, alongside you in a relaxed and open posture. However, especially for autistic people but for anyone denying themselves use of positive coping skills, this can compromise us internally and have a much higher cost both short-term and long-term. It can lead to increased anxiety that shows in more subtle ways, the more rigidly we try to control it, and be exhausting besides.

Your priority is to take care of you in the most effective ways for you. There are techniques other than body language to repel toxic people, and you are not required to behave a certain way in order to compensate for the predatory instincts of others. You can utilize more subtle ways to self-soothe that are effective for you if the other person feels uncomfortable or pushy. The more ways you find to soothe yourself, the more options you have.

There are also other ways of shifting your body language. Amy Cuddy’s TED Talk ‘Your Body Language Shapes Who You Are’ demonstrates the power of body language on each other, as well as on ourselves, and how we can fake it ’til we feel it.

If you find you’re often targeted by unwelcome attention and have trouble defending yourself, I recommend researching and looking into assertiveness training if you can. Self-defense classes can also boost confidence and improve body language—even if you’re not often physically endangered, it can improve confidence knowing you have the skills to defend your body should it come to that, and that confidence shows. If you have physical limitations, self-defense instructors are good at coming up with ways to defend yourself within your personal capacities and using your strengths. In the future I will write more in-depth articles about assertiveness in communication, and about boundaries and saying and maintaining no.

Finding a comfortable balance for yourself is key. No matter how subtle your self-soothing, if you are doing something unusual, questions may come. Remember that you owe no explanations for taking care of yourself. You can plan in advance whether you would like to explain, what explanations you’d feel comfortable offering, and deflecting unwanted questions. I’ll explore this more in-depth in future articles on assertiveness and boundaries.

“People will ask questions. Sometimes, it’ll be friendly, sometimes it won’t. Sometimes, you’ll not be able to deal with it all right then, and will be embarrassed afterwards that you gave in and used an easy way out and didn’t give all the information. (Like when I used my migraines as the reason I carry things which I would carry just for my migraines, but use to cope with other disorders).”

“I am much more comfortable in my own skin now. But that comfort means that, now, I expect to be treated well and I get angry when I am not. I’m much less willing to back down when people treat me badly or refuse to meet my access needs. This can be good, but it can get really bad really fast.” —comments on ‘A Shorter Version of the Last Post’

“Trying to become someone who won’t be stigmatized is likely to end poorly.” —‘On Being a Lonely Autistic Person’

“Acceptance creates abilities. Understanding and working with your real configuration rather than against it can greatly expand what you can actually do. Even though there are abilities you will never have. There’s a lot you can do, if you understand and accept yourself as you are.” —‘Shame is Not a Cure’

Examples and Resources

Your most important resource is your own awareness. Notice what works for you and what doesn’t. Notice when things work, when they don’t, and when you seem to need them.

For ideas of new things to try I love seeing the creative ways others explore self-soothing. In that vein I’ll provide some links to get you started, pictures, and what I use.

A ‘Sensory Kit’ featured on Sensory Squids

NeoBalls

• Sensory Squids 
• f***yeahstimming This Tumblr, while focused on sharing examples and ideas of stimming, can also provide a wealth of ideas for self-soothing sent in by readers
• NeoBalls neodymium magnets can substitute for skin picking/trichotillomania and meet a lot of the same sensory needs
• Rocking can be helpful (and it’s often not actually as conspicuous as it feels, especially in a rocking chair)
• Teething Bling necklaces look like ordinary jewelry
• Spikeletz Bracelets
• Therapy brushes
• Wooden balls
• Stress balls
• Fidgets made from keyrings and bicycle chains
• Office Playground features several other fidget toys
• Dollar stores and cheap kid toys racks can be a good source for cheap fidget toys
• Squishables — big round stuffed animals
• Knitting



Spikeletz Bracelet

• Listening to music—if you want to have music without compromising your awareness of your environment and potential dangers such as cars or people coming up behind you, there are headphones that let in ambient noise

Fidgets made from keyrings and bicycle chains

If you feel overloaded, here are a few suggestions for grounding without causing harm:

• Holding on to a solid object or an ice cube
• Snapping a rubber band on your wrist
• Hold onto another person or to hold their hand, if you have someone who is okay with that
• Get under a heavy blanket
• Wear a weighted vest
• Clasp your hands together
• Firmly rub your arm

My ‘ER Kit’

My goal feeling is a light trance. I carry around a wide variety of things I can use to self-soothe in different contexts:

• Velvet is my most discreet and omnipresent tool, since it’s all I wear; I can self-soothe just by resting my hand on my leg. Thrift stores such as Goodwill offer a lot of affordable, lightly-worn velvet year-round, including warmer-weather pieces like camisoles and skirts. I turn velvet pants worn at the knees into shorts.
• Singing provides both auditory and physical stimulation as well as emotional expression.
• Hula hoop—reduces anxiety, improves health and flexibility, fun, and great low-impact exercise for managing my fibromyalgia. I always have several in the car and plan to arrive early to most places and take a few moments to hoop when it’s warm enough.
• Book of stories—favorite quotes, zen koans and short tales, copied into a journal and illustrated with beautiful stickers.
• Vials of my favorite floral and spice scents.
• Lotions—my favorite is Earth Therapeutics’ Dream Silk Liquid Pajamas with valerian and lavender; combining olfactory and tactile stimulation.
• Pearl water wiggly—both tactile and visual.
• Postcards and small objects.

One of the most flexible and socially acceptable tools is my iPhone. My self-soothing apps:

• Makanim—a customizable interactive visualizer with several preset, tweakable modes. Colors, shapes, patterns, and chaos factors can all be adjusted. You can let it run, or use your fingers. It’s very hypnotic.
• Tumblr—I’ve set up one to only show pictures I find soothing, such as travel blogs and art blogs.
• Kindle, Office2 Plus—writing and reading are two of my favorite coping mechanisms.
• Bejeweled—the ‘Zen’ mode provides endless puzzle game action

Autonomous Sensory Meridian Responses 

This article talks about ‘Amélie’s’ sensory pleasures in the context of Autonomous Sensory Meridian Responses. ASMR refers to a distinct, pleasurable tingling sensation in response to sensory stimuli.  It’s also been referred to as attention induced euphoria, and attention induced observant euphoria.

Sources and further reading:

• ‘Self Soothe (DBT Self Help)’
• ‘Over the Influence: The Harm Reduction Guide for Managing Drugs and Alcohol’ by Patt Denning, Jeannie Little, and Adina Glickman
• ‘Stimming Without Hurting Yourself’
• ‘What is Stimming?’
• ‘Autism Awareness for Aides’
• ‘How to Use Body Language to Repel Toxic People’
• ‘Your Body Language Shapes Who You Are’ TED Talk by Amy Cuddy
• ‘A Shorter Version of the Last Post’
• ‘On Being a Lonely Autistic Person’
• ‘Shame is Not a Cure’
• ‘Amélie an Early ASMR Showcase’
• Autonomous Sensory Meridian Response (Wikipedia)