First Aid for all sources of suffering

The Basics

A chapter from Bob's book in preparation: Depression: A user's guide.

   There are seven requirements for a contented life. All of them may be present to varying degrees. If you have a good dose of all seven, you will have the inner strength and resilience to support you in your fight against Depression, Anxiety and similar devils.

   Your Depression knows this. It knows the list, even if you don't. It protects itself by sabotaging as many of these requirements as possible. It can do this very well. So, first aid, the way to fight back, is to return these seven features into your life. The rule is:


   I'll briefly discuss the list here, so you can take immediate action, before examining what depression is and isn't, then presenting tools for controlling it, and finally tools for getting rid of it altogether -- most of the time.

   The seven first-aid measures are:

   Since this is a first aid list, I've ordered it so that the easiest to implement is at the top.

   Note what is NOT on the list:

   ...and all the other reasons people tend to associate with their mood.

   The last requirement, meaning, comes from the work of Viktor Frankl. You just have to read his inspiring book, Man's Search for Meaning. The other six come from anthropological research on the lifestyles of hunter-gatherer people. You see, genetically, we are still identical to our ancestors from up to perhaps 10,000 years ago. By analyzing the lives of modern hunter-gatherers, anthropologists have extracted the essentials of the lifestyle humans have evolved in, and that's the list I've given you.

   Think of the measures I'll recommend as antidepressants. Only, these antidepressants have several huge advantages over the nasty little pills a doctor might prescribe for you:

   Let's now look at each of the seven requirements for contentment, see how monsters like Depression sabotage them, and what you can do to protect yourself.

Healthy eating

   Depression starves some people. It tricks others into ill health and obesity by getting them to eat too much, and all the wrong kinds of food. Either way, its job is easy in today's crazy society: even people who are not suffering distress are likely to eat badly, and many of the common foods are full of stuff that does you harm.

Too little

   Fred didn't want to get counseling. He knew it couldn't possibly help him -- nothing could. Life was hopeless, and that was that. But when he mentioned killing himself to his doctor, he was given my leaflet and ordered to come and see me. He canceled the first appointment, because his car (conveniently) broke down. He didn't show up for the second. I phoned him, and after a long conversation, he at last made the effort to be there the third time.

   Sound familiar? It may well be if you are in the grip of deep Depression.

   When we finally sat face to face, I asked him what was making his life so miserable that he contemplated suicide. A whole list of woes emerged, but the top item was, "I can't eat. If I have something, I feel like chucking up."

    "Have you ever done so?"

    "No, but it sure feels like it."

   I knew that his doctor had checked him out for any physical problems, so I told him, "Food is medicine. Eat a tiny bit, doesn't matter how it makes you feel, and do this every now and then until you have enough to keep you going."

   We organized a few strategies. He bought grapes, and popped them one at a time, ten minutes or so apart. He made a cheese sandwich, cut it into eight pieces and ate one piece, went on with whatever he was doing, ate another little square, and so on.

   At first, the nausea persisted. But, while he fed his body regardless of how bad he felt after it, he was starving his Depression. Within a couple of weeks, he could eat a normal meal.

   By the way, Fred wasn't his real name, and I'm not even telling you if the client was male or female. All my examples in this book are real, but I've changed identifying details. Where I could, I've asked the person's permission for inclusion.

Too much

   Depression tricks you into becoming overweight through "comfort eating" or "boredom eating," and always the things you swore you won't touch (but have handy all the same). You feel guilty, and put on weight -- and this gives something else that your Depression can use to beat you over the head.

   First aid is to get rid of all the wrong foods and store up on things that are good for you: apples, carrots, celery, chewy dried apricots, nuts of various kinds. When you feel like some comfort food, eat a small amount of one of these, then congratulate yourself. Tell all the people in your life that you're switching your food intake in this way, and ask them to help by keeping the problem foods away from you.

   Shopping is the danger time. Make it a rule: you come with a shopping list. If it's not on the list, don't buy it. The internet allows you to be up to date on specials in your neighborhood store, so even a reduced price shouldn't lead to impulse buying. If you do slip and buy something from the old times, then punish yourself by giving it away. Then, being generous to someone else will make you feel good about yourself.

Satisfying sleep

   As with food, Depression can trick you into either too much or too little. Or it can keep you awake all night, and then you'll feel too sluggish and sleepy all day.

Too little

   Do you lie in bed, your mind going round and round and round, torturing you with thoughts you'd rather not have? Among them will be the thought, I MUST get to sleep! I'll be so tired tomorrow! Oh, will I never get to sleep? On and on the wicked merry-go-round goes, keeping you awake.

   Some facts about the nature of sleep will help. Sleep has several stages, which can be grouped into two: rest, and dream time (called "rapid eye movement" or REM sleep because when you dream, your eyes can be seen to move through your closed eyelids). You can't do without REM sleep. No matter how many hours you spend asleep, if someone wakes you the moment your eyes start to move, you'll be like the walking dead in the morning. If you put all your REM times together, they'll amount to about two hours. You're guaranteed to get that much on the average awful night of disturbed sleep. So, typically, lack of REM sleep is not the problem. It is that you have not rested at all during your stay in bed.

   It actually makes no difference whether you are awake or asleep for the remainder of the time. As long as your body is relaxed, you'll be as rested as if you were asleep. In contrast, sleeping while tense doesn't rest you at all. You can sleep deeply for ten hours and wake tired if during all that time your body was like a compressed spring.

   So, the first aid trick is to learn muscular relaxation. I'll teach you in the next chapter, because it is an important tool in its own right.

   Then, it is just as restful to lie there, eyes closed, breathing softly, your body completely relaxed, as if you were asleep.

   It's good to fill your mind with a mantra: something you say over and over till it becomes boring, then till it becomes meaningless, and still do it. I use the mantra just as... ...restful to remind me of what I'm doing: resting whether I am awake or asleep.

   This is true. But even if it wasn't, it would cut through the negative thinking that's keeping you awake. Get relaxed. Lie there with your eyes closed, breathing softly, and keep saying this mantra to yourself. You'll soon be asleep. And even if for any reason you still stayed awake, you'll feel rested in the morning.

Too much

   Tony was a nice, decent seventeen-year-old. He and his group of close friends did everything together. Unfortunately, that involved substance abuse. One night, a member of the group murdered his best friend, while out of his mind on marijuana and alcohol. (In some people, marijuana can induce intense terror or rage.)

   Tony held the dying boy during his last moments. Months later, he was required to testify against his friend in court. Not surprisingly, he needed counseling for his grief.

   I asked him how he was affected. He told me that the worst thing was that he couldn't be bothered to do anything. He took "sickies" from work as an apprentice mechanic, because he couldn't get up in the morning, had no energy. All he wanted to do was sleep. "What's the point of doing anything anyway?"

   He hadn't realized that he was in the grip of Depression, a natural aspect of grieving.

   As part of working on his issues, I taught him a list of first aid measures. He agreed that whenever his grief tried to talk him out of doing something, he'd force himself to do just that. He set his alarm clock for the usual time he needed to rise for work, even on weekends and holidays.

    "If you feel too bad to go to work, then maybe you need to stay at home. But still get up at the right time," I told him. "Then, do all the other preparatory things you do on an ordinary day: have a shower, shave, get dressed, eat breakfast. After that, if you want to, you can undress and return to bed."

   When he did this, he ended up going to work. The first step is always the hardest.

   On the days when he defied his grief, he actually felt good, in power, for having done so.

Regular physical exercise

   Many people do things that get them tired, but that is not the kind of exercise I mean. You need to work up a sweat, and find yourself puffing for air. When you do this, your body generates chemicals called "endorphins." When endorphins settle in certain receptor sites, you feel good, happy, full of energy. So, aerobic exercise gives you a holiday from depression.

   Have a skipping rope handy, or do a few starjumps, of go for a brisk ten-minute walk, and you'll feel good for awhile.

   Exercise can be the wedge that allows you to escape the trap of Depression. It can become a "good addiction." If you do just the right amount of exercise for your current level of fitness, you'll enjoy the experience. So, you'll be motivated to do more.

   There are three dangers: to overdo it, so exercising also develops negative reactions; to set yourself unrealistic goals, so Depression can then torture you with thoughts of failure and inadequacy; and to compare yourself with others.

   The exercise is strictly an antidepressant. It doesn't matter whether you're improving or not. It doesn't matter if someone else can do it much better. All that matters is that you develop a tool for feeling good.

   It may seem like a paradox, but keeping records is a great motivator. Without trying to improve, you will, and this'll be obvious when you compare distances and speeds of walking, or the number of pushups you do, or the weight you use for a particular exercise, compared to what you could manage a few months ago.

Regular fun

   How can you have fun when you're miserable?

   You often do. I did an experiment once. My friend Georgia and I went to a concert. She is a musician -- and was suffering from severe depression. As I watched her, it was obvious that she thoroughly enjoyed herself. Her eyes never left the performers, I could see that she was up on stage with them. Her mouth was half open much of the time, her body subtly moved with the rhythm. After the performance, she chatted with me, bought a CD and talked for some time with the players, smiled at strangers.

   I saw her again a few days later. "How did you enjoy the other night?" I asked.

    "Oh... it was all right I suppose." Her tone of voice was bored, flat, shoulders were slumped forward, and she didn't look at me. She was in the pits, and couldn't even imagine that a few days previously she might have had fun.

   That's what the doom-colored glasses of suffering do to you.

   Don't believe your Depression when it tells you that you never have fun, can't have fun, there is no such thing as fun.

   There have been times in your past when life was OK. If you're in the pits now, chances are you won't remember them. But try. Think back to times when you got on with your life, and the misery was absent. What did you do for fun then?

   Whatever it was, deliberately schedule it into your week.


   One of the reasons for the high incidence of suffering in technological society is that so many people stop doing creative things for months, even years at a time. They go on day after day, week after week, year after year, round and round the same treadmill of routine and boredom. Get up in the morning, commute to work, go through the motions, come home, veg out in front of the idiot box, go to bed... who wouldn't be depressed? And these are the lucky ones who have a job.

   For many people, life is drab. Housework is a chore. Kids are an unending stream of problems. Work is a chunk out of your life. And when you go on holidays, you come back so exhausted you need to recover from them.

   Introduce creative activities. Here are a few examples:

   Where do you find the time for such things? Engaging in something like an item from this list gives you MORE time rather than less. This is because creativity recharges your inner batteries, and you'll be more efficient in everything you do.

Social connectedness

   Megan worked as a sales assistant in a huge department store. She described it as being a trained pair of hands and an automatic smile. To the customers, she was a thing that took their money. She had no contact with other workers except during the lunch break, and even then she knew they were not interested in her as a person. All the talk was on superficial topics that held no interest for her. To her superiors, she knew herself to be no more than a number, someone to keep an eye on.

   Irene worked in the same store. She loved her work, particularly the people aspect. She said there were customers who came regularly, and they always had a friendly chat with her. She'd watched their kids grow over the years. She took an interest in her colleagues, and several had become her friends, with frequent after-work contact. Her superiors treated her as an equal. After all, she used to be a department manager until she had kids and chose to work part time. She had no ambitions for promotion, but was happy with what she was doing.

   Both these women came to me for help through the store's Employment Assistance program. Irene came for chronic pain management, because she suffered from a painful lower back, and RSI in both wrists. It won't surprise you to find out that Megan came for help with her Depression.

   Research shows that a person needs to have close connections to other people. Being part of three (possibly overlapping) networks is the minimum, but more is better.

   Paul was the custodial parent of two daughters. His ex-wife had abused the girls, and he'd won sole custody, denying her access. He was also suicidally depressed. The only thing keeping him alive was that his death would impose terrible suffering on his daughters. When we worked together, the reason became clear: he only had ONE social network: he and his daughters. He had no feeling of connection to anyone else at all.

   When you're in the grip of Depression, you want to avoid company. Also, others won't enjoy being with a grump. A third way Depression isolates you is by whispering in your ear that the people you care for are too good for you, and the best thing you can do is to separate from them.

   Remember, whatever your Problem tells you, do the opposite. Remember, it's doom-colored glasses that hide the good things and focus on the bad.

   It is important to note that I am not talking about introversion-extraversion here. People vary according to their need for being with others. The extreme extravert is a party animal who dislikes being alone and craves human company. The extreme introvert is a loner who prefers solitude, and is uncomfortable in many social situations. Most people are in between -- about two-thirds of people are neither one or the other.

   You can suffer regardless of your place on the introversion-extraversion scale. And even extreme introverts need social connectedness. You could be on a solo round-the-world yacht trip with no radio, and be socially connected. This will be because you'll know there are people who think of you as important in their lives, and you carry them around with you, in your memories and even in your heart.

   So, when your Depression tries to isolate you, fight back by involving yourself with other people. Distract yourself from your woes by taking an interest in the lives of others. That's what I did in school and as an undergraduate: I collected "lame ducks" who needed my help, so I could worry about them instead of myself. Fight back by doing random acts of kindness, enjoy the play of little children. If face to face contact is more than you can cope with for now, use the internet.


   Two or three times a month, I get a desperate email from a young person. Here is the best of them, with only the name changed:

   We ended up exchanging several emails, some even years later when she was at University, studying psychology. Here is my first reply:

   By coincidence (if there is such a thing), I got a similar cry of desperation a week later, from a British medical student. His issues were so similar to this girl's that I sent the same answer to him.

   My words pulled both these fine young people out of their dark hole. The student wrote: