What depression is…

I’ve chosen to think that being depressed is about productivity.

Why that? Why not feelings?

Yes, I do get the thoughts that I can’t carry on, or that I am a failure, or that no one can possibly love me, or that I’m worthless and everything I touch will turn to dust.

But I’ve learned, slowly and with effort over the last decade, that I can monitor for those thoughts and that I can discard them when they happen.

There is nothing of that irritating think positive mindset in this, mind you. I still go through the pain and the feelings of worthlessness. What I can do though, is realise that such thoughts are merely the symptoms of a medical disease, and that they are therefore not “real”.

And if they are not “real”, then they can be discarded. So when I feel the pain, my overarching thought is “This is not real and I can ignore it. How I feel now will pass in time and the real me will emerge”.

It’s a lot harder to do that and have it succeed than you think. It takes practice, and trial, and failures. Just like anything else you are learning to do. Think weeks and months to get it working right. And you still have to live through the depression thoughts.

Ok. Where was I? Right. Productivity.

Unlike the thoughts of depression, I can’t get around the loss of productivity. And when I say loss of productivity, I mean the complete loss of productivity. So, not able to complete any tasks at work, can’t make the calls to colleagues, can’t go to the grocery, can’t take out garbage, can’t do any cleaning in the house, can’t call my friends or family, can’t shave. Can’t write for my website, can’t study, can’t do research, can’t make it out of the house to go to the cinema.

Can’t even reach out for help or explain to my partner what is going wrong.

Can’t.

Now everything doesn’t fail at once. What happens is that tasks fail progressively over the course of time until nothing is working. So you go through mild depression to bad depression to severe depression. Sometimes to very severe depression. Since I have a fast mood swing cycle, the onset of depression from mild to severe is usually about 2-3 days (for most people it will probably be longer, sometimes measured in weeks). And annoyingly these days, I can stay in severe depression for a week or two.

If that doesn’t sound so bad, imagine sitting at home doing exactly nothing for two weeks. And nothing includes not talking to other people. Or going to work. Or anywhere.

For all of us, doing that severely disrupts any kind of life you have. Severely.

So productivity drops to exactly zero.

Well…I still manage to feed the dogs. Though when I’m depressed, they get fed anywhere from about 5 pm to about 1 am, so it’s not exactly the most splendid show of productivity. And it’s the only productive thing I do for the entire day.

Most importantly, unlike the depression related feelings, I can’t set the lack of productivity aside and move on. If your illness stops you from doing things, then you can’t do something about it because you can’t, well, do things.

See the problem?

Yes, in time the depression ends and I start doing things again, but during the depression, I do nothing for a week or two.

As a result, I’ve taken to charting my depression, and the intensity of the depression, by my productivity instead of by my feelings. It provides a more meaningful measure of how successful my day to day life is.

Of course, because the quality of the productivity matters, I don’t have one scale – I have five scales, each of which measures a different facet of productivity (as well as one scale that measures how I feel). They are, with explanations (the higher the number, the better I’m doing):

Scale 1: Ability to Do Big Picture Thinking – (BP)

  1. No thinking being done about tasks for the day / Very important tasks may be forgotten completely or ignored.
  2. Can concentrate on the 1 important task that needs to be done, but requires focus. Other tasks may be forgotten or discarded to concentrate focus on the important task.
  3. Knows generally the tasks that need to be done, but random important or minor tasks may be forgotten. Tasks happen, but are done randomly without thought to importance or ease. New questionable value tasks may be inserted to the detriment of other plans.  Usually no memory aide used, even as reference. Small changes in schedule will trigger failure to hold the big picture together
  4. Able to generally plan the day, but requires effort to remember the tasks and sequence them in an orderly fashion. Memory aide may be used partially. Important task will probably be done but lesser ones may be forgotten. Less will be done than planned, even though the time was available. Changes in schedules will not be accommodated gracefully and may trigger failure to hold the big picture together. (About an average person?)
  5.  Shortly after waking up and while doing morning tasks, able to visualise the major and minor tasks needed to be done for the rest of the day, the sequence they will be ordered in, and ancillary items related to these tasks. Organiser or calendar or other memory aide in use. Changes in schedule accommodated gracefully.

Scale 2: Ability to focus on tasks – (F)

  1. Can’t imagine the next task to do. May not be able to remember the steps of rote tasks or simple tasks, and will not be able gather enough focus to concentrate on the steps necessary. Usually results in my doing nothing except the most basic / necessary tasks.
  2. Simple and rote level tasks possible with concentration, but will be slow. Only the most critical items will be done.
  3. Higher level thinking is not possible (no writing, making plans, conceptualising ideas, dealing with complex issues). Able to think about and act on simpler tasks which require rote work or habits. Decision making become indecisive, even for simple tasks.
  4. Able to think about tasks and ideas, but the concepts or plans or ideas may slip away if I stop concentrating on them and it requires specific effort to pick back up the thread of thought. Occasionally, thinking disintegrates into “white noise” where I cannot form the next thought or action.
  5. Thinking / concentrating about tasks and the subtasks attached is effortless. Ability to juggle multiple tasks and new tasks more or less gracefully – even in the cases when I am feeling somewhat harried / overworked. What I consider normal.
  6. (6+) Manic Inability to focus

Scale 3: Ability to do things – (D)

  1. No or just one or two tasks get done.
  2. Some tasks get done. Less than I would like.
  3. Normal day. Got pretty much the things I wanted done barring setbacks or changes of plan that are typical in most people’s lives.
  4. A great day. Got everything I wanted done and a bit more. Yay!
  5. Manic level of energy and number of things done.

Scale 4: Level of Withdrawal from other people – (WP)

  1. Run away from anywhere you might meet people that you know so there is no possibility of interacting.
  2. Don’t answer door of house/ hide under bed / Lock yourself in your room.
  3. Stop answering telephone calls / IM. Shut of phone / put on silent / unplug.
  4. Don’t respond to texts /  e-mail / IM. Stop answering telephone calls except from friends.
  5. Put off talking to anyone about anything that may be stressful – things you think you did wrong or badly, things you have to make a comment on, etc., things where you have to initiate a request.
  6. Normal interaction, but feeling like you are faking it. May pause to decide if you want to interact with someone before doing so.
  7. Normal interaction with people with no reservations

Scale 5: Productivity / Functionality –  What actually happens during the day – (P)

  1. You have just shut down and nothing is getting done (except feeding the dogs).
  2. Only the most critical or necessary tasks take place – the ones you HAVE to do.
  3.  All optional tasks have stopped. Many daily habits/tasks (including work) are not being done.
  4.  Many optional tasks stop happening. You may cut edges when performing a task.
  5. Productivity below par as if because of hangover / tiredness etc.
  6. NORMAL. What you would expect from a normal person on a normal day.
  7. Good to great day for normal person. A lot is getting done.
  8. Much accomplished but too much to be normal – manic levels of work.
  9. Incredibly high productivity – happens when you are hyperstable.
  10. Manic level of functionality – note that productivity can drop off as you become more manic and less focused.

Note: A scale measured from – 1-100 can also be used to measure productivity, where 60 is considered normal. This scale allows a finer measurement of how your day is going.

Scale 6: Emotional / Stability / Mood – How I am feeling – (E)

  1. True terrible depression. I stop thinking. Time to hide in the closet, or disappear. My life is a failure, I want out of my relationship, suicide starts looking good.
  2. Really low confidence. I don’t want to leave the house or talk with people, but I manage with great effort.
  3. Living through the day hurts. Everything appears insurmountable. I have low self confidence and it affects everything I do. It is nearly impossible to get anything done.
  4. I find it hard to think and I am sluggish. I don’t really want to try hard to do anything. Lowest end of a very bad day for a normal person.
  5. A bad hair day.
  6. Normal. Feeling how I imagine a normal person would.
  7. Good day. Lot’s accomplished.
  8. Feeling great. A little too much accomplished, but not too much hyperactivity. Upper end of a great day for a normal person.
  9. Definitely hyperactive / manic. Still functional, but remaining in control requires control.
  10. Hyperactive and not too much control. I require most of my energy to control myself, not too much left over for being functional.
  11. True mania. So far I have never had a true manic episode.

I’m still fine tuning the scales, so they may be subject to some change. Check me on Wednesday for more information here.

4 thoughts on “What depression is…

  1. I like the new scale and how detailed it breaks down every aspect of what moods can do to your everyday abilities. I use a modified version of your old scale to include agitation/irritability along with anxiety. Agitation makes me gauge how much interaction I should have and whether I should stay away from other people so I don’t inadvertently offend them or blow up at them for no reason. It also makes me take a step back and think about the fights I have with people in my head and helps me look at it objectively.

    Anxiety can also be huge if you have mania. Sometimes I slip into a hyperactive paranoid anxiety fest that also crushes productivity since all I can think about is some conspiracy theory (although at the time I usually think I am productive, but I can fill in the details after the fact). So for those with BP1, adding these scales might also help predict where your moods are and where they might be going since these symptoms might come before a full mania.

    I’ve also put it into a google docs spreadsheet form. They have a form function, so I just tick off the numbers and I can easily make a chart so I can track the direction of my moods more easily as well as provide hourly updates from my phone since I can cycle within a day. So more tech savvy people might like it. Plus, ticking off numbers on a form is somehow easier to do when I’m depressed and don’t feel like doing anything.

    Just some thoughts on how I’ve updated your system, love the new one though, especially its focus on objective behaviors rather than feels.

    James

    • James,

      If your agitation/irritability scale has explanations of what the numbers mean, could you send me a copy please. Wouldn’t mind adding it to the collection of scales we can use.

      I like the google docs spreadsheet as well, and the info via phone? Whoa, more tech savvy than I am! I still use pen and paper.

      Thanks for your comments.

      jinnah

      • I set it up on a five point scale:
        1-Persistently fighting with people in my head. Favors are annoyances, any discussion I can’t control is infuriating. Any road bump in a task makes me drop the entire thing. Constant feeling of lashing out or breaking things. Small ticks in people’s behavior infuriates me. No patience. Control is nearly impossible.
        2-Prickly. Favors require compensation. Feel the need to pick fights with people or to bring them down. Occasional feelings of lashing out. Most things are frustrating, but I persist in tasks. Small ticks in people’s behaviors irritate me. Very little patience with delays. Control is possible, but requires constant monitoring.
        3-Normal, can control anger. People’s ticks are just a part of everyday life
        4-Easy going. I don’t fight with people in my head. Slights and ticks are part of everyday life and make people unique. Favors are appreciated, and I feel fine in both doing them and asking for them. No need to control anger. May have some righteous indignation, but nothing irrational. Plentiful patience.
        5-Cannot become irritated or annoyed at anything. Passive and feeling perfectly calm. Not even righteous indignation at events. Everything seems explainable and normal. Patience with everything.

        Since I use it as a predictive measurement, I focus more on the phenomenology of agitation. But agitation is also a head game you play with yourself, so it works to some extent in labeling your actual agitation levels. The 4 and 5 levels for tracking drugs like xanax so I can pin down just what those drugs are actually doing to my mind.

        James

      • James,

        Got your scale. I would like to add it to the blog, and shortly thereafter to my website, but I need to now how you would appreciate my giving credit for it.

        I can (a) Add a byline saying “provided by James Littiebrant” with no link. (b) As above, but add a hyperlink to your webpage / twitter account / facebook account. (c) Have nothing on the blog / website, but keep the information about you in an invisible comment in the HTML source code. (d) Add a byline saying “provided by a reader to the website” with no information about you anywhere. (e) Not bother and just accept it as a free contribution to my website / blog with no byline at all. (f) Any other idea you may have.

        Note that for both (d) and (e), I would be able to track down that you did provide it to me since I archive all my e-mails (I am obsessive about some things, but that’s because I’m a crazy person). But I won’t necessarily be reminded each time I review or re-edit the page.

        Thanks, by the way.

        Cheers.

        jinnah

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