Can I recover from depression?
When I was warded at the Institute of Mental Health in 2017 for my own safety, the case manager for the ward sat down with me to have a chat about my condition. I don’t remember who initiated the topic, but I was under the impression that I would only be in the hospital for a couple of days. With treatment, I should recover quickly and be back to normal. I did not want to be this suicidal, weepy, tired mess that had presented itself to the hospital emergency ward a few hours before.
She had to gently disabuse me of that impression. I remember crying as she softly spoke, telling me that generally, depression was one of those things that would take months, if not a couple of years to recover from. My stay in the hospital was blessedly less than a week, as it turns out. She had warned me that many would stay for weeks or longer, depending on the severity of their conditions.
However, my recovery journey would take five long years, and even now I am still in treatment. How can I speak of recovery, when some days are still so dark that it becomes difficult to crawl out of bed? Will depression ever go away?
What does mental health recovery look like?
We seldom think about what recovery means. Physically, such as with a fractured or broken bone, the idea of recovery is clear—healing from the injury, followed by a (near) complete restoration of life as we knew it. Medical conditions like high blood pressure can also see a (near) complete restoration of life. But when it comes to mental health conditions, the reality is not as simple.
In the recovery journey for a physical condition, the expectation that things can go back to normal is fair. However, if the sufferer does not have a strong mental will to do the required exercises, to take the medications as needed, or to keep up with the doctor’s visits, recovery can be delayed or held off indefinitely. For someone struggling with depression or another mental health condition though, the mental will itself has already been affected by the condition. On top of that, some mental health conditions may require permanent lifestyle changes.
Some similarities remain: There is hard work to be done, including mental exercises and self-care routines. There are physical exercises that can help. Medications should be kept up with, and so on. That said, mental will in recovery is usually the biggest tool in our human toolbox, and thus recovery can and does look very different. We now come to the biggest thing we need to talk about when it comes to recovery—our expectations.
Expectations—the biggest part of the recovery journey
Recovery can only be defined by having goals and expectations. Some expectations are unspoken—we want life to be back to normal as quickly as possible. Due to the nature of mental health conditions, it is critical to talk about these as early as possible; disappointments and unrealistic expectations can lead to poor outcomes, such as not complying with medication or constant frustration that aggravates struggles. Such expectations and frustrations can come from caregivers as well, and without meaning to, be projected onto the sufferers they care for. It is important for both caregivers and sufferers to discuss how recovery looks like and what it means with their medical team.
Often, I still struggle with the length of time needed for my recovery. I have to bring it up to my psychiatrist and psychologist, who would gently point out how far I’ve already come. I expect to continue on my low dose of medication for a long time as my emotions seem to need constant assistance for regulation. My therapist continues to meet me regularly. We have had discoveries about my past, which explain some of my reactions now that are amplified by depression. We have talked about and practised new ways of thinking, identifying unhealthy patterns and triggers, and how to handle them.
There are implicit expectations about my recovery that creep in. When we discuss changes in medication, I instinctively recoil. I struggle to have a calm conversation about such a topic, even if it’s just about small adjustments in dosage. Around July every year, I tend to get really upset and frustrated with myself, as it marks another year that I am not able to earn my own keep or deal with stress in a “normal” way. I chafe at and question the rate of my recovery, prompting my therapist to gently remind me that the harm of thirty/forty plus years of unhelpful thinking patterns cannot be undone in a couple of years. I have days where the guilt of being alive eats at me so hard that it hurts physically to breathe.
Yet recovery means that I breathe on anyway, through the pain, and I make sure I stay safe. My recovery involves having a safety plan and a safe space in my house where I can retreat when I recognise that I’m about to lash out at myself or others. Recovery prompts me to talk to my wife, my main caregiver, about my suicidality and when my inner criticisms get too overwhelming. Recovery also sees me taking responsibility for my medication, knowing the side effects, talking to my psychiatrist about them, and advocating for myself when I am able to. My recovery journey looks like me turning up for therapy even when I’m scared to because of the intensity of the emotions I’ll have to face.
Recovery is also about me being able to address my suppressed anger in a healthy, controlled way now. Five years ago, I could either only try to swallow my anger, or explode in rage when the anger got too much to hold in. Depressed Dave can be difficult to draw on days when the emotions and energy are too unregulated, and I have had to learn how to forgive myself when I can’t draw. I have learnt to use my recovery to talk to others about their recovery, helping them manage their expectations and hope, or just by listening.
All these things and more make up my recovery journey. But if it also looks like a journey of learning, self-discovery and improved self-management, that is exactly what I’ve come to see mental health recovery as. It is not so much about lowering expectations as much as renegotiating the new normal and considering how that will look like for a time or for some time. That can change and will change as new lessons are learnt and new possibilities open up as a result. It does not promise to be a smooth journey. There will still be frustration, and my depression tends to bully me into thinking that I’m just making things up or guilt tripping me into thinking I’m not doing enough for my recovery, five years into this morass. But when I look back at where I was, and look down at my hands and feet, reminding myself where I am now…
I can see that I have come a long way in my recovery, even for me to be able to look at my hands and feet, recognising that I’m still here despite all the struggles. And maybe that’s good enough for my recovery journey so far.
If you are in Singapore and are experiencing self-harm or suicidal tendencies, help is available. 24-hour hotlines:
- Samaritans of Singapore (SOS): 1767
- IMH Mental Health Helpline: 6389 2222
- Alternatively, you can contact SOS via Whatsapp here.
Other resources:
- A list of resources about depression: https://depressioninsg.com/resources/
- A good introduction to depression from the American Psychiatric Association: https://www.psychiatry.org/patients-families/depression
- How to help others who might be struggling with depression: https://depressioninsg.com/how-to-help/