Highlights first synced by [[readwise]] [[September 2nd, 2020]]

• People persist in [[self-destructive behavior]] because they don’t know how to do anything else; (Location 122)
• [[depression]] has taught us certain [[habits]] that have come to feel natural, a part of who we are. But we don’t realize that those habits just reinforce [[depression]]. (Location 161) [[depression]]-habits
• no simple, single-factor theory of depression will ever work. [[Depression]] is partly in our genes, partly in our childhood experience, partly in our way of thinking, partly in our brains, partly in our ways of handling emotions. It affects our whole being. (Location 198) [[wholistic-depression]]
• recovery can only come about through a continuous act of will, a [[self-discipline]] applied to emotions, behavior, and relationships in the here and now. (Location 215) [[depression-recovery]]
• Instead of flailing at the water in panic, they have to learn [[emotional [[habits]]]] that are much more like swimming: smooth, rhythmic, learning to float, learning to be comfortable in the water. (Location 226)
• Most people react to the question with a cringe but really can’t describe pain or evoke the sensation in their memory. We repress it, push it away, so that most of the time we don’t think about it and we can get on with life. But when we hear the dentist’s drill, we suddenly remember exactly what it’s going to feel like. We do the same mental trick with depression. (Location 255) [[depression-memory]]
• In terms of overall economic burden to our society, [[depression]] is the second most costly disease there is. (Location 278)
• The number of deaths from suicide in the United States each year (33,000) is approximately twice the number of deaths from AIDS, and shows no sign of declining. (Location 285)
• This is the cruelest part of the disease: we [[blame]] ourselves for being weak or lacking character instead of accepting that we have an illness, instead of realizing that our self-blame is a symptom of the disease. (Location 299) [[depression-symptoms]]
• You feel [[guilty]] enough about being [[unproductive]] and [[unreliable]]; (Location 303)
• They will play on your own [[guilt]] about your condition to make it difficult for you to get anything more than the absolute minimum treatment. (Location 306)
• They count on discouraging you from pursuing your claims in order to save themselves money; and, in doing so, they reinforce your depression. (Location 307)
• [[Depression]] became chemical, and there was no need to look at the stresses in your life. (Location 328) [[Depression is Not Just Chemical]]
• When I first decided to try [[medication]] and consulted a [[psychiatrist]] who knew me socially, I asked if he thought I might be depressed. He was amazed that I didn’t know (Location 448) [[depression-medication]] [[depression-memory]]
• Do we call it depression if they are correctly seeing that the world treats them as useless and forgotten (Location 457)
• Men are socially prohibited from expressing or even experiencing the feelings associated with depression. Instead, they act them out through substance abuse, violence, and self-destructive behavior. (Location 460) [[depression-repression]] [[depression-men]]
• In Amish culture, where macho acting out is frowned upon, the incidence of depression is the same for both sexes (Location 463) [[depression-men]]
• The good news is that 80 to 90 percent of people with depression can be helped significantly, but the bad news is that only one sufferer in three seeks treatment (Location 503) [[depression-recovery]]
• More bad news is that almost half the American public views depression as a character defect, rather than an illness or emotional disorder. (Location 505)
• the opposite of depression is not happiness, but vitality (Location 508) [[depression-recovery]] [[What is Depression]]
• Depression is not an emotion itself; it’s the loss of feelings, a big heavy blanket that insulates you from the world yet hurts at the same time. (Location 511) [[What is Depression]]
• The hallmark of depression is a persistent sad or “empty” mood, sometimes experienced as tension or anxiety. (Location 514) [[depression-symptoms]]
• There is often a nagging [[fatigue]], a sense of being [[unable to focus]], a feeling of being [[unproductive]]. (Location 516) [[depression-symptoms]]
• Grieving the loss of someone or something important to you hurts like depression, but people with depression usually experience a lowered self-esteem, feel hopeless, and blame themselves, which is not common with grief. (Location 517) [[depression-symptoms]]
• Obviously, lack of sleep leads to [[fatigue]], [[emotional withdrawal]], difficulty with [[clear thinking]] — more symptoms of depression. (Location 522) [[depression-symptoms]]
• there are physical illnesses that cause symptoms like depression — Lyme disease, diabetes, thyroid conditions, anemia — and depressions can cause physical symptoms that look like other diseases. (Location 524) [[depression-symptoms]]
• very often, [[depression]] has gradually become part of [[the self]]: the person doesn’t remember and can’t imagine anything other than this depressed state. (Location 535) [[depression]]-memory
• Depression makes us see life differently; it changes how we think; it makes us feel inept and weak; it robs us of social skills and damages our relationships; it depletes us of all self-confidence. Depression pervades our entire being, like a metastatic cancer. And because it affects how we see, we become blind to the changes that are taking place in ourselves. Only rarely, if at all, do we remember that at one time we were happy, confident, active. (Location 542) [[depression-symptoms]] [[wholistic-depression]]
• People with depression, however, share a whole set of stories about the world that are highly [[distorted]], and because their stories are [[self-fulfilling prophecies]], they maintain and reinforce the depression. (Location 553) [[depression-symptoms]] [[depression-habits]]
• We differ from others in how we perceive the world and ourselves, how we interpret and express our feelings, and how we communicate with other people. We think of ourselves as unable to live up to our own standards, we see the world as hostile or withholding, and we are pessimistic about things ever changing. In our relationships with others, we have unrealistic expectations, are unable to communicate our own needs, misinterpret disagreement as rejection, and are anxious and unassertive in our presentation. (Location 554) [[depression-symptoms]]
• We don’t know what it’s like to feel normal. We fear that honest feelings will tear us apart or cause others to reject us. We learn what I call the “[[skills of depression]]” — denying or stuffing our feelings, putting up a false front for the world, being satisfied with less, not making demands (Location 558) [[depression-symptoms]] [[depression-habits]]
• Depressed people work harder at living than anyone else, although our efforts bring us little joy. (Location 569)
• People get good at depression — they overadapt and develop skills that, at best, just keep them going, and often make things worse. (Location 572) [[depression-habits]] [[skills of depression]]”
• This ability to maintain a [[false front]] is a primary skill of depression. (Location 576) [[depression-habits]] [[skills of depression]]”
• Often the meaning of a suicide attempt, a breakdown, or a psychiatric hospitalization is Look! I can’t keep up this charade. I feel terrible and I need help. (Location 577) [[false front]] [[skills of depression]]
  • Note: I wanted this in midde school, but never figured out an acceptable method. Hurting myself was never on the list. I dont think hospitalization occurred to me. But maybe just collapsing in the hallway. This may have been part of wishing i woul get hit by a car but not be seriously injured (though that was usually tied to a large honework assignmenthat i hadn't finished.
• [[Isolation of affect]] (Location 588)
• We are aware of what’s happening around us, but we don’t experience the emotion that we would expect to accompany the event. (Location 589) [[depression-symptoms]]
• people with depression learn not to show, or even feel, their feelings because it has only worked against them in the past. In some families, in some situations, to let others know how you feel is dangerous; it gives people ammunition to be used against you. (Location 590) [[depression-symptoms]] [[Isolation of affect]]
• [[Somatization]]. This is the use of the body to express feelings or an interpersonal message (Location 594)
• Their bodies are saying You can’t do anything to help me, or My suffering gives me special privileges, or My suffering means you can’t expect me to do my share (Location 596) [[Somatization]] [[depression-symptoms]]
• [[Somatization]] allows people to communicate feelings without having to take responsibility for them. (Location 597) [[depression-symptoms]]
• [[Denial]]. (Location 599)
• When I ask him how this makes him feel, he is completely unaware of feeling angry (Location 601) [[Denial]]
• [[Repression]] has two meanings now (Location 603)
• The depressive gets suddenly sad without knowing why — but the objective observer sees the event that led to the feeling. (Location 605)
• This leads us to the other, more common, meaning of repression, that of “[[forgetting]]” events that are too painful to remember. (Location 607)
• [[Procrastination]]. This can be considered a skill because it protects you from ever having to put your best self on the line. You always have an excuse: if only I’d had more time. (Location 621)
• [[Lethargy]]. Keeping yourself in a haze of television or sleep or fatigue will mean you miss out on a lot of opportunities. But for the depressed person, opportunities can be a challenge to be avoided (Location 623)
• Work till you drop, inability to prioritize, pushing yourself mindlessly — and never checking to see if you’re going in the right direction, thus not taking real responsibility for the decisions you make. (Location 625)
• [[depression and fear]]are closely related, each causing the other in a potentially endless feedback loop. (Location 628)
• [[Victimizing]], [[violence]], and [[acting out]]. Violence is often a response to shame. It can make you feel powerful again without facing what made you ashamed in the first place. Unfortunately, it usually leads to more shame. (Location 629)
• [[Victimization]] and self-mutilation. Treating yourself sadistically — or allowing others to — can make you feel real again, and provide a sense of focus, calm, and control during times of great distress. (Location 631)
• [[Pessimism]]. Expecting the worst protects you from disappointment. (Location 639)
• I’m trapped (Location 642)
• [[Passivity]]. People with depression tend to see themselves as acted upon by powerful outside forces, not in charge of their own lives, and thus not truly responsible for their fate. (Location 644)
• [[Selective attention]]. By selectively paying attention only to what confirms our expectations, we avoid stress and feel more secure in the world we’ve built for ourselves. (Location 646)
• [[Depressed logic]]. (Location 649)
• [[Recruiting accomplices]] — restricting your social world to those who don’t expect much of you. (Location 655)
• [[Social isolation]], avoiding contacts that might challenge your depressed thinking. (Location 657)
• [[Dependency]], putting someone else in charge of your life. (Location 658)
• [[Passive aggression]]. (Location 660)
• [[Porous boundaries]]. Not deciding how others’ actions, feelings, and expectations should affect you, just letting yourself be influenced. (Location 662)
• [[Impossible goals]], [[low expectations]], We believe we should be able to attain great things, at the same time as we believe we’re incompetent and inept. But we keep trying to hit a home run: This time will be different, this time I’ll make it, and then I’ll be happy. (Location 668)
• [[Passive aggression]] against the self. (Location 673)
• Lack of [[exercise]]. (Location 683)
• Depression is the replacement of parts of the self that are natural, spontaneous, and honest with these self-destructive skills. It’s the loss of parts of the self, the gradual numbing of feelings and experiences that we gradually come to believe are unacceptable and banish from experience. Cure comes from recovery of the missing pieces. (Location 688) [[What is Depression]]
• These questions require answers that make us question our deepest values — do we have the ability to make our own decisions in life, or are our decisions programmed by our heredity, nervous system, or early childhood experiences? If our decisions are determined, what happens to the social contract, guilt, crime, and punishment? (Location 717)
• [[weight gain]], or [[change in appetite]] (Location 754) [[depression-symptoms]]
• Activity level slows down (Location 756) [[depression-symptoms]]
• [[excessive [[guilt]]]] (Location 757) [[depression-symptoms]]
• [[Recurrent thoughts of death or suicide]], (Location 758) [[depression-symptoms]]
• The depressed mood is usually self-reported as a feeling of [[sadness]], [[hopelessness]], or [[discouragement]], (Location 760) [[depression-symptoms]]
• Some people emphasize physical complaints or report [[irritability]] more than [[sadness]]. (Location 762) [[depression-symptoms]]
• There is good statistical evidence that recent stress may precipitate the first and/or second bouts of major depression, but that it may take much less stress to set off later episodes. I find that patients can usually pinpoint what made them depressed the first time, but it’s not so easy for subsequent episodes. (Location 771) [[depression-relapse]]
• The essential criterion for diagnosis of [[dysthymia]] is a depressed mood for most of the day, for more days than not, for at least two years (! (Location 779) [[depression-symptoms]]
• [[hypersomnia]] (Location 781)
• [[Low self-esteem]] (Location 782)
• [[Poor concentration]] or [[difficulty making decisions]] (Location 783)
• These people are more accurately described as “[[walking wounded.]]” They get through life, but life tends to be nasty, brutish, and short. (Location 802)
• Like most men with critical, emotionally rejecting fathers, Turner had developed no internal mechanism for feeling good about himself. (Location 929) [[depression-men]]
• it’s how we live rather than what we do that leads to peace. (Location 934) [[depression-recovery]]
• Though most people can recover substantially from an episode of severe depression, they remain more vulnerable to [[stress]] and [[anxiety]] than others. (Location 947) [[depression-recovery]]
• disorder. It makes most sense to believe that people suffer from a general distress syndrome that causes symptoms that manifest themselves as depression, [[anxiety]], PTSD, autoimmune disease, [[cognitive impairment]], and what I call “nonspecific illness.” (Location 982)
• It may be that [[anxiety]] is the initial response to too much [[stress]] — our panicky attempts to escape an inescapable situation — while depression represents the damage done to the nervous system, and the mind, when the stress goes on too long. (Location 990) [[Depression and Anxiety]]
• these people [[sleep too much]]; they also [[eat too much]] and [[put on weight]]. (Location 1040)
• high degree of [[rejection sensitivity]] (Location 1041)
• Very frequently, especially in the first one or two episodes of major [[depression]], patients also feel extreme [[anxiety]] and panic attacks (Location 1051) [[depression]]-symptoms
• In the depressive phase, patients feel [[sad]], [[anxious]], [[irritable]], and [[socially withdrawn]]. They become [[lethargic]], [[sleep too long]], [[gain weight]], and [[crave carbohydrates]]. (Location 1113) [[depression-symptoms]]
• [[depression]] seems to lead to specific changes in brain activity that remain as a vulnerability when sad or stressful events happen to recovered patients. (Location 1147) [[depression]]-causes
• More and more research shows that with focused attention and practice we can change and repair our own brains. (Location 1153) [[depression-recovery]]
• A genetic predisposition. There is some inheritable component to depression. (Location 1194) [[depression-causes]]
• Difficulty in early relationships with parents (Location 1200) [[depression-causes]]
• Poor interpersonal skills. Shyness and social phobia are highly linked with depression. (Location 1204) [[depression-causes]]
• Unstable [[self-esteem]]. A hallmark of depression is that [[rejection]] seems to hurt terribly and corrode your self-image, while good things only result in a temporary and weak pleasant feeling. (Location 1210) [[depression-causes]] [[depression-symptoms]]
• many people with depression have a “crack in the pan” — a leaky oil system — and need more or less continual affirmation, love, or success to function, even though their behavior may get in the way of achieving these things. (Location 1216) [[depression-symptoms]]
• [[Pessimistic thinking]]. There is solid evidence that people with depression think in characteristic negative, self-critical ways that are quite different from other people. (Location 1218) [[depression-symptoms]]
• [[criticizing harshly]] (Location 1229)
• withdrawing attention or affection because the child has displeased the parent. (Location 1231) [[depression-causes]]
• Childhood problems with siblings also are linked to adult depression. Many of my depressed patients have felt that a sibling was favored, or that a sibling rejected or bullied (Location 1232) [[depression-causes]]
• We live in a very competitive society, where status is determined by wealth, not by what you contribute or how well people love you (Location 1245) [[depression-causes]]
• Other blows to [[self-esteem]]. These can be highly individual, (Location 1253) [[depression-causes]]
• [[Preoccupation with the self]]. People who are asked to do tasks like perform an activity in front of a mirror or video camera often experience a loss of [[self-esteem]], unrealistic standards for their own performance, increased [[self-[[blame]]]], and feelings of [[inadequacy]].15 People with depression often turn their focus inward like this, developing a harsh Inner Critic (see Chapter 9), who tells you that anything that goes wrong is your fault. (Location 1262) [[depression-symptoms]]
• [[Depressed thinking]]. (Location 1267)
• [[Self-destructive]] or [[self-sabotaging]] behavior is a hallmark of depression. (Location 1269) [[depression-symptoms]]
• [[procrastination]], [[disorganization]], [[shyness]], [[unassertiveness]], [[lethargy]], [[passivity]] — all these patterns resonate throughout the vicious circle of depression (Location 1270) [[depression-symptoms]]
• They tell you that you’re not in control of yourself. (Location 1271)
• They have lasting consequences because you’re not able to take advantage of school, training programs, or other opportunities. They drive away people who are mature and well functioning and attract others who are equally dysfunctional. (Location 1272)
• [[Lack of [[exercise]] ]]and [[self-care]] will result in long-term damage to the body. (Location 1273)
• [[Guilt]], [[shame]], and diminished [[self-esteem]]. There is a pervasive sense of guilt, [[inadequacy]], [[unworthiness]], or [[unlovability]] that can’t be erased no matter how loving or self-sacrificing you are, nor by reassurance that others love you and do not blame you (Location 1275) [[depression-symptoms]]
• [[Feared loss of emotional control]]. This is something that patients report all the time, although there’s not much attention paid to it in the professional literature; (Location 1277) [[depression-symptoms]]
• There is a sense that some awful, nameless, and permanent change to the self is taking place. (Location 1280) [[depression]]-symptoms
• the mere experience of this kind of [[fear]] does result in lasting change in how you feel about yourself — you may never again feel the kind of naïve [[self-confidence]] that you’ve relied on. (Location 1281)
• Impaired functioning in most aspects of living. Depression makes us think less effectively; we have [[trouble concentrating]], [[making decisions]], [[remembering]], and [[taking in new information]] (Location 1283) [[depression-symptoms]] [[depression-memory]] [[cognitive impairment]]
• You can make decisions in the midst of depression that will ruin your future: dropping out of school, turning to drugs, running away from or spoiling a good relationship. (Location 1284) [[cognitive impairment]]
• Children with depression have [[trouble learning]] and may suffer real educational deficits that will have lasting effects. They also suffer socially; they can become the target for bullying, and have difficulty making friends. Damage to their [[self-esteem]] can last a lifetime. (Location 1286) [[depression-symptoms]]
• Development of a stable, dysfunctional interpersonal world. (Location 1293)
• [[Assumption of the sick role]] (Location 1300)
• Neurochemical changes. (Location 1310)
• [[Discrimination]] and [[stigma]]. (Location 1317)
• the patient’s [[shame]] is validated by [[society]]. (Location 1318)
• Depression is not only a result of biochemistry, [[genetics]], faulty thinking, or [[self-destructive behavior]]. It is also a result of how [[society]] treats the patient (Location 1319)
• We can’t return to a state of health merely by an act of will, because we are caught in a process that repeats itself over and over; a vicious circle that creates the very conditions that sustain it. (Location 1326) [[depression-recovery]]
• it seems that more and more people are made vulnerable, chiefly because their childhood experiences don’t enable them to build a [[resilient]] self; then they have to face a much more stressful and difficult adult world than we were designed (Location 1337) [[Childhood experience]]
• [[Childhood experience]] — not only trauma and neglect, but also simply a poor relationship between caregiver and child — results in damage to the structure of the brain itself. This damage to the brain in turn results in things like a reduced ability to experience and control emotions; an unstable self-concept; damage to our immune system; difficulty in forming relationships; [[reduced ability to focus]], [[concentrate]], and [[learn]]; and damage to our capacity for [[self control]] (Location 1382)
• We have to forgive ourselves for not being able to do the impossible. (Location 1408) [[depression-recovery]]
• Emotions. People with depression usually have learned ineffective or self-defeating ways of handling emotions. (Location 1464) [[skills of depression]]
• Many depressed people have particular trouble with anger. We feel we should never get angry, so we bite back on it until we can’t take any more, and then explode. (Location 1467) [[skills of depression]] [[depression-symptoms]]
• Behavior. The patient often must also change patterns of behavior that lead to a depressed lifestyle. (Location 1472) [[depression-recovery]]
• Most depressed people are [[perfectionists]]. We feel that if we don’t do a job perfectly, our entire self-esteem is endangered. (Location 1473) [[depression-symptoms]] [[skills of depression]]
• Often this leads to [[procrastination]], so the job is never really begun. Outright failure is avoided, but the depressive knows he’s let himself down. (Location 1474) [[skills of depression]]
• Our [[perfectionism]] makes us want to make ourselves over from the ground up: we want to lose thirty pounds, run five miles a day, quit smoking and drinking, get our work completely reorganized, and have time for relaxation and meditation. (Location 1475) [[skills of depression]]
• It seems like there is so much to do that we never start; or we may start one day in a burst of energy that gets dissipated in so many directions that nothing really gets accomplished, and we are again confirmed in the belief that there’s no point trying. We have to learn that attaining more limited, realistic goals is much more satisfying than building castles in the air. (Location 1476) [[skills of depression]]
• Thought processes. We have to change the way we think. Jerome Frank talked about our unique “assumptive world,” the idiosyncratic set of beliefs we all have that explain to us how life works. We get some assumptions from our parents, we develop others as we grow up, and we continue to add to and revise our beliefs about what makes things tick into adulthood and old age. Depressed people tend to have certain assumptions in common, assumptions that are self-perpetuating and not corrected by experience. We think that we are responsible for the bad things that happen to us, while the good things are just accidental. We are [[pessimists]], thinking that things left alone will usually go to pieces rather than working out for the best. We think that we have to be in control of things at all times, and if we’re not, disaster will happen. These habits of thinking are largely unconscious. They must be brought out into the open, challenged, and changed for recovery to start (Location 1479)
• Jerome Frank talked about our unique “assumptive world,” the idiosyncratic set of beliefs we all have that explain to us how life works.2 We get some assumptions from our parents, we develop others as we grow up, and we continue to add to and revise our beliefs about what makes things tick into adulthood and old age (Location 1480)
• Twenty-first-century living conditions have us constantly in fight-or-flight response, pouring out stress hormones — adrenaline and cortisol — which are very useful in emergencies but over time have devastating effects on the body, brain, and mind, including but not limited to depression. (Location 1489)
• The only way I know how to cope with this kind of stress is to learn to be more mindful. Mindfulness — learning to be more conscious, aware, in the present moment — has been shown to be a very effective road to recovery from stress, anxiety, and depression. (Location 1491)
• Relationships. Relationships with other people are always difficult for the depressive. We walk around with a vast hurt inside and long for someone to heal it, but we’re also ashamed of feeling that way, so we don’t let anyone know. We care too much about how others feel and think about us, but we’re afraid to let them know we care; consequently we’re almost always disappointed. Always expecting rejection, we may reject first as a defense. Our boundaries are too porous, so that we often assume others know how we feel, and that we know how they feel. Despite the fact that we’re wrong about this so often, we don’t learn from experience and stop making these assumptions. We have to learn specific techniques of communication that will establish boundaries and stop the confusion. (Location 1496)
• We care too much about how others feel and think about us, but we’re afraid to let them know we care; consequently we’re almost always disappointed. (Location 1498)
• The body. Depressed people tend to be insensitive to messages from our bodies. We often overwork ourselves, then collapse with exhaustion, not realizing that this cycle is damaging. Simple things like eating become loaded issues, so we don’t eat well and are prone to weight gain or undernourishment or both. We’ve forgotten how to sleep. We don’t exercise. We can easily come to abuse alcohol or other drugs, both legal and illegal, to try to regulate our moods and bodies. (Location 1502)
• The self. Depressed people don’t have inner resources of self-esteem that help them get through trying times. We look to others to replace those resources but know that such wishes are unfair and unrealistic; consequently we are consumed by shame and guilt (Location 1506)
• We haven’t been able to determine principles and values for ourselves, nor to guide our lives by rational priorities, because we lack confidence in our own judgment. We can’t feel good when we accomplish a meaningful goal because all goals are the same; burning dinner feels as if it can undo our pride about graduating from college. We need to learn how to set priorities, to trust our decisions, and to take pride in our accomplishments. (Location 1508)
• Depressives fear feelings. (Location 1551)
• Other self-defeating habits that will be explored in the following chapters — in how we think, act, communicate, and view ourselves — are essentially ways we have developed to help us not feel certain things. (Location 1552)
• Understanding that emotions are not to be feared will free us up to change our other habits. (Location 1553)
• we feel guilt about feelings and desires without being aware of the feelings and desires themselves. (Location 1573)
• This is one of the great secrets of depression. The depressive is full of guilt about feelings, desires, and impulses he’s not even aware he has. If you’re going to feel guilty anyway, you’d better know what it is that you feel guilty about. If you know, you can do something about it. The first step in overcoming the guilt is to become aware of the feelings. (Location 1578)
• If someone steps on your psychological toes — for instance, by being rude or unfair — you may feel anger, jealousy, outrage. If you don’t experience these emotions, it’s because you are spending psychic energy to keep them out of awareness. This psychic energy could be better spent on other things. (Location 1590)
• When we’re confronted with a moral choice, we should pay special attention to our feelings, because if we think too much, our defenses go to work. (Location 1599)
• Our first, gut feelings are usually honest and objective. We should pay special attention to our first reactions to new people and situations. (Location 1600)
• Emotions in themselves are absolutely value-free. They are reflexes, like salivating when hungry or withdrawing your hand from a hot iron. (Location 1606)
• We have some ability to control how we express emotions, but we get in trouble if we try to control how we experience them. (Location 1608)
• It takes a great deal of practice for the depressed person to learn how not to experience emotions, but we get very good at it. Women get especially good at not feeling anger and men get good at not feeling sadness. (Location 1612)
• But people with [[depression]] overuse their defenses as ways to try to avoid feeling, and we run the risk of losing the ability to feel altogether. (Location 1628)
• Because depression won’t let us feel our feelings, we develop mood changes instead. One minute we’ll be feeling pretty good, then without warning we feel depressed — sad, discouraged, no energy. One of the favorite phrases of depressed people is “out of the blue” — “It just came over me, out of the blue, and I felt so awful again.” We’ve stuffed our feelings so much that just one more drop is enough for them to break through in a wave of sadness, regret, or guilt (Location 1642)
• mood changes are always caused by an unfelt feeling. (Location 1647)
• Accordingly, the depressive must monitor his or her own moods to help detect the feelings underneath. Trust that there is always a precipitant to a mood change, and use a Mood Journal to help analyze the connections between events and the change in mood. In this log you’re simply asked to describe your mood changes and the external and internal events accompanying them, in the hope that you will begin to see the connections. It’s a way of helping you to be more observant and objective. (Location 1650)
• This may not feel good at first. You may find yourself worrying more, feeling perhaps a bit more edgy. You are going to become more aware of things that upset you. This awareness is what depressives try to avoid. Just remember that this avoidance sacrifices your true self and makes you depressed. (Location 1658)
• The depressed person often feels there is no reason for feeling depressed (or angry, or scared), and thus feels crazy or out of control. But if we take the trouble to investigate, to get underneath our own defenses, we usually find that there are perfectly good reasons for feeling the way we do. Understanding that is the first step toward doing something about it. (Location 1665)
• There is a perverse gremlin within us that resists change, especially the kind of change that someone else says is good for us. My strategy has now become to appreciate the gremlin’s tricks on me, then try to outwit the little beast. So if you find yourself losing this book, or if you find that life always interferes with completing the Mood Journal, just assume that your gremlin is at work. Laugh ruefully at the games he’s playing with you, then see what you can do to be smarter than he is. (Location 1686)
• Anger is a particular trouble spot for most depressives. We are often aware of a feeling of estrangement from the world, our noses pushed up against the glass watching real life behind the window, and a consequent bitterness, hurt, or resentment lurking in the background. (Location 1695)
• This anger and self-blame can feed on itself in a vicious circle, so it is often nearly impossible to be sure that we are justified in feeling the depth of anger we experience in any particular situation (Location 1698)
• We second-guess ourselves constantly and often end up doing nothing but driving others crazy, Hamlet-like. (Location 1700)
• In other circumstances, our guilt makes us self-sacrificing: we will absorb ill treatment from others as if it is our due, but eventually we will get pushed too far and explode in a tirade of anger that unloads all the steam we have built up. (Location 1703)
• It’s important to remember that anger, like all other emotions, is neither good nor bad in itself; it’s just an innate response we have when someone steps on our metaphorical toes. Anger can be used for many worthwhile purposes. It’s the fuel that feeds our desire for justice, what makes us want to see wrongs put right. What is scary is that it feels as though it can run away with us. But I think that’s largely a myth about anger, because few of us ever do really lose complete control (Location 1706)
• Saying that we were so angry we lost control is an excuse. We had control, but we still did something shameful. (Location 1714)
• Dad alternates between withdrawal and rage. It’s an explosive combination (Location 1719)
• Practicing assertive communication and behavior, as described in Chapter 10, can help make sure that anger is constructively expressed and doesn’t hurt people important to us. (Location 1722)
• as we develop assertive skills, we find that we feel less aggrieved and isolated and thus have less to be angry about. (Location 1724)
• Less dramatic than anhedonia but a much more pervasive problem among the depressed is a condition that doesn’t even have a clinical name. It’s the gradual withdrawal into isolation and indifference that creeps up on us as we live with the disease. Robertson Davies called this condition acedia; it’s akin to the deadly sin of sloth. But it’s not merely laziness, it’s a gradual closing down of the world. (Location 1767)
• As depression makes us lose interest or pleasure in things, our range of activities constricts. We stop taking chances, we avoid stimulation, we play it safe, and we begin to cut ourselves off from anything that might shake us up — including loved ones. (Location 1771)
• depressives consistently evaluate their own performance more harshly than do nondepressives, whereas nondepressed people tend to overrate their own performance. (Location 1777)
• One reason why we don’t allow ourselves to experience these pleasurable feelings is our wish to remain in control at all times. Intense feelings of any kind are destabilizing (Location 1782)
• for the depressive, feelings like joy or pride evoke painful memories of past disappointments. We remember the father who was never satisfied, the mother who didn’t seem interested. The bereaved child within us, who has never stopped grieving for those incomplete relationships, is awakened at times of celebration, and becomes the ghost at the feast. No wonder we’re tempted to stay numb. (Location 1786)
• there is good reason to believe that the normal state of the human mind is one of mild anxiety. (Location 1790)
• happiness, instead of being a normal state of being that we don’t experience because something is wrong with us, is something that must be cultivated. (Location 1794)
• We need to practice feeling good. (Location 1797)
• We will have to face the painful feelings, the old disappointments that get stirred up when good things happen, but every time we do so, we accomplish a little more of our grief work: we grow stronger, and the old hurts have less power over us because they diminish in proportion to new, reparative experiences. (Location 1799)
• Choosing not to express won’t necessarily make us depressed, but trying not to feel will. (Location 1816)
• Exercise 1: Learning to Express (Location 1832)
• Gaining strength in the ability to experience and express emotions is the first step toward recovery from depression. (Location 1846)
• We have this unfortunate idea that we should be master of our emotions, that they are part of our animal nature that must be controlled at all costs. Instead, we should seek to live in harmony with our animal nature, to get that side of us and our intellectual and spiritual selves to live together with affection and respect. (Location 1848)
• Work — and here I mean everything from paid employment to child-rearing and housekeeping to the kinds of “work” we assign ourselves, like reading a good book or planting a garden — is a chore to the depressed. It drains us, leaves us feeling as bad as before, physically worn out and emotionally depleted, instead of proud of ourselves and invigorated. (Location 1872)
• Procrastinators have some big false assumptions about how work works. They assume that really productive people are always in a positive, energetic frame of mind that lets them jump right into piles of paper and quickly do what needs to be done, emerging only when the task is accomplished. On the contrary, motivation follows action instead of the other way around. (Location 1883)
• Depressed people assume that people who are good at work skills always feel confident and easily attain their goals; because they themselves don’t feel this way, they assume that they will never be successful. (Location 1887)
• most people who are really successful assume that there are going to be hard times, frustrations, and setbacks along the way. Knowing this in advance, they don’t get thrown for a loop and descend into self-blame whenever there’s a problem (Location 1889)
• Procrastination can also help protect the depressed person’s precarious self-esteem. We can always tell ourselves we would have done it better if. (Location 1892)
• The paradigm is the college term paper rushed together in a furious all-nighter. The student protects himself from the risk of exposing his best work by never having the time to do it right. This allows him to protect his fantasied sense of himself as special and uniquely gifted. (Location 1893)
• Procrastination is also a result of the depressed person’s tendency toward perfectionism, a crippling problem. Research has shown that the more perfectionistic a depressed person is, the worse his chances of recovery. (Location 1894)
• In the office, the person who insists on doing everything exactly according to the rules doesn’t acknowledge his own desire to control everyone else, though they certainly feel his control. (Location 1986)
• procrastination is a form of passive-aggression that the depressive uses very cleverly to make himself feel miserable. The resented authority is not the abandoning therapist or the bossy parent, but the part of the self that says to the depressive, “You really should (wash the dishes, paint the living room, get a better job . . .) (Location 1991)
• Finding more direct and healthy ways of expressing anger, developing autonomy, and acknowledging a need for intimacy is the obvious strategy to disrupt self-destructive behavior patterns (Location 1999)
• They seem to never have time to enjoy themselves, or take a day off, or fix a healthy meal — but they are angry at themselves for this. (Location 2049)
• Avoid triggers and distractions. (Location 2074)
• Avoid enablers. (Location 2078)
• It’s usually worse than you expect. (Location 2082)
• But it’s not as bad as you fear. (Location 2084)
• Don’t try unless you’re ready. (Location 2087)
• Ask for help. (Location 2089)
• Stimulus control (Location 2093)
• When you find yourself distracted or anxious or unable to decide what to do next, get up from your desk and give yourself a short break. (Location 2094)
• Reward yourself. (Location 2097)
• Baby steps (Location 2100)
• Don’t obsess — distract. (Location 2103)
• Don’t let a slip kill your resolve. (Location 2107)
• Savor the positive results (Location 2112)
• We would like to be looser and more relaxed, but we literally don’t know how. (Location 2199)
• One approach is to make leisure more like work: to add opportunities for deeper engagement or productive activity in our downtime. (Location 2206)
• That brings us to another approach to downtime, which is to make it meaningful — like joining the local rescue squad, volunteering for a charity or a political cause, or simply making an effort to better the lives of others in small ways every day. (Location 2210)
• So maybe we should think about developing skills for more passive activities — reading, playing, exercising your imagination, lying in the hammock, simply relaxing. These activities seem so antithetical to today’s world that we need reinforcement and practice in order to do them right, without either feeling guilty or having the nagging sense that we ought to be doing something productive. These things are productive, but not as we usually define the concept. They produce good health, an active mind, and the opportunity to get in touch with our interior selves. They make us more at ease, more fun to be around, more at home in our skin, and more comfortable with the concept of rewarding ourselves with what really matters (Location 2220)
• It can reliably lift us out of depression — but to do so, it can’t be played as background music. You have to stop what you’re doing, pay attention to the music, and play it loud. (Location 2233)
• Even sad music can stop a depressed mood. After all, depression isn’t sadness, it’s the absence of feeling, and sometimes a good cry is healing. (Location 2235)
• and beliefs that never get tested against reality. These thought patterns become entrenched and automatic; it takes therapy or serious self-examination with a good self-help book for us to become aware of them, and then it takes mindful practice to replace them with more logical or healthy thinking. (Location 2255)
• self-help book for us to become aware of them, and then it (Location 2256)
• The self. The depressed person is his own worst critic. He sees himself as defective, inadequate, or deprived. (Location 2271)
• He tends to underestimate and criticize himself, and he lacks hope because he believes he is missing the essential character traits that lead to fulfillment. (Location 2273)
• Present reality. The depressed person interprets interactions with the everyday world — people, events, and inanimate objects — differently from other people. He sees the demands the world makes on him as impossible to attain. He interprets his interactions with the world as representing defeat or deprivation, whereas an outside observer would see some successes in the failures, some acceptance among the rejections. (Location 2274)
• Future expectations. The depressed person has a negative expectation for the future. He doesn’t anticipate relief from his present suffering, and when he considers trying something new, he expects to fail. (Location 2278)
• Overgeneralizing, or the tendency to assume that if it’s true once, it’s likely to be true all the time. (Location 2283)
• Selective abstraction consists of focusing on a detail taken out of context, ignoring other evidence, and drawing conclusions on the basis of the detail. (Location 2285)
• Excessive responsibility. People who are depressed tend to assume that they are responsible for bad things that happen, while good things are caused by others, by luck, or other factors that can’t be controlled. When the car skids on an icy road, the depressive thinks, “I shouldn’t have been driving today,” rather than, “The road is icy. (Location 2289)
• Self-reference. Depression leads to a negative self-consciousness, a tendency to magnify one’s own part in things, even to believe that you are the center of attention. The depressed child in the school play thinks that all eyes are on her, that any mistake she makes will be the talk of the town. You also assume that you’re to blame whenever anything goes wrong. (Location 2292)
• Catastrophizing. Depressed people are well known for taking bad news to the extreme: “I had a flat on the way to work today. I must need new tires. They’ll all go bad and I can’t drive to work. I’ll have to quit my job. I’ll never find another job. I’ll starve. (Location 2295)
• Dichotomous thinking refers to the tendency to see everything as good or bad, black or white. The depressive puts himself in the bad category, people he admires in the good. He doesn’t see faults or weaknesses in those he admires, nor does he see strengths in himself (Location 2297)
• Emotional reasoning means that whatever you feel is true; going with your guts instead of your brain (Location 2301)
• In order to be happy, I have to be successful in whatever I undertake (Location 2309)
• To be happy, I must be accepted by all people at all times. (Location 2310)
• If I make a mistake, it means I am incompetent (Location 2311)
• If somebody disagrees with me, it means he doesn’t like me. (Location 2313)
• My value as a person depends on what others think of me. (Location 2314)
• They are so glaringly illogical that they have to be kept out of conscious awareness. It’s only when we back off and take an objective look at our own behavior that we can see assumptions like these at work. (Location 2315)
• These depressed assumptions are supported by automatic negative thoughts — the knee-jerk reactions that have become the default mode of thinking under stress. (Location 2322)
• Some like the acronym ANTS for automatic negative thoughts, because like ants they seem to creep in from nowhere to spoil the picnic. (Location 2327)
• Don’t go there. Don’t listen to that voice. Worry about that later. That’s not my problem. (Location 2330)
• The depressive usually judges things as negative, painful, difficult, or frightening, but this is a bias, a mindset we can put aside. (Location 2340)
• people who tend to give up easily have certain explanatory styles in common. They tend to see bad events as permanent and good events as temporary, whereas people with an optimistic explanatory style perceive events in just the opposite manner. (Location 2376)
• Depression can almost be defined as the abandonment of hope. When we’re depressed, we feel that hope has abandoned us, but this is a two-way street. (Location 2399)
• Identifying stressful situations Examining our thoughts and behavior under stress Determining what beliefs underlie our responses to stress Learning to challenge those beliefs Identifying alternative responses to stress Examining the effects of those responses, incorporating them into our belief system and behavior patterns if successful, modifying them further if not (Location 2409)
• It’s vital to emphasize that we can only become aware of our self-destructive beliefs through therapy or some means of objective observation, not through introspection; it’s like trying to see the back of your head. (Location 2415)
• Cognitive therapy has become so accepted now as a standard treatment for [[depression]] that some are considering [[depression]] largely a symptom of dysfunctional thought processes. This runs the risk of encouraging the depressive’s belief that he needs more control, not less. If he continues to be depressed, he is likely to feel that he has done a poor job of applying cognitive methods, which just reinforces his sense of self-blame and inadequacy. Depressives need to get out of their heads and into their hearts and their bodies. If you’re using cognitive therapy you must remember that [[depression]] is a very complex condition, that changing faulty thought processes is just one of many possible ways of treating it, and that addressing these thought processes is going to have repercussions in other areas of your life: how you process feelings, how you communicate with loved ones, how you feel about yourself. (Location 2452)
• depressed people vastly overestimate the performance of others. Those impromptu speeches? Depressed people give others scores that are far too high compared to the norm. (Location 2477)
• Nondepressed people think that others like them, even if they don’t; depressed people think that others don’t like them, even if they do. (Location 2480)
• They may view themselves a bit more accurately than nondepressed people, but they view others less accurately. (Location 2481)
• Defensive pessimists do things like work very hard to prepare themselves, while optimists may blithely assume they’ll breeze through. (Location 2489)
  • Note: I tend to assume ill breeze through, or maybe repress the urge to prepare. I wonder how that fits in.
• Anyone who’s been through a serious episode of depression is far too wise to develop the kinds of positive illusions that sustain others in wishful thinking and happy expectations; (Location 2494)
• Exercise 2: Your Dirty Laundry (Location 2506)
• What if I suggest you stop fighting? What if the fighting is actually making the problem worse, or at least keeping it alive? (Location 2524)
• There was a part of you that could really get in the spirit of raking yourself over the coals (Location 2531)
• It’s the voice of fear, looking for a simple explanation for a confusing situation, and it settles quickly on the usual suspect (Location 2535)
• There’s another part of you that tries to defend against the attacks of the Inner Critic. I call it the Timid Defender. (Location 2536)
• When people are beating themselves up, I suggest they’re being too hard on themselves. When they’re in defensive mode, I help them face what they’re afraid of. (Location 2543)
• When the Defender is in charge we indulge and spoil ourselves; we let ourselves off the moral hook; we make promises to ourselves we know we won’t keep. (Location 2549)
• We vacillate between spoiling ourselves and punishing ourselves. And, as with children who are raised that way, we end up frightened and traumatized, with no self-esteem and a lot of self-hate. (Location 2551)
• It suggests giving up judging and replacing it with empathy, a willingness to face the truth and all your feelings about it, without fear but with confident strength. (Location 2553)
• Contemporary society is so different from what our bodies and minds were designed for that we’re in a state of perpetual stress, which constantly floods us with stress hormones, and constantly pushes us back over that invisible cliff into depression and anxiety. (Location 2571)
• people who are depressed have much greater difficulty remembering random information than people who are not depressed. When given new material, they have more difficulty connecting it with what they know already — the information does not get organized in ways that help it get learned or recalled. (Location 2576)
• It’s not bad enough that depression causes us emotional pain, makes our behavior self-defeating, and drives others away from us. But because our thinking is damaged, when we try new pathways in an effort to recover, we’re handicapped at the outset because we have more trouble remembering and absorbing information, and we’re distracted by trivial inconsistencies and errors. (Location 2583)
• To me, mindfulness means deliberately trying to attain a new attitude toward your thoughts, feelings, and everyday experience — “an attitude of openness, compassion, and objectivity; a deliberate effort not to be guided by old habits of thinking and behaving but to see each experience in its uniqueness.”7 It means seeing yourself without illusions but with love. (Location 2625)
• Exercise 3: A Simple Mindfulness Meditation (Location 2655)
• That’s what we have to deliberately allow ourselves to practice: to treat ourselves with care and concern. That’s also what meditation does for our restless, anxious minds; it builds a structure we can feel safe in. (Location 2678)
• Depressed people, for instance, are naturally enough going to believe that thinking intensely about their problems will lead to solutions. But when thinking turns into rumination, it just perpetuates the feeling state of depression; so they feel worse, more immobilized and helpless. (Location 2730)
• This is the big news coming from brain research. We literally can’t change ourselves by thinking our way out (Location 2738)
• The depressed person makes himself miserable partly by trying to control things he can’t control. Indeed, some researchers feel that excessive worrying is the hallmark of [[depression]]. (Location 2746)
• we find a counterargument for every possible solution to our problems, and so end up taking no action at all. (Location 2748)
• Detachment is a skyhook we desperately need, (Location 2768)
• It seems as if depressives have an obsessive quality that won’t let us detach. We often worry constantly about things over which we have no control, or tell ourselves we won’t be happy unless something we can’t control happens. (Location 2779)
• Will this really matter tomorrow (next week, next month)? and What can I realistically do about it? (Location 2784)
• If I’m in a situation that is highly charged emotionally but whose outcome is not really crucial to me, perhaps I don’t have to act impulsively just to get some emotional relief. If I’m in a difficult, even an important, situation but my options are limited, I only make myself miserable by wishing for the impossible. (Location 2785)
• Avoidance sounds shameful and acceptance sounds passive. But there are many things in life we can’t alter and others that are not worth the trouble; wisdom has to do with knowing what’s worth fighting about. (Location 2808)
• alter, avoid, accept. (Location 2814)
• Observing ourselves mindfully, we become used to the idea of thoughts as mental events, things that are happening inside our brains. We stop thinking of our thoughts as the absolute truth or as moral imperatives that we must act on immediately. We see how our thoughts are influenced by feelings, the stress of the day, the weather, the background music, how much coffee we’ve had, how much Zoloft is in our systems, and we trust them less. (Location 2818)
• People with depression can be very difficult to live with. We need a great deal from others, but we are embarrassed and confused by our needs, so we don’t articulate them well. (Location 2837)
• Part of the reason why depressed people can have unrealistic expectations for others is that we rarely state our needs directly, instead keeping secret wishes locked in our hearts. (Location 2840)
• In the lab, they have trouble recognizing and responding to facial expressions of happiness, but seem oversensitive to expressions of sadness (Location 2849)
• other people’s feelings (except for the positive ones) get right to them. (Location 2852)
• I have the impulse to pick up and throw the nearest object when I’m spoken to this way, because I feel infantilized. But I’m better off to say it verbally: “I feel like you’re overprotecting me. You’re assuming you know what I want, but you’re wrong. Please just answer the question directly.” (Location 2902)
• When my wife asks what I want for dinner, pasta or chicken, and I say I don’t care, what I’m often missing is that she’s asking for a little companionship, a little mutual ownership of a decision. If I say, “Chicken sounds good,” but say it with a “Don’t interrupt me” attitude, I’m still dismissing her, even though I’ve answered her question. (Location 2930)
• Depressed people often fall into the trap of people-pleasing, trying desperately to make others happy in an effort to gain attention or love. This usually just scares others away, because they know it’s fundamentally dishonest. You’re giving the impression that you’re willing to say or do anything to be liked, and that you have no internal values or standards that you won’t compromise. (Location 2940)
• Being assertive means knowing your rights and giving yourself the same respect you’d give another person. It does not mean being pushy, demanding, controlling, or selfish (Location 2949)
• Projection means that I take my feelings, disconnect them from my conscious awareness, and attribute them to you. (Location 3018)
• These irrational sensations of knowing with perfect clarity exactly what the other person is thinking are sure indications of projection. (Location 3045)
• The tempting, easy thing to do when we’re feeling misunderstood is to withdraw. This is something depressives are good at. We can be wonderfully resourceful at entertaining ourselves. The feeling of being picked on, misunderstood, and isolated is an old, comfortable feeling. There is something that feels right about it. It confirms our fantasies that we are the ugly duckling, the Cinderella who is just in the wrong place at the wrong time, who can’t be happy because of all the mean people in the world. Withdrawal can feel self-righteous. (Location 3064)
• Divorced from feelings, we tend to see ourselves divorced from our bodies as well. But our “true self” is not only in our head, it is our whole being (Location 3086)
• Positive thinking is good for the body: people who believe in positive myths about themselves live longer, have fewer heart attacks, and require less anesthesia during surgery. Optimists’ wounds heal more quickly than those of pessimists.1 Being a pessimist can shorten your lifespan. Being depressed is even worse (Location 3099)
• people with depression usually have elevated levels of cortisol and adrenaline, (Location 3115)
• we keep on pumping out stress hormones. This can lead to exhaustion, cardiac strain, kidney damage, muscle fatigue, damage to the digestive and circulatory system, loss of appetite and the ability to absorb nutrients, damage to the immune system so we become more vulnerable to infection, loss of interest in sex, and the constant subjective feeling of tension and fear. (Location 3124)
• Exercise 4: Mindful Walking (Location 3314)
• Sadness, disappointment, and fear are emotions. Depression is an illness (Location 3358)
• Guilt and shame exist in what some call the “preconscious” world — we manage to forget about them most of the time, but when we go to bed at night, they pop up out of the darkness. Sometimes people with depression unconsciously look to others in their lives to undo these feelings we carry around, but it’s impossible, because we don’t really believe we deserve forgiveness; we believe our defects are far too deep. (Location 3369)
• associated with messiness, self-esteem with cleanliness. But if mommy, because of her own depression, anger, or frustration, seems (Location 3383)
• But if mommy, because of her own depression, anger, or frustration, seems inconsistently annoyed at some times and responsive at others, the child cannot learn adequate discrimination. Shame comes to be associated with the self of the child, not the child’s behavior or products. (Location 3384)
• We must learn not to strive to please others or merely to be different from others, in fact not to define ourselves in terms of others at all, but in terms of an objective evaluation of our own strengths and weaknesses, our own wants and needs. (Location 3421)
• What should be within the boundary of my self? Two things, primarily: awareness and responsibility. (Location 3428)
• I should be aware of my own thoughts, feelings, memories, beliefs, and choices; aware of my wants and needs; and aware that I have an unconscious that can distort everything. I should know that others cannot know these things unless I tell them, and that I cannot have this awareness of others unless they tell me (and they have a right to choose not to). I have to take responsibility for my own behavior, including what I communicate, and for setting direction in my life and making myself happy. I cannot make others happy, I can’t make them stop drinking, I can’t make my children successful — in fact, I can’t make others do anything at all. If I choose to, I can conduct my behavior so that they have a better chance of achieving the goals I want for them, but their achievement is their responsibility, not mine. Establishing healthy boundaries like these is a first step toward detachment. (Location 3430)
• We know that people with [[depression]] tend to be over-responsible, to care too much about how others feel and not enough for themselves. We accept blame for things that are not our fault, and we can feel horribly guilty about trivial events. But I think if we carefully examine what is our responsibility and what is not, we can free ourselves from much of this depressive guilt (Location 3456)
• Depressives must learn to practice self-care. We can fix our leaky oil pans ourselves. What this means is a deliberate effort to practice the skills we’ve been talking about — changing our emotional, behavioral, and thought patterns; changing how we are in relationships; assessing our priorities and trying to live in accordance with our values — and then letting ourselves feel proud of our accomplishments. (Location 3510)
• I think that [[depression]] is best understood as a chronic condition. But we can stay almost symptom-free if we just take proper care of ourselves. I suggest that part of good care requires that we put some time aside each week to reflect on our experience. Writing in regular mindfulness practice can help you understand the recurring issues that are causing you distress, and also help you learn what gives you pleasure and helps you feel good. It is necessary to consider again our priorities and assess the day in terms of how close we came to living in accordance with them, to figure out what we can do differently next time but also to reflect on and integrate what we’ve done well. It can be done in church, in therapy, in a group, in an intimate conversation, in journaling or meditation, but it needs to be done. (Location 3529)
• At the same time, do everything you can to exercise regularly, meditate mindfully, and add fish oil to your diet. (Location 4003)
• you should also try the advice in this book that fits you: seek a more mindful attitude toward your life, address life’s problems more effectively, and become more aware of opportunities for happiness. (Location 4005)
• For some patients, the opportunity to disclose to the therapist all the guilt and shame accompanying depression without being judged is enough to start recovery. For others, the therapist will need to provide guidance in such areas as assertiveness, communication skills, setting realistic goals, relaxation, and stress management — all problems that commonly interfere with recovery from depression. (Location 4027)
• Psychodynamic therapy refers to the way of thinking that you find in this book; a belief in unconscious motivations and reactions; in our use of defense mechanisms to deny pain, and their unintended negative consequences; in the importance of childhood experience in shaping the mind and brain; in a basic conflict within all of us between intimacy and independence; in depression as a way of avoiding difficult emotional states. (Location 4094)
• people with repeated episodes of depression begin to develop associations between sad thoughts and depressive feelings that most people don’t experience. Thus, for example, most people, hearing a song that reminds them of an old love on the radio, might feel a little sad and wistful, but also feel some pleasure at the memories evoked. Depressed people, however, experience a train of spiraling negative thoughts: (Location 4135)
• aside from taking more sick days than others, depressed people can be the best employees. We’re good at being responsible. We are good soldiers, honest and industrious. We have high standards and want to do any job well. We have too much guilt to pad our hours or take home office supplies. Treat us decently, and we’ll be grateful and loyal. (Location 4260)
• One of the things you have to do is take the risk of setting some goals for yourself. Depressed people, pessimistic and lacking confidence, tend to avoid setting goals as a way to protect themselves from disappointment. They don’t realize that the absence of goals leads to a completely different, and frequently worse, set of problems. (Location 4269)
• Research tells us that the simple act of setting realistic and concrete goals seems to improve both our experience and our performance (Location 4279)
• Because we’re so adaptable, however, those good feelings don’t necessarily last once we’ve got to where we’re going. We have to make a deliberate effort to savor and appreciate our achievement. (Location 4285)
• “the proper role of goals is to liberate us, so that we can enjoy the here and now.”3 If we leave the house without purpose or direction, every fork in the road becomes another decision to make, another point where we can become paralyzed by our own ambivalence. Will the scenery be better this way, or that way? Have we gone too far? What if there are no motel rooms? Should we stop at this battlefield, or that old cavern, or the antique center? But if we know where we’re going, our minds are saved all this hassle and we can enjoy the journey (Location 4287)
• Most of us have been conditioned to think of work as an imposition. Even if we are feeling challenged and stimulated, we feel it is for someone else’s benefit, not our own, and we tend to see the time spent at work as subtracted somehow from the time we have available to enjoy our lives. How much better off we would be if we could change our perceptions of work, so that we felt that our time spent there was an opportunity for happiness, for attainment of goals that were meaningful to ourselves, not merely time subtracted from our life span. (Location 4317)
  • Note: This might also be addressed by decoupling work from survival. Could people be happier if they were able to earn a living wage for things like volunteer work, teaching, etc. Less desireable jobs like assembly line work would have to pay their workers more.
• I’ve seen far too many depressed people stay stuck in terrible working conditions through fear of change; often that is the single greatest source of their unhappiness. (Location 4425)
• We do live our lives by certain values and principles, and we do have a sense of what we would like to accomplish for ourselves, but these are often largely unconscious. To make these conscious, we have to examine ourselves deliberately. (Location 4451)
• The reasons probably have to do with the conflicting commitments you’ve assigned yourself, and your difficulty experiencing emotions. (Location 4455)
• Exercise 5. Identifying Your Key Values (Location 4463)
• In the long run, we doom ourselves if our goals are in conflict. (Location 4519)
• you will feel better if you can add to your daily activities something that will help you get to your long-term goals (Location 4523)
• Depressed people tend to be overly dependent on external factors — continual feedback from others and a relentless quest for accomplishment — to feel good about the self. (Location 4565)
• Because there is really little we can do in life to influence the behavior of others or to change events, the depressive’s self-esteem is always in danger. (Location 4566)
• Everyone needs these relationships throughout life; they are like water to a fish. We swim in a sea of relationships that invisibly hold us up and provide us with nutrients. But the depressive’s need for relationships is more desperate, and sometimes more distorted or disguised. Because he’s depressed, he blocks the good things that come with connections, or avoids them altogether. It is as if the depressive has never learned how to swim effectively or float effortlessly. Instead, all he can manage is an exhausting, desperate flailing and gasping (Location 4569)
• Relationships are minefields for the depressed, desperately desiring yet afraid to connect (Location 4578)
• the opportunity to grow in the ability to trust, to be honest, to care and share. Those things are all good for us emotionally; they lead to positive mental health. (Location 4752)
• When one partner is depressed, the other needs to get deliberately involved. Not involved in offering advice and solutions, unless there is a clear signal that that’s what’s wanted, but involved in:   Listening, drawing out, and accepting feelings Exploring alternatives, brainstorming, playing out different scenarios Offering hope and encouragement, conveying the sense that you are not alone (Location 4806)
• Through most of history and in most cultures, it’s been understood that the purpose of marriage is to raise a family, not to make each other happy. Now too many spouses think that the first sign of trouble means that the marriage isn’t working and that divorce is the answer. (Location 4874)
• The authors made a clear link between this pattern and a feeling of abandonment by the father. They felt that girls in early adolescence and boys in later adolescence went through a period when father’s love and good opinion became needed much more intensely. If the father did not respond, they would internalize his lack of caring: if I were a better person, he would pay more attention to me. (Location 4898)
• Every patient I’ve ever known who was depressed had a difficult childhood. Sometimes it was a very critical, demanding father, sometimes a cold, narcissistic mother, sometimes both, sometimes variations on these themes. The death of a parent at an early age or loss of the parental relationship through divorce or separation certainly seems to make people susceptible (Location 4964)
• In my adult practice, most patients report that their [[depression]] only became a serious problem in college or early adulthood; but most would also say they had depressed episodes as children, and their depressed feelings now are closely connected to how they felt then — hopeless, lonely, worthless, defective (Location 5018)
• Children today grow up in a world of fear. The whole society is still reeling from 9/11 and the threat of terrorism, and children are affected too. In kindergarten they are taught about stranger danger; in fourth grade or earlier they are taught about the dangers of drugs; in junior high, the subject is AIDS. On television, politicians disgrace themselves, sports heroes abuse drugs, Wall Street is a shell game, but no one takes responsibility. No one is to be trusted. Parents don’t have neighbors or grandparents to help them with parenting. While it used to be that the whole community was involved in child-rearing, now there is no community. The task falls solely on parents and professionals, who seem to be more and more at odds. Parents and children alike are overwhelmed by mass culture, without a support system to reinforce any alternatives. (Location 5022)
• Parents’ emotional availability to the child is probably the single biggest factor in the later development of [[depression]]. (Location 5028)
• Good parenting is an easy and natural thing. Even if you had lousy parents yourself: if you can remember what you needed and didn’t get as a child, give your child that. If you can be undistracted enough to empathize with your child, to understand what he or she is feeling, then you know what to do. The empathy itself may be the most important thing (Location 5033)
• The painful truth is that youth culture is just an extension of the values of adult culture. We live in a society where we are defined as consumers; we are marketed and manipulated twenty-four hours a day; our leaders don’t lead but instead follow the ratings. (Location 5233)
• Therapists’ offices across the country are full of depressed adults grieving about how their parents let them down, never realizing that their parents were doing what they thought their children wanted. (Location 5260)
• You don’t have to be an expert to see that the mental health of our society has declined since then. Children have to be medicated to be able to attend school. [[depression]], drug abuse, incarceration rates, and homelessness are all soaring. The number of homeless people is a disgrace, and it’s hard not to despair for our country. During the Great [[depression]], Steinbeck wrote The Grapes of Wrath and John Ford made a powerful, touching motion picture of it. Such conditions were just not acceptable in America; they were cause for outrage. Today it seems as if we’ve given up. The gap between rich and poor is higher than it has been since the “Gilded Age,” at the end of the nineteenth century, which eventually led to the rise of powerful revolutionary movements. A presidential candidate is ridiculed by the media when he brings up the idea of redistribution of wealth — but I know many everyday people who feel that the time has come. (Location 5309)
• While the incidence of depression, homelessness, divorce, and incarceration have been climbing, rates for mania, schizophrenia, and panic disorder — more biologically based illnesses — have stayed about the same, supporting the idea that depression is tied to cultural change. (Location 5316)
• Depression has a lot to do with how we treat ourselves. (Location 5320)
• Scientists estimate that our caveman ancestors actually “worked” about four hours per day — as is the norm in so-called primitive societies today.2 The rest of the time was spent in communal activities — mostly just talking, but also a lot of time spent developing artistic skills, singing and dancing, and performing religious ceremonies. (Location 5321)
• social scientists have demonstrated that intimacy, community, and trust are the basic elements of human security and happiness (Location 5346)
• Every time the school system treats a child unfairly, every time the wealthy and powerful get preferential treatment, every time adults are not able to respect each other’s differences, we lose a little of our community mental health. (Location 5408)
• 1. A wish for mastery — to have an impact on the world — coupled with an objective view of one’s unique assets and handicaps. 2. The desire to gain intimacy through relationships based on caring and trust, balanced against the need to maintain one’s independence. (Location 5424)
• we’ve built elaborate rationalizations for giving up, and big walls to keep the problems out of view. We’ve lost faith in political leaders and bought the idea that government hurts more than it helps — we’ve accepted the convenient excuse that there are no real solutions for social problems. Too many of us gave up on the idea that a health care system should be accessible to all, turning a blind eye to the truly offensive profits that are being sucked out of the system. (Location 5437)
• Let’s expand our vision: the paranoid, self-centered “I’ve got mine” outlook leads to depression; the expansive, inclusive “Let’s work together” attitude, though uncomfortable and challenging, is life-affirming and joyful. (Location 5450)
• I wasted four years of college and a few years afterward, scared and depressed. I still had this self-image of a tragic hero who was going to write the great American novel, or accomplish something else earth-shaking. But I didn’t write or do anything else constructive. My idea of myself as a misunderstood genius was a pitiful attempt not to need anyone. I didn’t recognize my real fear, that if I let myself depend on someone again, I could lose them again — and of course it would be my fault, because deep down inside I was truly unlovable (Location 5476)
• Depression is an effort to avoid feeling. A great deal of what we depressives assume is our character and personality is the result of years of using self-destructive defense mechanisms — adopted in an effort to insulate ourselves from painful or upsetting emotions. (Location 5569)
• the idea that we shouldn’t feel the way we do is dangerous nonsense that eats away like acid on our self-esteem. (Location 5581)
• When we feel our mood change, there is always a reason; something has happened to make us feel this way. (Location 5584)
• regular mindfulness meditation practice can reprogram your brain so that you can stop your obsessive worrying and self-focus. (Location 5597)
• learning the skills of mindful living means you can be in thoughtful, deliberate control of yourself, not the phony control that depends only on obsessive thinking. (Location 5598)
• When we’re in a stressful situation and feeling upset, we need to ask ourselves two questions: How much does this really matter in the context of my life, and what can I realistically do about it? We can find that many things that worry us are really not all that important; we’ve just gotten caught up in emotional contagion and lost our bearings. Or we’re making ourselves miserable trying to change something we can’t. (Location 5604)
• We have to learn to stop ourselves, to halt the adrenaline rush that makes us feel there is a crisis we have to take care of right now. (Location 5610)
• We don’t have any steering or brakes and we can’t get out. We’re better off to look around and enjoy the experience, because we don’t get a second ride. (Location 5612)
• In order to recover from depression, we need to build our brains through practicing the new skills I’ve been describing: mindfulness, clear thinking, direct communication (Location 5616)
• It’s not your fault that you’re depressed, but you still have to help yourself. That feels inherently unfair, and I don’t want to dismiss the anger and frustration that you might feel as a result of that unfairness. I’ve felt that way, too. (Location 5623)
• You expect bad events to be permanent, pervasive, and personal (your fault), while you think good things are temporary, limited in scope, and simply the result of chance, certainly not caused by anything you did. This probably means that you don’t prepare adequately, give up too easily, and thus aren’t as successful as someone whose thinking isn’t dominated by depression. (Location 5631)
• You probably think of yourself as different from others: weaker, damaged, shameful. (Location 5635)
• Identify that Inner Critic, and stop listening to him. Every time you hear that voice, remind yourself: this is a bad connection in my brain; this is an inserted thought, left over from childhood; this is not me and not the truth about me. (Location 5639)
• The more of your time on earth you can spend doing things that will help you get what you really want out of life, the happier you will feel every day; the more time you have to spend doing things that are trivial or unimportant, the more miserable you will feel. (Location 5643)
• Think about how you use the skills of [[depression]] to keep yourself from pursuing them. How you think pessimistically and give up too soon. How you let yourself get distracted by anger and fear, so you can’t focus. How your unassertive behavior means you let others interfere with achieving what you want. How good you are at procrastination so that you never really get around to trying to change. Get a little mad at yourself, (Location 5646)
• Cultivate a better awareness of how your mind takes you away from the present; when you notice it, bring yourself back. Pay more attention to your senses than your thoughts. (Location 5663)
• Do what you can to make things more pleasant for yourself. (Location 5665)
• Learn to relax. Play whenever you get a chance. (Location 5670)
• Exercise, aerobically, for a half hour at least three times a week. Take care of your body, and learn to listen to it. Eat healthy but delicious meals. Don’t drink to excess. When we neglect or abuse our bodies, we’re only being passive-aggressive with ourselves. We’re treating ourselves as if we’re unworthy of love. (Location 5671)
• Remember that we depressives tend to give up too easily. We withdraw from conversation when it seems that we can’t get our point across. We feel tongue-tied and exasperated. We retreat into feeling misunderstood, put-upon, and hopeless. Instead, try slowing down. Focus on your feelings and express your feelings as “I” statements. Ask the other person for help in making yourself understood: “Please ask me questions. (Location 5679)
• Practice extraversion. Reach out to people. Smile. Talk more. Extraverted people are much more likely to experience themselves as happy (Location 5686)
• We construct our selves on models we derive unconsciously from our experiences with our parents and with popular culture. When our models are people we truly respect, we respect our selves. (Location 5700)
• Remember that [[depression]] means being all wrapped up in yourself, so make a real effort to break out. (Location 5718)
• Intimacy means laying oneself bare to another, to let the other see you, warts and all. It’s what we both desire and fear most in relationships. (Location 5721)
• everyone I’ve ever known with [[depression]] needs more intimacy. It’s curative. (Location 5723)
• If we just open up and let our loved ones know about our secret fears, our doubts, our inadequacies, we can grow through the corrective emotional experience of being loved and accepted despite our guilty secrets; as we do this, the gap between our public self and our secret self diminishes; eventually it may disappear altogether so that we are just one congruent person. No secrets, no shame. (Location 5730)
• Living your life according to these principles will not be easy. It requires a total commitment to change. It means accepting that much of what you take for granted about yourself contributes to your depression, and that you, and no one else, have to devote a lot of time and energy to a continuous self-examination. Then it means that you will have to self-consciously practice new skills to replace your old habits of depression. (Location 5744)
• Make sure you get some time every day when you can be alone and get into a reflective state (Location 5782)
• Watch where your mind goes when you leave it alone. (Location 5785)
• If you find that you’re constantly judging yourself, try to get your mind around the idea that the judging is the depression. (Location 5789)
• If you are worrying too much, are constantly reacting to fears, consider that what you do about fear may be the problem. (Location 5795)
• Pay attention to your dreams. Keep a pad of paper by your bedside and write down whatever you can remember when you first wake up. (Location 5801)
• Look for patterns in your life. (Location 5804)
• Where does it hurt? Sometimes there is a symbolic meaning to physical symptoms (Location 5807)
• Talk to your intimates. Are there things your best friend would tell you about yourself if you gave permission? Are there ways you keep shooting yourself in the foot, which others can see but you can’t? (Location 5810)
• Think back over the course of your life. At what point did things start to go wrong? When did you begin to be afraid, or feel that you were different or defective (Location 5812)
• If you can identify a hurt or injury like that, think about how you adapted to it. Our adaptations are really most of the trouble. (Location 5814)
• Exercise 6: Three Good Things (Location 5827)
• People who are prone to depression seem to need more from other people to feel whole, hopeful, and competent. However, they rarely seek what they need in a straightforward manner. (Location 5852)
• The defense is not against emotion, but against awareness of conflict. (Location 5857)
• one of the great cosmic ironies is that we can still feel guilty about feelings we’re not aware of. (Location 5863)
• Altruism (Location 5870)
• Sublimation (Location 5873)
• Suppression (Location 5877)
• Anticipation (Location 5882)
• Humor (Location 5888)
• The more I learn about people, the more I believe their problems stem from not knowing alternatives, rather than from pathology or resistance (Location 5903)
• true change comes from practice, not from the insight of psychotherapy or the effects of medication. (Location 5908)
• To Vaillant’s list of mature defenses I would add one more quality — the capacity for creativity — as essential for recovery from depression. (Location 5919)
• [[Depression]] tells us there is no meaning; to recover means we have to create meaning for ourselves. (Location 5925)
• The long-term cure for [[depression]] doesn’t come from anything other than living right — being productive, generous, caring, other-centered. (Location 5938)
• Happiness is something we achieve through our own effort, not something we can buy or acquire, not something anyone else can give us. It’s a by-product of living a certain kind of life that helps us feel good about ourselves. It comes from being fully engaged in life, from paying attention to the present moment, to the process of living. (Location 5939)
• adaptive spiral. (Location 5966)
• It’s when our response to a single good event makes it more likely that other good things will happen to us. (Location 5967)
• practice self-constructive behavior at a pace that challenges you. Get to know your own feelings. Question your assumptions. Cultivate mindfulness and humor. Practice altruism. Smile more. It doesn’t matter that these things will seem phony and forced at first. That is simply how you feel learning anything new, and the feeling of phoniness wears off quickly (Location 5972)
• [[Depression Books]]
  • [[Your Perfect Right]]: A Guide to Assertive Living. (Location 6000)
  • Cognitive Therapy of Depression. (Location 6007)
  • Train Your Mind, Change Your Brain (Location 6009)
  • The Relaxation Response. (Location 6010)
  • Asserting Yourself: A Practical Guide for Positive Change. (Location 6014)
  • Procrastination: Why You Do It, What to Do About It. (Location 6016)
  • [[Feeling Good]] (Location 6018)
  • The Feeling Good Handbook (Location 6019)
  • Unholy Ghost: Writers on Depression. (Location 6021)
  • [[The Depression Workbook]]. (Location 6023) [[book]]
  • On the Edge of Darkness: Conversations about Conquering Depression. (Location 6025)
  • [[Flow (book)]]. (Location 6027)
  • The Relaxation and Stress Reduction Workbook. (Location 6029)
  • You Mean I Don’t Have to Feel This Way? (Location 6031)
  • A Guide to Rational Living. (Location 6035)
  • The Now Habit (Location 6038)
  • Man’s Search for Meaning: (Location 6040)
  • [[Stumbling on Happiness]] (Location 6042)
  • Emotional Intelligence. (Location 6043)
  • Get Out of Your Mind and Into Your Life. (Location 6044)
  • Let Them Eat Prozac: The Unhealthy Relationship Between the Pharmaceutical Industry and Depression. (Location 6046)
  • When Smart People Fail. (Location 6051)
  • [[Full Catastrophe Living]]: (Location 6057)
  • Speaking of Sadness (Location 6060)
  • The High Price of Materialism (Location 6062)
  • Undercurrents (Location 6072)
  • The Drama of the Gifted Child (Location 6078)
  • Happy at Last: The Thinking Person’s Guide to Finding Joy. (Location 6086)
  • [[Undoing Perpetual Stress]]: The Missing Connection Between Depression, Anxiety, and Twenty-First-Century Illness (Location 6088)
  • Do One Thing Different (Location 6089)
  • The Road Less Traveled. (Location 6091)
  • A Primer in Positive Psychology. (Location 6092)
  • Man Enough: Fathers, Sons, and the Search for Masculinity (Location 6095)
  • Spark: The Revolutionary New Science of Exercise and the Brain (Location 6096)
  • A User’s Guide to the Brain (Location 6098)
  • Insight Meditation: A Step-by-Step Course in How to Meditate. (Location 6099)
  • Why Zebras Don’t Get Ulcers: (Location 6101)
  • The Developing Mind. (Location 6116)
  • The Ten Natural Laws of Successful Time and Life Management. (Location 6119)
  • The Noonday Demon (Location 6122)
  • You Just Don’t Understand: Women and Men in Conversation. (Location 6126)
  • The Wisdom of the Ego. (Location 6131)
  • [[The Mindful Way Through Depression]]. (Location 6134)
  • Getting Organized: The Easy Way to Put Your Life in Order. (Location 6136)

Highlights first synced by [[readwise]] [[September 4th, 2020]]

• They will play on your own guilt about your condition to make it difficult for you to get anything more than the absolute minimum treatment

Notes

• Genetic: [[mom]], [[dad]], [[grandpa]], [brother]
• Difficult early relationship with parents: Dad thought mom was too protective, but he was really critical and controlling. Anger issues. I didn’t want to go to him for comfort from a fairly early age. Emotionally out of tune? I’m not sure what that might look like, but I definitely didn’t develop a healthy sense of self-esteem
• Poor interpersonal skills: Very [[shy]]. Very uncertain. Felt like there were rules everyone else was following that didn’t make sense.
• Unstable [[self-esteem]]: extra sensitive to rejection, interpreting more things like conflict as rejection, being extremely anxious and beside myself for fear of someone being mad at me. Leaky oil system.
• [[Pessimistic thinking]]: not with everything perhaps, but maybe with myself - not thinking I’ll be able to accomplish something or thinking a task I have to do is going to be terrible
• Early loss or trauma: criticism from [[dad]], fearing the intensity of my feelings. I’m not sure if losing [[Trooper]] was especially long-lasting. Uncertainty about what would set dad of yelling. Yelling/punishing because he was in a bad mood. Possibly withholding attention when he was displeased.
• Problems with siblings: we fought an awful lot. [[Nathan]] was often one-upping me, stealing attention, stealing friends. [[Dan]] hanging up with Nathan felt like a betrayal since I liked him when he was a baby. Also maybe it felt like there was something wrong with me that everyone found it so easy to bully me.
• [[Failure]]: I think I feared failure like a feared [[rejection]]. Felt like I had to succeed to keep people happy and maybe let myself fail (or stopped trying) out of resentment of that. I still think I feel resentment toward someone else trying to get me to succeed at something.
• Loss of an important relationship: I can’t think of anything that happened here specifically, but do have a vague sense that I lost something... maybe it was three of my good friends moving away in the period of a year. Maybe some friend that I really liked that we just stopped seeing for some reason? Maybe the neighborhood kids being mean to me?
  • Somehow this also feels connected to me being afraid of having possessions taken away from me. What made me so scared to loose toys or food?