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Tuesday 6 March 2012

Hidden Symptoms of Depression: The Collapse of Automaticity

This is part of a series of posts on some of the less-talked-about symptoms that tend to go along with depressed mood. As stated in earlier posts, it’s important to note that each of these “hidden symptoms” can also occur at other times in our lives. Don’t fret if you see yourself in these experiences.
"I can drive this in my sleep ..."

Quick now: Did you brush your teeth this morning?

If you took the question seriously, you probably did one of two things:

1. You thought “Yes” because you brush your teeth every morning, so you must have done so today.
2. You ran your tongue over your teeth to see how they feel.

But you may not have a clear memory of brushing your teeth this morning. You do it automatically, and no memory of it gets stored.

Much of our behaviour is automatic. For example, most of us have a morning routine of some kind, in all likelihood including brushing our teeth.

We don’t haul ourselves out of bed and say “Right. I guess I should brush my teeth today. When shall I do that? Before I shower? After? I’ll need toothpaste. How much will I put on the brush this time?” We just do it. The process is so automatic that we don’t consciously think about it.

Some of us even catch ourselves and wonder “Did I do it?” We might feel our toothbrush to see if it’s wet. It is.

Other behaviours have at least some automaticity involved: getting the kids up and out the door, returning emails at work, chatting at social events, cooking, driving to familiar locations, shopping, and so on. They don’t require a lot of thought or planning, we just do them. If we add them up, they make up a substantial part of our lives.

Of course, we also have a few things with very little automaticity involved: giving a verbal report at a meeting, finding an unfamiliar address, raising a difficult issue with a family member, cooking a completely new dish, and so on. These tasks involve not only the effort of completing them, but also the effort of consciously initiating and guiding them. We have to think about what we are doing.

And during depression?

When people are depressed, they are often easily overwhelmed. Years ago a client of mine said, with some disgust, “I’ve brushed my teeth all my life, but it was only when I got depressed that I realized I have 28 teeth! And every single one of them needs to be brushed, on one side, then the other, then the top. It seems like too much work, and it’s hard to get myself to do it!”

Others have similar experiences. There’s a dish they’ve made hundreds of times, but now it seems too complicated and difficult to manage. They’ve paid the phone bill religiously every month without thinking, but now it seems like a herculean task to open the envelope. They’ve always done the laundry while chatting on the phone, but now it seems to take their full attention.

Part of the problem, of course, is the standard loss of energy that people experience in depression.

But partly, it appears that automatic behaviour patterns (chains of behaviour that are so well-learned that they do not require conscious guidance) fall apart. Suddenly every task needs planning and effort, as though it’s the first time you’ve done it. “Hmm, shaving. I guess I need lather first, right? Where is it? Here. Is that enough? Now, which side first?”

The actual behaviour required is the same, automatic or not. But non-automatic behaviours always feel more onerous to us. It’s harder to get ourselves to do them, and they seem to demand more effort. They are tempting to avoid.

The result is twofold. First, people with depression tend to do less, because of the increased effort that seems required to do even trivial tasks. Second, they become self-critical for having the symptom. “I’m lazy, I’m unmotivated, I can’t take care of myself, people must despise me.” Needless to say, this only magnifies the problem.

So what should be done?

As usual, part of the goal is to recognize that the symptom is just that: a symptom of something happening in one’s life, not a personality trait. To that extent, it can be accepted. If we have the flu, we expect a fever, and we don’t criticize ourselves for running a temperature. Rejection of a symptom doesn’t make it go away, it just makes us feel worse.

Waiting for the problem to go away doesn’t seem to work, however. We need to push ourselves a bit at a time to get back into something of a routine. We do this by deliberately giving up on being our nondepressed self for the time being. “Yes, if I felt better I’d be doing a hundred things a day. But I’m depressed, and if I try the unachievable I’ll only feel like a failure. So I’ll just focus on doing a few things. Right now, I’m brushing my teeth. When I’m done, I’ll decide what to do next.”

It’s also worthwhile to stop multitasking. At your best, perhaps you can get the dishes started, toss something in the oven, and go shower while planning your workday. When your automaticity collapses, you’ll feel overwhelmed doing this and you’ll get lost and forget things. A certain amount of multitasking is useful for most of us, but during depression it can be counterproductive. Relinquish the desire for efficiency, and focus on one thing at a time.

While doing things that used to be automatic, remind and reassure yourself. “You can do this. You’ve done it before. And you don’t have to do anything else right now. It’s okay that it’s more difficult than usual. It will get easier.”

Reducing the self-criticism, initiating small tasks, and shrinking the snowdrift of chores can all help give a sense that life is becoming more manageable, and thereby helps with depressed mood. And as the mood lifts, by this and other means, it becomes easier to do things, and repetitive tasks begin to need less and less conscious guidance. We can still be mindful of what we are doing in the here-and-now, but we don’t have to force ourselves into action.

Next up:  The inability to monitor.

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