Self-Care When You are Scared and Sad

Self-care is damn hard work when you do it right. It’s especially hard to do when you most need it. Before I get to to explaining why that is, let’s first address what exactly self-care means.

Self-Care Isn’t Just Privileged People Rationalizing Their Self-Indulgent Behaviors.

Self-Care can be easily mocked as an example of the self-absorbed, entitled activities of a privileged class of people. Think of “self-care” as pampering and capitalist excess: bubble baths; cups of tea as you gaze contemplatively out a window with white gauze curtains, while sitting at your perfectly tidy desk so that you can write for 15 minutes on a topic of your passion; mani-pedis; and 90 minutes of yoga. Think Tom Haverford from Parks and Rec exclaiming “treat yo’self” before going on yet another shopping spree.

It’s also celebrated as a key to improved mood and reduced anxiety. It’s touted as an important step to a “good relationship with oneself and others.” And yet, for most people who are prone to anxiety and depression, having a good relationship with oneself and with others is incredibly challenging. For many people, these are life-long projects.

At its simplest, good self-care involves being able to say no to things that you don’t like and that you no longer want to do and saying “yes” to a host of activities that are good for you. These include engaging in at least one pleasurable activity every day; eating a nutritious, healthy diet; getting enough (7-8 hours) sleep; exercising (also called “gentle movement”); keeping on top of doctor and dentist appointments; using relaxation exercises and/or practicing meditation; and spending time with loved ones.

Simple, right? Hahaha.

Good self-care often looks a lot like being an adult.

Good self-care means doing activities that you do not want to do. Not at all. It means making tough decisions that you fear other people will judge you for. (And sometimes, in truth, they might, although likely not as often as you fear that they will).

It means learning how to say no to people and places that don’t serve you, even though you’re terrified that that will mean the end of those relationships. It means telling your boyfriend that he needs to start paying his share of the rent. It means telling your friend that you won’t wait for an hour when she’s routinely late to your get togethers.

One of the really scary things about doing self-care is you don’t get to control how the other person responds. You can’t know how your friend (or partner, or boss) will react to your holding an important boundary until you’ve done it. Your boyfriend might agree to pay his share of the rent. Or he might not, in which case you will have to decide if you want to continue living together. Maybe your sister will understand that it’s not your job to help her get out of every mess she gets into financially. Or, she might make good on her threat to decrease the amount of contact she allows with your niece, whom you love dearly. And if this happens, it means grieving deeply for the decrease in the amount of contact you have with her.

Why Saying No Is Terrifying

For most of my patients, even those who are functioning at a fairly high level by society’s standards (maintaining a successful career, having some fulfilling personal relationships), saying no is incredibly hard. (For others, they’re good at saying no to most people or things, but struggle in their most important relationships.) They are often afraid that if they say no, it will damage the relationships they have with people. They fear that people won’t like them as much if they don’t go along with what the other person wants.

A majority of my patient’s families of origin includes tyrannical, narcissistic, and/or traumatized parents. These parents felt overwhelmed by their children’s difficulties and emotions. Patients’ nos were routinely ignored by these parents. In some cases, patients were literally hit when they dared to assert themselves. In other cases, parents withdrew into cold, punishing silences. Or they themselves became overwhelmed. Accordingly, my patients learned that saying no was a very dangerous thing indeed. For a child, the loss of a relationship with a caretaker would in fact mean death. The autonomic arousal my patients experience (racing heart, hyperventilation, nausea) as adults when they imagine saying no speaks to the continued effects on their nervous system of this programming.

Accordingly, learning how to say no to people, places, and events, even when you’re scared–especially when you’re scared– is something that I usually work explicitly with my patients on being able to do.

As a result of treatment, one patient has been able to decide to maintain no-contact with their (physically and emotionally) abusing parents (even with considerable familiar pressure from both the abusing parent and cherished siblings to “forgive and forget”). Another was able to stop doing everything that his boss asked him to do (which was not part of his job description), which gave him more time and energy to do the parts of his job that he felt energized and passionate about. A third stopped dating loser men, a pattern that she had maintained for the fifteen years prior to therapy. Once she was able to say no to those types of relationship, she could say yes to a relationship with a man who was able a peer in terms of professional success and who shared her desire to have a child together. When people get better at saying no, amazing things often start to happen!

Self-Care for the Truly Depressed

Basic self-care is harder for people who are depressed. Science has shown that depression is associated with decreased executive functioning (which is associated with decision making, emotional control, flexible thinking, planning and prioritizing, and willpower). When you’re depressed, it’s like your brain is running on only half (or a quarter!) power, and so everything is just so…much…harder….to…do. In some cases, it’s literally impossible, and trying to will yourself through it just ain’t gonna work.

So you may find yourself in a chicken-and-the-egg scenario. When you’re depressed, it takes everything you have just to get through your minimal commitments; you don‘t have the energy or motivation for self-care activities. Self-care, however, is essential for beating depression, which will allow you have more energy and motivation to do good for yourself.

Also, the fact that you have tried to do some of these things, and failed, is taken up as irrefutable fodder by that hyper-critical voice that tells you you’re a lazy piece of shit, a failure. That voice tells you that you’re not going to be able to do it anyway, so you might as well give up before you even get started. I’m always impressed with how sneaky that critical voice can be. It can use almost anything you do (or don’t do) to attack you and try to make you feel less than, worthless, and convince you that it’s hopeless to even try.

So What Can You Do To Get Better At Self-Care When You’re Depressed?

So what can you do? First, set small, small goals. I mean think about the smallest goal you can imagine, and then shrink it in half. Let’s say you want to be able to exercise. Start with having the goal of walking around the block. Or listening to one song, and trying to stay in motion while it’s playing. If you’re able to do that, hurray. Do it again the next day, too. If you’re not, your goal was too ambitious. Try for an even smaller goal. Of course your critical voice is going to tell you that it’s ridiculous and pathetic that you are struggling to do something so simple. Tell the voice thank you, but to kindly fuck off.

Or let’s say that food is feeling like a catastrophe. Set a goal for eating one healthy thing each day. Give yourself an expansive definition of what healthy means. If you need to Seamless it, that’s fine. If you were able to eat a sandwich, that’s great. If you were able to make the sandwhich yourself, you’re a fricking rock star! If you’re able to do that for three days in a row, increase the goal. If you’re not, set a smaller goal for yourself.

Having difficulty with really basic self-care? Try to brush your teeth each day for a week. Give yourself a sticker on a sticker chart for each day that you’re able to do it. Maybe do the same for drinking eight glasses of water. It’s a little infantilizing, but also, so what? Stickers are nice.

Also, Ask for Help!

Second, Ask for Help! If you’re not up for seeing friends (and socializing will likely feel like the opposite of the protective cocoon you want to wrap yourself in) try sending a text or an email to a friend daily. But here’s the caveat. It has to be a real text. You can’t pretend like you’re feeling any better than you actually are. If you’re feeling like shit, you have to say, “I’m feeling like shit today.” This bid for contact will likely lead to self-recrimination and the fear that no one could possibly want to spend another second with you. This is what is called projection: you don’t particularly want to spend another second with yourself (nobody does when they’re depressed), and would gladly excuse yourself from your own company if that were at all possible. Accordingly, you imagine that this will the case for others as well.

And here’s another sad but important truth. They might not be able to show up for you. If your M.O. has been to take care of other people, some of the people in your life might not want to take care of you. And that’s terrible, but it is also ok. It’s going to hurt like hell. You’re going to have to grieve for the ways that they weren’t able to show up for you. And it’s going to remind you of your parent, who also couldn’t show up for you in some ways. And it will take months (and probably years) to process fully. But the good news is that you don’t have to process this pain fully in order to start feeling better almost immediately. You can be heart-broken that your friend or partner can’t show up for you in the way that you want them to and you can still survive. Let your heart be broken. Let yourself experience this pain. It is useful pain, rather than the hopelessness and despair of depression. Mourn the ways your friends have failed you. And continue to reach out to those who do show up for you.

Self-care means different things depending on how much or how little you’re struggling. But it basically means doing things that will help you live more of a life that you want to be living (even when you don’t actually want to be living your life at all). For people who are functioning fairly well, that usually means getting saying to no to things (people, places, services) that are no longer serving you. For people who are struggling more, it usually means taking tiny steps towards taking better care of yourself. Even if you think you’re not worth it. Even when you think you’re totally worthless. Especially when you think you’re totally worthless.