My last blog post spoke about things that make us say “Today was a good day.” I love tuning into those things, but, looking over that post, I realized that it didn’t speak to something important that I want to name. Certain conditions that many of us have make everything I said in that post close to irrelevant. When someone is depressed or otherwise suffering with mental illness, sometimes joy simply cannot be accessed, no matter how purportedly good for you an activity is, and no matter how many experts (and armchair experts) promote it as a “natural” way to treat mental illness, and no matter how hard the person might try to squeeze joy out of it. 

Whether it’s yoga or getting out in nature or having an active social life, all the sometimes-helpful recommendations for getting and staying mentally and physically healthy are not fail-safe. This can be maddening. Kind of like a car that only starts some of the time is maddening. 

Embroidered pillows and flowery journal covers urge us to “choose happiness.” I’m not saying that advice is wrong, but I do think it leaves out some important complexity. If it were that simple of a choice, we would all be walking around happy 100% of the time. 

There are times in a life when recommendations for living the good life do lead us to that good life, when dutifully followed. But there are also times when one takes the actions and doesn’t feel any better. Joy seems to have been hoovered away. Even when we turn to the things that have brought us joy in the past, we are left anhedonic. 

Anhedonia, or inability to experience pleasure, is a symptom of depression and other mental illnesses, wherein nothing feels positive or healthful, even if it’s supposedly good for us. Not only do we miss being able to turn to something that brings us joy, but also the fact that it is “supposed” to be good for us is especially painful, confusing, and isolating. 

Painful, as in, “Why can’t I experience those good things that other people seem to enjoy?”

Confusing, as in, “What am I doing wrong??”

Isolating, as in, “What is wrong with me such that I can’t enjoy things? Do I not deserve to enjoy things the way other people do?” It’s a lonely feeling. 

Available statistics tell us that 15.5% of U.S. adults experienced depression in the year 2024.

(https://www.nami.org/about-mental-illness/mental-health-by-the-numbers/)

That’s higher than the percentage of U.S. adults who have food allergies. Think about how many people do you know with a food allergy. You know many, many people who either are depressed or have dealt with being depressed at some point in their lives. Just like food allergies, depression ranges from life-threatening to less serious. 

The life-threatening kind should be addressed with intensive medical care. If you or anyone you know is in this terrifying space, please call the number 988 or check out one of the other resources below for help.

For those who are not in the depths of a crisis but who are experiencing anhedonia, there are lots of things that we can do to help ourselves. This is good news! “Depression is one of the most treatable mental health conditions.” (https://my.clevelandclinic.org/health/diseases/9290-depression)

I love this statistic: “Approximately 80% to 90% of people with depression who seek treatment eventually respond well to treatment.” (https://my.clevelandclinic.org/health/diseases/9290-depression)

There is hope. Always, that “thing with feathers” is somewhere close by*. Hearing her song is not always easy. After all, it is a “tune without the words,” as Emily Dickenson describes it. Retaining some hope is necessary and not sufficient… There are still multiple barriers to actually feeling better. But there are also things we can do to land ourselves in that 80-90%.

This might be obvious, but those people studied who “eventually respond[ed] well to treatment,” by definition, were people who sought treatment. If you are suffering, please remember that you deserve to be in that 80-90% and the only way to do that is to seek treatment. It’s kind of like the cliché about missing 100% of the shots you don’t take. 

Treatment can look all kinds of different ways, but the first step is to seek help in any way at all (barring risky behaviors, such as the use of psychedelic drugs without clinical supervision. While psychedelic treatments are a promising area of treatment and can be relatively safe when taken in appropriate doses, in clinical settings, and with a professional trained guide, one should not go DYI on this one!).  

Unfortunately for the morale of a depressed person, the first intervention they try may not work, be it medication, talk therapy, yoga, a shamanic ritual, or anything else. The second or the third thing might not work either. Sadly, some people give up the search at this point. But there are many, many more things to try, way more than it feels like there are when you are in the scarcity mindset of depression. Sometimes it takes a crazy amount of trust to keep seeking and believing against all one’s intuitions that some combination of interventions is going to help by the end of the journey, if one keeps up the seeking.

I don’t know the statistics on this, but from observations, one isolated intervention rarely works for people. If it does, great, I’m envious of you! More people seem to need some combination of medication, psychotherapy, and some number of other things from a HUGE bucket of sundry approaches to the problem: complementary medicine (so-called), alternative healing, lifestyle changes, nutrition, self help, and more. Importantly, these are physical AND mental interventions. Because of the mind-body connection, a person needs either a treatment that addresses both, or they need more than one treatment so that both bases are covered. Don’t leave your body or your brain behind; you need them both to heal each other. 

This is where yoga comes in. As practiced in the West, yoga is nothing if not inclusive of both mind and body. It has ardent proponents who make claims about its healing powers. Far be it for me to dispute this, but I want to be very clear that yoga is still only one intervention, and it may not be enough to get one’s mental health back to a ten out of ten. I want to name that, because the books that I’ve read about yoga and depression kinda indicate otherwise. They tend to pay lip service to the fact that other interventions like medication might come into the picture, but then they go on to relate stories of sufferers who completely turned their life around with yoga alone (no medication necessary! All natural! Never depressed again!), leaving us with the impression that yoga has the power to cure depression. I’m not saying it can’t have that power sometimes, but it usually needs a little help from other interventions as well. (Don’t ask yoga to do all the heavy lifting on its own!) 

To those who think that we have it wrong in this country because the medical norm is to reach for antidepressant medications first and give little attention to “alternative” remedies, I would say a couple things:

1. This is changing. Maybe not quickly enough, but more doctors are prescribing things like yoga, exercise, nutritional supplements, skills-based therapies like CBT and DBT and in the best case scenarios, social connection than ever before. The best doctors acknowledge that sometimes medications make it possible for a person to engage with positive/healing activities and not just get discouraged if their anhedonia persists despite their herculean efforts to drag themselves out of bed and do them. If a medication can tip the scales just enough, then, and only then, might someone be able to engage with “all-natural” remedies that do really have value. I’m not anti-natural remedies! But let’s be clear that lifestyle interventions take a non-trivial amount of will to get started and a certain amount of time to pay off. What if medications are what help a person first get started and then hang in there long enough to let the lifestyle change do its work? 

2. If you would agree that medical treatments have a better chance of working when combined with lifestyle changes and skills development (like stress-reduction, mindfulness, etc.), why wouldn’t it also work the other way? A solid yoga-with-meditation regimen is all well and good, but why not pursue other interventions that come at it from  different angles in parallel, seeing as we’re talking about illnesses so complex that even the most expert experts do not know why they occur or how to predict their course. In cases of mental illness, even when the best possible outcomes are achieved, the doctors involved got there mostly by trial and error, not deep knowledge about the actual mechanics of the illness. Don’t let them tell you otherwise. We’re just not advanced enough in this field yet. Many doctors don’t like to admit this, but more and more are doing so these days, which is a great starting point for progress.

Some people are never cured of depression. That may sound sad, but what does that actually mean? It doesn’t mean that they suffer constantly for the rest of their lives. It means that it is a chronic illness, like diabetes, asthma, hypertension, or obesity. These conditions have to be treated and managed throughout life, sometimes off-and-on, sometimes continually, because no one has discovered a cure yet, at least not one that works across populations to the extent that it can satisfactorily be called a cure. 

Anyway, each of us with depression might be better served to seek out our cure, rather than the cure. Because while self-help books and plenty of Vitamin D3 and cold plunges might work for one person, it might take medication and exercise and transcranial magnetic stimulation (TSM) to help another. Another might need to do yoga three times a week, meditate every morning, and have enough positive social interaction in their life. And on and on. 

Even after one thinks they’ve found their recipe for mental health, it never stays the same over time, because life never stays the same! They reach menopause and their hormonal profile changes drastically. Or it’s something as trivial as taking a trip where one doesn’t have access to their regular yoga class, or proper nutrition, or quality sleep, or perhaps they forget to bring their medication. These might seem like small things to some, but they could mean the onset of a depressive or a manic episode for some, which can completely disrupt a life. 

Many of us have learned the hard way that even when we feel “cured,” it is crucial to do certain things in an ongoing way in order to stay “cured.” This can be challenging to accept, because we are so often fed stories about people who did a thing and were cured from then on. We all wish we were those people. We are usually more like the diabetic who needs exogenous insulin to be well. In the case of mental illness, there is a complex psycho-social component, and like I said above, it is opaque, even to doctors, what the causes and contributors are in any given case.   

Accepting the scope of the illness is another place where yoga might be helpful. Not the physical aspects of yoga, but an attitude encouraged in older forms of yoga, when it was about meditation and not yet about exercise. This attitude is often translated as “detachment,” but that word can be problematic in English. In this context, it doesn’t mean detachment as in apathy. A translation that I like is “not getting stirred up.” In a way, it’s about acceptance of the facts as they are. Not freaking out about what’s going on (even if what’s going on is… a personal freak out… It has layers to it). 

We can either rail against god for the fact that our depression may be with us (in the sense that it will come and go) for the rest of our lives. Or, we can not get stirred up about it. Accepting it as the reality is not easy at first, but even that changes. Soon one might feel as though a weight has been lifted, because now they aren’t fighting reality or holding onto unrealistic expectations of a miracle cure, which is exhausting to keep up. 

Being in touch with the facts on the ground might not sound like a definition of yoga, and it definitely doesn’t sound very exciting. But it can change everything. The ancient yogis figured a few things out through meditation: 

1. We have to get quiet inside ourselves in order to see things clearly, to become unbiased observers of reality.

2. Once we become unbiased observers, we can discover a peaceful inner quality and stop being so bothered by the bad stuff, even though we haven’t made it go away. (I’m paraphrasing.)

3. This allows us to get on with it, to get on with life. In their case, the early yogis may have directed the energy that they had freed up toward devotional practices. If you are less of a mystic and more of a “house holder” (as we are called if we are seeking truth but not pursuing a monastic lifestyle), we might direct our energy in any number of secular directions…. Caregiving, activism, deep work, deep relationships… These are not lesser pursuits, they are the work of being alive, and they tend to benefit when we engage the process of yoga.

For example, say I have a meditation practice in order to quiet my mind and body (in this case, I would have been called a yogi in earlier times if I were male, a yogini if I were female, whether or not I practiced the physical postures that we do today). The inner quiet that I find through meditation may help me clearly see and be okay with the fact that depression will cause me more and less suffering at various times throughout the rest of my life, but it will never entirely go away. When my mind calms down a bit, I can cultivate some acceptance of this, and then change can cross over from the meditation cushion to the rest of my life. My game plan shifts from hoping that the depression to go away forever (actually, if I’m honest, I still do hope that, because I’m human and I don’t want to suffer, but I hope it less desperately) to being bound and determined to live as fully as possible between depressive episodes. 

In this scenario, I have one more motivating reason to go to yoga class, because I know it is part of a multifaceted treatment plan, mostly preventative in nature, that keeps me well and able to make contact with joy in my life. I might have more self-compassion too (distinct from self-pity). And I will have more compassion for anyone with chronic pain or illness, because I relate not only to bouts of suffering but also to all the non-optional maintenance and work we have to do while in remission in order to (hopefully) prevent the next one. 

As an illustration, I’m going to do my best to sum up this part of my personal story:

I discovered yoga and meditation about 25 years ago, and having those skills crucially helped me on a healing journey that continues today. They were not the only thing that helped, far from it. But what I got from them was a chance to get quiet. Because I was able to get quiet, acceptance dawned (and continues to dawn… I certainly have my dark moments when I lose sight of it). I gradually shifted my endeavor away from trying to make my pain go away and towards creatively planning how to live a good life in light of it. Framed this way, I could start to dream about the life I wanted to have. Before that, I had been (subconsciously) waiting to start that dreaming, that living, until a time that I just hoped would come when I was “better.” 

I went on for years thinking this way. Do I wish I had made my important shift in understanding earlier in life? Sure. But better late than never when it comes to  starting to dream and work toward a fulfilling future while staying in contact with reality and the present. 

To wrap up the autobiographical section, I want to say that I lose track of my important insight and the acceptance that it brought me ALL THE TIME. It’s just that now I can shift into acceptance some of the time. Progress, not perfection. Many clichés are true. 

In an evidence-based form of therapy called DBT, there is a type of truth-seeking called a dialectic. That is when two seemingly opposite ideas can synthesize and turn out not to have a zero-sum relationship. Thus a deeper understanding is reached. Ok, that’s a little abstract, but the quintessential example in DBT, which relates to everything I’ve been talking about, is fairly simple:

If we want CHANGE in our lives (say, from less healthy to more healthy), we might not think that ACCEPTANCE would be helpful, the thinking being, “How will I ever be motivated to change if I accept the current state of things?”

But there is a deeper understanding of the relationship between ACCEPTANCE and CHANGE. In practice, acceptance is helpful (maybe crucial??) in working towards change. Somehow, for reasons we only partially understand, acceptance feeds change, or to use another analogy, it fertilizes the soil for it to grow. 

If your mind can’t quite grok this, that's okay. Try it, instead of trying to understand it. In any moment, on the meditation cushion or yoga mat or off, quiet yourself just enough to sit back and accept the present moment exactly as it is. Granted, acceptance is harder when bad stuff is happening, but try to get a taste of it in various moments, good ones and bad ones. With a little bit of exploration, you might find that this practice leads to small, positive changes. Enjoy. 

*Poem by Emily Dickinson:

“Hope” is the thing with feathers -

That perches in the soul -

And sings the tune without the words -

And never stops - at all -

And sweetest - in the Gale - is heard -

And sore must be the storm -

That could abash the little Bird

That kept so many warm -

I’ve heard it in the chillest land -

And on the strangest Sea -

Yet - never - in Extremity,

It asked a crumb - of me.

Resources:

• Suicide & Crisis Lifeline: DIAL 988
  Call or text 988 for free, confidential support for people in distress or crisis. 

• SAMHSA’s National Helpline – 1-800-662-HELP (4357)
  Free and confidential treatment referral and information service in English and Spanish, for individuals and families facing mental and/or substance use disorders. 

• The Trevor Project – www.thetrevorproject.org
  Specialized support for LGBTQ+ youth via call, text, and chat. 

• Mental Health America (MHA) – www.mhanational.org
  Resources for screening tools, local support groups, and educational materials. 

• NAMI HelpLine – 1-800-950-NAMI (6264)
  Information and resource referrals from the National Alliance on Mental Illness.