The Habit of Self-Compassion

My Tuesday morning subway commute typically includes reading the science section of The New York Times which reports on the latest developments in a wide variety of fields—from archeology to physics. Neuroscience and psychiatry are frequent topics. At least one article is devoted to some aspect of mental health or psychology. This past week, the article that caught my attention was titled “Go Easy on Yourself, a New Wave of Research Urges.” The article, (published 3/1/11) described psychological research on self-compassion which suggests that a key to mental health involves “giving ourselves a break and accepting our imperfections.”

This rang true for me, since many of the clients I see beat themselves up for the mistakes they’ve made, for their perceived flaws, for their imperfect relationships. And while most people are vaguely aware that they are very hard—needlessly hard—on themselves, the habit of self-abasing criticism is so ingrained that self-denigrating thoughts are automatically triggered whenever a loss of control or a personal failure is experienced. As many a client has said, “I tend to be very hard on myself. I HAVE to be so that I keep myself in line”. And they proceed to beat themselves up. (A variation: “I was really dumb. I should have [fill in the blank with your favorite ‘should’].”)

It makes sense that the lack of tolerance for one’s limits and imperfections—lack of self-compassion—is linked to depression, anxiety disorders, addictions, and other problems. And it makes sense that developing the habit of self-compassion would be a key to sustaining mental health. So how to change a lifetime of being hard on yourself?

Kristin Neff, the psychologist interviewed for the Times article, identifies three components to self-compassion: self-kindness (being warm and understanding toward our imperfections), affirmation of a common humanity (recognizing that all people experience inadequacy and make mistakes), and mindfulness (developing a balanced approach that suspends "good/bad" judgments, experiencing life as it is, not as we think it “should” be). Developing self-compassion focuses on cultivating all three. (Her website [www.self-compassion.org] provides more detail.)

It seems to me that self-compassion begins with developing awareness of and understanding how certain situations or events trigger self-punishing thoughts. What pushes the self-critical buttons? Notice the familiar sequence of thoughts triggered by those circumstances, the feelings associated with the thoughts, and the behaviors that tend to emerge in response to those thoughts and feelings. In other words, being present to yourself in the moment—being present to your thinking/feeling—is the first step.

Cognitive therapies offer specific techniques for changing the thinking patterns in support of self-compassion: consciously stopping the negative train of thoughts, introducing distracters, engaging in self-talk aimed at changing the content of the self-abasing thoughts, substituting negative thoughts with affirming self-statements. Some therapists also draw upon Buddhist mindfulness meditation traditions and suggest meditating on compassionate texts or statements (i.e., “lovingkindness meditation).

In addition, I think it is important to look more deeply at the patterns of self-abasement themselves in order to sustain a change in the direction of self-compassion. Where do the self-condemning thoughts originate? How did the pattern of self-abasement begin in the first place? Whose voices do you hear when you beat yourself up? What deeper purpose do these thoughts serve? How critical are these patterns of thoughts to the architecture of your psyche? How do these patterns play out throughout life?

It seems to me that developing compassion is related to learning to self-acceptance (with all our imperfections and limitations) which means, in turn, accepting our deepest desires. And we may not be fully conscious of our desires. (In fact, Freud taught us that we often defend against that which we most desire.) I suspect that those times when we are the least self-compassionate are the times when we have the most difficulty accepting ourselves, and have the most difficulty identifying and accepting our desires within the context of the present moment. Too often, we contort ourselves into untenable and unsustainable positions because we are not able to compassionately accept ourselves or our desires. Accepting ourselves often means becoming awakened to our desires.

(The word “should” in this context becomes a tool for perverting desire, changing desire into something unrecognizable. I think that one step toward self-compassion is becoming aware of the way we use the word “should” and even trying to move away from using the word. “Should” does not reflect what is. Self-acceptance, self-compassion focuses on what is.)

The habit of self-compassion is critical to mental health, but creating a new frame of mind founded on self-acceptance and self-compassion is not easy. While it takes conscious effort and practice (and sometimes professional help), living with self-compassion will bring greater satisfaction and joy to life. This is very hard work; it is the work of psychotherapy.

The Landscape of Depression

All the signs were there: pervasive feelings of sadness, inability to eat, insomnia, the sense that he was in a rut and could not break out of it, chronic pessimism, perceptions that he could not solve his problems, the belief that he would always come up “short”. In a word, he was depressed—although initially he bristled at the word “depression.” As he put it, “I don’t think of myself as depressed. I’m just going through a hard time right now.” However, as the session progressed he revealed that he had been feeling this way for months. In fact, he told me that he could not recall a time when he felt otherwise. Although he admitted to feeling depressed for a long time, the event that brought him into therapy centered on receiving a critical performance evaluation. The evaluation triggered a cascade of feelings and thoughts; he wanted to “re-evaluate my whole life” and felt overwhelmed by alternating feelings of sadness, helplessness, and anger.

Depression is most typically associated with a mood—usually sadness, feelings of helplessness and hopelessness. However, other feelings can be present in depression—feelings that, to an onlooker, do not look at all like depression: early in my training I worked with a man who was constantly agitated, irritable, and angry. I recall being surprised when my supervisor remarked that the client had an agitated depression; he certainly did not look depressed to me. However, I began to understand how complex depression really is when I hospitalized him after he became violently suicidal. Indeed, depression is an insidious illness.

Depression often has a particular texture: heaviness, lethargy, lack of energy. Sometimes, the sensations of depression are acutely painful. (This was especially true of the client I hospitalized: after he was stabilized and released from the hospital, he insightfully told me that he had been fighting the feeling of lethargy for quite some time; his agitation and anger had kept him from falling into the "abyss".) The novelist William Styron wrote of “the slowed down responses, near paralysis, psychic energy throttled back close to zero. Ultimately, the body is affected and feels sapped, drained… depression takes on the quality of physical pain” (from Darkness Visible, 1992). The pain of major depression can become so acute that thoughts of self-harm or even suicide arise. Although the client I described at the beginning of this essay did not report physical pain or suicidal thoughts, he reported a persistent feeling of fatigue, of “being weighted down.” (In Bi-polar disorder, the sensation of lethargy and heaviness alternates with the sensation of manic energy and a kind of pressure to discharge that energy.)

It’s been my experience, though, that a hallmark of depression centers on a particular pattern of thinking. The depressed person’s thoughts are distorted: life events are negatively personalized (e.g., “this would only happen to me” or “she didn’t answer my call; she must be mad at me”); perceived in stark, absolute terms (“only bad things ever happen to me” or “I can’t do anything right” or “I’m worthless”). The negative is accentuated while the positive is filtered out or minimized (“the glass is half empty”). As these distortions take hold, the depressed person loses a sense of communal context and tends to become isolated; the world narrows as the depressed person loses interest in people and activities that previously gave enjoyment or fulfillment.

At the core of these distorted thoughts (made worse, of course, by the physical sensations that can also manifest) are beliefs that are central to depression. Like the distorted thoughts, these belief are distorted and tend to center on self-efficacy, the sense of not having mastered or being able to meet and master life’s challenges, and one’s sense of relatedness: “I can’t do anything right. I am inadequate. I am incompetent. I am unlovable. I will always be this way, and I will always be alone.”

The landscape of depression is different for each person. Likewise, treatment will vary from person to person. Some people may require medication to address the imbalances of their brains’ chemistry and to ameliorate their physical symptoms. It’s important to be evaluated by a psychiatrist or psychopharmacologist for medication—especially when insomnia, changes in appetite, extreme lethargy, physical pain, suicidal thoughts or thoughts of self-harm occurs.

It's important to seek help to treat depression. It's often not a matter of "pulling yourself up by your own bootstraps." Indeed in major depression, it's not physically possible to move yourself out of depression. Moreover since the landscape of depression is typified by distortions in sensation and cognition, psychotherapy is even more critical to becoming well. It often takes a trained professional to spot depression because its signs can be so subtle and insidious. But once depression has been identified, a great deal can be done to treat it. Therapy is typically directed at assessing the patterns of thinking and beliefs that manifest, challenging and correcting the distortions in thinking, and eventually getting at the root causes of the depression.

The landscape of depression is full of shadows and can be dangerous. However, just as there are pathways that lead into the landscape of depression, so too there are pathways that lead out of it. To my mind, a healing relationship is critical to finding the pathway out of depression. Indeed, whatever the specific path one takes to enter the landscape of wellness, having someone who knows and understands the path and can serve as a guide seems key. A therapist can be just that guide.