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Sweat and Happy Thoughts Can’t Cure Depression

March 10, 2015
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Insert your own metaphor here, something about struggles and burdens and overcoming. Really, it’s my daughter, doing hard things.

I am a trainer. I train muscles, mostly. I am fortunate enough to have a couple hundred people who trust me with their bodies, and I take that very seriously. I approach it with the same “first do no harm” goal that a good doctor would.

We talk, obsessively, about injury prevention. About knowing, respecting and sometimes pushing your boundaries. We talk about the difference between being “in shape” (a term that is hopelessly entwined in the culture of body-shaming) and being “fit” (which means ready and able to do anything you want to do with your body, safely and functionally.)

But we talk about other stuff too. In the 3 years that we’ve owned a gym, I can safely say that every week I talk to our members about: divorce, love, shame, PTSD, body-shame, fear, death of loved ones, work / life balance, eating disorders, anxiety, severe depression, addiction, gender identity and why those big vibrators have 3 parts that vibrate and look like they go “somewhere.” Okay, the vibrator thing only happened one time, but some form of every single one of these subjects comes up every single week. I do a lot of listening.

Sometimes I think I am a therapist.

Fortunately for everyone, I know that I am not.

In my quest to constantly improve my coaching skills, I read everything that I can about coaching. Which is how I stumbled upon this piece by Hemalayaa, in which she discussed her shock and dismay to learn that some yoga instructors took anti-depressants. In which she discussed the taking of anti-depressants as a moral and personal failing, as well as a failing of their yoga practice.

I found it because many (probably all) of the yoga folks who I follow were outraged by it. (Thankfully!)

As they should be.

It is a weaponized diatribe so full of misunderstanding and shaming as to be dangerous on a mass scale. It is filled with the kind of language that stops people from seeking help when they are having a mental health crisis of any sort. It compounds the already real problems of depression and anxiety that cripple so many, because someone they look to as a teacher and a healer tells them that asking for help is tantamount to failure. As if every single person dealing with depression and anxiety isn’t already dealing with that message coming from inside their own minds on a regular, if not constant, basis.

I was, literally, sick to my stomach reading it.

I was also profoundly struck by how fantastically out of line she was. Not just in being so wrong, but in thinking that she had a right to dispense this information in the first place.

So let’s get this straight. No matter how much reading we do, or how well-intentioned we are, those of us who are fitness trainers are, generally speaking, NOT doctors. We are usually not psychiatrists, nutritionists, oncologists, rheumatologists etc…. When people have specific problems, we must refer them to the professionals who are trained to deal with those issues. Period. We are trainers, not gods. Our greatest power lies in the ability to help our members seek help, not in thinking that we can help all the people with all the things.

I am greatly humbled by the trust that our members place in me, whether they are trusting me to correct their squat form, or confiding in me that the depression is back and they are fighting with everything they’ve got and can I please call them if I don’t see them for a while because they just don’t want to get sucked back in.

I know my place. It is to listen, to validate, and to first do no harm. Which often means asking for help, and making sure everyone knows that asking for the help you need in life is the strongest and bravest thing you can do. Always.

Now, what does that look like?

For the physical stuff, these are my general rules:

1. Know what you don’t know.  I have a very firm, but not expert, grasp on body mechanics, metabolic response, large and small muscle groups, mobility, and herding a class full of athletes through a warm-up and a workout that will get them stronger in a general sense. I have a decent grasp on how to work through your basic owies and sore spots.

But when someone’s body is in PAIN, when something hurts and doesn’t work, I have a great collection of business cards that I whip out with great abandon. I have PTs, Chiropractors, Massage Therapists, Orthopedic Surgeons and acupuncturists at the ready. (Yes, I also have a ready list of mental health professionals, which I’ll get to in a bit.)

2. Err on the side of caution. Unless someone is training to compete and has some sort of career lifeline attached to that competition, there is NO REASON to risk injury in order to get a record of any sort. Keep people working AT, but generally not over, their boundaries. Teach people to stop if form is on the verge of failure. Teach people how to bail, and celebrate their ability to make that decision. This is especially true in weightlifting (where I spend most of my life,) but just as true in any sport. Teach people to know when something feels wrong, and listen to their gut. (True outside of the gym as well. This is most important thing I try to teach our daughters!)

Most importantly: IF IT HURTS, DON’T DO IT!

3. Don’t universalize the personal. Just because something works for you doesn’t mean it will work for someone else. Giving up gluten worked for you? Awesome for you. Doesn’t mean it will work for someone else. Working out 6 days a week worked for you? Awesome for you. Doesn’t mean it will work for someone else.

Same is true with goals. Your goal may have been to snatch your body weight, or run a marathon or …… that may not be someone else’s goal. Your goal isn’t better or righter or anythinger than someone else’s. DO NOT UNVERSALIZE THE PERSONAL.

What you want for yourself may not be what someone else wants for themselves. And you have no business wanting something for someone else because you are not in control of, and have no right to judge, the decisions that someone else makes about their own life. PERIOD.

______

But what of the emotional stuff? Our members come to us with all manner of issues that we share and care about. But they are not our issues to fix or control. We are vessels, or channels, through which they can flow their fears so that we can face them together. I firmly believe that strong and healthy bodies are a fantastic partner on the path to strong and healthy minds. When people let us into their minds and hearts, I know we are on a great path.

But it’s still not a path that I control.

When an athlete comes to me with their personal issues, here’s what I do:

1. Validate them. Tell them that you understand that what they are going through is hard. That it sucks. Or is scary. Or seems unfair. They are right about what they feel. The fact that you might feel differently if it were you is totally irrelevant, and you do not have any right to tell them that. Will it serve them? No, don’t do it.

2. Ask them what they wish was different. 9 times out of 10 they’ll be able to give you a list, some of which is out of anyone’s control. But there will be 1 or 2 things that you can help them set as goals. Those can be handholds to create a safety structure for people who are suffering. You’d be amazed how far a simple, “great, I’ll see you 3 times next week, I’m looking forward to it and paying attention” can go. Very far.

3. Ask them what you can do. Stay within the scope of your work, you do not have the right or the responsibility to let your role ooze into personal time, but within the confines of your role at your studio, you can do a lot. Ask them what you can do to help.

4. Know your boundaries and your limitations. Do not offer up any help that you are not qualified or capable of following through on. That is not fair to anyone.

5. REFER THEM TO THE PROS. If someone has a toothache, you send them to a dentist. A shoulder that won’t work right, you send them to an orthopedist. If someone is dealing with emotional trauma or a mental health problem, you refer them to an expert. You should gather a list of providers that you can refer to. How? Ask your members for their recommendations. I’m serious. Not only will you get a list that you can trust, but you will signal to your members that you care deeply and are a safe place to ask for help. One question on your private Facebook page could save lives, literally.

______

And now a few words about depression.

IT IS FUCKING REAL.

I’m sorry (not sorry) to yell at you like that. But if you have ever known anyone who suffers from depression and anxiety, it is as real as cancer. I’ve lived next to it all my life, and it is as real as cancer. As I got older I started referring to it as “cancer of the soul.” It is chemical. It is biological. It is as real as cancer, as diabetes, as MS. And for many people it can be helped with medication to correct some chemical imbalances.

If you’ve never witness the soul-decaying strength of depression, then you are lucky (and probably delusional.) If you’ve ever witnessed the life-saving effect of the right medication, then you know what I’m talking about when I implore you NOT to shame people for getting the medical help they need and deserve.

You cannot fix a chemical imbalance with a mantra. No more than you can wish away cancer or fix diabetes by thinking the good thinks real hard.

And if you’re sitting there saying that too many people take meds, I want to know who the fuck you are to judge? Really, who are you? Where is your degree from? How many hundreds of thousands of people have you witnesses suffering? Who are you to judge?

Who are you to tell another human being that you know their body and their life and their suffering and their hopes and strengths more than they do?

Because if you are a yoga instructor or a CrossFit coach or a body builder or a……. you are not a mental health professional and you need to step away and let the pros take this one.

There are very likely some very real genetic and biological components at play. And you don’t know what previous trauma may be living in that body you’re working on.

Look, I believe that healthy bodies are helpful allies to minds that are struggling. I believe all the research that says exercise is a powerful tool in the mental health arsenal. I think that eating a healthful diet, being part of a caring community and using your body helps almost everything.

HELPS. Doesn’t cure. And isn’t always enough.

As professionals who are committed to the well-being of our clients / members / athletes, it is incumbent upon us to help them find the help they need. We can’t solve it all, and that doesn’t make us weak. But helping people find the help they need – whether it’s for their bodies or their minds – that is our highest calling. That is what changes lives.

I’m just one coach, in one gym in one city. But if you’re one of “my” athletes, and you ask me for help, I will find it for you. I know that I can’t fix everything (I can’t even fix everyone’s squat,) but I can refer like a champ!

And I can assure you that you are right to feel what you feel. That you are not hopeless. That you, by virtue of asking for help, have everything you need to start feeling better. Whether it’s your shoulder or your soul.

You are not alone.

There is help.

It gets better.

(Except Burpees, those really never get better.)

___
Note: Hemalayaa took down her post since last night when i wrote about it. I will link to a cached copy when I get home. Not to be punitive to her, but because it matters. It is a very real and very common dialog that is so harmful and I think it serves as an excellent illustration of how even the most well-intentioned amongst us fall into dangerous traps.

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22 Comments leave one →
  1. March 11, 2015 2:04 am

    🙂 thank you for this article…it’s sad that there are people who say/write things that continue to stigmatize mental illnesss. I have struggled with depression/anxiety since I was a teenager and when I was younger, and before I sought up help…those kind of comments would send me into a downward spiral of deeper depression, because I all ready felt like “I was weak” or “being a drama queen” and “should just get over it” and the negative, unsolicited, and UNPROFFESIONAL (I love that you made that a point! Know what you don’t know and refer away! 🙂 ) opinions of others reinforced those negative feelings. My sport/exercise of choice is running, which definitely has helped but not cured…another excellent point! You rock!

  2. March 11, 2015 4:05 am

    Great!!! Thank you for pointing out what needs to be said. The very big danger when any coach, trainer or life style teacher leads from their ego.

  3. March 11, 2015 6:09 am

    Reblogged this on Big Red Carpet Nursing and commented:
    Important piece on the limits of physical fitness and gyms when it comes to helping folks with depression:

  4. March 11, 2015 6:37 am

    Reblogged this on Sexual Reminisces and commented:
    A broken spirit carries a heavy load, that said we can tackle depression with regular exercise, a healthy diet and sufficient rest.

  5. March 11, 2015 8:07 am

    Excellent article; thank you for this. I discovered your post/blog through Big Red Carpet Nurse. Like Betty, I choose running (sprinkled in with some weight lifting, stationary cycling, and other activities), but there was a time when anxiety forced me to stop running. There have been times when I’ve been depressed and not exercised. But, either way, as you say in the article, depression is something biological and elemental–and I discovered long ago, it isn’t evaporated completely/forever by any amount of sweat (and I produce a good quantity of that!).

  6. Move Those Mountains! permalink
    March 11, 2015 9:27 am

    Well done! This is an excellent post, Depression & anxiety can have physical causes and the right meds can make an enormous difference. We should all be celebrating this, not knocking it. You’re so right – it’s all horses for courses when it comes to healing anything, and what works for one won’t work for another. There are many things that can help depression – we need to have as many tools in the workbox as possible,

  7. March 11, 2015 10:47 am

    Thank you, thank you, thank you, thank you thank you!

  8. Alyssa Royse permalink*
    March 11, 2015 1:54 pm

    THANKS! I’ll insert it.

  9. Alyssa Royse permalink*
    March 11, 2015 2:03 pm

    UGH. I was so busy being sick over the meat of the post that I missed this little bit of sexist drivel: “…my friend Nathaniel skyped me and as soon as he asked me how I was, I started going into all the things that are great, and because there was so much space, (because he’s not a typical man, and didn’t interject to try to fix anything)…” Jeesh.

  10. March 11, 2015 3:36 pm

    I am one of the few (if perhaps, the only) person(s) who thanking applauds Hemalayaa for writing such a post. Her words remained from her perspective (acknowledged several times throughout the post), with respect for her purview (yogic science). Yoga is too often viewed as just a physical exercise, when it couldn’t be further from it. It is a spiritual practice rooted in the knowledge from doctors (teachers) who lived deep in the Himalayan Mountains of India 5,000 years ago. It is beyond our scope in one lifetime, but addresses all human issues, be they physical, mental, emotional and spiritual. I honestly believe that Hemalayaa was addressing her experience from a yogic perspective which is not comparable to Western allopathic medicine, and does a better job by addressing the root causes of dis-ease versus treating its symptoms. To ensure I am of complete bias, I am a certified yoga teacher, a student of Ayurveda, a graduate of Berkeley, and a life-long sufferer of Depression among other mental stigmas. I have taken medication on and off for a quarter of a century, had major surgery on my left arm after a suicide attempt with a blade, and remain a huge advocate against the western reductionist view of the mind. I think what Hemalayaa posted is a huge opportunity for us to open ourselves to a dialogue long overdo – no one should tell us they know more about our physical, spiritual, or mental health. We live in these bodies and we should educate ourselves on how to best meet our bodies needs. Yogic Science is a great place to start.

  11. Alyssa Royse permalink*
    March 11, 2015 7:51 pm

    All of those things can be true without defaulting to the very dangerous position of “You’re not doing it right because you don’t feel what I feel.” In ANYTHING, individual results vary, and people have the right to choose what works for them. When you are dealing with very real issues of mental and physical health, simply “trying harder” at something that isn’t working isn’t effective, or safe. The fact that it worked for you is FANTASTIC. But that doesn’t mean it’s right for someone else. The worst, WORST, thing you can do is the classic “if you were more like me it would have worked.” Which her original post, and your response, are both full of.

    Yes, yoga has a deep and rich history. And yes, it is one that only very few care about or seek the benefit of. The same is true of most things. But that is largely irrelevant. And even if one were to explore and feel one with the deep history, that wouldn’t make them – or it – a failure if it didn’t cure depression or cancer or anything else.

    I could not agree more that we need to educate ourselves on how best to meet our bodies needs. That means NOT assuming that something so simple as “do yoga right” will fix something that is usually quite complex. One can embrace all the history and nuance, all the work, and all the stories like yours in which it “worked,” and STILL respect that it isn’t right for everyone. And still – apparently – judge harshly those who choose a different path.

    At the root of it all is just the unfathomable arrogance of believing that your way is the right for everyone, if only they understood better and did it right. It is that arrogance that is at the root of so many problems in our society.

    It is that arrogance that allows us to shame people for things like depression, because we think we know what they need better than anyone else, including them.

    But at it’s core, what I’m responding to is the idea that a yoga teacher – or any trainer – thinks they are psychiatrists, therapists, doctors, nutritionists or anything else. None of us are – or should try to be – all things to all people. It’s dangerous quackery.

  12. March 12, 2015 5:27 am

    I see a lot of air quotes for thoughts that were never used in either my response of Hemalayaa’s blog. Ex. “Your not doing it right because you don’t feel what I feel”. Such statements are not being made, so I am confused as to where these ideas and beliefs are coming from. My intended point is to say that we easily turn to western psychology to fix things with pills that, in my opinion, do more harm than good, rather than trust other forms of science, much older and wiser and with better clinical track records, such as Chinese medicine and yoga. Yoga attunes you to your body and mind in ways that Cognitive Behavioral Therapy and other contemporary forms of Western Medicine never will. Yoga can affect your body’s chemistry and alter your biology (not so common practices in the yoga of the west, but still yoga). Yoga cannot be reduced to cross fit, aerobics, cycling or any other form of physical activity and I think seeing beyond that is essential to understanding where Hemalayaa was coming from.

    You say you are responding to a yoga teacher who thinks they are – one of any medical professionals from your list. I challenge you to reread the article and put that thought to the test. She never insinuates that she is better than the advice of a medical professional, in fact, she never qualifies that her offer to help is anything more than a caring soul with a desire to be of service. There is a big difference.

    On an aside, new research is proving that depression and cancer are auto-immune diseases, meaning our bodies are fighting themselves because of what we do, what we think, and what we put into our bodies. New research, but enlightening.

    One last thing. When we look to use the phrase do no harm, we should first look to our own thoughts words and deeds. In your blog you mentioned how important that phrase was to you, but I sense here a motivation to discredit and bash Hemalayaa. Is that not harmful? All just things to ponder.

  13. Alyssa Royse permalink*
    March 12, 2015 6:38 am

    Really?

    When you advise someone to take or not take meds, you are acting like a doctor. You are diagnosing and prescribing.

    When someone is suffering greatly, you refer them to experts. Not yoga instructors. There is a lot of emerging research about depression, I would refer someone to doctors who are trained and versed in that research, as well as many other options around mental health treatment. Not a yoga instructor. Reading articles about research in popular media is very very very different from understanding the studies, the implications and the treatments that result from them. I mean…..

    And she is not my athlete. I am absolutely intending to discredit her line of thinking. That is 100% my point. I do so in protection of the many people who are harmed by the shaming of mental health issues, and the suggestion that if they just tried harder they could fix them themselves.

  14. Cam permalink
    March 12, 2015 12:55 pm

    Kelly, The reason I left yoga is because I’d believed that yogic idea about just needing more yoga or to know more about yoga, dig deeper, eat better.

    Yoga doesn’t cure chemical imbalances. It might help you better understand yourself and the world around you, and make it easier for you to cope with things that trigger you, but yoga doesn’t fix the surge of adrenalin that comes out of nowhere inducing earth shattering panic attacks.

    Open the dialog yes, but don’t assume that your experience is universal or the best option. I’m glad you’re better, I’m glad yoga helped you get better.

    In my case, yoga and the greater yoga community with it’s yoga cure-all and paranoia of western medicine exacerbated my issues. I won’t tell people to not go to yoga, I won’t tell them it won’t benefit them or that it’s better or worse than other options. It’s one tool that CAN be used in an entire arsenal, it’s not the only one or the best one.

  15. March 12, 2015 2:12 pm

    I have not spoken to my experience as being the product of yoga, please understand that. I make no statement as to my mental health being cured or that yoga was a prescription for me in terms of my choices toward a more holistic approach to my mental health concerns. Centuries of yoga practitioners have documented profound effects on the mind and body as a result of the practice of yoga. Yoga being beyond the asana that we practice here in the west. It is quite unfortunate, in my opinion, that yoga practitioners are suggesting persons avoid any allopathic practice for the sake of more yoga, and I don’t think that is what most are intending to convey. If they are, that is a great shame. I am so sorry for your experience and the way you felt as a result of it.

    I merely want people to expand their view of what healthcare can be for them by challenging the current system of things. A pill does not cure anything. The number one drug epidemic in this country is prescription drug use. The number one side effect of anti-depressants is suicidal tendencies. These facts should be questioned. Know one is going to die of pranayama. The body cures it self when properly supported to do so. I think Hemelayaa was most shocked by two of her colleagues having been on anti-depressants for over a decade. That is not responsible care, by any practitioner. The pills are to be used to stabilize someone so that you can get to the root of an issue and instead they are being abused by a system that does not make the time for patients, nor cares for much more than making a buck. Next time you visit a doctor for a prescription, ask about their affiliations with the drug manufacturer. Many are granted some thank you in the form of financial support for pushing their meds. Also, look up the scope of practice for psychiatry under the AMA. Their license in provided for the sake of prescription writing, not patient relationships. Just things to think about.

    Lastly, I wish you and anyone else struggling to find a solution to there ills much peace. As someone who has suffered greatly, I would not wish my experiences on anyone.

  16. Alyssa Royse permalink*
    March 12, 2015 2:19 pm

    Kelly, for MANY people the root problem is body chemistry. MANY people.

    Is it irresponsible for someone to prescribe a pill and not look at any other causal and curative sources. Yes. But it is far worse to suggest that the underlying issues, which for many people are chemical imbalances, should just be ignored and people need to breathe better. Yes, in fact, people have died, many of them, for not getting the help they need and believing that they should just try harder to chill out.

    No one has suggested that yoga, fitness, diet and community aren’t awesome – essential even – aspects to health. No one is suggesting that it’s as simple as “just take a pill.” No one is eliminating personal or social responsibility from the equation. No one is saying not to do yoga.

    We are saying that it isn’t enough by itself. Maybe, for some people. But to suggest that people who need medication are weak, are not trying hard enough, should just breather better…… that is so incredibly dismissive and disgusting.

    And there is no need to not wish your suffering on others, because that isn’t possible. Your suffering is yours and yours alone. As is all of ours. That’s part of the point. we are all different. Our causes and our solutions are all different. What worked for you may not work for others. Eliminating some valuable tools by filling them with shame and name calling is harmful to many.

  17. Cam permalink
    March 12, 2015 2:31 pm

    The pills I take aren’t a cure, they just make things more manageable. I’m as suspicious as anyone else of the pharmaceutical industry, and my physician (NOT my psychiatrist), was the one who recommended medication, but said very clearly that if I wanted to try other avenues that was completely up to me. He wouldn’t pester me to accept or fill a prescription.

    Yes, there is much we can learn from the history of yoga, but eschewing modern medicine that has been scientifically tested and peer reviewed to work (yoga and its spiritual benefits can’t be quantified in the same way) does nothing but further stigmatize those who wish to seek help off the mat.

    I spoke at length with Hemalayaa about her post, and whether said directly or insinuated through the lenses of surprise that yoga teachers would be on meds – it can reinforce the stigma of mental illness.

    And honestly, attempting to turn people away from western medicine for a more “yogic science” treatment puts yoga in the same camp as medicine. If more people do yoga to “cure” their mental illnesses that financially benefits the yoga community. You won’t hear a doctor saying “Be skeptical of yoga, or exercise, or meditate or pray. Those things don’t really work and they can be really damaging!”

  18. March 12, 2015 2:53 pm

    http://vedanet.com/2015/02/26/vedic-counseling-a-new-model/

    I see that our perspectives are just so different and I feel that no one is to win or lose this argument as, there are too many variables and too many persons to be considered. Not that I view any competition, please understand that. I am grateful for this dialogue. I will be better able to help people, the more I understand the diversity of the issue. As a student of Ayurvedic Medicine I highly value these experiences.

    I don’t believe anyone said that those who resort to taking medications are weak, and that should be fully understood. I also don’t feel that anyone, including myself, suggested turning away from western medicine. I merely want people to be cognizant of their choices. Your body is your responsibility. Do what is best for you, and arm yourself with the most knowledge available to you. I added a link to an article I believe, my opinion only, speaks to this issue. You can access it above.

    Om Shree Dhanvantre Namaha! Salutations to the being and power of the Celestial Healer!

  19. emlor24 permalink
    March 13, 2015 7:54 am

    Thank you for writing this.

  20. March 13, 2015 4:26 pm

    Let’s remain vigilant by ensuring our doctors follow appropriate protocols for the diagnosis of depression and other mental conditions by using the appropriate DSM and not just using their opinions. If one is not trained in how to use the DSM then they should refer someone to a physician who is. Proper diagnosis can be a long and arduous process, but will ensure correct action of allopathic protocols regarding.treatment, and most importantly, pharmacology.

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