Rage, rage against the dying of the light

作者：梁雅穎 臨床心理學家

This form of depression is uniquely challenging to navigate—not because of its extreme severity, but precisely because it remains "not quite severe enough."

She feels no desire to go on living, yet has no active intention of taking her life. She makes an effort to attend school daily, taking occasional sick leave, while meticulously keeping her grades and attendance right at the passing threshold. She maintains friendships, has a boyfriend, and manages a functional social circle. Naturally, her school and parents believe she could simply "try a little harder," as her outer social functioning seems entirely intact. Yet, only she knows the reality: chronic sleep issues, and a dark void that periodically returns despite medication. When a depressive episode hits, all motivation vanishes; she can only lie in bed. She cannot cry, nor does she reach out, knowing intuitively that others cannot help. In those moments, an internal voice echoes endlessly: "You are useless."

I asked her: "Do you want to get better?"

"I do. That's why I'm here."

"This isn't an easy dynamic to resolve. I've worked with it for a long time, and honestly, there are no absolute guarantees. However, there are a few proactive paths forward. Though they may not lead to a complete 'cure,' they are worth trying.

First: Do you like who you are?"

"Fifty-fifty, I suppose. I'm just... too lazy (hea)."

As it turned out, she already had a clear direction in mind: she wanted to study design at university. Meeting the baseline DSE entry score was all she needed, given that the discipline prioritizes portfolio experience over pure academics; her current school subjects didn't warrant exhausting all her energy. Yet, with everyone around criticizing her lack of effort, she fell into step with the crowd—judging herself harshly for being unproductive, even while knowing her heart lay elsewhere.

"Can you put in effort when you're doing something you actually enjoy?"

"Yes, I can."

"Then there isn't a problem with you. It's only natural that you can't push yourself for things you don't care about. You aren't innately lazy—you simply lack opportunities worthy of your dedication."

Step One: Learn to like yourself. Identify the sources of self-criticism and address them one by one.

"Second: What kind of life do you want to live in the future?"

"Work in design by day, play video games after work."

"Do you want to move out on your own?"

"Yes."

"That lifestyle isn't overly out of reach. It would be much harder if you wanted to marry, have children, amass wealth, gain fame, or change the world. Since your goal is clear, let's work toward it. Earning money is a solid first step—would you like to find a summer job?"

"Yes, I would."

Very good. Step Two: Discover what kind of life you truly desire. You don't need to adopt societal benchmarks of success; simply move toward the life you genuinely want. Challenges will arise along the way, but remembering that you chose this path will give you the strength to overcome them.

"Third: Do you recognize the pattern of your negative emotional episodes? Could they be linked to hormonal shifts?"

"I'm not entirely sure, but possibly."

"Start tracking them. For instance, two days before my own period, I experience a sudden drop in mood that naturally lifts a few days later. Once you understand this cycle, you realize that the overwhelming despair and thoughts during those low periods aren't objective truth. They are simply a temporary bug in your body's factory settings. Don't buy into that despair, and avoid making major decisions during those days."

We can rarely prevent negative emotions from surfacing, especially during times of adversity or stress. Certain psychological approaches encourage total acceptance—observing thoughts as they rise and fall, letting them come and go without reaction. Yet, negative thoughts often feel suffocatingly real; I find it difficult to simply "let them pass" without being shaken. Instead, I tell myself: Don't get on the train. Don't let it carry you away. At critical moments, it takes deliberate effort to push back.

Step Three: "Rage, rage against the dying of the light."1 Even when immersed in darkness, refuse to bow to the void and despair trying to consume you.

Persistent depressive disorder may not disappear easily. The black dog will still bark at times, but we can learn how to tame it within our daily lives. No matter how loudly it barks, we don't have to rush to eradicate it immediately.

Here is a three-step framework for you—may you live with more patience than the dog, and outlast it.

1 From British poet Dylan Thomas's classic poem written for his dying father, "Do not go gentle into that good night."