On Getting Out of Bed: The Burden and Gift of Living

by Alan Noble

Psychiatry has at least one possible alternative. . . . It could decide to return to a less hierarchical understanding of its place in the mental health and medical systems; one that . . . would acknowledge that mental suffering is a larger category than mental illness, and that even disorders with a likely biological basis are not just medical, because the experience of all human beings, ill or otherwise, are shaped by their cultural, social, and familial circumstances.1

We should keep in mind one very basic fact. Among the very many people who present with a mental affliction, some are (almost certainly) suffering from a real illness, one that is understandable (in principle) like any other mental complaint. By the same token, others are (almost certainly) not. Mental suffering takes many forms, only some of which have roots in disease. The suffering of those who are not really ill in any meaningful medical sense can still be acute.2

There’s a kind of unspoken conspiracy to ignore how difficult life is, or to reframe it as something romantic—a heroic challenge we overcome on our way to the good life. In this conspiracy we each try to hide our scars, even from those closest to us and sometimes even from ourselves. Almost every cultural institution, church, government, or corporation promises you a good life if you just do what they ask. Make the right life choices. Marry the right person. Go to the right church. Get the right education. Work the right job. Buy the right products. And you’ll be fine.

But technique’s promise that life is easier than ever turns out to be just another source of dread and shame: if life doesn’t have to be this hard, if there are answers and methods and practices that can solve my problems, then it really is my fault that I’m overwhelmed or a failure.

This is one reason why we don’t want to be honest when someone asks us how we are doing. Why admit to failure or weakness? If we tell the truth, they’ll start offering advice, recommending some new method for “fixing” our problem, for overcoming anxiety or achieving our fullest potential or whatever. By the time they are done, we’ll just feel the weight of a new obligation, another method to try, and another chance to fail. “Have you tried this diet?” “I heard regular exercise can improve your mental health. Maybe that’s your problem.” “Here’s a book on prayer.” “I heard this scientist on a podcast talk about how your mental disorder can actually be treated by drinking more water.” If you suffer from a chronic mental illness, these conversations can be particularly humiliating because they remind you of all the things that have already failed to cure you. And you just feel tired of the whole thing.

Each morning you must choose to get out of bed or not. All the medication and cognitive therapy and latest research and self-care in the world can’t replace your choice. This decision can be aided by these resources but never replaced by them. Which means that you have to have an answer to a fundamental question: Why get out of bed? Or, more bluntly, why live?

there are many ways to throw a life away, and most of them involve continuing to live. We like to think of suicide as a singular act: intentionally ending your life. But you can also destroy your life slowly through alcoholism and drug addiction. You can destroy your life through an addiction to gambling. You can destroy your life (and the lives of others) through abuse and violence. You can destroy your life passively by being so overcome with fear of failure that you cannot move. You can even destroy your life by giving up all hope and devoting yourself to fleeting, vacuous, mind-numbing pleasures. So this question is not primarily about what we normally think of as suicide. It includes that, but it also includes all the various ways we can deny the goodness of life and act in defiance of it—all the ways we can choose not to get out of bed and face the day.

When we must finally face the question of life, many people turn to platitudes. We reassure one another that our lives are precious because life is precious. Or that the world needs us. Or that we each matter. So have hope! Which is all fine and good until you actually think about it and realize that each of these phrases is an empty affirmation, a tautology. And then it starts to look a whole lot like we’ve been conditioned to lie to each other that life is worth living because we can’t or won’t accept the possibility that it’s not. There’s that unspoken conspiracy again.

In addition to busyness, pleasure, and platitudes, there is still one more way of avoiding this question: We can see the question itself, or the suffering that raises the question, as a sign of a treatable medical condition. If we can just treat the illness, the question won’t matter anymore.

If we aren’t careful, medical and scientific language can obscure or replace the very thing it’s supposed to be treating. It can draw our attention away from the conscious, moment-by-moment responsibility of living by reducing the difficulty of that responsibility to a label. With a diagnosis we try to objectify our suffering, and we hope to place our despair in a nice tidy, medical box. We can set it on a table, examine it, and communicate it to others: I am not depressed. I have depression. It is over there and I am over here. My experience has a listing in DSM-5. I can name it. So, maybe it’s manageable after all? Except that mental suffering is never “over there.” It can’t be. By its nature, mental suffering is always experienced subjectively, inside us. And at best, that experience can only be communicated to others in figurative language.

Psychology and psychiatry don’t have an answer for why life is worth living despite suffering. They can’t shield you from the question by curing you. They can do a great deal to help us manage our mental suffering, whether it counts as a formal, insurance-approved medical diagnosis or not. But we’re still left with the same choice. We still have to get out of bed.

Human existence inescapably involves suffering. For all of human history we have known this to be true. But it’s hard to recall this truth when we are surrounded by forces that promise us greater and greater explanations, control, and strategies of happiness. So, remember this: tremendous suffering is the normal experience of being in this world. Beauty and love and joy are normal, too, but so is suffering.

You need to know that your being in the world is a witness, and it “counts for something.” Your existence testifies. There is no mitigating this fact. There is nowhere you can hide where your life will not speak something to the world. All we can do sometimes is to decide what our existence is a witness to, what it speaks of, and how we can share the burden of witnessing with one another.

When we sin, for example, we not only defy God’s law and harm ourselves and wrong our neighbor. We also lie to our neighbor. Our sin proclaims to others that God’s promises are not enough.

All these actions add up. It’s not just the lust and infidelity, or the pride and anger, or the greed and vanity. It’s the way these sins make sin more plausible for others. When others face similar choices in life, our example will affect their imagination and how they respond. We almost never take the witness of our actions seriously enough. I suspect that’s because if we did, it would frighten us. It’s scary to realize that my every decision communicates to people around me something about the nature of God, the goodness of His creation and laws. It means that my sin is never containable. It’s never something I can “make right.” The effects of my actions ripple throughout time and space, drawing in more and more people, for good and for ill. While God’s grace is sufficient for our sins, we do well to recognize the consequences of our sins.

Your existence is a testament, a living argument, an affirmation of creation itself. When you rise each day, that act is a faint but real echo of God’s “It is good.” By living this life, you participate in God’s act of creation, asserting with your very existence that it is a good creation.

For the stoic, though they can choose to face death bravely, death is the final word. For the Christian, death has been conquered, so we can face it bravely regardless of our fears. We can take a step to the block, confident in our hope.

Sometimes the risks of life overwhelm us, and we avoid making a decision. This is especially true in a society like ours, which gives us more and more options. If we can’t know who to marry or what to do with our lives or which brand of clothing is the most ethically manufactured, maybe we can’t do anything at all. Eventually we fold in on ourselves, unable to commit, or only committing to things half-heartedly, exhausted by our own sense of inadequacy. This is despair. We will still move toward the block, but we’ll be dragged there against our will.

The most fundamental decision is the decision to get out of bed. And it too communicates something. The decision to get out of bed is the decision to live. It is a claim that life is worth living despite the risk and uncertainty and the inevitability of suffering—one of the few things we can know for certain in this life.

We offer our bodies as a living sacrifice by daily embracing life and dying to our flesh: our sinful desires, our selfishness, our pride, even our fear and despair. Unlike the sacrifices offered under the old covenant, which came through death, our sacrifices come through life, from the decision to honor God with our lives. Christ’s death is the once-and-for-all sacrifice, and now we participate in that sacrifice by participating in His life. And like properly offered sacrifices in the Old Testament, when we live before Christ, our bodily living sacrifice is a sweet aroma to Him.

In my experience, the only way to move forward is to dedicate yourself to doing the next thing. To do the next thing is not to deny our other responsibilities but to recognize that faithfulness is always an obligation for the present.22 Right now we have a duty to serve God by doing whatever good work He has put before us. And if we trouble ourselves with all the other things we are burdened with, the things of tomorrow or the next hour or minute, we will be overwhelmed. God asks only that we serve Him now. Choose this second who you will serve, and then serve Him by doing the next thing. Place it in the forefront of your mind so that you don’t lose sight of it: I will get out of bed. Put on my shoes. Walk downstairs. Make coffee. And so on. We have to do all these things without getting lost in perfection, in frantically trying to master our lives by choosing the perfect next thing. Very often it is only by focusing on the concrete details of life, the singular actions demanded of us, that we can keep moving. But when we do the next thing, we communicate with our bodies that the next thing is worth doing. This moment is worth living. This life and all the responsibilities it entails is worth whatever hardships we experience. We need to be reminded of this. So do our neighbors.

Living for the sake of living—doing things so that you can continue to efficiently do things—begs the question, Why live? To live. That isn’t a sufficient answer. Now or sometime in the future that answer will fall flat for you or someone you love. The mere fact that you can cope with great suffering is not in itself a reason to cope with it. So when we encourage depressed and anxious people to be active, get out of the house, and stay busy just so that they’ll feel good enough to stay busy, we may help them get out of a funk, but we aren’t helping them understand the goodness of their existence. Don’t do the next thing just so that you can keep doing the next thing. Do the next thing because it honors God and testifies of His goodness and the goodness of your life to your neighbor.

When your days are filled with mundane tasks, none of which are worth posting on social media or even talking about, it can feel impossible to build momentum, to feel like your life is going anywhere for any purpose. This is precisely why we must see that each choice to do the next thing is an act of worship, and therefore fundamentally good. Feeding your pets is an act of worship. Brushing your teeth is. Doing the dishes. Getting dressed. Going to work. Insofar as each of these actions assumes that this life in this fallen world is good and worth living despite suffering, they are acts of faith in God. Choose to do the next thing before and unto God, take a step toward the block. That is all you must ever do and all you can do. It is your spiritual act of worship.

To love myself I must hope all things. This hope is founded on the promises of God, not on my own ability to fix myself or control my circumstances or solve the problems of the world. My hope is in God’s promise to preserve me, to work all things together for my good, to finish the good work He started in me. And finally, to love myself properly, I must endure all things—including the torments of my own mind. I may tremble at the agony of life. At times I may feel crushed and overwhelmed and undone, but to love God, I must love myself; and to love my neighbor, I must love myself; and to love myself, I must endure. I cannot do this alone, however. I bear, believe, hope, and endure not from my own capacity for love but with the aid of the Holy Spirit and with the comfort and encouragement of my friends. It is only with the aid of others that I can love myself and thereby honor God’s creation.

it is also true that the lines between our freedom and the power of a mental illness are murky at best. At the point of contact with the world, when our feet hit the floor, all questions of agency become inconsequential. Freedom and determinism have no bearing or relevance. They belong to a theoretical way of understanding the world, which has its place, but in practice, no person knows where their agency ends. With few exceptions, we experience each moment as if we have a choice of how we will act. Even when our minds suffocate us with hopelessness and we feel unable to move, we still experience the ability to choose.

Acknowledging our responsibility to get out of bed and live does not mean that we can condemn those who reject that responsibility. When someone loses their life to a mental illness, it is not our place to question whether they fought hard enough, whether it was really the illness or a weakness in their character. The truth is that many faithful, strong, godly people have been so broken by their trauma or mental illness that they have succumbed to suicide. And Christ’s work on the cross is more than sufficient for them, just as it is sufficient for your grievous sins and mine. It is presumptuous and uncharitable for us to judge their actions. God is Judge, not us. The experience of mental suffering is always incommunicable —except to God. So no matter how well you think you know someone and their illness, remember that you know very little—far too little to judge them.

Life is an awesome responsibility and burden. The uncomfortable truth is that suicide becomes a slightly more viable option for people when someone they respect succumbs to it. If you give up, it will open up the possibility for others to give up, whether “giving up” means suicide or apathy. You have the solemn responsibility and privilege to bear witness to the goodness of life by living despite suffering. Like the father in The Road whose every action is judged by his watching son, there are vulnerable, frightened people watching you, waiting to see how you will endure. And don’t think you can control who witnesses your life, like a celebrity carefully curating their public image—as if you could contain your life, hiding the shameful parts so that they only affect you. That’s not how life works. You are not your own, and neither is your suffering. In this world you will encounter untold numbers of people in circumstances beyond your knowledge and control. It’s entirely possible that the ones watching you most closely are total strangers.

I take the command to cast our anxieties on God not as a simplistic solution to hand over our psychological experience of anxiety, but as acting on the belief that it is God who cares for us, that in fact we can’t care for ourselves. That is the lesson at the center of Christianity: we cannot live a fully human life apart from God. The practice of offering our anxieties to God may not make them disappear, but it will remind us that we are in the hands of our loving Father.

The next commands, to be sober-minded, to be watchful, and to resist the devil, are good reminders that living with mental affliction requires vigilance. The devil would like nothing more than to persuade you that your life is meaningless, for it is in the destruction of what God has made good that the devil seeks to defy God. Practically, resisting may look like talking to yourself: making a habit of identifying and denying thoughts of worthlessness, hopelessness, and despair. The goal is not to reason your brain out of despair. That rarely works, in my experience. Instead, it’s to form habits that in their very nature affirm what you know to be true when you don’t feel it to be true. When you are tired, sick, stressed, burned out from doing some thankless good work—any time you are vulnerable to self-doubt—be ready to label it as the lie it is and move on. You’ll probably still feel bad, but that’s okay. Just do the next thing in faith.

And the thing is, as J. D. Salinger’s Zooey says, “There are really nice things in this world. I mean nice things. We’re all such morons to get sidetracked. Always focused on our ego.”24 You can get lost in your own head (trust me) and in your ego. When that happens, if you try to think your way out of being egotistical, you’ll only dig yourself in deeper. You must take a step to the block. You must do the next thing. And when you do, eventually you will remember that there are really nice things in this world. And you’ll feel like a moron for getting sidetracked in your own head. But that’s okay. There’s grace for us morons.

As soon as you decide in your heart to spurn God’s gifts—beauty, love, a good meal, laughter, and so on—because you feel unworthy or unfit, you are denying the reality of God’s grace.

It’s ridiculous, but I think most people would rather try to take pleasure in something pitiful and degrading and self-destructive than sit still and accept grace. Sometimes the best we can do is make the choice to act as if this life is a gift. That honors God. And if we make a practice of it, a practice of defying our anxiety and depression by getting out of bed and just giving a few moments of silent prayer of thanks for this life that maybe we still loathe—that pleases God. It gives hope to people you don’t even know. In time you’ll start to feel it, too, and if you don’t, at least you did what was right.

TO LIVE THROUGH MENTAL SUFFERING, you must have an answer for why life is worth all the anguish. But if your suffering is from a chronic mental illness (diagnosed or not), then answering this question once isn’t enough. You also need to know how to live with the mundane burden of a mental illness. Because answering this question doesn’t make your depression or anxieties or fears disappear.

Part of the nightmarish quality of mental illness comes from the fundamental disconnection between the way you experience the world and the way everyone else seems to experience it. You’ll be going through the worst episode of your life and discover that nothing changes for anyone else. They don’t feel bad. They enjoy books, food, or sex. They pray easily. They find comedies funny. And you’ll want to yell at them, “Look around. Do you not see how profoundly terrible and empty this all is? How guilty and inadequate we are? Why aren’t you worried? Why aren’t you panicked? What’s the point of doing anything?” You may find yourself pitying them in their ignorance, but more often you’ll find yourself irritated. Their joy makes your own despondency seem all the more dramatic by contrast, which is why it’s often hard to be around happy people when you feel bad.