Saturday, February 27, 2010

Does Depression Serve a Purpose?

In his article "Depression's Upside" Jonah Lehrer reports on new research that asks how a painful and debilitating condition like depression can serve an evolutionary purpose. Link here.

Of course, it matters whether we consider depression a condition or a disease. If some, but not all, depressions are maladaptive responses to events, then it is not so obvious that we should be treating them as diseases. It is one thing to say that someone is demoralized; quite another to say that he is sick.

For our purposes, it is significant that the researchers who are questioning the adaptive purpose of depression have also been led to offer treatment that is much closer to coaching than to psychotherapy.

Let me offer my own sense of what it means to be demoralized. When someone has suffered a trauma, either a psychological injury or a failure, he will naturally withdraw. The pain of trauma provokes an instinctual reaction: to avoid any and all threatening situations.

If your goal is survival and a situation threatens your survival, you will naturally want to avoid it.

But there's avoiding and there's avoiding.

If your job search keeps coming up empty, if you have been repeatedly rejected by prospective dates, if you have suffered from a series of bad investment decisions... your first reaction will be to take a step back, to withdraw from the fray, to reconsider.

If the pain of trauma is so intense that you cannot imagine ever going through it again, you might make withdrawal an end in itself. At that point you will fall into the category of what we usually call depression.

The theorists call the process of withdrawing to reconsider things ... rumination. I would rather reserve the term for the kind of overthinking that causes people to become dysfunctional.

Take an example. If an army attacks a city and is repelled, it will withdraw to reconsider its strategy. It might replace its leader; it might reconsider its strategy; it might call in reinforcements; it might work out a new plan of attack.

You can say that the army is ruminating, but I would prefer to think that it leaders are simply planning for a new attack.

But if after a period of taking stock and reconsidering what went wrong, the army cannot bring itself to attack again... for fear of being repelled or of taking more losses, then we may say that the adaptive advantage of replanning has become maladaptive.

There's thinking and there's overthinking. Usually rumination applies to the latter, not the former.

Depression becomes maladaptive when thinking becomes an end in itself, when it lasts too long, and when it loses, as Hamlet put it, "the name of action." When thinking becomes a substitute for action, you have a problem.

Darwin's definition of depression is consistent with this view: "Pain or suffering of any kind, if long continued, causes depression and lessens the power of action, yet it is well adapted to make a creature guard itself against any great or sudden evil."

Researchers who see depression as a condition and not as a disease are better equipped to treat it. Psychologist Paul Andrews makes the salient point: depression "... is usually a response to something real, a real setback."

Thus, treatment involves learning how to deal with the setback, the real situation that caused the psychological pain. In most cases trauma and failure cause people to feel shame. Thus, treating depression must always involve face saving strategies.

At the least, the research suggests that depression is not all in the mind. When Dr. Andy Thomson was treating a young assistant professor who was having trouble with his department: "Thomson helped the patient analyze his situation and think through the alternatives."

Note well that analyzing a situation and thinking through alternatives is not the same as analyzing your psyche, uncovering your past traumas, and getting in touch with your feelings. Dr. Thomson's approach is far close to coaching than to psychotherapy. In fact, it is my definition of coaching, as I defined it on my website.

Does it work? Dr. Thomson said: "Once you show people the dilemma they need to solve, they almost always always start feeling better." I doubt you can say as much about showing people that their problems are caused by not-good-enough mothering.

This approach also sheds light on the problems that arise when depression is medicated, as though it were a disease. A patient asked Dr. Thomson to reduce her medication, not because the meds were not working, but because they were working too well. They were making her feel much better, but as she said: "... I'm still married to the same alcoholic son of a bitchy. It's just now he's tolerable."

As Dr. Thomson says: "... the woman was depressed for a reason; her pain was about something."

Surely, there are some forms of depression that are diseases: the depression associated with bipolar disorder is one. Yet, as Dr. Thomson says, most depression involves behavior, a mode of conduct. You would never say that someone got the flu for a reason, or that diabetes was about something.

How should you approach depression or demoralization. Dr. Thomson might have been defining the approach that life coaches take: "Once you show people the dilemma they need to solve, they almost always start feeling better." Does this tend to make depression into an illness or into a maladaptive behavior?

Psychological pain, the shame of trauma and failure, is trying to tell us something. It is also trying to motivate us to change our behavior. It is trying to tell you to be more efficient, more effective, and more successful.

For your part you have a choice. You can either heed the message or ignore it. You are, after all, a free individual.

If psychotherapy wants you to detach your feeling of shame from the real event that provoked it, thereby to attach it to your own personal history it will be doing you a serious disservice. It will be inducing you to overthink the problem, to imagine that you can diminish your pain by ruminating about it, the better to fit it into the narrative of your personal history.

Introspection is the royal road to depression.


Anonymous said...

Having suffered major clinical depression for 4 years,I can tell you there is no simple cure for everyone.
Let me give an example...
Two men have a tumor that requires surgery if they are to be healthy. The first man is told the operation is too risky and so they decide not to undergo surgical treatment. The second guy undergoes surgery and the operation is successfull. He returns to good health.

What might work for some people might not work for others. Depression is something I agree should first be treated as a cognitive behavioural issue, and the individual should seek counselling. But the reality is that major clinical depression is a real illness. It is a real disease. Yes mental exercises, improved thinking can be helpfull. But for many they dont help much.

Clinical Depression is a complex condition and there is no simple cure. I agree that many people who are 'depressed' are ligitimately suffering, but may not necessarily be suffering from an illness or a disease.

Comments like:

'For your part you have a choice. You can either heed the message or ignore it. You are, after all, a free individual.'

when attributed to depression really piss me off. Let me be very clear here... depression is a complex illness. There is no simple remedy. How would you feel if you had AIDS or diabetes and were told 'you dont have a legit disease. Just ignore it' said...

Thanks so much for the article, pretty useful data.