Monday, February 20, 2017

Understanding Depression

You are walking home one evening and suddenly you have a strange feeling of dread. You have a premonition that something bad is going to happen. You become more alert to your surroundings and start walking more quickly. You reach in your pocket to see whether you brought your pistol. You look to see if anyone can help you.

Your anxiety, in other words, is trying to tell you something. You might or might not heed its message, but it is not just a random sensation that welled up from the depths of your soul. But it is not just trying to tell you something. It is helping you to deal with the danger. The emotions connected with anxiety will cause you to take actions to reduce the threat.

Obviously, anxiety is not infallible. You might have seen a picture in a store window that recalled a prior threat. You might have seen a shadow that resembled someone lurking behind a car. Anxiety alerts you to threats, but the threats need not be present threats.

Given the option between deciding whether the threat is real or imagined, you do best to assume that the threat is real. If the threat is real you have something to gain. If it is not real you have little to lose. Thus, reacting to an imaginary threat seems to be a correct adaptive response.

Nothing about this should feel strange or new. When we come to depression, however, the situation feels more complicated and difficult. What is depression telling us? And what are its symptoms telling us to do.

Recent research has suggested that the complex of symptoms that accompany a depressive episode serve an evolutionary purpose. Of course, anyone who has ever been prey to such an episode will not see it that way. As much as we believe in Darwin we will hesitate before drawing such a conclusion.

Paul Andrews of McMaster University suggest that the symptoms want to pull us away from everyday life and to send us into our minds to find out what happened and what we should do.

Matthew Hutson reports on Andrews’s theory:

Andrews had noted that the physical and mental symptoms of depression appeared to form an organized system. There is anhedonia, the lack of pleasure or interest in most activities. There’s an increase in rumination, the obsessing over the source of one’s pain. There’s an increase in certain types of analytical ability. And there’s an uptick in REM sleep, a time when the brain consolidates memories.

Andrews sees these symptoms as a nonrandom assortment betraying evolutionary design. After all, why would a breakdown produce so synchronized a set of responses? And that design’s function, he argues, is to pull us away from the normal pursuits of life and focus us on understanding or solving the one underlying problem that triggered the depressive episode—say, a failed relationship. If something is broken in your life, you need to bear down and mend it. In this view, the disordered and extreme thinking that accompanies depression, which can leave you feeling worthless and make you catastrophize your circumstances, is needed to punch through everyday positive illusions and focus you on your problems. In a study of 61 depressed subjects, 4 out of 5 reported at least one upside to their rumination, including self-insight, problem solving, and the prevention of future mistakes.4

Notably, this theory does not tell us what produced the depression. It might be telling us that we have a problem, and it might want us to solve the problem. Yet, the feelings of worthlessness are telling us that we are not capable of solving it. They are telling us that it’s all hopeless.

As with anxiety, the depressive episode does not necessarily refer to a current problem. It might also have been triggered by something in the present that recalled a past defeat. If the feeling of depression is telling us to distinguish between past and present defeats, that is one thing. If it is telling us that we can do nothing to solve the problem, that is quite another.

But, what is the threat, what is the danger that the depression is signaling? It is not a threat to life and limb... as happens with anxiety. We understand that losing a loved one produces mourning, not depression. We do better to understand depression as a loss of face. 

This assumes that we understand what it means to lose face. Obviously, if depression involves losing face, then treatment involves taking actions that save face. Perhaps Andrews was dealing with the fact that it is not always easy to know how one has lost face, thus, why other people see us differently. In other situations—a relationship failure or public humiliation—we know very precisely what triggered the depression. Surely, we might not have done anything to lose face. The charge may be unjust. And, we do not always know what we should do to save face.

If depression sends you searching for meaning, or some such, it is tricking you into thinking that you can save face by changing the way you feel about yourself. Or, by taking a pill. Yet, if depression is depressing because it involves how you look to others, the feeling of hopelessness signals the difficulty you will have in changing the way others see you. Evidently, if you can figure out how to change how you look to others you will feel better about yourself. And if you always find such situations hopeless you might well profit from a treatment that offers—not hope—but different ways of dealing with the loss of face.

It becomes more complicated. As you know, the Chinese have two words for face. Neither refers to the state of your soul. In the first you have face because you belong to a group. In the second, you have face because you have status or standing within that group. You can therefore lose face in two ways: by being expelled from the group, being ostracized or shunned. This is clearly the worst way to lose face. Second, you can lose status or standing, by being passed over for a promotion, by being demoted or even by being disrespected.

By this theory depression signals a loss directed at your social being. The same is not true when you are mourning the loss of a loved one. It tells us why Dr. Richard Mollica was pointing in the right direction when he said: “The best antidepressant is a job.” A job offers structure; it offers belonging; it offers relationships; it offers a role and rules. It provides a social support system.

If you do not belong to a group, join one. Simple, isn’t it. Well, maybe not that simple. At times, there are no jobs. If so, join a religious group. Their job is to give you face, to give you a place and a home and a connection with other people. One understands that some people try to treat their depression by becoming a denizen of a local saloon. Obviously, this is not the best way to go.

Take the case where someone has insulted you. He has offended you. He has treated you with disrespect. Now, you need to figure out how to respond. If depression, by the Andrews theory, causes you to put aside your bodily appetites and your pursuit of pleasure, it is telling you to ruminate … but without considering how you feel or what you want. It suspends questions of pleasure and desire. And, it also tells you to think before you act.

When someone offends you your first impulse might be to strike out in anger, to show how enraged you are, to demonstrate publicly that you refuse to accept the disrespect. Might we not say that some people, having seen their candidate lose the last election are feeling that their social status and standing, their position as part of the management team-- the managerial elite that enjoys the greatest social prestige-- has been compromised. So they strike out blindly, in anger.

That is: they are not thinking about how best to restore their status. I have in different posts offered some suggestions, but still many of those who have found their status compromised by the Trump presidency are so enraged that they cannot control themselves. They come across looking like fools... thus, looking like people who deserved to lose status. This suggests that some forms of status might be illusory.

This shows us why depressive symptoms cause the offended individual to step back from the situation, to ignore desire and pleasure, to ignore what feels right in order to do right. When you have lost prestige in society you ought to show that you did not deserve to lose that prestige. If you go out in public and act like a raving maniac—all the while accusing your orange-haired adversary of being a raving maniac— you will be showing that you do not deserve a more exalted status. If people start thinking that your adversary is acting a part while you really mean what you are saying... you will have been lured into a trap.

Among other things, people who have higher status in society know how to control their emotions.  They do not allow themselves to be led around by their desires. They set a standard for good behavior, and good behavior does not involve making your emotions, no matter how authentic, a public spectacle.

The moral of the story is: depression is telling you to do something, but, as opposed to anxiety, it does not know what you should do.


trigger warning said...

I can't comment on the adaptive value of depression from a neo-Darwinian perspective. Don't know enough about genetics.

But, in my opinion, a major source of depression in modernist culture was articulated by CS Lewis:

"For the wise men of old, the cardinal problem of human life was how to conform the soul to objective reality, and the solution was wisdom, self-discipline, and virtue. For the modern, the cardinal problem is how to conform reality to the wishes of man, and the solution is a technique."

There are over 22,000 "technique" titles in the Amazon "self-help" and depression category. 'Nuff said?

Reality is.

Philip K Dick famously said, "Reality is that which, when you stop believing in it, doesn't go away."

Reality is hard. Not hard as in difficult, hard as in unyielding.

Denying reality, fighting reality with chemicals and techniques, seems to me to be the perfect way to set the table for endless rumination and pain. The harder you kick it, the more it hurts.

Shaun F said...

I think the hardest thing to diagnose wrt depression is the difference between, pain, change and anger. None of which constitute depression. However, I presume many people think they are depressed when they don't feel good. I will also note that people, who are sensitive, have harder times living in a dishonest world. It can be quite painful. I have experience periods of "the blues", but I am a fairly serious person. My conclusion has been the only way out is through, which isn't always pleasant. But change rarely is. And sometimes you can’t do anything – changing behaviour or attitude doesn’t change the problem. It may change your focus. I will differentiate from "real" depression, where at say 50 you realize your life was a complete lie, at which point the therapists will make a killing.

Sam L. said...

" Yet, the feelings of worthlessness are telling us that we are capable of solving it. They are telling us that it’s all hopeless." I think you left out a "not" in front of "capable", Stuart.

"If you go out in public and act like a raving maniac—all the while accusing your orange-haired adversary of being a raving maniac— you will be showing that you do not deserve a more exalted status. " I notice there's a LOT of THAT these days.

Ares Olympus said...

It is fun to speculate on the nature of depression. I don't think it always has to do with loss, whether status or something else. Or perhaps sometimes you've "won", thus a happy ending, you've reached a long sought goal, but you don't know what to do next. Perhaps it was the striving that brought you energy, and the achieving leaves a hole

And it could be perhaps all the discipline you used to get there has forced you to neglect parts of your life, perhaps relationships or friendships or other things of value that don't involve achievement, while do involve work, work you avoided when you were focused. And perhaps other neglected parts of yourself are calling for attention, and you don't know how to find them.

I've noticed that in exercise, that is when I've been very busy, I don't notice I've not exercised at all for a couple weeks, and don't feel good and don't know why, and its not until I actually get some exercise do I realize that it was what I was missing. I remember in college I called it "adventure starved", and what's strange is how I don't have any idea that's what's missing. So without "good habits" or some physical goal, I forget, and that can feel like a depression, where I really don't believe I want to do anything. At least that taught me to not trust feelings to tell me what I want, since I can't predict how I'll feel after I do something. I can't imagine feeling better until I do.

Perhaps depression isn't good with feelings, but I've also read that its a more "sober" emotion that is willing to look at hard facts that we've wanted to avoid because they're uncomfortable, but if we're already down, we are more willing to look at grief, and experiences of loss and change, and perhaps we need to take some down time to process the past before moving on. And perhaps growing up requires a lot of this, since there's so much we must let go of when moving from one stage of life to the next. Maybe conscious mulling is what we do, but the unconscious is working too, so this time can encourage things from the unconscious to rise up, like seeds planted that will lead us to a new life when the old is gone.

I recall Thomas Moore, author of Care of the Soul, working under archetypal ideas from Carl Jung and James Hillman, offered opinions about depression, and he associated it with the Roman God Saturn. Hey, that chapter is online here:

Perhaps the hardest part of depression is that it is inconvenient, and life has constant demands on us, and so depression can give a reason to say no to things that no longer have meaning to us. Its a scary thing if our self-identity is X, and so depression says we're more than X, if we can just find what we forgot.

Dennis said...

And I wonder why every time I scan Ares I keep thinking about the "Wizard of Oz?'

Ares Olympus said...

Dennis, the story or the character?

Maybe Dorothy's escape from B&W Kansas into technicolor Oz perhaps suggest that fantasy can seem more real to people than reality? Just don't let Toto pull the curtain away too quickly or you'll spoil the drama and adventure.

Certainly our President who says "Only I can fix it" is a wizard of some sort.

Another wizard, pschologist Robert Moore, suggested low-grade depression exists as a "defense against the numinous", since gaining access to inner power can threaten the order of things, and uncontrolled grandiosity can cause great destruction.