Mood

PLACING DEPRESSION IN CONTEXT

 

YOU KNOW you're depressed, but your inquiry has only just started. The first thing we looked at was whether your depression had vegetative (retarded) characteristics or agitated (energized ones) or fell somewhere in between. This may be a simplistic sorting exercise, but it does force us to carefully examine everything that is going on with our emotions, mental activity, physical activity, and behavior. Moreover, we have have a rough navigational guide.

Moving right along ...

Depression - Situational or Clinical? Mind or Brain?

One of the old versions of psychiatry's diagnostic bible, DSM-II of 1968, distinguished between "endogenous" and "exogenous" depression, namely between what it saw as depression occurring as a result of the mysterious biological processes of the brain and depression as a result of how one reacts to one's environment. In one sense, the DSM-II was making a naive "mind-brain" distinction.

Yes, it is useful to think in terms of the mind. But every decision we make, every thought process, every emotional reaction, is mediated through the meat housed inside our skulls. And some of our meat is not as well-equipped as others to handle the load our environments dump on us.

But the endogenous-exogenous distinction does encourage us to examine where our depression might be coming from. If your marriage is falling apart, for instance, or your situation at work is going badly, it is obviously worth exploring this association. Sort of like investigating whether a person with a pulmonary disorder is working in an asbestos mine. For some crazy reason, the "modern" DSM-III of 1980 and its successors didn't think this was important.

A personal example:

In November, 2004, I went out for the evening happily thinking I had fired the President, only to have Dan Rather inform me a few hours later that my optimism had been unfounded. Immediately, I felt like Augustine of Hippo after Alaric the Visigoth sacked Rome in 410 AD.

Was I "depressed"? Sure. But was it clinical depression? No. We all have our bad hair days. The DSM mandates at least two weeks for a depressive episode. But suppose my bad hair day had triggered something far more pernicious, a depressed state that persisted for weeks and months? Clearly, I would be in a state of clinical depression (more accurately, in my case, a depressive episode in bipolar).

But I knew I could ill-afford to assume that I was merely having a bad hair day. The situation was not going to go away. There would be post-election follow-up. Days on end of mindless blah-blah-blah. Days on end of incessant exposure. For me and my biologically vulnerable brain, this was the equivalent of sending me back down into an asbestos mine. My obvious solution was to immediately change my environment: a total news black-out. No discussing politics.

Also, as a result of my depressive funk, I found myself unable to concentrate on my usual work. So I turned to a different project. This turned out to be my neglected draft to a book I had in mind. The change in routine reanimated me and booted me out of my depression. I completed the manuscript a couple of months later, then found a publisher.

Maybe I should have dedicated Living Well with Depression and Bipolar Disorder to George W Bush.

But here's the important point. By acting fast, "situational" did not escalate into "clinical." But for that happy outcome to have occurred, first I had to acknowledge the "situation" I was in.

Is Your Depression Related to Stress and Trauma?

Let's take situational depression a step farther. The "old" DSMs reflected the Freudian mindset of the day, namely that mental illness was a maladaptive "reaction" to stressful situations such as interpersonal relations. The assumption downplayed the biology of the brain, yet - ironically - today's brain science is validating this view, but with genes and biology in the mix, namely:

Take a vulnerable brain (say one with a hyper-reactive limbic system), throw in a stressful current event or two, combine it with old memories - and brace yourself for some form of mental distress.

Tied into the equation is anxiety. As fear and anxiety overtake us, we lose our sense of control. Lab animals in these situations quickly shut down and become immobile, roughly equating to depression. Over successive experiments, these same lab animals may develop a sense of "learned helplessness."

 

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Modern life is booby-trapped to set us up for depression. Abby Sexias, author of Finding the Deep River Within, describes depression as "the disease of a-thousand-things-to-do." For instance:

The average working couple in America spends 20 minutes a day together. "Family time" has become a goal, an achievement, rather than a natural consequence of being a family. Most Americans are trapped in a vicious cycle of overwork and over-consumption. Dropping in on a neighbor is practically nonexistent. Keeping busy and multitasking are praised, while slowing down is frowned upon.

Our brains simply weren't built for this. Even "well-adjusted" individuals with resilient brains have their breaking points.

I would fold into this a certain class of "outliers" in our midst, sensitive and gifted individuals who don't fit into "normal." For these people, trying to lead lives according to other people's expectations is only going to bring on depression. But building a successful life based on being true to yourself is also an invitation to depression. Do artists and musicians pursue their callings because choosing a career in law or business would make them depressed? But they can't escape. Inevitably, they become depressed because of all the inevitable setbacks. The world may love creative types, but it is very unkind to those who are struggling.

You may not find an obvious stressful situation to connect to your depression, but it pays to look for one, such as a working or living environment that has grown much more difficult. Even if you can't change your immediate surroundings, even if you feel your situation is a healthy one, chances are there is room for improving your skills for coping with it.

We're not done: Trauma and abuse add another dimension to depression by making your entire world stressful. There is no escape. The battlefield is always there, the attacker is always lurking around the corner, your vehicle is always about to spin out of control.

Rooting out past trauma and abuse is advisable, but this needs to be regarded as a long-term project.

Is Your Depression "Normal"?

Clearly, there are times when depression is a perfectly normal - even healthy - response to an abnormal situation. Loss of a loved one is one example. We are supposed to be depressed in these situations. At the same time, depending on circumstances, these depressions may need to be treated.

Also, our depressions may be telling us something, such as the need to be making an immediate course correction. This is straight out of evolutionary psychology. Depression has been called the end of denial. The rose-colored glasses come off. Reality takes over. Maybe instead of banging your head against the same wall - again and again and again - you need to cut loose destructive friends, bail out of a bad relationship, rethink that toxic work environment.

Listen to your depression. It may be an unwelcome guest in your brain, but it is definitely telling you something.

Additionally, an evolutionary psychology approach compels us to look at depression as part of psychic healing. In a sense, depression is an enforced break from the craziness around us. Here, we need to think of depression as the equivalent of pain radiating out of a fractured brain. We may be telling ourselves, for instance, we need to go to work, meet our deadlines, attend to our personal obligations. Our depression is telling us: Screw that, time out. You're not going anywhere.

For decades, under Freudian influence, psychiatry sort of endorsed this view. "Depression" was seen as part of an underlying "neurosis," the pain rather than the fracture. You treated the neurosis - the fracture - rather than the psychic pain of depression.

The catch was that the treatment of the day - psychoanalysis - did not make depressed patients better. Biological psychiatry, which replaced Freud, did have some success in improving outcomes, in treating the pain. The catch was patients often remained miserable and relapses were common. Obviously, merely treating the pain has its limits.

Clearly, there is room for reconciling the Freudian mindset with biological psychiatry - the DSM-II world view, in effect, with the DSM-III and its successors. Indeed, Nobel Laureate Eric Kandel of Columbia University talks of a new "science of the mind" that would embrace both Freud and neurobiology.

Tying This Into a Bow

There are no easy answers here. But we need to be asking a lot of questions. Just knowing you are depressed represents only part of the picture. Finding a context to your depression begins to fill in that picture. In effect, you are tethering your depression to your situation and environment and deeper psyche. If depression is dynamic and complex, these relationships are infinitely more so. There may be different strategies for different circumstances, but they all need to be mobilized in the service of that singularly unique piece of work that is you.

Trust me, you are worth the effort.

Don't stop now. Next article: Depression Plus

This article is the third in a four-part series. Previous articles:Depression - What Is It? * Figuring Out Depression

Reviewed June 16, 2016

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