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Transforming Depression
Healing the Soul Through Creativity
By David Rosen NICOLAS-HAYS, INC.
Copyright © 2002 David H. Rosen
All rights reserved.
ISBN: 978-0-89254-609-1
CHAPTER 1
Understanding Depression and the Quest for Meaning
"Where there is sorrow, there is holy ground."
— Oscar Wilde
Theorists in psychology and psychiatry can be divided into two groups: the lumpers and the splitters. In classifying depression, lumpers strive to fit all possible forms of depression (which, in common parlance, would include sadness, moodiness, grief, suicidal despair, and so forth) under one umbrella. Splitters, on the other hand, endeavor to draw precise, significant distinctions between all possible forms of depression. These differences aside, both lumpers and splitters tend to define depression in negative terms, as a disorder or disease (or, in the case of splitters, as a multitude of disorders or diseases) characterized by a self-punishing loss of emotional and physical vitality.
I will take a middle ground, incorporating the most significant insights into depression offered by both lumpers and splitters. I will also depart from them both, viewing depression as a favorable affect and linking it to the quest for meaning. I believe that depression can help a person adjust to a new reality, and therefore can have a positive value.
Imagine aboriginal men and women forced to take shelter during the day in a dark cave, to escape a predator, bad weather, or an earthquake. Maybe they are hungry, cold, and fearful, but at least they are safer than they would be outside, and their withdrawal from the light of day has given them a chance to regain their equilibrium. Depression is analogous to seeking sanctuary in a cave. For the human psyche, depression is a natural reaction to a disruptive situation, and though it is unpleasant in many ways, it is essential if the psyche is to adapt to, and live through, that situation.
Or think of depression as a dark underground, where seeds fromdying plants can germinate. If the soil of depression is nurtured properly, the result will be New Life for the psyche — in other words, psychic rebirth. This type of organic growth occurs naturally within us during our emotionally stormy adolescent years, when our psyche goes through the Symbolic but painful Death of the parent-dominated ego as a prelude to the birth of its own, young adult ego.
Although my view of depression as a positive state is atypical, it does have other proponents. In ancient times, Plato (arguably the first important splitter in Western thought) divided mental illness, and therefore depression (as one of its principal forms), into two main categories. One of them, disease, is indeed negative. But the other, divine gift, is decidedly positive and consists of four subcategories, each with its own special inspirational value: prophetic, religious, poetic, and erotic.
In modern times, a very prominent advocate of depression as a positive force has been Carl Jung, who went through his own agonizing but transforming depression after his break with Freud in 1913, and experienced a psychological renewal similar to the death-and-rebirth experience of the adolescent.
More recently, Arthur Schmale has argued for the adaptive role depression can play in the human psyche. He states that "the [depressive] reaction, unpleasant as it may be when it is personally experienced, has adaptive significance for growth, reality testing, and even survival." In Schmale's theory, which he attributes to George Engel, depression operates as a biological conservation-withdrawal mechanism that can be found not only in plants and single-celled organisms but also in more highly evolved animals, including primates and humans. This mechanism serves to protect the individual "by means of withdrawal and inactivity when stimuli become excessive and cannot be actively avoided." At the onset of withdrawal and inactivity, the mechanism allows for rest periods (such as sleep or hibernation) that may be either gradual or sudden. Another very recent book by Emmy Gut focuses on the adaptive role of depression and how unproductive moods can be made productive.
I, too, see depression as potentially helpful. When an individual's psychological conservation-withdrawal mechanism is operating, the person is in a state of adaptive depression — a temporary period of inactivity like the period of incubation before a creative idea emerges. This is not a pathological reaction, but a natural, perhaps essential process, much like Anthony Storr's concept of solitude as a necessary state for active imagination and the reviving of mental health. Depression becomes pathological only when the individual remains locked in this state of inactivity, instead of progressing beyond it.
Unfortunately, the prevailing trend in Western civilization has been to view all forms of depression as somehow shameful, with the exception of a reasonable period of grief after a major loss, especially the death of a loved one. To an outside observer, depression doesn't seem productive at all; on the contrary, the depressed person appears to be giving up, abandoning his or her soul to a dark abyss. Historically the Roman Catholic Church considered sadness and sorrow as symptoms of tristitia, one of the cardinal sins. In the secular world industry, optimism, and self-control have always been cardinal virtues. Thus, depressed people, subtly pressured by their culture to think of themselves as sick and possibly even evil, don't give themselves time and space to understand their depression so that they can recognize it for what it truly is. They're too ashamed or concerned with denying it, hiding it, or bemoaning it.
I'm not claiming that depression is all positive. I'm simply saying that depression has both positive and negative features, and that people who are depressed often must learn to understand the true nature of depression in order to complete their journeys back to health. To paraphrase Ecclesiastes, there is a time for darkness, depression, sleep, and withdrawal, and a time for lightness, joy, activity, and engagement. What is truly negative is to remain for long periods of time at one extreme or the other (manic-depressives, technically sufferers of bipolar disease, wind up experiencing the worst of both worlds in this manner).
Above all, I am suggesting that depression is an archetype — an affectual predisposition, as old as life itself, that expresses itself in biological, psychological, social, and existential/spiritual ways. As with any archetype, it has both a dark side and a light side. In this respect, depression resembles the Chinese principal of yin/yang, an archetype of all existence as a balance of opposites (Figure 1-1). The dark (yin) and the light (yang) function together to make a whole. Within each is a little of the other; they can't be separated by drawing a straight line.
How I Conceptualize Depression
I sympathize with lumpers and view depression as one basic entity. Objectively, it manifests itself through the persona as a mood. Subjectively, it may or may not be felt as an emotion and, on a deeper level, it takes the form of a felt or unfelt affect.
An affect refers to the deepest or archetypal level of the psyche. When an individual has an explosive outpouring of feeling, be it rage, anger, or grief, it is because the person has been touched at the core of his or her being. The result is a psychic eruption of affect — like a volcano spewing red-hot lava.
One level closer to the surface is the actual emotion related to the affect. It is a subjective state of feeling, in contrast to an archetypal affect or predisposition toward emotion. In any given situation, individuals may or may not consciously recognize the emotion they are experiencing; and even if they do, they may or may not express that emotion.
Mood is the uppermost level in which a feeling manifests itself and the first level of feeling an outside observer notices. Sometimes an individual exhibits a lack of congruity among affect, emotion, and mood. There is a depressive disorder known as masked depression, in which the individual manifests an untrue or false self, suggesting an affect that is not authentic. For example, a person may put on a persona of happiness and contentment; but behind that smiling face may be emotions and affects of depression and rage. What eventually happens in such cases is that the mask develops cracks and the true emotions and affects become evident, both to outside observers and eventually to the person harboring them. The false self has serious implications in regard to suicide.
Normally, depressed affects, emotions, and moods may cast gloom on a person's psyche for a few hours, a few days, or even a few months; but they do not indicate that the person has a mental disorder, nor do they interfere with his or her ability to lead a normal life. They are transient by nature and pass without causing major problems. However, when a person's depression is accompanied by more disruptive symptoms, such as severe despair that continues relatively unabated for a year or more and compromises his or her ability to function, then the depression is considered abnormal (or, strictly speaking, pathological).
The single entity of depression forms a continuum from normal to abnormal. On the extreme, normal end of the continuum are the temporary experiences of sadness, grief, and bereavement that don't impair one's ability to function — what most people would experience due to a mild disappointment or a real, important loss. At the other end of the continuum are the more lasting and impairing types of clinical depression, such as neurotic and psychotic depression.
The Restoration of Morale
One characteristic common to all cases of depression, regardless of the particular symptoms or classification, is a loss of morale. In practice, morale makes itself known in a person's day-to-day morality, sense of purpose, and loyalties. Psychologically, if a depressed person's morale can be restored, then his or her chances of recovery are enormously improved.
Loss of morale is generally associated with a collapse of a person's spirit, will, or courage. In defining a state of demoralization as one of the universal characteristics of depression, Jerome Frank describes demoralized individuals as follows:
[They are] conscious of having failed to meet their own expectations or those of others, or of being unable to cope with some pressing problem. They feel powerless to change the situation or themselves. In severe cases they fear that they cannot even control their own feelings, giving rise to the fear of going crazy, which is so characteristic of those seeking psychotherapeutic help. Their life space is ... constricted both in time and space. Thus, they cling to a small round of habitual activities, avoiding novelty and challenge, and are reluctant to make long-term plans. It is as if psychologically they are cowering in a spatio-temporal corner.
Demoralized individuals feel that they can neither cope with nor extricate themselves from difficult life situations. Such a feeling generally stems from environmental stresses as well as from vulnerabilities built into the individual's psyche. Psychotherapy can be very effective in helping an individual overcome such demoralizing conditions as learned helplessness, existential despair, and hopelessness.
Like Frank, I think that demoralization is one of the major reasons why most people enter into psychotherapy. The restoration of morale involves a patient's quest for meaning: a life- regenerating meaning that can be the basis for new confidence in one's self and in the future.
Understanding Depression: A Holistic Approach
Let me reiterate that I am more of a lumper than a splitter in my view of depression and suicide. Yet to understand any single case, I believe that it is necessary to split the factors (biological, psychological, social, and existential/spiritual) before recombining them into a single system. If we separate a single factor group from all the others and say that it contains "the truth" about depression or suicide, that is exactly where, when, how, and why we get into trouble. Because I firmly believe that all factor groups must be considered in coming to a comprehensive understanding of depression or suicide, my approach to every case is a holistic approach, or what some might call a systems approach. Before considering the whole system, however, let's look at the various factor groups: (1) biological, (2) psychological, (3) sociological, and (4) existential/spiritual.
Biological Factors
Biochemical compounds are clearly implicated in the etiology of depression. Depression is associated with low concentrations of certain monoamine neurotransmitters in the brain or with abnormalities in the reception of these neurotransmitters into individual neurons.
Psychoneuroendocrinology (PNE) demonstrates that the monoamine neurotransmitters also regulate the secretion of hormones from the pituitary gland, along with the secretion of peptides from the hypothalamus. The adrenal and thyroid systems are two common endocrine systems that, when imbalanced, often lead to depression.
Psychoneuroimmunology (PNI) studies the combined influence of psychological and neurological events on an individual's immune system. A recent PNI study indicating that a person's psychological state of mind can influence his or her general health was included in Norman Cousins' book concerning the biology of hope. It involved two groups of patients with malignant melanoma. One group — the control group — was given the standard medical treatment for this condition. The other group received the same treatment plus psychosocial enhancement, administered by a team called the Society of Challengers, which featured group support, therapy, and specific help in overcoming feelings marked by loss of control, helplessness, and hopelessness. We can assume that humor was a part of the psychosocial enhancement, since Cousins, a member of the Society of Challengers, was well known for having successfully treated his own life-threatening illness by keeping himself laughing (for example, by watching Marx Brothers movies). Measurements of all subjects' mood states, personality adjustment to illness, quality of life, and immune-cell function were made at the beginning of the study and at six-week, six-month, and one-year intervals. These measurements indicated that psychosocial enhancement was correlated with significant decreases in tension, anxiety, depression, and dejection and significant increases in personality adjustment to illness, quality of life, and positive immune system changes.
Genetic studies (adoption, twin, and family) suggest that depression is inherited. This is particularly true with bipolar disorder or manic-depressive illness.
Psychological Factors
Freudian views are important as a beginning. In early psychoanalytic theory, depression is attributed to a blockage of libido. This theory claims that when people give up their sexual desires without being gratified, they feel unwanted and unloved, with subsequent self-reproach and self-degradation.
Sigmund Freud's classic work in this area, Mourning and Melancholia, contrasts normal bereavement with pathological depression. According to Freud, a person can experience a depression equal to, or possibly more severe than, bereavement even though a loved one is still alive and healthy. This melancholia, as Freud calls it, can result from a loved one's being lost to an individual as an object of love or gratification. The individual feels anger toward the lost love object; but because that anger cannot be vented on the love object, it turns against the individual's own ego. This depressive backlash effect can be made even worse due to guilt feelings (from the super-ego) for harboring anger in the first place. Freud characterized melancholia as "a profoundly painful dejection, cessation of interest in the outside world, loss of capacity to love, inhibition of all activity, and a lowering of self-regard sometimes to an extreme delusional degree." Normal mourning or grieving yields the same symptoms, except that there is no significant lowering of self-regard.
Heinz Kohut maintains that without idealized love objects, an individual develops either an "empty depression" based on a lack of self-esteem and energy, or a "guilt depression," based on a self-rejection.
Carl Jung, like other early psychoanalysts, saw depression as blocked libido — an "I am stuck" feeling — resulting in a loss of energy and enjoyment. However, he also saw it, radically different, as a regression into a symbolic "womb" associated with an unconscious state described as "psychic death," which was often accompanied by "loss of soul." To Jung, such a slide into depressive depths represented an involuntary introversion on the part of the individual, facilitating a "relapse into the past" for the purpose of integrating the activated aspects of the past into consciousness and into the present.
(Continues...)
Excerpted from Transforming Depression by David Rosen. Copyright © 2002 David H. Rosen. Excerpted by permission of NICOLAS-HAYS, INC..
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