Monday, July 27, 2009

Rational depression

I had already worked out that much of what people suffering depression do—no matter how destructive—can be understood as a rational response to managing pain. Dorothy Rowe in her challenging and insightful book Depression: The Way Out of Your Prison argues that it goes further than that. That the constructed prison of depression itself is a rational response to the gap between the story we tell ourselves about who we are and how life works and what actually happens to us. Thus, for example, she argues that the crucial thing is not what parents did to us (if that is the original source of our depression, which she clearly thinks is often the case), but how we interpret what they did (p.212).

To take an example from my own life, children presume their parents love them. But, if their parents never show any affection to them, it is natural—given parental love is presumed—to assume that there is something deeply wrong and unworthy in oneself, for that explains why such wonderful, loving parents never showed any affection in terms the child could understand. Children infer love, not affection and certainly not their own worthiness.

Dorothy Rowe—a clinical psychologist who worked for many years as a therapist—rejects the “biochemical” explanation of depression. She points out there is no such test for depression and that we do not use such an explanation for other mental patterns. For her, depression is always and everywhere about beliefs we have about ourselves and the world around us. It is a prison we have constructed, which means it is a prison we can leave.
Some of the book is very challenging, since Rowe argues strongly that patterns of depression can be a way to avoid responsibility, to give ourselves an out. That depression is a self-constructed prison based on reasons. Turning those reasons around means that we can dismantle the prison. But to that we have to give up our pride, our demand that our mental map is completely correct and events must be construed so as to uphold its correctness. The sufferer from depression would prefer to be right and suffer than wrong and happy (pp160-1). Pride stops us repenting and repairing our errors. When Gwyneth Lewis asked fellow poet and depression sufferer Les Murray what was the cure for depression his instant response was the truth (p.240).

But there is a deeper point, that the beliefs underlying depression have often developed in us long before we had any chance to examine them effectively, or even be aware of them. She writes movingly and insightfully of the suffering depression causes. The metaphor of depression as a prison is not used lightly.

Rowe argues that it is easy to construct the prison of depression. Just hold the following propositions as Real, Absolute and Immutable truths (p.17).
1. No matter how good and acceptable I appear to be, I am really bad, evil, valueless, unacceptable to myself and other people.
2. Other people are such that I must fear, hate and envy them.
3. Life is terrible and death is worse.
4. Only bad things happened to me in the past and only bad things will happen to me in the future.
5. It is wrong to get angry.
6. I must never forgive anyone, least of all myself.
These are strong versions of each proposition. Holding weaker versions of them strikes me as eminently sufficient. For example, you might fear people’s anger or bad opinion without hating them. You might feel yourself to be unworthy, that you do not matter, without thinking you are evil.

Rowe puts it too much in the moral dimension of conceptions of good and evil. I entirely agree that depression is built on the belief that, in some important sense, you are a bad person. But bad does not only mean evil. It also means incompetent, poor quality, unworthy, low value, don’t count for much. Either is enough to generate an incapacitating sense of helplessness.

Rowe is very much about seeing the structure of meaning we have created in our lives and then building a new one. She regards sufferers being able to tell their story as being very important, citing much evidence that sufferers from depression often literally have no one they can talk to seriously. Someone they have confidence in who will actually listen. Story first, examine later is clearly her preferred path.

Rowe is very critical of the hostility to religion and religious sentiments among psychologists and psychiatrists, pointing out that religious sentiments are often quite central to how people construe events in their lives. Religious sentiments can help build the prison of depression, or they can be part of the path of leaving it and not going back. Rowe appreciates Zen Buddhism in particular, as she appreciates is concept of being in the now and stilling the mind. Rowe regards an unbalanced sense of time as being basic to depression (a past of woe, a future of worse). But she also understands the bottomless sense of fear that underlies the resistance to “letting go” and stilling the mind (p.232).

Rowe can have an arresting way of putting things. For example, Suicide is an act of violence against the part of us that wants to go on living (p.58). She writes with considerable insight into the problems of the imposition of other people’s expectations. The need to feel in control of our life. The way the Yes But, game can be played to block attempts to get better. How domestic self-sacrifice does no good—it merely encourages other folk to behave badly (or undermines their sense of competence). And the self-serving aggression that often lies behind such smothering “concern”.

Rowe notes that people have been writing about depression (previously known as melancholia) for centuries, and the persistence of the recommended cures for depression (p.216). She quotes extensively from other people’s writings about their experience of depression. I was particularly struck by one sufferer who reported that the worst time in some ways was when he was getting better, and had to deal with the detritus of what he had done while in the depths of depression.

Rowe provides some deeply practical advice about how to deal with therapists (giving various indicators of the sort of therapists not to bother with). Extending to a very informative and intelligent discussion (pp 253ff) of hospitalisation and therapy: what to look for, what to insist on, what to avoid or refuse. Including some very perceptive criticism of cognitive therapy as too ready to label patterns of thought disfunctional and not sufficiently interested in the stories the sufferers themselves have to tell. (The book itself is based on personal construct therapy.)

While she clearly does not regard them as cures, she argues that anti-depressant drugs can give us psychic space in which to heal. They are aids, not cures (Pp.222ff).

Reading the book first time, it struck me that I had the notion that love was something that either was “poured into” you from someone or that “poured out” of you to someone. If I wasn’t in either of those situations, if there was no such someone, then there was a howling emptiness. But, having achieved the “imbalance flow” metaphor, I thought about the Buddhist concept of compassion, which is something that just is. Something that is just there if you let it be. Since then, I have found it much easier to go to the calm, compassionate place. And emotions can become much easier if you offer no resistance, just let them have their moment and flow through. To the extent that I found one can even get a little emotionally “drunk” on the calm, arriving late at a school because the normally worry-worry mechanisms I used to constantly check time were not operating.

There is much rationality in depression. Indeed, that is where it gets most of its dreadful power, its imprisoning logic. While depression may be rational, it is not wise. Nor truthful.

It is important to avoid the trap that one cannot change’s one’s construction of one’s self and reality. That somehow there are not better and more truthful ways of looking at yourself and the world. It takes time, but creation of a new structure of meaning is eminently possible. Which does not make it easy, because habits of mind can be so dreadfully easy to fall back into.

I found Depression: The Way Out of Your Prison an extremely useful book to read. I came upon it when I was nowhere near the depths of depression I had been, but it helps provide understanding and to consolidate and build on the gains achieved. Highly recommended.

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