Wednesday, February 28, 2007

Depression as an Adaptive Trait [Updated]

My morning client just canceled on me, so I have some time to write about this article from the LA Times that looks at the emerging field of evolutionary psychology.

One of the sections of the article that seems to have struck a nerve with bloggers is the mention of depression as an adaptive trait (not coincidentally, it's the beginning of the article). Here is the relevant section:
IN the fall of 2005, psychiatrist J. Anderson Thomson Jr. was treating an 18-year-old college freshman whom he describes as "intensely depressed, feeling suicidal and doing self-cutting."

A few years before, Thomson says, he would have interpreted her depression as anger turned inward. But instead he decided that her symptoms might be a way of signaling her unhappiness to people close to her.

He discovered that his client's parents had pressured her to attend the university and major in science, even though her real interest lay in the arts. In the course of therapy, he helped her become more assertive about her goals. When she transferred to another school and changed majors, he says, her depression lifted.

Thomson based his approach on the idea that depression is not simply a disease to be eliminated, but a way of eliciting support from family and friends. It's a concept derived from evolutionary psychology, a burgeoning field that is starting to influence psychotherapy.
The article goes on to examine the different approaches evolutionary psychologists are taking to the traditional problems in psychology, everything from depression as a social cue to schizophrenia as a genetic flaw in gene transcription.

One of the interesting things to me, from an integral point of view, is that evolutionary psychology has the potential to become an all quadrant affair. Traditional psychology operates mostly in the UL (interior, individual) quadrant of the psyche, although both Freud and Jung sought to "medicalize" their theories. Contemporary neuropsychiatry nearly dismisses the UL in favor of the UR (exterior, individual) realm of the body, treating brain chemicals rather than emotional states.

Increasingly, over the years, there has been some interest in including the influence of cultural values (LL quadrant, interior collective), behaviors, and prejudices in the practice of psychology, especially with the rise of humanistic psychology in the sixties.

What we need is a an approach that combines all of these with the addition of the LR (exterior, collective) realm of society, environment, and habitats.

Ken Wilber's Integral Psychology -- as brilliant as that book is -- doesn't really offer too much of an all quadrant approach. The emphasis is squarely in the UL quadrant of the psyche. Maybe if he ever writes the textbook on integral psychology that this book was supposed to be the Cliff's Notes for, we will get a more all quadrant model.

Back to the article. Toward the end of the piece, they present a lot of different ways evolutionary psychologists are working with depression, many of which seem very productive. When we begin to understand depression as an adaptive response to specific situations, it ceases to be something to feel shame about. Rather, it is an almost healthy response to very unhealthy situations and experiences.
Two other new therapies rely on the common-sense notion that normal, adaptive functioning can go awry because of unfavorable life circumstances, including abuse and trauma.

Paul Gilbert, professor of clinical psychology at the University of Derby and former president of the British Assn. for Behavioral and Cognitive Psychotherapies, is developing a regimen he calls "compassionate mind training." Its aim is to help patients who are highly self-critical learn techniques for soothing themselves.

The therapy draws on both evolutionary psychology and attachment theory. Certain systems in the mind trigger anxiety and depression, while others soothe and provide feelings of safety — a capacity that may not develop in people from abusive or neglectful families, Gilbert says.

For a pilot study published in December in the journal Clinical Psychology and Psychotherapy, Gilbert recruited nine volunteers already undergoing cognitive behavioral therapy for personality disorders or chronic mood disorders.

Therapists explained the evolutionary significance of attachments to the participants and helped them analyze the origins of their self-critical feelings. Participants were taught to feel empathy for their own distress, and then practiced imagining an "ideal of caring and compassion."

They kept weekly diaries of their progress. The paper reports "a significant impact on depression, anxiety, self-attacking, feelings of inferiority, submissive behavior and shame" among the six who completed the regimen.

In Toronto, Leslie Greenberg, professor of psychology at York University, is testing "emotion-focused therapy," which seeks to replace unhealthy, or maladaptive, emotions with healthy ones.

In an article in the summer issue of the Journal of Contemporary Psychotherapy, Greenberg offers a case study of a woman suffering from major depression, anxiety disorder and interpersonal problems after having been raised by emotionally and physically abusive parents.

Greenberg encouraged the woman to engage in imaginary conversations with her parents in which she expressed her feelings about their sadistic behavior.

In therapy, the anger she felt, an adaptive emotion, eventually replaced her fear and feelings of worthlessness. "She began to create a new identity narrative," writes Greenberg, "one in which she was worthy and had unfairly suffered abuse at the hands of cruel parents." That emotional rewiring left her "open to learn to love" again, he writes.

Shani Robins, president of the Institute for Wisdom Therapy in San Diego, also draws on evolutionary psychology in his therapy — a combination of cognitive behavioral therapy, mindfulness meditation, training in humility, and psycho-education.

Understanding the evolutionary origin of problems can help patients put them in perspective, he says. Fear of heights, snakes and open spaces may have been useful to our ancestors, for example, even if such phobias seem excessive today.

Explaining these mechanisms "normalizes the reaction itself, and that's huge," Robins says. "When patients come in, they not only have symptoms — they're feeling pretty bad about it." In time, they learn to "self-judge a lot less."
In many of these approaches, attachment theory is an underlying mechanism. This is essentially a LL quadrant look at an UL quadrant need. Attachment theory basically states that a child needs to form a healthy bond with at least one adult figure as it grows up so that it can feel safe to explore itself and its world, and to learn proper social functioning. In an abusive family, that attachment may not happen or it may happen in ways that leave the child wounded as an adult.

When a child doesn't form healthy attachments, s/he grows up to be an adult who also cannot form good attachments. Love relationships, especially, become difficult or impossible to navigate or feel comfortable in, leading to depression and isolation. Substance abuse also can become an issue for these adults (addiction is often just an attempt to escape pain).

Several of the approaches outlined above work from this foundation toward healing depression by examining the pathological attachment history of the individual. Especially in the case of abuse or trauma, these are very profitable avenues of healing.

Another approach mentioned in the article suspects that we are not evolutionarily adapted to living the lives we find ourselves in now. The approach advocates increased omega-3 fats (proven to reduce depressive symptoms), increased sunlight and exercise, and getting more sleep. This is a distinctly LR quadrant look at the depression problem that offers UR solutions, without neglecting the UL emotional realm (employing group therapy) or the LR cultural values context (we are expected to work hard and function well).

My hope is that as evolutionary psychology evolves over time, the field will begin to integrate the useful material from each of the disparate lines of investigation currently being explored into a more comprehensive and integral model.


I want to suggest another way that depression can act as an adaptive trait that isn't mentioned in the article, or anywhere else that I am aware.

People often mistakenly think of depression as being sad or unhappy. In reality, true depression is a near total absence of affect. There are few emotions at all in true depression. What there is for many of us who have suffered with depression is a desire to escape, to not feel anything; therefore, sleep and substance abuse become common behaviors. Many depressives can sleep 12 to 16 hours a day.

This in itself, I think, is an adaptive behavior. From my experience, the psyche can only handle so much at one time. If it feels overwhelmed, it shuts down. One way that it can shut down when faced with overload is depression. If there is too much pain to process, the psyche orchestrates a chemical cocktail of neurotransmitters that launches a person into a depressive state.

The problem seems to be that we often get stuck in that space without therapeutic intervention. Anti-depressive medications can make people functional in their day to day lives, but they cannot heal the underlying causes of the depressive state. For that, we need to access the original emotions and release them -- and/or we need to relearn a healthy response pattern that short-circuits the overload state and allows the emotions to come up and be released naturally.

My sense is that many depressives have a veritable bottomless pit of unprocessed emotions that need to be released. But the psyche feels overwhelmed and shuts down, preventing the emotions from coming up. Even when a person is able to start accessing some of the emotions, without a proper filter (and I suspect many depressives don't have a good filter) or adequate self-soothing techniques (the article mentions this as an issue related to attachment theory), the emotions come on too much and too fast and the individual will shut down again into a depressive state.

The combination of drug therapy with depth psychology (and here some somatic work might be a healthy addition, since many depressives suffered early childhood trauma that may be pre-verbal) seems like the best approach. And of course, many of the techniques described in the article sound like valuable additions to the therapeutic arsenal.

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