Thinking more about depression as "adaptive"

""I suspect there are features of the higher order organization of neurons that need to be included among the "underlying rules" to achieve a better understanding of depression, both conceptually and for therapeutic purposes."  ... PG, An expanded neurobiology of depression, June, 2009

"depression is not necessarily in all cases best regarded as an "illness" or defect in the individual that needs to be "repaired." An alternate perspective is that depression is an extreme form of a quite normal and adaptive feature of brain organization. And that at least sometimes, even in the extreme form, it continues to serve the function of reconciling conflicts between the unconscious and the conscious" ... PG, Exploring depression, March, 2008

"Depression involves a "break down," in the sense that one feels unable to accomplish tasks that one would normally be quite able to do.  And perhaps in a deeper sense as well, that the unconscious givens that one uses as a basic structure for living no longer work well and need to be rebuilt.  Periods of depression may in fact be quite productive in this regard, and this is another way that depression may be an "adaptive" response: a period of relative disengagement from "normal" things so as to allow a needed rebuilding." ... PG, Depression continuing, addendum June, 2009

"Perhaps, with regard to both depression and mental health generally, the important thing isn't the relative values and/or problems of existing "shared subjectivities" ... but rather the variety of different individual subjectivities and a commitment to finding out of them new "shared subjectivities"? ... PG, Depression, mental health, and "shared subjectivities", February, 2010

"we hypothesize that depression is a stress response mechanism (a) that is triggered by analytically difficult problems that influence important fitness-related goals; (b) that coordinates changes in body systems to promote sustained analysis of the triggering problem, otherwise known as depressive rumination; (c) that helps people generate and evaluate potential solutions to the triggering problem; and (d) that makes trade-offs with other goals to promote analysis of the triggering problem, including reduced accuracy on laboratory tasks. Collectively, we refer to this suite of claims as the analytical rumination hypothesis."  ... P.W. Andrews and J.A. Thompson, Jr., "The Bright Side of Being Blue: Depression as an Adaptation for Analyzing Complex Problems," Psychological Review 116: 620-654, 2009

Thinking about depression in terms of an adaptive feature of brain organization, as suggested by Andrews and Thompson's recent paper,  rather than simply as a chemical imbalance or an "illness,"  seems to me a useful contribution to moving in the direction of understanding depression not only in relation to properties of neurons but of higher order properties associated with more complex neuronal organization as well.  I'm glad it is getting some serious broad attention (cf Depression's evolutionary roots and Depression's upside). 

At the same time, there are features of Andrews and Thompson's "analytical rumination hypothesis," both in its original form (and, even more, in the popularizations of it) that don't fit my own experiences with depression nor my current understandings of depression based on the experiences of others.  And that provoke strong and not entirely unjustified negative reactions (cf Depression is helpful?).  I'd hate to see the more general move toward a less "illness" based way of thinking about depression aborted entirely because of one particular formulation of it.  In hopes of preventing that, I want here to try and pull together some earlier as well as more recent thoughts of my own about a somewhat different way to conceive the adaptive value of depression and its precursors.

The "analytic rumination" hypothesis, it seems to me places too great an emphasis on the conscious and "analytic" resolution of well-defined problems.  In so doing, I think it may missing a distinctive adaptive function characteristic not of full-blown depression so much but rather of what underlies it, and an associated creative role for the unconscious.  The "analytic rumination" hypothesis also, I think, fails to appreciate the intersection of several distinct features of full-blown depression and, for this reason, treats the associated discomfort of at best unsympathetically and at worst as a feature necessary for its underlying adaptive function. 

My own experiences with full-blown depression mirror those of the English philosopher David Hume:

"I was continually fortifying myself with reflections against death, and poverty, and shame, and pain, and all the other calamities of life. These no doubt are exceeding useful, when joined with an active life...in solitude they serve to little other purpose, than to waste the spirits, the force of the mind meeting with no resistance, but wasting itself in the air, like our arm when it misses its aim" ... A Letter to a Physician, 1846

And, like Hume, I have found that "as there are two things very bad for this distemper, study and idleness, so there are two things very good, business and diversion." In short, my preferred prescription for alleviating depression is the opposite of engaging in "analytic rumination." It is to give up "rumination" entirely for a period, as something that exacerbates the problem rather than lessens it ("depressive cognition," a favorite term of one of my therapists, makes matter worse, not better).  My advice to myself and others experiencing depression is the same as that provided by psychiatrists before the development of anti-depressants: stop thinking, find the best approximation one can of an expenses-paid ocean cruise, let your mind wander in pleasant, potentially interesting, and non-challenging surroundings.

Take a vacation?  Stop thinking?  Stop trying to solve problems?  That sounds nice, perhaps even idyllic, and might indeed make one feel better.  But isn't that running away from things rather than dealing with them?   How can taking a vacation support "adaptation"?  Its here where I think a distinction between conscious and unconscious processes in the brain, and an associated distinction between the world "out there" and the world "in here,"  becomes important.   Yes, the brain can sometimes have problems dealing with things "out there," and need to find more productive ways of doing so.  But it can equally have problems dealing with things "in here" and need to find more productive ways of doing that.  And in both cases, much of the work of doing so is done not consciously, by analytic thinking of which we're aware, but rather unconsciously, by negotiations among the diverse array of entities within ourselves that constitute the cognitive unconscious, what Marvin Minsky has called the "society of mind."  We "feel" ourselves into new and more productive ways of being as much as we "think" our ways into them.  And at times, conscious thinking, and the necessity to deal with what is "out there," can get in the way of that process rather than facilitating it.  Hence, the "take a vacation" approach, understood not as "running away" from the problem "out there" but rather as reducing distractions "out there" so the brain has space and time to deal productively with problems "in here."  

In short, I'm inclined to agree with the Andrews and Thompson focus on facilitating adaptive processes but suggest some modifications:

Underlying depression is an adaptive mechanism (a) that is triggered by difficult problems in internal brain organization; (b) that coordinates changes in body systems to promote sustained work on the triggering problem; (c) that helps people generate and evaluate potential solutions to  triggering problems; and (d) that makes trade-offs with other goals to promote exploration and resolution of  triggering problems.  The most important part of this process occurs unconsciously.  Perhaps we might call this the "internal realignment" hypothesis. 

In the modified form, it is "difficult problems in internal brain organization" rather than "analytically difficult problems that influence important fitness-related goals"  since the problems are in fact internal, may not be "analytically" soluble at all,  and deciding what the goals are may be an important part of what needs exploration.  Its "sustained work" rather than "sustained analysis" and "to promote exploration and resolution" rather than "to promote analysis"  for the same reasons.  And, of course, I've left out  "we refer to this suite of claims as the analytical rumination hypothesis" since I don't think the point is "analytical rumination" at all but rather something much more interesting: a need to reconceive not only one's relations to the world as they are consciously understood but to renegotiate the unconscious relations among various parts of oneself.  For this reason, I've added "The most important part of this process occurs unconsciously.  Perhaps one might call this the "internal realignment" hypothesis."

In the context of contemporary thinking about depression, the similarities between the "analytical rumination" and "internal realignment" hypotheses are at least as significant as their differences.  Both approach the experience of depression not as an illness or a problem needing correction in its own right but rather as an expression of an adaptive problem solving process, one in which the concerns of  common every day behavior are temporarily set aside to focus attention on longer run issues.  Both conceive the existence of problems not as an oddity or a deficiency but rather as a normal part of human existence.  Both perspectives encourage facilitating the problem solving process rather than aborting it, and both acknowledge that some degree of discomfort is normal and inherent in problem solving processes rather than being itself a problem needing immediate and complete correction.   In addition, both the "internal alignment and the "analytical rumination" hypotheses incorporate important features of the older psychoanalytic tradition; both recognize an important distinction not only between the self and the world but also, within the self, an equally important distinction between conscious and unconscious processes.   In all these respects, both perspectives seem to me an improvement, both conceptually and therapeutically, on traditional "medical model" characterizations of depression, and I would hope they both contribute, individually and jointly, to recognizing the limitations of thinking about depression as a glitch in neurotransmitters best dealt with by pharmacological intervention. 

That said, I think recognizing the conceptual differences between the "analytical rumination" and "internal realignment" hypotheses, and corresponding differences in the therapeutic practices each would encourage, are also important in moving towards a more coherent and useful understanding of depression.   Like cognitive behavioral therapy generally, the "analytic rumination" hypothesis suggests that problems dealing with the world can exist for reasons one is unaware of, and that the appropriate intervention is to to become aware of them, to make the unconscious conscious, and then make use of conscious processes to override the troublesome features of the unconscious.  "Analytic rumination" can, the hypothesis suggests, contribute usefully to the recognition and overriding of troublesome features of the unconscious.  The "internal realignment" hypothesis, in contrast, suggests that misalignments can exist not only between the unconscious and the world but also within the unconscious and between the unconscious and the conscious, and that conscious processes can sometimes actually get in the way of adaptive realignments. 

Could "cognitive rumination" be adaptive?  I suspect it can, in particular cases, where there actually is a well-defined aspect of the unconscious that is making trouble in dealing with the world and one is willing/able to exercise the "self-discipline" involved in overriding that part of the unconscious.  The "analytic rumination" that accompanies depression is certainly capable of identifying troublesome characteristics within oneself.   The problem, as anyone who has experienced it knows, is that it is often too good at doing so: anything and everything becomes a candidate troubling feature.  One finds oneself increasingly  lost in a swirl of troubling features, bouncing chaotically from one to another with a progressive loss of confidence that there exist in oneself any  features that aren't troubling (cf Daphne Merkin's A journey through darkness and My life in therapy).

Associated with this is not only the loss of any ability to discriminate among candidate problems but also all sense of any ability to act productively on any of them.  It is a state in which "self-discipline" seems not only unlikely but impossible.  Indeed, from my own experiences and the writings of others about theirs, it would seem that the loss of a sense of agency, of an ability to oneself act in ways that would change things for the better, is a more fundamental feature of depression than is "analytic rumination."  Far from being the central feature of depression, it might well be that analytic rumination is often a product of it, and one that makes it worse.  One can't "think oneself" out of depression; efforts to do so exacerbate it.

In what sense then might one think of depression as related to an "adaptive response ... a way of dealing with difficult problems"?  Here is where I think one needs to go a step further than the "analytical rumination hypothesis, or cognitive psychotherapy in general, by recognizing not only a division between conscious and unconscious processing but recognizing as well the richness and complexity of the unconscious, and its dynamic interactions both with consciousness and with the outside world.  The unconscious (what's I've called the "neurobiological" or "cognitive unconscious" to distinguish it from the Freudian unconscious) is not only a source of problems in dealing with the external world, it is also a rich, diverse, and constantly adapting set of tools for dealing productively with the external world.  And so the conscious ("thinking") is not the only way to fix problems; the unconscious is good at this as well, sometimes better  Moreover, the conscious,  as much as the unconscious, can be a source of problems.  Equally importantly, not all problems have to do with the relation between the self and the world.  Conflicts can exist entirely within the brain, between one or another component of the unconscious as well as between the unconscious and the conscious. 

This more expansive perspective on the richness and complexity of the brain not only opens the possibility of problems to be fixed within the brain itself but also shifts the emphasis from "problem solving," with its associated sense of pathology due to a particular problem needing to be identified and fixed, to "internal alignment," a process that  is an ongoing and quite normal part of life.  One is continually experiencing conflicts between one's conscious understanding (one's "story") of oneself and components of one's unconscious and negotiating internal conflicts by revisions to both.  Similarly, various components of the unconscious are constantly adjusting to one another.  That is the process of living, of defining and redefining oneself.   This tuning process continues throughout life without our being aware of it but may occasionally run into difficulties that require special attention.  At this point we become aware of it, not initially as an intense pain and sense of hopelessness, but rather as a mild discomfort/disorientation,  caused either by difficulties in dealing with things around us or because of an internal disequilibrium or both. 

This experience of misalignment we might think of as the potential origin of depression.  It is not an "illness," in the medical model sense of that term.  There is no "abnormality", much less one that can be simply correlated to a particular cause nor corrected by a simple therapeutic procedure.  Nor is it attributable to any well-definable problem that needs to be fixed.  It is simply a more extreme instance of something the brain is doing all the time, and is best dealt with from that perspective.  There is, from this perspective, no particular "problem" to be identified and solved.  There is instead a process to be facilitated, a normal process in which the characterization of the problem and the conception of alternative solutions to it are fundamentally interdependent.  Defining the problem to be solved consists in significant part of trying out various alternative ways of being to see which most effectively reduces the discomfort, in both the near term and the longer run.

The "internal alignment" hypothesis not only goes a step beyond the "analytical rumination" hypothesis in characterizing depression in terms of an internal adaptive response, but also offers new ways to think about both the discomfort associated with full-blown depression and its frequent correlation with anxiety.   Based in part on my own experiences, I've been intrigued for some time by the notion that depression (and perhaps many other mental health issues) not only reflects internal conflict but has an intriguing possible parallel to motion sickness, where internal conflicts lead to lethargy and an inclination to disengage not only from the external world but from one's own thought processes as well (by going to sleep).  Motion sickness is mildly discomforting but not usually accompanied by either intense anxiety or extreme pain as depression often is.  There is though a mild sense of loss of agency.    What this suggests as a possibility is that the most troubling aspects of depression, those that bring someone to a doctor's or therapist's office and tend to dominate therapeutic attention, may actually be not the origins of depression but rather, like "analytic rumination," be secondary consequences of it.

Along these lines, some recent experiences of my own may be relevant.  Several months ago, I noticed in myself a diffuse sense of "listlessness," a disinclination to apply myself to any of a myriad of tasks needing to be done that I normally enjoy doing.  Accompanying the listlessness was an equally diffuse sense of being "scattered," of lacking a clear focus, of missing a sense of how the various activities I was involved with related to one another in some coherent pattern.  Neither the listlessness nor the sense of being scattered seemed to have any compelling explanation in external circumstances at the time.  Both, in hindsight, seemed to me feelings I have had in the past prior to episodes of significant depression.

Like Hume (and many others I suspect), I have tended in the past to react to such feelings as reflecting "a laziness of temper, which must be overcome by redoubling my application."  And, more recently, by using anti-depressant and anti-anxiety medication to forestall what seemed likely to be impending depression.  On this occasion, however, in part because of my own evolving thoughts about the nature of depression, I decided to experiment with a different approach.  There are, I told myself, worse states to be in than "scattered."  Indeed, one can make a serious argument that coherent pattern emerges from doing a variety of things rather than itself being a necessary take off point for the variety of things one does.  The lack of a "clear focus" might be seen as a sign of a process of giving up existing foci in order to create new ones.  And, I reminded myself, there are worse states that "listlessness."  It wasn't that I wasn't enjoying things; all the bodily pleasures retained their appeal.  It was just that I didn't feel like working ... or thinking.  Maybe that too, I thought, is an indication that my unconscious is busily working on something new.  Let's just sit back, relax, and wait to see what it comes up with?  Maybe a mild loss of sense of agency in the short run is a reasonable price to pay for an enhanced sense of agency in the longer run?

I wouldn't of course be telling the story (at least not now) if the outcome had been a full blown depression.  And I can't, of course, say for certain that a full blown depression would have occurred if I hadn't experimented with a different approach.  For present purposes, though, its enough to say that both the listlessness and the sense of scatteredness declined over a month or so, with again no obvious compelling explanation in terms of external circumstances.  And I found myself to be changed by the process, with new understandings and enthusiasms about things I had previously been working less satisfyingly on and a new sense of focus.  Those new things came neither from the world outside me nor from my own thinking but rather from internal shifts in my unconscious, shifts that were, I think, facilitated by my conscious decision to let them happen rather than to try and direct them.

There is though a bit more to the story than simply the notion than that we might all learn to put greater trust in our unconscious.  Listlessness and scatteredness are not only mildly uncomfortable but anxiety provoking.  The feeling that one is neither organized nor up to tasks in ways one has been in the past tends to make one feel that there is something wrong, that there is a problem that needs to be fixed.  People around one, whether consciously or not, are likely to contribute to a sense of deficiency.  And that sense of wrongness in turn makes one further doubt one's capabilities which in turn enhances the sense of something wrong, and so forth.  In thinking back on my own episodes, a full blown depression is preceded not only by listnesses and scatteredness but also by a rising anxiety due in at least some part to the reactions of people around me.  It seems actually to be an interaction of an internal sense of of listlessness/scatteredness and of anxiety,  both internal and facilitated by interactions with others, that results in the profound apathy, anhedonia, hopelessness, and sadness that characterizes full blown depression.  

What this suggests is that the underpinnings of the experience of depression, its actual adaptive function, can take place without the most painful and troubling aspects of depression.  Indeed, it is possible that these, like "ruminative cognition," are not inherent in the adaptive process underlying depression but instead result from situations that frustrate rather than support the adaptive process.  The philosopher Otto Neurath's metaphor of "seafarers condemned to repair and rebuild their ship forever on the open ocean, without any possibility of taking it into a dry-dock and rebuilding it there on a firm basis" seems to me relevant here.   Under optimal circumstances, the rebuilding of a ship under weigh can be done by a process of mutually respectful negotiation between the deckhands (the components of the cognitive unconscious) and the captain (the conscious), one that acknowledges the possible need to alter or even override not only the current activities of the deckhands but also the captain's existing sense of the ship's mission.  If the captain gets stubborn, however, either because of his/her own sense of what needs to be done or out of a sense of duty to some outside force, the deckhands will mutiny, break off negotiations with the captain, lock him/her into a cabin, and do what they need to do to rebuild the ship.   In this case, the ship building goes on to varying degrees, while the captain, isolated from the deckhands, feels increasingly alone, bereft of enjoyments, apathetic, incoherent, meaningless. and hopeless.

Full blown depression is an intensely painful and debilitating state, one deserving of the most sympathetic and sophisticated support one can get from others.  To suggest that its origins, and even the state itself, has adaptive significance is not to trivialize it but rather to open the possibility of new and more productive ways of thinking about it, of treating it, and perhaps even of avoiding it.   What the "internal alignment" hypothesis suggests as a framework is that the adaptive function to be served is not primarily one of getting along better in the world but rather of getting along better within one self, and that it is in fact not full blown depression and the associated extreme pain that helps realign the unconscious and the unconscious with the conscious, any more than it is "ruminative cognition."   The latter are instead features of a frustrated realignment process, ones that can make the  process still more difficult and so in turn may require treatment in their own right before realignment can effectively take place. 

The upshot of this line of thinking?   The most painful and serious features of depression may not be adaptive responses at all but instead result from the frustration of an adaptive process, an unconscious one that aligns parts of the cognitive unconscious with each other as well as with one's consciousness.  Treatment of full-blown depression, pharmacological or otherwise, should, from this perspective, be aimed not at identifying and solving particular problems in dealing with the the world but rather at reinstating some sense of safety, well-being, and future potential so that the various components of the unconscious are comfortable trying out new possibilities, and negotiation, both among them and between them and the conscious, is re-activated.   The same, it seems to me, holds for cases of milder depression as well.  People need to be encouraged to recognize that they have within themselves the capacity to create new and more satisfying selves, and to be provided a supportive environment and time in which to do that. 

Perhaps the same holds for people in general, depressed or not?  We live in a culture in which we are constantly being pressed to establish our value by one or another fixed set of standards, and that encourages us to incorporate such a process into our our own evaluation of ourselves.  Perhaps that plays some role not only in how we approach the problem and treatment of depression but also in its rising incidence?  In a culture like ours, a quite normal process of "internal realignment," associated with one or another degree of incoherence and withdrawal from the outside world, can easily be seen, both by others and by ourselves, as "pathological" and requiring immediate action to return people to a state of coherent engagement with immediate tasks at hand.  Perhaps a wider recognition that periods of incoherence and withdrawal are essential for internal realignment could help to make more humane not only our approach to depression but our culture as well?   It is not only depressed people who could usefully be helped "to recognize that they have within themselves the capacity to create new and more satisfying selves," and "provided a supportive environment and time in which to do that."  It is all of us.  Maybe the depressed among us are like the proverbial canaries in the mind shaft, calling attention to a cultural problem to which we are all at risk.  "We all deserve a new world now and then, one that we have ourselves played a role in bringing into existence"

PG notes