Tuesday, June 5, 2012


You know, wishing won't make it so
Hoping won't do it, praying won't do it
Religion won't do it, philosophy won't do it
The supreme court won't do it
The president and the congress won't do it
The UN won't do it, the H-bomb won't do it
The sun and the moon won't do it
And God won't do it, and I certainly won't do it
That leaves you
You'll have to do it

- Todd Rundgren, intro to "Fair Warning"

Depression is an all too common topic these days in any number of forums, but despite all our musing about it, the condition remains dimly understood by most. Without going into too much detail about my life, I've had reason to consider the various aspects of depression thoroughly and carefully, and I thought I'd try to convey some of what I have learned. It doesn't scare me to talk about, and maybe someone might read this and be helped by some perspective they didn't have before.

First, I'll discuss the current model of depression as a neurological disease. This is often correct, and it's a far, far better and more humane explanation than the prior models of depression as resulting from some sort of moral failing. We all have moral failings, depressed people included, but depression is not in any sense a moral choice in itself. But a more useful description of depression and other mental conditions is that they are the mind's ineffective attempt to adapt itself to the stresses of everyday living. This can be caused by a chemical imbalance in the brain, and in such cases antidepressants can give remarkable relief. But from what I know and have read, it appears that most people with depression are helped only subtly by drugs, if at all. One researcher estimated, for example, that about 70% of the effect of antidepressants on most people who take them can be explained by the placebo effect. This does not surprise me. A pill can only address chemical problems - no pill can undo thought patterns or change the environments that create and reinforce them.

If these ways of thinking are so poorly adapted to life, then why do millions of people develop them? The best explanation I know of is that the very same patterns which lead to despair today once led to happiness or safety or fulfillment instead and did so often enough to create a system of rigid, automatic responses to the world. For example, a child might misjudge that if conditions X, Y and Z are true, he will be safe; if they are not, he is in danger - which in turn engages the primitive fight-or-flight response we all have and creates anxiety. If over time the anxiety (misplaced fear) comes to be seen as unavoidable, a form of learned helplessness can become part of the family of automatic responses. You remember the not very nice experiment from years ago that showed that if a dog is subjected to unavoidable electric shocks enough times, the dog will stop trying to avoid the shocks and just lie down and take them. That learned helplessness in conscious humans often shows up as depression: an overwhelming, total sense of futility. What kept us safe as children might well be the very thing that holds us back as adults, if we are rigidly tied to it.

Perhaps the scariest aspect of the above is that these automatic systems of response can develop without our conscious minds being aware of them. The depression (and usually some form of anxiety along with it) becomes the new normal. That so much of that conditioned response happens unconsciously is why depressed people can't just "snap out of it". You cannot simply choose to override a decision-making mechanism built and reinforced for many years, much of which you're not even conscious of now; it was built little by little and must be disassembled the same patient way. There are no shortcuts. If it takes a good while to de-condition learned helplessness in a dog, how much longer would it take to do so for an adult human with a conscious mind and decades of life experiences?

In the meantime, can people live with and fight through depression to accomplish the goals of their lives? Yes, to varying degrees, depending on the severity of the condition and the circumstances; millions of people do it every day, in a struggle mostly unseen by others. Humans can gut through a hell of a lot when we have to. The device we use to gut through tough things is called willpower. Research into human motivation tells us that willpower takes the form of short, intense bursts. We developed the capacity for willpower so we could have the strength to do things like run away from predators - the caveman runs from the hungry man-eating tiger like a man possessed for as long as humanly possible until he is safe, and then collapses in a heap: all out of willpower now. Willpower works great if you use it only when you really need it, but as a day-to-day coping device, it's like a baseball team trying to put its ace starting pitcher out there for every game. They'll win a whole lot at first, but then he'll get tired, and then more tired, and eventually he'll get injured and won't be able to pitch at all.

The more well-adapted our coping mechanisms are, the less we have to rely on sheer willpower to gut through stressful or unpleasant things. So how do we adapt? We all would love to have an answer for this, but because each person's mind and environments are so different from one another, every depressed person is working on different and largely incomparable problems. In this sense depression isn't a singular disease or condition - it's more like a frame surrounding the whole big picture than some ugly defect in a part of that picture. Everyone's picture and frame are their own. I admit it does bug me when I've been struggling and people presume to advise me based on their own experiences, and I hope I'm not doing that here myself. (I've made the ignorant mistake of making judgments on other depressed people that way before, and I truly regret not being more compassionate there and resolve not to do so in the future.)

Everyone's depression is unique, which means, as the Rundgren lyrics said up top, "That leaves you/You'll have to do it". It's a fair question, though too often not a kind one, how much responsibility depressed people have. To say they have less responsibility than non-depressed people do for their lives is to demean them. But on the other hand, depressed people operate under a different set of working assumptions, and it's unrealistic to always expect them to act as if they don't. Most generic depression advice, as sick of hearing it as I'm sure most chronically depressed people are, is true as far as it goes. But part of the condition is an overwhelming internal resistance, both conscious and unconscious, to taking positive action in and of itself. Sometimes the depressed person can get through the resistance, and sometimes they won't be able to manage it. There is no cure - the faulty automatic responses can be weakened over time with new understanding and commitment, but it's a slow, slow process with many backward steps. To say it requires patience is an absurd understatement. Support and non-judgmental listening from those close to the depressed person is crucial to that process, but the battle, just like everyone else's, is ultimately a solitary one.

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