Exploring depression: drugs, psychotherapy, stories, conflicts, a conscious/unconscious dissociation?

Paul Grobstein's picture

For a variety of reasons, I've been thinking a lot about depression recently, not only about peoples' experiences with it (including my own) but also about how to make sense of it from a neurobiological perspective. A variety of conversations, including a recent one in a senior seminar course in neural and behavioral science, has significantly added to my thoughts, helped to crystallize some of them, and suggested some intriguing directions for further exploration.

These days, most people think of depression in terms of a contemporary pharmacology-based "medical model", the core of which is the idea that depression is an "illness" resulting from "chemical imbalances". From this perspective, the actual feelings and experiences that depressed individuals have are of relatively little interest, either therapeutically or in terms of trying to better understand depression, and the principle task is to find ways to "correct" the underlying disturbed pharmacological pattern.

My own guess has been and continues to be that while there are certainly pharmacological correlates to depression, the condition does not at all reduce to those, and that a fuller understanding of both depression and ways to treat it depends fundamentally on paying more attention to individual feelings and experiences, to observations made and reported "from the inside". This intuition reflects, in part, experiences with treating depression pharmacologically that have been gained since new pharmacological treatements became available. Those observations seem quite clearly to be saying that that some pharmacological treatments can be helpful for some people at some times but no pharmcological agent is effective for all people at all times. And that, in turn, is consistent with my intuitions as a biologist and neurobiologist. Given the complexity of the brain and its variation from one person to another, it is inconceivable to me that there is any fixed relation between pharmacological profile and behavioral state in individuals, much less that the same relation holds across different human populations. Equally importantly, one's mental state is a function not only of pharmacological and external variables but also of things going on inside one, one's internal feelings and experiences. The latter are not only not fully determined by pharmacological and external variables but in turn influence both pharmacological and external variables.

In short, depression (like any other mental state) refects a rich, complex, and bidirectional interplay of influences, no one of which is determinative in any individual. Pharmacological agents can of course influence these interactions but should be expected to be, at best, a quite coarse tool for doing so. One might sometimes improve the function of a high performance engine by changing the oil that bathes it, but that's a distinctly limited approach to the problem of sustaining effective function of the engine, to say nothing of enhancing it. And this is, of course, even more the case with brains, which not only reflect a still richer and more complex bidirectional web of influences but also vary quite significantly form individual to individual.

So, where does one go from here? One certainly does not want to deny the worth of pharmacological manipulations, either for therapy or as a tool for better understanding depression (among other mental conditions). At the same time, there is clearly, in both respects, a need to move beyond the purely pharmacological approach to something both more subtle and more individualized. In this regard, there is more than a mild irony, indeed a potentially tragic irony, in the tendency in medical circles (and in the health care industry generally) to regard pharmacological manipulation not as an adjunct to but instead as a replacement for earlier approaches to making sense of and treating depression (see Of Two Minds: An Anthropologist Looks at American Psychiatry and Have You Ever Been in Psychotherapy, Doctor?).

The irony is that a body of more subtle and individualized approaches, various forms of "talk therapy", existed prior to the development of contemporary pharmacological approaches, and the tragedy is that we may be losing them as a body of expertise and a source of continuing insights precisely when the need for them, on both counts, is becoming most evident. Rather than contending over the relative merits of pharmacological approaches and talk therapy, there is a clear need to begin trying to understand how they two relate to one another, how they can best be used in complementary way, and what their joint efficacy is telling us about what depression actually is.

There are in fact some already some encouraging movement along these lines. A particular form of talk therapy, cognitive behavioral therapy, has begun to be recognized within the medical community as a procedure whose effectiveness may in some cases may be comparable to pharmacotherapy. Still more significantly, it is becoming clearer that talk therapies, like pharmacotherapies, produce observable effects on the brain and that in some respects the effects on the brain are similar. Neurobiologists, who presume that changes in behavior always correspond to changes in the brain, are not surprised by this, but it clearly serves as important reassurance to others who have doubted that talk therapy could be a way of producing observable changes in the brain.

Even more interestingly, there are suggestions that while talk therapy (cognitive behavioral therapy in this case) and pharmacotherapy produce similar changes in some areas of the brain, they do so by influencing in different ways other areas of the brain. The therapeutic effects of pharmacotherapy seem to reflect a primary action on more primitive areas of the brain, those responsible for unconscious activities, while the therapeutic effects of cognitive behavioral therapy (at least) seem to depend instead on primary action on parts of the brain involved in our awareness of ourselves and our surrounding, those involved in conscious activities.

This in turn offers a possible opening for further thinking about the relations between pharmacotherapy and talk therapy in depression, both conceptually and therapeutically. As a neurobiologist, I've been struck by the need in a variety of contexts to acknowledge that there are distinguishable unconscious and conscious (or story telling) processes going on in the brain, and that the brain function in general involves a continuing dynamic exchange or negotiation between the two. My own experiences with depression have long seemed to me to make sense in terms of a breakdown in this dynamic exchange, particularly if one accepts that feelings and intuitions represent signals from the unconscious that contribute to the vividness and functionality of our conscious experiences. In lieu of those, the conscious feels helpless, bereft, empty, and has great difficulty marshalling the resources for even simple tasks. Conversely, the conscious feels genuinely unable to alter or even significantly influence one's own feelings. The upshot is a sense of profound discomfort (sometimes associated with anxiety and agitation, other times with profound lethargy) that is difficult to localize and next to impossible to describe (see William Styron's Darkness Visible).

There is an intriguing parallel to the experience of depression in that of motion sickness. In this case, a profound but difficult to localize discomfort that frequently begins with agitation and resolves into lethargy results from a substantial conflict in the brain between two sets of signals that relate to one's perception of stability or motion relative to one's surroundings. One set of signals originates in sensory pathways, from the eyes, the inner ear, and other sensory endings in the body. The other set originates within the nervous system itself, and consists of "corollary discharge" or "efference copy"signals sent by parts of the nervous system causing output to the muscles to other parts of the nervous system for use in intepreting inputs. When a comparison of the two sets of signals yields no sign of conflict (I'm sitting and my sensory input shows no motion of me relative to the environment); I'm walking and the sensory input I'm getting shows motion of me relative to the environment), all is well. When there is a severe mismatch of the two sets of signals (I'm sitting but my sensory input suggests substantial motion of me relative to my surroundings; I'm walking but my sensory input implies no motion), there is discomfort and in the end a desire to lie down and go to sleep.

The possible parallels between motion sickness and depression may well be worth exploring futher in a number of respects (the effectiveness of drug treatments versus other kinds of therapy, the variation in individuals, etc) but, for the moment, one additional feature of motion sickness seems worth noting. With no significant mismatch between the two relevant sets of signals, one is unaware of the ongoing comparison between the two. With very significant mismatch, one feels very substantial discomfort. Between these two extremes, there is a continuous spectrum of possible outcomes of the comparison, with an increasing degree of conflict as one goes from one to the other. This intermediate spectrum of conflicts is being continually used by the nervous system to fine-tune motor outputs, interpretation of sensory inputs, and the comparison between them itself. The upshot is an ongoing process of mutual adaptation that gives the brain an ability to function effectively over a wide and somewhat unpredictably varying set of circumstances.

It is tempting to think of depression in the same terms, as a breakdown in a normally continual exchange between the unconscious and the conscious, one in which each adapts to the other in ways that facilitate adaptive function over a wide and somewhat unpredictable set of circumstance. The sets of signals being compared could in this case be reports from the unconscious of its current state, observed as feelings and intuitions, and the conscious story of oneself, who one feels/believes onself to be. Under normal circumstances, there only small conflicts between the two sets of signals, and those are used to make small adjustments both of the unconscious and of the story to bring them into correspondence. When however the conflict is great enough to preclude easy adjustments of one or the other, the exchange breaks down and serious depression results.

Such a story of depression as an unconscious/conscious dissocation provides a straightforward explanation of why both pharmacotherapy and talk therapy can be therapeutically effective: one can bring back into correspondence the unconscious and the conscious by action on either, with pharmacotherapy perhaps acting primarily on unconscious processes and talk therapy on conscious ones. Indeed, cognitive behavioral emphasizes the distinction between unconscious and conscious processes and is directed specificaly at the latter. Patients are encouraged and helped to distinguish their feelings and intuitions from themselves (their conscious "story"), to acknowledge that their unconscious processes may be defective, and hence to create a new story about themselves in which they can recognize and avoid acting out of the defective unconscious processes.

An increasing recognition of the role of "story" in therapeutic practice, and of its observable impacts on brain function, is a positive movement that could facilitate a needed greater recognition of the complexity of the brain, of the role of internal experiences in its function, and hence of the quite significant variation from individual. At the same time, cognitive behavioral therapy doesn't, it seems to me, go quite far enough down this road. There are rich bodies of expertise in older talk therapy traditions, including the psychoanalytic, that one might hope to somehow bring on board in a new and still broader approach. And there remains in the cognitive behavioral therapy approach more than a little of the "medical model" flavor: patients are encouraged to use their own story telling capabilities but to do so in the context of an agreed upon "defect" in their unconscious processing.

A broader approch to talk therapy might retain, with both cognitive therapy and various other existing forms of psychotherapy, a central recognition of the distinction between unconscious and conscious processes and of the contributions both make to one's behavior and experiences without granting primacy to either (Writing Descartes and Making the Unconscious Conscious and Vice Versa). The task is neither to make the unconscious conscious (as is sometimes asserted for psychoanalysis) nor to rely on the conscious to notice and correct defects in the unconscious, but rather simply to facilitate an ongoing process of negotiation between the two. From this perspective, conflict is not a problem to be resolved but rather the source of continuing growth and development, and becomes a problem only when it comes great enough to stall that process. The task of the therapist is simply to encourge and facilitate that process, using whatever tools achieve that end in any given case, tools that would be expected to vary enormously from case to case given the enormous variety of ways the unconscious and conscious can conceivably come into serious conflict.

Among other desireable features, such an approach would necessarily and appropriately acknowledge the need to treat depression in ways that are more subtle and more individualized. Indeed, such an approach would acknowledge that 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. "Psychological unease can generate creative work and the rebirth after depression brings a new love affair with life ... Don't beat yourself up about being depressed, in most cases it wil run its course provided you take yourself out of the situation that caused it ... Sometimes its not easy to escape but that's the fault of society, not the fault of depression" (Paul Keedwell, quoted in Is Depression Good for You?). Maybe sometimes the best treatment for depression is to simply provide a supportive environment for the brain while it works out its own individual resolution?

Are drugs useful for depression? Of course, sometimes. Is talk therapy useful? Yes of course, sometimes. Is there more to depression than a chemical imbalance? Almost always, perhaps always. Are one's own feelings and experiences significant in depression? Yes, always. Is depression useful? It can be, if the circumstances are right. Does depression make sense as an unconscious/conscious dissociation? Perhaps. Is there more to learn about depression? From depression? Unquestionably.

Updating

Depression's Evolutionary Roots - 25 August 2009

Mind over meds - 19 April 2010

 

Comments

Murfomurf's picture

Research on recovery from depression

Interesting thoughts- and you've provoked some in me too. I have suffered from major depression for most of my life, only recognising the depth of the problem in my early 30s. I promptly took myself off for some talking therapy and pills, which worked fairly well for about 6 years, although it wasn't all wonderful! I gradually relapsed after that, while still on a massive dose of fluoxetine ("became resistant??") and took about 8 years to find anything that worked again. I'm OK now on 600mg of venlafaxine but can't drink coffee or wine any more. I'm a health researcher when I can get work and I thought it might be interesting to do a PhD on people's own accounts of how various medications have helped or hindered their recovery. I used to blindly think that clinical trials of anti depressants were quite OK until I started working for someone who wanted to market pharmacogenetic tests to doctors. Then it occurred to me that not only are people coming from so many different starting points and personalities when they are given a medication, but they also have genetic makeups that render some medications unsuitable, or only suitable in tiny or huge doses. These varied doses aren't tried in clinical trials and of course prior history and personality aren't really either. I wonder if its a good idea to do a PhD by analysing the narratives and replies to interview questions by people who have taken different medications (and amounts) and now feel pretty good or cured? Perhaps a better way of "measuring" the effects of medications might be discovered which might guide treatment, alongside knowledge of genetic factors. What do you think? I am just finishing my MPH with a dissertation on adverse medication effects which may be avoidable by using PGX tests. The people in my department are not really into mental health or medication, so they are not good to toss around ideas with me on the current topic!

Tina Webster's picture

3rd semester RN Program

I am reviewing this website for our RN Class and I am amazed at the depth of the information. Thanks!

Paul Grobstein's picture

Updating depression conversation

For continuing discussion of depression along these lines, see

Depression: continuing the conversation 

Paul Grobstein's picture

Medication, pros and cons

See Individuality and my response.  
Depression and the "I-Function" | Serendip's picture

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Mawrtyr2008's picture

A Brief Tangent

I revisited the NBS senior seminar forum that you link to in the beginning of this article and reread "Daring to Think Differently about Schizophrenia" from the 2008 NY Times Business section.  

Here's an excerpt from that article: 

Although scientists sometimes decide to study a disease because of problems it has caused among family members, Dr. Schoepp says his fascination with mental illness has been purely academic. “My family has more heart disease than anything else,” he says. 

 I know many, many scientists who attribute their passion for their area of research to experiences with family members.  I find that this is particularly the case with neurobiologists, psychologists, and psychiatrists.  

 It just dawned upon me that this bizarre shared experience in this particular community - that many scientists share of a professional drive rooted in experiences with families and loved ones - is perhaps a struggle to reconcile the conflicting stories of their own lives.  It's interesting to me that observing a loved one struggle with reconciling conflicting stories about his or her life may have this interesting transformative effect on others nearby.  Almost like a catalyst.  It's equally interesting to me that so many people see science as a tool to reconcile those stories. 

merry2e's picture

Notes on Stigma and a combo of therapy and meds for me

“To discover who she is, a woman must trust the places of darkness where she can meet her own deepest nature and give it voice…weaving the threads of her life into a fabric to be named and given…sharing it with the women around her as she comes to a true and certain sense of herself.” Circle of Stones: Woman’s Journey to Herself ~Judith Duerk

Hello Profs. Dalke and Grobstein and all the wonderful people who have contributed to the important and stimulating conversation going on here in Serendip!

I wanted to share my own experience with depression and the world of mental health in hopes there may be a reader out there in cyberspace who will come across these words and find some hope within their own darkness and know they are not alone.

I am the daughter, granddaughter, niece, cousin and sister of people who suffered/suffer through times of “unhealthy” mental states that caused some of them to live their lives in isolation, fear, anger, dependence on alcohol or drugs, some of which ended up taking their own lives. Since a young child I was taught that it was a “family” secret when my mother wasn’t “feeling well.” I lived, not only in a dark cloud of my mother’s deep depressions, but I developed what I call “the illness of stigma.” Because of the fear of what people would think, it took a very long time for my mother to receive the help she needed and when she finally did, she was then labeled “crazy” losing many friends, self-esteem and dignity.

Along with many other factors involved, when I became an adult and needed help with my own mental health several years ago, I found it almost impossible to jump the hurdle of “the illness of stigma.” I did not want to be crazy. I did not want to have to take meds. I did not want people to think I was weak like my mother or any of my other family members. What I finally realized was that not getting the help I needed was actually crazy and having a problem was not “weak”, but not until I hit rock bottom. But, I wanted to know, why did this happen to me?

Erving Goffman (1963) Stigma: Notes on the Management of Spoiled Identity

“By definition, we believe the person with stigma is not quite human” (151).

Stigma is an “attribute that is deeply discrediting” and that reduces the bearer “from a whole and usual person to a tainted, discounted one” (3).

(Thank you to Prof. Kate Thomas for the definitions from Here and Queer Class)

One important issue that I began to understand is when our government allows for our citizens who suffer with depression and other mental health issues to live on the streets, for insurance companies to allow for only 5-10 “therapy” sessions a year (and that will make you all better?) and then use psychotropic drugs as a band-aid in some cases as the SOLE means of addressing the depression, these policies not only further allow for possible damage to the person and family members suffering, it allows for the continuation of the stigmatizing effects on mental health. The effects of “the illness of stigma” can have devastating effects, causing the sufferer to avoid reaching out for help and contribute to feelings of unworthiness (felt in many people with depression).

 

It was not until I realized that I was worthy of help and that I was not crazy because I needed to take meds that I began to see the effects of depression on my life and how I could begin to live without relying on the darkness. I had the ability to receive intensive therapy including a year of DBT (Dialectical Behavior Therapy, a type of CBT). In DBT, the client is taught four different modules teaching different skills:

1. Core Mindfulness Skills-based on Buddhist meditation to teach the client to stay in the present

2. Interpersonal Effectiveness Skills-teaches client to learn how to ask for needs/wants effectively, maintain relationships in healthy ways, etc.

3. Emotion Modulation Skills-Teaches client how to deal with emotions in healthier ways than using old behaviors.

4. Distress Tolerance Skills-teaches client how to deal with situations that feel intolerable and techniques

Not only does this type of therapy combine life skills, mindfulness (meditation) and talk therapy, but in most cases clients are on medication for symptoms during therapy. The support received through the group process and a trusting relationship between client and therapist allows for the client to work through past experiences (unconscious and conscious), empowers the client to make positive life decisions, and teaches the client about biology behind traumatic childhood experiences and genetics. These interactions can provide positive validation and acceptance for many people who have felt lost, alone, and unworthy for many years of their lives. (http://bpd.about.com/od/treatmentoptions/a/DBTprofile.htm)

For me, a serious hurdle to beginning DBT and a huge downfall surrounding this type of therapy (which I personally think could be of great benefit for many who suffer with depression and other associated mental health issues), is in order to be referred to DBT, a client must be considered a “difficult” case or resistant to other types of treatment. Most people who are recommended for DBT are those with the diagnosis of Borderline Personality Disorder, which in itself, is stigmatizing if not understood within the proper context. Most insurance companies are unwilling to invest the resources and would rather psychiatrists simply write prescriptions with little follow up care. (http://www.sciam.com/article.cfm?id=the-medicated-americans)

It was obvious in my family that biology was linked to my depression, and knowing and understanding the need for meds to control the ups and downs for me in combination with different types of therapy permitted me to finally let go of the “illness of stigma” in my life. I was worthy of help and all the GOOD that life has to offer. (Another good article relating to biology, genes, depression and anxiety in Scientific American Mind -http://web.ebscohost.com.proxy.brynmawr.edu/ehost/pdf?vid=4&hid=15&sid=2d71a184-5e3f-4c06-a0a2-19f45a07a077%40sessionmgr2

My vote is a combination of meds and therapy, FOR ME, proved to be the most helpful path to my recovery from depression and other major mental health hurdles. I still visit the darkness as depression and anxiety became my friends for a long time, but I do not choose to stay with them for very long as happiness, joy, and living have moved into my life to provide friendship to me, also. I have so much to say on this topic but I must stop for now…

Thanks for the wonderful conversation and listening!

Meredith

 

llamprou's picture

My personal experience

This was in my humble opinion quite a good article, and I wish that it had been printed several years ago, when I was diagnosed. I was in tenth grade and had lived in the Middle East my whole life, my sister and I were constantly bugging my parents to leave Riyadh and relocate home to Athens, Greece (our hometown). However the year (tenth grade for me) finally came by body went into shock, it was almost something I could not control, I was in complete denial and I was terrified of leaving the only place I ever knew. I began absolutely bizarre behavior, I would sleep all day to avoid interactions with my family and then all night I would be up watching TV, I became extremely emotional feel absolute dispair for no reason, my grades dropped significantly and I was on almost a daily basis calling my dad to come pick me up from school early because I could not cope with so many 'happy' people around. The kids at school picked up on my 'weakness' and relentlessly torchered me socially. My parents took me to see a 'professional' who recommended medication (obviously, it is what most doctors know to do first). No one explored the possibility of therapy and some of my family even considered it a taboo subject, anyone who sees a therapist must be totally loopy right? Wrong, by freshman year of college I was seeing one (perhaps I am completely crazy) and feeling much more in control of my life. I am not going to say that I know exactly how much the medication helped...but what I do know is that it was therapy that allowed me to understand how to embrace and control my saddness. Being sad was not something I needed to rid myself of, it was something I needed to embrace and deal with. It has been about 6 years now and I know when I am beginning to feel low, I have been taught strategies for not allowing depression to run my life, but I also appreciate that all feelings are healthy and that I no longer see depression as ominous, or as something that can be completely treated with medication.
Judie's picture

Other Views on Depression

Good to communicate with you again Paul. A recent event at Rutgers paired Jerry Wakefield (The Loss of Sadness- Horwitz and Wakefield Oxford Press) and Peter Kramer (Listening to Prozac & Against Depression). Their similarities and differences on topics of depression requiring treatment and distinguishing depression from sadness were intriguing. Highlights (at least as I heard them): PK challenging the idea that depression and creativity are associated in any meaningful or positive way; JW stressing (though not as fully in the presentation as in the book) that depression research is nearly always conducted using DSM de-contextualized criteria, therefore leading to research findings of questionable validity; my impression that each argued from their role assumptions- PK as a clinician argues that more depression should be diagnosed and treated to avoid the disabling effects of a MDD progressing to such deep depression that suicidality is a risk and theorist and researcher JK focused more on the distinction between the normal sadness that can accompany multiple forms of loss (including , I would argue along with Paul's posting, the loss of connection between "stories" one holds- whether between conscious and unconscious or even when 2 contradictory stories within the conscious are held as equally valid but disturbingly so). (Sorry for the run-on sentence there!).

In any case, the line between depression and sadness is often fuzzy, yet like pornography, one generally knows it when one sees it. I might argue that sometimes it is less easily recognized in oneself until it has advanced. As one who works with many bereaved people, recognizing the point at which support and meaning- making talk therapy strategies start to work vs. when it becomes clear that meds might be a useful addition, that point is critical and it seems there's a tipping point that is hard to articulate. That tipping point seems to have more to do with intensity and impact on the client's functionality than it does on the number of DSM defined symptoms.

Anyway, thought I'd share those ideas...

Paul Grobstein's picture

Depression: two "tipping points"?

Thanks for the event report. Some students and I are developing new Serendip materials on depression (see for example David Hume: A Letter to a Physician). Along these lines, its useful to be reminded of the recent Kramer book, and to hear about the new Loss of Sadness.

Agree, of course, that there is a somewhat "fuzzy" line between sadness and depression, and would like to explore that terrain more, to hear more of your intuitions as a clinician (and that of others as well) and compare that to experiences "from the inside". My hunch is that the "tipping point" comes when sadness comes into conflict with other unconscious feelings/understandings/aspirations and so makes it difficult/impossible to generate a reasonably stable/coherent story of oneself. To put it differently, my guess is that it is not sadness itself that creates the symptomatology of depression but rather difficulties in creating a "story" that makes sense of sadness. To talk more about?

Maybe there is also another "tipping point"? The one where depression evolves into a suicide risk? I certainly share Kramer's interest in assuring that people don't ignore the potential hazards of depression but think he may be paying inadequate attention to some potential positive features of depression per se. The notion of two tipping points bounding a space between them may be helpful in this regard, and perhaps in developing further ways to think about the relation between "story" and behavior/inner experiences?

Judie's picture

Boundaries and Tipping Points

I find the idea of at least 2 (though I always look for more) tipping points intriguing. Certainly the lethargy of many depressions seems "sad", but many of the clients I've known with suicidal tendencies actually did not present quite as "sad-ly", though certainly with hopelessness and despair, but often with more angst- possibly as a result of trying to integrate mutually exclusive stories of themselves. I'll have to think about that one some more.

Interestingly- to me anyway- the big movement in grief theory is toward meaning-making (Neimeyer is the big theorist here)which he describes in a more psychological manner of creating personal meaning of the loss; I find it interesting to consider how this works within the context of disenfranchised loss (Doka)where the thrust of grief work is often more connected to social-context meaning making- ie how can I get others to recognize the legitimacy of my loss and provide some support? I believe typical losses like the death of a loved one may provoke the first type of meaning making, but the losses of the disenfranchised (a divorce, the death of an ex-lover, many perinatal losses, loss of parental love and care, loss of safety, loss of positive regard or social status) seem to me to make one more susceptible to a state that continues for a longer stretch of time and may make one more likely to hit the tipping points discussed above.

Will look forward to thinking this through more with you and any others who join the discussion.

Anne Dalke's picture

Not going off on story lines

like pornography, one generally knows depression when one sees it.
we know it's porn when we are aroused; we know we're depressed when we can't be?

I'm struck by the similarity between Paul's describing depression as "difficulties in creating a story that makes sense of sadness," the impossibility of generating "reasonably stable/coherent story of oneself," and Judie's saying that "the big movement in grief theory is toward meaning-making."

Last night, I was telling one of my daughters about my own current struggles to re-make my living situation (and myself!). She directed me to the counsel of the Buddhist nun Pema Chödrön, who advises a diametrically different approach than those described above; this one avoids altogether meaning making, storytelling and self-constructing:

"The Buddha said that what we take to be solid isn't really solid. It's fluid. It's dynamic energy. And not only do we take our opponents and obstacles to be solid; we also believe ourselves to be solid or permanent. In the West, we add the belief that the self is bad....

meditating, I discovered that there is no solid, bad me. It's all just ineffable experience. I experienced the fluidity of what I once thought of as a solid self...by staying with the immediacy of my experience and not going off on story lines, as we are always doing. These stories we make up about ourselves distance us from the rawness of our immediate experience."

What I take from this is the idea, not to try and revise my coherent story of myself, but to work @ letting go -- or @ least @ holding more lightly--the meaningful story of coherent self.

Paul Grobstein's picture

Maybe a little Hinduism would help?

Anne Dalke's picture

thought-stopping

(At least) three different directions for further exploration here, in response to the question about what neurobiology might be involved in "'conquering' the I-function":

one is an experiment in Psychotherapy for All, a low tech, low resource way of reaching depressed patients in the developing world: a program in western India that is training laypeople to identify and treat depression and anxiety;

two is a U.S. Christian-based experiment in changing patterns of negative thinking, said to resemble the technique in cognitive behavioral therapy known as "thought stopping";

three is the very different approach we think of as the scientific method (as described by Jonah Lehrer), which refuses to stop thinking, and

"accepts no permanent solution. Skepticism is its solvent, for every theory is imperfect. Scientific facts...are ephemeral, because a new observation, a more honest observation, can always alter them."

Laura Cyckowski's picture

re "'conquering' the I-function"

I was shown those quotes about the mind as friend/enemy yesterday and have been thinking about the concepts of "conquering the I-function", realizing/exploiting the split between conscious/unconscious, or reaching that level of mindfulness when one is actuely aware of the existence of such distinct entities, the conscious/or "storyteller"/mind from unconscious/body/everything else. The prospect of reaching such a state is somewhat frightening to me, actually. It would seem that if one is so aware of these distinctions then it would be harder/impossible to create that cohesive/complete sense of self. And I can't help but feel that I'd never want to reach that state for fear of finding out that "that's all there is"...
Anne Dalke's picture

"The greatest tragedy is to live without tragedy"

As an alternative to the fear of the destabilizing consequences of being fully mindful, see a new book by Eric Wilson, Against Happiness: In Praise of Melancholy, which argues for melancholia as a force for creativity, essential to a full experience of life: "The greatest tragedy is to live without tragedy." It would follow that Wilson cautions against the use of antidepressants (as denying us this full spectrum of emotional experience). His arguments seem akin to those in a new book by Daniel Smail On Deep History and the Brain, which suggests that "we are all the choreographers of our own chemical dance, enjoying the 'spikes' and 'dips' as they follow one another, and simply for their own sake." Both seem a little, um, callous in terms of the cost of the suffering involved in such experiences.

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