CHAPTER 5-2 THE NATURE OF SADNESS AND DEPRESSION Depression is one of the great afflictions of modern life -- widespread, and often seriously painful. It is a disorder of thinking, and it has much in common with other modes of poor thinking discussed in the book. Furthermore, it is very frequently curable by improving one's thinking. Therefore, this book devotes two chapters to it -- this chapter which explains it, and the next chapter which discusses how to overcome it. People we call "normal" find ways to deal with the pain from losses and negative self-comparisons in ways that protect them from prolonged sadness. However, it is probably that anyone will eventually get depressed if continually subjected to painful experiences, even if the person does not have a special propensity for depression; consider Job. For example, paraplegic accident victims judge themselves to be less happy than do normal uninjured people.1, old 19 And consider this exchange reported between Walter Mondale, who ran for president of the United States in 1984, and George McGovern, who ran in 1972: Mondale: " George, when does it stop hurting?" McGovern, "When it does, I'll let you know." But despite their painful experiences, neither McGovern nor Mondale seems to have fallen into prolonged depression because of the loss of the presidency. And Beck concludes that survivors of painful experiences such as concentration camps are no more subject to later depression than are other persons.2, old 20 These are some of the ways one may respond to unfortunate events, negative self-comparisons, and the consequent pain are as follows: 1) One can sometimes avoid pain by changing the real circumstances involved in the negative self-comparison; this is what the "normal" active, undepressed person does, and what the normal rat does who has not previously been subjected to shocks that it cannot escape3, old 9. Sufferers from depression typically lack such purposive activity with respect to their negative self- comparisons because they have a sense of helplessness to improve the situation. 2) One can deal with the pain by getting angry, which tends to make you forget about the pain -- until after the rage subsides; at that time the pain usually returns, intensified. Anger can also be useful in changing the circumstances. Anger arises in a situation where the person has not lost hope but feels frustrated in attempting to remove the source of the pain. 3) You can lie to yourself about the existing circumstances. Distortion of reality can avoid the pain of a negative self- comparison. But this can lead toward schizophrenia and paranoia.4, old 10 A schizophrenic may fantasize that her actual state is different than it really is, which can remove the painful negative self-comparison is not in the person's mind. The irony of such distortion of reality to avoid the pain of a negative self-comparison is that the comparison itself may contain a distortion of reality; making the comparison more realistic would avoid the need for schizophrenic distortion of reality.5, old 11 4) Still another possible outcome is that the person assumes that he or she is helpless to do anything about it, and this produces sadness and eventually depression, the subject we now turn to. WHAT DO WE MEAN BY "DEPRESSION" ? Let's be sure that you and I are talking about the same state of mind when we use the word "depression." People sometimes say "I'm depressed" when they refer to a state of mind quite different from the established psychological meaning of the term -- for example, when they are just annoyed with a current state of affairs. The term "depression" means to psychiatrists and psychologists a continued state of mind with these central characteristics: (1) You are sad or "blue." (2) You have a low regard for yourself. (3) You have a sense of being helpless and hopeless. Some mention other elements, but these are the fundamental characteristics of depression. The rock-bottom element is the feeling of sadness. The term "sad" includes without distinction the feelings and moods one might call "melancholy," "blue," "being down," "misery," "grief," "despair," and similar descriptions of negative feeling. The prolonged feeling of sadness, plus the thoughts "I'm worthless" and "I'm helpless" constitute depression; these three elements are the hallmarks of the depressed person. A variety of other symptoms also are found in some depressed persons--inability to sleep, disinterest in sex, inability to work, for example. But these other symptoms are by no means universal. If we stick to a definition of depression as sadness plus low self-esteem and a sense of helplessness, we will be clear and unconfused about the subject of this chapter. Prolonged sadness and depression felt to me -- and others have used similar language -- like living in a pool of pain, feeling helpless to escape from it. Similar descriptions of depression--or "melancholia"--have been given from ancient Roman times until now.6, old 1 Some sadness is inescapable and normal, of course; life without sadness would not be human. But the subject here is the state of sadness which does not pass as fast as it "ought" to, and the person who stays sad longer than is "reasonable." And in depression, thoughts of personal worthlessness ("low self-esteem") are more frequent and intense than most people experience. Sadness is not equivalent to depression, and not all sadness is pathological. Everyone is sad from time to time, sometimes in response to genuinely sad events such as the loss of a loved one. The sadness that follows such a loss is natural and even necessary, and should be accepted as such. Unless the sadness continues un-normally -- that is, continues so long that it disturbs a person's life, and the person feels that there is something wrong -- the label "depression" does not apply. But if the sadness does continue un-normally, and then picks up a feeling of worthlessness as a companion and turns into a prolonged state, the condition then becomes an enemy that must be fought. Very occasionally there may be some doubt about whether to call a person "depressed", especially when sadness continues for a long time after a tragic death. In such a case, the person may not feel worthless. But almost always depression is clearcut, though the depth of depression may vary. Sadness is caused by the thought mechanism which will be described shortly. If you understand and manipulate the mechanism properly, your chances of getting rid of the sadness are excellent. The depression mechanism does not by itself produce or explain low self-regard. But if you operate the thought mechanism appropriately you are likely to get rid of the low self-regard, too, and at the least you will not be preoccupied with it and ravaged by it. The mechanism which causes the sadness in depression was discussed in Chapter 5-1. To repeat, whenever you think about yourself in a judgmental fashion--which most of us do frequently -- your thought takes the form of a comparison between a) the state you think you are in (including your skills and capacities) and b) some other hypothetical "benchmark" state of affairs. The benchmark situation may be the state you think you ought to be in, or the state you formerly were in, or the state you expected or hoped to be in, or the state you aspire to achieve, or the state someone else told you you must achieve. This comparison between actual and hypothetical states makes you feel bad if the state in which you think you are in is less positive than the state you compare yourself to. And the bad mood will become a sad mood rather than an angry or determined mood if you also feel helpless to improve your actual state of affairs or to change your benchmark. This precise formulation constitutes a new theoretical understanding of depression. The comparison you make at a given moment may concern any one of many possible personal characteristics--your occupational success, your personal relationships, your state of health, or your morality, for just a few examples. Or you may compare yourself on several different characteristics from time to time. If the bulk of your self-comparison thoughts are negative over a sustained period of time, and you feel helpless to change them, you will be depressed. Check yourself and you will observe in your mind such a negative self-comparison when you feel bad, whether or not the sadness is part of a general depression. The sense of loss, which often is associated with the onset of depression, also can be seen as a negative self-comparison -- a comparison between the way things were before the loss, and the way they are after the loss. A person who never had a fortune does not experience the loss of a fortune in a stock market crash and therefore cannot suffer grief and depression from losing it. Losses that are irreversible, such as the death of a loved one, are particularly saddening because you are necessarily helpless to do anything about the comparison. The key element for understanding and dealing with depression, then, is the sadness-producing negative comparison between one's actual state and one's benchmark hypothetical situation, together with the attitude of helplessness as well as the conditions that lead a person to make such comparisons frequently and acutely. Why does one person respond to a particular negative event in his/her life with short-lived sadness after which normal cheerful life reappears, whereas another responds to a similar event with persistent depression? And, why does a trivial or almost non-existent blemish in life trigger sadness in some people and not in others? The answer in brief is as follows: Some people acquire from their personal histories: 1) a tendency to make frequent negative self-comparisons, and therefore a tendency to have a Rotten Mood Ratio; 2) a tendency to think one is helpless to change the events that enter into the Rotten Ratio; and 3) a tendency to insist that one's life "should" be better than it is. There are many possible interacting elements in the development of a propensity to make negative self-comparisons, conceivably including a genetic element, and the elements differ from person to person. The negative self-comparison is the last link in the causal chain leading to sadness and depression. If we can remove or alter this link, we can relieve depression. The tendency to make frequent negative self-comparisons does not mean quite the same as "thinking poorly of yourself" or "having low self-esteem." The idea of "negative thoughts" has been mentioned by just about every writer on depression through the ages, as has been the more specific set of negative thoughts that make up low self-evaluation. Negative thoughts have not, however, been previously discussed in a systematic fashion as comprising comparison, as every evaluation is by nature a comparison. Nor has the interaction between the negative self-comparisons and the sense of helplessness, which converts negative self-comparisons into sadness and depression, been described elsewhere as it is here. It is the conceptualization of the negative thoughts as negative self-comparisons which opens up the wide variety of theoretical and curative approaches discussed here. Your "actual" state is what you perceive it to be, of course, rather than what it "really" is. If you think you have failed an examination, even though you will later learn you passed it, then your perceived actual state is that you have failed the test. Of course there are many facets of your actual life that you can choose to focus upon, and your choice of facet(s) is very important. The accuracy of your assessment is important, too. But the actual state of your life usually is not the controlling element in depression. How you perceive your life is not completely dictated by the actual state of affairs. Rather, you have considerable discretion as to how to perceive and assess the state of your life. The "benchmark" situation to which you compare your actual situation may be of many sorts: a) The benchmark situation may be one that you were accustomed to and liked, but which no longer exists. This is the case, for example, after the death of a loved one; the consequent grief-sadness arises from comparing the situation of bereavement with the benchmark situation of the loved one being alive. b) The benchmark situation may be something that you expected to happen but that did not materialize, for example, a pregnancy you expected to yield a child but which ended in miscarriage, or the children you expected to raise but never were able to have. c) The benchmark may be a hoped-for event, a hoped-for son after three daughters that turns out to be another daughter, or an essay that you hoped would affect many people's lives for the good but that languishes unread in your bottom drawer. d) The benchmark may be something you feel you are obligated to do but are not doing, for example, supporting your aged parents. e) The benchmark may also be the achievement of a goal you aspired to and aimed at but failed to reach, for example, quitting smoking, or teaching a retarded child to read. The expectations or demands of others may also enter into the benchmark situation against which you negatively compare your actual situation. And, of course, the benchmark state may contain more than one of these overlapping elements. The best proof that sadness is caused by the unfavorable comparison of actual and benchmark situations is self-inspection of your thoughts. If you observe in your thinking, when you are sad, such a negative self-comparison along with a sense of helplessness about changing the situation -- whether the sadness is part of a general depression or not--this should convince you of the key role of negative self-comparisons in causing depression. The concept of negative self-comparisons enables us to understand how a person can be bereft of life's good things yet happy anyway, or have everything a person could want but be miserable nevertheless. The author of Ecclesiastes -- King Solomon? -- tells us how useless and helpless he felt despite all his riches: So I hated life, because the work that is wrought under the sun was grievous unto me; for all is in vain and a striving after wind (2-17) The American poet John Greenleaf Whittier (in Maud Muller) caught the nature of loss as a comparison in these lines: "For of all sad words of tongue or pen, the saddest are these: It might have been!" Whittier makes it clear that sadness arises not just because of what actually happened, but also because of the counterfactual benchmark which "might have been." Notice how what we call "regret" hinges on the counterfactual benchmark--how an inch more to the side would have won the game which would have put the team into the playoffs which would have led to a championship; how but for one horse's nail the war was lost; how--if not for the slaughter by the Germans in World War II, or the Turks in World War I--the Jews and Armenians would be so much more numerous and their cultures so much stronger: and so on. The basis for understanding and dealing with depression, then, is the negative comparison between your actual and hypothetical benchmark situations that produces a bad mood, together with the conditions that lead you to make such comparisons frequently and acutely, and combined with the helpless feeling that leads the bad mood into a sad rather than angry mood; this is the set of circumstances constituting the deep and continued sadness that we call depression. WHY DO NEGATIVE SELF-COMPARISONS CAUSE A BAD MOOD? But why do negative self-comparisons and a Rotten Ratio produce a bad mood? There is a biological connection between negative self-comparisons and physically-induced pain. Psychological trauma such as a loss of a loved one induces some of the same bodily changes as does the pain from a migraine headache, say. When people refer to the death of a loved one as "painful", they are speaking about a biological reality and not just a metaphor. It is reasonable that more ordinary "losses" -- of status, income, career, and of a mother's attention or smile in the case of a child -- have the same sorts of effects, even if milder. And children learn that they lose love when they are bad, unsuccessful, and clumsy, as compared to when they are good, successful, and graceful. Hence negative self-comparisons indicating that one is "bad" in some way are likely to be coupled with the biological connections to loss and pain. It also makes sense that the adult need for love is connected to the infant's need for food and being nursed and held by its mother, the loss of which must be felt in the body.7, old 4 Indeed, research shows a statistical link between the death of a parent and the propensity to be depressed, in both animals and humans. And much careful laboratory work shows that separation of adults and their young produces the signs of depression in dogs and monkeys8, old 5. Hence lack of love hurts and makes one sad, just as lack of food makes one hungry. Research shows chemical differences between depressed and undepressed persons. Similar chemical effects are found in animals which have learned that they are helpless to avoid painful shocks9, old 6. Taken as a whole, then, the evidence suggests that negative self-comparisons, together with a sense of helplessness, produce chemical effects linked to painful bodily sensations, all of which results in a sad mood. A physically-caused pain may seem more "objective" than a negative self-comparison because the jab of a pin, say, is an absolute objective fact, and does not depend upon a relative comparison for you to have a painful perception of it10, old 7. The bridge is that negative self-comparisons are connected to pain through learning during your entire lifetime. You learn to be sad about a lost job or an examination failure; a person who has never seen an examination or a modern occupational society could not be made sad by those events. Learned knowledge of this sort always is relative, a matter of comparisons, rather than involving only one absolute physical stimulus. All this represents opportunity for managing our emotions: It is because the causes of sadness and depression are largely learned that we can hope to remove the pain of depression by steering our minds properly. This is why we can conquer psychologically-induced pain with mental management more easily than we can banish the sensation of pain arising from arthritis or from freezing feet. With respect to a stimulus that we have learned to experience as painful--lack of professional success, for example--we can relearn a new meaning for it. That is, we can change the frame of reference, for example, by altering the comparison states that we choose as benchmarks. But it is impossible (except perhaps for a skilled practitioner of yoga) to change the frame of reference for physical pain so effectively as to remove the pain, though one can certainly reduce the pain by quieting the mind with breathing techniques and other relaxation devices, and by teaching ourselves to take a detached view of the discomfort and pain. To put the matter in different words: The pain and sadness which are associated with mental events can be prevented because the meaning of the mental events was originally learned; relearning can remove the pain. But the impact of physically- caused painful events depends much less on learning, and hence re-learning has less capacity to reduce or remove the pain. The difference between this view of depression and that of traditional Freudian psychotherapy should now be clear: Traditional psychotherapists, from Freud on, believe that negative self-comparisons (or rather, what they call "low self- esteem") and sadness both are symptoms of the underlying causes, rather than the negative self-comparisons causing the sadness; their view is shown in Figure 1. Therefore, traditional psychotherapists believe that one cannot affect depression by directly altering the kinds of thoughts that are in one's consciousness, that is, by removing negative self-comparisons. Additionally,they believe that you are not likely to cure yourself or ameliorate your depression in any simple direct way by altering the contents of your thoughts and ways of thinking, because they believe that unconscious mental elements influence behavior. Rather, they believe that you can only remove the depression by reworking the events and memories in your early life that led you to have a propensity to be depressed. Figure 1 In direct contrast is the cognitive viewpoint explained above, as shown in Figure 2. Negative self-comparisons operate between the underlying causes and the pain, which (in the presence of a sense of being helpless) cause sadness. Therefore, if one can remove or reduce the negative self-comparisons, one can then cure or reduce the depression.] SUMMARY When you are depressed you feel sad; this is the basic fact about the condition called "depression." The feeling of sadness is accompanied by the thought "I'm worthless." An attitude of "I'm helpless" is a precursor of the sadness, and the belief "I ought to be different than I am" usually helps keep the person locked into sadness. Our task, is to understand sadness--to learn what causes sadness, what relieves sadness, and what prevents sadness. Attempts to distinguish "normal" from "abnormal" sadness have not proven useful. Apparently there is but a single sort of sad feeling; the pain is the same whether it follows upon the loss of a friend (a "normal" event) or, say, the keenly-felt loss of an honor which it was not reasonable for you to expect but on which you had nevertheless set your heart. This makes sense when we notice that one does not distinguish between the pain from a finger that got cut in an accident, and the pain of a self- inflicted cut on the finger. The contexts are very different, however, in the cases of the two sorts of loss mentioned above, and it is those contexts that distinguish between the depressed person and the person who suffers from a "normal" sadness. Page # thinking sadns52@