THEORIES ABOUT THE CAUSES OF DEPRESSION

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Irrational ideas

 Rational-Emotive therapy, as described by Ellis & Harper (1975), Hauck (1973), and Maultsby (1976), emphasizes that irrational ideas cause all our unreasonable or excessive emotions. In the 1st century A.D., Epictetus, a Greek teacher enslaved in Rome, said, "Men are not disturbed by things (that happen to us), but by the views which they take of those events." In the 1960's Albert Ellis started teaching this simple philosophy: our thoughts cause our feelings. Here is an example:

 Rational-Emotive therapy is more challenging and aggressive than most other therapies. These therapists immediately point out and attack the client's irrational thoughts and unreasonable expectations. They directly suggest more reasonable ways of viewing the self, the world, and the future. They also assign homework designed to correct false beliefs.

 What are some of the other harmful irrational ideas and thoughts?

 Note two things: first, a, b, and c are unreasonable expectations, often impossible goals. They are, of course, nice, common and in many ways useful wishes; everyone would like to be approved, successful, and loved, but we can't demand that our wishes always come true. When things don't go our way, it isn't something awful to go into a rage or deep depression about. Although an event may be regrettable, it is always a psychologically understandable and behaviorally lawful outcome. Later we will see that Karen Horney referred to these insistent neurotic needs or demands that things be the way we want them to be as "the tyranny of the shoulds." Secondly, d and e illustrate other kinds of faulty logic that might underlie depression (see cognitive therapy) and other exaggerated emotions. Rational-Emotive techniques and self-help methods are discussed in chapter 14.

 Some scientists doubt that irrational ideas and faulty logic cause depression. Some doubters believe the sad feelings existed before the sad-helpless thoughts, i.e. that depressing genes or hormones or life events lead to our negative cognitive styles (Barnett & Gotlib, 1988). Other doubters, like Robert Zajonc, believe that emotion and cognition are independent systems and, furthermore, irrational behavior is based on emotions, not irrational thoughts (Cordes, 1984). In spite of criticism, cognitive explanations are the most accepted explanations of depression among psychologists today.

Unreasonable thinking and faulty conclusions

 Depressed people are prone to think in several ways that may produce sadness and pessimism. If things have gone badly in the past (depressed people are past-oriented), there may be a tendency to conclude that the future will be awful too. Actually, depressed people usually don't think much about the future. The future is depressing precisely because it has little meaning or no purpose for them... or is threatening. The erroneous belief that things will not get better may lead to suicidal thoughts. This hopeless vision of the future is based on a general global perception that their problems are huge, innumerable, and insolvable. A depressed person may have only a vague notion of wanting "to be happy," "to put my life back together," "to find love and happiness," etc. Of course, without the problems being definable, objective, specific, manageable, and circumscribed, depressed people don't have specific plans, i.e. doable, clear-cut, self-help steps in mind for attaining realistic goals. Without plans for changing, they have no hope and no motivation. They feel like victims, not masters of the situation. That is unreasonable. They can change.

 Depressed people seem to reason poorly in several other ways. Examples: they are concrete thinkers and have difficulty generalizing (e.g. after being taught to be assertive with his/her boss, he/she doesn't think of being assertive with his/her spouse). They see nothing illogical about giving credit to luck, other people, God, fate, etc. for the good things and blaming themselves for the bad things in their lives. While depressed people focus on the bad happenings in their lives, some of them tend to deny the "bad" emotional parts of themselves, such as anger, violent, and selfish urges, etc. Others see only the bad. And, their "solutions" for their problems are often unrealistic, such as a person with two children and an unhappy marriage who wants to have another child "to improve the marriage" or a floundering overly critical student decides to drop out and live with his/her father although they have never related well. We can't cope well without thinking straight; this includes having a purpose and a plan for living (see chapters 2 & 3).

 There is still more wrong with the depressed person's thinking processes. Therapists and scientists studying the brain have contended that a part of our mental make up compels us humans to explain everything (see attribution theory in chapter 4). Some of us, hating uncertainty, need an immediate, simple, "it's for sure" explanation; others of us need lots of data, time to weigh different opinions, and careful thought about the issue before we arrive at an explanation. This reflects the difference between simple "black-and-white thinking" (dichotomous thinking) and complex "tolerance of ambiguity." Depressed people grab hold of immediate, clear-cut but pessimistic explanations; that is their "explanatory style," namely, "it's my fault" (happy folks blame the situation or someone else), "my weakness messes up everything" and "it will never change, so why try?" Wow, what a prescription for depression! Reality is: you aren't entirely to blame, the supposed fault won't mess up everything, and the situation--including you--can and will change. Depressed people must learn to think differently.

 We need to understand why some depressed people are such rigid and poor thinkers. It is critical knowledge for working with suicidal patients. The closed-mindedness of depressed people is amazing. Yapko (1992) describes counseling a patient who recently had a heart attack and a quadruple bypass. This man wouldn't talk or open his eyes during the first hour of therapy; he quietly cried while his wife told his story. When the patient finally talked in the second session, he only said, "I'm going to die!" and sobbed. He could do nothing and think of nothing but dying. In contrast, Vikor Frankl survived the brutal conditions of a Nazi concentration camp, while many died, by intensely desiring to live so he could be re-united with his wife. He had a purpose and thought there was some chance if he could stay alive. We must use our rational mind to find those rays of hope and to develop realistic plans to make our future better.

Self-critical withdrawal

 If we are sad, we respond more slowly and avoid ordinarily pleasant (it may not be pleasant to the depressed person) and unpleasant events. Indeed, there is evidence that depressed people are especially sensitive to pain and even mildly irritating situations (Carson & Adams, 1981). Perhaps because of this sensitivity, some depressed persons have developed unique ways of reducing pain or stress in addition to avoiding or withdrawing, namely, by making self-critical or self-hurtful remarks (which may reduce criticism from others or, in some masochistic way, reduce the stress). This sounds a lot like the story of Sooty Sarah below. The outcome could be a miserable recluse.

 We need to understand why some depressed people are such rigid and poor thinkers. It is critical knowledge for working with suicidal patients.Forest and Hokanson (1975) did an interesting study supporting the notion that self-punishment could be rewarding, i.e. an escape from conflict with someone else. In this study an aggressive partner was permitted to shock depressed and non-depressed subjects. Then those who were shocked were given the choice of shocking their partner back, shocking themselves, or making a friendly gesture to the partner. If the depressed subjects elected to shock themselves, their autonomic responses (stress) declined more rapidly than if they were aggressive or friendly. Non-depressives got relief only by shocking the other person, not by self-punishment or being friendly. For most of us, it seems astonishing that anyone would hurt themselves more after being hurt by an aggressive SOB. Well, there seems to be some relief--a payoff--for depressed persons if they punish themselves instead of attacking the aggressor. Maybe sadness is partly a self-punishment (and/or substitute for aggression). This needs to be understood better and may also be involved in the next odd-sounding theory.

Anger turned inward

 Psychoanalysts have long believed that anger towards others gets turned against ourselves. Our anger converted into self-hatred causes depression. Karen Horney (see Monte, 1980, or any theories of personality book) wrote that the basic problem starts with neurotic parents who are inconsistent (both overindulgent and demanding), lacking in warmth, inconsiderate or openly hostile, or driven by their own needs. The child resents these things. But parents are powerful and a child's only means of survival. So, because of fear or love or guilt, the child represses the anger. The child, being small, alone, confused, and helpless in an unpredictable, hostile world, is, of course, scared. How does the child protect itself?

 The child, aware of his or her weakness, the criticism of others, and his or her own hostility and fears, develops a "despised" self-concept. Also, the resentment of others has been turned against the self: "I am unlovable, a bad person." At the same time, the child starts to develop a notion of an "ideal" self--what he/she should be--in order to survive and get the love and approval he/she wants. This ideal self, trying to compensate for weakness and guilt, sets up impossible demands, called neurotic needs. These needs are unconscious, intense, insatiable, anxiety-causing, and out of touch with reality. For instance, if one has a neurotic need for affection, it becomes urgent to be loved by everyone, all one's peers, all the family, teachers, the paper carrier, etc. Horney listed several neurotic needs, primarily needs for perfection, power, independence, and affection. All are attempts to handle the primitive hostility from childhood. So, how do we get depressed?

 In extreme cases, some people become so self-effacing, i.e. compliant, unselfish, and modest, they almost do away with their "self." Suffering, helplessness, and martyrdom are their ideals. They need to be loved, liked, approved, important, but taken care of. Their "solution" is: "If you love me, you will not hurt me." But beneath this saintly, goody-goody surface sometimes boils the old anger, rage, and strong urges to be aggressive and mean. Besides, love never runs smoothly--remember everyone must love them--so these kinds of dejected people may turn against themselves, becoming very self-critical and unhappy. Often they have also become bitter because the unwritten agreement was broken, namely, "I'll be nice and not hate you, if you will love, respect, and care for me always." People striving for sainthood often suffer because others will not always put them first.


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