“he that increaseth knowledge increaseth sorrow”
I owe a great deal of the content of this blog to Neel Burton’s “Psychiatry” (2nd edition), which I cannot recommend highly enough to anyone looking for a grounding in the aetiology, diagnosis and treatment of mental illnesses.
The interesting thing about depression is that when you compare two individuals side by side – one depressed, one not – there may be almost no discernible difference in ability, upbringing, wealth, physical attractiveness, health, social status or any other criteria generally accepted to contribute to happiness.
Why then do people with depression tend to view themselves as deficient, inadequate or even inherently unlovable? What causes this disparity in self worth? Why do depressed people internalise more guilt than our non-depressed counterparts?
Burton’s book explores many different reasons for this. Interestingly, while the book explores thinking errors, or cognitive distortions, as a cause, Burton also points out that scientific literature suggests that depressed people may actually have a more realistic judgement of contingent events (things that could happen) – meaning that depressed people see their own limitations more clearly.
I don’t think that Burton, or the scientists, were suggesting that this ‘depressive realism’ means that every negative thought a depressed person has is valid and accurate. Rather, it seems he is suggesting that non-depressed people have self-protective mental mechanisms, or unfounded optimism, which prevents them from internalising the full extent of their own limitations.
So is it better to be the optimist and be blissfully oblivious to our limitations, or would we rather be self aware and be the accurate judge of our own shortcomings?
Perhaps people with depression can take comfort from the idea that, while we might be accurately identifying things about ourselves that we don’t think are great, other people are just as flawed as us – they just can’t see it!
The real challenge with depression is distinguishing between genuine (albeit unpleasant) perceptions and thought errors or negative automatic thoughts.
Aaron Beck’s theory of depression proposed a cognitive triad of depression (negative appraisal of self, present and future) and the following cognitive distortions:
“No-one will ever love me”
An arbitrary inference is a thought or conclusion that has no basis in evidence.
“My friend said I’m nasty yesterday. I must be the nastiest person in the world.”
Overgeneralisation means using one incident to form a conclusion.
“My boss said my presentation wasn’t very good today. I must be a terrible employee”
(Despite the fact she normally praises me and recently gave me a pay rise)
Selective abstraction is a thought based on one incident taken in isolation, while excluding other relevant incidents which may point to a different conclusion.
“The train is delayed, are they trying to annoy me on purpose?”
A thought that an independent event is related to oneself.
“If she doesn’t help me with this, she doesn’t love me”
This is black and white, or absolute, thinking.
Magnification or minimalisation
“I lost my job. I’ll never be able to find another one because I’m completely useless”
Blowing things out of proportion or diminishing the importance of a good event.
“My relationship ended. If he couldn’t love me then no-one ever will. Maybe I’m just not loveable and everyone will always leave me. I’ll end up alone and I’ll never have a family of my own. What is the point of living if no-one needs me?”
Catastrophic thinking is taking an event and exaggerating the negative consequences to an extreme scenario.
The ability to identify these cognitive distortions is the first step towards rejecting and overcoming them. But many people with depression feel that their thoughts, even the negative thinking errors, are somehow part of their identity. The depressed mind is one that feels the extremes of emotion more acutely – as such, much of our greatest art, literature and music is generated from these feelings. For these reasons, many people with depression reject anti-depressants, which are seen as chemically treating the symptoms rather than the cause. This is not to discredit the use of antidepressants which can be highly effective.
Perhaps it is really a question of reaching beyond the mind experiencing the depression and realising that all minds have flaws and that this is what makes us complex, unique beings. We need to accept there is no perfect ideal to aspire to.