Another reply to Leon Sloman
I am pleased that so many people have accepted your invitation to
comment on my essay. I should like to reply to each individually, but that
would be hogging too much space in ASCAP. I will prepare an overall reply, but
first I would like to deal with a slight difference in model between myself and
Leon. This has been confusing me lately and may be confusing others too. Leon
and I have a lot of common ground, particularly:
1. Depression evolved as one of the yielding components (yielding strategies)
of ritual agonistic behaviour.
2. Ritual agonistic behaviour (including
depression) is a means of amplifying
small differences in capacity (RHP);
and, in so doing, it increases
the correlation between small inherited differences in capacity (such as
intelligence) and reproductive success. Thus depression is of interest not only
to psychiatry but to evolutionary biology as a whole, in that it is a mechanism
for speeding the rate of evolutionary change.
3. Therapeutically, depression may be "reframed" as
yielding and be given
"positive connotation" as such (these are technical
terms used in family therapy). In doing
this we are following the example of the I Ching,
approving the accomodating tendency or Yin, that
which bends but does not
break. Of course, depression may sometimes more usefully be
reframed in other ways, such as nurturance-eliciting behaviour
or physical illness. The choice of frame depends on therapeutic need, not on
beliefs about evolution or adaptive function.
To turn to our differences,
submission --- hypersubmissiveness
--- depression.
The individual is driven to the right along this dimension by the
strength
of his angry feelings (dominating tendency).
With mild anger, voluntary
submission can occur and lead to resolution of conflict; with moderate
anger, hypersubmissiveness is needed to
overcome the anger, and with severe
anger, clinical depression is required to achieve yielding. Without the hopelessness and
helplessness of depression, mere voluntary submission would not be effective in the face of strong
anger.
In my model, the two ends
of
Analogy of temperature control
In order to clarify the (slight) difference
between the two models, let me return again to the metaphor of body
temperature control (see ASCAP,
November, 1990). Consider all the ways we know about for combatting cold.
We
can move our bodies (into the sun, out of draughts, to the other hemisphere, etc), we can put on clothing, we
can light a fire or switch on the
central heating; on the other hand, we
can shiver, we can vasoconstrict,
we can cut down sweating, we can generate heat in the liver. These two groups
of responses are clearly occurring at two different levels of CNS organisation.
For simplicity, I will just talk about switching on the central heating as the higher
level response and shivering as the lower
level response. Now, let cold be the equivalent of interpersonal
adversity (originally, in evolution, the
RHP signals of a rival; by
derivation, stress, bad news, failure,
punishment, frustrative non-reward, etc.). Then depressive yielding is to
shivering as voluntary submission is to switching on the central heating. The central
processes which mediate between cold and response are carried out at two
different levels of the nervous system,
one leading to the decision to "switch on", the other leading
to the "decision" to shiver.
Likewise, interpersonal adversity affects the brain at two levels, one leading
to voluntary submission, the other to depressive yielding.
This model can be expressed in diagrammatic form as follows:
negative feedback
upper brain
------------------------- voluntary submission
Interpersonal adversity
lower brain
------------------------- depressive yielding
negative feedback
If the upper negative feeddback
loop is not effective in keeping interpersonal adversity below a
certain threshold, the lower feedback loop
is called into operation. (I have left out the strategy of elevation of mood,
which is an alternative to depressive yielding.)
The difference of level underlies important differences between the two
methods of combatting cold and between the two
methods of yielding:
1. Access to different information in
the decision-making process. The cold --- central heating sequence is processed
at a level which can take into account
information about weather forecasts, the amount of oil in the storage tank, government requests to conserve
fuel, etc. This kind of
information is not available to the cold --- shivering sequence. Other information may
be available to the lower level process which is not available in deciding about the heating; for instance, body temperature, fat reserves, current level of
vasoconstriction, etc.; but our
conscious minds are not privy to the
decision about shivering and therefore we have
no "insight" into the information used to reach it.
Voluntary submission may be affected by various types of
information which are not likely to
affect the threshold of depressive yielding;
for, instance, cultural values
about the honourableness of yielding; is it a
"discretion is the better part of valour"
or a "death before dishonour" culture?
In the determination of depressive yielding, we do not know what
sort of information about adversity our
lower brains are processing, just as we
do not know what information is used in the decision to shiver. The basic information
is a comparison of own RHP with opponent's RHP, and it may well be that the sums are carried out
differently from a comparison of relative
RHP at the higher brain level. Possibly the lower brain has information about internal matters
such as liver glycogen reserves.
2. Reversibility. Another important
difference is that the central heating may be turned off again, even
without any rise in the ambient
temperature, if new information becomes available, such that there is
a malfunction in the boiler or the fuel
is running out. But shivering cannot be
switched off, and nor can depression, and this is probably why it is more reassuring to see one's rival depressed
than to see him submitting voluntarily.
3. Timing. Related to reversibility
is timing. Voluntary submission is an act which may be of extremely short
duration. Depressive yielding is a state which lasts a certain length of time.
4. Variation in "willingness".
With voluntary submission, as with the central heating, there may be enormous
differences in willingness. Imagine a man who, in the middle of winter, is
demonstrating his new central
heating system to his friends. He is highly motivated to switch
it on. On the other hand, take a man who believes that only weaklings turn on the central heating
before the first of November; he is
presented with a sudden cold snap in
October and the cold tempts him strongly to switch on; there is conflict between his feelings of
cold and his feelings of manliness; then his wife moves in on the act, accuses
him of stinginess, and drags him
screaming to the thermostat, which he switches on under extreme duress. I would still call this a
voluntary act, even if it is performed most unwillingly, because it is in a
different order of
"voluntariness" from
shivering.
In
the case of yielding, consider a wife who gives up her job at the request of her
husband. She may do so with great relief, thankful that he now earns enough to maintain her as a
lady of leisure. On the other hand, consider a wife who works because she
likes it, who believes women have the
right to work, and may even believe that "my job is the only thing
that keeps me sane". The husband
does not wish her to work, and nags her daily about it. She tries to persuade him to
her point of view, but fails. The husband goes on and on at her to such
an extent that she realises it is endangering their marriage. The only way she
can save the marriage is to
give up work, and so she does so, albeit with great reluctance. I
still call this
voluntary submission, because she had the choice of giving up the job or continuing until some other end-point
is reached. This could be
marital separation or it could be depressive yielding. In the
latter case she
gives up her job, not because she decides, either willingly or unwillingly, to do so, but because she is too
ill to go to work.
With the involuntary responses of shivering and depressive yielding, the dimension of
"willingness" is not relevant. It does not make sense to discuss whether or
not a person is willing to shiver; nor
does it make sense to discuss whether a
person is willing to become depressed.
5. Insight. One always knows why one
is switching the central heating on, but one does not always know why one
is shivering. It could be cold, but it could be fear or sexual desire.
One's attitude might be, "why is my body shaking like this?" In the case of yielding, one knows why one is
submitting, but one does not know why one is depressed. In the case of the wife who gives up
her job because she is driven into a state of depressive yielding, she probably does not realise that it is her husband's nagging which has made her ill, and nor, probably,
does the husband; in fact, they are likely to attribute her incapacity to
"the change" or the Pill or to
'flu or to myalgic encephalomyelitis, etc.
This lack of insight into
causation is one reason why depression is such an effective
yielding strategy; if one doesn't know what it is due to, it is
difficult to do anything about it.
6. Directedness. Shivering is not
directed, whereas "switching on" is directed towards the objective of
raising the temperature. Voluntary submission has an object, one submits
to someone or something. Depressive yielding has no object. More
technically, depression signals low absolute RHP;
it is not associated with an increase in signals of unfavourable relative RHP.
The observations of Schelde (ASCAP, February,
1991) are important here; his depressed
patients were high on passive yielding but low on active submission. Possibly this lack of
active submission makes it difficult for critics to take the yielding
hypothesis of depression seriously.
Causal relation between the voluntary and
involuntary response
We should note that the relation between
"switching on" and shivering is not symmetrical. Switching on prevents
shivering, but shivering does not
prevent switching on; in fact, if
anything, it facilitates it - the
shivering man is more likely to switch on than the non-shivering man. Do the same relations
hold between depressive yielding and voluntary
submission? Certainly, voluntary
submission pre-empts depressive yielding, as in the case of the wife who decided
to give up her job, and thus stopped the
husband's nagging and the depression it would eventually have caused.
But does depressive yielding facilitate
voluntary submission? On the one hand, the mood of
"giving in and giving up" which is characteristic of depression would seem to do that; as Shand said (1), "sorrow abates pride". On the other hand, depression
does not seem to facilitate
"directed submission" in the sense of flattery, flowery
speeches of submission, or even the task
of going out and finding someone to submit to.
Returning to the wife who worked, let us say that she became depressed due to her
husband's nagging, but was not yet sufficiently depressed to be unable to work. Then the depression might
well facilitate her passive
submission to her husband's wishes. She might say, "Oh, all
right, I'll chuck
it in, I'm really past caring." Her
loss of interest (in the job and the feminist cause) and her reduced
self-esteem (about her worth as an
employee) would also facilitate the giving up. But this would still be voluntary
submission, albeit facilitated by the depression, in the way that switching on was facilitated by shivering.
An
example of depressive yielding facilitating voluntary submission can be seen in the film The St. Louis Blues
about the jazz composer W.C.Handy, and in The Last Chronicle of Barset by Trollope; and depressive yielding not leading to voluntary submission is
depicted in the film Rustler's
Rhapsody and in Whip Hand by Dick Francis.
Are depressed patients likely to be in a
posture of voluntary submission?
Are depressed patients likely to be in a
state of voluntary submission, or are they, as Bibring
(2) says, people who are clinging on grimly to unrealisable
goals? The answer is not
straightforward, and depends very much
on one's sampling - it is similar to the question, are shivering people more or less likely to have the
heating switched on? Shivering people consist of different
subgroups: those who have decided not
to switch on, those who have switched on
recently and have not yet felt the
benefit, and those who have tried to switch on but whose central heating does not work. Likewise, depressed people are
likely to consist of those who have
decided not to submit, those who have submitted but whose depression still has some momentum of its own
which needs to "run its
course", and those who have tried to submit but whose submission
was blocked for some reason. On the
whole people at the onset of depression are likely to be non-submitters, in
the way that people at the onset of
shivering are unlikely to have switched on; whereas at the end of a depression they are more likley
to have submitted, in the way that people
stopping shivering are likely to have switched on. People with very chronic depressions who reach the
psychiatrist are likely to be people of
such overweaning pride (or such great anger,
as Leon points out) that they will never
submit (Bibring's cases) or people who cannot submit,
because they cannot physically produce
the goods.
Yielding decision and yielding task
In the case of the woman working, either
voluntary submission or depressive yielding will achieve the end-point of
her not working and thus cut off the husband's
nagging. The woman may decide to submit, and her task is merely to refrain from working. But what if
the husband's requirement is that she should go to work? Then she not only has to submit to his
wishes, but actually
to carry out the task of getting a job. She may not be able to get a job, and so even if she makes a
decision of submission, she may not be able to carry out the submissive task.
And continued nagging, by making her depressed, will make it even more
difficult for her to carry out the task,
even if it helps her to make the decision. The same applies to other yielding tasks,
particularly those over which there is no voluntary control. If the husband is nagging because
she does not respond to him
sexually, then neither form of yielding is available to her
(unless she is a very good actress, and
even then she cannot simulate the physiological
components of the sexual response);
in fact the depressive yielding, by
reducing her libido, actually makes voluntary submission more difficult.
In such a case, the husband may not be aware that he is angry at her because of the
lack of sexual response, and she may not be aware that she is depressed because he is nagging. The seeds
of chronicity have been sown, and a final referral to Dr Bibring is more than likely.
If
I may be allowed to return rather pedantically to the temperature control model, we can distinguish
between the decision to switch on the
central heating and the task of manipulating the switch. Even if the decision is made,
the task may be impossible because the switch is faulty; then, if switching on is delayed, the onset
of shivering may make the task of
switching on even more difficult because of reduced manual dexterity.