ASCAP July, 1990
The yielding hypothesis of depression
Readers of ASCAP will be familiar with the
hypothesis that depressive
states evolved as part of the yielding component of ritual agonistic behaviour. The hypothesis has been outlined
and examined in other
publications, here summarised:
1. One of the basic plans of vertebrate social
organisation is asymmetry
between conspecifics of the same sex. This social asymmetry tends
to be manifested
as hierarchical rank or territorial ownership/non-ownership, or both. Some form of social asymmetry was
predicted by
2. The social asymmetry is usually produced by
ritual agonistic behaviour,
which consists of threat, fighting, escape and submission.
3. The losing or yielding behaviours of escape
and submission can usefully
be thought of as consisting of two components: an action component and a message component. The action component
consists of not fighting back, and of desisting from whatever the
original fight was about; the
message component consists of informing
the opponent that one does not intend to
fight back. In the case of escape, the message is conveyed by the act of fleeing; in the case of submission, the message is
conveyed partly by the cessation or
absence of fighting, and partly by the emission of specific submissive signals.
4. In social primates yielding consists of
submission more than escape,
and the very existence of the group depends on effective
submission by subordinates, who, in
spite of being in full health and strength, and
sometimes in spite of having enjoyed social dominance in the past, may
have to remain for long periods in a
state of behavioural inhibition, particulalry in relation to social and sexual objectives.
Therefore,
underlying the repertory of
"voluntary" submissive behaviours, there is an involuntary form of yielding which I will
call depressive yielding, and which may
be switched on whenever voluntary yielding is ineffective, thus acting as a safety net or fail-safe mechanism
to ensure that some form of yielding
occurs. The relation between depressive yielding and voluntary yielding is similar to that between
shivering or vasoconstriction on the one
hand, and putting on warm clothes or switching on the central heating on the other hand.
5. Depressive yielding may be acute or chronic.
In the chronic form, which characterises
those individuals who never achieve territory or high social rank, and cannot accept this fate
"voluntarily", it consists of
depressive neuroses or personality disorders characterised by low self- esteem,
fatigue, anxiety and indeciciveness. In the acute
form, which occurs
in individuals being pushed down in rank, or having attempts to rise in rank thwarted, it takes the form which we
recognise as depressive illness.
6. The depressive yielding reaction evolved
because it permitted
individuals to remain group members during periods when the
social situation was unfavourable to
them. Those who did not have the capacity for depressive yielding were killed or
driven from the group.
7. Ritual agonistic behaviour is so widespread
in the vertebrate sub- phylum that its underlying mechanisms may well be
homologous, in which case
the depressive state in humans may share the same neurochemistry
as yielding reactions in animals such as
the defeat state described by Henry et
al. (1986).
8. The implication for therapy is that we
should look for relationships in which the patient is losing but is not
yielding voluntarily. He or she should
be encouraged to settle the cause of the conflict by peaceful means; or, if that is not possible, to bring the
matter to a conclusion, which he might
do in a number of ways, such as by conquering, by submitting or by escaping from the relationship. This approach
is not included among
current psychotherapeutic models of depression. Of course, we
must bear in mind
that our patients are men and not monkeys, and that the conflict may be in a symbolic rather than a personal
relationship. C.S.Lewis in The Problem of Pain proposed
that the function of depression is to enable man to submit to God, and to take the difficult
step of abandoning the attitude:
"My will, not thine, be done." Many avenues of human "salvation" such as cult
membership are based on voluntary submission, often in extreme form (Gallanter,
1989).
9. Like other evolutionary hypotheses, and like
the theory of evolution by
natural selection itself, the yielding theory of depression is
not refutable and is therefore not
strictly scientific in the Popperian sense. However,
the hypothesis has heuristic value in two other senses: first, it draws attention to relationships which
might otherwise be overlooked; and, secondly, it gives rise to directly testable
hypotheses.
Both
these features of the hypothesis can be illustrated by the case of research on the
expression of hostility in depression. The hypothesis draws attention to the
relative rank of the patient and the object of the hostility as a potentially important variable
in this field, a variable which has not
been considered in any of the many published studies on the expression of hostility in depression (Price,
1968). If depression is seen
in the context of social ranking, we become aware of the fact
that for any group-living primate, there
is all the diference in the world between an act of hostility expressed up the hierarchy
and a similar act expressed down the
hierarchy; therefore a patient who
expresses hostility to his boss cannot
be considered in the same category as a patient who is hostile to a subordinate or to his child. It was also
possible to derive a
prediction about the expression of hostility in depression: that, if
depression occurred in a partner to a marriage which had developed complementarity along the
dominance/submission dimension, the expression of hostility to the spouse would be increased if
the depression occurred in the dominant
spouse but reduced if the depression occurred in the subordinate spouse (Price, 1968).
Problems with the hypothesis
Although the hypothesis has face value in that
it accounts well for the
"giving in and giving up" mental state of depressed
patients, there are several problems
which have prevented the hypothesis from influencing our thinking about depressive states and so from
assisting in obtaining funds for research
into them. These problems, it could be argued, are due to the very different social environment in
which we now live, compared to the
environment in which depressive yielding evolved and became integrated
with
other hominid behaviours.
Rank order between two human beings of the same sex is seldom determined by ritual
agonistic behaviour (except in places
where society has little control such as the street corner and the
school playground) but rather it is determined
by other group members external to the
dyad. This means that it is unusual for depressive reactions to be directly due to
losing in ritual agonistic encounters (except within the nuclear family, such as between husband and
wife). This may account for the objection that whereas depression is
more common in women, ritual agonistic
behaviour has always been regarded as an essentially male phenomenon,
and was actually classified by Moyer as
"inter-male aggression".
Another objection is that depression tends to be triggered by "exit events"
whereas the yielding hypothesis predicts that it should be followed by "entry events" (someone new to
yield to), but since rank order in man is
so dependent on patronage and alliances, the loss of a loved one is
more likely than the arrival of a
potential competitor to result in loss of
rank.
One
other serious objection, to which I want to devote this essay, is that depressed
patients sometimes appear not to be submissive, and even to use their depression to get their own way.
The depressed patient as yielder
Most writers agree that the basic attitude of
the depressed patient is one
of giving up and giving in. The patient feels inferior and is
inclined to self-effacement.
He is not likely to proclaim his objectives, still less to achieve them. Beck (1976) puts it
well:
"The term "loser" captures the flavor
of the depressive's appraisal of himself and his experience. He
agonises over the notion that he has experienced significant losses, such
as his friends, his health, his prized possessions. He also regards himself as a
"loser" in the colloquial sense:
He is a misfit - an inferior and an inadequate
being who is unable to meet
his responsibilities and attain his goals. If he undertakes a
project or seeks
some gratification, he expects to be defeated or disappointed. He finds no respite
during sleep. He has repetitive dreams in which he is a misfit, a failure." (p106).
Not only does he not get his own way in the
present, he has no anticipation of getting his own way in the future:
"The predictions of depressed patients tend to be overgeneralised and extreme. Since the patients regard the
future as an extension of the
present, they expect a deprivation or defeat to continue
permanently. If a
patient feels miserable now, it means he will always feel
miserable. The
absolute, global pessimism is expressed in such statements as
"things won't ever work out for
me"; "life is meaningless....It's never going to be any different." The depressed patient judges
that, since he cannot achieve a major goal now, he never will. He
cannot see the possibility of
substituting other rewarding goals. Moreover, if a problem appears insoluble
now, he assumes he will never be able to find a way of working it out or somehow bypassing it." (p117).
Thus, whether or not his objectives conflict
with those of others, the
depressed patient is not in a mood to realise them, and we could
say that his mental state was ideally suited to a strategy of not getting his
own way.
The depressed patient as non-yielder
However, various views have been expressed
which conflict with the idea
that depressed patients accomodate
themselves passively to the wishes of
others. Freud (1917), in his classic paper Mourning and Melancholia,
wrote of his
depressed patients:
"They are far from evincing towards those
around them the attitude of
humility and submission that alone would befit such worthless
persons; on the contrary, they give a great deal of
trouble, perpetually taking offence and
behaving as if they had been treated with great injustice."
Fenichel (1983) wrote:
"The depressed patient, who seemingly is
so extremely submissive, is
actually often successful in dominating his entire
environment." (p116).
Bibring (1953) wrote:
"It is hardly necessary to discuss the
conscious and unconscious secondary gains which many patients derive from
a depression. This may proceed on the external as well as internal
level. By demonstrating their sufferings they try to obtain the
"narcissistic supplies" which they need, or they may exploit the depression for the justification
of the various aggressive impulses
towards external objects, thus closing the vicious circle." (p46).
In his
reconsideration of Szasz's Myth of Mental Illness Birtchnell (1989) raised the issue of whether or not
psychiatric patients get their own way. Szasz used words like "domination" and
"coercion" to describe their behaviour. Hooper et al. (1959),
commenting on their intensive study of marital interaction, wrote that
"it is possible to see the whole
depressive stance as a massive attempt to exercise control over the
marital relationship".
In the
clinic and the psychiatric ward it is not uncommon to encounter instances in which depressed patients
do not yield as easily as one might expect. Sometimes, in clinging to
depressive but grandiose delusions, such as that they are responsible for all
the suffering in the world, they refuse
to be persuaded by the opinions of others. Some "stubbornly" decline to be
treated with ECT or even with drugs. Nurses often regard the depressed appearance presented at ward
rounds as "put on" for the sake of
the doctors in order to avoid discharge or some other undesired outcome.
Relatives may also regard depression as a form of manipulation. Recently
I treated a couple who used to spend alternate weekends with their respective parents. The wife's
depression tended to be worse when the time came to visit the husband's
parents; she was too depressed to
prepare herself and too anxious to make
the journey so that often they cancelled
the visit. She enjoyed visiting her own parents and visits there were seldom
cancelled. She was getting her own way in visiting her own parents and avoiding visiting her husband's
parents. In another case the husband wanted to move house to be nearer his
work, but the wife wanted to stay where
she was; in the end they stayed, because
the husband felt that to move away from
her few friends would make his wife even more depressed.
Do depressed patients wield paradoxical power?
Recently Michael McGuire made some relevant
comments. Introducing a
session entitled "Evolution of mood and anxiety" at the
1988
"The second issue deals with affect as a
form of manipulation. While this may be minimally apparent among those
persons considered to be "normal",
the use of affect as a manipulation "tool" often seems
apparent among persons suffering from
psychiatric disorders. To the degree that we encounter persons who are
"effective affect manipulators" -- that is, they get us to change our behaviour -- we also
encounter a potential paradox. Effective affective manipulation presupposes
that the manipulator is
capable of accurately "reading" how others will respond
to particular affects. This possibility
is not easily reconciled with what we assume when we encounter persons with
psychiatric disorders".
McGuire is making the point that to use one's
depression to manipulate
others requires social skill, whereas lack of social skill is
part of the impairment of function which
characterises the deregulation of psychophysiological systems in depression (McGuire 1988).
Ethological studies of depressed patients have concentrated on speech and non-verbal
communication and they have not addressed themselves to the outcome of conflict or the reaching of
contested decisions. The simple question
"Do depressed patients get their own way by virtue of being depressed?" cannot be answered from
available data, and therefore it seems
excusable to make a foray into theory and see if the problem can be reformulated in such a way that the paradox
described above is resolved.
The agonic and hedonic modes
It is useful to distinguish between situations
in which a group or dyad is oriented
towards agonistic behaviour on the one hand, and those situations on the other hand in which it is oriented
towards sexual, nurturant or affiliative behaviour or to the performance
of some task. In a number of
publications, recently summarised, Chance (1988) introduced the concept
of the agonic mode for a group which was
oriented towards fighting (even if no
fighting was taking place) and he pointed out that this mode affects
a number of behaviours of members of the
group, such as cognition (especially the
type of interpersonal evaluation which is undertaken), attention, physiology and muscular tension; if this mode is prolonged the members
are liable to stress disorders and
depression. In the hedonic mode, on the other hand, there is no orientation
towards fighting; the members are relaxed and their attention is free to
undertake learning, tasks and
constructive thought. Chance gave the rhesus monkey as an example of a species which
operates in the agonic mode, and the chimpanzee as one which favours the hedonic mode (because fights are
followed rapidly by reconciliation). It
is clear that man combines both agonic and hedonic tendencies, and that a human group or
dyad can switch rapidly from one mode to
another. An act of behaviour does not necessarily have the same meaning in the two
modes; for instance, another person escaping from oneself may be rewarding in the agonic mode but aversive in
the hedonic mode.
(script
part 2)
According to the yielding hypothesis, depression as yielding behaviour evolved in
relation to agonistic behaviour, and therefore it makes no predictions about who gets their own way in
relation to sexual behaviour, nurturing
behaviour, affiliative behaviour, etc.
Of
course, the agenda of the agonic mode is very conspicuously concerned with who gets their own way. Fights
for territory and dominance rank are
dedicated to setting precedents and rules which determine who gets
their way in the future, not only in
matters of rank but in "hedonic" matters such as feeding and sleeping. Moreover, when
a conflict of interest arises between two individuals in the hedonic
mode, the dyad may switch to the agonic
mode to sort it out, a process which Heard and
Signals as manipulation
Almost all signals can be seen as an attempt on
the part of the sender to
manipulate the receiver (Krebs & Dawkins, 1984). This is
particularly true of
agonistic behaviour. When a dominant monkey stares threateningly at a subordinate, the
latter is usually being manipulated into not doing something that it wants to do, like mating,
eating or occupying a certain place. It
is less obvious that a subordinate monkey is manipulating the dominant when it gives a submissive
signal; the manipulation is in a
very limited area, serving only to force
the dominant to stop attacking.
Submissive signals cannot force the dominant to
yield rank or territory. It is interesting to note that submissive signals may
be manipulative
whether they are rewarding or aversive. Most submissive signals are probably
rewarding to the recipient, but the chimpanzee has developed the infant's distress call into its submissive
repertory, and this call is appears to
be so aversive to adults that they are quick to acknowledge the submission by giving signals of reassurance
(Goodall, 1986).
In the
domain of nurturing behaviour signals are also manipulative. The gaping mouth of the young cuckoo
drives its foster-parents into a veritable
slavery of food collection. The human baby's cry forces the parent to take some action,
hopefully to feed or change it, sometimes to batter it. Much childish behaviour is designed to
coerce the parent into protecting,
feeding or in some way caring for the child. The same applies to sexual and
affiliative behaviour.
From
the above argument, we would predict that depressed patients would fail to get their own way in the
agonic mode, when by definition the dyad
or group is oriented towards agonistic behaviour (Chance, 1988); but would
get their way as much or as little as anyone else in the hedonic mode,
when the group is oriented towards
non-agonistic behaviour such as nurturant, sexual or affiliative behaviour. This does
not quite answer all the
objections, because there is an impression that depressed
patients get their own way more than
others, and that they actually use the depression to get their way.
I
think the answer to this is that submission tends to be expressed
as a metaphor, and the metaphor may
involve non-agonistic forms of behaviour. If we want to convey the message
"I am weaker than you", human beings can
simply say it, but without
language it is quite a difficult message to get
across. It must be coded in symbolic form, and it is not surprising if evolution has used
symbols which are correlated with weakness;
and in order to find suitable
symbols it has had to trespass on the hedonic mode and borrow metaphors based on childish
behaviour or female behaviour. The message then transmitted in the agonic
mode is, "I am just like a child (or
a woman) and not worth bothering about;
ignore me, I am no threat to you."
But, at the same time, the message may retain its hedonic meaning which is "Pay
attention to me, I am a child in need of nurturing (or a woman in need of loving)" and this hedonic message may
be responded to as well.
Metaphors of submission
Let us first consider metaphors involving
nurturance-eliciting behaviour. In most animals agonistic behaviour and
nurturance-eliciting behaviour are quite separate, reflecting the fact
that they are parts of separate
biological systems, performing different functions, and presumably subserved by
different brain mechanisms (Gardner, 1988; Gilbert, 1989). But in the wolf (and
in the rat) there is overlapping. In the wolf, the nurturance-eliciting behaviour of the
puppy has become ritualised as a
submissive signal. The defeated and submissive adult wolf rolls over on its back and
exposes its belly to the dominant animal, in the way that the puppy presents its perineal area to the
parent asking for it to be licked clean
(Eibl-Eibesfeldt, 1970). The recipient of this signal
stops attacking,
but it does not do any cleaning:
the exchange of signals has been
sufficiently ritualised for the nurturant response of
cleaning to be dropped from the
sequence.
The sickness metaphor
During human evolution the nurturing of sick
adults has become part of our
instinctive behaviour, possibly
derived from the nurturing of children. Unlike the wolf, we do not respond
favourably to adults behaving like children. But we do respond
protectively to adults who are sick. It was Alfred Wallace, who with
"He thought that once natural selection began to foster in those protomen reason and sympathetic feelings (especially moral
sentiments which led them to care for their unfit brethren), selective
pressures on their physical structures would cease." (italics
added)
It
seems likely that whereas childish behaviour has become ritualised as a metaphor of
submission in the wolf, "sick role" behaviour (Pilowsky, 1988) has become ritualised as a metaphor of
submission in man. The basic
vertebrate depressive yielding reaction has come in our species
to be expressed, sometimes, in the
metaphor of "sick role" behaviour (Price, 1988b). Therefore it is not surprising that
many depressed patients both
present themselves as, and feel themselves to be, physically ill.
Sometimes the metaphor is so pronounced that depression appears secondary and a
diagnosis of hypochondriasis or somatisation disorder
seems appropriate.
In the
agonic (coercive) mode (Chance, 1988) depressive behaviour conveys the message "I am no
threat to you" and as a manipulation it has the limited effect of stopping the attacks of
conspecifics. In the hedonic
(affiliative) mode, and in the context of a caring relationship,
it elicits the same response as other
forms of sickness behaviour;
namely, nurturance. It may be
that the hysterical patients discussed by Szasz have the capacity to
adopt the sick role by means of conversion symptoms, possibly before the pressures of life get
intense enough to make them depressed.
In either case their principle message is, "Stop attacking me, I am out of
action". Of course, like any other sick people they can exaggerate their signals and become
tyrants of the sick room; although
in that case their empire is very
limited, and does not lead to the
acquisition of rank or territory in the main social arena; they are only
getting their way in the hedonic mode, not in the agonic mode in which
rank and territory are determined.
If
Wallace was right and we have an evolved tendency to nurture sick relatives, it may well be that this tendency
is only elicited by apparent physical
illness, whereas incapacitating emotional states such as depression are perceived in other terms such
as laziness or even rebellion (in the
form of failure to carry out allotted tasks). To think that one's submissive signals were being
interpreted as rebellion would be very
anxiety-provoking, and this anxiety may underly
the strong motivation of patients with,
for instance, myalgic encephalomyelitis, to be
categorised as physically ill. Probably
it is only in our sophisticated, psychiatrically oriented Western
society that depressed patients present
themselves as emotionally ill; in
other cultures the somatic symptoms of
depression tend to dominate the clinical picture, and depressed patients
are perceived, not only by themselves and by relatives, but also by their doctors, as physically ill.
Other metaphors of submission
Both the wolf and man have evolved metaphors of
submission using care- eliciting behaviour;
in one case the submissive individual presents himself as a child/puppy, eliciting parental
care, in the other he presents himself
as a sick person, eliciting the instinctive care which in man is given to sick relations. Perhaps this
connection between submission and care-eliciting behaviour may be set in
perspective by considering a metaphor of
submission which has evolved in monkeys such as macaques and baboons and which is not related to nurturance.
Whereas the submissive
wolf says, "I am like a puppy to your adult", the
submissive monkey says, "I am like
a female to your male." He (or she)
adopts the female form of
sexual presentation, following which the dominant monkey gives a
brief ritualised version of the male
sexual response (mounting). Here the submissive metaphor elicits sexual
rather than nurturant behaviour, but as with nurturance, we could say that the
subordinate monkey is coercing the
dominant monkey to switch from the agonic (coercive) mode to the hedonic (affiliative) mode. Some monkeys may use a
dermal metaphor of submission, conveying the message, "I am pale
to your bright" (Price, 1989b).
Another metaphor of submission uses the "vertical dimension" of directiveness/receptiveness
(Birtchnell, 1987). This occurs in man, monkey and wolf, and is probably widespread
among vertebrates. The submissive individual says, "I am like a
small person to your big person." Various forms of
crawling, crouching, cringing and prostration express this metaphor. This metaphor is not drawn from
another category of behaviour, and therefore there is no specific
response by the dominant individual, equivalent to the mounting or the
nurturance elicited by the other
metaphors. Therefore in using this metaphor the submissive individual does not appear to be
coercive, except in so far as the other is coerced into stopping his attacks.
Having
considered some (possibly not all) of the submissive metaphors which have evolved in vertebrates, it
might be instructive to consider one
which has not evolved and the reason for it. No human beings use the metaphor "I
am an animal to your human being". Nor, to my knowledge, does any other
species use such a metaphor. One could imagine, for instance, among the Canidae,
the submissive individual using the metaphor of another, "inferior", species, such as
"I am like a lamb to your wolf."
This has not
evolved because submission is a component of agonistic behaviour
which is ritualised, whereas
relations between species are typically unritualised, especially when one species is the prey of
the other. Therefore to use
this metaphor would be to risk losing the protection from serious
injury which is the adaptive value of
ritualisation in the case of agonistic
behaviour. In contrast to the lack of animal metaphors in submissive behaviour,
they are frequent in aggressive (catathetic) behaviour, and it is common for insults to take the form of
worm, louse, rat, bitch, etc. They are also used for group aggrandisment; for instance, the Christian Dorze tribe has a
belief that leopards are Christians whereas hyenas are pagan, and this supports their belief that
the Dorze are fine people who eat fresh meat, whereas their pagan
neighbours are scavengers like hyenas. Maynard Smith (1988), who quotes Sperber's work on the Dorze,
comments wrily
that the belief does not go so far that the Dorze
shepherds stop guarding their flocks agains leopards on fast days.
Culturally determined submissive signals are recognisable because they
mean different things in different cultures. In
There
is one important difference between the sick role metaphor and the metaphors using
female, childish or diminutive behaviour. The latter occur at quite a "high" level of
the nervous system, so that we might say that
the actors in these cases "know" they are submitting, and
possibly have some voluntary control
over their actions. It is unlikely that the subordinate male monkey thinks it is
female, or the defeated wolf thinks it
is a puppy. But the sick role metaphor occurs at a "low" level
of the nervous
system; it is probably a modification of
the basic vertebrate
yielding reaction, one of
agonistic and sexual inhibition, controlled in
the reptilian brain (MacLean, 1985). Therefore the individual using the sick role
metaphor does not realise he is submitting. He thinks that he is sick.
I am
not saying that the sick role metaphor is the only submissive signal used by depressed patients.
Even the wolf has more than one submissive signal: in addition to the puppy metaphor, and the
vertical dimension (crawling on its
belly), it has a submissive signal in
Patients often describe their depression to doctors in terms of metaphor.
Metaphors and similes of being dead, a hibernating animal, a defeated boxer, a nonentity and
suchlike are common. A recent patient expressed herself as a flat tyre or
deflated balloon: "Normally you
get kicked and you bounce back again,
but I've been kicked too many times in
the same place, there's a hole there and all the air's gone out." These statements are quite different from
the submissive metaphors described
above, in which the patient acts out the metaphorical part. Different again are
the submissive metaphors used in verbal flattery; e.g., "I am a candle flame, you are the sun."
In
conclusion, the fact that depressed patients may get their own way in the hedonic mode
does not negate a hypothesis which states that depression evolved as a losing strategy in agonic
interactions. The very fact that they use a sick role metaphor to
express their submission ensures that they
obtain the care and consideration which is normally given to physically
ill loved ones. Depressed patients are
sometimes said to be attention-seeking, and it is interesting to note the
opposite message about attention which is
given in the two modes. In the agonic mode the message is, "Pay no attention to me, I
am sick and therefore no threat to you."
In the hedonic
mode the message is, "Pay attention to me, I am sick and
require nurturing."
Acknowledgements
I am most grateful to colleagues who have taken
an interest in the yielding
hypothesis of depression and who have discussed these ideas with
me, particularly Michael Chance, Leon
Sloman, Russell Gardner, Jay Feierman,
Paul Gilbert and John Birtchnell.