The Black Hole of Depression

scream faceRecently, a fellow HSP blogger raised the question of whether knowing one is an HSP might make depression a little easier to handle. In other words, could knowing you are an HSP help you to take a step back and become conscious of your own reactions and needs, instead of automatically acting them out?

The Thinking Cure

But are depressed people capable of that? If the problem is that your brain doesn’t work correctly, can you think your way out of that… with your brain?

That’s the question I’ve always had about cognitive therapy, despite the high ratings it garners in research. As I understand it, cognitive therapy teaches you to take a step back and become conscious of your thoughts and feelings, instead of automatically acting them out, much like the depressed HSP described above. That could be helpful to a mildly depressed person with enough detachment to observe thoughts and feelings, if in no other way than to help them recognize that treatment is needed. As anyone with a depressed family member or partner can tell you, that’s no small thing.

However, during more intense depression, you feel so bad all the time that it’s impossible to conceive of feeling any other way. Your brain churns out worst-case-scenarios for every actual and potential action and interaction in your life, non-stop. There’s no quiet island above the roiling seas from which to pause and check out the big picture. You’re too busy paddling desperately with all your energy just to keep your head above the waterline.

woman in the waves

Life in the Vortex

I was clinically depressed in varying degrees for about 40 years. My depression was partly SAD (Seasonal Affective Disorder) and partly a not-so-optimal childhood, aggravated by periodic situational stresses. I knew I had SAD, and that it was a form of depression, but I didn’t understand what depression was, so I had no inkling of how – and how much – it was affecting me. I think a whole lot of depressed people are in the same boat. It’s just criminal that we don’t ditch the stigmatization and get the word out to prevent that. A $300 light box changed my life, after decades of mostly preventable anguish. How many other people are suffering needlessly? It’s inexcusable.

Most depression diagnostic criteria share a fatal flaw: they compare the depressed state to a presumed pre-depressed state. This is utterly useless for people who are chronically or severely depressed, who either won’t be able to recall a happier state, or may never have experienced one.

That was me. I didn’t have a clue how bad I felt, since I had nothing better to compare it to. Yet on some level I sensed something was wrong. I found many reasons to explain to myself why I seemed less functional than other people, but none of them was quite satisfactory.

ladder against a wall pink-brownI see now that this was protective denial. If I had been conscious of how bad things really were, with no prospect for improvement, I couldn’t have continued to live. But I think I must have an exceptionally strong survival instinct. My brain found a way, and hid the magnitude of my pain from me until I finally stumbled upon the explanation that not made only sense, but offered hope.

Getting Situated

My fellow blogger had a very different experience of depression, as a one-time episode during a period of extreme stress. In other words, situational depression. I had always been a bit skeptical about situational depression, since the depression I experienced could find the cloud in any situation, no matter how shiny the silver lining. Then again, the next day, the very same situation might seem fine – that’s the emotional landlessness that is depression.

However, I believe her description of her experience, and it’s gotten me thinking. She is an HSP extrovert. Could being an introvert actually make depression worse, not because of whether or how introverts socialize, but because they process things more deeply? Is it possible that introverts are more prone to chronic depression, while extroverts are more likely to have one or more discrete episodes? I would love to see some research on that (and I don’t mean “Big 5” research in which people with “low extroversion” are assumed to have “high neuroticism” because extroverted sociability is – literally! – the definition of happiness).

What Emotions Are For

thinking man interesting pointHere’s my theory of depression: so-called “negative” emotions exist for a reason. Fear makes you run, anger makes you fight back, sadness makes you slow down and turn inwards. When the brain is working as it should, “negative” feelings are stages of a process, impelling you to take action, reconsider your perspective, or take time to heal. Once that stage is completed, the emotion transforms or fades.

Depression blasts that process to smithereens. “Negative” emotions are generated randomly, producing equally random behaviors. The emotional switch is stuck on high, or fluctuates wildly, playing havoc with all sense of reality and identity.

Depression and the Highly Sensitive Person

I’ve seen a lot of obviously (to me, and doesn’t 40 years make me an expert?) depressed people posting on various HSP forums. Elaine Aron tells us that we are more prone to depression than the general population IF we experienced childhood neglect or abuse (but also more prone to thrive with reasonably good parenting).

Intriguingly, in at least one case, being an HSP makes a major difference in the effectiveness of depression management. According to Michael Pluess and Jay Belsky’s 2012 paper, Vantage Sensitivity: Individual Differences in Response to Positive Experiences (pg.6/906), a depression prevention protocol administered to 166 high-risk British schoolgirls was effective only for the girls who scored in the top 3rd of the HSP scale.*

square_peg_round_hole_sml_narrowWhen I first heard about this research, it blew my mind. We can’t know without additional research whether this particular program would have a similar effect for boys and adults who are HSPs, as the study subjects were all 11-year-old girls. We also can’t assume that being an HSP is a crucial factor for other depression prevention protocols just because it was for this one. But what if it is? Potentially, all previous research into depression management that doesn’t differentiate between HSP and non-HSP subjects needs to be done over again.

Depression and Going Deep

Getting back to our original question, I’m inclined to think that deeper brain engagement would make anything beyond mild depression worse. Since depression is by definition (in my experience, anyway) a state of mental and emotional processes gone haywire, deeper engagement with that state is the last thing a depressed person needs. However, I’m still a little hazy on whether my brain engages more deeply because I’m an HSP, or an introvert, or both, and whether there’s a difference in the kind of engagement experienced by introverts vs. HSPs.

question marksThe more I think about this, the more questions I have. If there’s a difference of quality, as well as quantity, of engagement between introversion and high sensitivity, what does that mean for people who are one or the other, but not both? Does the double engagement make depression harder for HSP introverts than for non-HSP introverts? Or does HSP insight help? Are HSP extroverts more self-aware than extroverts who aren’t HSPs, or are they more burdened by the impact of depression on the interactions that energize them?

Obviously, it is essential to differentiate between introverts and extroverts in future depression-related research, as well as between HSPs and non-HSPs (hopefully in a more introvert-positive way than by describing introverts as “low extroverts”).

This Post is Historical

I should probably wrap things up by reminding myself and my readers that 20% of 7 billion is a lot of people. There are many other factors besides being HSP/not that influence personalities. That goes double and a half for the 50% of 7 billion that are introverts.

cosmic compassStill, the lack of visibility these particular distinctions have had in all forms of research, not just psychology, is a huge, elephant-in-the-room-sized flaw. It’s exciting to think how much there could yet be to discover in education, communication, sociology, and particularly in political science, where new insights and approaches are desperately needed.

When I became fully conscious of my depression in the late 1990s, I was grateful not to be grappling with it 50 or 100 years earlier, when I might have been shunted away into a nightmare institution for life, or subjected to horrendous treatments like high intensity electric shock or (shudder) lobotomy. Instead, I was able to check out the research, identify and purchase helpful products and supplements, and form an online peer support group with an international membership.

I am equally grateful to become conscious of being an HSP/introvert at this particular point in history. Thanks to the popularity of Susan Cain’s book (I don’t mean to give her all the credit – others had been talking about HSPs and introverts for years, but it’s obvious that Quiet was the perfectly-timed spark), there is a LOT of conversation going on about this now.

Let’s keep talking.

* Unfortunately, we can’t learn more about exactly what the girls were taught, as the study hasn’t been published yet. Here are authors/titles for the two articles about it that are under review.

Pluess, M., & Boniwell, I. (2012). High sensitive personality moderates responsivity to positive effects of a school-based resilience-promoting intervention.

Pluess, M., Boniwell, I., Hefferon, K., & Tunariu, A. (2012). Evaluation of a school-based resilience-promoting intervention in a high-risk population in England: A controlled mixed methods trial.

UPDATE: The report on this study has now been published, and you can download the full article by clicking on the link below.
Sensory-Processing Sensitivity predicts treatment response to a school-based depression prevention program: Evidence of Vantage Sensitivity

5 thoughts on “The Black Hole of Depression

  1. I agree that with severe depression, the answer is much more complicated than to “step back and become conscious of your thoughts and feelings.” From my own experience, becoming conscious, during severe depression, that I was separate from my thoughts and feelings was marginally helpful. However, then I was left with being cognizant of terrible feelings that aren’t going away. It isn’t as simple as “thinking your way out of it,” but I do think being conscious that you are separate from those thoughts and feelings is an important step. And it’s interesting to think about depression being different for an HSP versus a non-HSP…lots of mysteries.

    • You have put your finger right on my concern about cognitive therapy (or as I call it, The Thinking Cure): Understanding that one’s feelings are shaped by depression does not necessarily change them one iota. In my experience and observation, depression is first and foremost an emotional condition, so failing to improve how people feel is a failure to effectively treat depression. I have discussed this at greater length elsewhere (Are You Happy Now?).

      There are certain personality types that tend to identify exclusively with their thoughts, and, when they are dysfunctional, to simply repress or deny any feelings to the contrary. I’m sure we have all run into such people at some points in our lives. I can see how The Thinking Cure would appear to work beautifully for them (and in the eyes of researchers and practitioners with the same orientation), while in fact it was having no impact whatsoever. This is a problem.

      I don’t mean to single out this form of dysfunction as any worse than any other psychological misconception – every personality type has its own version of dysfunction. However, it’s reasonable to assume that the thought-identified personality type is over-represented in the thought-identified academic world. It’s also apparent that many people are drawn to the study of mental health-related fields because they are searching for their own answers. I am concerned that the conjunction of these two influences has produced a skewed assessment of the effectiveness of cognitive therapy for the overall population.

      The more we learn about personality types, the more likely it seems to me that a one-size-fits-all approach to the treatment of mental disorders is fundamentally flawed and outdated. Instead, personality testing needs to happen in the research phase, so we are never assessing what works (or doesn’t) without also knowing for whom.

      • You write so articulately about this issue. I have long been concerned about “Positive Psychology,” which I think is related to The Thinking Cure. It’s the idea that simply changing your thoughts or practicing gratitude will be enough to fix a brain chemistry imbalance. The points you bring up have troubled me also: that depression is an emotional disorder, and while that is related to thought, the thoughts are not necessarily the origin of the emotions. So we need to address the emotions at their roots, and be honest about them. “Positivity” to me encourages dishonesty about feelings, or not truly looking within. It has also made me feel ashamed of my negative feelings, and when the feelings do not change when I think positively, I feel deficient. I also have no doubt that many mental health care providers, and writers of studies, are indeed searching for their own answers, and this may influence their research. Would you possibly be willing to do a guest blog about this topic on my blog at some point? I would be honored! If not I completely understand.

      • I couldn’t agree more about the risks of “positivity.” All too often, it becomes a standard, with all the baggage of judgment – of self and others – that behavior standards can beget.

        I do believe that thoughts can influence feelings – in a healthy brain. In a brain that is fully functional, I believe thoughts and and feelings influence each other in a constructive, dynamic way that ultimately results in finding the best balance between the two for the feeler/thinker in any given situation.

        But in a chemically disabled brain, thoughts and feelings are far too likely to feed each other in an endless, descending loop of pain and anxiety. The distinction between a healthy brain and a disordered one is so important, and almost never mentioned in discussions of “positive” thinking. The assertion that thought can fix depression is rooted in the assumption that depression is volitional. That assumption kills people.

        All of that said, I do think research about brain plasticity (i.e., that you can “exercise” your brain into certain channels) holds some promise for depressives. However, an essential (and often overlooked) prerequisite for the treatment of any medical condition is that people with that medical condition are able to do that treatment. If they can’t, no matter how helpful the treatment would be if they did, it is not a good treatment for that condition.

        Light therapy for SAD is a perfect example. Light therapy, when done regularly and correctly, works pretty well for most people with winter SAD – better than prescription medications. The problem is, it’s very difficult for depressed people to do anything regularly, even when they know it will make them feel better. And then they feel bad about that.

        Furthermore, depression messes up memory and judgment, so even those who do their light therapy often don’t do it correctly (don’t use the right kind of equipment, don’t sit close enough to it, don’t do it for long enough, don’t do it daily, decide in the face of all research and logic that spending 20 minutes a day in a car in a cloudy climate is a reasonable substitute for light therapy, etc.). So IS light therapy such a good treatment? I would say no, at least not without additional elements (like inpatient or other live-in supervision). If it were, SAD wouldn’t be a problem anymore, would it?

        I’m honored by your invitation to guest blog on 2mostrareaffections, but I wonder if it wouldn’t be most interesting to our readers if we did a dialogue? I so rarely run into someone else with similar experiences and perspective on these subjects. I have an idea about how to do that – drop me a line on my Contact page.

      • You are right–“The Thinking Cure” fails to distinguish between a healthy brain and a disabled brain. The implication that a disabled brain could somehow think healthy thoughts–enough to make itself better– implies volition. And I do believe you are right–people die because of our culture’s belief that mental illness is a choice. Also, I did send you a contact message, and I’m looking forward to hearing from you.

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