Depression: The turbulence paradigm

What is depression?

Yesterday’s, text message.

“Dr. Hill,

I’m looking for a therapist to treat my depression. I can’t go on. Everything feels overwhelming. I can’t keep a job, my partner is avoiding me. When I’m out, everyone looks at me like I’m a freak. I’d like to see someone right away. Are you available?”

Does anything in this message ring familiar?

My first reaction is that this person may be experiencing psychic turbulence.

This is in addition to sadness, helplessness, and worthlessness. If so, this could be depression, but it might not be. Either way, can you imagine what the outlook and the typical day of this person might be like?

It’s probably hard for this person to get out of bed, leave home, or face any daily challenge. If this person encounters a challenge or a hassle, they probably feel like the world is crashing in on them. They have no emotional reserve capacity to “steady the ship,” especially when they experience turbulence in the world around them. They may create their own turmoil, such as assuming no one likes them, that they can’t accomplish tasks, or that there is no future. This is a hard existence.

Let’s talk about a client whom I will call Mary. Mary is an amalgam of characteristics of people who would send me a text like the one that started this entry.

Mary is 42 years old, an educated person with a master’s degree in business. She grew up in a home where the parents struggled with their marital issues, so Mary’s needs were not a priority, being the third child with two older sisters.

Mary liked learning. In high school, she was in the top 5% of her class academically, but she was physically awkward, didn’t make friends easily, and was prone to emotional swings. She wanted to study English literature because she enjoyed reading the classics (Jane Austen, William Wordsworth, and Mary Shelley) and had a close relationship with her high school English teacher. But her mother thought she would not get ahead with a degree in English literature, so Mom persuaded Mary to seek a degree in business.

This was Mary’s first encounter with real conflict. “Should I follow my heart or should I make a pragmatic choice that emphasized what Mom thought was a marketable career skill?”

She chose the latter and now regrets it. In her Senior year, she fell in love with a boy, Carl, in what she remembers as a whirlwind courtship. Carl was her soulmate; that is, until she found out Carl was cheating on her and had been cheating and lying to her from the start of the relationship. She never confronted Carl about this. Instead, she broke up with him because she believed that he loved someone else.

Heartbroken, terribly sad, dejected, feeling like she was unlovable, Mary’s distrust of others grew. This set in motion patterns of thinking and feeling that would be a foundation for her worldview. It was:

“A Hostile World View”

Mary’s story helps us frame a theory of depression. What is depression? How does it work? Can you ever get out of a depressive state? Can you ever change a depressive POV?

When I meet people for the first time, they usually don’t feel well. Frequently, there is a reason.

My girlfriend broke up with me. I lost my job. My parents kicked me out of the house. I’m retired and I hate it. I failed an exam.

In Mary’s case, she says she is in a depressive state and she can’t get out. When you believe you are depressed, things happen. You lose your job because you have no motivation. Mary is astute and realizes that things have gone badly for her because she lacks something internal. It’s as if she has lost her drive and is now left with a negative outlook, an inability to bounce back from an adverse life event.

There are three things about a person that, for the most part, don’t change:

• Temperament

• Psychological Energy

• Emotional Liability.

What are these?

Temperament

Temperament is a characteristic or habitual inclination or mode of emotional response (a nervous temperament). There are thousands of studies linking a particular kind of temperament to depression. Take, as an example, behavioral inhibition (or reticence) of a child. This child, no matter what happens to her in life, good, bad, or indifferent, will have a bias towards withdrawal. Withdrawal is associated with rejection, anxiety, and loneliness. People prone to withdrawal or have a withdrawing temperament are likely to experience depression. This is the link between temperament and depression.

Psychological Energy

Psychological energy is latent (or in reserve). It is existing (within-person) energy to act on the environment. When someone asks for volunteers, those who feel the most ready will raise their hands. Does this mean that they are prepared? No. It only means that they think they are ready. People are born with a certain sense of their readiness, and this sense really never changes.

Someone with high psychological energy can be in an almost constant state of readiness. There is the person who comes home, takes his shoes off, flips on the remote, and stays there all night. This is a persona with low psychological energy.

The person who comes home opens the coat closet, gets out the vacuum, and vacuums the rug while his coat is still on. This individual has high psychological energy.

Psychological energy is not good or bad in and of itself; it just is. You are born with an energy set-point that is set at a certain level of readiness, and that set-point stays where it is your whole life. You can certainly push against it, but either way, you will always gravitate back to your original energy set-point.

For evidence, observe how different people approach physical exercise. Some people are quickly activated, seek an opportunity to exercise whenever it is available. Others eschew exercise even though they know it is good for them. Psychological energy is manifest in a readiness to do something.

Mary feels terrible. She says she is depressed. Is she ready to change? Her psychological energy is not known from the vignette.

Emotional Lability.

This is a tricky idea. Think of a radio wave (see the picture below).

If you imagine that the top of the curves are positive emotions and the bottom curves are negative emotions, then the picture becomes clear. All people experience the rollercoaster of emotional ups and downs. It is abnormal if you don’t have ups and downs. This condition is called “Alexithymia” (a-lack, lexis=word, thymos=emotions).

I’ve treated people with Alexithymia. Their complaints are almost entirely physical because they seem unable to feel, experience, or even talk about emotions. People may experience negative emotions, but are not depressed. Depression is different than simply experiencing negative emotions. You may be sad even though you are not depressed. Some people mix this up, and when they do, it can cause trouble.

In my next post, I will introduce the term “turbulence,” which is the active psychological agent in depression. Mary appears to be in turmoil.

The vignette does not indicate whether I can validate that she is depressed. I need to understand the nature and the pattern of the turbulence that Mary is experiencing.