How to Get Depression Right

A recent Psychology Today blog post went viral arguing that maybe depression is trying to “save us.” Grounded in an evolutionary perspective and polyvagal theory, the author, Dr. Alison Escalante, argues that we should see depression as a kind of “immobilization” strategy that makes sense in response to chronic or inescapable threat. I support this analysis. Indeed, I argue here that we should look at things like depression and anxiety first and foremost as symptoms rather than diseases.

Regarding depression, the unified theory of psychology—which combines evolutionary theory, behavioral science, cognitive science, neuroscience, personality and interpersonal theory, anthropology, and sociology in a way that allows us to obtain the proper relations between matter and mind—frames depression much as Dr. Escalante did. Specifically, as described here, here, and here, the unified theory characterizes depression as “a state of mental behavioral shutdown.”

The theory starts with the basic idea that "the mind" is designed by evolution and learning such that it tries to guide the animal toward paths of investment that pay off in terms of needs, drives, and desires. However, those paths are not always attainable for a host of reasons. If one is chronically deprived of achieving one’s goals in a safe or effective way, then the system shifts its frames for investment and engagement. Specifically, it drops the positive emotions that are about desire, engagement, excitement, and seeking, and jacks up the negative emotions, which are about threat avoidance, risk aversion, and conservation of behavioral energy to avoid more failures, injuries, and losses.

If you have been in a depressed state, you know what this feels like from the inside. The positive seeking energy drops such that everything becomes dull and you lose interest in pleasure or exploration. Many also withdraw socially. In addition, everything hurts, especially rejections and failures. And there often is an experience of “turning against the self.” Virtually all the symptoms of depression make sense from this perspective.

The behavioral shutdown model tells us the way we get depression right is first by describing it as a state of mental behavioral shutdown and apply the basic logic of behavioral investment. That is, we consider the situation and the person and their learning and development, and wonder what might be contributing to the shutdown. We can then derive three logical categories in terms of (1) depressive reactions; (2) depressive disorders; and (3) depressive diseases. Depressive reactions are when the shutdown basically makes sense, and it can be understood as a kind of immobilization strategy that Dr. Escalante discusses. This slide offers some ways of thinking about why a depressive reaction makes sense.

Source: Gregg Henriques

Depressive disorders are when the initial reaction makes sense, but then a vicious, maladaptive cycle follows because in part the person's reaction makes things worse. Thus, someone might get rejected by a lover, then feel horrible and go home and sulk and then lie to their boss about being sick and then make posts on Facebook that get them revealed and then they get fired. Then they decide that life has no purpose and/or they are horrible people who should be rejected or maybe just kill themselves. I consider these to be “neurotic” depressions and the maladaptive responses to losses and injury are often the focus of change in psychotherapy (see here).

Source: Gregg Henriques

Finally, depressive diseases are when the immobilization/mental behavioral shutdown is pervasive, entrenched and likely exacerbated by neurobiological structures that are not adaptively responding to changes in the environment. This is more of a genuinely medical or bio-psychiatric condition that can be thought of more in terms of broken biology. I think the best description of this is “melancholic depression.”

Source: Gregg Henriques

In short, yes, we should reframe depression as a state of behavioral shutdown or immobilization and then interpret the reaction in those terms. That might help us learn how to better listen to depression and respond to it in a way that results in adaptive growth.