While depression and anxiety aren’t “all in your head”, a fair bit does take place… In your head. Your mind, let’s say. As such, since the field’s infancy, psychologists have been excavating the depths of the human mind for water holding theories on the how and why of mood disorders. Some have been quite successful, others have found themselves heavily modified, adapted, or discarded.
Many researchers have tried their hand at this problem. I’ll be covering a few of them. These theories are by nature very deep, more in-depth than a simple blog post can cover, so consider this post something to pique your interest in different theories and use that as a base to find an appropriate psychologist/psychiatrist.
We’ll start with the granddaddy of all our theories, Psychodynamic theory.
Psychodynamic theory was famously pioneered by Sigmund Freud (as Psychoanalysis) and is more or less discarded as a whole, though many of his theories have been integrated into mainstream Psychology. Due to Freud’s focus on libido and its role in childhood development/neurosis, Psychodynamic theory has a pretty rough PR image. (Though this was not its greatest area of criticism.) The weird aside, Psychodynamic theory does have a few interesting tidbits to consider in one’s quest to uncover any disruptions in your psyche.
Psychodynamic/analytic theories focus mainly on childhood development and where it may have gone awry. One common theme in Freudian theory on depression (Or Melancholia, as it used to be called.) was that of anger turned inwards. To elaborate still simply, this theory is often within the context of a child treated poorly by their parents during their formative years. The power dynamic of parent-over-child creates an environment where the child feels that they cannot appropriately be angry towards their parents for the mistreatment/failure to raise properly, and so with no other outlet, the child becomes increasingly angry and disparaging towards themselves. The child blames and berates themselves for their mistreatment and any subsequent consequences of their childhood.
Melanie Klein, a psychoanalyst specializing in child development also posited that the disruption of the mother-child relationship during infancy and formative years could also lead to the development of neurosis and maladaptive coping.
A key tenant of this theory is that much of this inner hell happens on an unconscious level- the child-now-depressed-adult, does not consciously realize where these manifest symptoms of depression arise from. The goal of Psychotherapy then is for the patient to engage in talk therapy and introspection to uncover these unconscious neuroses and make them conscious. It was the belief of many Psychodynamic/analytic therapists that once the unconscious became conscious, the patient would then be able to resolve the neurosis and heal their psyche.
The main and relevant takeaway is that there are many things that happened in childhood, many outside of our control at the time, that impacted our psychological and physiological development. Some of these may be in the form of genuine trauma and abuse, while others may be maladaptive techniques or bad habits that were taught or absorbed. These can interfere with our normal functioning in day to day life and relationships. It is best to uncover and resolve these issues with a trained therapist, and in fact, talk therapy remains one of the most common and popular forms of therapy today.
Behavioral, Cognitive, and Cognitive Behavioural Theories.
Behavioralism was a research area that focuses on how behaviors are learned or unlearned through reinforcement. In behavioral theory, depression is a learned state, cultivated through the patient’s dysfunctional behavior, and lack of skill. For example, a child/adult may lack basic or sufficient social skills to meet their psycho-social needs and also lack the coping skills needed to deal with these failures. Eventually, the patient will become frustrated and depressed.
Behaviorists also propose that patients can also develop depression when they are no longer receiving positive reinforcement, or are receiving insufficient reinforcement. This often also correlates with high amounts of environmental stressors, adding to the weight a patient feels.
It is thought that if the depressed or anxious patient is able to learn new behaviors and skills and receive the proper positive reinforcement, the disorder will resolve.
In Behavioral theory, there is a dark side to reinforcement. Depressed or otherwise ill patients may come to see the attention and help they receive from loved ones as positive reinforcement and therefore forge a stronger depressed behavior as a response. While the attention from others is regarded as a strong enough reinforcement, the patient will have little to no actual drive to resolve their disorder.
One weakness of pure Behavioralism is that it fails to account for the internal thoughts and motivations of the patient aside from reinforcement and “extinction” responses. Pure behavioralism focuses solely on external factors and observable responses to those factors.
Cognitive theories focus on internal thoughts and beliefs that patients hold about themselves and the world. These cover thinking and processing styles that can predispose and increase one’s risk of mental illness.
Martin Seligman’s Learned Helplessness
Cognitive researcher Martin Seligman proposed a theory of “Learned Helplessness” for depressed and anxious patients. He and his fellow researchers came across this idea when experimenting with conditioned responses in dogs. They trained dogs to associate the sound of a bell or buzzer with an unpleasant shock. Once the dog had learned the association, they then put the dog in a box with a fence dividing it. Then administered the tone and subsequent shock, expecting the dog to jump the fence (presumably to avoid the shock or get free.) However, the dog simply laid down, even when only the tone sounded. Unconditioned dogs jumped the fence as expected.
Seligman proposed that not only had the dog learned to associate the tone with the shock but that the shock was unavoidable, no matter what it did.
The theory of learned helplessness proposes that depressed and anxious patients become so due to an internalization of the belief that the also cannot “escape”. People prone to this form of depression also tend to be more naturally pessimistic and negative in their thinking styles. This helplessness is also commonly accompanied by a hopelessness in the situation or self.
Not all depressed patients have this learned helplessness, nor do all people who suffer prolonged exposure to adverse and uncontrollable events develop depression, so this is not by any means an overarching theory.
Albert Ellis defined that depressed patients often have strict, irrational beliefs that impair thinking and cause significant distress. These beliefs are a firm “should,” “must”, or “have to”, and are directed towards the world, or the self. The three common “Musts” he defined are;
- ‘I must do well or else I’m no good.’
- ‘Other people must treat me fairly and kindly, and if they don’t, they are no good and they deserve to be condemned and punished.’
- ‘I must get what I want when I want it, and I must not get what I don’t want. If I don’t get what I want, I can’t stand it.’
These three “Musts” impair a person’s ability to react and interact with the world around them and result in psychological distress when they inevitably cannot be met. The first belief often leads to anxiety, depression, shame, and guilt. The second belief often leads to rage, passive-aggression, and acts of violence. And the third belief can lead to self-pity and procrastination. The demanding nature of these beliefs causes problems; being less demanding and more flexible in your belief system leads to healthy emotions and helpful behaviors.
The goal of Ellis’ cognitive therapy is to get patients to realize and revise these irrational beliefs into rational ones.
Aaron Beck’s Cognitive Triad
Dr. Aaron Beck conceptualized and founded Cognitive Behavioral Therapy, (Or CBT) in the 1960’s, He found during his research that depressed and anxious patients fell into continuous and seemingly automatic streams of thought that dominated their internal narratives. These automatic thoughts fall into three categories; thoughts about the self, the world, and the future. In depressed patients, these automatic thoughts are overwhelmingly negative. This is your classic, “I am worthless, everyone thinks I’m worthless/a burden, and I will always be worthless/ a burden.” This trio of negative thoughts had come to be known as Beck’s Cognitive Triad.
Image: Beck’s Cognitive Triad: Negative Thoughts about The World, Negative Thoughts about One’s Self, and Negative Thoughts about The Future.
These are known as negative self-schemas and are formed throughout childhood. Schemas are a type of Heuristic, a mental shortcut our human brains take to speed up the process of thinking and evaluation during decision making.
Beck posited that these faulty schemas correlated with faulty logic and negative biases, which helped to further confound thinking. These are fallacies such as; Arbitrary Inference; drawing a negative conclusion, even in the face of other evidence. Selective Abstraction; Focusing on the worst aspects of any situation. Magnification and Minimisation; a problem is made to be larger than it is, and any solutions are deemed smaller in impact/importance. Personalization; Negative events are internalized as their fault. Dichotomous Thinking; Everything is seen as black and white. There can be no alternatives or grey areas. (While there are many logical fallacies, these are particularly common and relevant to depressed patients.)
An elaboration on this theory is Jeffery Young’s Schema therapy, in which he defined 18 negative schemas that patients with chronic, relapsing disorders exhibit (Though not all at once.)
- Emotional Deprivation- The belief that your emotional needs will never be met.
- Abandonment- that you will always lose someone you are emotionally attached to.
- Mistrust/Abuse- The belief that others will intentionally take advantage of you.
- Social Isolation- That you are isolated from the world/your community.
- Defectiveness- That you are inherently internally flawed and that others will be withdraw once they discover this “real you”.
- Failure- The belief that you are incapable of performing as well as your peers. You feel stupid and inept/untalented.
- Dependance- That you are incapable of performing tasks and handling day-to day responsibilities on your own.
- Vulnerability to Harm and Illness- the irrational belief that you are always on the edge of catastrophy. You become overly cautious and protective.
- Enmeshment- You become too emotionally involved with others (parents, romantic partners, etc,) and the sense of too little individual identity.
- Subjugation- The belief that you must submit yourself to the control of others, usually to avoid negative consequenses.
- Self Sacrifice- The excesseive need to sacrifice your needs to help another. Paying mind to your own needs leads to feelings of guilt or shame.
- Emotional Inhibition- The belief that you must suppress spontaneous emotions or impluses- positive or negative because any expresssion of feelings would lead to harm, embarassment, or loss of self-esteem.
- Unrelenting Standards- The belief that whatever you do is not good enough and that you must always strive harder. Charactarized as perfectionism.
- Entitlement- The belief that you should always be able to do, say, or have whatever you want regardless of cost or consequenses to others.
- Insufficient Self Control- The inability to tolerate any frustration in reaching your goals, as well as the inability to restrain expression of impulses or feelings.
- Approval seeking- Placing too much emphasis on gaining the approval an drecognition of others. Emphasis on status and appearance over genuine needs.
- Negativity or Pessimism- Overwhelming focus on the negative aspects of life while minimizing the positive aspects.
- Punitiveness- The belief that people deserve to be harshly punished for making mistakes. You may be overly critical/ unforgiving of yourself and others.
The goal of both CBT and Schema Therapy is for the patient to learn about these internal automatic responses and to recognize where they arise in their life. Different exercises are given to elevate awareness and retrain automatic thoughts.
Humanist Theory of Depression
The humanist theory of depression states that there are specific needs to being human and that when not met, psychological disorders arise and physical health is affected. Humanists focus on the individual, rather than a group of similar symptoms a patient manifests. This was a reaction to what was viewed as the overly mechanistic approach of Behavioralism and Psychoanalysis. By nature, Humanistic therapies are deeply rooted in Existential Philosophical thought and often integrate Religious ideals into the therapy. Humanistic therapy focuses on the present, rather than the past to look for solutions and healing and focus on guiding patients to self-fulfillment and growth.
Books for further reading, and self-therapy
∴A General Introduction to Psychoanalysis, by Sigmund Freud
∴The Interpretation of Dreams by Sigmund Freud
∴The How-To Book for Students of Psychoanalysis and Psychotherapy, Sheldon Bach
∴Man and His Symbols, by C. G. Jung and Others
∴Science and Human Behavior, by B. F. Skinner
∴About Behaviorism, B. F. Skinner
∴Cognitive Behavioral Therapy Made Simple, S
leth J. Gillihan, PhD
∴Cognitive Behavior Therapy: Basics and Beyond, Judith S. Beck
∴The CBT Toolbox; A Workbook for Clients and Clinicians, Jeff Riggenbach
∴Reinventing Your Life: The Breakthrough Program to End Negative Behavior…and Feel Great Again, Jeffrey E. Young
∴Schema Therapy: A Practitioner’s Guide Jeffrey E. Young
∴On Becoming A Person, Carl Rogers
∴The Farther Reaches of Human Nature, Abraham Maslow
Generally speaking, psychologists will be able to cover multiple theories of mental illness and therapy styles. After talking with you for a time, they will generally decide on which type of therapy may suit you best. Everyone is different, so no one therapy fits all.
If your mood disorder is comparatively mild, it may be safe for you to explore these things on your own for a while, though the guidance of a trained professional is best. If your disorder is chronic and deeply rooted and severely disrupting your life, I highly recommend finding a professionally licensed therapist!
Costs can be high, but the value of professional help cannot be understated.
Take care, and see you next time!
“I am commanded to go to the land of Mordor, and therefore I shall go,” said Frodo. “If there is only one way, then I must take it. What comes after must come.”
J. R. R. Tolkien, The Lord of The Rings, The Two Towers
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