Monday, May 26, 2014

The Evil Demon - Depression and Perception

I shall suppose that some malicious, powerful, cunning demon has done all he can to deceive me...I shall stubbornly persist in this train of thought; and even if I can’t learn any truth, I shall at least do what I can do, which is to be on my guard against accepting any falsehoods, so that the deceiver – however powerful and cunning he may be – will be unable to affect me in the slightest...

-Rene Descartes, Meditations on First Philosophy

The Evil Demon is a concept in Cartesian philosophy. In his philosophy, Descartes argues that he cannot know if there is actually an external world, or if an evil demon more powerful than him is deceiving him to believe there is an external world when in reality there is not, or that the external world is vastly different than what he perceives it to be.

Initially it sounds absurd, but think of how our eyes work. We don't actually see things in the world, but rather the nerves in our eyes receive the light bouncing off those things, convert them into electrical signals, and then deliver those signals to our brain which produces an image in our mind. It's possible that our eyes are malfunctioning, and that we're not seeing what we think we're seeing. The same is true for other senses. We might not actually be hearing the things we think we're hearing, or feeling what we think we're feeling. For all we know, we're all actually just brains in vats having all these sensations delivered to our brains, which lead us to believe we're perceiving an external world that isn’t actually there.

I don't find it particularly useful to believe that the external world is a vast illusion created by an evil demon or that we're brains in vats. Not the least of which because we don't have any other reality to think we're actually living in, and also because believing that the reality I perceive doesn't actually exist kind of makes this whole blog-writing enterprise just feel silly. However, the idea of how our perceptions dictate how we understand the world is very useful when thinking about mental illness.

Perception is everything. That's not just a pithy saying. Perception is literally everything. Or at least everything we perceive (which depending on your philosophy might be everything anyway). We don't see the world without light entering through our eyes and getting interpreted by our brains. We don't feel things without our nerves transmitting electrical signals based on what we touch, which are then interpreted by our brains. And we don't draw conclusions about the world without drawing them with our brains.

Mental illness is, among other things, a disease of perception. A disease wherein the way we see the world is different from how it actually is (or at least a close approximation to how it actually is). With mental illness, we observe the world, and draw conclusions from those observations, in ways which can differ radically from the observations and conclusions of more "healthy-minded" people.

Since early adolescence, I have struggled with anxiety, particularly as it concerns valued relationships. I have a tendency to overthink and overanalyze every small detail of interactions, down to the exact order of words in sentences. Often with that analysis I come to believe that I have done something to bother or annoy other people. For example, if, say, Dave the hypothetical person doesn't respond to a text message I send in as timely a manner as I would like or expect, I become convinced that there was something in the last message I sent, or in my recent behavior, that led to Dave not wanting to speak to me. It did not matter if I could not think of any particular example of this supposed bad behavior, or if I didn't see anything particularly offensive in my previous text. Nor did I consider that maybe the reason Dave wasn't responding to me was because he was distracted by something else, wasn't at his phone, or simply didn't think the text was one he needed to respond to. I was convinced I had done something wrong, and that he was reacting to that.

Thought leads to action. I believe that I have done something wrong, and this leads to me profusely apologizing, or continuously engaging in "checking" behaviors, to make sure I hadn't done anything wrong. Time and again, Dave responds to these apologies and checkings with confusion--he did not think I had done anything wrong, and was surprised that I was apologizing. If anything, it was the constant apologizing and checking that was more problematic than any perceived mistakes I had made. I don’t need to go further into detail on that, I’ve described it well enough before.

The reality of what was going on was radically different than how I perceived it to be. In reality, I hadn't done anything wrong to Dave. But I perceived that I had. With the evil demon, Descartes thought it possible that he might not be living in the world he thought he was, and his perceptions were lying to him. It is the same with mental illness. We don't live in the world. We live in a torture chamber contained entirely within our own heads, where we see the world through filthy lenses and distorted mirrors. The worst possibilities, unlikely though they may be, become distressingly real. And because of how real they become to us, we feel we have to act on those possibilities, often with unpleasant results.

The question which should be asked of any person with depression or other mental illness is "why do I think that the way I view the world is right?" As I discussed last week, mental illness is in part related to habit, and how we perceive the world is one of those habits. Instead of perceiving the world in the dismal terms that come so easily in our mental illness, we can instead attempt to perceive them in a more positive, or at least neutral, light.

So with that in mind, I send a message to my hypothetical buddy Dave, and he doesn't respond in as timely a manner as I would like. My first response to this is to think "he's not responding to me because he hates me, or because I've offended him." However, I could also think "maybe he's not responding because he hasn't seen my message or he forgot about it."

Both my first response and my second response are valid ways of looking at things, because both are theoretically possible. The kicker is that we don't know which one is true. The truth of the matter is ambiguous, at least until we can talk to Dave and find out, and even then there's no guarantee that we'll get the right answer. The difference between the options is that one of the ways makes me feel like crap, and the other makes me feel more understanding of Dave and of myself. So why not go for the more positive possibility?

Alternatively, some may argue that the positive outlook is risky. If we try to view things in a more positive light, we run the risk of deluding ourselves. Which is true, but it works both ways. Viewing things in any light, we run the risk of getting things wrong, simply because reality so rarely conforms to our expectations. And I would argue that viewing things in a negative light is the greater risk, because not only are we more miserable, but we are more likely to act on that misery, which tends to lead to similarly miserable outcomes. I've talked before about the importance of hope, and it applies again here. If I believe Dave hasn’t responded because I’ve offended him, I become distressed and want to apologize, which may bother Dave. If on the other hand, I choose to believe that Dave must have forgotten about the message, I allow myself to feel content, and do not apologize for anything, because I’ve done nothing to apologize for!

The point isn't to believe one option or the other. The point is to remember that you don't know the answer, but are assuming the one that makes you miserable. Either could be possible, only one possibility actually is. I don't know which, or if it's even one of the two possibilities I'm consideringc (for example, it could very well be that Dave is actually a hypothetical person and therefore is not capable of responding to my text message at all). I view the negative possibility as reality, and thereby act on it, to potentially damaging results. Of course, no matter how we react, the outcome might not always change. What changes is how we feel, and how we behave in response to those feelings.

Perception is key. In fact, it's not just key, but also lock, door, floor, wall, and the rubber stopper on the floor that keeps the door from banging into the wall and ruining the paint job. Our interior world is the thing which we can most control, even if it doesn't always feel like that. We can't always change the world. But there is a world that we can change. Our world.

If there is any advice to take from this post, it's this: if you have mental illness, be it depression, anxiety, or any other condition that you suspect might impact your view of the world, doubt. Doubt what you believe about the world, about yourself, and about others. Doubt what you think you know. Doubt your intuitions, your first reactions, and your common sense. Doubt your reasoning and your justifications. Doubt what you think about the future, and doubt what you think about the past. Doubt that life is as bad as you think it is. Doubt every way of looking that has harmed you or made you unhappy. Because there is a pretty good possibility that the way you're looking at the world is wrong.

Monday, May 19, 2014


“We are spinning our own fates, good or evil, and never to be undone. Every smallest stroke of virtue or of vice leaves its never so little scar.” - William James,

In 1965, Martin Seligman and his colleagues were conducting an experiment that involved giving dogs electric shocks, because this is what scientists did before the idea of humane treatment of animals came into vogue. They split the dogs into two groups. One group would be able to press a panel to stop the electric shock, and one group would be kept in a harness and unable to do anything to prevent the electric shock.

They then placed the dogs within an area separated from another area by a low fence. On the side of the fence which the dogs were placed on, the floor contained an electric charge, while the other side of the fence did not. The fence was low enough that the dogs could easily jump over it to the shockless floor. 

The dogs which had been able to stop the electric shock quickly jumped over the fence to the other side, while the dogs which had been unable to stop the electric shock simply lied down and did not attempt to escape the shock. Because they could not escape the pain before, the dogs did not think they could escape it then, and so they didn't even try. 

Martin Seligman coined this phenomenon "Learned Helplessness". Learned helplessness is the idea that when we are unable to improve our well-being in some areas, we grow to believe that we cannot improve our well-being in others. To some degree it's a logical response; we can't escape this pain, therefore we can't escape other forms of pain.

Depression is, in part, a habit.

Which is not to say it's not other things as well. Depression is an incredibly complex condition with poorly defined boundaries. The exact combination of factors which lead into depression--be they habitual, neurochemical, psychological, philosophical, spiritual, or otherwise--vary from person to person. Today, however, I will focus primarily on the habitual side of depression.

Our lives are made up of habits. Every thought, every feeling, every action done reinforces itself, so that it is easier to do the next time. This can be used to good extent, obviously. When we begin driving, we spend a lot of time looking at the road, and feeling every turn and sensation, which ironically makes us less likely to notice obstacles on the road, because we're overloaded with information. Yet after enough practice, the basic components of driving become so easy to do we hardly think of them, and our mind is free to focus on the road in front of us (whether we actually do that is another story).

At the same time, however, it can similarly be used to bad effect. When we think certain negative thoughts, for example, it becomes easier to think those thoughts in the future, and harder to argue against them. Over time, the thoughts can come so easily that it's as if we don't think them at all, the thoughts are just there. And when we don't have the resources to try and argue against them, the thoughts seem perfectly reasonable, for we don't have any alternative or them.

What Martin Seligman showed with the experiment, among other things, was how habitual ways of thinking in the past inform our present habits. Many of us have had occurrences in the past where we were hurting and couldn't stop from hurting. For some people this may have had to do with upbringing. For others it's related to trauma. For others it was simply the depression. Regardless of the cause, we hurt, and we could not stop it. We felt powerless.

Over time, we grow used to that feeling of powerlessness. It sinks into our minds and changes the way we think of things. The sense of powerlessness moves from its point of origin to other areas as well, into the parts of our lives that have nothing to do with the hurt. We feel not only powerless in that one place, but in other places, like with keeping friendships, holding down jobs, or working for our lives to improve. Even when removed from the hurtful environment, those habits stay with us as a remnant

It's this concept of habit that is related to the idea of the "hedonic treadmill", or happiness set-point. The idea is that though certain life events may temporarily change our feelings, we generally return to a certain state of happiness over time.  However, this set point can change. Richard Davidson, for example, has argued that, because of the neuroplastic nature of the brain, happiness can be cultivated just as any other habit can, such as through counseling, physical exercise, and meditation. Research has shown that engaging in small but consistent activities such as religious practice and exercise can improve one's overall levels of happiness. Martin Seligman, who you may remember as the dog-electrifier from earlier in this post, is one of the leaders of the positive psychology movement, which asserts the capacity for individuals to change their ways of thinking,  and has written numerous books on the subject.

What this all means is that our happiness, and by extension our depression, need not be set in stone. We may not be able to control all factors which contribute to our depression, but we can control how we think and what we do, and their effects on our overall well being cannot be understated.

Which then leads to how to approach it.

The above image is called the Cognitive-Behavioral Triangle, which is the foundation used in Cognitive-Behavioral Therapy (CBT). What the triangle shows is that our thoughts, feelings, and behaviors are all interrelated, with each informing the others. If we feel a certain way, for example, we may think a certain way. If we think a certain way, we may behave a certain way. And if we behave a certain way, we may feel a certain way. And so on.

CBT is closely related with the idea of forming habits and breaking them. By feeling a certain way long enough, we reinforce the thoughts that initially led us to those feelings, and in turn reinforce the behaviors that also stem from those feelings, and so on. This applies to both helpful and unhelpful points. What's important is that we can interrupt the unhelpful cycles of thought by replacing some unhelpful thing within the triangle with a more helpful thing.

Suppose I wake up feeling depressed. I don't have any particular reason for why I feel depressed, I just do. But while I'm depressed, certain thoughts are easier to think, namely negative or pessimistic thoughts. "This day is going to suck" or "I won't be able to get anything done today". By thinking those thoughts, I in turn reinforce the sense of unhappiness. Which reinforces the negative thoughts.

On the other hand, suppose I wake up feeling depressed, but rather than allowing those negative thoughts to come unresisted, I challenge them. I may not be able to stop the "this day is going to suck" thought, but I can respond to it with "I don't know how the day will turn out but I can still do my best in my current situation, which can improve my chances of getting a possible outcome." Wordy, perhaps, but it's challenged my first thought with a more hopeful, reasoned thought.

Similarly, suppose I'm applying for a job. My first thought may be "There's no point in doing this, I'm not going to get the job anyway", and I may be inclined to not write my resume.  But a thought to respond to that might be "I may not get the job, but I definitely won't get the job if I don't try." And then push myself to write the resume and submit it. I may still not get the job, but I've provided an alternative to think instead of the pessimistic thought I originally had.

That's just two examples, and I am far from an exhaustive reference on this subject. There are books upon books on CBT, and many therapists are specially trained in it. Worksheets and other resources are available online. And of course, this is not the only method of therapy or habit-breaking available.

But what's perhaps most important to note is that this method and any other method cannot be done inconsistently. It must be performed constantly and doggedly. Habits are tough to break, and it'll be all the harder to break a habit if it's not tackled with enough energy and commitment. It'll require a lot of hard work, and at times it will be a real pain. But the outcome can be very, very positive. We can, if not rid ourselves of depression, then improve how we respond to it. We can make our lives better, not by changing the world around us, but by changing ourselves. We can learn to approach the world in a different way, a way that is affirming and empowering to us.


The Depression Habit Spiral

Monday, May 12, 2014

Explaining Depression: The Apple and the Tortoise

If that title sounds like a bad rip-off of an Aesop's Fable, rest assured, it'll all be explained a few paragraphs down. Sort of.

Depression, in many cases, is about perception.

Ask yourself what it's like to be depressed. If you're anything like me, you'll use a lot of sense-related verbs. When you have depression, things feel bleak. They seem hopeless. When I actually am depressed, I don't just think that things feel bleak, or seem hopeless. When I'm depressed, things are bleak, and are hopeless.

With depression, the tools we use to perceive and interpret the world are not functioning correctly. We perceive the world in dismal terms, that we have no future and are unlikely to get good outcomes, and that nothing we do can make a difference, among other things. And because we perceive the world that way, we come to believe that is how the world actually is.

That's one of the reasons why people who are depressed, in a lot of cases, struggle to believe they have depression. Other people may tell them they have depression, and that what they're feeling isn't true, but it is very hard for a depressed person to believe that, because their feelings exist in direct contradiction of what the other person is telling them. The other person may say things aren't as bleak as the depressed person thinks, but the depressed person feels like they are that bleak.

Imagine trying to convince someone that the apple they are holding in their hands isn't actually an apple, but is actually a tortoise wearing a straw hat. No matter how hard you reason, argue, beg, and assert, the other person is very unlikely to believe that they're holding a hat-wearing tortoise. When they look at what's in their hands, they see an apple. When they touch it, they feel the shape and texture of an apple. When they smell it, they smell an apple. And when they bite it, they taste an apple (as to how the supposed tortoise feels about being bitten, well, best not to think about that).

Now imagine telling the person holding the apple/tortoise that the reason they think it's an apple is because someone has put a mind-control chip in their head causing them to perceive tortoises as apples. Most likely, the person would be somewhere between amused and insulted. How ridiculous is it that someone put a tortoise-to-apple mind-control chip in their head, when it's so clear to them that they're holding an apple in their hand and not a tortoise! People tend to trust their own senses. For the most part that's a good thing, as it was probably the main reason we're not still living in caves. It becomes a problem when the things they're sensing are unnecessarily infringing on their lives.

The best way someone could be convinced that they have that mind-control chip in their head is if a lot of people, whom they trusted, told them that is exactly what is happening. Loved ones and medical professionals would have to line up and explain to them that a mind-control chip is in their head. If the person's still doubting, they might ask questions like when the chip was put into their head, how it works, and if they can't get good enough answers to that, it's all the easier for them to doubt.

And even after telling them all that, and giving convincing reasons, the person might still resist believing, because of how disturbing the thought is that they're wrong.  If they have such a chip in their heads, that means that the apple they perceive in their hand was never an apple at all. That they were wrong the entire time. That there is actually a tortoise in their hand (and given how long the tortoise has been there through all this, it's probably gotten hungry and started chewing off a few fingers). It's easy to believe what you already believe, especially if your feelings back it up. Changing what we believe is tremendously uncomfortable, especially if our faculties lend themselves to what we already believe, and more so if the new way of looking at things makes us feel weaker, less intelligent, or simply duped.  So for the most part, we try not to do it.

It's important to remember that depression (because we're talking about depression again) says nothing about how strong we are, how smart we are, or how good a person we are. All depression says is that we have depression. And what depression has done to us is make us see things in a way that's different than how they actually are.