We started this chapter by wondering whether one could be depressed in heaven. It turns out that the 'if not—why not' reasons illuminate many common assumptions about depression, and based on these assumptions/beliefs, many people over the ages have tried many different things. Our modern Western assumptions fall (fairly) neatly into biopsychosocial ones of social contexts, early life sensitisation, internal psychology, and physiology (Akiskal & McKinney, 1975). However, the biopsychosocial approach is not just a set of different assumptions and models thrown together. As argued elsewhere (Gilbert, 1995), we need to understand interactions and why some interactions cause the effects they do. My own biopsychosocial approach has always had strong evolutionary flavourings because I think that many of the elicitors of depressed states have a lot to do with how our brains and needs have been shaped over millions of years.
We noted that the onset of depression can be gradual, or there may be marked and intense shifts in states. For these, we need models that can account for system discontinuities in function when a system can switch between states (as in catastrophe theory). We also suggested that it is shifts in PA that might be the key to depression. We then went in search of evolved regulators that might produce shifts of states (especially loss of PA), and we suggested that protest-despair and entrapped defeat might be good candidates. For there, we explored the evolution of human needs for care and to be seen as attractive and able to secure important and evolutionarily meaningful biosocial goals (for example, close alliances, access to sexual opportunities, and freedom from oppression)—social relationships are powerful biological regulators. We noted how people compete for them and how early life prepares us to enter the competition. We also noted that control theory, attachment theory, and social-rank theory are not competitive models—but the devil is in the detail of how such biopsychosocial processes interact—on this, far more research is needed. Finally, contrary to what some people think about social-rank theory, while its therapeutic implications can be about helping people escape adversity or become more assertive and independent, it is also about helping people become more inwardly compassionate and give up excessive competitiveness and internal self-attacking (called internal bullying and harassment), in order to develop a compassionate rationality (Gilbert, 2000b;c;e).
I agree with Nesse (2000) that it is not possible to say whether serious depression itself (or what type) is an adaptation, is at times adaptive, or is simply an unfortunate side effect of the evolution of other mechanisms, such as competencies for self-reflection and rumination. I guess that if we had not evolved the capacity to plan, fantasise about our futures, reflect on ourselves, and ruminate for good or ill, some of the sources of our depression and the maintenance of it would not be there. But though these are powerfully involved in human depression, the state itself speaks to something deeper, darker, and older in us. It is about physiological systems that evolved long ago, primitive defensive responses that become compromised; about feeling defeated, trapped, and excluded. It is about old-time regulators of PA and NA. It is old brain stuff in new minds. Our new minds will take us to the moon and create great concertos, but they can also give conscious feeling to the most primitive of affect regulators.
To lose the ability to feel PA does literally turn the lights off, and creates the blackest of despair. While evolution may well have made it possible to downregulate PA systems for defensive reasons, to become conscious of this is the stuff of nightmares. For many, then, heaven is associated with love, union, and belonging; with PA; with bliss even. Hell is its absence. No wonder, when people enter depressed states, some would rather give up all consciousness of a self (kill themselves) than be conscious of a life without PA and where NA runs amuck. The terror of no escape is a terror indeed that perhaps compassion can help bridge.
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