Internal harassment

One of the criticisms of the social-rank model of depression is that people can occupy a low rank in society but have positive (personal) self-esteem and not be depressed, while those in high social positions (such as top models, pop stars, or actors) can still experience feelings of low self-esteem and depression. This also suggests that having access to resources (such as wealth or social position) does not always protect from depression. This is one of the reasons I am dubious about depression being only an issue of control over goals (Peterson et al., 1993) or a monitor of good and bad circumstances, as suggested by Nesse (2000)— although, of course, poverty and negative life events are certainly major risk factors (Morriss & Morriss, 2000; Wilkinson, 1996). Social-rank theory offers a different explanation for the depressed pop star. First, successful people can be competitive and perfectionist, sometimes as efforts to make up for earlier failures to win love and affection (insecure attachments). In fact, some forms of perfectionism are related to underlying feelings of inferiority (Wyatt & Gilbert, 1998) and probably a sense of defeat if standards cannot be met. Cognitive therapists (Beck et al., 1979) suggest that a small defeat or setback can, via a process of overgeneralisation, spread to more global self-perceptions such that people believe that anything they try to do will end in defeat or not be good enough. Second, many successful people I have worked with can feel internally harassed, put down, and defeated by their own negative and self-attacking thoughts. Their self-attacking is both a drive to achieve and a liability. Third, people often feel trapped by their own self-attacking thoughts and would like to escape from them (Gilbert & Allan, 1998; Gilbert et al., 2001). Fourth, self-attacking affects the ability to form affiliative relationships. Zuroff et al. (1999) found that those high on dependency needs are submissive and inhibit hostility to others. Self-critics, however, behave in hostile and resentfully submissive ways, are relatively poor at validating others, and have problems in developing affiliative relationships. Zuroff et al. (1994) found that the degree of self-criticism in childhood is a predictor of later adjustment.

One can often trace the origins of these ways of treating the self back to abusive or neglectful experiences, or trying to please a parent, and analysts have long talked about internalised relationships coming to control one's view of oneself (see Baldwin & Fergusson,

2001, for research and discussion of this). But whatever their sources, there is an ongoing set of signals that people are giving themselves that are basically put-downs and attacks. Cognitive therapists, of course, call these 'negative automatic thoughts' and link them to self-other schema. But the point is that negative automatic thoughts do not operate in a physiological vacuum; some forms of them depict internal (social-like) relationships, and may activate more primitive strategic defences (Gilbert, 2000c).

Internal stimuli, one's thoughts and images, can act like external ones. For example, generating sexual imagery (even when alone) can lead to sexual arousal, and focusing on the enjoyment of a holiday can lead to excitement (with the relevant physiological elements). Similarly, one's own self-attacking thoughts can be sources of stress. The negative self-cognitions ('I'm no good, a complete loser, a failure; no one could love me') so typical of depression (Beck et al., 1979), can, for example, also stimulate desires to submit to (to appease or agree) and/or escape from these put-downs (Gilbert & Allan, 1998; Gilbert et al., 2001). Greenberg et al. (1990) suggested that depression is more likely when individuals cannot defend themselves against their own attacks and feel beaten down and defeated by them. In a fascinating study of these ideas, Whelton (2000) measured students' levels of self-criticism with the Depressive Experiences Questionnaire. He then asked the students to sit in one chair and spend 5 minutes imagining themselves sitting in the other chair, and to criticise themselves. They were then invited to switch chairs and respond to the self-criticism. Those high in self-criticism often submitted to (agreed with) their own self-criticisms, exhibited shame postures (slumbered with head down) and sad faces, and felt weak and unable to counteract their own self-criticisms—in other words, submissive and defeat-like profiles were activated by their own attacks. In an ongoing study in our department, we are finding that students high in a self-report measure of self-attacking find it relatively easy to imagine and visualise a self-critical part of themselves, but less easy to imagine and visualise a self-supporting part. For those low in self-attacking, the reverse is the case. It is difficult not to get the impression that what is going on inside a self-critical person is a kind of war—a war of shaming and dominating parts and submitting and defeated parts (that is, internal high expressed emotion (HEE) and bullying harassment). Internal mechanisms for enacting social roles (dominating and subordinating) are playing off (interacting) with each other (Gilbert, 2000c). As one recent patient said, 'I don't need others to put me down, I do it so well myself!'

Gilbert et al. (2001) used this idea to explore negative self-cognitions (self-attacking) in depression and malevolent voices in schizophrenia. They found that for both depressed people and those with schizophrenia, depression was associated with how powerful and dominating they felt their thoughts or voices to be. Moreover, be it a hostile voice or a self-attacking thought, depression was associated with desires to escape but feeling trapped with it. People can want to escape from their own thoughts and feelings, especially when these are subordinating, hostile, and painful (Baumeister, 1990).

BiPolar Explained

BiPolar Explained

Bipolar is a condition that wreaks havoc on those that it affects. If you suffer from Bipolar, chances are that your family suffers right with you. No matter if you are that family member trying to learn to cope or you are the person that has been diagnosed, there is hope out there.

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