Goals and Depression

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Striving towards meaningful goals is good for your well-being; even just having goals by themselves are indicative of well-being. This is an established dogma of positive psychology, so how can one argue that goals may be at the root of the experience called depression.

A framework that aims to throw some light on this is the dual-process Tenacious Goal Pursuit (TGP) and Flexible Goal Adjustment (FGA) theory as proposed by Brandstatdter and colleagues.

As per this framework, we all strive towards goals, but only goals that are meaningful (say goals which align with our self-identity) and attainable (we have self-efficacy beliefs and can figure out strategies to achieve the goals) lead to well-being. A goal that we find meaningful and are highly committed to, but which becomes unattainable due to either external circumstances or our internal capacities, may lead to depression.The depression, and the helplessness and rumination that accompany it, may paradoxically have the function of decreasing our commitment to the goal and releasing ourselves from that unattainable goal.

And here is where the TGP and FGA theory comes to the rescue. In view of internal or external obstacles, that is when you are not able to make progress towards meaningful goals, you may either try to change the situations or your actions to ensure that they are congruent to the goals and would thus be demonstrating an adaptive process of assimilation (not to be confused with Piaget’s use of assimilation) also known as Tenacious Goal Pursuit (TGP), or you may adjust your goals and ambitions to reflect the situations / your capacities using the process of accommodation also known as Flexible Goal Adjustment (FGA).

Now, lets backtrack a little and reflect on the many routes to happiness: some say its all in your head- that you just need to change your mindset/ perception of events and you can be happier;  others say that happiness is dependent on your situations and the actions that you take- you can and should cultivate happiness by activities and by changing your circumstances. Like all debates, like Nature-Nurture, the answer probably lies in the interaction and in-between. Haidt has famously claimed that happiness lies in-between, and I concur.

Similarly, sadness or depression may lie in your flexibility and tenacity of goal pursuits – while showing rigidity to a goal and not giving up may lead to sadness and depression, giving up too early or not being tenacious when circumstances could have been changed, may also lead to regret and sadness.

Bring Back My Happiness

Bring Back My Happiness (Photo credit: Wikipedia)

Its important to note that changing circumstances/ TGP etc are active processes; meanwhile changing mindset/ FGA are relatively passive processes, in that they happen in the background and not so much consciously.

That brings me to my major thesis: Depression is a disorder characterized by inability to use the adaptive process of FGA optimally. To me, Depression is a disorder of Behavior related to the Passive polarity of the ABCD Behavioral dimension. When one has a goal, to which one is committed, but is no longer attainable (and this may include an irreparable loss like bereavement ) then most people will use Flexible Goal Adjustment to come out of that state. However, the people with depression may be less able to use FGA and may remain committed to unattainable goals.

One of the evidence that comes to mind is, and for this you have to refer to my previous post about personality disorders and emotions,  that the passive pole of Behavior dimension in ABCD model is also associated with Dysthemic and borderline personalities and hypothesized to be associated with the Conscentiousness trait. Now, It does seem that there is some evidence that highly conscientious people who have high commitment to goals, also are more likely to get depressed following setbacks or adverse life events. This makes immense theoretical sense too.

One can also examine the Active pole of the Behavior dimension in ABCD model to gain equivalent insights. As I had mentioned in my last post, that is associated with personality disorders of Histroinic and Hypomanic personality disorders and likely associated with the trait Impulsive Sensation Seeking. Extending this joy/ happiness related dimension, all these are also likely to be associated with the active process of Tenacious Goal Pursuit; here it is instructive to note that a high score on Impulsive Sensation Seeking may prevent TGP from happening as the person may keep moving from one activity to the other; and extremes of this may lead to manic behavior. The high scores on Impulsive Sensation seeking leading to less TGP leading to full-blown mania, is similar in nature to high scores on Conscientiousness leading to less FGA leading to full-blown depression.

To me, this seems a novel and fruitful approach to think about and conceptualize depression- as an inability to give up goals that are no loner feasible. If we focus more on this aspect, perhaps we need to augment our talking therapies of CBT etc that focus on negative self-talk and also introduce safe spaces and experiences whereby people can indulge in Flexible Goal Adjustment and give up on goals that are no longer feasible and replace them with other more meaningful and attainable goals.

Emotions and Personality: Take 8

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I am currently reading ‘Emotions in the practice of psychotherapy‘ by Robert Plutchik and have been finding it a good read. In it Plutchik elaborates on his famous psycho-evolutionary theory of emotions that led to the circumplex and the Plutchik wheel of emotions. Basically, Plutchik argues that emotions can be classified on three dimensions- intensity, similarity and polarity (complementarity) and if one were to focus on similarity and polarity one can find eight basic or primary emotions, with other emotions either being a blend of the primary emotions or differing in intensity.

Cover of "Emotions in the Practice of Psy...

Cover via Amazon

An example will help clarify: if one takes anger as a basic emotion then emotions like rage, fury or irritation, annoyance differ in their intensity from anger; likewise when two emotions like disgust and anger are co-present, then one may feel the emotion of hatred/hostility, which is a secondary emotion.

Long-term readers of this blog will know that I am sympathetic towards the basic emotions concept and also believe that their are eight basic emotions; the eight basic emotions identified by me are same as those by Plutchik though the polarity aspect varies slightly.  For e.g., I believe the right polarity combinations are Fear-Interest; Sadness- Joy; Anger – Love; and Disgust- Surprise. Note that Plutchik considers Anger-Fear to be opposites and believes that Love is not basic but a blend of Joy and Acceptance.

Plutchik believes, and I have been arguing in my series of posts on emotions and personality, that emotions and personality are intimately connected and that regular/ habitual emotional experiences/ states lead to enduring related personality traits. Also having a particular personality trait likewise increases the probability of experiencing a particular emotion predominately. Thus there is a string bidirectional linkages between the emotional states one finds oneself in and personality traits one has.

Emotions evolved because they helped us survive and thrive. They are related to particular contingencies or features of the situation and help prime action tendencies that effectively deal with those situations to restore one towards homeostatic state (in case of negative emotions) or move towards flourishing and growth (in case of positive emotions). Personality or stable differences in emotional, behavioral, cognitive and motivational responding evolved as it enabled different persons to adapt to different niches of the (social) environment. Personality disorders evolved when things were taken to an extreme or their were unresolved conflicts related to the corresponding emotions.

English: Robert Plutchik's Wheel of Emotions

English: Robert Plutchik’s Wheel of Emotions (Photo credit: Wikipedia)

We will look at emotions and corresponding personality disorders to delineate the relationship between personality and emotions.

Examples will make this clear.

Consider Fear. Fear evolved whenever Danger was present and primed the action tendency to Escape/ withdraw/ protect. Or consider Sadness that evolved in relation to a significant Loss and primed the action tendencies towards Reintegrating or gaining social support or renegotiating. Anger evolved in situations where Obstacles impeded progress or goal achievement and primed the action tendencies of Destruction of that obstacle or aggressiveness in social situations. Disgust evolved when faced with Unpalatable or harmful object priming the action tendency to Reject that object, be it physical or social.

Positive emotions have similar situational triggers and similar action tendencies.

Now, Plutchik also looked at personality disorders, their co-morbidity in patients and the similarity ratings by experts for personality disorders, that were factor analyzed, to lead to a circumplex structure of personality disorders. This structure could clearly delineate which personality disorders were similar and clustered together. Remember this clustering is based on actual empirical data and not arbitrary like the clusters defined by DSM.

Plutchik listed three clusters; but I could make out four clusters based on theoretical rationale as well as inspection of the circumplex.

The four clusters of personality disorders are :

  • Cluster A: Avoidant, Self-Defeating and Dependent personality disorders.
  • Cluster B: Dysthemic, Borderline, Histrionic and Hypomanic (this is not there in Plutchik circumplex)
  • Cluster D: Antisocial, Narcissistic, Sadistic and Passive-aggressive
  • Cluster C: Schizoid, Schizotypal, Paranoid and Obsessive-compulsive.

This brings me to my ABCD model, especially as applied to personality. To extend it to above relationship between emotions and personality disorders, I will make a point that Fear-Interest emotional dimension is related to Cluster A (Affect based) personality disorders, Sadness-Joy to cluster B (Behavioral), Anger-Love to cluster D (Dynamic/Social) and Disgust-Surprise to Cluster C (Cognitive).

Consider Avoidant and Self-defeating personality disorders – they are clearly related to (social) withdrawal, escape etc. and thus to Fear;  Dependent can be related to lack of Interest.

Dysthemic and Borderline are clearly related to reintegration/ renegotiation etc and thus to sadness; Histrionic and Hypomanic are clearly related to problems with Joy/ Activity.

Sadistic and Passive-aggressive are related to destructiveness (either overt or covert) and related to anger; Narcissistic (too much self love) and Anti-Social (no love for society)  are problems with Love/compassion.   Taken together the four personality traits related to above like Sadism, Machiavellianism,  Psychopathy and Narcissism make the Dark Tetrad.

Lastly, Paranoid and Obsessive-compulsive are related to getting rid of something undesirable (external conspirators or internal thoughts) and possibly related to disgust.  Schizoid and Schizotypal may on the other hand be related to Surprise.

If one were to continue extending the circumplex and extrapolate from emotions and personality disorders circumplex, one would arrive at the same ABCD structure of personality that I arrived from other considerations.

In essence, Fear is related to Neuroticism personality trait which is related to Avoidant and self-defeating personality disorders. Interest is related to eXtraversion trait and Dependent personality disorder.

Sadness is related to Conscientiousness trait and Dsythemic and Borderline disorders. Joy with Impulsive Sensation Seeking trait and Histrionic and Hypomanic disorder.

Anger is related to Agreeableness trait and Sadistic and Passive-aggressive disorders while Love is related to Honesty/Humility trait and Antisocial and Narcissistic disorders.

Finally, Disgust is related to Imagination trait and Paranoid and obsessive -compulsive disorders; while surprise is related to Openness to Experience trait and Schizoid and Schizotypal disorders.

To me, the above seems conclusive and makes immense sense. The cluster A disorders (as I have defined them, not the DSM ones) are primarily disorders of Affect; Cluster B of Behavior , Cluster C of cognition while cluster D of motives or are interpersonal in nature. This to me is an important theoretical advancement and should be followed up with empirical work.

The Stages of Moral Development

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I have alluded to Kohlberg’s stage theory of Moral Development a few times in this blog, but never devoted an entire post exclusively to that; time to rectify that. For those not familiar with the Kohlberg model, I suggest that they read up an excellent description here.

Morality Play (novel)

Morality Play (novel) (Photo credit: Wikipedia)

To recap, Kohlberg argues, that we go through three levels (and two stages within each level) as we advance on our path of moral development. He arrived to this conclusion, among other things, based on a long-term study of 58 young men over a span of two decades. The stage of moral development was assessed by analyzing answers to moral dilemmas like the famous Heinz dilemma. (in which a not-so-well-off person steals from a druggist a drug to save his dying wife).

After presenting people with various moral dilemmas, Kohlberg reviewed people’s responses and placed them in different stages of moral reasoning. According to Kohlberg, an individual progresses from the capacity for pre-conventional morality (before age 9) to the capacity for conventional morality (early adolescence), and toward attaining post-conventional morality (once Piaget’s idea of formal operational thought is attained), which only a few fully achieve. Each level of morality contains two stages, which provide the basis for moral development in various contexts.

The standard stages, as deciphered from say the below responses to Heinz dilemma, are as follows:

From a theoretical point of view, it is not important what the participant thinks that Heinz should do. Kohlberg’s theory holds that the justification the participant offers is what is significant, the form of their response. Below are some of many examples of possible arguments that belong to the six stages:

  • Stage one (obedience): Heinz should not steal the medicine because he will consequently be put in prison which will mean he is a bad person.
Or: Heinz should steal the medicine because it is only worth $200 and not how much the druggist wanted for it; Heinz had even offered to pay for it and was not stealing anything else.
  • Stage two (self-interest): Heinz should steal the medicine because he will be much happier if he saves his wife, even if he will have to serve a prison sentence.
Or: Heinz should not steal the medicine because prison is an awful place, and he would more likely languish in a jail cell than over his wife’s death.
  • Stage three (conformity): Heinz should steal the medicine because his wife expects it; he wants to be a good husband.
Or: Heinz should not steal the drug because stealing is bad and he is not a criminal; he has tried to do everything he can without breaking the law, you cannot blame him.
  • Stage four (law-and-order): Heinz should not steal the medicine because the law prohibits stealing, making it illegal.
Or: Heinz should steal the drug for his wife but also take the prescribed punishment for the crime as well as paying the druggist what he is owed. Criminals cannot just run around without regard for the law; actions have consequences.
  • Stage five (human rights): Heinz should steal the medicine because everyone has a right to choose life, regardless of the law.
Or: Heinz should not steal the medicine because the scientist has a right to fair compensation. Even if his wife is sick, it does not make his actions right.
  • Stage six (universal human ethics): Heinz should steal the medicine, because saving a human life is a more fundamental value than the property rights of another person.

Or: Heinz should not steal the medicine, because others may need the medicine just as badly, and their lives are equally significant.

From the above it should be amply clear what is salient for each stage and level.

Today I came across an old article by William Damon in Scientific American (PDF here) and he does a pretty good job of describing the stages, and levels, using terminology that is easy-to-understand and correlate.

Level 1: SELF-INTEREST

 

Stage 1:PUNISHMENT “I won’t do it, because I don’t want to get punished.”
Stage 2: REWARD “I won’t do it, because I want the reward.”

 

Level 2: SOCIAL APPROVAL

 

 

Stage 3: INTERPERSONAL RELATIONS “I won’t do it, because I want people to like me.”
Stage 4: SOCIAL ORDER “I won’t do it, because it would break the law.”

 

Level 3: ABSTRACT IDEALS

 

 

Stage 5: SOCIAL CONTRACT “I won’t do it, because I’m obliged not to.”
Stage 6: UNIVERSAL RIGHTS “I won’t do it, because it’s not right, no matter what others say.”

Now, long time readers of this blog will be familiar with my ABCD model of psychology and the eight stage model of development. To recap, the four dimensions important for any psychological model are Affective, Behavioral, Cognitive and Dynamic (motivational/social) – the right order of development is A->B->D->C. There exist two polarities relevant at each dimension. For Affect, it is the polarity of Pain-Pleasure; for Behavior, the polarity of Active (approach/reward)-Passive(avoidance/ punishment) , for dynamics (or social) it is Self vs Others and finally for Cognition, it is Narrow vs Broad. This model is based on the pioneering work of Theodore Millon and combines various other theoretical frameworks.

If one were to see the Kohlberg’s levels/stages from an ABCD lens, it is clear that SELF-INTEREST is a Behavioral level, with the people moving from a passive (punishment avoidance perspective) to an active (reward approaching perspective) way of reasoning and acting as they function and evolve at that level; SOCIAL APPROVAL is a Dynamic /Social level where people move from a primarily Self focus (avoiding social disapproval) to a primarily Others focus (keeping the glue of society intact); and finally The ABSTRACT IDEALS is a Cognitive level with people moving from a narrow view of morality as utilitarian/ social contract based to more broader conceptions like based on universal human rights.

All the above is fine, but what about A or Affect based level/stages in our model? Are there moral reactions and behaviors of children (less than 9 or say even 5 years of age) that cannot be explained solely as a matter of rewards and punishments? Did Kohlberg miss on an important moral foundation on which many of our initial moral acts are based? My contention is yes, Kohlberg did leave out an important moral foundation. I will call that Affect based moral level Level 0.

The Level 0, of moral action and reasoning, is before an infant/ toddler/ child start thinking of, and justifying, their moral actions in terms of self-interests or rewards and punishment. This Level 0 is the Level of EMPATHY. Research in infant and toddler development has shown that the first moral or pro social behaviors develop out of an ability to empathize with others; if an infant or toddler will witness another person crying they will try to soothe the other person even if their means of helping may be inadequate; similarly toddlers, given an opportunity to help another person by saying opening a cabinet, when a stranger has his hands filled with books, will help the stranger, without any regards to any rewards or punishments, but because of the sheer joy of seeing the other person become happy as a result of their actions.

It’s unfortunate that infants cannot speak and many toddlers haven’t developed a good vocabulary, so the verbal responses to dilemma approach cannot be applied as is to them; but clever researchers have developed ingenious protocols to observe and ascertain moral behavior in children of that age group, and probably can develop new techniques to figure out their moral reasoning too. For example, in one of such experiments, children are shown animated clips of figures like squares and triangles that are either helpful or hurtful (pushing around a loved object ) and based on which figures the child prefers, one determines that indeed children like helpful figure/ animation characters over hurtful/ bullying characters; one could modify this paradigm by varying the distress felt by a loved object, that is being pushed around, by increasing the squeaking noise that object makes, to find whether more squeaking leads to more empathy and thus more moral/ pro social action.

The point I am making is that the prediction that there is an earlier moral reasoning/action stage characterized by empathy, is an empirically testable fact and I do hope someone conducts appropriate experiments to modify and add to Kohlberg’s theory.

To reiterate, there does exist a Level 0 of morality based on EMPATHY and the stages here are that based on Avoiding Pain and Enhancing Pleasure; the Avoiding Pain reasoning goes like ” Heinz should not steal the medicine, because it will cause the druggist to become sad (as the druggist has lost something dear to him)” ; the Enhancing Pleasure reasoning goes like ” Heinz should not steal the medicine, so that the druggist can live happily based on profits he earns” .

So the bottom-line, we all start with EMPATHY on our paths to moral development and that provides a solid foundation on which higher stages like those based on abstract ideals are achieved.

Growing From Depression

“Growing from depression” is a short, easy read on the subject of the depressive experience and how to make best use of and grow from that experience. The book is written by Dr. Neel Burton, who is a psychiatrist as well as a philosopher, and an exceptionally good writer.

“If I had more time, I would have written a  shorter letter” so wrote Pascal/ Twain and in case of Neel he seems to have spent enough time on this book, making it succinct yet easy to understand and follow by a layman.

The book is organized in four sections; one dealing with defining and delineating depression – an experience that is bound to affect us or our close family/friends once in the lifetime. Some estimates have put lifetime incidence of depression as high as 30 percent , which means we are either a sufferer or a caregiver at some point, thus the importance of the topic.

The second section deals with current treatments for depression, including CBT, ECT and antidepressants. Maybe in future editions newer treatments like Metacognitive therapy or rTMS/ DBS can be explored and elaborated at in depth.

The third section makes the meat of the book- its a self help section with bite sized chapters making one think aloud and get help growing from the depressive experience. Given that Neel is a philosopher, some chapters do digress a bit and become more philosophical/ at tangent with the main premise of the book, but overall the suggestions and elaboration is grounded in what we do indeed know about depression- including things like depressive realism.

The last section is related to mental health services and mental health law and has limited appeal to international audience as its focused and based around the UK health care system and the UK laws.

Overall, its a pretty good read and makes you realize that there is much that you can gain from the depressive experience- including wisdom as to how prevent a relapse by controlling daily stress, maintaining good daily habits like exercise etc.

I wish many more experts and scientists  were able to break up from the jargon, and write a self help book for people at large. I am sure we all will be richer for that!

Buy the book here.

Psychotherapy, East and West

Reading philosophical texts can be daunting- sometimes the terminology and words are dense and sometimes you have to re-read multiple times to understand what the writer means. But reading original sources can be highly enriching too.

Buddhist monk in Phu Soidao Nationalpark, Phu ...

Buddhist monk in Phu Soidao Nationalpark, Phu Soidao Nationalpark Waterfall, Thailand, Uttaradit Province Location: Phu Soidao Nationalpark Thailand. (Photo credit: Wikipedia)

So when I came across an opportunity to read and review ‘Psychotherapy east and west,’ by Alan Watts, I proceeded ahead with some mixed enthusiasm- I like his quote ‘What if money was no object’ very much; but I also knew that I might not have the right expertise to do justice to the book. I am not a participating psychotherapist- the only saving grace is that I am very much familiar with some of the eastern ‘ways of liberation’ like Vedanta and Yoga and somewhat moderately familiar with the other oriental ones like Zen Buddhism and Taoism.

However, there is much that I could not understand, so take what I say with a pinch of salt.

Alan Watts, considers the eastern ways of liberation as something akin to western psychotherapy, with the aim being to bring about a change in individual consciousness.

The main resemblance between these Eastern ways of life and Western psychotherapy is in the concern of both with bringing about changes of consciousness, changes in our ways of feeling our own existence and our relation to human society and the natural world. The psychotherapist has, for the most part, been interested in changing the consciousness of peculiarly disturbed individuals. The disciplines of Buddhism and Taoism are, however, concerned with changing the consciousness of normal, socially adjusted people. But it is increasingly apparent to psychotherapists that the normal state of consciousness in our culture is both the context and the breeding ground of mental disease. A complex of societies of vast material wealthy bent on mutual destruction is anything but a condition of social health.

And thus the importance of context to understand this book- it was first published in the early 60’s a time of cold war as also a time when the, now controversial,  double-bind theory of psychosis was proposed by Gregory Bateson, whose work Alan Watts seems to admire. Watts assumes, and tries to show ,that Eastern ways of liberation also work by making an individual come to see the true nature of the double bind that society / culture imposes. He references the Hindu concept of Maya or ‘world-as-illusion’ and applies it to social institutions and believes that even western psychotherapists are in the game of dispelling Maya for their clients:

For they (psychotherapists) are dealing with people whose distress arises from what may be termed maya, to use the Hindu-Buddhist word whose exact meaning is not merely “illusion” butthe entire world-conception of a culture, considered as illusion in the strict etymological sense of a play (Latin, ludere). The aim of a way of liberation is not the destruction of maya but seeing it for what it is, or seeing through it. Play is not to be taken seriously, or, in other words, ideas of the world and of oneself which are social conventions and institutions are not to be confused with reality.

 

….

Yet very few modern authorities on Buddhism or Vedanta seem to realize that social institutions constitute the maya, the illusion, from which they offer release. It is almost invariably assumed that Nirvana or moksha means release from the physical organism and the physical universe, an accomplishment involving powers of mind over matter that would give their possessor the omnipotence of a god.

Eastern ways of liberation work by dispelling Maya, dissolution of ego and letting Eros or Love/spontaneity reign. But first we have to understand the double-bind to comment on it and to come out of it.

 

And that is just the paradox of the situation: society gives us the idea that the mind, or ego, is inside the skin and that it acts on its own apart from society.
Here, then, is a major contradiction in the rules of then social game. The members of the game are to play as if they were independent agents, but they are not to know that they are just playing as if! It is explicit in the rules that the individual is self-determining, but implicit that he is so only by virtue of the rules. Furthermore, while he is defined as an independent agent, he must not be so independent as not to submit to the rules which define him. Thus he is defined as an agent in order to be held responsible to the group for “his” actions. The rules of the game confer independence and take it away at the same time, without revealing the contradiction.

This is exactly the predicament which Gregory Bateson calls the “double-bind,” in which the individual is called upon to take two mutually exclusive courses of action and at the same time is prevented from being able to comment on the paradox. You are damned if you do and damned if you don’t, and you mustn’t realize it. Bateson has suggested that the individual who finds himself in a family situation which imposes the double-bind upon him in an acute form is liable to schizophrenia. For if he cannot comment on the contradiction, what can he do but withdraw from the field? Yet society does not allow withdrawal; the individual must play the game.

….

But in liberation this comes to pass not through an unconscious compulsion but through insight, through understanding and breaking the double-bind which society imposes. One does not then get into the position of not being able to play the game; one can play it all the better for seeing that it is a game.

But we are getting ahead of ourselves. I will let Watts describe an example of double bind to you , both in philosophy and in practice, so that you get a clearer idea:

If all this is true, it becomes obvious that the ego feeling Is, pure hypnosis. Society is persuading the individual to do what it wants by making it appear that its commands are the individual’s inmost self. What we want is what you want. And this is a double-bind, as when a mother says to her child, who is longing to slush around in a mud puddle, “Now, darling, you don’t want to get into that mud!” This is misinformation, and this — if anything — is the “Great Social Lie.”

The theory of double -bind for psychosis, though largely discredited/ unproven; may still be a useful starting ground to think about how ways of liberation work. Is the purpose of Zen Koans like ‘show me your true self’ a way to put a person in double bind? Watts wanted this book to be provocative and not a summary of what  research had already happened in terms of commonality between eastern and western approaches to psychotherapy- and I believe he succeeds in making one think.

I loved the book and came out richer for having read that- but beware that like all philosophical books it could be a little dense at times. I hope others, including myself,  continue taking ideas from both east and west and keep cross fertilizing them, until we are all ‘liberated’!!

But the book here:

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