Abstract
While analyzing the depressed state scientifically, it is useful to compare the empirical evidence with the experience as described by artist-writers who have been afflicted with the disorder. The artists question the appropriateness of the term “depression” to label the state. William Styron, e.g., experienced it as a “storm,” much more turbulent emotionally than the depressed, semi-paralytic quality described in the clinical literature. Opposing perspectives on its causes held by Europeans and Americans are reviewed, as is the research on its phenomenology prior to the introduction of the antidepressants. The treatments espoused by biological or psychological proponents were different, neither very successful. Following the drugs, new studies of the disorder found more evidence for the focal roles of anxiety and hostility in its composition, thus, supportive of the artists’ emphasis on turmoil and conflict of emotions in the basic experience. Clearly, measuring specific behaviors and feelings associated with the disorder has been neglected in the decades-long neurobiological analyses of drug actions. To advance understanding of basic mechanisms, a more refined behavioral approach and methodology was applied in concert with neurochemical analyses. That behavioral approach is described in the next chapter.
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The writer-artists have it that the every day language utilized to describe this state of suffering has not served us well. The depressed state is not so simple as the stereotypical concept most often used to describe it. These simple descriptions of an emotional state that most normals have experienced in lesser amounts and on fewer occasions is not, according to those actually afflicted with the disorder, an accurate picture of the disordered state. It is because of the common view that it is part of everyone’s experience, that it has been so mischaracterized in every day literature and in the popular press. A more realistic description requires a grasp of language and a capacity for articulation much beyond that which is available to the average person, and apparently, the average clinician. The gap between the stereotype and the artists’ articulation of the state is vivified by the author, William Styron, later in this chapter.
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The anxiety reported by the patient is most often initially experienced in the early morning on awakening as he confronts a new day. The clinician almost always considers it within the overall syndrome of depression but views it as part of “general emotional distress”, a core component of the disorder. The anxiety is not ordinarily seen as a separate element. Yet whereas depression is by definition primarily a “down” state, reflecting an extreme slowing down of the central nervous system (CNS), anxiety is associated with “arousal”, a negative excitement, and an entirely opposed state of the CNS. Logical thinking would make it difficult to accept these opposed CNS states as part of the same “emotional component”, or derived from the same source, so it is strange that we have been so quick to conflate them in clinical thinking.
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The main reason for this neglect of behavioral aspects appears to be the fact that clinicians and scientists, once they accept the drugs as the most effective of extant treatments, are then further convinced that the major depressive disorders are biological disorders, much like other medical disorders. In view of acceptance of that model and of the primary role of drugs, the specific disturbed behaviors or emotions associated with the diagnosed disorders become increasingly less important. This is a natural reaction but the entire position is, regrettably, based on false assumptions about the specificity and the mechanisms underlying the efficacies of the established “antidepressants”.
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Katz, M.M. (2013). Depression is a “Storm” not a Lowering of Spirit: The Experience and Psychology of the Severe Depressive State. In: Depression and Drugs. SpringerBriefs in Psychology. Springer, Heidelberg. https://doi.org/10.1007/978-3-319-00389-4_3
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DOI: https://doi.org/10.1007/978-3-319-00389-4_3
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