Q: How does depression work? Is it often connected with social anxiety? What can be done about it (other than prescription drugs)? – Anonymous
Dear Anonymous,
Here are a couple of terms you’ll need to know for this answer: categorical and functional. These are two ways of looking at problems like depression and anxiety. The categorical approach involves finding the proper diagnostic label. It’s done by comparing an individual with groups of people who have similar symptoms. The functional approach involves finding a proper understanding of the problem, based on the individual’s unique circumstance. Both can lead to solutions in their own way, and both have their strengths.
The categorical approach works like this: If you complain to a physician about physical symptoms such as blurred vision, excessive thirst, rapid weight loss, etc., she might place you in the category called “diabetic.” You look like others who have the condition therefore you probably have it.
Many psychiatrists and psychologists take the same approach with cognitive and emotional symptoms. If you were to complain about loss of interest, fatigue, feelings of worthlessness, and so on, then you might fit into the category called “depressed.” So says the Diagnostic and Statistical Manual of Mental Disorders (DSM). According to this Big Book O’ Breakdowns, anyone who satisfies five out of nine symptoms fits the category. There are similar criteria for anxiety and other disorders. To help myself remember the difference between crazy and sane, I wrote this little mnemonic:
Four out of nine, of sound mind;
Five or more, sane no more.
Sorry, I’m being facetious again. The categorical approach works pretty well for physical problems, and this is why physicians tend to rely on it. But in case you missed my subtle sarcasm, I believe it has limited usefulness when it comes to understanding matters of the mind. Labeling something is not the same as understanding it.
And, by the way, the short answer to your question is: yes, there is often an overlap between the categories “depressed” and “anxious.” There is seemingly endless overlap among DSM diagnoses, and that is another reason that the categorical approach is difficult to apply to psychological problems.
That brings us to the functional approach (cue applause)
A functional analysis of cognitive or emotional difficulty asks, “how does it work?” just like you did – hence, the smartitude of your question. As functional thinkers, we would want to know how depression and anxiety function within the life of the individual, rather than in the many lives that comprise a statistic. We would follow a basic formula:
1) Define the problem (What does the patient want?)
2) Form a hypothesis (What’s standing in the way?)
3) Create a strategy to solve the problem (How do we get there?)
4) Test the solution (Did it work?)
With your question, we might begin by gathering data about the persons’s experience of being around others. What thoughts and feelings arise? What fears? What types of experiences make him anxious or depressed, and what experiences would he like to have? We might even begin with a supposition gleaned from evolutionary psychology and common sense: we are meant to be around others. It’s crucial to our survival.
If a person is anxious around something that he needs (such as other people), he might choose to avoid it. On the other hand, if he’s depressed, he might not have the energy to seek it out in the first place. Does it matter which problem came first? Probably not. What matters is that the person is left with a reduced repertoire of behaviors. He’s not interacting with others in the way that he wants. His life has become small and less-than-vibrant. Who wouldn’t be depressed?
Teamwork
A functional analysis would help identify the barriers that are keeping the person from pursuing the life that he wants. From there, it’s a matter of teaming up with the patient and finding ways to get past those barriers. Even if we were wrong at any point along the way, our failed effort becomes more data to help us zero in on a more useful approach. That’s the beauty of functional analysis.
Not everyone agrees. Many shrinks – probably most – argue for the categorical approach through word or deed. It’s especially tantalizing for those who prescribe medication or do therapy step-by-step from a manual.
I don’t knock medications. I’m all for them in some cases. Even though there are often other ways to manage psychological problems, there’s no reason to suffer needlessly while you’re figuring it out. Nor do I oppose manualized therapy. Sometimes necessity and limited resources rule the day.
But you didn’t ask about any of that. You wanted to know how to address problems without prescriptions drugs, and that’s where a functional approach comes in.
Now you may be wondering: just where are these functional thinkers hiding? They’re not hiding anywhere, Skippy. They just have crappy marketing. If you’ll allow me to boast about my profession, functional problem solving is where many psychologists excel. We train for it in a way that physicians, psychiatrists, and social workers do not. The Association of Contextual Behavioral Science is a great place to find scads of goll-derned super geniuses:
http://www.contextualpsychology.org/therapist_referrals
These folks specialize in helping people create the lives they want to live. Tell them that I sent you.
-IS