Is it good to feel bad sometimes?

Sometimes it's good to feel bad

Transcript

1 1 P&S (magazine for psychotherapy and pastoral care),, S Sometimes it is good to feel bad On the question of the meaning of grief and depression Daniel Hell Grief is understood in all cultures as a meaningful processing process, whereas today depression is almost only pathologized. That was not always the case and it does not have to stay that way. The transition from grief to depression in particular can show that certain forms of depression also have a protective function in the event of overwhelming loss. Introduction Depressive suffering is extremely distressing. It blocks and seems pointless. One might even wonder whether depression cannot be characterized as a disease of loss of meaning. So a person in deep depression can also lose his faith. Nevertheless, the question of the meaning of depression has moved people at all times. Philosophers and religious thinkers, but also natural scientists have tried to wrest a meaning or at least a purpose from the depression. Even depressed people often do not let go of the question of meaning, although seriously ill people usually do not find an answer or even perceive the question as meaningless and a provocation in view of their suffering. It is different after surviving depression, when the mood brightens and thinking becomes more open and flowing again. Then many of those affected ask why and why questions. What is the purpose and where does the depressive event lead? Is there a hidden message in depression? The writer Adrian Naef is e.g. convinced that the soul has forced a course correction on him, without which he would never have come to the insights that are important to him in life. He notes that the depression has forced him to change direction that he urgently needs.

2 2 Few people who have experienced depression go as far as Adrian Naef in discovering a wisdom in depression that forces them to stop and to reorient. But many see their lives at the other end of the depressive tunnel with different eyes than before. This can make it easier for the weights to be redistributed in life and, for example, to reduce the pressure to succeed in favor of personal interests. In fact, the path into the shadow realm of depression can change a person profoundly. It can destroy, but it can also cause people to leave the old behind and open to the new. Many people today feel that the modern equation suffering = disease does not work out. It is not enough for them to see themselves only as passive victims of a cause-and-effect disease, as helpful as it is to know about the neurobiological nature of the depressive blockade in a severe depression and to be treated and relieved as a sick person. It is also important for them to find a meaningful classification of the depressive experience in the larger whole of their life. Such a question about meaning and meaning is also peculiar to some modern forms of psychotherapy such as e.g. Frankl's Logotherapy or Hayes’s ACT (Acceptance and Commitment Therapy). But it is not new and can be historically traced far back to the beginnings of various religions and the history of philosophy. Melancholy as a distinction In ancient Greece, the Hippocratic citizen doctors first turned the depressive experience into an illness, which they called melancholy (black gall). Polybos attributed the melancholy to a thickening of the bile, which Galen later expanded upon in his theory of temperament as a predominance of black bile over yellow bile, phlegm and blood. If the old Hippocratic doctors saw in excess of the bile exclusively a disease, in the ancient philosophy positive things were ascribed to the change of the bile, and therefore to the melancholics. The beginning of a work from the school of Aristotle, the so-called Problem XXX, has become famous, in which it says: Why were all outstanding men, whether philosophers, statesmen, poets or artists, evidently melancholics? And some to such an extent that they even suffered from the morbid attacks caused by the black bile ...? These sentences were ascribed to Aristotle for a long time, but are likely to come from one of his pupils, Theophrast (372 to 287 BC). Problemata XXX end with the statement: That is why all melancholics are excellent people, not because of illness, but because of their natural disposition. According to Theophrastus, this melancholy disposition consisted in a particularly unstable state of the bile

3 3 stence and temperature). According to this ancient view, it is not the balanced person who is creative, but the one who has to struggle with mood swings or temperature fluctuations of the bile and has to strive again and again for a balance (whereby the cooling of the bile tends to lead to melancholy and the Heating tends to be more of a mania). What characterizes this concept of melancholy and has made it so fruitful over the millennia is, on the one hand, that a depressed mind has an inner dynamic and is not a constant deficit, and on the other hand, that depression comes from the same substance or, in modern terms, from the same biochemistry as health , so to speak grows out of the healthy, and third, that the healthy hypertrophies, or to put it pointedly, that melancholy is too much and not too little of nature (Theunissen, 1966). Melancholy is therefore an anomaly, one that makes a person suffer, but also one that challenges people to transcend themselves. This ancient understanding of melancholy has given way to a medical concept of illness that has replaced the theory of humors with the theory of nerves and the brain. Medically, depression is mostly attributed to a hypothetical brain pathology today. If someone wanted to take on the role of a modern theophrist, he would have to pervade modern neuroscience philosophically in such a way that the old dynamics of bile would give rise to a new dynamics of neurons capable of transcendence. Akedia as a drama of human freedom Historically, another concept of depression has influenced the modern era. Today it is largely forgotten, but nevertheless of decisive importance for our question: the Akedia concept of the Middle Ages. In contrast to the biological concept of melancholy of ancient philosophy, it is a spiritual and spiritual concept of Christian theology. It is based on desert experiences of hermits and is therefore less loaded with theory than it is characterized by existential depth. Because the early Christian hermits in extremis had to confront their thoughts and feelings, it has been aptly said that their lonely life was a tremendous psychoanalysis. This also makes it more understandable that they anticipated many psychological findings of today's psychotherapy for a millennium and a half, such as the self-aggression theory of depression by Sigmund Freud or the treatment approach of cognitive psychotherapy by Aaron Beck.

4 4 They were particularly troubled by depressive moods, which they called Akedia (translated: indolence, weariness or self-disgust). They tried to defend themselves against it in a targeted manner, but not by locking their heads in the sand, as it were - but by trying to understand it better (cf. Hell 2009). Abbas Evagrius Ponticus in particular developed deep insights into this problem. He observed e.g. to himself that he became depressed when he was frustrated and directed his disappointment hatefully (full of hatred and shame) against himself. He illustrated the Akedia with the concise image of a beast of burden pulled from the front by desire and beaten from behind by hatred. In order to limit depressive impulses, he countered negative thoughts with neutralizing or positive sentences from the Bible and collected such biblical words in an almost manualizing way in his work The Great Controversy. The desert fathers and mothers equated the Akedia with the eclipse of God and judged it as a demonic temptation, but also accepted it as a challenge. The saying of Antony has come down to us: No one can enter the kingdom of heaven untried. Take away temptation and it is not one to find salvation. For the early Christian hermits, the Akedia was part of the human condition, because they themselves had to experience time and again how they lost their inner peace. They not only tried to prevent Akedia with psycho-hygienic and spiritual means, but also felt it as a warning sign, as a protection against pride and arrogance and as an indication that a person has exaggerated expectations and is annoyed with himself if they are disappointed. Consequently, the claim to defeat the depressive element once and for all was alien to them. But it didn't stop there. The more the theological dogmatics took hold of the Akedia, the more it was understood exclusively as a sin and, in the High Middle Ages, even as a mortal sin. However, it is mostly overlooked that medieval theology of sin also adhered to human free will. But she wanted to limit the tragedy of the Akedia with bans and overlooked the fact that there are depressive developments that cannot be stopped with good will. Today the depression has lost not only its melancholy distinction, but also the Akedic drama of freedom, so that to a subtle modern thinker like Walter Benjamin the Akedia doctrine appears like a reflection of a distant light that stands out from the darkness of a depressive notion of fate. In fact, the modern

5 5 ne promoted non-personal cause-and-effect thinking that turns depression into an unconscious or neurological event. Depression and grief today Today we are faced with the challenge of combining freedom and illness in such a way that one does not simply cancel the other, but complements each other. In severe depression (corresponding to the melancholic type) the degree of freedom is severely restricted, while in lighter depressive moods (which was originally meant by Akedia), this development from depressed to depressed can still be counteracted through a mindful and decathrophic attitude. But this requires an understanding of depression that does not reduce the depression to a biosocial occurrence, but rather assigns a certain degree of influence to the human decision-making ability. In order to combine pathological process thinking and personal influence, it is helpful not just to pathalogize the depression, but to see it as a biosocial and psychological event that develops out of the healthy and can make sense in its approach. Depression often occurs in situations of loss that overwhelm a person. Mourning is also often associated with depressive symptoms. However, mourning is understood transculturally as a healthy processing process. If a loss is so severe that it overwhelms a person, the grieving process of processing can come to a standstill. Then there is often a depressive inhibition of feelings and drives, as it were as protection against overwhelming emotions. To see only one pathological mechanism of action at work seems counter-intuitive. If the depressive symptoms are only mildly pronounced (in the sense of the German term depressed or the English term low mood), it is easier to see a meaningful reaction in them. If the symptoms are more pronounced, it is more difficult. But a sharp demarcation between the different degrees of severity is not possible. The transition between depressed and depressed or between healthy and sick is fluid. There are many indications that severe and disabling depression is a dysfunctional complication of normal depression. The latter makes sense insofar as it temporarily slows people down and protects them from short-circuiting actions that worsen their own situation. However, this protective component can become so excessive and persistent that it becomes a problem in itself.

6 6 Depression about depression Such an understanding of depression (presented in detail in my book Depression as a disturbance of balance [2013] and illustrated in What makes depression? [2014]) is based on a spiraling escalation from depression to depression. Just as morbid anxiety is better understood when assuming healthy anxiety, depressive episodes are better understood when assuming normal depression. It is well known that fear serves as an alarm bell or as a sensor that draws attention to dangers. Fear is vital. Nevertheless, under certain circumstances, fear can take on a life of its own and turn into a pathological panic disorder or phobia. In an analogous way, normal depression or a depressive mood that most people are familiar with can be understood as a protective reaction that protects us from greater harm when we are under excessive stress. As anxiety escalates into panic, depression can escalate into depression. This danger is greatest when, in addition to constitutional, biographical and situational influences, brooding and strife increase the distress and a one-sided pathologization weakens hope. In recent years, psychotherapists have drawn attention to the possibility that depression can, in favorable cases, be a starting point for new developments. This does not happen as profoundly as with Romano Guardini, who in his much-read book Vom Sinn der Schwermut differentiated between good and bad depression; but there is a similar, albeit secularized result. The American psychologist Ellen McGrath writes under the telling title When it's good to feel bad: For me, the process of allowing (psychological) pain and responding to it ultimately led to a liberation from depressive feelings that I would never believe possible would have held. And she continues: There are times when it is perfectly healthy and normal to be depressed, especially for women in our culture. Accordingly, Ellen McGrath developed the term healthy depression, which differentiates it from unhealthy depression that requires treatment. Similarly, the psychoanalyst Emmi Gut differentiates between productive and unproductive depression. With the support of John Bowlby, one of the most outstanding psychiatrists of the second half of the 20th century, Emmi Gut sees depression as a vital process at work that can either be useful or harmful. She is of the opinion that in a depressed state a failure or a loss situation can be dealt with by forcing the depression to calm down and at the same time giving the opportunity to wait and see what happens

7 7 Unconscious climb up. But where the defense is too great, there is a risk of an unproductive depression. The Swiss writer Ludwig Hohl put similar lines of thought in a memorable picture: At times everyone has to take the step over the place where everything is momentarily questioned (which is the reason for all our depressions), the step over the precipices of the mountains. The new is not yet, the old is no longer; You walk over a gap between two rock walls, the rock behind you was firm and the new one will surely be one day, but now the emptiness is under your feet. Ludwig Hohl postulates, according to the doctrine of melancholy, that depression is an obligatory companion of the creative, not as a source of the new, but as a transition stage when border crossings leave the old behind and make new possible. At best, he sees a bridging function in the depressed state, which helps to withstand a dangerous-looking emptiness, so that a transition from a left-behind to a new basis of life becomes possible. Between pathogenesis and salutogenesis Such a positiveization of depression is not without its dangers. It must not lead to the disabling and sick side of the depressive process being overlooked and the suffering to be glossed over. Rather, it remains a therapeutic task to help patients overcome their misery. It is important to help break the vicious circle of the depressive spiral and win the patient as an active partner for this challenge. This, in turn, is better possible through destigmatization and decathastrophication than if a patient is only pathologized. The greatest danger of ascribing meaning, however, is its instrumentalization, from which even spiritual approaches are not immune. Finding meaning is something very personal. Spirituality cannot be prescribed either; it can only be sought and lived by someone. The person concerned can decide what makes sense. If a therapist nevertheless ascribes meaning to the suffering of a depressed person, he is depriving a person of what he has to defend most, namely his very personal relationship to himself. When dealing with the question of meaning, it should also be borne in mind that too many people are still broken by the depressive events for it to be permissible to force them the question of why, if they need acceptance and understanding in the here and now in their distress.Nevertheless, the struggle for a meaningful classification of the depressive event that has gone through is like introductory for many affected people

8 8 set out - a major concern. I am convinced that we can help these people if we are open to their questions of meaning. Despite all defense attempts, despite denial and looking the other way, despite all scientific advances and despite increasingly selective drugs, depressive forms of suffering seem to become more and more often even more chronic. Everything points to the fact that the technocratic path of isolation and fight against depression in the sense of an exclusively organic understanding of illness is not sufficient to do justice to depression. We probably have no other choice: We cannot separate the depressive events from the cultural evaluation and from psychosocial contexts. It is all the more important not to look at the depressive event in isolation and not to evade the question of its meaning and message. Literature Guardini R (1996): From the sense of melancholy. 6th edition. Topos Vol. 130 Gut E (1989): Productive and unproductive depression: succes or failure of a vital process. New York: Basic Books Hayes SC, Strosahl K, Wilson KG (1999): Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. New York: Guilford Hell D (2009): Understanding the Language of the Soul. The desert fathers as therapists. 9th ed. Freiburg: Herder Hell D (2013): Depression as a disturbance of balance. 2nd edition Stuttgart: Kohlhammer Hell D (2014): Which sense does depression make? An integrative approach. 17th ed. Hamburg: Rowohlt Hohl L (1990): Nuancen und Detail. Frankfurt a.m .: Suhrkamp McGrath E (1992): When feeling bad is good. New York: Henry Holt Naef A (2003): Night Walkers Logic. Berlin: Suhrkamp Theunissen M (1966): Preliminary drafts of modernism. Berlin: de Gruyter