Understanding the Depressions. Wyn Bramley
research, though its general tenor would not be disputed by most professionals in the field.
Chapter 2
What Causes
“The Depressions”?
Who falls prey to them and why? Are they inherited or acquired? Are they associated with intelligence, social or educational factors? Are certain personalities – artists, ambitious types, grumpy characters maybe – more susceptible than others?
The short answer is that there appears to be no isolated single determinant, except perhaps in the cases of severe and recurrent Depression or bipolar illness, where a personal and/or pronounced family history make clear that genes must dominate, whatever other factors may be involved. When, how and why those genetic tendencies become actualities, however, begs further research. Are incidents already primed to “go off” no matter what, like an alarm clock; or might there be predictors that, once identified, could mitigate an attack, or alert us sooner to an impending one?
Neither do profiles exist, boxes of personal characteristics to tick, that will neatly slot you into the different types of Depression you are likely to suffer, though there are indices, likelihoods. These types (chapters 4 and 5) are in any case sketches not portraits. Anyone of any intelligence, personality or background, whatever their genes, can be affected by mood disorder. Though adverse circumstances such as bereavement, poverty, redundancy might contribute to or worsen an already negative outlook, they’re not single explanatory causes. The picture is more complex than that.
It may be more useful to look at the Depressions – from the littlest ‘d’ to the biggest ‘D’ – from a dynamic rather than a causative point of view, the word dynamism referring to a field of interplaying forces. A simple diagram can illustrate how many features within and without the individual can interact with each other in countless combinations and in constant movement to produce the state of mind (and body!) we know as Depression. The symptoms themselves will vary, wax and wane, according to the unique distribution of those features and which of them are being stimulated, charged if you like, in that especial person at a specific point in time. “Causes” are lifeless, abstract things: this diagram illustrates potent forces that move around in a person all the time, hence the possibilities for getting worse and (hallelujah!) for getting better.
The Human Onion
Think of a human being as an onion. There’s a sturdy outer covering and vulnerable layers within. Not very poetic I know, but the analogy suits, because the human being and the onion are structured in a similar way. Should you peel back the “face” that a person shows to the world you will find layer upon layer of complex individual qualities behind it, be they deeply hidden or open for inspection, that have resulted from their unique life experience. Like the onion, each of those layers has an interconnected growth history. Possibilities still exist for them to grow, remain static or fade away. Let me now try to guide us through the main layers. Of necessity the diagram is two dimensional but try to keep in mind a real, spherical onion.
Genes
We will start at the densely wrapped centre. There’s not much that will yield to pressure or that will expand or shrink, in the way other layers can. This core is analogous to your set of genes. Long before your brain has even finished forming, before you have anything remotely akin to a personality, your ancestors have bequeathed to you in the form of your genes a bag of both potential and definite characteristics. Some can’t be changed – eye colour, left handedness, fingerprints. In the diagram these are represented by the blocked out centre.
You also inherit predispositions as well as certainties. For instance, a tendency toward anxiety, aggression, optimism or pessimism may lie within your genes, but it doesn’t necessarily morph into mental illness. It all depends on whether life’s vicissitudes draw out and reinforce the tendency or minimise the need to manifest it. These potentials surrounding the core are drawn as broken lines, just as in a real onion the deep embryonic shoots encasing the core can develop over time into a recognisable functioning layer or remain stunted, depending on growing conditions within and without the plant.
Upbringing 1
The nature/nurture debate
Having started at the centre of the diagram, we now work outwards, coming next to the huge area inside you that encompasses your upbringing; or rather, what you made of how you were brought up. For you participated in that process, had to somehow grow an identity out of it. You had to discover or decide who you were, how you were going to operate successfully within the universe of your family. You had to work out, albeit without consciously articulating it, whether and how to compete, share, declare a need, attack or defend yourself; whether and when your relationship with others in your home was best cultivated and enjoyed, and when it might be better avoided. Was your family experienced as safe and dependable or too emotionally threatening? Did it feel too close or too distant? Against this context, how difficult or easy did it feel to take pride in your strengths and achievements, or did you decide to hide or even reject them? Did you express your interests and pleasures or did you have to defend them against perceived saboteurs? All this work, your work, shaped your unique personality. It wasn’t dropped into your head ready formed.
So far, no one has been able to accurately calculate what proportions of family and genetic influence go to make up both the mentally healthy and unhealthy person, though clinical experience places enormous weight on how a child interacts with its carers. Here’s an example. Someone brought up in a violent household becomes violent too. Grandma on one side of the family is violent as well, but Granddad on the other is pious and withdrawn. Our violent person’s equally abused brother or sister turns out to be gentle as the proverbial dove. How much is genes and how much upbringing? Were brother and sister’s differing temperaments already sealed in by their genetic endowment, each having inherited different bits from the gene pool? Or were they fashioned from the disparate way each understood, reacted to and managed their relationships within the family? Common sense suggests there are complex combinations of Nature and Nurture operating here that can’t be judged by simple arithmetic.
We should also remember that we inherit “positive” tendencies too: curiosity, optimism, gregariousness for instance (though these can work as much against us as for us, depending on how we deploy them). Some of these qualities may offset or compensate for the “negatives”, but at birth all exist as merely potential, not actual, characteristics of the developing individual. They lie dormant. They are yet to be shaped by lived experience (upbringing) and of course the later learning/ unlearning/relearning process. Some children engage eagerly in learning about relationships whilst some are too sluggish and afraid to experiment – early conditioning or genetic predestination? Research cannot yet accurately quantify or map these determinants. We can only rely on educated guesses accrued from long clinical experience.
Upbringing 2
The consequences: relations with your Self
Your attitude to your own Self has a bearing on mood. The more you like, enjoy, feel proud of your own Self, the more your mood will hold up, whatever is occurring in your life. The more you doubt, disapprove of, are ashamed of your Self, the more readily undermined will be your mood. You can act confident, unafraid, anxiety free, but acting doesn’t make it so. If you have a pretty unfavourable secret attitude to and beliefs about your own worth and attractiveness to others, you’re clearly vulnerable when something bad happens. A job loss or ending of a relationship may confirm long held suspicions that you are a hopeless failure, that it must be your fault, and your mood collapses. Lack of self-esteem is learned, not genetic, and is a huge risk factor for many. It has to have arisen from early family “messages”, overt or unspoken, deliberate or not, sent to you and absorbed by you as a child, aided and abetted by your self-critical interpretations of them. But don’t forget that messages can to some extent be decoded and rewritten later on.
What is it then, that determines which of three people who lose their job becomes a) merely unhappy, b) little ‘d’ depressed, and c) big ‘D’ Depressed? The one who reacts with ordinary unhappiness is the one who, in the struggle