Now, I would like to invite our next speaker, Professor Sam Vaknin, and he is from Southern Federal University, Russia, and I would like to invite with his presentation titled Preparation and Authentic Pathologist of the Self.
So, Professor, can we start your presentation?
Thank you. Thank you for having me.
My name is Sam Vaknin. I'm a professor of psychology in Southern Federal University in Rostov-on-Don in the Russian Federation, and I'm a professor of finance and a professor of psychology in the outreach program of SIAS-CIAPS, Centre for International Advanced and Professional Studies.
My apologies for inflicting all this on you, but it's according to my contract. I have to say it in every presentation.
Today, actually, I would like to discuss a topic that is a bit different from the one published, and that is the topic of rethinking depression. Trying to reconceive of depression is actually a positive thing, and questioning whether it is a wise idea to try to quell depression, intervene with depression, suppress depression, eliminate depression. Is it a good idea?
Everything in nature and everything in psychology has a reason. Depression is there for a reason. It had arisen through an evolutionary process, and it fulfills critical functions.
When we administer antidepressants, when we deal with depression through talk therapy, for example, cognitive behavioral therapy, are we not interfering with natural processes which should be allowed to run their course?
This is the topic of my presentation, and I would like to open with a quote by Argos Haxley in his famous tome, Brave New World Revisited. He says, the real hopeless victims of mental illness are to be found among those who appear to be most normal.
Many of them are normal because they are so well adjusted to our mode of existence, because their human voice has been silenced so early in their lives that they do not even struggle or suffer or develop symptoms, as the neurotic does. They are normal not in what may be called the absolute sense of the word. They are normal only in relation to a profoundly abnormal society.
Their perfect adjustment to that abnormal society is a measure of their mental sickness.
These millions of abnormally normal people, living without fuss in a society to which, if they were fully human beings, they ought not to be adjusted.
These are very profound words.
The concept of depression relies on two meta concepts, on two pillars, conceptual pillars of psychology, modern psychology at least.
The first pillar is the individual, and the second pillar is dysfunction.
We can distill all the science or pseudoscience of psychology into these two concepts, the individual, the individual's style, the individual's personality, but always the individual in divisible, like an atom, and the concept of dysfunction.
But you see, individual and dysfunction are not real entities. They're not objective entities.
These are counterfactual ideals, and they are based on a statistical normal.
We survey big populations, we study cohorts, groups of people, and we say, okay, this is normal, this is statistically most prevalent and most common, so it is normal. Anything outside, to the left or to the right, in this Gaussian distribution, anything, the tails, the tails of the distribution, are actually dysfunctions.
And who are the points? Which are the points in this Gaussian distribution, the individuals?
There's no such thing as an individual. It's a fake counterfactual concept.
In the 1960s, there was a school of psychology in the British Isles. It was called the British Object Relations School. And one of the major contributions of that school of thinking was that the self, the individual, as we call it today, is the outcome of intersections and interactions with other people.
If we were to prevent a baby from interacting with other people, if we were to isolate an infant and prevent the infant from reacting to reality, that infant would have not developed a self. Jung called this process constellation.
The infant would not have a constellated self. The self is like a Venn diagram. It's like the intersection of multiple circles. It's the outcome of having interactions with other people and with reality.
So in reality, there is a spectrum.
The approach to mental illnesses should be dimensional. The ICD-11, the latest edition of the International Classification of Diseases, had adopted this approach.
The Diagnostic and Statistical Manual, Edition 5, is trying to adopt this approach in its alternate models.
So we are transitioning now from a discrete, differential, atomized form of psychology to a holistic, relational form of psychology, where the human being is embedded in social networks and is defined by these networks.
So depression is supposed to be an individual trait or property or an individual process, process within the individual, and it's supposed to be a dysfunction.
But if there is no such thing as individual and if a dysfunction is merely a statistical norm, then maybe the whole concept of depression is wrong. Maybe it's not a dysfunction. There's no question that depression has biological underpinnings or at least correlates.
We know that depression is somehow correlated with a microbiome in the intestines, the gut flora, and dysbiosis, imbalances in the gut flora. We know that serotonin is produced mostly in the intestines, in small part in the brain, but 90% of serotonin is produced in the guts.
We know that depression is somehow associated with an imbalance in the reabsorption of certain neurotransmitters, the processing of certain neurotransmitters in the brain.
So clearly there are some biological correlates, something afoot biologically and physiologically, that somehow yields or is connected to or is correlated with what we call depression.
But the medicalization of depression is philosophically erroneous. It's a fallacy. It's a fallacy to say that A causes B.
The only thing we can say for sure is that depression is concomitant, co-occurring with, appears together with certain physiological, biochemical, neurological, and hormonal events or processes.
How do we know, how can we tell whether depression is a brain event, whether it's a cerebral effect?
We administer antidepressants and then antidepressants when consumed sometimes, not very often by the way, but sometimes alleviate depression.
So we say, oh well, if since we had administered antidepressants and we had affected the brain and the depression disappeared, we can now reverse engineer the process and we can say, well, depression is an artifact of the brain. It's an epiphenomenon. It's an emergent phenomenon in the brain.
But of course it's utterly wrong because whatever is happening in the brain when you're depressed, this could be mere correlation. There is even the possibility that the depression had caused the changes in the brain, not the other way around. And there is a possibility that there's a third overlying, third overarching structure or process which give rise to the changes in the brain and to depression simultaneously.
We simply don't know. We are very far from knowing the brain.
Neuroscientists like to brag and pretend narcissistically, megalomatically, I would say even grandiosely, that they are fully acquainted with the brain. We don't know anything about the brain.
These are baby steps. We know nothing.
In 100 years we will know that we had known nothing today.
And so this is hubris to claim that we can trace depression all the way to the microstructures of the brain, to multi-unit activity in the brain, to hormones.
I mean, that's hubris. It's also probably counterfactual.
One thing we do know, depression is an adaptive, appropriate response. I repeat, depression is a positively adaptive, appropriate response to stressful or dystopian environment.
If you were an inmate in the extermination camp Auschwitz and you were not depressed, that's a sign of mental illness.
To be an inmate in Auschwitz and to not be depressed shows that something is wrong with you because the only adaptive, appropriate response in Auschwitz is to be depressed.
Auschwitz was a depressive environment, depression-inducing environment.
To live in today's world with pandemics, with economic recessions, with disintegration of institutions and society, with disorientation, with dislocation, to live in today's reality and not to be depressed is sick. It is sick to not be depressed when you are faced with the daily news.
Our world, our reality is depressing and the only appropriate, mentally healthy, positively adaptive response to our world, to our existence, to our reality today is depression.
If you are mentally healthy, you're going to react to the news cycle with depression. It's a sign of mental health.
You are right to be depressed. It's healthy to be depressed. You should be depressed. And if you're not, something is wrong with you.
So depression is context-dependent, context-dependent, and yet we don't treat it as context-dependent.
Whenever we come across depression, we immediately medicate it. We immediately try to eliminate it. We immediately try to remove it.
Why? Why are we doing this?
This is wrong. We must analyze the context, the culture, recent events, personal history, future horizon. We must analyze a panoply of multiple dimensions before we reach a decision to medicate depression away.
Depression has many evolutionary adaptive and recuperative functions.
Depression is an alarm signal. It tells you that something is wrong. It alerts you to danger. It alerts you to threats. It motivates you to act, to preempt. It's an alarm signal.
Depression involves catastrophizing. Catastrophizing is preparing for the worst. Catastrophizing is a pathological process.
But if you are embedded in a pathological environment, if you live in a sick society, if the world around you is falling apart, catastrophizing is not pathological. It's adaptive because it allows you to prepare for the worst possible scenario, the worst case scenario.
Depression is about mourning and grieving. It's about loss, adapting to loss, adjusting to loss, digesting loss, assimilating loss, accepting loss, the famous five-stage cycle of Kubler-Ross, five stages of grief.
So depression is an integral part of mourning and grieving, and mourning and grieving is an integral part, our integral parts of depression.
Depression allows you to mourn and grieve sequentially and structurally. Depression helps you to reframe.
Depressed people reassess and re-evaluate their lives, people in their lives, events, decisions they've made, choices, better, good, outcomes.
Depression is a processing. It's a process of processing. It's a process of re-evaluating and analyzing the entirety of your life.
So it allows people to reframe, to gain new insights, a new understanding, which ultimately is the very foundation of healing.
Depression restores reality testing. When we are not depressed, when we are relatively content and happy, when we inhabit an environment where we have favorable outcomes, where we have self-efficacious, we tend to drift apart from reality.
We develop delusions. We develop illusions. We develop fantasies. We develop grandiosity.
It happens to all of us, to the best of us, to everywhere, every time.
It is depression that brings us back to reality with a bang. Depression forces our feet back to the ground. Depression grabs us from the clouds. Depression confronts us with the things in our lives that are wrong, that should be amended, that should be discarded, that had unfavorable outcomes, choices and decisions we have made, which had impacted us and others adversely.
All this is part of depression, the process of reframing, and the process of restoring reality testing.
Depression also provides emotional release. It is true depression that we cry, sometimes for no reason. That is emotional release.
We need to release emotions in an environment and in a society that frowns on emotions, that mocks emotions, because our Western society is a death count. We worship dead objects. We worship material objects. We sacrifice human beings and we sacrifice human emotions to preserve the economy, the sum total of material goods.
We had objectified reality and in turn we had objectified each other. We are objects to each other, sexually, emotionally in every possible way. We had become objects.
And so depression legitimizes, allows us to cry, allows us to feel sad, lets us experience that which is not allowed, that which is frowned upon, that which is taboo.
Depression is accepting our frailty, our weakness, our neediness, our vulnerabilities.
Finally, which is a very healing process, a very good process.
Depression also allows us to economize energy. In daily life, when we are not depressed, we overspend energy and we end up being very depleted, very exhausted.
Depression slows us down, reduces the rhythm and tempo of life, lets us sit aside and recuperate, gradually.
Animals do this. When a dog is wounded, the dog withdraws and retreats under a bush until the wound heals. We are wounded daily, multiply and it is depression that provides us with a respite, with a break within which we can gradually heal and recover.
Depression also allows us to rebuild shattered psychological defense mechanisms.
Depression usually follows decompensation and technically depression could be thought of as a form of acting in rather than acting out, internalizing conflict and dissonance to the maximum, internalizing aggression. Internalizing aggression, that was the old view of depression.
So it allows us to rebuild functional defense mechanisms so that we again can cope with reality without being constantly injured, constantly wounded, constantly battered, constantly devastated.
And finally depression allows us to reconstitute the self. The self is sometimes subject to torsion and conflict and dissonance and pressures and stress that damage it.
The self is not immune to damage and is not immutable in all its parts.
Depression allows us to reintegrate the self, to reconstitute the self, to reconstitute the self.
I in other words, regard depression as a very healthy process, a process of healing.
We should intervene in depression only when there is suicidal ideation, never before, never otherwise.
What we are doing today is disastrous and counterproductive. We medicate and we intervene whenever and wherever depression appears.
That's bad, that requires growth, that prevents healing.
We are not healers, we perpetuate depression. We perpetuate victim mentality and victim stance. We don't allow people to develop scar tissue over the wound. We keep probing the wound. We keep preserving the initial state which preceded the depression which was not a healthy state.
Depression is a healthy reaction to a preceding unhealthy state and by giving antidepressants we preserve the unhealthy state by removing the defense known as depression.
When there is suicidal ideation of course we should intervene, no question about it. Any hint of suicide should bring us to the fore with all the weapons we have, antidepressants, talk therapy, CPT, you name it, hospitalization if needed.
But otherwise we should let nature take its course in restoring equilibrium, homeostasis and ultimately functioning and happiness.
Thank you for listening.
So much for this wonderful presentation and I would like to ask if anyone is having any query, kindly ask him if that will answer us.
Hello. Yes doctor. I just want to appreciate from his excellent presentation and the reality grounded in his speech. Thank you very much.
I think generally in psychology and psychiatry we tend to throw medicines, throw pills at problems because it's very easy you know. You come with a problem, take a pill, leave me alone.
It's learned helplessness, it's embedded laziness. We don't bother to think about the role, the function of mental illnesses or mental dysfunctions. They have a role, the evolution made them happen because they are useful.
Okay, thank you very much for listening.
I have a client I'm afraid I have to run. It's very kind of you and see you next conference. Thank you.