Endurance of Pain and Suffering

painHe knew how to handle pain. You had to lie down with pain, not draw back away from it. You let yourself sort of move around the outside edge of pain like with cold water until you finally got up your nerve to take yourself in hand. Then you took a deep breath and dove in and let yourself sink down it clear to the bottom. And after you had been down inside pain a while you found that like with cold water it was not nearly as cold as you had thought it was when your muscles were cringing themselves away from the outside edge of it as you moved around it trying to get up your nerve. He knew pain.
― James JonesFrom Here to Eternity

Why does depression exist?

Last week we heard a fascinating presentation by Dr. Julio Ozores of the UCSF Mood Disorders Clinic on some of the evolutionary psychology and neurobiology hints about the adaptive value of depression, in other words, why depression exists as a potential.

I hope that I’ll be able to interview Dr. Ozores for one of our “conversations” in the next couple of weeks, because he has a wealth of knowledge on these topics, but just attending his lecture got me thinking again about the value and purpose of depression.

Today I had more opportunities to think about this, because I met with a woman in her thirties who’s been wrestling with depression and PTSD for several years, and she told me that her husband had just informed her that he wanted a divorce.

Se was in shock, and a lot of what we talked about was processing the news, which was, not entirely without warning.  The two of them had been in couple counseling for a year or so.

I found myself musing about the role that depression had played in her life, and in her marriage.  This line of thought was sparked by her comment that, at least for the last year, she found that she was often detached emotionally and disconnected from herself.  Indeed, she even reported some loss of memory about events. It is as though time was passing without her having a very clear sense of what was going on.

All of this brought to my mind the theory that one of the adaptive roles that depression plays is to allow people to endure in relationships and situations where escape is either impossible, or has some potential very negative consequences (for example, where there are small children at risk).

It can be a kind of hunkering down.  A turning off emotions and thoughts for the future, and even awareness of the present and what’s going on, in order to endure and hopefully come out on the other end intact.

Unfortunately, these days the capacity for endurance is often not what is needed.  A thousand years ago a woman with children trapped in a relationship with an abusive husband may not have had any choice that didn’t put her children at risk. Nowadays, people have many more choices.

Often depression (and developing endurance to pain) is not helpful because what should be happening is finding a path out of the intolerable circumstance. And depression makes it easier to stay in the cold water of pain… may in fact make the memory of the warmth of happiness seem somehow false. The cold water becomes reality and everything else is an illusion.