A Clinical/Remedial Concept
by Robert DePaolo
This article discusses a type of depression pertinent to high activity/high achiever personality types. The clinical picture discussed is of individuals who must (by analogy to an ocean dweller – thus the word Piscean) “move to survive.” The point is made that the need to be on-task and chronically active represents an ongoing, remedial attempt to fend off chronic depression. The underlying cause of this pathology is discussed in neuro-behavioral terms.
Most fish must move to breathe. By their perpetual movement they are able to force water over their gills in a rapid enough manner as to manufacture oxygen, fuel cells and carry out digestive and other homeostatic functions. Should they stop moving the flow of the water slows down to a point where the friction between water and gills is so minimal as to preclude biological functioning.
Other than in an astrological sense it is a bit awkward to refer to a human as “Piscean.” Yet some of us are bound by psychological movement. This includes covert activity manifest as fantasy, imagination, anticipatory anxiety which provides impetus for us to act in order to avoid or escape from something – real or imagined) and overt actions. There are underlying reasons for such a movement imperative.
Research in the field of behavioral psychology has demonstrated that mood is largely a function of the relationship between one’s behavior and the procurement of reinforcement, (Carvalho, Hopko 2010) Seligman (1992), (1996). The latter has suggested states of learned helplessness can result from a sparse relationship between effort and confirming feedback. Meanwhile research on the depression-elation effect has shown that when there is a rapid shift from a sparse to a higher reinforcement schedule organisms display rapid response patterns and heightened physiological arousal. In humans this is often accompanied by feelings of elation and hyperactivity. (Coleman 2006)
Reinforcement need not always be primary, as for example the procurement of food or other forms of primal gratification nor secondary, i.e tied associatively to a concrete reinforcer. It can also take the form of a closure experience, where expectations are confirmed in the aftermath of a response sequence. (Messinger, 1998) (DePaolo 2014). In that context studies have shown that certainty attainment in one form or another provides negative reinforcement, i.e. relief from the pan-activation in brain that crops up in cognitive and problem solving activities. (Berlyne 1960).
The Perils of Passivity
An interesting aspect of this is that (as if to mimic a meritocratic social system) the mind/brain complex typically registers elation when there is movement or behavior preceding and leading to the outcome. To receive pleasure without acting to produce it, not only fails to provide closure but can produce mood instability – for example guilt. The same is true when behavior is exerted without confirming feedback. In other words a requisite element in preventing depression and securing adaptive, effective mood and behavior lies in a close, functional correlation between actions and feedback. (As an aside clinicians might one day be able to mathematize the dynamics of some types of depression using with this concept. That brings to mind the case of individuals with what will be referred to here as Piscean depression.
Some individuals have what McClelland referred to as a high achievement drive (2014) the nature of which can reach extreme proportions. The roots of this are myriad and somewhat unclear. Certainly a familial over-emphasis on success could be one component, particularly within the context of merit-based socio-political systems seen in many western societies.
Other factors undoubtedly play a role. For example overplaying the achievement motive can run parallel to failure-induced compensatory behaviors and cognitions. A person who feels inferior will not usually simply dwell in that domain. Rather he or she will tend to move in the opposite direction, possibly through mere braggadocio but often by summoning a super-achievement motive. Life for such individuals becomes a constant quest to override a sense of inadequacy. As Adler suggested with regard to neurosis, this is usually not momentary but a pervasive driving force in one’s life style (1979).
Adler proposed a way around this problem via adherence to higher, more altruistic concerns – what he called “social interest”) but for some individuals with a clinical picture that might not be sufficient. As seen in politics, religion, philanthropy and other social endeavors a competitive mindset seems unavoidable. Humans are primates and we can, through learning, override certain evolutionary behavior patters – but not all. Given Homo sapiens’ need for heroes and idols, it appears the primate proclivity for climbing the totem pole (forming hierarchies) seems an inescapable psycho-evolutionary albatross around the neck of our species.
Still other factors come into play. For example, while sex is a basic biological need it is also a highly social/political phenomenon. Since females in virtually all social systems (primate and otherwise) seem to prefer the most accomplished (high status) males there is a high correlation between attained success/status and mating opportunities. Thus, when it comes to propagation, altruism might not be enough.
Mind, Brain and Success
In nature it is often the case that, despite Darwin’s monolithic concept of fitness an organism’s most adaptive trait can also be its most potentially maladaptive trait. Dinosaurs, particularly the large carniverous species, had the advantage of size, strength and imposing jaws and teeth. But those large bodies required vast food resources and once the latter dried up for various climatic and catastrophic reasons size became a liability.
A similar trend might be seen in the quintessential human adaptation – a large brain. Having so vast a neural network and a tendency within the brain to pan-activate in cognitive and problem solving activities (Lashley, 1950) means a great deal of neural sifting is required to extract from that network a precise thought, word or action. That involves a tricky, stressful (and potentially pathogenic) process. Unless resolution/closure is reached fairly quickly prolonged arousal will ensue along with neural fatigue, leading to task avoidance via what Pavlov referred to as protective inhibition, (Tjew-A-Sin, Samur et.al 2014). That makes control extremely important to human beings, indeed a likely foundation for the exploratory, high achievement, creative and indeed destructive behavior patterns that seem to have characterized our species throughout history.
The neuro-behaviorally driven needs to create-control-manipulate-seduce, build, defeat, explore and conquer are not represented equally in the psyche of all people. Since the control dynamic is to an extent a negative reinforcement process (relief from failure to control or succeed) it might be more prevalent among individuals with high levels of anxiety and/or concomitant self image rigidity. That is because the stress resulting from lack of control (response-feedback uncertainty) would tend to be greater in individuals with lower stress tolerance. Such individuals would be more caught up in the compensatory actions alluded to previously.
Interestingly, the need for constant (Piscean) movement toward a goal might be somewhat paradoxical in that while the actor is seeking an external outcome he is most fundamentally engaged in an act of internal self regulation. That leads to discussion of the essential nature of this pathology; specifically whether it should be classified primarily as a form of anxiety or depression.
In many ways that question is academic. Often the symptom patterns of anxiety and depression are so similar as to suggest a diagnostic synthesis. Medications such as Prozac, Zoloft, and Celexa that work for one tend to work for both. Masserman has discussed the causative relationship between anxiety and uncertainty (1970). Like anxiety, depressions are accompanied by great uncertainty;one reason why such an extreme act of suicide, which is in the final analysis an attempt at resolution occurs in the aftermath, (2014).
For purposes of discussion this article proposes that depression is a more primary factor; not just because it is more potentially dangerous and reflective of desperation but because it seems closer to a last step on the path from confusion-fueled anxiety, which initially can be dealt with through compulsions, avoidance behaviors, phobic creation/control scenarios and dependency. At the point where anxiety descends into depression options are either limited or non-existent, as Seligman’s notion of learned helplessness suggests (1995).
In that context Piscean depression might be viewed as a case in which individuals afflicted with “end-stage anxiety” possess a self image that declines rapidly in the absence of quests, goals and movement. The individual really does not exhibit primarily an anxiety symptom cluster, possibly because his self image and general experiences over time rendered anxiety-reducing behavioral adaptations ego-alien. It is as if compulsivity, fantasy, ritualistic behaviors, dependency and stimulus avoidance are too weak and escapist to assimilate.
For many individuals afflicted with such a syndrome, there are several critical dangers. For one thing the individual will tend to be so outwardly independent and “hooked” on action/feedback sequences that he might not seek help. Also if this pattern should persist into older age levels physiological and medical setbacks could result from the constant psychic and behavioral effort required to sustain this energy consuming, compensatory pattern.
Still another pathological feature is an impoverished ego function. The ego is at its functional best when it has referential breadth, i.e. can override rigidity to consider and weigh various outcomes, solutions, consequences and perspectives. Piscean depressives would tend to have difficulty with such a “forest and trees” perspective due to the narrow topography of their drives and motivations.
Treatment implications for such a symptom pattern might seem fairly obvious. As Carl Rogers suggested, broadening the self and focusing not just on external experiences and goals but on the life long process of creating an adaptive, expansive and resilient self would seem necessary to psychological functioning (1985). The one problem that would pose is that the client with Piscean depression would invariably experience significant anxiety in the course of abandoning his or her hyper-focused, compensatory action/feedback-based world view. To take the client beyond that threshold would seem to require a very strong support component in the counseling process and in that context tolerance by both client and counselor would be necessary to navigate a potentially rocky therapeutic road.
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Note: on Suicide and Closure. 7/29/14. 16 Suicide Warning Signs and Behaviors to Recognize. Mental Health Daily