Tom Wootton says that a few years ago he would have screamed if anyone had said there was an advantage to depression. So, to get a bit in your face, he named his book, The Depression Advantage. And that book came after The Bipolar Advantage.
I didn’t scream when I saw those titles. As I recall, there was some seething, groaning, a “not another one of those!” – but no scream. Unfortunately, a snap judgment kept me from looking closely at what he had to say for quite a while. That was my loss. Now that I’m past the preconceptions, I’m learning a lot from his ideas.
Seeing Depression Differently
Wootton has spent most of his life struggling with bipolar mania and depression. He’s been through all the terror and despair these illnesses can unleash. He does not underestimate their danger since they almost cost him his life.
Nevertheless, he came to see these conditions in a completely different way than we usually do. He regards them not as simply as symptoms to be gotten rid of but as intense experiences that we can learn to live with.
He believes that we can expand the scope of our manageable experience to include these extremes without feeling overwhelmed and becoming dysfunctional. But he doesn’t stop there. He himself has been able to find a richness and deeper awareness of life from going through them.
As I understand it, this is what he means when he talks about a depression “advantage.” Now, I can’t go all the way with him in that direction. (He referred to one extended depressive episode as “beautiful” – I did scream at that one.) But there’s a lot to learn along the way.
From Crisis to Recovery
He uses an analogy from Daniel Siegel’s Mindsight to capture the way we handle the process of living. In this view, life is a flow of energy and information that we’re constantly responding to, each of us in a unique way. We have a comfort zone in which we feel confident and well grounded. When intense experience pushes us out of that zone, we start to feel lost.
Wootton describes three phases in which we feel dominated by depression or bipolar and focus primarily on the effort to stop the symptoms.
Crisis: Illness corresponds to a breakdown in our ability to handle the flow of energy and information. It becomes too much, and we feel overwhelmed and out of control. From the outset, Wootton is describing illness as our way of responding to the flow of life, not as a thing in itself that invades us and has to be removed.
He doesn’t in any way minimize the potential deadliness of the loss of ability to handle the flow. Our reaction can be the difference between life and death. His own extremes of mania and depression led him to attempt suicide, and these conditions have been with him for most of his life. He’s clear that we need help in the crisis mode, often in the form of medication and hospitalization.
Managed: Treatment ends the crisis state by cutting down the intensity of life we’re exposed to. It’s reduced to a level within our comfort zone, but it’s a zone that’s far more restricted than the life we want to get back to. In this condition, we feel we can manage with the help of medication, therapy or whatever tools we rely on, but feel fragile. There’s a constant fear that we’ll slip back into crisis.
Wootton points out that a great many people spend much of their lives in this managed state. Often they believe that this is the most they can expect. The hope is that eventually all of the symptoms can be removed, but they haven’t experienced this yet.
Recovery: Recovery itself is defined by mainstream psychiatry as the complete removal of symptoms for an extended period. “Complete” really amounts to a reduction in the score on a standard scale far below the level of diagnosable illness but with a couple of minor symptoms possibly remaining.
Wootton believes this approach simply doesn’t work. He cites the most important government study of bipolar as demonstrating that current treatment does not prevent relapse. I think the same is true in depression.
In his view, the goal of recovery as removal of symptoms only traps people in a vicious cycle. They endlessly repeat the phases of crisis, managed, recovery and then relapse. They keep getting the very same treatment over and over, even though it doesn’t stop the cycle.
From Recovery to Self-Mastery
Instead of focusing on removal of symptoms, he advocates a multidimensional approach of building skills to help expand the comfort zone. In this way, we’re not just restoring the ability to handle the “normal” ups and down of living. We’re getting better at living in the midst of intense experiences we once thought of as purely negative symptoms of illness.
He uses the analogy of learning to play baseball. When he started, he could hit a slowly pitched ball, but as he got older pitching got faster. For a while, he’d lose the ability to judge the speed and angle of the ball and couldn’t get a hit. He was out of his comfort zone. But he stepped a little way outside that zone to learn how to master the next level of play. As he became more experienced, he could hit a ball traveling at a speed that would have paralyzed him at an earlier point in his development.
That’s the way he sees the strengthening of life skills to move from illness to a sense of self-mastery. You learn to handle more difficult and demanding situations by taking small steps and gradually expanding the intensity of experience you can live with.
Wootton organizes this expansion of the comfort zone in three further stages that he calls freedom, stability and self-mastery. I’m not all that comfortable with steps, phases and stages. Every system like this gets creaky and creates its own jargon. But the general idea is an interesting one.
You reach a turning point in dealing with bipolar and depression. You start to feel that you can handle events and actions under the duress of intense conditions you once experienced as devastating. You’re no longer preoccupied with the danger of relapse but are now trying to enhance your abilities to live well.
To achieve that, you need to use tools and therapies that help you with all phases of living – physical, emotional, mental, spiritual, relationships and worklife. He emphasizes that the starting point has to be the full acceptance and awareness of all the dimensions of illness and a commitment to deal with them.
He talks about the need for introspection to identify the specific patterns and symptoms you have to deal with, and mental focus to bring your mind back under your control. As a successful businessman, he urges careful planning to work toward the kind of recovery you want.
It’s a complicated and demanding scenario. Getting to the point of having a “beautiful” experience of depression still sounds far removed from the reality I know. But I’m learning a lot from trying to envision how that might one day be possible.
What do you think about Wootton’s approach?