What You Can Change _. And What You Can't - Martin E. Seligman [51]
Mania is a psychological condition that looks like the opposite of depression: Its symptoms are unwarranted euphoria, grandiosity, frenetic talk and action, little sleep for days on end, and inflated self-esteem. Bipolar depression always involves manic episodes; it is also called manic-depression (with mania as one pole and depression as the other). Unipolar depressives never have manic episodes. Another difference between the two is that bipolar depression is much more heritable. If one of two identical twins has bipolar depression, there is a 72 percent chance that the other also has it. (This is true of only 14 percent of fraternal twins.) Bipolar depression is exquisitely responsive to lithium carbonate. In more than 80 percent of cases, lithium will relieve the mania to a marked extent and the depression to a lesser extent. Taken continually, it tends to prevent new episodes. Manic-depression is an illness, appropriately viewed as a disorder of the body and treated medically. It is similar to unipolar depression only in appearance.
Now, therapists are not usually sued for malpractice when they use an outdated or ineffective therapy, and a poor therapist can always find some other guild member who does the same kind of therapy to testify that their therapy is a “usual” procedure. But so clear are the data that lithium usually works and that any form of psychotherapy alone usually does not that manic-depressives who are not treated with lithium should, I believe, be able to win malpractice lawsuits. At any rate, if you have manic-depression and are being treated with any form of psychotherapy only, drop your therapist. It is simply wrong to do psychotherapy on bipolar depression, except as an adjunct to drug therapy.
More common than manic-depression—probably ten to twenty times as common—is unipolar depression. This is the disorder that so many of us know well. It springs from the pain and loss that are inevitable parts of being creatures who think about the future. We don’t get the jobs we want. Our stocks go down. We get rejected by people we love. Our spouses die. We give bad lectures and write books that flop. We age. When such losses occur, what happens next is regular and predictable: We feel sad and helpless. We become passive and lethargic. We believe our prospects are bleak and that we lack the talent to make them brighter. We don’t do our work well, and we may not even show up. The zest goes out of activities we used to enjoy, and we lose our interest in food, company, sex. We can’t sleep.
But after a while, by one of nature’s benevolent mysteries, we start to improve. Mild forms of this depression (called normal depression) are extremely common. I have repeatedly found that at any given moment, approximately 25 percent of us are going through an episode of mild depression.
There is sharp disagreement about whether unipolar depression (a certified disorder) and normal depression are related. I believe they are the same thing, differing only in the number of symptoms and their severity. One person may be diagnosed as having unipolar depression and be labeled a patient, while another with just the same symptoms may be held to be suffering from acute symptoms of normal depression and not be a patient. The distinction between these two diagnoses is shallow, often no more than a matter of how readily a person will seek therapy, or whether his insurance policy covers unipolar depression, or how comfortably he can bear the stigma of being labeled a patient.
My view differs radically from prevailing medical opinion, which holds that unipolar depression is an illness and that normal depression is simply passing demoralization of no clinical interest. This view is the dominant one in spite of strong evidence that unipolar depression is just severe normal depression. No one has established the kind of distinction between the two that has been established between, for instance, dwarfs and short normal people—a qualitative distinction.
Most crucial, I feel, is that normal depression and unipolar