Severe depression can be conceptualised as ritualized death or physical incapacity
John Scott Price, Sussex Partnership NHS Trust
1 March 2008
It is very understandable that people who have suffered a severe depression would see that state purely as an error and pathology in the system. It is difficult to see that such a painful and incapacitating condition could be serving some useful purpose. However, we should bear in mind that other states exist in nature about which the same could be said. We do not know for sure the function of sleep, yet the sleeping person is totally helpless and does not function. Hibernation is another condition in which function is severely impaired. Hibernation almost certainly evolved to enable animals to survive adverse climatic conditions. It is perhaps not unthinkable that severe depression evolved to allow us to survive adverse social conditions.
As Wolpert rightly points out, minor degrees of depression may be associated with awareness of the cause, and be responsive to alterations in the causative situation, and may help the individual to escape from whatever situation led to the depression in the first place. Evolutionary psychopathologists have explored these matters extensively [1].
But here we are concerned with severe depression, even psychotic depression, and the depression associated with bipolar disorder, which we know to have an incidence greater than to be expected from random mutations [2]. These depressions are so severe that they are unlikely to contribute to the individual improving his or her immediate lot.
Writing in support of the social competition hypothesis of depression [3,4], I would like to suggest that the severe depression experienced and so vividly described by Professor Wolpert [5] is a ritual equivalent of death [6,7]. One of the main findings of comparative ethology has been the almost universal ritualisation of agonistic (fighting) behaviour in the vertebrate subphylum, and if fighting is ritualized it makes sense that losing is also ritualized. Instead of being incapacitated or killed by a sword or a club, the unsuccessful combatant is "pole-axed" by severe depression, which makes him or her totally incapacitated and out of action, as effectively as if he were indeed dead. This state is indescribably unpleasant, a veritable hell on earth. It is generally agreed that severe depression is the most unpleasant disease in the medical textbook, except possibly for rabies. One patient who recovered from severe depression and then died of secondary cancer told me in her hospital bed that cancer was a "doddle" (an easy thing to deal with) compared to her depression.
I would argue that the question of whether this severe psychological incapacity is adaptive is still an open one. Admittedly some commit suicide. Others remain chronically incapacitated. But some recover completely. I have seen spontaneous recovery after 20 years, but recovery is usually after six months or so.
Imagine a scenario in ancient times in which a human group contains two ambitious cousins, both with different policies and both determined to be in charge. They both have "win at all costs" mentalities, both are stubborn and ambitious, and both hold the view that "this town ain't big enough for the two of us." If they come to blows, one could easily kill the other, in which case the group is deprived of a valuable member, and the close relatives of the dead man are likely to be filled with ideas of revenge - not good for group solidarity. If, on the other hand, the battle takes place on the floor of the council chamber, and the weapons used are verbal put-downs, the loser may develop a severe depression and stop putting forward his point of view, and probably cease attending the council chamber altogether. After six months when he recovers the situation may be entirely different, the cause of conflict may no longer exist, or his rival may be so well established that the prospect of challenging him again does not arise. His close relatives will be spared the obligation of taking revenge.
Moreover, the ritually dead person is likely to be perceived by his supporters as physically ill. This may be why depression is associated with so many physical symptoms. In our collective unconscious there is no archetype for depression, or for non-psychotic mental illness. We have an archetype for madness, the response to which is avoidance, and we have an archetype for physical illness, the response to which is nurturance. But there is no archetype for depression or neurosis. If the signs of depression are not regarded as physical illness, they are treated as laziness or cowardice, or the person is seen as being deliberately unhelpful. This is why so many patients are desperate to get a physical diagnosis.
Another advantage of a diagnosis of physical illness is that the cause of it is not likely to be attributed to the successful rival. Even if the group has observed the verbal put-downs, these are not likely to be seen as the cause of a physical illness, which might well be attributed to a Jinn or to sorcery by a neighboring community. So there is no obligation for revenge. It is my experience that patients with severe depression do not know the cause of their illness (even if there is one), nor do their relatives, and it is sometimes impossible to persuade them that the terrible and life-threatening illness in their loved one is due to some interpersonal conflict. And often their medical attendants may make a diagnosis of "endogenous depression". This lack of apparent causal connection between ritual combat and ritual death releases everyone from attributing blame or taking revenge.
In the Book of Job we are given an example of extreme determination:
I swear by God, who has wronged me
and filled my cup with despair,
that while there is life in this body
and as long as I can breathe,
I will never let you convict me;
I will never give up my claim.
I will hold tight to my innocence;
my mind will never submit. (Job 27:6 [8])
In spite of one of the severest cases of depression ever described in either prose or verse, Job stuck to his guns. Only the actual sight of God induced him to submit. It is this "win at all costs" mentality that prevents people "just giving in" and creates the need for a fail-safe mechanism at a lower level of the brain.
We have called the ritual incapacity of severe depression the IDS (involuntary defeat strategy or involuntary de-escalatory strategy) to emphasize both that it is involuntary, and that it is an alternative to an involuntary escalating strategy [9]. This strategy set (of escalation and de-escalation) is mediated by the reptilian forebrain (roughly the basal ganglia) and takes the form of elevated or depressed mood [10]. The IDS has at least five functions, three of them social and two intrapersonal:
Intrapersonal functions of the involuntary de-escalatory strategy (IDS):
1. It incapacitates the individual (like non-ritual death). He or she does not fight back or retaliate, lacking the psychological equipment to do so.
2. It inclines the higher levels of the brain towards de-escalation, by generating pessimistic thinking, lowering self-confidence, reducing reinforcer effectiveness, and reducing sense of entitlement.
Social functions of the IDS:
1. It reassures the winner that the loser is not likely to try a come-back, so much so that he can turn his back on the loser without anxiety. The message is not one of submission but of incapacity, saying, in effect, "I am too incapacitated even to put on a display of submission."
2. It sends a message to supporters, saying, "Do not push me into the arena to fight on your behalf"; otherwise the aggressive vocalizations of supporters might undermine the message of incapacity of the depressed protagonist.
3. It facilitates reconciliation with the former rival. This appears to be achieved by the mood of anxiety which often accompanies depression. Depression as an affect has no object or goal, but this is not true of anxiety which has the goal of safety, comfort and reassurance. This is often achieved by reconciling with the former rival, a process Franz de Waal has called conditional reconciliation (conditional on a new power differential between the two) [11]. For social reasons, this reconciliation is seen more in chimpanzee groups than in human society, in which rivals are not often available for reconciliation. On the other hand, human hierarchies are more often based on attraction than intimidation [7]. In a successful resolution of conflict, subordination comes to be based on respect rather than fear.
In summary, we should keep open the possibility that severe depression is an adaptation which serves a function as part of the de-escalating component of ritual agonistic behaviour; that it is, in effect, a ritual form of death or incapacity. The advantage of ritual over actual death is twofold. First, there is a reasonable chance of the victim surviving and recovering, which is not only good for the victim, but is likely to contribute to the inclusive fitness of the winner; this advantage is likely to have been operative for more than 250 million years, since our common ancestor with present day reptiles. Secondly, the lack of apparent causal connection between the actions of the winner and the state of the victim absolves the relatives from a duty of revenge; from the evolutionary point of view, this is a new advantage, applying only to the human lineage, and it could explain why depression may take such a severe and physical form in our species. Whether adaptive or not, depression is a serious illness and should be treated as such. Finally, the view of severe depression as ritual death has implications for treatment, and suggests a large number of potential animal models for research [4].
1. Gilbert P: Evolution and depression: issues and implications. Psychological Medicine 2006; 36: 287-297.
2. Wilson DR, Price JS: Evolutionary epidemiology of endophenotypes in the bipolar spectrum: Evolved neuropsychological mechanisms of social rank. Current Psychosis and Therapeutics Reports 2006, 4(4):176-180.
3. Price JS, Gardner R, Erickson M: Can depression, anxiety and somatisation be seen as appeasement displays? Journal of Affective Disorders 2004, 79:1-11. Author's website: http://www.johnprice.me.uk/site/default.asp?k=473
4. Price JS, Gardner R, Wilson, DR, Sloman L, Rohde P, Erickson M: Territory, rank and mental health: the history of an idea. Evolutionary Psychology 2007, 5(3):531-554.
5. Wolpert L: Malignant Sadness: The Anatomy of Depression, 3rd edition. London: Faber & Faber; 2006.
6. Price JS: The ritualisation of agonistic behaviour as a determinant of variation along the neuroticism/stability dimension of personality. Proceedings of the Royal Society of Medicine 1969, 62:1107-1111.
7. Gilbert P, Price J, Allan S: Social comparison, social attractiveness and evolution: how might they be related? New Ideas in Psychology: An International Journal of Innovative Theory in Psychology 1995, 13:149-165.
8. Mitchell S: The Book of Job. London, Kyle Cathie; 1989.
9. Sloman L, Farvolden P, Gilbert P, Price J: The interactive functioning of anxiety and depression in agonistic encounters and reconciliation. Journal of Affective Disorders 2006, 90:93-99.
10. Gardner R: MacLean's paradigm and its relevance for psychiatry's basic science. In The Neuroethology of Paul MacLean: Convergences and Frontiers. Edited by Cory GA, Gardner R. New York: Greenwood-Praeger; 2002:85-105.
11. De Waal, F: The reconciled hierarchy. In Social Fabrics of the Mind. Edited by Chance MRA. Hove: Lawrence Erlbaum; 1988:297-312.
Competing interests
No competing interest recognized
A reply to Price
lewis Wolpert, UCL
5 March 2008
Price's suggestion that depression has the evolutionary advantage of being a way an individual does not fight back does not fit with most depressions being triggered by a loss of some sort. The loss triggers the emotion sadness and leads the individual to try to restore the loss. Also, the fact that women have a twofold higher incidence of depression than men does not fit with not fighting back. Almost all the known characteristics of depression, such as negativity, sadness, and suicidal feelings, do not fit with his suggestion. Moreover, considering the similarities between mourning and depression, it is very hard to see how this could fit with not fighting back.
Severe depression can be conceptualised as ritualized death or physical incapacity
1 March 2008
It is very understandable that people who have suffered a severe depression would see that state purely as an error and pathology in the system. It is difficult to see that such a painful and incapacitating condition could be serving some useful purpose. However, we should bear in mind that other states exist in nature about which the same could be said. We do not know for sure the function of sleep, yet the sleeping person is totally helpless and does not function. Hibernation is another condition in which function is severely impaired. Hibernation almost certainly evolved to enable animals to survive adverse climatic conditions. It is perhaps not unthinkable that severe depression evolved to allow us to survive adverse social conditions.
As Wolpert rightly points out, minor degrees of depression may be associated with awareness of the cause, and be responsive to alterations in the causative situation, and may help the individual to escape from whatever situation led to the depression in the first place. Evolutionary psychopathologists have explored these matters extensively [1].
But here we are concerned with severe depression, even psychotic depression, and the depression associated with bipolar disorder, which we know to have an incidence greater than to be expected from random mutations [2]. These depressions are so severe that they are unlikely to contribute to the individual improving his or her immediate lot.
Writing in support of the social competition hypothesis of depression [3,4], I would like to suggest that the severe depression experienced and so vividly described by Professor Wolpert [5] is a ritual equivalent of death [6,7]. One of the main findings of comparative ethology has been the almost universal ritualisation of agonistic (fighting) behaviour in the vertebrate subphylum, and if fighting is ritualized it makes sense that losing is also ritualized. Instead of being incapacitated or killed by a sword or a club, the unsuccessful combatant is "pole-axed" by severe depression, which makes him or her totally incapacitated and out of action, as effectively as if he were indeed dead. This state is indescribably unpleasant, a veritable hell on earth. It is generally agreed that severe depression is the most unpleasant disease in the medical textbook, except possibly for rabies. One patient who recovered from severe depression and then died of secondary cancer told me in her hospital bed that cancer was a "doddle" (an easy thing to deal with) compared to her depression.
I would argue that the question of whether this severe psychological incapacity is adaptive is still an open one. Admittedly some commit suicide. Others remain chronically incapacitated. But some recover completely. I have seen spontaneous recovery after 20 years, but recovery is usually after six months or so.
Imagine a scenario in ancient times in which a human group contains two ambitious cousins, both with different policies and both determined to be in charge. They both have "win at all costs" mentalities, both are stubborn and ambitious, and both hold the view that "this town ain't big enough for the two of us." If they come to blows, one could easily kill the other, in which case the group is deprived of a valuable member, and the close relatives of the dead man are likely to be filled with ideas of revenge - not good for group solidarity. If, on the other hand, the battle takes place on the floor of the council chamber, and the weapons used are verbal put-downs, the loser may develop a severe depression and stop putting forward his point of view, and probably cease attending the council chamber altogether. After six months when he recovers the situation may be entirely different, the cause of conflict may no longer exist, or his rival may be so well established that the prospect of challenging him again does not arise. His close relatives will be spared the obligation of taking revenge.
Moreover, the ritually dead person is likely to be perceived by his supporters as physically ill. This may be why depression is associated with so many physical symptoms. In our collective unconscious there is no archetype for depression, or for non-psychotic mental illness. We have an archetype for madness, the response to which is avoidance, and we have an archetype for physical illness, the response to which is nurturance. But there is no archetype for depression or neurosis. If the signs of depression are not regarded as physical illness, they are treated as laziness or cowardice, or the person is seen as being deliberately unhelpful. This is why so many patients are desperate to get a physical diagnosis.
Another advantage of a diagnosis of physical illness is that the cause of it is not likely to be attributed to the successful rival. Even if the group has observed the verbal put-downs, these are not likely to be seen as the cause of a physical illness, which might well be attributed to a Jinn or to sorcery by a neighboring community. So there is no obligation for revenge. It is my experience that patients with severe depression do not know the cause of their illness (even if there is one), nor do their relatives, and it is sometimes impossible to persuade them that the terrible and life-threatening illness in their loved one is due to some interpersonal conflict. And often their medical attendants may make a diagnosis of "endogenous depression". This lack of apparent causal connection between ritual combat and ritual death releases everyone from attributing blame or taking revenge.
In the Book of Job we are given an example of extreme determination:
I swear by God, who has wronged me
and filled my cup with despair,
that while there is life in this body
and as long as I can breathe,
I will never let you convict me;
I will never give up my claim.
I will hold tight to my innocence;
my mind will never submit. (Job 27:6 [8])
In spite of one of the severest cases of depression ever described in either prose or verse, Job stuck to his guns. Only the actual sight of God induced him to submit. It is this "win at all costs" mentality that prevents people "just giving in" and creates the need for a fail-safe mechanism at a lower level of the brain.
We have called the ritual incapacity of severe depression the IDS (involuntary defeat strategy or involuntary de-escalatory strategy) to emphasize both that it is involuntary, and that it is an alternative to an involuntary escalating strategy [9]. This strategy set (of escalation and de-escalation) is mediated by the reptilian forebrain (roughly the basal ganglia) and takes the form of elevated or depressed mood [10]. The IDS has at least five functions, three of them social and two intrapersonal:
Intrapersonal functions of the involuntary de-escalatory strategy (IDS):
1. It incapacitates the individual (like non-ritual death). He or she does not fight back or retaliate, lacking the psychological equipment to do so.
2. It inclines the higher levels of the brain towards de-escalation, by generating pessimistic thinking, lowering self-confidence, reducing reinforcer effectiveness, and reducing sense of entitlement.
Social functions of the IDS:
1. It reassures the winner that the loser is not likely to try a come-back, so much so that he can turn his back on the loser without anxiety. The message is not one of submission but of incapacity, saying, in effect, "I am too incapacitated even to put on a display of submission."
2. It sends a message to supporters, saying, "Do not push me into the arena to fight on your behalf"; otherwise the aggressive vocalizations of supporters might undermine the message of incapacity of the depressed protagonist.
3. It facilitates reconciliation with the former rival. This appears to be achieved by the mood of anxiety which often accompanies depression. Depression as an affect has no object or goal, but this is not true of anxiety which has the goal of safety, comfort and reassurance. This is often achieved by reconciling with the former rival, a process Franz de Waal has called conditional reconciliation (conditional on a new power differential between the two) [11]. For social reasons, this reconciliation is seen more in chimpanzee groups than in human society, in which rivals are not often available for reconciliation. On the other hand, human hierarchies are more often based on attraction than intimidation [7]. In a successful resolution of conflict, subordination comes to be based on respect rather than fear.
In summary, we should keep open the possibility that severe depression is an adaptation which serves a function as part of the de-escalating component of ritual agonistic behaviour; that it is, in effect, a ritual form of death or incapacity. The advantage of ritual over actual death is twofold. First, there is a reasonable chance of the victim surviving and recovering, which is not only good for the victim, but is likely to contribute to the inclusive fitness of the winner; this advantage is likely to have been operative for more than 250 million years, since our common ancestor with present day reptiles. Secondly, the lack of apparent causal connection between the actions of the winner and the state of the victim absolves the relatives from a duty of revenge; from the evolutionary point of view, this is a new advantage, applying only to the human lineage, and it could explain why depression may take such a severe and physical form in our species. Whether adaptive or not, depression is a serious illness and should be treated as such. Finally, the view of severe depression as ritual death has implications for treatment, and suggests a large number of potential animal models for research [4].
1. Gilbert P: Evolution and depression: issues and implications. Psychological Medicine 2006; 36: 287-297.
2. Wilson DR, Price JS: Evolutionary epidemiology of endophenotypes in the bipolar spectrum: Evolved neuropsychological mechanisms of social rank. Current Psychosis and Therapeutics Reports 2006, 4(4):176-180.
Journal website: http://www.current-reports.com/article_frame.cfm?PubID=PT04-4-1-06&Type=Abstract
3. Price JS, Gardner R, Erickson M: Can depression, anxiety and somatisation be seen as appeasement displays? Journal of Affective Disorders 2004, 79:1-11. Author's website: http://www.johnprice.me.uk/site/default.asp?k=473
4. Price JS, Gardner R, Wilson, DR, Sloman L, Rohde P, Erickson M: Territory, rank and mental health: the history of an idea. Evolutionary Psychology 2007, 5(3):531-554.
Evolutionary Psychology website: http://www.epjournal.net/filestore/EP05531554.pdf
5. Wolpert L: Malignant Sadness: The Anatomy of Depression, 3rd edition. London: Faber & Faber; 2006.
6. Price JS: The ritualisation of agonistic behaviour as a determinant of variation along the neuroticism/stability dimension of personality. Proceedings of the Royal Society of Medicine 1969, 62:1107-1111.
7. Gilbert P, Price J, Allan S: Social comparison, social attractiveness and evolution: how might they be related? New Ideas in Psychology: An International Journal of Innovative Theory in Psychology 1995, 13:149-165.
Author's website: http://www.johnprice.me.uk/site/default.asp?k=460&p=pubs
8. Mitchell S: The Book of Job. London, Kyle Cathie; 1989.
9. Sloman L, Farvolden P, Gilbert P, Price J: The interactive functioning of anxiety and depression in agonistic encounters and reconciliation. Journal of Affective Disorders 2006, 90:93-99.
10. Gardner R: MacLean's paradigm and its relevance for psychiatry's basic science. In The Neuroethology of Paul MacLean: Convergences and Frontiers. Edited by Cory GA, Gardner R. New York: Greenwood-Praeger; 2002:85-105.
11. De Waal, F: The reconciled hierarchy. In Social Fabrics of the Mind. Edited by Chance MRA. Hove: Lawrence Erlbaum; 1988:297-312.
Competing interests
No competing interest recognized
A reply to Price
5 March 2008
Price's suggestion that depression has the evolutionary advantage of being a way an individual does not fight back does not fit with most depressions being triggered by a loss of some sort. The loss triggers the emotion sadness and leads the individual to try to restore the loss. Also, the fact that women have a twofold higher incidence of depression than men does not fit with not fighting back. Almost all the known characteristics of depression, such as negativity, sadness, and suicidal feelings, do not fit with his suggestion. Moreover, considering the similarities between mourning and depression, it is very hard to see how this could fit with not fighting back.
Competing interests
None declared