The Inside View and the Outside View: Depression
Our history:
Babylon, 3000 BCE: Zirratbanit felt the heavy weight of the world pressing down on him, felt he could not rise in the morning, that the sun was out to crush him. His uppu was under attack by demons. Not all days were like this, but most days, the demons weighed down the rays of Shamash like boulders. Seeking to help the priest Abdi-Ili first beat Zirrabanit about the neck and shoulders with a wooden stick, then locked him in a temple chamber and starved him for a week, then commanded Zirrabanit sacrifice at the temple to remove the demons that had taken root in his uppu.
Athens, 300 BCE: Akakios bled. First, he bled because he had too much black bile, so much that he could not rise from his bed, wanted only to hide away and speak to no one. He worked erratically and his home became steadily more cluttered. When the bleeding did not work, Akakios was proscribed exercise. He did not do this exercise and was convinced his physician was a fraud. He tried baths, donkey’s milk, eating only meat, and massage. The last he liked, but nothing helped.
Oxford, 1680: Harry Lewis sighed and closed the quarto. He had hoped that Burton would do more than merely describe melancholy, but proscribe a remedy. Burton was dead accurate, of course. Harry hit every criteria. His melancholy went and came “upon every small occasion of sorrow, need, sickness, trouble, fear, grief, passion, or perturbation of the mind, any manner of care, discontent, or thought, which causes anguish, dulness, heaviness and vexation of spirit, any ways opposite to pleasure, mirth, joy, delight, causing forwardness in us, or a dislike.” And it was clear that his melancholy was set, “ a habit, a serious ailment, a settled humour, as Aurelianus and others call it, not errant, but fixed: and as it was long increasing, so, now being (pleasant or painful) grown to a habit, it will hardly be removed.” And it didn’t matter how much Burton quoted Galen, Hippocrates, or Aristotle. There was no hope for Harry now that melancholy had become a habit. Why had God so cursed him with melancholy and was there naught but prayer to save him?
Vienna, 1935: “It is clear that the source of the patient’s melancholia is an unconscious anger over their fall in status, stemming from a self-hatred, and ultimately rooted in a striving to overcome the unconscious patriarchal archetype of the Father.”
Parker, Colorado, 2004: “Okay, based on this survey, you’ve marked the sad face for a lot of questions. This looks like depression. I’m prescribing 50mg Sertraline—Zoloft— to be taken daily. That should help make things better.”
My History:
For about a year of my life, I was very depressed. I had a been suffering with a daily migraine headache for 8 years that help my head in a vice grip on my temples. I was badly vitamin D deficient, living in the darkness of the Pacific Northwest. I had a job working at the Boeing factory that I loathed and was actively searching for a new job, slinging resumes for any role that seemed like a good fit. Every morning, I’d park in this massive parking lot, badge in to get past the barbed wire fence surrounding the factory, then have to cross 4 lanes of truck traffic to get into the building. See, airplane parts are big, and they need to be moved around the factory at all hours, including the start of my 6am shift. It was dark, often rainy, and visibility was poor. Every morning for months I thought to myself, “It would be better if one of those trucks hit me.” All I had to do was stop in the road.
Eventually, I found a better job, found a cure for my migraine, and moved out of the darkness of the Northwest. But I’ll never forget what that period of my life was like.
From the outside, things looked good. I had a lovely wife, a good paying job, friends who liked and loved me, hobbies that I enjoyed. Sure I had a headache, but it was invisible and reasonably managed. I am educated, white, and a man. What’s to complain about?
Depression as Insight:
Depression gives us an ugly, gnarled lever to pry open the difference between the inside view and the outside view and why both true and relevant. Zirrabanat describes his feeling of depression as the sun being heavy, I describe my depression as a feeling of meaninglessness. Freud sees depression as an issue with the ego and prescribed psychotherapy, modern physicians see it as a chemical problem and prescribe antidepressants. All of us are right.
Depression is both a feeling of heaviness, and a brain chemistry issue, and a psychological issue, and a philosophical issue. It’s all of them, but it's not any one of those things alone.
Only the most insensitive people would reduce depression to the outside view. There is a live experience of being depressed that is very clearly happening to the folks experiencing depression.
But a funny thing happens when we try to transition that intuition over to feelings of meaning. (It also happens around moral intuitions, spiritual experiences, and drug trips). We reduce the feeling of not having meaning, or wanting purpose in our lives to something cold and scientific. We look at the physical world, turn over rocks, uproot trees, analyze the composition of the stars, and say, “Where is meaning? It’s not under the rocks, between the atoms, or found during a dissection, so it must not be real.”
Worse still is a reduction to chemistry: “We’ve done studies with people in the lab and seen that people feel meaning when their dopamine and serotonin and oxytocin are increased. So meaning is just those chemicals acting on the brain.”
Both the physicalist story and the chemical story of meaning are true. But they aren’t the only story. They probably aren’t even the right stories to tell about meaning in the first place, because meaning isn’t the sort of thing that exists under rocks or inside of stars, and it isn’t something reductive to chemistry, anymore than depression reduces to chemistry.
Meaning is something that happens inside us, is experienced by creatures like us.
So, as we’re off tromping about the meaning landscape, looking for an answer to the question, “how should we live?” we really need to ask, “Which microscopes do I need to answer this question?” There can be legitimate discoveries to be made in the outside view, but the whole point of this essay is to show that the inside view is legitimate and that you already use the inside and the outside view side-by-side. We must become much more comfortable leveraging the inside view if we’re to have any hope of running down our quarry.
In the next essay, I’ll share a few other areas that I’ve noticed the inside view-outside view colliding, so you, too, can get some practice noticing the inside view.
