The Secret Strength of Depression, Fourth Edition

From the Foreword...

What is depression? Over thirty years ago, back in the early
1970s, judging from the national surveys of the day, the majority of Americans gave a confident answer to that question. Depression was a form of laziness; tangible evidence of a moral turpitude that was best hidden from the public eye. Whether in one's family or in oneself, depression was something to be suffered alone and in silence—as an unwholesome secret. So when Frederic Flach's The Secret Strength of Depression was first published by Lippincott in
1974 and started to appear in bookstores nationwide, there was some scratching of heads. Surely the title was a bad joke, an oxymoron: depression, we all knew, was weakness—and usually a secret—so where was the strength amidst such malaise?
 
Within the first few pages of reading The Secret Strength of Depression the answer was readily apparent. Dr. Flach's message was simple and compelling: for the majority of us, a single episode of depression is destructive only if we fail to manage it successfully. Indeed, working through the experience and coming to understand the roots of sadness offers an opportunity not just to learn about oneself, but to be enriched and to grow stronger as a person. For those who had suffered in depression's dungeon, confined in public silence, it was a message of hope—as evidenced by how the book flew rapidly off the bookstore shelves. Within a few months The Secret Strength of Depression was released in paperback and went through seven printings before a new, revised, edition appeared in 1986.
 
Frederic Flach's own reason for writing The Secret Strength of Depression was his fascination with the complexity of human behavior, and his hope of advancing public and professional appreciation of that complexity. Dr. Flach was entirely comfortable in tearing down the usual fences that give comfort in thinking about complicated things in abstract, linear ways, circumscribing precise categories such as sociology, psychology and biology. Thus in the early 1970s, when mainstream psychiatry was casting aside the cloak of Freud's dynamic parapsychology in preparation for a leap into the vortex of psychopharmacology and neurotransmitters, Frederic Flach took pains to avoid such fractionation. As a consummate psychotherapist and physician, who earlier in his career had been involved in basic research, and was above all a teacher, Dr. Flach's goal with The Secret Strength of Depression was one of dynamic integration of the best thinking in the field, presented in engaging, simple prose. With similar concerns for accessibility it is a book filled with personal stories, for stories are the way we make sense of the world. Moods—including sadness, Dr. Flach insisted—are part of the human condition and can only be successfully managed through an understanding of the central role that emotional experience plays in the narratives we construct for ourselves.
 
Frederic Flach was right in his insistence and in his focus, which is what has made The Secret Strength of Depression a timeless, classic text for the general reader. The shifting pendulum of emotion is vital to staying alive and to negotiating everyday stresses and strains. Emotions are part of a pre-verbal system of social communication that we share with our mammalian forebears. Even though, as human beings, we have the extraordinary facility of language, we use emotion everyday to communicate our desires to each other, and to monitor our social environment. Emotion is part of the brain's early warning system, intimately linked to the body's ancient mechanisms of survival. When the swing of the emotional pendulum signals that events are not moving favorably, feelings of anxiety and irritability are commonly mixed with a mood of sadness, especially if adverse circumstances persist. At the opposite end of the spectrum, as exemplified by the wonderful energy and optimism that accompanies falling in love, we experience happiness. Thus our emotions are constantly changing as the brain monitors the ups and downs of a shifting social world.
 
For most of us, the challenges and opportunities of everyday life lie in our relationships with others—in the intimate bonds of family and the affection of lovers and friends—and in understanding the intricate social systems of the workplace while learning the skills that are essential to economic survival. These are extraordinarily complex tasks demanding vigilance and mental agility and generating continuous challenges. Remarkably, most of the time we succeed in navigating these social complexities. But then there are those weeks when nothing seems to go our way; when plans come apart and friendships are called into question. We remember those weeks; we feel them. There is a sense of anger and tension, a distracting preoccupation with the details of the problem and irritability towards those who don't seem to understand. But, then, slowly the feelings pass. We find some compromise and the struggle resolves, or seems less important. The memory recedes. We move on.
 
What Dr. Flach teaches us in The Secret Strength of Depression— and it is a lesson as important today as it was in 1974—is that blindly pushing ahead at such times, without thoughtful reflection, is a mistake. It is when under stress that we witness the emotional brain at work, and with self-reflection such moments offer opportunity. Each and every one of us can become depressed, given the right set of circumstances. Most common are those challenges that present chronic insoluble problems, usually of a social nature: divorce or a loveless marriage; a demanding and difficult work situation with little personal reward; the death of a lifelong companion. It is then that we encounter such obstacles and depression threatens, as is virtually inevitable during the span of a lifetime. After the ensuing turmoil, appropriately harnessed, we are then able to move forward on a path of self-knowledge. This is the secret strength of depression.
 
For Frederic Flach the experience of hope came from an understanding of resilience. He was fascinated by this dynamic inner strength that we each possess and wrote about it extensively in his book, Choices, first published in 1976. The argument goes something like this: in its early stages the experience of depression is very similar to that of profound grief. But most of us, even under complex and difficult circumstances, do not stay despondent. This is because the emotional brain, like all brain systems, is self-correcting. In the same way that a thermostat returns to a set point when maintaining the temperature of a room, so does emotion balance itself around the habitual temperament of an individual.
 
Without mindful self-awareness, however, resilience is compromised. Conflicting situations awaken alarm mechanisms in the brain and body that are intended to defend against acute emergencies. But, when this state of affairs coincide with another illness, like the flu, or is magnified by life changes that compound the stress, such as menopause or retirement from work, then a depression commonly follows. Resilience is lost. It need not be so, Dr. Flach instructs us. With self-knowledge informing sensible choice and good health practice, resilience can be strengthened and we can guard against such challenges that depression can pose.
 
Frederic Flach was a man ahead of his time in resisting the plunge into rote pharmacology as the sole solution to our mental ills. For Dr. Flach it was self-knowledge and life-long learning that held the key to emotional health. While extraordinarily important, technical advances in genetics, pharmacology and neurobiology, cannot alone resolve depression. Depression, or any other mental illness for that matter, is not simply an irregularity that has invaded a body organ, as an illness might invade the liver. With depression, the organ of disability is the brain and in disturbing the chemical regulation and integrity of the brain's emotional monitoring systems depression enters and disturbs the person—and in turn perturbs the relationships the afflicted individual has with others. In other words, as Dr. Flach taught in his writings and in his clinical practice, depression is a disorder that afflicts the integrity of the self—that collection of vital feelings, behaviors, and beliefs that together shape each of us as unique human beings.
 
There is an important lesson to be learned. In seeking to understand mood disorder we cannot easily isolate the illness from the experience of being human, for in truth all of us have seen the shadows of these afflictions in our own lives. Such experience can either be considered a comfort and an opportunity to understand the origin and true meaning of emotion and its disorder or, through fear and studied ignorance, it can lead to a stigmatization of those who visibly suffer. It was Frederic Flach's passionate opinion that to take the latter route is to deny one's own humanity. I agree with him.
 
—Peter C Whybrow, M.D.
Los Angeles, January 2008
 
Dr. Whybrow is the Director of the Semel Institute for Neuroscience and Human Behavior and the Judson Braun Distinguished Professor of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine, University of California, Los Angeles. His book A Mood Apart:The Thinker's Guide to Emotion and Its Disorders, is published by HarperPerennial.