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Section 17
Depression is Debilitating

Question 17 found at the bottom of this page
Answer Booklet | Table of Contents
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Depression is so debilitating! Years ago, I was the psychiatric liaison to a surgical ward. The most common consultation request involved patients who would not follow routine instructions after an operation: walk, cough, eat, breathe deeply. Depressed patients just gave up. They had no strategy, not even obedience to those they trusted. Retreat to the cave to lick your wounds, fine-but get licking. In demanding circumstances, how often is it adaptive to lose the capacity for action altogether? I mean, in this fashion, where death seems preferable to effort, where the signals of a supportive community-nurses, friends, family- are ignored?

Seeing the depressed fail regularly, in the face of challenges that others meet, might dispose anyone to the alternative possibility, that depression confers no benefit. Some illnesses, and some normal traits, represent happenstance in evolution.

In a famous essay, the late Stephen Jay Gould compared such evolutionary accidents to "spandrels." Spandrels are triangular spaces below the domes of Gothic churches. (The correct term of art for such a space is pendentive, but spandrel remains the word used in the evolution debate.) Long assumed to be purposive-they hold images of the apostles-spandrels turn out to be not planned decorations but incidental forms that result from the limitations of medieval architectural methods. If you mount a dome on pairs of rounded arches, you're stuck with spandrels. The apostles are late additions-a use that was conceived centuries after the construction of the Cathedral of San Marco in Venice and others.

Spandrels are by-products; they represent limitations of engineering, an unintended consequence. It is the main project that is shaped and optimized by natural selection, not the spandrel, which comes along for the ride. Sometimes spandrels are later put to use, as in the addition of mosaic portraits of saints. Gould coined the word exaptation to cover this development, a late modification that manages to make the best of a spandrel. Depression may be a spandrel-natural without having contributed evolutionary advantage. And then there is no reason that depression would not be decorated exaptively-for instance, by attracting a mythology regarding its value, or through acquiring a role in song and story.
- Kramer, Peter D., Against Depression, Penguin Group: New York, 2005.

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Personal Reflection Exercise #5
The preceding section contained information about how depression is debilitating. Write three case study examples regarding how you might use the content of this section in your practice.

QUESTION 17
How is depression a spandrel? Record the letter of the correct answer the Answer Booklet.