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Monday, January 02, 2012

What Does It Mean to Be Strong or to be Weak?

One of the things I often hear from patients is that they is that they feel they are weak for having depression, or they feel they are weak because of coming to a counselor.

Because I have heard this so much from my clients, I have thought a lot about that term, "weak," and to tell you the truth I am confused about it.  I am still not sure whether it has any place in psychology and in the way we think of ourselves and others.

One way of thinking about depression is that under the pressure of environmental stresses, the brain has quit working properly.  (This is an oversimplification, but just stay with me for the moment on this.)  Depression means that some pathway in the brain, or some segment of it, is not working correctly.  That could be compared to the weak link in a chain.  It could be compared with a bridge giving way under the strain of an excessive load.  Some grouping of nerve cells has quit operating properly.  We talk about a weak link in a chain, so why not talk about "weak" nerve cells? 

If a bridge collapses, we would speak of it being weak, or would we?  We might simply say that the bridge was put under an excessive load.  We might blame the load as being too heavy rather than blaming the bridge for being too weak.

If we were going to talk about the brain being weak, wouldn't we need to talk about "weak" pancreases when people have diabetes or weak bones when there are broken bones?  But we generally don't.  If a bone is broken, we assume that it was under too much stress--the person fell or was in a car accident.  We don't normally talk about weak bones unless the person is old.  We do talk about weak bones when there is osteoporosis. But with younger people, we don't say that they or their bones were weak when a break occurs.  We assume that the load was just too much for the bone to bear, as when bones break in an automobile accident.

What do we really mean by saying that someone is weak?  Are we referring to "weak" nerve cells?  Probably not.  When a depressed person calls themselves weak, they are not referring to nerve cells; their are generally referring to their character.   I think when people use the term "weak," they are really  making some kind of a moral judgment.  They are talking about something which is not physical but almost metaphysical--something invisible.  If we call someone weak, we are in essence implying that they just shouldn't be that way.  They should suck it up and be stronger, whatever that means.

But "strength" is after all only a metaphor.  What does it really mean in human behavior?  We can measure weakness in structural materials in an engineering sense when a component breaks under pressure.  How many newtons or pounds of force are required before a physical object breaks?  That is a clear statement about strength in physics.  But surely the use of the term "strength" and "weakness" if someone develops a mental disorder is something quite different.

So it comes down to metaphors.  Words like "strong" and "strength" and "weak" and "weakness" are metaphors.  The question is are they good and useful metaphors or not?

Actually, I think these terms are bad metaphors because they often make the problem (depression, anxiety, etc.) worse.  The metaphor becomes an additional problem  Once we refer to ourselves as weak, we then are likely to begin to feel more depressed.  Which can cause more negative thinking.  Which can make us more depressed.  And so on.  Moreover, to tell ourselves that we are weak is an attribution which is internal, stable, and generalized, which does not help our feelings of self-efficacy.

Would there be a better metaphor besides being "strong" and "weak"?  Perhaps.  Perhaps we could say that people are resilient or not resilient.  That metaphor makes a certain amount of sense.  We have all seen how a blade of grass can bounce back after it has been bent down.  It can be resilient and bounce back after a stress.  I don't think any of us would feel nearly as bad about telling ourselves that we would like to be more resilient instead of telling ourselves that we are weak.  However, even here we have to watch out for labeling ourselves in a generalized sort of way.  For example, most of us are resilient in some situations but not others.  Rather than saying, "I am not resilient," the alternative would be to say, "I am having a hard time being resilient in this situation."

So maybe to say we are weak after becoming depressed makes a little bit of sense, but in the end, but the metaphor bs damaging in its own right because of what it implies.  It may be true that some system in our brain was "weak" enough that under a heavy load of stress, it "broke" or quit operating in a satisfactory manner.  We felt depressed, quit eating, couldn't sleep, and so on.  But I say we let go of that term because for many of us what we really mean telling ourselves that we are weak is that we are flawed, no good, worn out, etc.  And that would not be true.  And it would bring on more depression.ecom

Here's another problem with the "weakness" metaphor.  And this perhaps gets more to the heart of how illogical the metaphor really is.  Let's say that a cell can malfunction in two ways.  Let's say that it can fire too much or too little.  Now let's say that if that nerve cell fires too much, the person becomes more manic.  He or she has more energy.  The person has more confidence.  They take chances.  In battle, maybe they get up out of the foxhole and charge at the other line.  Now let's say that if the nerve cell fires too little, that the person holds back.  They feel tired and unsure of themselves.  In battle, maybe they would not charge at the other line.  They might appear weak.  It's all a matter of whether that nerve cell fires too much or too little.  Either way, the nerve cell would be malfunctioning.  And that might be a matter of genetics, or even a matter of what moment in time it is.  Certainly, a bipolar person could appear super humanly strong one day and "weak" on another day.  So if the nerve cell (purely theoretically for this example) malfunctioned by firing less, society would label the person as a coward, and if the nerve cell malfunctioned by firing more, society would laud the person as brave and give them a medal or promotion.  The "coward" would be referred to as "weak" and the soldier charging the enemy line as "strong."  Recall the scene in the movie Patton where the general was disgusted with the soldier with "battle fatigue" and berated him.

To put it another way, if the cell malfunctions and the person becomes manic, then there is a problem, but the term "weakness" would probably not be used.  Other metaphors are used for mania, such as "He had a nervous breakdown."

But now let's complicate it even further.  In the brain are excitatory neurons and inhibitory neurons.  We would expect that depression would result from too little firing of excitatory neurons.  But what if it actually results from too much firing of certain inhibitory neurons?  Then the neurons being too active would end up causing behavior which appeared to be "weakness."  That would seem somewhat contradictory.  Or putting it another way, it's all a matter of which neurons are overly active.  Certainly if certain neurons in the amygdala fire a lot then there is anger, perhaps causing bravery on the battlefield.  But if other neurons in the amygdala fire too much, then there is anxiety, perhaps causing someone to pull back in battle.  It might be just a matter of which set of neurons are firing the most, and they may not be far away from each other in the brain. 

When all is said and done, I think it is better not to use the concept of "weakness" in talking about people and psychological problems.  It confuses us.  It can make us look down on ourselves or on others.  It does not lead to solutions of problems.  It makes it harder to solve the problem of our depression or the depression of those close to us.  What is the alternative?  I think there are a variety of ways of thinking about depression without ever referring to weakness.  I think that the concept of resilience is a fairly good one.  "In this situation I am having a hard time being resilient."  That is likely to describe what is going on without adding to the problem.

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