Zindel Segal, Ph.D., has studied and written about psychological treatments for depression for over twenty-five years. He is a professor of psychiatry and psychology at the University of Toronto and directs cognitive behavior therapy at the Center for Addiction and Mental Health.
Inquiring Mind: Poets and writers often romanticize depression. Do you think this is a disservice to those who suffer?
Zindel Segal: There certainly has been a tendency in the arts to value the depressed state of mind. Fueled by an intuition that pessimism allows one to live life without the usual blinders, the artist “sees through” the reality that most people blithely accept. Such a vision can inform an artist’s creativity and elevate their work. Unfortunately, somewhat grisly statistics argue that this idealization obscures the more common obstacles brought about by depression. Creative individuals appear to be overrepresented among sufferers of bipolar disorder, and suicide rates are very high in this group—one need look no further than Sylvia Plath and Mark Rothko. Even with unique gifts, the withering effects of depression are often difficult to contain, especially in the absence of effective care.
IM: When is meditation inappropriate for depressed people?
ZS: We need to be sure we’re talking about depression that has reached a level
of interference requiring treatment, and not normal, self-correcting fluctuations of mood. In the case of the former, one of the better-documented effects of depression on cognitive functioning is impaired concentration. For example, depressed persons find it hard to perform everyday activities requiring sustained attention, such as reading or problem solving. For this reason, meditation may not be appropriate, since it requires harnessing those very faculties that are disrupted by the illness. This is not to say that briefer, perhaps more movement-oriented practices could not be beneficial, but practicing mindfulness of the breath may be daunting.
IM: What is your view of antidepressants? Many meditators believe taking them is a cop-out.
ZS: This also gets back to what we mean by the term depression. When depression interferes with a person’s social or occupational functioning, then treatment is indicated. However, no single treatment is universally effective. If someone has tried psychotherapy and it hasn’t helped, I don’t see how taking an antidepressant is a “cop-out,” especially if the intention is to do one’s best to look after oneself. The darker interpretation of this attitude is in believing that meditation can address whatever ails you, and so if depression is present, perhaps this is a sign that your practice is insufficient. There is an interesting fusion of arrogance and denial in this view. It fails to take into account the evidence that depression can change the brain, making those regions that support sustained awareness more difficult to access, while at the same time blaming the person who is depressed. Skillful means, including compassion and wisdom, must be used to address this painful issue. [See also “Beyond Mental Health,” our interview with Jack Kornfield.]
IM: What do neurologists know about the effects of meditation on depression?
ZS: If people are motivated to relate wisely to sadness and judgmental thinking, for example, they will benefit by learning how to shift between different modes of mind. Mindfulness, because it involves directed attention, allows us to move out of automatic, maladaptive patterns of response and into an alternate mode that allows us to befriend challenging emotions. Results from recent neuroimaging studies are beginning to support this view. In a study we just completed, novices to mindfulness relied on medial prefrontal regions of the brain when processing personal adjectives—regions that signal information as self-relevant and as problems that need solving. In contrast, those experienced in mindfulness meditation shifted to a ventral prefrontal network when processing the same material—regions that provide homeostatic information about the body and the present moment. Although not conclusive, this study suggests that training in mindfulness opens access to a second neural mode. What is conclusive is that the healing power of meditation, from a scientific point of view, has tremendous potential.
Also in this issue of Inquiring Mind:
Ronna Kabatznick’s review of The Mindful Way Through Depression, which Zindel Segal coauthored.
An interview with Jack Kornfield, “Beyond Mental Health.”