Depression: Social Pressures, Relationships, and Perfectionism
The following is an excerpt from my research and interview with Dr. Mitch Prinstein, Ph.D., ABPP, Bowman and Gordon Gray Distinguished Professor, Director of Clinical Psychology, Editor of the Journal of Clinical Child and Adolescent Psychology, University of North Carolina at Chapel Hill, Department of Psychology. Professor Prinstein is active in two programs of developmental psychopathology research, examining: interpersonal-cognitive models of adolescent depression and self-injury, and peer influence and adolescent health risk behaviors.
Me: The first thing I want to discuss is that in attempting to describe the depression that I experienced a number of years ago, I say it was something like walking-pneumonia—so ‘walking-depression’ or functional depression. There is a big question as to why so many people in my life didn’t know that I had depression. I did not share that with very many people at all. And so, in explaining it to other people now I like to say that it was functional depression. I went to school and to work; I was successful and highly functional. And yet, I had this dark secret that a lot of people didn’t know about.
Dr. Prinstein: “Yes, I think that’s a nice analogy because it is possible for people to function and the impairment that they may have in social or occupational functioning may be relatively mild. Especially for people who have a number of skills and a number of supports and resources that might make them able to compensate for the ways in which depressive symptoms might otherwise impair their ability to experience pleasure, to really be able to engage in the kinds of social activities and work activities that are required to be able to continue with daily life. Some of the symptoms of depression are the kinds of things that are noticeable like crying, hopelessness, general feelings of sadness. But a lot of the symptoms of depression are things that people won’t know anything about like appetite disturbances, a loss of pleasure, sleep disturbances, or potentially suicidal thoughts. People can be remarkably covert about those symptoms.”
Me: “You deal with adolescent depression and self-injury—how would you describe how young people might develop depression?”
Dr. Prinstein: “That’s a great question. We’re still learning that. People have demonstrated that the relationship between stress and depression, particularly in adolescence, is probably explained through COGNITIVE, INTERPERSONAL, and BIOLOGICAL factors. In our ongoing research we’re really learning that there are some kids that when they experience an interpersonal stressor, their biological reactions are very different than kids who have not had a history of depression. And there ability to think about logical, plan-full or measured ways of coping—that diminishes among those who have experienced depression compared to others. I often talk to my students about The Breakfast Club. I don’t know if you saw that movie?”
Me: “Of course.”
Dr. Prinstein: “Think of Anthony Michael Hall’s character (Brian the brain). He was contemplating suicide once he wasn’t able to get an A on a project for school. The idea being that—and I believe—All human beings have the capacity to experience a stressor that is so severe and so dramatic and so relevant to one’s own sense of self that when experiencing that stressor they can temporarily lose the ability to cope with it adaptively. And for girls, young women are socialized to experience their social worlds as being so salient for the sense of self.
And it makes sense. It makes sense that so many girls, after experiencing a break-up, or another type of interpersonal stressor, particularly affecting a dyadic interaction, why that could be the stressor that for girls in particular makes them temporarily lose the ability to adaptively cope. And that combined with a perfect storm of a number of other factors—maybe these biological vulnerabilities we talked about due to long-standing chronic stressors—for some girls, yes a break-up is that last final straw that triggers all of these other vulnerabilities. Unfortunately it happens a lot. Our data from the Center for Disease Control shows that about eight percent of adolescence, in our country, report attempt at suicide within any given one year period.”
Me: “You mentioned the word perfect, and perfectionism is one of the key ties-ins for the way that I experienced depression. Let’s talk about the affects of perfectionism in culture today, where many of us put on a face for the world. There is a certain expectation in society. It seems almost like a trend to project this image of being together or successful or simply of being happy in your life—life is good, it’s a perfect life. But it seems to be rather self-isolating. So then now you can’t really be honest with your feelings because you’ve put up this image of yourself that is something very different from your reality.”
Dr. Prinstein: “Absolutely. I think that makes a lot of sense. The research on adolescent suicide has suggested that there are about three different kinds of suicide attempters. There are the kids that might be experiencing, for instance, psychosis. There are the kids who might be experiencing delinquency types of outcomes and risk behaviors like substance use, and they might be very likely to aggress against someone else and maybe the next day feel very emotional and dis-regulated and decide to attempt suicide. But then, there’s that third type which is more of what we think of in adulthood—yet that third type with kids is that they very slowly and increasingly become depressed and ultimately decide to attempt suicide. And it is that group that is typified by more of those socially prescribed perfectionisms, just as you say. That makes a lot of sense. Now, it’s not for all adolescent suicide attempters, but it is captured by more of that adolescent depression picture. And there has recently been some talk about while our society has made great strides in thinking about the unique challenges that females face—particularly now where there’s been a step towards more equity and occupational opportunities for instance, not all the way there but a step towards more equity—that has had the backlash effect of remarkable pressure on young girls, that is new, and people don’t know exactly how to deal with that. I have a colleague (Dr. Stephen Hinshaw, Ph.D., Professor of Psychology at UC Berkeley, and Psychiatry at UC San Francisco) that wrote an interesting book on this called, The Triple Bind, about how girls are now expected to be excellent at everything. And this has now setup unrealistic expectations.”