November 21, 2014

agency5-1In a recent New York Times editorial, David Brooks writes about agency, and how the great British writer, George Eliot (1818-1880) acquired it as she matured in her life.  Her novel, Middlemarch, is recognized as one of the finest in the English language.  Her other great novels include Adam Bede, The Mill on the Floss, Silas Marner, and Daniel Deronda.

Agency is the sense of being responsible for one’s actions, the author of one’s life.  Albert Camus, the great French/Algerian writer, philosopher, and Nobel Prize winner for literature, was also interested in agency.  He famously wrote that “after a certain age every man is responsible for his face”.  Sigmund Freud famously described the meaning of human life as deriving from love and work.  Agency might be defined as the condition of being either a lover (including all forms of love) or a worker (including all kinds of work), or both.

Severe depression deprives us of our sense of agency.  The psychologist Martin Seligman has described this as “learned helplessness”.  It is essentially a loss of agency.  In psychiatry we recognize unipolar depression, referred to as major depression, and bipolar depression, associated with bipolar disorder.  Untreated posttraumatic stress disorder (PTSD) commonly leads to depression, which might be referred to as posttraumatic depression.  All of these forms of depression are associated with learned helplessness.

The goal in treating depression of whatever kind is to help the sufferer regain a sense of agency.  Medications can sometimes be helpful toward this end, but a sense of agency cannot simply be ingested by someone in the form of a medication.  It must be earned by the individual through actions in the world.  Effective psychotherapy for depression is directed toward helping people develop a sense of agency.  Dream revision therapy, described in other blog posts on this website, attempts to do this symbolically within the person’s dreams.  If they can successfully change an unpleasant dream, then they may have the power to improve their daytime life as well.  The goal of such therapy is not to fix the person, but to enable her/him to fix herself or himself.  This is reminiscent of the quotation attributed to the great Jewish philosopher, Maimonides: “Give a man a fish and you feed him for a day; teach a man to fish and you feed him for a lifetime.”

Antipsychotic medications given to people suffering from schizophrenia, especially young people with this condition, can help them gain a sense of self.  This sense of self can then motivate them to develop agency in the world.  The medication does not create agency, but provides cognitive integration, a likely prerequisite for developing agency.

Though David Brooks is a Republican columnist for the New York Times, the belief in agency as important in people’s lives is nonpartison, neither conservative nor liberal, Democrat nor Republican.  Agency is desirable for anyone and everyone, white or black, Hispanic or Anglo, European or Asian, poor or rich, male or female, gay or straight, regardless of religious creed (Islamic, Christian, Jewish, Buddhist, Hindu, Humanist, Agnostic, or Atheist).