Skepticism, Compassion, and the Treatment of Depression

Sona Dimidjian

Correspondence concerning this article should be addressed to Sona Dimidjian, Department of Psychology, University of Washington, 1107 NE 45th Street, #310, Seattle, Washington 98105.
E-mail: sdimidji@u.washington.edu

On Monday evenings, I used to go to Neil's house, together with Jackie Gollan, Eric Gortner, and Lisa Roberts, to discuss our lab's current depression study and the study of depression in general. The meetings began each week in his kitchen, sharing drinks and food and rich laughter about stories from our daily lives. After a while, however, Neil's eyes would brighten, and he would put down his glass, rub his hands together, and proclaim, "Let's do some science."

Neil taught us about science by teaching us about skepticism. Neil was passionate about skepticism. He accepted no theory of change, no treatment model, no basic tenet or assumption without subjecting it to a rigorous, exacting empiricism; and he taught his students to do the same and to take pleasure in it, as he did. The 1996 article, which is reprinted in this collection, exemplifies the ways in which Neil's unwillingness to accept prevailing belief has advanced our thinking about the treatment of depression in profound and important ways.

What fueled this passion for skepticism? On one level, Neil loved the game of outcome research and the particular mischievous excitement provided by what he described as "muckraking." In this way, he taught his students that research can be great fun and high adventure. He taught us the thrill of discovery when everything is open to question. And if any of us could cast a skeptical eye on a theory or treatment approach that was embraced by many, so much the better.

On another level, however, I think it was compassion that primarily inspired Neil's skepticism. And it is perhaps about compassion that Neil taught me most. Neil treated me and his other students with an enormous generosity of spirit, and in so doing, schooled us in compassion for him and the work in which we were together engaged. He created a rich tenderness in the often-rugged terrain of academia and clinical research, a place to which we could return time and again for inspiration, courage, connection, and a reminder of why the work we were doing was important and worthwhile.

Neil's skepticism was thus born, not of cynicism but of love. He loved his students. He loved the practice of psychology. He loved life. He experienced such joy in his own life—in his work, with his children, with his wife, Virginia. He knew the potential, the opportunity that life provides each of us. This gave Neil a compassion for his clients and the participants in our studies, who were struggling daily under the weight of depression, which would not allow him or us to accept as adequate or sufficient what the field currently offered. He wanted to find more powerful interventions—ones that worked more quickly and lasted longer, that could be delivered in more cost-effective ways, and that could be disseminated more widely. Neil's skepticism about the state of the field stood as an ever-present reminder for all of us, always, that we could and must do better.

This compassion also shaped his particular approach to the behavioral treatment of depression. Neil's emphasis on compassion is a clear aspect of the integrative couple therapy model that he and Andy Christensen developed, which focuses explicitly on the importance of acceptance in the treatment of couple distress. However, acceptance—and compassion—while perhaps less visible, are equally present in his behavioral activation approach to depression. Neil often criticized the prevailing treatments of depression as "defect models" because they located the cause of depression as internal deficits within individuals. Neil, in contrast, brought a contextualist epistemology to the treatment of depression and encouraged us to look outside the individual in our effort to understand and treat depression. Neil had a unique ability to listen to people's stories and to understand their lives from the inside, to ferret out the particular logic of their distress and suffering, regardless of how irrational it appeared at first glance. And he believed that it was by changing the conditions of people's lives that we could help to alleviate depression. It was an approach that he believed represented not only an advance over other available treatments but also a more humane way to think about depression.

Neil also demanded that we approach the study of depression in a way that respected and honored the complexity of the problem and people's experiences. The breadth of knowledge and interest that Neil brought to depression research was distinctive. The briefcase he carried, black leather long since cracked and softened by daily use, was always overflowing with books, journals, and papers written by students and by colleagues around the world on wide-ranging and varied topics. Only with Neil could I talk one day about the latest pharmacological interventions and, on the next, delve into the complex relationships between gender, vulnerability to depression, and what Neil had termed "the politics of intimacy." No one close to Neil was immune from his infectious love of learning. He modeled a tireless enthusiasm, a kind of exuberant hunger for knowledge. It was so strong, in fact, that he was able to engage committed experts—from the very fields and models he criticized—as active colleagues and dear friends. He created an enduring sense of community around him, and he instilled in all of us the knowledge that working with him meant being part of something larger than ourselves.

I am grateful for each moment I spent working with and knowing Neil. There are no words to convey the enormity of the absence his death has created. But just as Neil did in life, his death represents a challenge for us—a call to infuse our research, our clinical practice, and our lives with the passion and exuberance, boundless curiosity, spirit, and compassionate skepticism that he shared with all of us so generously and so completely every day.