An Integral Perspective on Depression

21 Pages·2017·0.24 MB·English

by  Dinu S. Teodorescu

IInntteerrnnaattiioonnaall JJoouurrnnaall ooff TTrraannssppeerrssoonnaall SSttuuddiieess
Volume 22 Issue 1 Article 14
1-1-2003
AAnn IInntteeggrraall PPeerrssppeeccttiivvee oonn DDeepprreessssiioonn
Dinu S. Teodorescu
Norwegian Transpersonal Association
Follow this and additional works at: https://digitalcommons.ciis.edu/ijts-transpersonalstudies
Part of the Philosophy Commons, Psychology Commons, and the Religion Commons
RReeccoommmmeennddeedd CCiittaattiioonn
Teodorescu, D. S. (2003). Teodorescu, D. S. (2003). An integral perspective on depression. International
Journal of Transpersonal Studies, 22(1), 100–119.. International Journal of Transpersonal Studies, 22 (1).
http://dx.doi.org/10.24972/ijts.2003.22.1.100
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
This Special Topic Article is brought to you for free and open access by International Journal of Transpersonal
Studies. It has been accepted for inclusion in International Journal of Transpersonal Studies by an authorized
administrator. For more information, please contact the editors.
An Integral Perspective on Depression
Dinu Stefan Teodorescu
Norwegian Transpersonal Association
The integral approach to therapy proposes to accommodate all the etiological factors of
unipolar depression in its theory, as well as to make use of all existing therapies, both phar-
macological and psychological, in the treatment of unipolar depression. Integral Therapy is
compared to cognitive therapy to find evidence for its superiority over the cognitive
approach. It appears that the cognitive therapy is more cost-effective than Integral Therapy
as an individual approach in the treatment of depression, but that the integral perspective
accounts better for etiological factors.
Introduction are not really double-blind, since during the trials the
subjects come to realize whether they have placebo or
Depression is the most widespread mental dis- not. Because of the pressure from medical insurance
order, and in 1999 as many as 1 in 20 companies, psychotherapies have been urged to devel-
Americans were severely depressed (Satcher, op short-duration therapies that can be quantified,
1999). Every year, about 6 million people suffer from and today the field has developed a new approach, the
depression in the U.S., with a cost of more than 16 bil- so-called evidence-validated therapies (EVT), propos-
lion dollars; 60% of suicides have their roots in major ing that only those therapies that have a research-based
depression, and 15% of patients admitted for depres- evidence should be considered. However, the benefits
sion to a psychiatric hospital kill themselves of EVT over the other therapies have been questioned
(Nierenberg, 2001). The recovery rate from major (Lampropoulos, 2000; Henry, 1998; Garfield, 1996).
depressive disorder (MDD) is as follows: 50% of those For the time being, there are only two therapies
who had a major depressive episode and recovered will that are recommended by the American Psychiatric
never experience a new episode; while 40% will have Association (APA) for the treatment of MDD based
MDD recurrence in the future, and 10% will never on research evidence: namely, cognitive therapy (CT)
recover and will experience a chronic depression and interpersonal therapy (IPT) (American Psychiatric
(Passer & Smith, 2001). Association, 1993). The question which remains is
Depression is perhaps the most researched mental what shall be the fate of the 200 or more existing psy-
disorder. Street et al. (1999) list more than 27 theories chotherapies (Bohart et al., 1998; Chambless et al.,
of depression and 99 factors that contribute to its 1998) that may work as well as CT and IPT, but for
onset and maintenance. Of the 27 theories, none is the time being don’t seem to have the “credentials”
able to accommodate all these factors. The classical from research. Some of them, such as psychoanalysis
ones have concentrated only on some of them, often and some humanistic psychotherapies, may prove
getting in conflict with other theories that emphasised impossible to quantify using a research setting, and in
other factors, and thus giving rise to an unfortunate the end they may prove “too long and expensive” for
competition for the “truth.” the health insurance companies.
Today we see in the U.S. a real battle between phar- Given this growing problem for today’s psy-
macotherapy and psychotherapy in claiming full rights chotherapies, it is indeed “unreasonable” to propose a
in the treatment of MDD. The psychotherapy quarter new therapy, which may prove even longer in achiev-
seems to be losing ground because of the problem of ing results and even more difficult to be tested in an
funding research, while the pharmacology quarter is experimental setting. And it is a problem for the pres-
obviously supported by large grants from the pharma- ent paper, meant to introduce a new form of therapy
ceutical industry. The double-blind pharmacology for MDD, Integral Therapy (IT).
studies on MDD have all been criticised, because they Psychotherapy integration has long been an ideal
100 The International Journal of Transpersonal Studies, 2003, Volume 22
for many psychotherapists dreaming of an overall and to propose a more parsimonious and more effica-
framework with a theory endorsing specific therapy cious therapy. The common factors present in all gen-
techniques. Efforts for an integration of different the- uine psychotherapies are: a positive therapeutic
ories were first made in 1936 by trying to combine alliance, a supportive relationship, genuine interest in
psychoanalytic and behavioral approaches, in order “to the client’s problem, authenticity, warmth, empathy,
combine the vitality of psychoanalysis, the rigor of the openness, unconditional love, arousing hope and pos-
natural science laboratory, and the facts of culture” itive expectations in the client, the client’s emotional
(Wachtel & Messer, 1998, p. 231). Surveys have found involvement in the therapy, encouraging new ways in
that between 30% and 65% of interviewed psy- the client to understand oneself and one’s problems,
chotherapists identified themselves as eclectic and generating new patterns of activity outside the
(Norcross & Goldfried, 1992). But there are big differ- therapy session (Norcross & Goldfried, 1992).
ences. Whereas the eclectic perspective is just borrow- A common-factors therapy for depression has been
ing freely from the classical schools and just chooses proposed by Arkowitz (1992), emphasising one basic
from the existing therapies, the integral perspective factor, lack of social support, as the main cause of
tries to create an umbrella that may accommodate all depression. He argues that there have been no signifi-
existing factors and therapies, as well as combine dif- cant differences between different treatments for
ferent therapies (Jensen et al., 1990). The integral depression (Robinson et al., 1990, Elkin et al., 1989),
approach tries to create something new, unifying the and that common factors are responsible for the out-
parts, while the eclectic approach is just applying the come of the treatment. Lambert et al. (1986) found
parts of what there is. that the common factors are responsible for some 40%
Today there are three popular pathways toward the of the therapy outcome, specific techniques for only
integration of psychotherapies: technical eclecticism, about 15%, expectancy (placebo effects) for another
theoretical integration, and common factors. The 15%, and extratherapeutic change for maybe 30%.
main aim is to increase therapeutic efficacy and effi- We also have an integrative therapy that combines
ciency by looking beyond the boundaries of single the- pharmacotherapy and psychotherapy (Beitman &
ories and restricted techniques. Klerman, 1991).
Technical eclecticismseeks to select the best treatment Finally, the last development on the integrative
for the person and the problem. It draws its techniques front is Integral Psychology (IP) as proposed by Ken
from a large number of different systems of psy- Wilber (2000a), which sets out a master template the-
chotherapy, which may be epistemologically or onto- ory that can accommodate 100 psychological models,
logically incompatible. using freely all possible therapeutic interventions and
Theoretical integration seeks to integrate two or weighing their strength according to the master tem-
more therapies, hoping that the resulting therapy may plate theory.
be better than each constituent therapy alone. The The aim of the present study is to compare the the-
emergent theory is more than the sum of its parts. oretical and therapeutic virtues of Integral Therapy
There are several examples of efforts meant to integrate (IT) and cognitive therapy (CT) (Beck et al., 1979).
two therapies: psychoanalysis and behavior therapy
(Wachtel, 1997), humanistic and behavioral therapies The Study’s Questions
(Wandersman et al., 1976), family/systems therapies,
biological and individual therapies (Pinsof, 1995), In this paper we shall look more closely at the virtues
incorporating interpersonal factors in cognitive therapy of IT in the understanding and accommodation of
(Safran & Segal, 1990), or integrating multiple thera- multifactorial causes for unipolar depression. Further,
pies such as the integrative psychodynamic therapy we shall look at the capacity of IT to use freely, in an
which combines psychodynamic, behavioral, and fam- integral perspective, from all existing therapies, either
ily systems theory (Wachtel & McKinney, 1992), and alone or in combination, to better serve the particular
the transtheoretical approach, which integrates the needs of the client in prevention and treatment, and
major therapy systems (Prochaska & DiClemente, 1992). against recurrence of major depressive episodes. IT will
The common-factors approach seeks to identify then be compared to an established, empirically vali-
similarities and core ingredients of different therapies, dated therapy, cognitive therapy (CT), in order to
Special Topic: Depression 101
identify its strengths and weaknesses. To this effect, we Etiology
have formulated two separate questions: (1) Does IT
provide a better understanding than CT of the multi- Several causes have been proposed as the origin of
factorial causes of unipolar depression, accommodat- depression, such as: personality and intrapsychical
ing all the factors into a coherent theory of depression? causes (Millon, 1996; Bowlby, 2000), personal vulner-
(2) Does IT provide a better therapeutic offer than CT ability (Vrasti & Eisemann, 1995), genetic causes
for preventing the first onset of the MDD, treating, (Barondes, 1999), sex differences (Nolen-Hoeksema,
and preventing recurrence? In order to answer these 1990), interpersonal causes (Joiner & Coyne, 1999;
questions a literature search has been undertaken. Brown & Harris, 1979; Hammen,1991), avoidant
coping strategies (Chan, 1995; DeLongis, 2000), culture
Nature of the Disorder (Manson, 1994; Culbertson, 1997), learned helplessness
(Seligman & Isaacowitz, 2000), and environmental
Depression is primarily a disorder of mood, charac- causes (Nezlek et al., 2000; Tseng et al., 1990).
terized by cognitive, motivational, and somatic Different therapies have considered only some of
(physical) symptoms. Emotional symptoms include the possible etiologies, because of limitations of the
sadness, hopelessness, misery, loss of pleasure, dys- theory or out of ideological reasons, leaving unad-
phoric mood, affective emptiness, and depersonalisa- dressed all the rest. There are theories emphasising
tion. Cognitive symptoms can be briefly described as some factors while ignoring others: biological psychol-
negative cognitions about self, the world, and the ogy emphasises brain structures and chemical imbal-
future. More specifically, cognitive symptoms are the ances in the brain; behavioural theories emphasise
following: thoughts focused toward the past, followed inappropriate behaviours (Wolpe, 1982); cognitive
by intense regret; feelings of worthlessness; poor con- theories emphasise maladaptive cognitive processes
centration; intense rumination; diminished locus of (Kovaks & Beck, 1978); social psychology emphasises
control; magnification; minimisation; absolutistic the importance of relationships, life events and chronic
thinking; confirmatory biases; and the utilisation of stressors (Brown & Harris, 1979); self-psychology
the availability heuristic (Clark et al., 1999). Common emphasises personal needs and desires (Arieti &
motivational symptoms are loss of interest, loss of Bemporad, 1980); psychoanalysis believes in early neg-
interest in others and social relationships, lack of drive, ative experiences as the origin of maladaptive coping
and difficulty starting anything. Somatic symptoms mechanisms (early loss giving rise to anger directed
are loss of appetite, lack of energy, sleep difficulties, inward) (Freud, 1959); attachment theory emphasises
weight loss or gain, somatic preoccupation, and psy- early interpersonal conflicts (Bowlby, 1977); attribu-
chomotor retardation with fatigue. tional style theory emphasises the role of making
Unipolar depression is a kind of depression where wrong attributions about the outcome of events; and,
the individual experiences only the above symptoms, finally, the helplessness theory emphasises the role of
without mania, distinguishing it from bipolar depres- learning helplessness throughout one’s life (Alloy et al., 1988).
sion. To diagnose MDD, according to DSM-IV-TR, One of the best models to date proposes that per-
the subject must report five of the following nine sonal vulnerability to depression is determined by a
symptoms in the last two weeks: depressed mood and combination of biological, psychological, and social
feeling sad; markedly diminished interest or pleasure variables (Eisemann & Vrasti, 1995), but it fails to
in almost all activities; significant weight loss or weight include the developmental levels and lines of the
gain; insomnia or hypersomnia; psychomotor agita- patient (Wilber, 2000b).
tion or retardation; fatigue or loss of energy; feelings of Notable efforts have been made by Street et al.
worthlessness or excessive or inappropriate guilt; (1999), who tried to integrate 27 theories of depres-
diminished ability to think and concentrate, or indeci- sion. They found 99 psychological factors that can
siveness and recurrent thoughts of death or recurrent cause the onset of depression, leaving out other theo-
suicidal ideation (APA, 2000). retical approaches such as biological and sociopolitical
ones. They proposed that an individual vulnerable to
depression might interact with the environment in cer-
tain maladaptive ways, resulting in the formation of a
102 The International Journal of Transpersonal Studies, 2003, Volume 22
negative view of the self, the environment and the therapy (ECT) (Rey & Walter, 1997; Petit et al.,
future, and in the occurrence of the depressive symp- 2001), vagus nerve stimulation, or with transcranial
tomatology. magnetic stimulation (TMS) (Boutros et al. 2001,
Four fundamental dimensions have been identi- Wassermann & Evans 2001). Treatment of depression
fied, each designated by a cluster of factors. either with drugs or with psychotherapy (DeRubeis et
The cognitive-bias dimensionproposes that infor- al., 1999; Hollon, 1996) has been the subject of a hard
mation is processed selectively by the individual, thus dispute between the biological and the psychological
contributing to the creation of a negative view of self perspective. But now, any such ideologically motivated
and negative self-schemata. These two are involved in perspectives no longer have a place in choosing the
the etiology and maintenance of depression. right therapy for any given individual (Weismann,
The second dimension is the lack of positive rein- 2001).
forcement for the self, resulting from the individual’s What are the best therapies for MDD?
maladaptive social behaviours and pursuit of unrealis- Antidepressants are effective in approximately 70% of
tic social goals. cases with MDD and there are today more than two
Lack of social support and interactionis the third dozen drugs with seven distinct mechanisms of action
dimension, which has two aspects, a cognitive one and (Manning & Frances, 1990). Both pharmacotherapy
a behavioural one: for the cognitive one, the individu- and psychotherapy are available to treat MDD, and
als are unable to express their own thoughts and feel- often the treatment is a combination of the two (Blatt
ings and to monitor those of others; for the behavioural et al., 2000). In Norway, at a Consensus Conference in
one, individuals behaving in socially undesirable ways 1999, American publications on the effects of drugs
have deficits in social skills and lack social relationships were criticised as being biased by selective publishing
and/or a network of contacts and support. and by the economic interests of the big drug compa-
The fourth dimension proposes the importance of nies. The general consensus was that there appeared to
goal pursuit and achievement and indicates that a be very little effect from recommended drugs such as
failure to achieve goals affects self-esteem, which may TCA, SSRI, MAO and RIMA, and that psychothera-
give rise to depression. It is also stressed that inappro- pies like CT, cognitive-behavioral therapy (CTB), and
priate or unachievable goals may have the same impact interpersonal therapy (IPT) were recommended for
on self-esteem. Finally, four negative beliefs have been treating MDD.
found that contribute to the onset of depression: neg-
ative self-view, worthlessness, loneliness, and failure. Cognitive Therapy for Depression
In the effort better to serve the needs of those who
do not benefit from one therapy alone, an eclectic and Today we have a couple of dozen cognitive thera-
integral perspective has developed. IT has come into pies, but in this paper we shall consider in depth
being to address all the different factors of depression only Beck’s cognitive therapy (CT) (Beck, 1967),
and accommodate them in a comprehensive theory to while mentioning Ellis’s rational-emotive therapy
be used in the process of choosing a treatment. (Ellis & Dryden, 1987), covering the two most impor-
tant figures in cognitive therapy. Both Beck and Ellis
Prevention and Treatment consider the person as a biosocial organism and the
basic unit for analysis and therapeutic interventions.
Unfortunately, very little research in preventing the They believe in individual differences in biological
onset of depression has been done, showing the functioning, proposing that psychopathology is a
current widespread interest in treating rather than pre- result of innate vulnerabilities or biological tendencies
venting (Munoz et al., 1996). One researcher found to either over- or under-react to environmental influ-
several measures that may prevent the onset of depres- ences. In their view, depression is seen as the result of
sion: prevention of childhood abuse and racism, relief predisposing factors, such as heredity and physical dis-
from economic hardships, early diagnosis, and safe, ease leading to neurochemical abnormalities, and of
effective treatment (Poslusny, 2000). precipitating factors, such as physical disease and
Treatment for MDD currently uses drugs, drugs in chronic or acute stress. Cognitive therapy emphasises
combination with psychotherapy, electroconvulsive psychological functioning as the main area of interest,
Special Topic: Depression 103
saying that human functioning is organised and regu- 5) If somebody disagrees with me, it means he or she
lated primarily by cognitive processes. Beck and Ellis doesn’t like me.
see healthy people as good scientists who gather 6) My value as a person depends on what others think
rational empirical data, formulate hypotheses, and test of me.
them. In contrast, malfunctioning people deviate from Depression is also seen as being caused by a depressive
these principles, are irrational, illogical, distorted, attributional style and learned helplessness (Seligman,
overgeneralised, and absolutistic, and display inade- 1975). Depressed people interpret success and positive
quate reality testing for their beliefs. events as due to external factors, while attributing fail-
Beck proposes that negative beliefs and dysfunc- ure and negative events to internal ones. Failing to take
tional, maladaptive processing of information are at credit for success and blaming themselves for failure
the origins of depression. The latter sets in when neg- and feeling guilty and worthless, they lower their self-
ative self-schemata are activated by current circum- esteem, thus maintaining their depression. Three
stances. Self-schemata are cognitive structures that can dimensions of causal attributions have been proposed:
be viewed as sets of rules, standard strategies that indi- internal-external, stable-unstable, and global-specific.
viduals use subconsciously to evaluate and control Depression is also seen as the result of making
their behaviours. Negative schemata are developed in internal, stable, and global attributions for negative
childhood due to repeated negative experiences of dep- events (Abramson et al., 1978). Learned helplessness
rivation, loss, or death of a loved one. Circumstances theory proposes that, due to earlier repeated experi-
analogous to those when the schema was created can ences involving bad events that one could do nothing
activate negative schemata, which are usually inactive. to prevent or escape, one learned that nothing can be
The activation of a negative schema causes dysfunc- done, and thus feels helpless, hopeless, and finally
tional, biased processing of information toward depressed (Seligman, 1975; Seligman & Isakowitz,
schema-consistent information and systematic cognitive 2000).
errors. Negative self-schemata manifest in conscious- The goal of cognitive therapy (CT) is to identify
ness as automatic thoughts, which can take the form of automatic thoughts and modify or restructure them in
the depressive cognitive triad: negative opinions about order to help the client to develop and use more func-
oneself, about the ongoing experience, and about the tional patterns of thought, emotion, and behaviour.
future. The therapist teaches clients to revise dysfunctional
Negative automatic thoughts result from processing schemata and faulty information-processing by reality
errors through which perceptions and interpretations testing of automatic thoughts, reattribution training,
are distorted. They include many errors in logic, such and changing depressogenic assumptions.
as overgeneralisation (making judgements based on a Reattribution training implies teaching the client to
single experience), selective abstraction (attending change the attribution for failure from internal, stable,
only negative aspects of the experience), dichotomous and global to external, unstable, and specific explana-
reasoning (thinking in extremes), personalisation (tak- tions (Ellis & Dryden, 1987).
ing personal responsibility for events), arbitrary infer- In CT, the therapist is seen as having much of a
ence (jumping to conclusions on the basis of inade- teacher role, teaching his or her client to identify, chal-
quate evidence), magnification (exaggerating personal lenge and test the automatic thoughts and depresso-
small faults), and minimisation (reducing the impor- genic assumptions. The therapist may use different
tance of personal successes). techniques, such as verbal challenging of the negative
In addition to errors in logic, depressed people also thoughts and dysfunctional assumptions, or assigning
make six depressogenic assumptions on which they behavioural experiments for a reality test of these
base their life: thoughts and beliefs. CT is a time-limited therapy,
1) In order to be happy, I must be successful in every- usually not extending beyond 20 sessions for treating
thing I do. MDD, and today there is a solid evidence for its effects
2) To be happy, I must be accepted by all people at all from a number of studies. Some 28 metaanalytic stud-
times. ies for unipolar depression showed CT to be better
3) If I make a mistake it means I am inept. than pharmacotherapy, behaviour therapy, and other
4) I can’t live without love. therapies, as well as the wait-list condition (Dobson,
104 The International Journal of Transpersonal Studies, 2003, Volume 22
1989). Research has shown differential relapse follow- Integral Psychology
ing CT and pharmacotherapy for depression, with the
greater relapse being after pharmacotherapy (Evans et Integral Psychology (IP) is a vigorous attempt to
al., 1992). The problem of matching patients to cog- change the memetic perspective (Price 1999) of cur-
nitive and interpersonal therapies in research programs rent psychology by proposing a new meme of looking
has been an important factor for the outcome of the at psychopathology and treatment. Integral psycholo-
therapy (Barber & Muenz, 1996). gy has risen to unify many of the existing psychologi-
The CT field is in continuous expansion and one cal, biological, social, and environmental theories,
of the latest developments is the cognitive-interpersonal from both East and West, into a master theoretical
approach (Safran & Segal, 1990), which criticizes template that may serve as a sound basis for research
Beck’s view as too reliant on an informational process- and treatment in the new millennium.
ing model. Safran and Segal stress the need to study The IP theory has been created by Ken Wilber, an
people from an ecological perspective, pointing out American seen by some as the Einstein of conscious-
that cognitive structures develop in relation to other ness (Ingram, 1987), because of his integration of
people. They propose interpersonal schemata to be more than 100 psychological models, East and West
added to self-schemata for a thorough understanding (Wilber, 2000a). Wilber is the only psychologist who
of the person. Interpersonal schemata are cognitive has his collected works published while alive.
representations of interpersonal events created by the Currently he is leading his private Integral Institute
person out of the need of relatedness to significant with more than 300 respected scientists working
others in order to maintain these relationships. The together in a new, integral way of doing research.
interpersonal schemata have a functional utility and Integral Therapy (IT) is both a perspective for
include cognitive, affective, and interpersonal compo- looking at causes and treatments of mental problems
nents. Some authors regard this new development as and a particular therapy, which tries to address “all
an integration of CT with interpersonal therapy quadrants, all levels, all lines” (4 dimensions of the
(Norcross & Goldfried, 1992). Kosmos, 10 levels of development, and 30 lines of
There have been some criticisms about Beck’s development) of the person. Today we know too much
description of schemata, because its vagueness and from so many sciences to ignore all the factors that
imprecision make it inadequate for testing and verifi- may contribute to the MDD, and it is IT that has the
cation (Mahoney, 1995). Cognitive theory says little capacity of integrating all of them into a master tem-
about developmental issues and the impact of environ- plate. IT is not an eclectic approach either in theory or
ment on individual development. Now some efforts in practice, but is in its own right both a theory and a
have been made to address the role of affect and inter- therapy that integrates all existing therapies, following
personal relations in the negative self-schema (Safran a careful logic based on the perspective of treating the
& Greenberg, 1991). whole person, “all quadrants, all levels, all lines.” IP
A new development in CT is its combination with can be seen as an ecological psychology, which takes
mindfulness, namely the Mindfulness-based Cognitive into consideration the person-in-context, as its pri-
therapy, that is used mostly as a cost-efficient group mary unit of analysis. This approach contrasts with
preventive program for major depressive disorders cognitive therapy, which concentrates mostly on the
(MDD) (Teasdale, 1999). psychological side of the person, while considering the
Overall, CT is very effective in treating depression importance of biological and social factors.
(Blackburn et al., 1986) and it is one of the two evi-
dence-validated therapies recommended by the The Four Dimensions of the Individual
American Psychiatric Association (1993) for the treat-
ment of MDD. The human being is seen in Integral Therapy as a
bio-psycho-social system that has an individual
existence; and also is part of a collective existence. Any
individual has two dimensions: an interior and an
exterior existence, or better said, a subjective life open
to introspection and phenomenological research, and
Special Topic: Depression 105
an objective life open to scientific investigation. The rants as important in understanding and treating
collective also has two dimensions: an interior domain depression; interpersonal theory stretches out to cover
created by the intersubjective contact between individ- also the third quadrant, stressing the importance of
uals, and an exterior domain that consists of the inter- relations between people, while integral theory covers
objective relations between the material entities. all the four quadrants.
Wilber (1999) has named these four dimensions that
define any person the four dimensions or quadrants of The Notion of Self in Integral Therapy
the Kosmos. Kosmos contains the physical and the
spiritual dimension of the universe. The self concept is a key one in Integral Psychology,
The Kosmos is made by holons, which are organ- where it is not seen as a monolithic entity but
ised in hierarchies, so that higher holons enfold and rather as a collection of lesser selves, composed by var-
include the previous ones. All holons have a quasi- ious subpersonalities and different modules of devel-
independent life, living their own life while at the opment—cognitive, emotional, social, spiritual,
same time being an integrated part of a higher holon. moral, and so forth (Rowan 1993). A subpersonality
Finally, every holon has its own four quadrants that may develop when, following a childhood trauma, a
evolve together with it. A short description of the four part of the existing self has defensively split off, with
quadrants follows. which consciousness remains identified. The subper-
The Upper Left Quadrantis the individual’s inte- sonality endures over time and maintains all the char-
rior dimension, involving the psychic dimension, soul acteristics of the personality at the moment the split
and Spirit. The right investigation method here is a occurred, usually characterized by specific age needs,
phenomenology that may describe qualitatively the desires and impulses. The subpersonality does not
subjective experiences of the person. develop further and lives its own life, at a conscious,
The Upper Right Quadrant is the individual’s subconscious, or unconscious level of awareness.
exterior dimension, composed by the body with its The feeling of a unique self is given by the integra-
brain. The right investigation method here is the sci- tive function of the overall self who tries to unite all
entific method, which may describe quantitatively the the subpersonalities and different cognitive modules in
physical changes of the body and brain. Between these a cohesive entity.
two dimensions there is a close relationship, so that The self is seen to also have several other functions,
any change in one dimension produces an effect on the such as cognition, will, caring for others, justice in
other, for example any thought involves an accompa- relationships with others, aesthetic apprehension,
nying emotion and a specific brain wave. metabolism (metabolizing the experience to build
The Lower Left Quadrant is the collective interi- structures), integration (integrating the function,
or dimension; it is characterized by intersubjective needs, states, waves and streams of consciousness)
relations between people and nations, and is the pub- (Wilber, 2000b).
lic domain of culture. The self also evolves through identification with
The Lower Right Quadrantis the collective exter- higher levels of the Kosmos, following a Piagetian
nal dimension; it is characterized by interobjective stage–like development of a constant process of
relations between physical objects, and is the home of embedding in the proximal level and then disembed-
nature and the environment, with its political struc- ding, and transcending that level for further develop-
tures. ment.
Any modification in any of the four quadrants The development of self can be stopped by child-
gives a reaction in the other three, so the causes of hood trauma, such as depression produced by the loss
pathology and the treatment of depression must con- of a loved one in the early stages of development, the
sider all the quadrants equally. Any change in any of preconventional stages, which may create a split in the
the individual, collective, biological, psychological, self. This creates a subpersonality that is characterized
social, or environmental dimensions has a direct influ- by preconventional impulses and needs, impulsivity,
ence on the other parts of the system, setting the cop- narcissism, egocentricity, moral stage one, and an
ing skills of the person to trial. archaic worldview. While the subpersonality stops its
Cognitive theory considers only the first two quad- development and endures over time as a distinct entity,
106 The International Journal of Transpersonal Studies, 2003, Volume 22
the main part of the self continues to develop. This psychosexuality, self-integration, religious faith,
split in development between the subpersonality and affects/emotions, needs, worldviews, gender identity,
the main self creates tensions in the integrative func- and defense mechanisms. Some of the Lower Left
tion of the overall self, which may result in psy- Quadrant–oriented developmental lines or streams,
chopathology. such as socioemotional capacity, communicative com-
The psychopathology of the self is then this inter- petence, interpersonal capacity, role taking, and empa-
nal conflict between the main part of the self-system thy, if they have an arrested development, may be
and the subpersonalities, which are at different levels responsible for vulnerability to depression. These
of development (each with its own needs, wishes, modules or streams tend to develop in a relatively
worldviews, morals, and so forth). The goal of therapy independent fashion and each needs a careful develop-
of the self-system is to end these internal conflicts and ment if the self is to function to its fullest capacity and
achieve a horizontal as well as vertical integration of to avoid the onset of depression.
the various self structures. IT acknowledges the exis- Different societies have emphasised different devel-
tence of defenses of the self, and for therapy it is opmental lines, and we may find a huge variation even
important to identify the level of defenses, so that if within the same society, so that we may not yet have a
these are not adequate for the present level of develop- clear consensus about which are the most important
ment, they may be changed, allowing the self to release and desirable lines of development. Howard Gardner
the internal tensions caused by the incompatibility of (1985) has demonstrated the existence of multiple
the level of defenses with the level of self-development intelligences, which has ended the monopoly of the IQ
(Wilber 2000a). as the only measure of human intelligence. For exam-
ple, a person may have a high IQ, but be underdevel-
Developmental Lines or oped emotionally, morally, spiritually, and interper-
Streams of the Self sonally.
None of these developmental streams can finally be
Psychological development is seen in IP as a parallel separated from the others, but each tends to be orient-
development of several lines, which may develop ed toward a particular quadrant. Cognitive therapy is
independently but nevertheless are held together by concentrated mostly on the cognitive modules from
the integrative function of the self. Because of the the Upper Left and Upper Right Quadrant, giving lit-
quasi-independent characteristics of the developmen- tle importance to the affective, social relationship, and
tal streams, disjunctions and tensions occur, causing communication modules.
possible psychopathology. Wilber (2000d) identified
around 30 lines of human development, the most Developmental Levels or
important being sense-identity, defense mechanisms, Waves of the Self
interpersonal development, affects/emotions, needs,
morals, and worldviews. Integral Psychology is a whole-spectrum psychology,
Developmental lines included in the Upper Left which unites Freud’s depth psychology of the
Quadrant (subjective components) are self-identity, unconscious with the height psychology of the super-
affects/emotions, needs (Maslow’s hierarchy of needs), conscious of Eastern psychologies (Wilber, 1977). It
and the like; those in the Lower Left Quadrant (inter- covers ten levels of development, from the most basic
subjective components) are worldviews, linguistics, material level to the highest spiritual level. Human
aesthetics; those of the Upper Right Quadrant (objec- development is seen as a rising of consciousness from
tive components) are exterior cognition and scientific the unconscious to conscious and further to the super-
cognition; and those of the Lower Right Quadrant conscious (Alexander & Langer, 1990). This develop-
(inter-objective components) are sociopolitical and ment may also be called the development of the self,
environmental structures. whose gravity centre rises its through ten fulcrums of
The most important lines or streams responsible development, trying to balance the different lines or
for vulnerability to depression may be the undevel- streams of development in each level or wave. Wilber
oped or arrested lines of development in the Upper follows the Piagetian scheme of cognitive develop-
Left Quadrant, such as cognition, morals, self-identity, ment, but identifies higher levels, such as post and
Special Topic: Depression 107
post-post formal levels of development, calling them moral stage 1, and animistic worldview, to the socio-
“second and third tier” (Wilber, 2000c). Self-development centric level, when it identifies with its family needs,
is seen more like a spiral than as neat levels on a lad- moral stages 2 to 3, and mythic worldview. Then the
der, but nevertheless, in order to move to one develop- self develops to the world-centric level, when it identi-
mental wave, the preceding level must have been con- fies with needs of the whole world, is at moral stages 4
quered. Wilber emphasises that no wave can be to 5, and holds a pluralistic postconventional world-
skipped in favour of a higher one, and every wave has view. Further, development can still proceed to the
an equal importance for the overall spiral. The main transpersonal level, when the ego is transcended and
point is that each wave is equally important and any what remains is a total identification with the Kosmos,
jump is dangerous and ultimately impossible, so that a post-post conventional worldview, or One Taste, and
the mission of the therapist is not to help people to a moral stage defined by Jesus by His commandment:
move to higher waves, but to help clients to accommo- “Love your neighbour like yourself!.” Table 1 shows a
date and integrate the waves where they are in the pres- graphical representation of all the levels of develop-
ent moment. ment correlated with memes, worldviews, psy-
The sense of self (“ego”) develops from the egocen- chopathologies and treatments (Wilber, 2000a).
tric level, when it is dominated by its narcissistic needs, Why is it important to know the levels of develop-
Table 1. Structures, levels, memes, worldviews, pathologies and therapies according to Wilber
108 The International Journal of Transpersonal Studies, 2003, Volume 22