Body Agency: Your Natural Antidepressant
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Anyone who’s ever experienced depression will attest that it’s not just a mental or emotional experience; it’s a deeply embodied one.
And yet, this understanding hasn’t yet trickled through to mainstream medicine. For instance, let’s take a look at how depression is diagnosed. The Diagnostic and Statistical Manual for Mental Disorders, Edition 5 (DSM-5) is the canonical manual for diagnosing mental illness—and therefore, a gatekeeper for insurance-related treatment. Criteria, and therefore Interventions, tend to focus on depression’s mental and emotional elements. The DSM-5 lists only one bodily attribute of depression: the poorly named psychomotor retardation, which refers to a slowness of speech and movement and an immobilization of facial expressions. But there’s so much more to the bodied experience of depression than slowness of speech and movement.
Today I’d like to focus on a key, and missing, piece of the mental health puzzle: body agency, one of our five inner senses and a key node of embodiment.
What Body Agency Is and Why It Matters
Body agency isn’t a metaphor or a figure of speech; it has a whole field of scientific study devoted to it. And it’s a key factor in emotional and social well-being.
Agency refers to the ability to move and to act in a way that matches our intentions. The word comes from the Latin agere, “to set in motion, drive forward, or perform.” It’s also the root for terms like agitate, activate, and activism.
Body agency is such a critical part of the genesis and maintenance of numerous mental illnesses that I can’t believe we’re not shouting from the rooftops about it.
It's a major contributing factor in anxiety, depression, bipolar disorder, mania, chronic pain, obsessive-compulsive disorder (OCD), schizophrenia, narcissistic personality disorder, borderline personality disorder, antisocial personality disorder, and ADHD. Some issues involve a scarcity of body agency (anxiety, depression, OCD), while others have an excess (mania, narcissistic personality disorder, antisocial personality disorder). In my opinion, physical issues come into play with agency too, like neurological diseases, cancer, and menopause.
Body agency is also the signature wound in most forms of trauma. The traumatic event—the assault, abuse, combat experience, natural disaster—doesn’t just hijack our nervous system. It violates our sense of agency and with it, our self-determination. Restoring agency is a key element of posttraumatic growth and survivorship.
Let’s focus for today on the sense of agency in depression.
In 2019 B.C. (Before Covid), the World Health Organization estimated that a whopping 280 million people in the world already had depression. They forecast that by the year 2030, depression would be our number one global disease burden.
Then the pandemic hit. The Institute for Health Metrics and Evaluation, from which the World Health Organization obtains its data, stated:
“As we near the third year of the COVID-19 pandemic, a noticeable and disproportionate increase in the global burden of depressive and anxiety disorders has impacted the mental health of women and children worldwide. A major new study published in The Lancet showed that in 2020, the COVID-19 pandemic led to a stark rise in depression and anxiety globally. The overall number of cases of mental disorders rose dramatically, with an additional 53.2 million and 76.2 million cases of anxiety and major depressive disorders (MDD), respectively.”
These are significant increases in the prevalence of depression. They show that we need more arrows in the quiver for understanding and treating it.
We need a new paradigm for understanding and treating depression. In an earlier column, I quoted the World Health Organization’s generative acknowledgment that mental health is a social issue, and that we can’t separate what goes on inside people’s heads from social structure and context.
In my opinion, we also can’t separate what goes on inside people’s heads from what’s happening in their bodies.
As always, I’m not suggesting that people discontinue medication or psychotherapy. At the same time, I’m pointing to the insight that medication and psychotherapy cannot remain our only options, and that effective interventions will also address the embodied experience of depression.
Body Agency Is a Somatic Experience
Science and psychology divide agency into three basic components:
The ability to form intentions
Generating alternatives from which to choose
Initiating action
Having worked with people as a psychologist and yoga therapist for nearly 25 years, experience has taught me that people can experience difficulty in one or any combination of these three areas. When collaborating with people individually, I’ve found it helpful to work together to identify which element(s) of agency feel most compromised in any given moment: intention, generating alternatives, or taking action.
This can require a deeper dive into assessing agency, and more nuance and granularity. But it also gives us several creative avenues for boosting agency and with it, emotional well-being.
Cultivating Intention
Let me take a moment to bring in a little yoga philosophy. In classical yoga, the term sankalpa is the closest to intention. Sankalpa refers not just to personal intention, but to the alliance of personal intention to universal will, or to your higher truth—or, if this resonates more, your highest values.
My take: There’s also a social context here: In modern western society, we tend to celebrate individual values and overlook collective ones; this also impacts our collective agency. (This is actually a thing even in science, and is referred to as we agency.)
It can seem as though intention is a cognitive issue, that it stems from our mind and thoughts. This is not the case. Rather, when an intention forms, it does so largely in the primary motor cortex, a key region of the brain for initiating movement. (This area, in fact, is where scientists place the brain-machine interfaces that encode intention and direct a robotic limb or computer cursor to take action in people with tetraplegia, ALS, and other issues that impact the motor system.)
This means that intention isn’t cognitive, but intimately related to movement and to the body.
It might seem that intention is always there, while follow-through is problematic. Yet many people experience extended periods of time when intention (and motivation) are at a low ebb. There’s apathy. Lethargy. A lack of desire.
This can happen in depression, but it’s also a hallmark of certain neurological issues like Parkinson’s, MS, and ataxias. And in my opinion, it’s part of Long Covid Syndrome. Low levels of intention can resemble what I think of as a biological depression, one in which lethargy and lack of motivation dominate. There may also be sadness and negative thinking, but these often occur as a result of low intention. If you boost intention, you can also boost energy and motivation.
I’ve experienced a dearth of intention for extended periods, particularly due to Long Covid and, at times, hypothyroidism (when thyroid stimulating hormone is far too low). My favorite tools for this are: cold exposure, novel movement (and other means of creating novelty), small amounts of caffeine early in the day, eustress (see this column), and frequent dynamic rest periods centered around connective tissue self-massage and restorative yoga.
Wait, whaaaaat? Why would rest, of all things, be helpful when intention is compromised? Wouldn’t that exacerbate lethargy and low intentional states? Quite the opposite, in fact.
My take: Many of us have functioned for years like energizer bunnies, exceeding our own battery life and running on reserves (or, when those are used up, fumes). Regular use of dynamic rest practices like restorative yoga, also known as yoga nidra, can recharge our inner batteries and with that, often spark intention.
We see this in yoga philosophy, too, which tells us that sankalpa is most resonant during yoga nidra, a state of very deep relaxation where the body is outwardly still but inwardly dynamic. This helps sankalpa to be written into our subconscious (and, I’d add, encoded onto our nervous system).
Generating Alternatives
This part of agency may also seem to be cognitive, as though the mind forms choices, reasons each one out, and chooses the best option. (I’m thinking here of the pro + con lists that many of us have been taught to create.) But there’s more to generating alternatives than meets the eye.
You can think of a continuum: At the low end, you may have difficulty creating alternatives at all. At the high end, you may perceive a dizzying array of choices, all of which seem to hold equal importance. This can lead to the kind of “choice paralysis” that occurs in both anxiety and depression.
Generating more alternatives has been shown to increase our sense of agency. This too has bodily aspects. In fact, the science shows that the dorsolateral prefrontal cortex, a part of the brain involved in paying attention, is involved in the brain’s capacity to create a working space of possible actions from which we can choose. But we can do this through the bod, by employing connective tissue work, small nuggets of movement, or restorative practices to help in the generation of alternatives.
Psychologists use the term learned helplessness to describe a hallmark of depression that involves repeated lack of control and with it, predicted lack of control in the future. Researchers conducted a series of studies that instilled learned helplessness in participants. They created an unsolvable task in which subjects couldn’t succeed no matter how hard they tried. After repeated trials in which their actions had no effect on outcomes, the subjects’ sense of agency decreased and their depression increased. Let me restate this another way: You can induce depression by reducing someone’s sense of agency.
This, to me, is shout out loud huge.
In another study, researchers asked participants to write about a personal experience in which they felt depressed. Compared to simply recalling the previous day’s events in chronological order, remembering and processing a depressive episode, one in which they didn’t have agency, further reduced their sense of agency. This suggests the possibility that journaling about activities in which we generated or experienced agency might have a beneficial effect.
Promoting Action
Sometimes, intentions can seem robust, even inspired, but the capacity to take action just can’t get off the ground. This is a much more common area of challenge for many people with depression.
Some of this is related to circadian rhythms. Ideally, dopamine and cortisol levels peak in the early part of the day (ideally), decrease throughout the day, and are lower in the evening. In depression (and ADHD), dopamine and cortisol (and with them, the strength of our intentions) can paradoxically rise late in the day or peak in the evening, when the ability to follow through is at low tide. This is often a vicious cycle; it goes hand in hand with difficulty achieving lift-off, not just on any given day but on the ones that follow it as well.
Research shows that physical effort or working against resistance can increase our sense of agency. One study asked participants to pull stretch bands with varying degrees of resistance. As effort increased, the brain’s experience of agency grew, too.
My take: This is especially true for survivors of sexual assault. In my own experience, and in my dialogues with other survivors, many of us develop a greater sense of power and agency by engaging in physical movement against resistance, including various kinds of water sports, trail running, weight or resistance training (I mean, it’s right there in the name!), martial arts, and similar activities.
Working against resistance using the body can also help us to generate more agency in places that feel more mentally difficult, or where we experience mental blocks. This is true especially when we can keep track of (think: notes in a journal or on your computer) the sensory benefits of moving through resistance, and connect this when you encounter future experiences of resistance.
Inhibition, or refraining from action, is also important to our sense of agency. In many ways, it’s more difficult to actively refrain from action than it is to take action.
As an aside, in my column on ADHD two weeks ago, I talked about the impulsivity that is a hallmark of ADHD, and how difficult it is to inhibit it. For this reason, I’ve found it helpful to train inhibition. I do this by identifying the sensory elements of agitation, such as the feeling of wanting to jump out of my skin, a physiological impulsivity and desire to move, and the urge to discharge this discomfort by: picking up my phone, logging on to the New York Times, checking email, or immersing myself in someone else’s experience. (If you’re an empath, that last one will make sense.) I then resist the urge multiple times a day. t has taken me a while to train inhibition, in part because taking action has a clear dopamine hit or reward, while refraining from action has a more subtle one. This has required me to attend more closely to what inhibition feels like, particularly to the minute (but critical) boosts of agency that come from each one, but more powerfully, from the sum total of refrained actions over the course of a day.
The Social Context of Agency
In my opinion, agency is one of the first things that dominant social forces go after in order to keep us down. We may know it by other names, such as bodily autonomy, body sovereignty, and self-determination. Underneath it all, we’re speaking about personal and collective agency. This column is on the long side already, but this is a focus in the agency chapter of my book, and I’ll talk about it in future columns.
In closing, I invite you to undertaking a study of your own experience of agency using the nodes of evaluation and intervention I mention here, plus your own creative additions and variations. As always, let me know in the comments how it goes.
Reader Summary:
If you contend with anxiety, depression, OCD, ADHD, or any emotionally-mediated illness, assessing and cultivating your sense of agency, and doing so through your body, is one of the most empowering tools you can employ.
We can’t separate what goes on inside people’s heads from what’s happening in their (our) bodies
Body agency refers to our ability to move or act in a way that matches our intentions
Our sense of agency is one of the most vital elements of depression, even though we don’t talk about it directly (yet)
Body agency has three main components: intention, generation of alternatives, and action
Intention is not just cognitive; it happens in the motor (movement) cortex of our brains
Intention is related to dopamine: we can use cold exposure, caffeine, and strong intentions to boost it
We can work on developing what scientists call a response space, a working space of possibilities from which to choose; connective tissue self-massage, rehearsing choices in and with our bodies, and restorative yoga help here
Journaling about activities in which you generated or experienced agency can help
Actively develop your capacity for inhibition, or refraining from action; it can help, especially in the beginning, to formally notate when you’re able to do so
Working against physical resistance can strengthen our capacity to take action, particularly when we bring awareness to the link between resistance and action.
Sources:
These are significant increases, particularly since the World Health Organization estimates: https://www.who.int/news-room/fact-sheets/detail/depression. Accessed July 22, 2023
The Institute for Health Metrics and Evaluation, from which the World Health Organization obtains its data, states: https://www.healthdata.org/news-events/insights-blog/acting-data/new-global-burden-disease-analyses-show-depression-and. Accessed July 24, 2023
A major new study published in The Lancet showed that in 2020: COVID-19 Mental Disorders Collaborators (2021). Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. Lancet (London, England), 398(10312), 1700–1712. https://doi.org/10.1016/S0140-6736(21)02143-7
According to yoga philosophy, the term sankalpa: https://www.yogapedia.com/definition/5751/sankalpa
Regular use of dynamic rest practices like restorative yoga, also known as yoga nidra, can: https://www.yogapedia.com/definition/5751/sankalpa
Generating more alternatives can increase our sense of agency: Haggard, P. (2017). Sense of agency in the human brain. Nature Reviews Neuroscience, 18(4), Article 4. https://doi.org/10.1038/nrn.2017.14
In a third study, researchers asked participants: Obhi, S. S., Swiderski, K. M., & Farquhar, R. (2013). Activating memories of depression alters the experience of voluntary action. Experimental brain research, 229(3), 497–506. https://doi.org/10.1007/s00221-012-3372-5
Research shows that working against resistance can increase our sense of agency: Demanet, J., Muhle-Karbe, P. S., Lynn, M. T., Blotenberg, I., & Brass, M. (2013). Power to the will: how exerting physical effort boosts the sense of agency. Cognition, 129(3), 574–578. https://doi.org/10.1016/j.cognition.2013.08.020