Abstract:

Sudden and spontaneous remission of depressive symptoms has been observed in clinical research, but virtually no investigation has used qualitative research methods to examine the phenomenon. The pathways of spontaneous and rapid recovery are poorly understood, and the role of subjective experience on spontaneous recovery has been practically ignored. This study hypothesized that transformational subjective experience might precipitate a sudden and spontaneous recovery from clinical depression. Twenty adults, aged 18-62, who reported a spontaneous recovery from depression were recruited and interviewed. Participants were screened to exclude bipolar and psychotic disorders. The study utilized thematic analysis to examine retrospective narratives of depression, the phenomenology of the transformational subjective experience, and the aftermath of that experience.

Participants' depression included suicidal ideation and attempt, aversive impact on work and relationships, a panoply of uncomfortable emotions, and formal treatment attempts including psychotherapy, antidepressant medication, and inpatient treatment. Precursors to the spontaneous recovery experience included high intrapsychic stress combined with low environmental stress. Transformational subjective experiences clustered into 2 broad categories: Noetic experiences were marked by sudden insight whereas spiritual experiences featured a perceived relationship with the Sacred. Aftermath of the experience included rapid shift in mood, restructured personal values and beliefs, increased engagement in work and relationships, relapse prevention strategies, and a reluctance to share the experience with others for fear of ridicule or dismissal. Changes proved stable over time, and the majority did not suffer a relapse of depression. Results indicated that the pathway of spontaneous and rapid recovery from depression could include a precipitating subjective experience followed by the attainment of a higher degree of personal wellness.

The transformational changes observed in this study were congruent with other forms of sudden, discontinuous change such as epiphanies and "quantum change." Chaos theory was proposed as a metatheory that might offer an explanatory framework for such discontinuous change experiences because they share the qualities of an antecedent state, suddenness, transformation, and durability.