Storied Mind» depression

Depression Is a Creative Force in Human Evolution?

john — Fri, 05 Mar 2010 22:05:17 +0000

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What is it about depression that draws people to search for the benefits it brings to its lucky victims? Since I’ve been writing this blog, many writers have had great success with books and articles describing its positive role in life – giving people a creative edge, helping them figure out their lives or simply serving as a healthy and normal response to misfortune. The problem with each of these essays is that they invite confusion between mild depression, or limited periods of deeper mood changes caused by life events, and the much more severe depressive disorders.

The latest contribution in this vein is Jonah Lehrer’s New York Times article, Depression’s Upside. It’s about a theory that takes depression’s virtues to a much higher plane than that of individual insight. Depression, it turns out, evolved as part of our genetic makeup because it enhanced the human capability for analytical thinking and problem-solving. In short, depression has helped the human race survive.

This isn’t his idea. He’s summarizing the conclusions of a scientific paper by J. Anderson Thomson, a psychiatrist, and Paul Andrews, an evolutionary psychologist, but he adds a lot of additional material to support the notion that depression has its brighter side.

The concept is that depression improves the mind’s ability to focus attention on “complex social problems” (failing marriage, loss of job) through the process of rumination – the repetitive analyzing of a single problem. (Hence, the theory is called the analytic-rumination hypothesis or ARH.) Rumination fires up the area of the brain that specializes in analytical thinking, making it easier to break apart the elements of a problem that might otherwise seem overwhelming and so make it easier to find a solution.

Isolation from the rest of the world supports this tight mental focus and keeps the mind from being distracted, as does – I presume – loss of interest in sex, food, human relationships and fresh air. Since all these symptoms are coordinated so nicely to help with problem-solving, the authors contend that they must represent an evolutionary adaptation rather than a malfunction.

If this is true, I’ve really bungled the gift of my genetic inheritance. In all the decades of dealing with severe depression I never solved a single complex social problem. Amazingly enough, my mind was infinitely distractible, incapable of clear decisions and subject to aimless drift into a cloud of nothingness. At other times, I obsessed about my failings and worthlessness in prolonged self-torture and often thought of suicide. Perhaps, though unaware of it, I did sharpen my analytical abilities while sleeping all the time. However, my isolation from my family, if you can believe it, seemed to create problems rather than solve them. Clearly, I’ve given evolution a setback, especially since I’ve likely passed on this my distorted version of this gift to our three sons.

But quite possibly, it’s not true at all – at least when you untangle the confused use of the word depression. Lehrer has taken a lot of heat for failing to do that. The psychiatrist Ronald Pies, for example, writes in his Psych Central post, The Myth of Depression’s Upside that Lehrer ignores many studies that reach the opposite conclusions about the effects of depression on thinking, relating both to mental function and the level of activity in the brain. He offers this anecdote:

The notion that severe depression may bring forth good things reminds me of a lecture I once attended on “fire safety” in the hospital setting. We were shown a movie of a house that had burned down in such ferocious heat that a package of frozen muffin dough had been completely baked. “So, the house wasn’t a total loss!” quipped one of the world-weary attendees. Yes, of course—people can learn from their severe depressive episodes, but often at the cost of emotional and spiritual conflagration.

Edward Champion at Reluctant Habits attacks Lehrer’s interpretations of the experiences of Charles Darwin, Kay Redfield Jamison and David Foster Wallace.
Peter Kramer also has little patience for the idea. That’s not surprising since Kramer produced a very convincing study, Against Depression, that attacked a long-standing tendency in our culture to glorify depression.

Prior to Lehrer’s article, Jerry A. Coyne, a Professor in the Department of Ecology and Evolution at the University of Chicago wrote a devastating two-part critique of the Thomson-Andrews paper itself. He’s an expert on evolution and author of the highly praised Why Evolution Is True. He methodically takes apart the speculative reasoning and “paper-thin evidence” supporting the conclusions of Thomson and Andrews about the evolutionary benefits of depression. He looks at the original research papers cited by them and brings out the way in which their interpretations distort the actual findings of the studies.

So what’s going on? Why have there been so many claims about depression as a boon to human life, and why has there been a strong positive response from the public (excluding, of course, the hundreds of thousands of us who’ve lost so many years to the effects of this illness)?

I think part of it has to do with the confusion about what “depression” means. The same word is used to refer both to feelings of sadness or dejection in everyday life and to a set of clinically defined illnesses. Unfortunately, the psychiatric profession, however much it hopes to dispel this confusion with the Diagnostic and Statistical Manual (DSM), only reinforces it.

By setting the bar so low for a diagnosis of a major depressive episode (experiencing five out of nine listed symptoms for at least two weeks), the DSM invites psychiatrists and physicians to prescribe treatment for even isolated occurrences. To add to the prevalence of a depression diagnosis is the startling fact, reported in a recent study, that a quarter of psychiatrists and two-thirds of non-psychiatric physicians do not bother to use the loose DSM criteria when making a diagnosis.

Even when studies or popular books and articles do make the distinction between severe and mild depression, they tend to drop the qualifiers after that caveat, rely on the single word and make much more sweeping claims about depression’s beneficial impacts on life. The influence of drug industry advertising also encourages the idea that people shouldn’t put up with sadness but rather take the latest medication to restore a happy outlook on life. (But that’s a long story for another day.)

Many people do value depression as a factor that gives them a distinctive outlook on life, and they don’t want to sacrifice this dimension of mental experience to a drug-induced “cure.” I have no quarrel with that and respect whatever adaptation to depression people need to make. But individual experience and choices are one thing. Speculative theories about the brighter side of depression from psychiatric researchers are another. They have real-world consequences and need a lot of rigorous testing before put into practice. Unfortunately, that usually happens, if at all, long after the idea has gotten wide publicity and influenced attitudes of public and providers alike.

Reflections in Mind: Sherwin Nuland’s Recovery from Depression

john — Fri, 05 Feb 2010 18:59:25 +0000

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An important part of my recovery has been exploring emotional memory when I respond so deeply to a story or song or even just a moment in a film that somehow reaches right inside. A feeling long held back flows out freely, even though broken away from the memory that stirred it. So I have to stop and ask – what is this, where is it coming from? The emotion is often grief over loss – and there have been plenty of those through decades of depression – but it can also be a happier surge of recognition, powerful reminder of a breakthrough in recovery.

Sherwin Nuland’s 2001 Ted Talk video about his recovery from depression provoked just such a response. It affected me so deeply that I started looking for a written version. I found it in the opening pages of his memoir about his father, Lost in America: A Journey with My Father.

Nuland grew up in the South Bronx in the 1930s and 40s, one of two sons of Russian Jewish immigrant parents. Quite apart from the personal meaning I found in that opening chapter, the memoir is a moving, beautifully written story of life in a close-knit family dominated by an overbearing father – who also played a part in his depression.

Nuland’s recovery story parallels the experience of many who’ve been through this nightmare. He captures so well those powerful moments – the terrible ones that led him into a mental hospital and the thrilling, even funny ones that brought him back. There are several that resonate for me.

In the video, he describes the gradual collapse of his work life. Even while struggling each day to get out of bed and consumed by obsessions, fears and feelings of worthlessness, he tried to keep up the pretense of his surgical practice at a university hospital. But his condition was no secret, and fewer and fewer cases were referred to him. As he said in his talk, “I couldn’t work…I had no more patients,” I felt keenly for him since I had gone through a similar and humiliating decline that I had been helpless to stop.

Even at the worst moments of this years-long catastrophe, he remained determined to will himself out of depression. Despite many failed attempts to pull himself out of the depths, he could always “retain an image of my inner ogre as it looked when I could distance myself from it.” I know that glimmer of survival that persists in spite of endless frustration and defeat – it’s the one reminder that you’re not completely lost.

The voice of the young psychiatrist who attended him during his hospitalization proved to be an enduring source of guidance and strength, especially when he felt some recurrence of depression in later years. This was the doctor who saved him from a lobotomy that would have destroyed him. He alone on the medical staff was convinced Nuland could be brought round with electroconvulsive therapy. And the treatment worked but only at the twentieth session.

The way in which this treatment helped him captured exactly my own sense of the function of any treatment. It brought back enough of his mental and emotional strength and clarity that he could finally push himself to recovery. As he puts it, “the act of will that had seemed impossible now came within reach, and finally in a single surge of determination, I made it happen.”

What he then describes sends a thrill right through me since it captures almost exactly what I experienced. It makes me laugh and cry at the same time to think of it.

One Sunday morning in January 1974, I was standing alone in the little kitchen of the residence unit where I lived with some fifteen other patients, thinking very calmly – analytically, in fact – about the content of the galaxy of pathological ideations. It crossed my mind that it was no longer necessary to give in to them each time one or another would flash into consciousness. Why not figuratively turn away and refuse to succumb? Why not respond to their pernicious urgings with some dismissive formula, like “Ah, fuck it?”

Then and there I resolved to abandon my pathological limitations in a single determined stroke.

When at last it became possible to shrug off the demons that had pursued me for so long, the experience seemed at once simple and triumphant. I shouted out that big No with vast relief in a thrilling, giddy, crying, laughing instant. And it’s the words I used then that I repeat – as Nuland does – like a magic spell when ghosts of depression try to take over again. A monster of such power, suddenly weak and overwhelmed, looks so ludicrous. These days I tip it over with a finger push.

But there is always more to do. Nuland told his story of recovery at the beginning of this memoir in order to introduce the power that his father had over him. During depression, he felt that influence so strongly that his posture stooped to resemble that of the older man in his illness. He was becoming his father, the man who had held him back all his life.

Nuland writes of a haunting memory that symbolizes the relationship. His father had so much trouble walking that he had to lean of his son’s arm to get down a street. The life-long fight to free himself is captured in those moments when Nuland felt the tight grip of his father’s hand pulling him back to match his own halting pace. The force of this pull never left him, even after recovering from his disastrous depression, even long after his father’s death.

I find this story, in both its video and written versions, a recurring source of hope and encouragement for sustaining recovery and starting life over. Is there a story of recovery that you’ve found to be a support and guide?

Trying to Explain Recovery from Depression

john — Fri, 04 Dec 2009 21:48:42 +0000

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A friend recently asked me if I could help him understand the change for the better I’ve experienced in the last couple of years. At the same time, a reader here asked if I could elaborate on what I mean by taking charge or putting myself at the center of my own recovery – an idea I first discussed soon after starting this blog. Both are closely tied together, and I thought I’d summarize a few thoughts I’ve had so far on how to account for what I’ve been through.

As I’ve written earlier, I don’t really know what turned me around. I doubt that the experience can ever be explained in the sense of cause and effect. It’s something that comes from the wholeness of a person, not the cut-away sections that are analyzed in isolation from all the others.

Here are some of the actions I’ve taken in the recent past that have helped get rid of depression – not the more conventional treatments. I’ve taken medication for most of the past 18 years, but it has never had a lasting effect or come close to ending the problem. I’ve also had many types of therapy over several decades. While many of those experiences have been powerful in terms of personal growth, they’ve never changed the overall dominance of depression. The reason for bringing them up in this list is to discuss the mindset that these treatments tend to encourage.

Writing. First, I started writing Storied Mind. I’d written journals off and on for years, and these were full of ideas and descriptions of depression. Mostly they recorded the raw experience and the frustration I felt at not being able to get better for very long. There were also several periods when I was too depressed and mentally blocked to sustain writing. The blog has been quite different because I’ve written more consistently and looked at many more dimensions of the illness than ever before. Writing is the way I discover things, and it also has an important healing effect. This has helped me stay with the revitalizing energy that creative activity brings with it.
Online Community. The people I’ve gotten to know as a result of getting active online are a treasured resource in healing. Reading about the experiences of so many others, exchanging ideas with them, receiving and offering support – all have had an enduring impact. This community has been a source of insight and encouragement throughout the past two years. What I’ve learned has helped change permanently some of my basic attitudes about depression.
Running out of Medical Options. A couple of years ago, I was quite nervous about running out of medical options since none of them worked for very long. At the time, I was putting my hopes on TMS – transcranial magnetic stimulation – and followed its progress in working toward FDA approval. I’d heard a lot of positive reports since I knew someone who had worked on one of the major studies of its effectiveness. However, the evidence submitted to FDA didn’t show much advantage over placebo. Medical treatment seemed less and less likely to offer any hope.
Challenging the Mindset of Treatment. So I stopped waiting for something to cure me and relied more on internal work of my own, bolstered by the help of the online community. I was starting to question the whole concept of the medical model of treatment that focused narrowly on a few key neurobiological processes. The medications based on that model didn’t work in my case. Health providers tended to blame me, in effect, by attaching the label of treatment resistant. That was no help at all.

I realized I had to stop expecting cures within the limitations of that model. Before then, I had understood – based on my experience with cancer – that I had to become an active partner with the medical providers. My energetic determination to get better had made a big difference in the speed of recovery at that time. Now I had to push farther in that direction. Taking charge of my recovery from depression meant changing the basic expectation that someone or something outside myself was going to cure me. That approach didn’t work, so I had to come up with a different strategy – and there was no one to do that but me.
Rethinking Depression. I found inspiration in reading Reynolds Price’s memoir (A Whole New Life) of his experience in stopping the extreme pain of spinal cancer that permanently severed nerve connections to his legs. Nothing helped him until he did hypnosis. That started his ability to rethink the pain so as to end its debilitating effect. One of the interesting things about this was that the pain itself was pure phantom – it came from his legs where he had no nerve sensation at all. That got me thinking that such concepts as pain or depression are powerful mental constructs that respond to sense perceptions and chemical changes in the body. They assume a life of their own and influence the expectations and assumptions we have about their permanence. If Price could disempower “pain” in his experience, could I do the same with “depression?”
New Assumptions. Somehow, I internalized this idea and felt new hope. Combined with the healing effect of writing the blog and all the support I had from the online community, this new idea helped me to change long-held assumptions. I stopped assuming, for example, that depression was a permanent condition that would always reassert itself. I stopped assuming that it was a single overwhelming force and broke it down into the separate symptoms that were more manageable. I challenged more effectively the inner voice that was always telling me I had no hope, had no self-worth, had never done anything right. Most important, I assumed that depression had no more power over me than I gave it – however unconsciously. I didn’t have to be its victim. That was a hard one since it contradicted all my earlier ideas.
All that was exciting and hopeful, but there was still something missing. I’d often had breakthroughs and new awareness of possible recovery in the past, but those never resulted in real change because they never touched my basic beliefs about myself. Those beliefs had been completely negative, and depression had been their perfect mate. The eroding emotional and mental effects of the illness seemed the natural outcome of my lack of self-worth. The belief that I deserved only a life of depression had to change, and somehow it did. That was a great gift, a sudden realization that I was fine, that depression was a nuisance rather than my fate, that I could live a full life again.

All these factors, and others, must have had a cumulative effect in helping me get to that shift in belief. I can list, narrate and speculate about all this, but that’s about as close as I can get to explaining the outcome. Of course, changing for the better is a process, not a one-time achievement, and it takes a lot of attention and quick response each day to make sure I’m staying on the right track.

I’ll keep on writing about it and always seek insight from the online community. So I hope you’ll share some of your experience in making progress, however halting or incomplete it may seem. Every step counts, even the backward ones.