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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.

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Lately, I’ve come across a number of questions online by plainly anguished people, asking: Why do I have no friends, no life? The first time I saw one this blunt, I reacted almost defensively, laughing as I recalled an old film in which a man hires a private detective to find out why he has no friends. Isn’t it obvious? But I knew so well how much the question implied. Lonely and depressed, I had often asked that same question, or at least felt the need to ask it.

I wrote an earlier post about the difference  I experience between loneliness and depression. Loneliness is a sadness at the loss of close relationships. It drives me to reach out to people. Depression pushes me away from them. When I feel these two at the same time – as I can if the depression is not too severe – the tension of these opposing forces makes it all the harder to find the help I need.

Thinking back over many years of living with depression, I can quickly find many reasons why I had such trouble finding a friend to talk to when I most needed one. (I’ll set aside the much worse problem of not talking to my wife. I’ve said a lot about the reasons behind that, especially in this post.) Here are some of the problems from my experience. I can’t say how true they might be for others.

1. Sometimes it wasn’t I who had an issue with reaching out but friends who had trouble opening themselves to listen. Many people refuse to talk about depression or other serious illnesses. I first found that out when I had cancer. It was stunning to me that a few people I had known quite well simply disappeared from my life. Though I never heard any explanation from them, my wife and I believed they couldn’t face the risk of emotional involvement and possible loss.

   Depression adds another dimension. Many may feel helpless in the face of a friend’s pain and despairing mood. When I reached out for support, some friends were sympathetic but at a loss as to what they could do to help. And, of course, some friends are not in the habit of probing their own emotional lives and run from the idea of listening to someone else trying to go deeply into feelings. That’s a language they haven’t learned and never want to know.

2. One habit of my own depressed thinking was to assume that everyone I met had the same negative and contemptuous view of me that I did of myself. I projected my own shame into their minds and then retreated before the dislike I was sure they felt. It’s so strange to imagine that this could have been such a common occurrence, but it was. I stopped myself from reaching out because I “knew” these friends wanted to have nothing to do with me.

3. Then there was the isolating drive of depression, the belief that I was in too much pain to face anyone – too lost in despair to move. I believed I could survive only by cutting myself off from everyone, yet that only intensified the feeling of having nowhere to turn. I ruled out the possibility that anyone could break through the wall I’d put up around me. The result was that I went more deeply into despair. Eventually, the crisis passed, but it wasn’t the isolation that had helped me survive. That only increased the likelihood that I might push myself over the edge.

4. When feeling more numb than despairing, I could often get out and talk to people, even at social gatherings. But I became very nervous at what I might say. It wasn’t uncommon for me to make an attempt at getting to know someone or to get into a personal issue with a friend. But the words I found myself speaking were not at all what I intended. They had an edge to them, putting a jab into each pleasantry, souring a compliment with a sarcastic tone, or pouring out so much so fast that I sounded impossibly egocentric and uninterested in anyone but myself. I acted like someone I would never want to know. Of course, people could tell at once that I had “issues” and walked the other way.

5. So often, I had to mix with people when I wanted only to hide. I made it hard for anyone to find me, no matter how many people might be in the room or how prominent my role was supposed to be. Emotionally, I lost connection with what was happening and just watched it go by. I felt so small and tried to be invisible. If anyone asked me a question, I’d become tongue-tied, or, if I tried to say much, the words and thoughts came with painful slowness. It was impossible for anyone to talk to me.

6. At other times, anxiety and fear could hold me back from talking freely. Taking part in conversation was hard because I had to double-think everything I wanted to say. There was a danger in the simple spontaneity of conversation among friends – a danger for me of any uncontrolled talking. I had to reflect to get the words just so, and then would miss the right moment as talk flowed on to something different. It’s hard to imagine now, but talking freely felt risky, as if an inner violence might escape my control.

7. Apart from all this, there was the natural reaction anyone might have at suddenly hearing from me when I was in need of someone to talk to. Wrapped up in myself and in depression, as I was, my reaching out was an attempt to meet my own need in a one-sided way. Not only that, but my friends would not find me at all even if they wanted to listen and offer support. I wasn’t the same person because I was driven by the strange, isolating rules of depression. Even if I didn’t want to be hidden, I was nowhere to be found.

All this added up to a comprehensive strategy for remaining friendless. And that’s what it was – a series of my own actions to keep me isolated from the help that friends might offer and pull me out of the life I’d had with them. This hit me one day when I was the one who was asked to listen to a friend in the midst of a terrible depression.

I met him at a restaurant for lunch one day, and I could tell at once that he had changed in a way that made him hard to recognize. Of course, he looked and sounded the same, but there was nothing in his words or reactions that was like my friend. He was lost, partly in rage, partly in despair.

When I tried to tell him the deep sympathy I felt for what he was going through, that only made him angry. More than that, I felt a deep rage boiling inside him as his eyes stared through me with steel intensity.

It was especially hard to see him this way since I knew I was looking at myself.

What has your experience been in trying to reach out to friends when deeply troubled?

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It may seem strange to pose this question: is it loneliness or is it depression? After all, many people feel loneliness at the loss or weakening of close relationships because of depression, and most of us who’ve lived with the condition over a lifetime experience those broken connections as some of its worst effects.

On the other hand, lots of lonely people are not depressed – sad, most likely, but not necessarily experiencing the classic symptoms. The two are different but often occur together. Getting straight about the difference isn’t a matter of hair-splitting for me. It’s been an important part of learning how to take my life back from depression.

The recent book, Loneliness: Human Nature and the Need for Social Connection reminds me of the way I got started in recovery and also offers new and helpful insights about the differences between loneliness and depression.

The authors explore why social connection is an essential part of human nature and what the effects of loneliness are, including long-term physical deterioration. They cite many cultures in which the worst punishment is not death but banishment, because it cuts a person off from every connection that gives them a meaningful place in the world. Deprived of that, they begin a collapse on many levels – from neurological to spiritual.

But this study also describes the importance of the pain of loneliness in the broad trend of human evolution as a possible warning sign. It can help sustain the bonds that hold a community together by reminding an individual of the central importance of human connection to survival. That impels a lonely person to restore the lost relationships. There is a pull to return.

We have all known the long loneliness and we have learned that the only solution is love and that love comes with community. – Dorothy Day

Depression, on the other hand, serves as a different kind of warning. Stress and other causes have created such harm that an individual can no longer be a helpful part of the community and must retreat from contact in order to heal. Depression impels a person away from social bonds, at least for a time.

The concept of this contrasting pull-push is a good description of what I’ve gone through.

Isolation and Loneliness

When I’m in the depths of depression I’m completely isolated from people. I can hardly focus on what they might be telling me or bear to make a gesture in their direction. My feelings aren’t there – I can’t respond. People sense I’m not really in their presence at all. Trying to be with others is painful, and I need to retreat to deal with my own sense of despair, worthlessness and the rest of the charming attributes of depression. I need to start healing and to do that I have to be alone and get into whatever treatment might help.

It isn’t until I’m coming out of depression and can see the damage I’ve done to my relationships – even if unintentionally – that I can begin to feel that loss. Then I’m deeply lonely and hope I can rebuild and restore the closeness and trust I’ve undermined. In our culture, though, that’s hard. There are no ceremonies to celebrate a return. I may more likely be greeted with mistrust, anger and distance.

No soul is desolate as long as there is a human being for whom it can feel trust and reverence. What loneliness is more lonely than distrust? – George Eliot

Connection

When I was putting this blog together, the first topic that came to mind as essential to recovery was connecting. It was a main theme that ran through the journals that were my first source for these posts. Connecting meant that, first, I had to reconnect with my own feelings, always so remote and unreachable during the worst periods of depression. I had to be able to feel again, and to do that I had to open doors shut firmly against even sense impressions of the world around me. Most fundamentally I had to accept myself again as a whole person.

I had to feel the strength come back to my own body, see the colors in things, hear the words people spoke, and laugh, grieve, feel lonely, want to be part of my family again, want to go to work. Reconnecting with my own feelings, responding to daily life, I could begin to restore deeper connections with my wife and children. I often went through all this quite quickly, sometimes waking up one morning and feeling human again. At other times, I had to use all the tricks I’d learned just to get started.

Hard as most of those periods of recovery were, they were lost in depression before long, and the whole process had to start over again. What has encouraged me more recently is that the pull from loneliness back into connection has been so much fuller and more complete than ever before.

This push-pull idea is a useful reframing of experience, partly because it suggests that there are forces moving in depression and loneliness that go far beyond my own boundaries. That is another reminder that I’m not so alone as I imagine when isolation seems most complete.

………..

I know the experience of loneliness in relation to depression can differ widely in meaning for each person. What is it like for you?

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What do I really deserve from life? That’s a question that comes up online a lot, even if it’s only implied. And the dismaying but common answer is often: not much. It always saddens me to read that, but it’s never surprising. Those of us who’ve lived with depression for a while know that the first thing to go is self-esteem. I lost it early on and formed the habit of tearing myself down, focusing only on what I’d done wrong.

For me, it was a short step from losing self-respect to believing that I didn’t deserve success or happiness and that I would turn every good experience into something bad. In the midst of depression, behaving in self-defeating ways wasn’t so hard to do.

That was partly because I could never pass the inner rating system I used – the one that began with the question: What do I deserve?

Even thinking, “I don’t deserve…” (fill in the blank) … turns the experience of life on its head.

• A depressive friend told me some time ago in the midst of a market boom that she’d sold her stocks because she had made far too much money. She felt shame and said, only half jokingly: “God doesn’t want me to get any more money.”
• Driving one day with another friend, a man of considerable accomplishments, I asked him if shame and depression had been problems for him as they had been for me. (I only asked because I believed they were.) He laughingly dismissed the idea of depression, but shame about who he was? That was different. “Of course – what else? If I don’t amount to much, shame is right. What could I possibly deserve?”
• In my own case, I’ve had shame attacks in response to praise. I’ve also felt  scorn for an honor that I knew damn well should not have been given me. I’d be thinking: Those people can’t see the real me or they would know that I don’t deserve this.
• One woman I knew years ago had an off-again on-again affair with a married man who came and went as he pleased. That was her main relationship. She assumed that was the best she deserved.
• I’ve read many comments in forums that tell of confusion about what to do when faced with a partner who turns abusive. They ask the question of strangers – What should I do? There is doubt about who is causing the problem: Maybe I’m wrong, maybe it’s my fault, maybe I deserve this.

To deserve: to be worthy of, qualified for, or have a claim to reward, punishment, recompense, etc. …

Why do we even use words like deserve and worthy in talking or thinking about our deepest nature? Those words carry an assumption from the outset that we’re being evaluated for what we have done or for the talents we have demonstrated. In my case, there was always a mysterious standard I couldn’t meet and a  judge who determined how far I fell short. He always handed down the same verdict no matter what the evidence – undeserving.

The idea that I wasn’t worthy or deserving of love was the worst of all, but at times I believed it. Like so many, I often blocked out chances of intimacy through actions that repeated harmful patterns from the past – but to me they seemed only to confirm the belief that happiness in love was something I would never reach. I could yearn for intimacy, a trusting embrace, a deep bond of love, but I usually tensed up at opening fully to another. I was too afraid of what I was to do that, too convinced that the real me wasn’t fit to be that close to anyone.

It was a sure sign of recovery when I could finally stop listening to everything the inner voice was telling me about what I deserved. When that happened it was like seeing the emperor’s clothes for what they were – nothing at all. And into that nothingness also went the empty certainties of a rating system that was stacked against me from the start.

But for so long until then I listened to the voice, sometimes whispered, sometimes shouted from within, that I didn’t deserve whatever good might come my way. On the other hand, I took the bad, the disappointing as revealing the true me. Even if good things happened – and many did – I would likely feel undeserving and convince myself it was either a mistake or a strange bit of luck that couldn’t last long.

What occurs to me now is how the familiar, almost comfortable, the bad news felt. That was my element. My own success seemed intolerable, and I instinctively set about undoing it.

How do you feel when good things happen? Do you celebrate what’s happened, feel pride in what you’ve accomplished? Or does it feel undeserved, as if it resulted from a bureaucratic mistake, like a payment in the wrong amount that you’ll have to return?