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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.
Thanks, John…much appreciated! And I am glad that the grief-depression distinction makes sense in terms of your own experience.–Best, Ron Pies MD
Hi, All–I have been following the comments with great interest and appreciation. One issue that is hotly debated among my colleagues is the critical distinction between ordinary (uncomplicated) “grief”, and true, major depression. If you want to see how this debate is unfolding, you can find posts by Dr. Allen Frances, and by Dr. Sidney Zisook and me.
The bottom line: ordinary grief may well be adaptive and often productive; major depression, not so much! The link follows. –Best regards, Ron Pies MD
http://www.psychiatrictimes.com/blog/couchincrisis/content/article/10168/1538825#add-comment
Hi, Dr. Pies –
Thanks for that link. The Frances article and yours seem to me to be models of effective, respectful argument on both sides of the grief/depression issue. Hopefully, there will be a way to make the distinction in DSM5 in a much more helpful way than the present draft proposal does.
Being able to distinguish an experience of grief from the droning misery of depression actually marked an early step in my own recovery. That deep grieving emotion came in response to a specific event – I let myself feel and express it fully – and then it was over. That really helped me start separating out the recovering part of my life from the part still stuck in depression. So I’m especially interested in how that question is handled.
Thanks for coming by.
John
First, evolutionary psychology is highly speculative and bankrupt of data. The fact is that whatever combinations of genes have not been purged from the gene pool by our lack of “fitness” in the Darwinian sense. All that needs to happen is for the DNA with depression in it has to be passed on to the next generation, and many people with depression and related traits manage to procreate.
My own speculation is related more to the pessimism (possibly of depression) and optimism spectrum. Someone in the tribe had to think “what could go wrong” when the enthusiastic member of the tribe wanted to do something without regard to tigers or neighboring tribes who just don’t like ours. Maybe the optimists would have been the ones to die out without the pessimists to hold them back some of the time.
To creativity, my depression expresses itself in such lack of energy that I can’t bring myself to make the effort to design anything or even make my house look nicer. Then I feel more guilty for not being productive. Hard to see how it enhanced creativity. I do get caught up in hypomanic episodes from time to time that seem creative, but fall short when I run out of gas.
While we have lots of examples of creative individuals with depressive disorders, we’re not looking at data. There are a lot of us who are depressed and just trying to get by, and wouldn’t be called “creative” anyway.
Lately I’ve been wishing that I could find meaning in this “gift” I must live with. If it’s there, I can’t feel it.
Hi, Karen –
Right on! and well put. I like a spectrum model as well, but the pessimism-optimism dimension doesn’t capture the whole thing, at least in my experience. Martin Seligman elaborates on that in Learned Optimism, but he stretches the idea – which seems based on very limited data – to cover too much. His work would be more convincing if tied in to a broader sense of personality – like the dimensions Jung used to get at psychological types – perhaps optimism-pessimism should be added to that (introversion-extroversion/ intuition-sensation/ thinking-feeling – Meyers-Briggs added perception-judgment). It would be great if someone could bring together the personality ideas and the neuroscience findings – genetics and all the rest to give a complete explanation. Whoever might come up with that, it’s not going to be an evolutionary psychologist.
John
As a child I twice won local community art contests. I continued to excel in art in school. It was second nature, a pastime to draw, create, decorate and I went on to experience nearly every artistic medium through the years. There was always the quest for beauty. The creativity was in place for me long before I was diagnosed or experienced depression. Now, after so many years, I’ve no creative desire left, although it is an innate aspect of who I am, depression has taken away the energy needed to create, I’ve long since thrown out my art supplies. It is as though the depression just suffocated the desire out of me. Yet, it is very possible it is the very vehicle I need to escape but I want no demands on me whatsoever and artistic pursuits can be very demanding. I now am at my best when I’m by the seashore, in nature as an observer, just being, not doing.
Hi, Louise –
I’ve shared a lot of what you describe so well – for me it’s been writing rather than visual art but the same need to express something. Any form of art is terribly demanding. For me much of what made it hard was a terror of facing my own deepest emotions and letting them find this outlet in creative work – but even more in day to day living. I did have to get back to myself and the acceptance of simply being who I was. But then the ability and need to write returned – after so many years of assuming it was simply gone.
So who knows what you might do in the future. I’m glad to hear you’ve found that pace in just being.
Thank you for commenting.
John
Enternal Love
Grab hold of the utmost love,
gaze upos its eternaty.
Passionate images enclose you in a dream.
Chosing illusion over reality.
Dreams over life.
Pleasure over freedom.
Your desires take hold where you’re sheltered.
Only to get a glimps of a healing wish.
Leaving unheard echoes behind.
Waiting for the miracle that will embrace your soul.
You’re touched by the unblemished angel.
Your ambitious heart is betrayed, lost and wretched.
Invisible to the eye,
controling over your mind,
Precious memories will stay at ease.
Intertwined into a collapsed promise.
Only to remember your unconditional detemination.
So the fragile body has warmth.
Thanks, Tanisha –
Those are powerful thoughts – choosing illusion over reality, dreams over life. The captures it so well.
John
I have just come through one of those periods, following a missed promotion at work, where I was completely depressed. Reading this helps me understand that, in part, it was a natural response to be depressed.
Hi, David –
I’m glad you found this useful. A disappointment at work is so hard to take – of course, it’s natural to feel depressed about that. Great to hear that it’s over now.
Thanks for your comment.
John
I’ve been fighting the last few weeks to find reasons to keep breathing and get out of bed, my depression has been so severe. I will gladly give my depression to anyone who wants to improve his or her life with it. It hasn’t done squat helpful for mine.
Hi, Immi –
I’m sorry to hear that things have been so bad. Ideas like this evolutionary psychology notion are so offensive – and laughable, if you’re not down.
Here’s hoping you feel better soon –
John
John,
Anyone who has suffered with even just 1 episode of MDD, or those of us with a lifetime of dysthymia + depressive relapses, know that there are few benefits to our experiences. It has made me a more compassionate person, especially with depressed people/patients (I am a MD.) It has made me appreciate the beauties + joys of life to a greater extent. But, MDD has made me less productive + “successful” personally, socially + professionally. Moreover, MDD has many negative health effects and can be fatal (suicide).
It is also true that the umbrella of “depression” is getting wider, as is the umbrella of “bipolar disorder” and “ADHD”. I believe that Big Pharma has played a large role in these larger umbrellas. The other factor is the desire that people have to take a pill and feel better. A “normal” life has episodes of sorrow, sadness, anger, frustration, as well as happiness, joy and elation. The biggest reason that antidepressants work no better than placebo for so many people diagnosed with “depression” is that the diagnosis was wrong to start with.
Sorry, I am rambling.
As always, I enjoy reading your essays, John!
Hi, Margaret –
Exactly my experience on all counts. Lots of loss over decades because of depression – I’m not sure if the antidepressants haven’t worked for me because of the diagnosis or because they just don’t work. I’ve read a bit about the limitations of the amine theory of depression and especially about the narrow focus on particular neurotransmitters as the cause of depression. Of course, it’s hard to find a cause that applies across a spectrum of mood problems covered by one word.
Thank you for stopping by to comment.
John
Hi John,
Just to say that I read this post with what I can only describe as a sense of relief… Thank God that there are people who challenge this absurd notion that depression is somehow a god thing.
As someone who has suffered from this for long periods of time, I have to say that I have felt utterly frustrated and perplexed by books which claim that depression has an ‘upside’, that it can be used as a force for creativity, and even the notion that (and this one makes me want to howl) depression could be viewed as a ‘gift’.
You may well be right to point to the chasm which lies between mild and severe depression.
It certainly strikes me that the term ‘depression’ is used far too sweepingly…
I have had often pondered the suggestion that depression has a “creative edge” (whilst simultaneously grieving for my own creativity / passion for playing/singing, which completely dried up with the onset of my own illness about ten years ago).
That there is a link between the depression and creativity,seems undeniable.
It is true that many of the greatest artists, poets, designers, musicians, comedians, thinkers suffered depression… (wasn’t it Socrates who pointed out the similarity between genius and madness?)
Depression seems to be the blight of the creative mind / soul… and to my mind, it is here that the misconception about the issue of depression’s upside lies.
It is not that depression leads to genius; to incredible discoveries; to profound works of beauty and art.
It is more that the people who suffer from this hell tend to be those who are, by their nature, more creative. Creativity, the craving to create, to express, to pour into something, can be like torture… Existential torture.
Depression often seems to hit those who are capable of feeling such depths of torture.
I know I have rambled and probably made very little sense… I haven’t sat down and ordered my thoughts… I should really.. I have a few…
Thanks, as always, for making me think.
You write withsuch eloquence about something so, so difficult.
WS
Hi, Wondering Soul –
I agree – if there’s a connection between creativity and depression at all, it’s simply that depressed people are often the type who turn to creative outlets. Peter Kramer’s Against Depression has a very good survey of the romantic view of the creativity-depression tradition. The need, as you say the craving to create has brought torture to me, especially when I was terribly blocked about expressing deep feeling. For years I couldn’t do that and produced a lot of flat writing as a result. That block only went away a couple of years ago, so less torture.
Thanks for commenting – I hope you’re OK.
John
Hi John, I have really gifted friends who have battled serious depression. In all cases has been awful for them and very painful and never at any stage helped them with their gifts or insights in any way at all. (You can tell I have strong feelings about this I guess.)
My negative opinions about ‘evolutionary psychology’ are confirmed once again.
Hi, Evan –
These ideas are so silly I couldn’t even get angry about them – this time. There are a great many writers of scientific papers who need to be reminded on the difference between reasoning and wishful thinking, logic and guesswork, evidence and self-deception, etc.
Thanks for dropping by.
John
As the author of the “myth of depression’s upside” piece, I want to commend John for one of the best essays I have ever read on the mythology of depression’s supposed “adaptive advantages”. In fact, I’m a little chagrined to say that it shows a better understanding of severe depression (and the nuances of the term “depression”) than some of my colleagues have demonstrated! Perhaps, then–somewhat paradoxically–the insight that comes from suffering with depression is that no great insights issue forth while suffering with depression!
I also agree, John, that the current DSM criteria for Major Depressive Disorder are too broad and set the bar too low, as you say. My colleague, Sid Zisook, and I have argued that the “two week” minimum duration is too brief–that it ought to be extended to at least three weeks if not longer. And, you are right to note that many clinicians ignore the criteria entirely–which is one reason (though far from the only one–there are those Big Pharma ads!) that increased rates of diagnosing “depression” have been reported among primary care practitioners in recent years (see Pirraglia et al, Prim Care Companion J Clin Psychiatry 2003;153-57).
I have posted another blog on the Psychiatric Times website, FYI:
http://www.psychiatrictimes.com/blog/couchincrisis/content/article/10168/1533463
Also, please see the excellent dismantling of the “analytic rumination” hypothesis at:
http://news.psydir.com/Psychology-Articles/depression039s-cognitive-downside/
Best regards, Ron Pies MD
Thank you, Dr. Pies –
I’m honored to hear that you find this post helpful. Thank you also for these references; I’ll look into them right away.
I thought your post captured so well the attitude of someone who’s come through a period of severe depression and provided an excellent corrective to the Lehrer piece. Unfortunately, the New York Times is such a grand platform that his article has had enormous influence.
Your efforts regarding the DSM revision are right on target, and I only hope your view will be reflected in the final DSM-5.
Thanks so much for commenting.
John