Jonah Lehrer’s essay “Depression’s Upside” in the Feb. 28, 2010 New York Times Magazine raises many important questions about depression, and what, if anything, we can “learn” from suffering a bout of serious depression. Alas, the article obscures almost as much as it illuminates, and I fear that its net effect may be to perpetuate what I call “The Myth of Depression’s Upside.”
But first, let’s be clear: a “myth” is not the same thing as a lie. A myth is a transgenerational story we tell ourselves, which often has a grain of truth to it, and which usually serves some unifying function in our culture. It is a myth that George Washington threw a silver dollar across the Potomac River — there were no silver dollars at the time — but the story usefully reminds us, across many generations, that our first President was a powerful man capable of great accomplishments. No lie in that!
So, too, we have the myth of depression as a “clarifying force,” or as an “adaptive response to affliction” — notions being advanced by a number of psychologists, psychiatrists, and sociologists. Thus, Lehrer quotes psychiatrist Andy Thomson as saying, “…even if you are depressed for a few months, the depression might be worth it if it helps you better understand social relationships… Maybe you realize you need to be less rigid or more loving. Those are insights that can come out of depression, and they can be very valuable.”
Before posting, please read our blog moderation guidelines. The comments below begin with the oldest comments first. Click on the last comments page to jump to the most recent comments.
Before posting, please read our blog moderation guidelines.
Post a Comment:
Copyright © 1995-2013 Psych Central. All rights reserved.
Site last updated: 21 May 2013
|
I agree completely with this. Added to that, how about the people who say bipolar disorder is a ‘gift’?
Dude chill.
Clinical Depression is pathological, awful, destructive and without recompense. The discussion at hand, however, is not “Clinical Depression’s Upside,” or “Pathological Depression’s Upside.” Because the word “Depression” is used, everyone responds with made-up minds and a sense of moral outrage.
Clinical Depression is a subset of people who experience depression, which in turn is a subset of people who experience persistent sadness. “Depression” the word is used to describe all three groups. You narrow the scope of your reading to “depression = clinical depression” and get morally outraged.
Also, you cannot lambast Lehrer for poor use of literature and citation and the declare “depression = spandrel” without citation. The behavior of depression is pervasive throughout the animal kingdom. The extended memory of the feeling of depression is unique to humans. You again conflate.
Why is persistent sadness biologically fit? This important question provides valuable direction in the study of our complex human nature. Jonah Lehrer’s article was thoughtful, your tone was, well, different..
To readers of this blog, I am appending a note that I posted on Jonah Lehrer’s own blog site,
http://scienceblogs.com/cortex/2010/03/critiques.php
With respect to the term “depression”, it is certainly true that the term is used in all sorts of ways, to cover a wide range of mood states. However, I think there is little question that Mr. Lehrer was using the term in the same context as that of the original article by Dr. Andrews and Dr. Thomson; i.e., as a clinical disorder. They state that,
“Depression is an affective state characterized by sad mood, anhedonia (the inability to derive pleasure from activities such as eating or sex), and changes in psychomotor, sleeping, and eating patterns (American Psychiatric Association [APA],
2000)….The predominant medical view is that depression is a mental disorder (APA, 2000). The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the primary reference manual for diagnosing mental disorders in the United States…”
Their original paper may be downloaded by going to Dr. Andrews’ website,
http://sites.google.com/site/paulwandrewsphd/home/andrews_pr_2009-1
Finally, I advanced the idea of depression as a “spandrel” not as a “declaration” of settled science, but merely as one possible alternative mechanism by which depression might be conserved in the human genome. As I indicate below, I am not the first to suggest this.
Sincerely,
Ronald Pies MD
Pies note to Lehrer blog:
Readers of this blog may be interested in my rejoinder to Mr. Lehrer’s NY Times piece, at:
http://psychcentral.com/blog/archives/2010/03/01/the-myth-of-depressions-upside/
Although I am very critical of Mr. Lehrer’s essay, I want to make it clear that I bear him no animus, and that I consider him a thoughtful, intelligent, and creative writer.
Had I been a senior editor at the NY Times Magazine, I would have said to Mr. Lehrer, “Why don’t you talk to two or three directors of mood disorder clinics, to get their take, and do a more thorough review of that prefrontal cortex literature. Oh, and–why not talk to a couple of people who have actually been through a severe depressive bout, or read some accounts by them in the published literature?”
As a writer and blogger myself, I am sympathetic to the limitations of time and space that constrain what any writer can do. My critique is thus more in sorrow than in anger, and I hope Mr. Lehrer will take it in that spirit.
Having tried to help seriously depressed individuals for nearly 30 years–and seen the destruction major depression can wreak on both patients and families–I confess to a certain irritation and dismay when I read about half-baked theories claiming that major depression is “adaptive”. The 15% mortality rate in this condition (based on naturalistic studies), mainly due to suicide, speaks volumes about how “adaptive” depression is.
Finally, in my own essay, I offer a tentative hypothesis regarding depression as a “spandrel”–i.e., as a non-adaptive trait that is a kind of genetic “hitch-hiker”, on the backs of more adaptive traits. I want to acknowledge, as I just discovered today, that my colleague, Dr. Peter Kramer, also suggested this possibility in his excellent book, “Against Depression”. Further discussion of this issue can also be found on the website of Prof. Jerry Coyne PhD [http://whyevolutionistrue.wordpress.com/2009/08/30/is-depression-an-evolutionary-adaptation-part-2/]
Sincerely,
Ronald Pies MD
Tufts USM and
Upstate Medical University
Hey Cole,
I think Dr. Pies actually has some good points. In order to make sense of depression, we need to be more precise in our usage of terms. Words such as depression, dysthymia, sorrow, grief, melancholy, sadness, or low mood all have distinct meanings.
I think there is often a huge disconnect between philosophers of mind/consciousness (Jonah Lehrer) and people who work those who suffer from very real psychological pain (Dr. Ronald Pies) – these discussions are important and necessary.
We need to find some common ground if we are to move our understandings of human beings forward in any useful sense.
“There is no credible, controlled evidence that antidepressants “interfere” with the development of problem-solving skills”
That is because you’re not looking for it and don’t believe antidepressants have negative side effects. When someone complains that the ADs are causing adehonia and cognitive impairment, issues that interfere with problem solving skills, it is usually blamed on the person’s illness. Hey, you can’t believe those mental patients, right?
AA
Once again you have proven how shorted sighted your really are John. You seem to me as a person trying to defend his livelihood. As we all know depressed patients make up the lion’s share of people in treatment. If the word were to get out that you can actually gain some benefit from depression it would destroy so much.
But…there is some positives to be gained from depression and it is true that Aerosmith and Metallica sucked after they cleaned up and got happy.
The thing about depression and being an artist is that it allows you to create such powerful works because of the power of the emotions that can come from deep depression. So in essence it doesn’t improve creativity but rather gives perspective that allows creativity to come forward.
I was told 15 years ago that I would not be able to function as an adult unless I was on antidepressants and I am so glad that I ignored that advice. Even though my social/psycho disorders have severely affected my life they have also given me a perspective that could not have been achieved any other way.
I WOULD NOT TRADE MY DEPRESSION BOUTS FOR ANYTHING IN THE WORLD THEY ARE PART OF WHO I AM!
I do however enjoy the manic bouts even more but that is for another discussion.
Kenneth – I did not write this entry; it might be beneficial to check who you’re replying to before addressing your comments to a specific person. Admittedly, if I had written about this topic, my points would have been eerily similar to Dr. Pies’ points.
Can some people “benefit” from depression (and other disorders, like bipolar disorder)? Absolutely. But do we know who these people are ahead of time? No, we have no way of telling.
And since most people don’t have any measurable “benefits” from depression, I think it’s a bit dishonest to suggest we should treat everyone as though they could.
I think it’s a logical fallacy to suggest that every symptom of a disorder or disease — no matter how common — has a “purpose.” Do these same theories explain all the other symptoms of depression? No, of course not. They explain one or two of them, and the others? Well, let someone else explain them.
Ronald and William,
WH:
I think you write a great summary for perhaps the most salient point – people suffer tremendously from the mood state of depression. I answer a suicide hotline, and know the agony of this condition. We all agree that the need to help others with their suffering is imperative.
Because Depression is such a significant challenge for some many, it will be a topic of study for the psychopharmacologists, psychiatrists, neuroscientists, psychologist, evolutionary biologists, economists, sociologists, anthropologists, philosophers etc. Every major field of the study focused our complex human will study this topic, using their lingo, jargon, POV etc. Too often these fields use a common word such as “depression” and mean different things.
When a person schooled in one field of study response with a sharp dismissal of a point raised in another, we devolve into moral food-fights where everyone is trying to justify their own conceptualizations of the issues. The issue of suffering gets lost.
Back to the discussion. First, the degree to which we treat depression is a moral choice. Who cares if depression is evolutionarily fit? We treat anyway. The morality of depression is independent of the science of depression. And should science develop alternative courses of treatment which provide better outcomes, then we change treatment regimes.
Second, and this point is another one I think gets lost, depression is an affective state with represents a collection of behaviors (which I have started to call “persistent sadness”). The consequence of the affective state can be tremendously severe even if the underlying behavior is adaptive. With clinical depression and MDD, we encounter a mood condition which is pathological, and aversive from any perspective. Yet this outcome is a small cohort of the people who engage the behavior of persistent sadness. So there is the question, which slice of the pie are we looking at.
Third, my personal belief is that there is trauma (not the clinical PTSD Trauma necessarily) which underlies many episodes of persistent sadness. Conventional wisdoms is that these two conditions are more exclusionary than co-morbid, but there is usually a trauma wound when there his helplessness and helplessness unlies depression. The behavior ‘persistent sadness’ is in response to what?
Ronald, and Jonah in is reply similarly, make the point that the discussion was regarding MDD. Most conditions have both costs and benefits. Why only focus on the costs of MDD? Even if we recognize potential benefits, such knowledge does not change the moral choice to treat aggressively. A small caveat: when treatments have side effect, we look for treatment options with fewer side effects. What if learn that MDD does provide some benefits, but the current treatment options limit this outcome? Then I believe it is good practice to search for better means of treatment. We can only adapt changes to treatment if they are more morally-satisifying than the current practice. At the end, it’s all about the suffering.
John,
I apologize for my mistake, I should have visually verified the author.
So instead of accepting that their could be benefit for some if they are capable of understanding it, you would rather sound the alarms as if some great injustice has been done.
Anybody that believes that one philosophy or treatment will work for everyone is clearly delusional and if I somehow implied that I had a universal solution then I apologize again.
Also, just like every plant and animal regardless of its danger to us has a place so do these symptoms. Do they sometimes mutate out of control? Yes depending on a variety of factors including environment and genetics. Social evolution is very real and just as sickness and disease shape physical evolution so do these mental “diseases” shape social evolution. How many people have read a poem or heard a song or witness some other form of art and was forever changed? This change sets off a whole string of changes in that persons life that ripple exponentially forever affecting everyone in society whether for good or bad.
The first step is to remove the stigma that we are somehow “broken” and need to fixed or surpressed through drugs.
Went to the U of Winnipeg, and then worked as an IT Consultant before event in my life took me to a state of depression, where I no longer wish to live.
I am sitting on an old mattress on the floor, with metal spring protruding but I have gotten use to the pain of sleeping with metal pressing on into my body.
Sometime I go without food for a few days. How I can do this? Because I have adapted to my state, not sure, I have always be determined. I was not the sharpest knife in the drawer but very determined. My childhood was horrible as I see it.
Money is for rent and internet, food I eat very little.
Use to go from one temporary job to another hoping to find my way out one day, I cannot do this anymore.
With no friends, no family or a career I once loved, running is keeping me alive for now, run five day a week about 50miles on average.
Speaking for myself, I agree with this blog, you cannot make broad conclusion that depression is a “teaching moment”. All experience good or bad, give us an opportunity to learn.
When we are learning, who is looking after us? How are we paying out bills? When would we get out of this hell? What saving for retirement.
I could go into detail but will not, because I cannot distill all I want to say in such a few paragraph. I am 50 now and I cannot start my life over.
As someone who has suffered from depression of some kind since age three, I can say without doubt that depression has its notable upsides. While some may argue with me, I believe that depression is the cause of my compassionate, loving nature. Do I, however, think that depression is an overall good thing? Absolutely not.
“Wait!” many of you will scream, “you just said it benefited you!” True, I did say that. It is important to point out then, that any illness or affliction can bring about some positives. In fact, it happens all the time. Cancer patients better appreciate life, those with severe infections learn to clean care for their wounds more thoroughly and so forth. We don’t promote those conditions as good things, nor do we insult the medical treatment for them.
Which is a whole other point being argued here. Just to make things clear, I do recognize that there are many people who react badly to antidepressants. They feel sick, tired and some even feel dulled. It defiantly happens. That doesn’t, however, mean you should discredit them. I know for me, I was skeptical about medication. I didn’t think they would work and feared the worst side effects. Do you want to know what happened, though? I got better – a lot better. Of course, therapy is just as important as the pill I take every morning; however, without the medication I would be too disabled to go through therapy.
Dr. Pies,
You are very wrong about this and your wrongness hurts many, many people, including all of your patients.
Depression has tremendous survival value for human beings. If it didn’t it would have been wiped out long ago by natural selection.
Depression is a protective move by the bodymind to avoid the damage from extended periods of extreme stress. It is also a very valuable wake-up call that the sufferer better stop doing what s/he is doing, stop focusing on the outside world and go inside to take care of the life issues that s/he is facing. It is also a wonderful message telling us that what we have lost is precious and that we need to be careful to nurture and protect it in our lives. Like insulin, fever and water, for that matter, it is helpful in the right amounts and at the right times and can be very harmful in the wrong amounts and at the wrong times.
To dismiss it as you do as something alien and sick, something that should be gotten rid of as soon as possible without paying attention to it and learning from it is a terrible mistake, one that our culture is suffering from.
Dr Pies et al,
The idea of a single upside is hugely mythical. It is the magic pill myth regenerated– that one single drug will cure depression or any other mental disorder. I have bipolar II disorder and I have recently done some work on what possible benefits could accrue from it–but still I would not wish this disorder on anyone. I believe that any benefits of depression are those people make, just as anyone who suffers a tragedy of any kind constructs meaning from it, and in so doing, eventually heals. So to claim specific benefits is arguably against the individual and antitherapeutic. Let me repeat: each individual heals by constructing meaning, i.e. benefits, from bouts of depressive disorder. And by construct I mean process and make. These meanings don’t simply land on those who’ve suffered from depression like the house lands on the witch in “The Wizard of Oz.”
Perhaps the one benefit I can see as common to most people with depressive illness is that it brings all the psychic pain from a lifetime into the foreground. This emphasizes the need for ongoing therapy to deal with and process those things. It is as though all faults have been pointed out, and with treatment some of these can be worked out. This would be especially true for those with recurrent bouts of the illness. But surely, it would be much easier to simply enter therapy and skip the depressive episode (or more than one), were that possible.
I do think I may owe some of the way my mind works to my disorder– and there are other claims in that direction, most notably in Kay Redfield Jamison’s book, “An Unquiet Mind.” But I don’t see my condition as adaptive, and I would still rather be without it. I have especially not enjoyed episodes of hypomania or depression, that have hurt myself and my family, and that have threatened my life. I am glad for this condition for a few reasons. I’ll be entering an MSW or MFT program soon, and I know that I will bring to it a sensitivity on the issue of bipolar disorder that I hope will prove useful. However, I fully recognize that there are brilliant therapists who didn’t need a disorder to be brilliant. And again, having bipolar II made me seriously scrutinize the emotional pain I was carrying– the work of therapy has helped me to address that.
Ultimately, each person determines the upside of a psychiatric disorder. It will be different depending on the person, and the drug/ no therapy approach is likely to leave people wondering if there are upsides, since the advantage of analyzing psychic pain is then stolen. Depression is tragedy magnified and anyone encountering it gets to determine the personal meaning of it, which is flexible. I very much appreciate Dr. Pies take on this because I don’t have patience with an approach celebrating what is essentially a disease. Will the upside of cancer come next?
Tricia
I read the NY Times article and could not for the life of me figure out what was being said. Depression sucks! I can’t see how in my life, my depression has afforded me anything other than misery. It has kept me locked up inside myself, afraid of anyone and everything, afraid to take a step forward or step back. It is immobilizing and demoralizing and I am glad that with antidepressants I can function. I sure don’t feel happy and I don’t dance a jig daily but at least I can get out of bed and make the best of me. It always felt like being shrink wrapped and seeing out but not being able to get out. With meds the shrink wrap is off.
For what it’s worth, I think that the title of the original article was misleading. It didn’t seem to me to be arguing that depression itself had an upside. It seemed to be arguing that the same traits that lead to some sorts of depression in some people can have advantages. That seems pretty common sense to me. The article was clear that not all depression is the same and not all depression has the same cause.
I thought the article was balanced, suitably limited in scope, and a great example of the shades of grey type of thinking that is a lot healthier than black and white thinking.
Just my opinion. And for the sake of disclosure, I ruminate myself. I find rumination and self doubt to be fine character traits.
The main function of your mind is not to make you feel good, but to identify objective reality. Depending on the truth or falsity of the facts fed in, this identification may be rational or not. That goes for all mental evaluations, including depression! And no, that is no cop out for redefining reality. Most mental states are rational, or we wouldn’t have survived as a species.
It’s true that virtually any difficulty we encounter in our lives has the potential to teach us something about ourselves and about what it means to be human. The way someone else deals with a difficult life situation can be a source of inspiration for others. Many of us watched and admired the way the late Christopher Reeves survived and in a sense transcended the terrible accident which left him a quadriplegic. Out of this event, he was forced to discover aspects of his own character and personality which might never have come to light had he not suffered the accident.
But — does that lead us to speculate that falling off a horse and breaking one’s neck is evolutionarily adaptive behavior? I would suggest not. Similarly, depression can be the most challenging of conditions. Many people who experience depression eventually, after much work, make great and valuable discoveries about themselves, sometimes in a way which lifts them (and others) to great heights. Nevertheless I would not conclude that depression itself is an evolutionarily adaptive characteristic. Rather there is something in human nature: the possibility of transcending what might seem to be an otherwise dismal condition or event, and transforming it into something beneficial. That is the adaptive quality, not the depression itself.
Perhaps the possibility of suffering depression is, in some way, a consequence of our possessing the quality which enables humans to transcend our difficulties. That’s an interesting speculation, but I would venture that it’s only that: speculation.
Thank you Dr. Fries for your article. I have suffered from clinical depression for many years & I have never believed that there was any kind of “upside” to this illness. It squashed my creativity, destroyed relationships with friends & family, caused me to lose my business & almost killed me. Antidepressants have allowed me to start putting my life together… (barely) & without them, I firmly believe I would not be here today. I have never experienced any kind of “net mental benefit”. Depression did not give me insight into social relationships & how to improve them & it did not give me the chance to look inward therapeutically. Quite the opposite, when deep in depression my thought processes were muddled at best & even now, feeling better, I find that I am not able to navigate any of life’s problems any better at all. To suggest that I may be able to cope better now, after suffering major depression is ridiculous to me.
Articles, as the one written by Lehrer, give those who have never suffered from depression the idea that it isn’t really that bad. When my depression was at its’ worst, I had many, many well meaning people tell me to just “get over it”, “smile”, “think positive”. Where do they get the ideas that depression is not a severe, legitimate disease? They get those ideas from what they read. Those same people who gave me the well meaning advice, often cited articles that they have read, such as ones written by Lehrer.
I can’t thank you enough Dr. Fries, for your article. Deep understanding & empathy of clinical depression & how it affects us is the key to helping us get better. I have no doubt that you are an amazing doctor. Your patients are very lucky to have you.
rlh
p.s. I apologize for the many spelling and grammatical errors I have made.
if losing my job, wife, ability to think straight, suicidal thinking and struggling to stay alive is romantic, i say think again, for me i hate this depression and the burdens it has placed on my life.
It’s interesting the difference between those that have suffered their their whole life with depression and those that developed in adulthood. It seems that those of us who have always dealt with depression have learned much from it whereas those that did not develop depression until adulthood cannot see any benefit….
…much like a person who was been poor their whole life but somehow finds happiness and the rich man who suddenly loses everything and kills himself…
rmw,
I think you may have hit the nail on the head. And wonderfully written too.
rmw
If a person falls from their horse and breaks their neck and dies then they cannot reproduce therefore a person either A) has stronger bones, B) does not fall off, or C) does not ride horse will have a greater chance of having offspring thus continuing their genetic or social makeup….so yes falling off a horse and breaking your neck does affect evolution…
Beautiful article!
I have many other things I can and may say but am in a rush, but I am particularly distressed when W. Styron’s book is brought into the discussion owing to fact that he was on some powerful medications when he went through his darkness, which I believe rather cancels the validity of the discussion as pertains to his specific experience being applied to rest of clinically depressed population (unless they were on same drug cocktail or similar).
lisjardine
Hi, All–
First, thanks to you all for your important and stimulating contributions. I apologize for not replying personally to everyone, but I hope that I can address some of the salient issues raised.
So much of the debate turns on what is meant by the term “depression”. A major problem with Jonah Lehrer’s original piece is that he did not fully clarify what he meant by “depression” –though it is quite clear that the paper on which Lehrer bases his evolutionary claims used the term “depression” to describe DSM-IV “major depression”.
Second, we need to distinguish three related yet distinct concepts and claims: (1) major depression is “instructive”; (2) major depression is “adaptive”; and (3) major depression is “conducive to significant mental health (or physical health) benefits.”
I would not deny that depression, like other challenges in life, may be “instructive” for some proportion of individuals–though probably a minority. I have very serious doubts (as do most of my colleagues) that major depression is “adaptive” in any significant way, though perhaps very brief and mild bouts of depression could confer some modest advantages in an evolutionary sense; e.g., by increasing one’s empathy toward others, which could be highly adaptive in obvious ways. [cf. “A broken heart prepares man for the service of God, but dejection corrodes service.”— Rabbi Bunam of Pzysha].
This could be true, in theory, for more severe depression, but there, the maladaptive aspects of the illness would likely outweigh any modest advantages by a huge margin; e.g., the 15% mortality rate in major depression (naturalistic studies), mostly by suicide.
As regards mental health benefits, such as increased clarity of thought or problem-solving ability issuing from depression, this strikes me as, well–unlikely in the extreme (to use civil language!). So, too, with any putative physical benefits-–on the contrary, major depression is associated with substantially increased health risks, such as cardiovascular disease and diabetes.
I also think it’s helpful to ask, in philosopher William James’s terms: what is the “cash value” of the idea that major depression confers an adaptive advantage by improving our problem-solving skills? Let’s stipulate such an advantage. So what? Where does that information get us, in our attempt to help people live better, more productive lives? How does it help our severely depressed patients? Should we encourage patients to prolong their depressive bouts in order to increase their analytic abilities?
We have known for decades that the sickle-cell trait provides a survival advantage over people with normal hemoglobin, in regions where malaria is widespread—but this trait also increases rates of painful and debilitating sickle-cell disease.
If, in a malaria-rich environment, we had the means both to reverse the sickle cell trait and to prevent malaria, would we not do so? By analogy: if we could prevent major depression with all its disadvantages, but still find ways to improve people’s “problem-solving skills”, would we not do so?
Surely there are ways of teaching people how to “analyze” their problems without asking them to bear the immense burdens of major depression! By the way: William Styron’s severe depression may have been related in part to alcohol and/or prescription drug misuse—but the horrible symptoms he describes are not at all atypical in many, many severely depressed patients.
None of this is to say that people who are depressed are in any way “broken” and must be “fixed”. One should never confuse a person’s mood state or illness with his or her value or goodness as a human being!
The Talmud teaches us that we should learn from all persons, even a thief. For example, thieves work hard at night! I see severe major depression as a kind of thief. Now, being robbed (of happiness, pleasure, ease of mind and body, etc.) may indeed be instructive-–one learns courage, resilience, caution, and the need to take care of oneself.
But a thief is still a thief–-and few of us would recommend a “good burglary” to our friends or family, as a means of instruction in life’s lessons!
Ronald Pies MD
As I person who has dealt with chronic-severe depression for roughly three years now, I must say that I disagree with the primary perspective of this article..
Sure; it has some very valid points… in my opinion, depression is Hell on Earth. It can be the epitome of misery. It’s the concentration of hopelessness, despair, apathy, and turmoil. In my worst points of depression, I felt that I was physically weighed down by lead weights and could barely motivate myself to move… I just wanted to die at every waking moment of life.
If someone had told me that depression has positive aspects to it while I was in my worst periods of the condition, I probably would have been inclined to give them the finger and tell them that they have no idea what they’re talking about.
Now; at a point where I’m almost off the antidepressants and I’m managing quite well, I can confidently say that I am extremely grateful for having depression. There is nothing more exhilarating and self-empowering than conquering the demons of depression. Since I have pulled this off, I appreciate the little things so much more deeply…. I have experienced the complete and utter lack of happiness; therefore, I appreciate the moments of happiness that I do feel more than I ever would have, otherwise.
Depression is a double-edged sword…. It is the most unfathomable misery that a human can feel, and it surely can annihilate him…. but if he can manage to escape its wretched clutches of tyranny, Life brings on a completely new and beautiful landscape.
To all fellow sufferers of depression; my heart goes out to you all… but please heed my words; I know what it feels like to want to just kill oneself… somehow I was able to manage this condition. I survived; it’s one Hell of a journey, but it’s possible….
There may be some benefits to life’s normal up’s and down’s – known as temporary disappointments when one is in good mental health. This is not depression and I wonder just how many times this point needs to be made. Many have made a similar argument but I just have to put it down for the umpteenth time: How about an article entitled, “The benefits of chronic liver disese and what it can teach us.” We wouldn’t see this article because (let’s face it!) liver disease just lacks the “Romance” that depression still elicits in those who have not had it.
What options do I have? I have resistance major depression. I suffer constantly, daily with worthlessness, guilt, crying, and helplessness. I have been working with my doctors for years. I just recieved disability without benefits (no insurance due to pre exiting conditions), has put my family in finanical hardships. I have tried sucide and I know it was me reaching out for help…I am desparate for any help. I am a burden for my family and I hate feeling sorry and pitting myself. I just want appropriate help to get this diease cured or at least to achieve relief for myself and my life. Please give any advise…I need information I can use now, not just one more run around without real advise for help. I am afraid and I am willing to do what ever is offered…this is a major cry for help.
Dear Rose–I am terribly sorry to hear of your suffering. What you describe truly reveals the “real world” of major depression, and speaks volumes about how empty all this “upside of depression” discourse really is.
I regret that I’m not in a position to offer you medical advice or assistance. However, I want to urge you to discuss all available treatment options with your doctors, including ECT. I know that may seem like a scary idea for you, and for many people who misunderstand ECT. But it is by far the most effective treatment we have for severe, intractable major depression that has not responded to other remedies.
There may be other treatment options to consider as well, depending on what services are available to you. If you have access to a good psychiatric social worker (ask your doctors), you should be able to get advice on your financial options, which I realize are very limited. In the mean time, please discuss with your doctors any support groups in your area that help people with severe depression deal with their condition.
Also, in the mean time, you can log on to the website of DBSA (Depression and Bipolar Support Alliance),
http://www.dbsalliance.org/site/PageServer?pagename=support_findsupportlanding
where you can locate support groups near you.
I want you to know that there is hope, and that even severe, chronic depression can respond to treatment. I understand, if you find that hard to believe–but please know that I believe it! Also, please know that you are not alone and that help is available, if you keep at it!
With my best regards for your recovery,
Ronald Pies MD
Rose,
I don’t want to elaborate but I totally understand. I am not a medical professional so please understand that as you’re about to read my post. But these are my experiences I want to share that might help you.
Have you tried fish oil capsules with high EPA? I was having very negative thoughts due to a current stressful situation and I just took one. It helped immediately.
Google high EPA fish oil and depression. It has shown to be helpful.
I also have found St. Johns Wort to be helpful. My only caution is if you have to check with a pharmacist to make sure there isn’t a dangerous interaction with meds you are taking.
I took it many years ago when I stupidly cold turkeyed off of a psych med and suffered horrific depression. It helped immediately.
Have you had your vitamin D levels checked as low levels can contribute to depression?
Normally, I would post my email address but for various reasons, I don’t want to do it. If you want to post yours, I would be happy to write to you.
Or I could write psych central and leave it with them so you could access it.
Hang in there. Don’t give up.
Dr. Pies…
“A broken heart prepares man for the service of God, but dejection corrodes service.”— The quote you offered is an elegant distillation of the difference between sadness or grief and chronic/major depression. Experiencing feelings, no matter how painful, – joining, in Helen Keller’s words,”the great family of the heavy-hearted into which our grief has given us entrance” – is a sign of being connected to others; hopelessness and despair come from feeling cutoff from the very possibility of connection.
I do think our society in general allows little public expression of grief; if it goes on “too long” it is labeled depression, even when it is not. And those who are depressed are seen as problematic because most of the “non-depressed’ want to see a clear cause and effect (and remedy).
Actually – as someone who spent years in cycling depressions, I spent a lot of time looking for the same thing, and could find lots of possibilities – but in the end needed medication to stop the cycling, and get to the point where cognitive and behavior approaches could help. FYI, I was never diagnosed with major depression, but had taken myself to different therapists over years to wrestle with the problem; unfortunately I saw my inability to “get better” despite therapy as another sign of being hopelessly different and doomed to bouts of misery. At the time, I did not tell my therapists this; it was part of the hopelessness. Like most people with major or chronic depression, I lost some major opportunities in life, and screwed up relationships, because of seriously impaired functioning. Have I given up anything through treatment? Side effects of the meds include the sex thing. Also , for me that a certain acute appreciation of music and art has diminished. There was a trade off. It was worth it.
Rambling – Dr. Pies, I think your response to the Lehrer article is very comprehensive and may help a lot of folks understand depression a bit more. Lehrer isn’t wrong to seek to understand what purpose depression may serve humanity; but the implication of the article is that depression is “sadness,” not the bleakness so many have experienced. Great posts.
Lehrer is well know for his posturing and non-sensical arguments that sound good. That’s pretty much covers his first two books.
And people who say they there is an upside to depression: Get a grip! Of course any experience that you survive becomes part of you. Taking up running instead probably would have had more of an upside.
What next? The upside of torture? “It made me a better, more compassionate person.” or how about the upside of losing a loved one? “It made value the everyday moments in life.”
Thanks again to you all, for your thoughtful and often courageous comments. I have probably said more than enough, and will “sign off” for a while.
However, for those of you who want to read an elegant and science-based “take down” of the myth that depression really buffs up your problem-solving ability (not!), I highly recommend the post below.
http://neurocritic.blogspot.com/2010/03/depressions-cognitive-downside.html
Best regards, and courage…Ron Pies
P.S. CG, I think you are right on the mark with your comment that Rabbi Bunam’s comment is “…an elegant distillation of the difference between sadness or grief and chronic/major depression.”
Thank you Dr. Pies for this long-overdue unmasking of Mr. Lehrer’s scientific incompetence. Writing about science requires scientific expertise, not just the ability to hook a reader. In pop science articles, what doesn’t get put in the article is just as important as what does, and only someone with expertise is able to determine which results are important based on ALL the evidence. I put your article up there there with Steven Pinker’s fisking of Malcolm Gladwell. You’ve done the community a good service.
I’m a clinical social worker who has suffered from cyclical depression for 30 years – this disease has no redeeming qualities and is an utterly useless waste.
Articles trying to romanticize it are psuedo-intellectual claptrap and drive me insane. I rarely bother reading them, but this is in the NYT, the most influential paper in America. They should be ashamed of themselves for publishing such transparently hokey tripe.
New York City is the most provincial place I have ever lived. They are stuck in the 40′s at best on issues of mental health. I attended NYU ad Columbia and have worked in the mental health field for 15 years. Almost anywhere you can name is more up to date and creative in its approach to mood disorders.
Dr. Pies,
Thank you for this article! As someone who has been severely depressed before, and have recently recovered and as a clinical psychology student, I agree completely with your response to Lehrer’s article. I see no benefit to moderate to severe depression. All your energy is focused on self-preservation and minimizing damage, and there is little time and energy for creative pursuits, self-refection, or problem-solving, if there is even a clearly identifiable problem driving the depression. Major Depression weakens the immune system, often leads to substance abuse, causes massive weight loss or gain, and greatly increases mortality due to suicide risk and overall poor health. None of these things help the survival the species. The only slight benefit I can see is that it might make you a more compassionate person and teach you to take care of your self better and u appreciate “little things in life” but all these benefits are incurred after you recover and could be said of cancer and other serious diseases. Honestly, For me personally, the devastation caused by the disease greatly dwarfs these possible benefits.
Furthermore, when I experience depression, I really don’t feel anything, good or bad, so I don’t see how that would enhance my creativity. Perhaps there are depressed patients, Like Kenneth who commented above, that experience deep emotions that fuel creativity, but I certainly don’t. And the majority of depressed patients don’t. In fact, far from making me deliriously happy, once I found an effective antidepressant, (tried 4), it simply restored my full range of emotions and gave me more energy and concentration to solve problems and participate in therapy. (also I experienced no side-effects whatsoever)
I would have maybe agreed with Lehrer’s article if he has clearly specified that he was referring to acute sadness or melancholia or possibly mild depression and that severe clinical depression has no upside. However, since he irresponsibly lumped those 2 very different things together, his theory has little merit. I worry that severely depressed people will read Lehrer’s article and think that they should stop taking their antidepressants or get even more hopeless because they see that there is no “upside.”
Lastly, to Rose: My heart goes out to you. I guess you could say I have “resistant” depression, but after trying several different meds, one finally worked and it worked tremendously well. Although it’s easy to lose hope and declare that your depression is “resistant to treatment, in reality, there are so many different drugs that combat depression. So if SSRIs (ie Prozac) for example, didn’t work, there are still non-SSRI antidepressants, mood-stabilizers and psycho-stimulants that can be tried and most likely one or a combination will work. Also, many of these “antidepressants” are available as generics making them remarkably cost-effective. As Dr. Pies said, there is ECT as well. In addition, if possible, a therapist can be tremendously helpful you can use Psychology Today’s listings or other internet sources to find one that works on a sliding scale basis. There are a number of psychological interventions for depression. I would also recommend the book, The Mindfulness Way through Depression and mindfulness meditation in general (also known as Vipassana). I hope this advice helps and you get well soon! (I am not a doctor)
Depression is hell for me and if I could give it away to anyone who wants to find out if there is an upside I would gladly do so. I’d even pay them all my savings and through in the home. Of course I am being unrealistic here to make a point. For me there has been no upside only a miserable life that has cost me dearly in so many areas.
You wrote the foreword, not forward, to Borchard’s book.
Readers following this may be interested in my post on this whole kerfuffle — which Dr. Pies was kind enough to engage there — at my blog Neuron Culture: Does depression have an upside? It’s complicated.
Thanks to all of you who wrote to me, particularly those of you who shared some of the immense pain you have experienced with your own bouts of severe depression. Thanks, too, to David Dobbs for some thoughtful comments on this contentious subject; and, finally, to Anne, who has evidently channeled my 9th grade English Teacher and reminded me that a computerized “spell-check” is no substitute for a sharp editorial eye! —Best regards, Ron Pies
Ronald Pies MD
(A long term sufferer)
If I lose my leg , I will learn to hop.
I`ve got to get happy (?) somehow ..lock on to the next stretegie …onesided maybe obsessively happy with this source . I suffered long and couldnt relate it .. I ve invested alot of time in learning how to tell someone , learning about me , it intefers with my job !
Where are my sources of …happiness – what do I ..tend to do .
Accept me .. the way I am ..what I do ..
My depressions are.
I am not able to survive in this world without outside help..from people.
I have to adapt ..find other ways to get what I need….. sources of happiness , security , food.
This ever developing world is very strange to me when I am depressed . I am me ..when I am depressed ..without the distractions of the world outside … the world where ..I should find the high of happiness or …contentment.
I am impatient with my pain and am unable to bear it – I stop the pain , somehow. The world out side is impatient ..the bills need to be paid.A world of bills. I know this . I dont want to go back though .
Along comes hope .. I´ll hop away in a different direction ! Eureka.
Does doubt and indecision come first ? just keep doing what your doing and oh God ..dont ask …keep running and dont look back .. Yeah this is great ..
I think I am two ..me this world and me.
Me in this world needs ..this this and that.
Me ..needs other things .
both have their ..behaviours.
what do I …tend to do ….and How do I explain it to someone.
I don’t think that it is more likely that depression is a spandrel than that is an evolutionary adaptation. I do have trouble distinguishing these hypotheses, though (as I will go on to show). It is also worth investigating the view that depression was adaptive in the evolutionary ancestral environment (of small social groups) even if it is not adaptive now (in large urban societies). Or the view that variation in a trait (e.g., emotionality) is important because variation is a protection against extinction given radical enough environmental / cultural change.
If depression is thought to be an inevitable by-product of a ‘sensitive, altruistic, and compassionate nature’ then what is to prevent one thinking that actually the relevant trait that was adaptive / selected for is ‘sensitive, altruistic, compassionate, and depressive nature’. If a spandrel (depression) is an inevitable product of some other trait (sensitivity etc) then one can’t have the other trait (sensitivity) without the spandrel (depression) or the latter would not be a spandrel (inevitable by-product)! It is controversial whether there really are spandrels in the biological sciences. Talk of x being a spandrel of y really seems equivalent to the value of x minus y was more adaptive than alternative trade-offs (in the environmental context).
> what is the “cash value” of the idea that major depression confers an adaptive advantage by improving our problem-solving skills? Let’s stipulate such an advantage. So what? Where does that information get us, in our attempt to help people live better, more productive lives? How does it help our severely depressed patients? Should we encourage patients to prolong their depressive bouts in order to increase their analytic abilities?
One notion is that in our attempt to help people ‘live better, more productive lives’ patients might be better off if we (doctors, family members, greater society) accepted them as they are (in their depression) rather than if we attempted to change them. Of course we can think of severe cases (e.g., catatonic depression) where the significant majority of us have the intuition that they would be better off if they snapped out of that. But then we can also think of cases (e.g., a person who grieves a couple weeks more than the DSM allowed 6 months) where it really is unclear whether they would be better off if we allowed them to grieve or whether we labelled them with a mental disorder and attempted intervention.
> None of this is to say that people who are depressed are in any way “broken” and must be “fixed”.
The significant majority of people have the intuition that ‘people who are sick would be better off if they weren’t sick (other things being equal)’.
> One should never confuse a person’s mood state or illness with his or her value or goodness as a human being!
But if a person isn’t better off if they aren’t sick – then what is it that justifies our trying to change them to make them *better*?
Not to say that people who aren’t sick are better than people who are – just that a person is better in their state of health rather than their state of sickness. Viewing certain kinds of disorders as potentially evolutionary adaptive or possibly having current adaptive value (in ways that we haven’t considered yet) shows us that there really are value judgements about what is best for a person going on in medicine.
But things aren’t so straightforward…
E.g., those who are hearing impaired often have enhanced tactile processing – would they be better off to lose the hearing impairment and the enhanced tactile processing or just different?
E.g., If the medications that effectively control depression turn out to have a consequence that deep attachment bonds (compassion etc) aren’t felt then is it better to lose the depression and the feeling of attachment (compassion etc)?. Figuring out what is an inevitable by-product of what (or what the adaptive value of some trade-off of linked traits is) can help us get clearer on the kind of intervention that is appropriate and also the amount of resistance to that intervention might be justified.
Interesting piece.
I think it is uncontroversial to say that people who are hearing impaired have been found to have enhanced tactile processing compared to people who aren’t hearing impaired. In trying to find out what benefits there might be to being hearing impaired we found some. There might be a similar value to considering what benefits there might be to being depressed.
If we now consider that treatments for hearing impairment come at the cost that they reduce the tactile processing then it seems less clear whether people with hearing impairment and enhanced tactile processing are ‘better off’ than people without hearing impairment with comparative tactile impairment. We can understand why some people might choose not to seek help for their hearing impairment and we can accept that it might be that a person isn’t in fact better off having their hearing impairment fixed given the costs.
Similarly, if it turned out that depression was linked to such things as compassion, empathy, ability to form strong attachment bonds etc then the issue comes up how much treatment for depression impacts upon these. If it were found that cognitive behavioral therapy worked by way of turning a socially focused person into an individually focused person (reducing attachment bonds) or that medication worked by way of muting compassion, empathy, and attachment responses then we might similarly think that it is less obvious that people ‘should’ get treatment for depression in order to be ‘better off’.
I have trouble distinguishing between the adaptation hypothesis and the spandrel hypothesis. If x is an inevitable by-product of y (if x is a spandrel of y) then why isn’t that equivalent to the thought that the fitness value of y given x was higher than alternatives in the environment. The latter thought seems equivalent to the claim that y given x was adaptive.
(Apologies for the double post the first one only appeared to me now even after reloading the page several times. Please disregard the first and feel free to delete)
I thank Kim Johnson for the thoughtful comments on depression and its supposed “adaptive” value.
First, with regard to “spandrels”, I am not an evolutionary biologist, and I would not claim to have certain knowledge on these matters. I merely suggested the “spandrel” hypothesis as a plausible alternative to the “analytical rumination hypothesis” (ARH) put forward by Thomson and Andrews, and discussed by Jonah Lehrer.
I would encourage Kim Johnson and others interested in hearing a “real” evolutionary biologist go to the website of Prof. Jerry Coyne; there, he presents a detailed rationale for rejecting the ARH and the notion that major depression is “adaptive”. The website is:
http://whyevolutionistrue.wordpress.com/2009/08/30/is-depression-an-evolutionary-adaptation-part-2/
Here is one telling comment from Prof. Coyne re: the ARH:
“The authors [Thomson & Andrews] give no cost-benefit analysis for depression, despite the fact that the costs are certainly severe. At present they include an appreciable frequency of suicide. And, as one alert reader pointed out, a loss of appetite or desire for sex would have been seriously maladaptive in our savanna-dwelling ancestors. Imagine an ancestral Homo erectus, curled up on the floor of his cave, ruminating obsessively because he suspects his mate of infidelity. He doesn’t sleep; he doesn’t eat; he doesn’t have sex or go hunting with his mates. Does this really give him an adaptive advantage? This scenario is a bit facetious, but the point is serious.”
Kim Johnson expresses concern regarding “…a person who grieves a couple weeks more than the DSM allowed… where it really is unclear whether they would be better off if we allowed them to grieve or whether we labelled them with a mental disorder and attempted intervention.”
First, it is critical to understand that ordinary “grief” and “major depression” are two very different entities. Most psychiatrists would acknowledge that grief in response to loss is a normal, and probably “adaptive” response common to a number of mammalian species. Grief overlaps with depression, but differs in many ways—not just quantitatively, but qualitatively. For more on the differences, please reference the discussion from Dr. Sid Zisook and myself on the Psychiatric Times website: http://www.psychiatrictimes.com/dsm-v/content/article/10168/1523978
and also my article for Psychcentral: http://psychcentral.com/blog/archives/2008/10/04/is-grief-a-mental-disorder-no-but-it-may-become-one/2/.
Second: diagnosing a major depressive episode, and involving the person in psychotherapy—possibly with an antidepressant trial in severe cases—in no way interferes with the grieving process. On the contrary, many patients with bereavement-related major depression (after the death of a loved one) seem unable fully to grieve, until their major depressive symptoms (severe insomnia, weight loss, impaired concentration, loss of pleasure in nearly everything, suicidal ideation, etc.) are adequately treated. There is no credible evidence that treating the depressive symptoms delays or suppresses the grieving process. For more on this, and the construct of “complicated grief”, please see the excellent paper (available online) by my colleagues Sidney Zisook MD and Katherine Shear MD: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2691160/?tool=pubmed.
Of course, treatment for depression ought to be (except in rare emergencies where the patient is unable to give informed consent) a matter of consensual agreement between doctor and patient, after informed consent is obtained. It is not a matter of our “allowing” or not “allowing” a person to grieve. Remember, most of the depressed patients seen by psychiatrists have come in on their own accord, seeking relief from their suffering –they are not dragged in off the streets!
Finally, Kim Johnson wonders , “…if it turned out that depression was linked to such things as compassion, empathy, ability to form strong attachment bonds etc then the issue comes up how much treatment for depression impacts upon these. If it were found that cognitive behavioral therapy worked by way of turning a socially focused person into an individually focused person (reducing attachment bonds) or that medication worked by way of muting compassion, empathy, and attachment responses then we might similarly think that it is less obvious that people ’should’ get treatment for depression in order to be ‘better off’.”
Whether or not major depression might be “linked” in some way with traits such as compassion or empathy—merely a speculative hypothesis on my part—there is no credible evidence that while people are in the throes of a major depressive bout, they are “socially focused”, especially “empathic” or strongly “attached” to others. On the contrary, the evidence is overwhelming that while in a major depressive bout, most people become extremely “self-focused”, introverted, irritable, and—if anything—anti-social.
Moreover, I am not aware of any evidence that either CBT or antidepressant medication interferes with the depressed person’s ability to express or experience compassion, empathy, or attachment to others. In contrast, there is excellent evidence that major depression interferes with social function in precisely these ways. One study, for example, by Pietromonaco and Rook, ( J Pers Soc Psychol 1992; 63:247-59) found that subjects with “dysphoria” (roughly, depressive mood) tend to under-estimate the “sympathy” their partners show toward them—this hardly seems an adaptive trait. Similarly, a study by Whitton et al (J Clin Psychol 2008; 64:791-805) found that young adults with depressive symptoms showed a “negative bias” in assessing their own “social competence”—the more depressed the subjects, the more they under-estimated their own social competence. Again—this hardly seems an attractive feature in the evolutionary scheme of things, so far as I can see. In my personal experience, it is when patients begin to “climb out” of their major depression that their ability to connect with others actually returns.
Finally, I’ll close with a quote attributed to “The Father of Medicine”,Hippocrates, which nicely summarizes why we clinicians do what we do:
“If sick men fared just as well eating and drinking and living exactly as healthy men do…there would be little need for the science [of medicine].”–Hippocrates
Best regards,
Ronald Pies MD
Thank you for your article. This is a lengthy topic and as seen by the diverse comments each one suffers uniquely and yet shares common ground. As Rose has suggested, research strongly suggests that fish oil supports mental well-being. What do you say Dr Pies? I take a 2000 mg of omega 3 fatty acids every day in a triple strength fish oil capsule. I find it has been helping me.
Hi, Chris–I’m a believer in maintaining overall good health–”mens sana in corpore sano”–as a kind of bulwark against depression. Part of that certainly involves a healthy diet, including fish dishes high in omega-3-fatty acids. The issue of omega-3 supplements is, I think, a bit less clear for actual treatment of depression, but as the abstract below suggests, the early results look promising! –Best regards, Ron Pies MD
J Clin Psychiatry. 2009;70 Suppl 5:7-11.
Omega-3 fatty acids in major depressive disorder.
Freeman MP.
Center for Women’s Mental Health, Massachusetts General Hospital, Simches Research Building, 185 Cambridge St, Boston, MA 02114, USA.
Patients with major depressive disorder have high rates of cardiovascular disease and other medical comorbidity. Omega-3 fatty acids, particularly those found in fish and seafood, have cardiovascular health benefits and may play an adjunctive role in the treatment of mood disorders. However, existing studies on omega-3 fatty acids in depression have limitations such as small sample sizes and a wide variance in study design, and results regarding efficacy are mixed. The preponderance of data from placebo-controlled treatment studies suggests that omega-3 fatty acids are a reasonable augmentation strategy for the treatment of major depressive disorder. More research is necessary before omega-3 supplements can be recommended as monotherapy for the treatment of depression. For many individuals with major depressive disorder, augmentation with omega-3 fatty acids should be considered, as general health benefits are well established and adjunctive use is low risk. (c) Copyright 2009 Physicians Postgraduate Press, Inc.
I have suffered from depression since I was about 13 years old(26 now). While at times this can be a debilitating disease, there are moments of enlightenment that I am able to take away from my disorder. There are many trials in life and I just take this as a cross I must bear. Every episode is a new lesson for me. Whether any of your are able to cope with your own responsibility in your emotions or not, I know my personal feelings about myself cause my depression. This is not some disease without a cure. This is a coping disorder. I have problems coping with life therefore I shut myself down. But when I am out of this slump, I am able to take away a lesson of clarity from my months/years of my sadness as to what caused it and from there I continue to grow as a human being. I stopped taken the many medications I’ve been prescribed for my depression because pills can delay symptoms, but they are always there. I’ve come to accept and be at peace with my sadness.
I can’t believe in the imperative to treat depressed people. I admit, I haven’t known many, and depression might be a condition worse than I’ve experienced, but I have general disagreements with the idea that a person should be chemically treated for a genuine emotional response to some reality of the world.
This talk about an “upside” excusing non-treatment is in the hands of the pharmacologists. This wording is not suitable for an unbiased discussion of the phenomena. There need not be an “upside.” This is just more pressure on the “depressed” to perform and produce for gain.
I react against this idea that anything less than maximum output is a loss, and the conclusion that people with private issues are holding back from the productivity and creativity of a nation. We must compete for jobs, clients, and so forth, but it does not follow that we must deny the privacy of our emotions to succeed.
In fact, we don’t need to “succeed.” This word is also in the hands of the pharmacologists – how smooth sounding are the words “success and happiness.” A depressed person should be able to live a humble life without dragging people down.
Maybe there are extreme cases – but the doctors and pharmacologists are going to always be pushing for more clientele because it doesn’t make a big difference to them if some office worker is making cordial conversation with coworkers at lunch, being given the effects of antidepressants, instead of eating quietly by himself.
It is inexcusable to create a social attitude against a non-damaging (though non-contributing) emotional state such as depression commonly is. Advertising for antidepressants should be held accountable to a consideration for the emotionally reflective person who doesn’t enjoy the superficial aspects of society, even if his reflectivity is not interesting or beneficial to any of us.
I have gained “net mental benefit” from my depression. I am still depressed, but I refuse to use it as a crutch. If anything, feeling like completely worthless to humanity from an existential standpoint has enabled me to ascend not only in my emotional intelligence, but in the way I understand the world around me as well. I believe in love and light, and I try to handle every situation with ease and grace because of every single depressing thought I have ever had. When I was younger (before I ever started to feel ‘down’ in regards to life), I just walked on the people around me like I walked with my feet on the ground. It has ultimately resulted in my spiritual growth as a human-feeling-being.
(Rhetorical) What of existential depression? My question to you is how can one NOT benefit from depression unless he or she is merely just feeling bad for his or her self? Forgive me if I sound callous.