Here’s where I sound very, very bipolar. I wrote an article a few weeks ago on “10 Good Things About Depression” and now I’m supporting psychiatrist Ron Pies’s viewpoint that we should not perpetuate what he calls “The Myth of Depression’s Upside.”
Pies, who is Editor-in-Chief of Psychiatric Times and a professor of psychiatry at Tufts University School of Medicine, gives a much needed response to Jonah Lehrer’s essay “Depression’s Upside” in the Feb. 28, 2010 New York Times Magazine about all the wonderful tasks depression can do for you — foster creativity, sharpen analytical skills, improve problem-solving skills, yada yada yada all the way to the psych ward.
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“The traits–sensitivity, altruism, and compassion–are adaptive … we need them to evolve as social creatures.”
While it is technically true that these traits can and do exist separately from depression it is unlikely that they will to any real depth. It’s all about perspective if I want to create a piece of art that can evoke a certain feeling then I have to understand that feeling depression when handled correctly can really give you an opportunity to gain that perspective. You can measure the joy of what you yearn for by depths of your sadness as well as being able to relate to another human who is in the same state or maybe worse. Being able to understand and express that connection is what gives those on their down swing the hope that it will get better but by constantly deriding it as something horrible that needs to gone you give them a feeling of hopelessness combined with the guilt that it must be somehow their fault that they are “broken” and that no one will ever want them until they are “fixed”.
Does it have to be either/or? Can’t both views have some element of truth in them?
Perhaps having short periods of depression-like behaviour can be adaptive for the reasons Lehrer outlines. Therefore, a genetic predisposition for this type of activity is passed down. However, the mechanism may be a bit unreliable and leave us vulnerable to more serious debilitating depression. This may be exacerbated by our modern lifestyles. ‘On the savanna’ we would probably have lived in smaller, more closely knit tribal groups and would probably have had very little time off from the basic activities of survival. Both of these things would have mitigated any depressive tendencies by preventing excessive rumination. Nowadays, we have more leisure time in which we could be inactive and we are often more isolated from other people. The adaptive rumination now has nothing to restrain it so we develop depression.
Am I being naive or is that what Pies was saying anyway?
For people who say that depression is adaptive, have you experienced it? Have you experienced the feeling that getting out of bed is too hard. That the world would be better off if you were dead?
My other argument is would you tell someone that cancer is adaptive, because it is hard and a person could learn compassion for others while they suffer from the chemotherapy or radiation treatments. Would you say that the pain they learn to deal with is a positive adaptation? That the cancer that might kill them (as depression kills people,) is something that has become a positive adaptation? Why is depression seen as any different? I lost years of my life because I was depressed and could only pull myself through. I was always a sensitive person. I didn’t need the experience of depression to develop my compassion for other people.
If you would say that cancer is adaptive because of what a person can learn from it, then come back and have a conversation about the adaptiveness of depression. Until then, stop minimizing the pain that comes with depression by saying it is positive and adaptive.
Experiencing any sort of pain (not only depression-related, but the result of other diseases and injuries as well) can, under certain circumstances, teach us something of value, sometimes even of great value. And it’s true that a case can be made for not medicating all the pain out of our lives. After all isn’t that what those who abuse alcohol and drugs are attempting to do, usually with little long-term success? But, given the possibility of medical relief from pain, we are still faced with the question of how, when, and whether to medicate. The answer is probably not the same for all patients, and probably not even the same for the same patient at different points in time.
Hi, All–I will have a much more comprehensive response posted beneath my original blog, within the next day or two. However, just to prefigure that response, I’ll say a few things here.
First, thanks to you all for your contributions. Nobody has “all the answers” to the riddle of depression, and I certainly don’t claim that! I think you all make valuable points.
So much of the debate turns on what is meant by the term “depression”. As the philosopher, Ludwig Wittgenstein said, “Philosophical problems begin when language goes on holiday!” 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 separate 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 adaptive in obvious ways.
This could be true, in theory, even for more severe depression, but there, the maladaptive aspects of the illness would seem to 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 unlikely in the extreme (to use civil language here!). So, too, with any putative physical benefits–if anything, major depression is associated with substantially increased health risks, such as cardiovascular disease.
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 person!
The Talmud teaches us that we should learn from all persons, even a thief. For example, thieves work hard at night! I see major depression as a kind of thief. Being robbed (of happiness, 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 would recommend a “good burglary” to one’s friends or family, as a means of instruction in life’s lessons!
More on this anon.
Ronald Pies MD
Thank you, Ronald. I couldn’t agree more with the thief analogy.
Martina
Having originally missed the “Upside to Depression” and “10 Good Things About Depression” I find myself at a loss to choose one side of this argument. I hear the vociferous responses of those who state that to find an upside is to minimize the gravity of one’s struggle with depression. And I can see why they might insist this.
However, as I consider this further, I feel compelled to add my voice to those who, in the midst of the pain, or perhaps for some, only when on the other side of the pain, free from the crippling hopelessness, somehow manage to find something positive in the midst of all the — to use a very technical psychological term — crap. Anyone who has struggled with depression understands well enough the depth of despair and the fear that they will never prevail over that which threatens to pull them down, forever a prisoner. While there are a handful that unfortunately do not escape depression’s clutches, there are many more who not only manage daily life with depression, but in fact prevail over depression, finding a life that authentically acknowledges their struggle without letting it rule their lives. I believe, therefore, that is is important to find the “upside” to their struggle, if for no other reason than to demonstrate to themselves and others than to have depression is not the worst thing that may have happened to them.
Depression carries enough stigma; isn’t it OK to acknowledge the side benefits?
Is it helpful to differentiate between depression itself and recovery from it? Melancholy may bring few intrinsic benefits, but its lifting may confer character strengths such as: an increased lifelong love of learning and an awareness of beauty (Peterson, Park & Seligman, 2006). Here’s the rub- without the despair, there would be no recovery and arguably, without the recovery, these strengths would not flourish. We all seek meaning for our experiences. To say that an event as weighty as depression has no meaning, that it is merely evolutionary white noise, is, well, depressing!
I think it’s natural to want to find meaning in one’s experiences, and that’s great if you do. However, I can find none in my experiences with depression. Any incidental benefits (increased compassion) could have been gotten in any of a number of other ways that do not involve excruciating agony and lost years. I completely agree with Ronald’s thief analogy.
Martina
It has absolutely unthinkable that “depression” could be a “spandrel” that “hitchhiked” its way through time on our genome with other adaptive traits. That is easily disproven by the fact that many species of mammals and non-mammals too exhibit depressive behavior, often in response to social or environmental circumstances that could be expected to elicit depression in humans, it clearly has some adaptive function. Additionally depression is not per se a “genetic” disorder. All humans clearly have the capacity. It is absolutely laughable that such a ubiquitous, human and at many times understandable response to a big uncertain world would be a genetic “spandrel”. It’s not my fault Dr. Pies took all his biology courses 50 years ago.
Now, Im not trying to malign Dr. Pies, or what he does, but he clearly is not a basic science researcher and he also has an agenda, which is pretty much perpetuate the informational status quo in psychiatry. From reading a lot of his writing over the years he seems to believe antidepressants are near magical and don’t blunt your emotions or make you feel emotionally flat.
As someone who has struggled with depression that has at times gotten very out of control, I can tell you Id rather not have it, there is nothing “beautiful” or likable about it, but i can also tell you I have tried every antidepressant to no avail only to have my libido wiped out and my emotions go flat.
Depressed people do tend to be more realistic about things that they are not emotionally involved in, they tend to have a more critical style of thinking which in some circumstances can be beneficial. Depression can easily get out of control, it is not pleasant in any way, but our society also has little to no tolerance for depression in general. Blind optimism, emotional repression, mind-over-matter thinking there is a cultural history of all that in our country that still exists today. Its enshrined in the mental health field in a little something Dr. Grohol knows as CBT.
I think phrasing something as being “unthinkable” — when clearly many of us have had very similar thoughts on this matter — is a prime example of black-and-white thinking that misrepresents the complexity of something like depression (and arguments made by Dr. Pies, and in other places, myself). Indeed, it is quite “thinkable,” and as Dr Pies’ piece on this matter clearly demonstrates, the original article by Jonah Lehrer was full of logical fallacies and holes.
I would say Dr. Pies’ viewpoint about the usefulness and power of antidepressants is not dissimilar to that other psychiatrists in this field, like Dr. Carlat — they can be a useful tool in the treatment arsenal, and when wielded with some care, can be extremely helpful. But he’s also said (indeed, noted again in the linked essay) that psychotherapy is an additional powerful tool to help people with depression.
That some research has shown that people with depression may view situations with more “realism” (“depressive realism”) than those without depression speaks nothing to the point of the evolutionary argument. And, in fact, some studies don’t support the depressive realism theory:
Moore, MT & Fresco, DM. (2007). Depressive realism and attributional style: Implications for individuals at risk for depression. Behavior Therapy, 38(2), 144-154.
For some reason this idea really seems to be viscerally repulsive to a lot of people who have been in the mental health field a long time.
Dr. Grohol, with regard to your last point, cognitive deficits are not experienced in a state of constancy in depression as Lehrer pointed out. A number of factors will influence a depressed persons cognition, and so regardless of whatever metrics you are using to measure whatever you consider special enough to measure, the persons internal and external environment/experience is something that needs to be controlled for.
With regard to your first point, you simply used a little CBT on me and stated that my thinking was “black-and-white” to invalidate what I said without having to address the content of what I actually said. In fact, it’s not very clear to me how stating that depression could not possibly be a genetic “spandrel” (ie useless) is “Black-and-white” thinking unless you yourself are the harbinger of the absolute truth on this question. Perhaps you would be surprised to know that indeed most things in life are a shade of gray, but in fact some things are black and white. Thats an aside, this issue isn’t black and white as you falsely injected into the argument, one real dilemma here is that you state:
–Indeed, it is quite “thinkable,” and as Dr Pies’ piece on this matter clearly demonstrates, the original article by Jonah Lehrer was full of logical fallacies and holes.–
“Indeed”? — that’s your proof it is “thinkable”? That’s the extent of your argument? Well, I’ll say it again and hopefully you can actually explain why it may be otherwise, but depression and depression-like behavior is an extremely common in mammals and some non-mammals, and can be elicited in predictable ways similar to ways it can be elicited in humans.
Depressive feelings and behavior are no more of a genetic “spandrel” than joyous feelings and joyous behavior.
The very fact that it is prevalent across so many different species of mammalian animals and non-mammals alike, really calls into question the idea that it is just some pointless aberration of feeling and behavior some of us unfortunately suffer.
Any system in nature that has any chance of maintaining itself needs the ability to adapt to its environment no matter what socially constructed meanings we have attached to a particular feeling or behavior. Such constructions in the present remove any perceived context from the feelings and behavior, and you probably end up with something like depression which is ubiquitous, not very well understood, and which does not have very good outcomes in some large percentage of cases (ie treatment is inadequate[ goes to not being well understood]).
With regard to the issue of whether or not depressive feelings and behaviors are a genetic “spandrel” or not I feel like I am wasting my time trying to explain it, when its a pretty obvious argument and when the most Dr. Grohol can do is simply state the opposite without explaining why.
So hopefully you can explain to us why you think depressive feelings and behaviors are a genetic “spandrel”.
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.
Can someone explain to me why the idea that depression was once adaptive but is now maladaptive because of changes in societal interactions is not a possibility?
Is it not possible that depressive rumination was useful in early humans and that in most cases it was prevented from tipping over into major depression by the social conditions of the time. It’s pretty clear that early humans lived in close knit social groups and spent much of their time in physical activity. I think I’m right in saying that both of these factors are known to mitigate the effects of depression.
It might be the case that adaptive depressive rumination is more likely to develop into debilitating major depression nowadays because the natural counterbalances that once existed are less prevalent. We have a society in which people are increasingly isolated from each other and in which daily physical activity is a choice rather than a necessity.
Is it not also true that spandrels tend to be transmitted only if they do not cause significant adaptive disadvantage, ie they are neutral or only mildly harmful? I would think that major depression hardly falls into that category (especially as it reduces sex drive and therefore reduces the chance of procreation).