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.”
Now, with all due respect to Dr. Thomson, I am inclined to ask, “Worth it to whom?” Perhaps the patients Dr. Thomson has treated emerge from their three-month bouts of depression saying, “Ya know what, Doc? It’s been a bad three months—lost my job, almost killed myself, and couldn’t get a damn thing done—but overall, it was worth it!” The depressed patients I evaluated over the past nearly 30 years almost never reported that their major depressive episodes had a “net mental benefit,” to quote Lehrer’s article. Most felt that their lives and souls had been stolen from them for the duration of their depressive episode. Many would have understood and endorsed Willam Styron’s description of his own depression, in his book Darkness Visible:
“Death was now a daily presence, blowing over me in cold gusts. Mysteriously and in ways that are totally remote from normal experience, the gray drizzle of horror induced by depression takes on the quality of physical pain… [the] despair, owing to some evil trick played upon the sick brain by the inhabiting psyche, comes to resemble the diabolical discomfort of being imprisoned in a fiercely overheated room.”
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.
Similarly, Lehrer trots out the old war-horse claim that there is a “…striking correlation between creative production and depressive disorders.” But such a correlation hardly proves that depression itself heightens creativity. Psychiatrist Richard Berlin, M.D., editor of Poets on Prozac: Mental Illness, Treatment, and the Creative Process, has summarized his experience as follows:
“The idea that depression might enhance creativity is a myth, often based on the life stories and statements of deceased artists and writers… Contemporary poets who are alive and can tell us about their experience with depression are consistent in reporting that it was only after effective psychiatric treatment that they were able to create at their highest levels.” (R.M. Berlin M.D., personal communication, 1/27/08).
One of the other notions put forward in Lehrer’s article is that depressive “rumination” may actually help us analyze our way out of difficult dilemmas — the so called “analytic-rumination” hypotheses. To support this claim, Lehrer cites several studies showing that depression leads to increased activity in the “problem-solving” part of the brain, the prefrontal cortex.
But there are also numerous studies showing the precise opposite, which Lehrer fails to note. For example, Hosokawa and colleagues in Japan found that, compared with healthy controls, subjects with major depression showed decreased metabolic activity in frontal brain regions. Furthermore, there are innumerable studies showing that major depression impairs higher-level thought processes. Dr. Charles DeBattista, in a recent review, concluded that, “The types of executive deficits seen in depression include problems with planning, initiating and completing goal-directed activities” and that such “executive dysfunction” tends to worsen in direct proportion to the severity of depression.
Lehrer is a thoughtful writer, but in this article, his conflation of terms like “depression,” “sadness,” “melancholy,” and “low mood” produces a kind of conceptual tossed salad. Some of the studies he cites, in which subjects are tested under transient, experimentally-induced states of low mood, have evidently befuddled Lehrer, who assumes that these brief, artificial states are somehow comparable to clinical depression. For example, Lehrer cites the work of social psychologist J.P. Forgas, who “…has repeatedly demonstrated in experiments that negative moods lead to better decisions in complex situations.” But Forgas’s research induces “negative mood” by giving his subjects bad feedback on a bogus test of their verbal abilities. It is simply ludicrous to extrapolate from a few minutes of bruised feelings to a few weeks of severe, major depression.
Lehrer also perpetuates the fiction that antidepressant treatment “interferes” with recovery from depression, by posing the issue as a classic false-choice. Citing psychiatrist Andy Thomson and psychologist Steven Hollon, Lehrer suggests that depressed patients prescribed medication will be “discouraged from dealing with their problems” — as if prescribing a medication slams the door shut on providing concomitant psychotherapy! Most studies find that, for severe depression, medication and “talk therapy” complement and enhance one another. There is no credible, controlled evidence that antidepressants “interfere” with the development of problem-solving skills.
That said, I fully agree that effective psychotherapy may have a greater “protective” effect than medication alone in preventing depressive relapse. Indeed, I advocate psychotherapy as the “first line” treatment for most mild-to-moderate depressive states.
Finally, it is time to challenge the dubious notion that if a condition, such as depression, is highly prevalent in the general population, this must mean that the condition confers some kind of evolutionary advantage, or represents a useful “adaptation.” (Following that line of logic, ignorance and superstition must also have some adaptive advantages, since they are both so widespread throughout the world!). It is more likely that the tendency to develop depression remains “conserved” in the human genome as a spandrel — a kind of genetic hitchhiker that does nothing to improve the ride.
In architecture, a spandrel is simply the space between two arches. Molecular evolutionist Richard Lewontin and paleontologist Steven Jay Gould argued that many traits in nature are nonadaptive, and—like spandrels—are simply byproducts of other, presumably adaptive traits. For example, Gould notes that bones are made of calcite and apatite for adaptive reasons, but they are white simply because that’s the color dictated by those minerals—not because “whiteness” confers an adaptive advantage.
In her upcoming book, The Pocket Therapist, Therese J. Borchard candidly observes that, “…the sensitivity that produces so much of my [emotional] pain is precisely what makes me the compassionate person I am.” [Disclosure: I wrote the forward to Borchard’s book]. I believe that Borchard may be gesturing toward one possible mechanism by which depression is genetically conserved: not by virtue of its adaptive value, but by virtue of depression’s ability to “hitchhike” along — as a spandrel — with a sensitive, altruistic, and compassionate nature: traits that are indeed adaptive, in many social contexts.
As Borchard wisely counsels, we should not renounce or disown the part of us that produces depression — it is a piece of our messy, complex, and wondrous humanity. And, to be sure: ordinary sadness or grief may indeed be a good teacher. We should not rush to suppress or “medicate” what Thomas à Kempis called “the proper sorrows of the soul.” At the same time, we should be under no illusion that severe clinical depression is a “clarifying force” that helps us navigate life’s complex problems. That, in my view, is a well-intentioned but destructive myth.
Lehrer, J: Depression’s Upside. New York Times Magazine, Feb. 28, 2010.
Forgas, JP: On being happy and mistaken. Journal of Personality and Social Psychology 1998;75:318-31.
Hosokawa T, Momose T, Kasai K. Brain glucose metabolism difference between bipolar and unipolar mood disorders in depressed and euthymic states. Prog Neuropsychopharmacol Biol Psychiatry. 2009 Mar 17;33(2):243-50
DeBattista, C. Executive dysfunction in major depressive disorder. Expert Rev Neurother. 2005 Jan;5(1):79-83.
Borchard, TJ. The Pocket Therapist. New York, Center Street, 2010 (April).
Gould, SJ: The Structure of Evolutionary Theory. Belknap Press of Harvard University Press, 2002.
Pies, R: The anatomy of sorrow: a spiritual, phenomenological, and neurological perspective. Philos Ethics Humanit Med. 2008 Jun 17;3:17. Accessed at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2442112/?tool=pubmed