Sunday, February 28, 2010

Why Can't We Be Sad?



Today's New York Times Magazine has a really interesting article by Jonah Lehrer called "Depression's Upside." Mr. Lehrer talks about a possible evolutionary purpose for Major Depression.

Mr. Lehrer writes:

The persistence of this affliction — and the fact that it seemed to be heritable — posed a serious challenge to Darwin’s new evolutionary theory. If depression was a disorder, then evolution had made a tragic mistake, allowing an illness that impedes reproduction — it leads people to stop having sex and consider suicide — to spread throughout the population. For some unknown reason, the modern human mind is tilted toward sadness and, as we’ve now come to think, needs drugs to rescue itself.

The alternative, of course, is that depression has a secret purpose and our medical interventions are making a bad situation even worse. Like a fever that helps the immune system fight off infection — increased body temperature sends white blood cells into overdrive — depression might be an unpleasant yet adaptive response to affliction. Maybe Darwin was right. We suffer — we suffer terribly — but we don’t suffer in vain.

So I didn't like the article at the beginning; it relied on anecdotes--the woman who felt so much better with antidepressants that she'd grown complacent in a bad marriage, for example. It doesn't capture all the patients I see, and any way you dice it, if you end up dead from suicide, your productivity comes to a halt. It seems to me that there are some people who suffer in ways that these anecdotes don't explain. I suppose, however, even if we assume that depression is an unproductive, tormenting state, when it ends, is there something to be gained from having gone through it. Lehrer tells us, "Wisdom isn't cheap, and we pay for it with pain." I, personally, think there remains a differentiation between pain and major depression, and that perhaps one can grow through all sorts of suffering, and I'm all in favor of finding my own personal path to wisdom in ways that might not entail so much suffering. Just a thought.

But I ultimately, I liked the article because Lehrer, while clearly a proponent of the "don't mess with evolution, less drugs, please," school of thought, presents a balanced view. He gives Peter Kramer (
Listening to Prozac) a voice, and talks about the objections to the viewpoint he puts forth. He describes a theory that depression is evolutionarily helpful because of the ruminative nature of the illness. He also cues us in that this is just one explanatory theory which remains unproven, and there are others. Lehrer continues:

Other scientists, including Randolph Nesse at the University of Michigan, say that complex psychiatric disorders like depression rarely have simple evolutionary explanations. In fact, the analytic-rumination hypothesis is merely the latest attempt to explain the prevalence of depression. There is, for example, the “plea for help” theory, which suggests that depression is a way of eliciting assistance from loved ones. There’s also the “signal of defeat” hypothesis, which argues that feelings of despair after a loss in social status help prevent unnecessary attacks; we’re too busy sulking to fight back. And then there’s “depressive realism”: several studies have found that people with depression have a more accurate view of reality and are better at predicting future outcomes. While each of these speculations has scientific support, none are sufficient to explain an illness that afflicts so many people. The moral, Nesse says, is that sadness, like happiness, has many functions.

The article finishes off with the idea that people in depressive states are better thinkers, they notice more, they work better. He talks about a study that shows that on gloomy days with dismal music playing, shoppers notice more trinkets by the cash register. Gloomy weather and oppressive music might set a low mood tone, but this seems a far cry from an episode of major depression, and not something that is generalizable to anything more than clouds and music and trinkets. There's a second study mentioned of undergrads doing an abstract reasoning test that shows people with a "negative mood" perform or focus better; again, it falls short of being a comparison for major depression. The shrinks among us find it hard to imagine that 'negative moods' and Major Depression are all that linked. Everyone has negative moods. Not everyone has major depression.

What about the studies that link mood disorders and creative tendencies? This does seem likely, and we're left to wonder (my own thoughts, not the article) if the intense experience of an episode of mood disturbance either fuels creativity by feeding it material or requiring a release, or if the genetics are wired such that mood disorders and artistic talents might be coded near one another.

You thoughts?

15 comments:

NiroZ said...

Eh, only scanned what you quoted, but I suspect he needs to look up the terms 'genetic drift' and 'linking'. In other words, not every feature of mankind needs to have an evolutionary reason to exist.

cactus wren said...

I also find it hard to believe that people are more focused or creative during a depressive episode. At the same time, I can see how certain tendencies like sensitivity, rumination and generally having an intense inner life would make someone more creative and productive but also more prone to depression.

Like many other things (obesity, wisdom teeth), depression could be a byproduct of something that was adaptive at one time but is now getting us in trouble. I think that depression has existed for much of human history, but our modern lifestyle has made it much more common. From my own life, exercise is that one thing that has really helped with mood. Maybe my problems are just mild but I think the security of modern life versus depression is an OK trade off. I'd rather be 22 and depressed than to have died from an infection at age 3 and I'd rather be 50 and depressed than have died in childbirth at 22.

Sunny CA said...

I am a proponent of the "don't mess with evolution, less drugs, please," school of thought like Lehrer, but I still did not like the article at all. For one thing it seems on the surface to be science based, but it's just an opinion piece.

We are living in a world far different from our primate forebears. If we were gathering berries & roots and hunting now-extinct species while trying to keep from being eaten by saber tooth tigers or wolves we might not be feeling depressed. The pressures of the modern world are not what we evolved to handle. Like Cactus Wren, I feel better when I exercise a lot.

When I am depressed I don't feel more productive or focused; I feel the reverse. For all the pain of depression I have found no personal benefit. I find it hard to buy the argument that Darwin was a success as a result of depression rather than in spite of it.

Novalis said...

Evolutionary advantage is irrelevant when considering whether to perpetuate a behavior or state of affairs. Rape, abuse of stepchildren, genocide: all evolutionarily advantageous to the perpetrators.

I think of Dickinson:

I like a look of Agony
Because I know it's true
Men do not sham convulsion
Nor simulate a Throe

Oops, but they *do*, not consciously usually, but sometimes unconsciously in response to the social environment.

Sherri Nichols said...

I disliked the article, for all the obvious reasons. The notion that drugs would prevent people from working on their problems certainly runs counter to my own experience. I was incapable of working on my problems until drugs could break me out of the spiral of major depression. As Lehrer mentions in the article, evolutionary psychology is controversial; I find it so because it seems to be mostly guesses not backed by any science.

Anonymous said...

I read the article and was not a fan. As others here have pointed out, it completely ignores the possibility that evolution neither selects for, nor against, depression. It argued that sadness and rumination and the occational depressive episode could teach the mind to problem solve and work through things, but virtually ignored the fact that major depression does not fit the same mold.

If anything, I find articles like this unhelpful because they suggest that depression is a normal process that people should work through, that it's not all that different from sadness, and that, in the words of South Park, "drugs are bad". And I simply disagree.

Anonymous said...

This seems to me like a statement of the obvious fallen victim to black-and-white thinking. Medication is not as wonderful as your drug reps would claim, nor is it as awful as anybody who has fallen victim to a psychiatrist who takes everything their drug rep says as gospel truth would say it is. If you're somewhat discontented, you have motivation to improve your life. If you're in the depths of depression, you don't have motivation to do anything at all.
The entire concept simply fails to differentiate between "depression" as generally used to mean "I'm feel down" and the disorder of clinical depression. The fact that some discontentment will bring about change doesn't negate the fact that clinical depression is a disorder that needs to be treated. Was there ever any question of that?

jessa said...

I think that one of the biggest problems in understanding depression is that we tend to view all depressions, all along the spectrum, as qualitatively the same. I don't think this is true. Andrews gives a nod in this direction, and I have seen other researchers do the same, but their research still seems to be structured based on an assumption that all depression is qualitatively the same. And certainly the wider society is not so careful to make this distinction as the researchers.

From my experience, I am fairly certain (though, of course I can never be totally certain) that my depression is qualitatively different than what most people experience, even than what most people with a diagnosis of depression experience. There is something other about it, it is oppressive, and all the talking it through and good coping skills in the world cannot make it go away. Those things can help me live my life a little better in the midst of the depression, but they can't make me feel any different. When I am on drugs that work for me (and I base my faith in the drugs having alleviated that oppressive depression on the timing of my depressions relative to the timing of the drugs; I am fairly confident in their power.), that depression is able to lift to a level that still fits the diagnostic criteria, but that actually can be helped with talking it through and good coping skills. I can only fence off the oppressive depression with drugs; it is there waiting for me if I stop taking the drugs and I fear that the drugs might ever quit working for me.

I find that oppressive depression to be profoundly double-edged. I think differently, and that is not always for the better. I may perhaps have better focus, but I am unable to direct that focus usefully. I suspect that some of my critical thinking skills that I have and enjoy the use of when I am well come partly from my experience with depression. But I can't say for sure because I became oppressively depressed when I was 14 and it only lifted when I was 22; there would have been a big difference in my critical thinking skills over that time period whether I was depressed or not.

Cole Bitting said...

The anti-evolution argument miss several relevant points.

1) Depression is a mood yes, but it also represents an underlying behavior. The consequence of the mood might be awful, but the behavior still can be adaptive. Extended periods of low energy are pervasive for mammals. The adaptability is similarly pervasive. Much more science would be required to dismiss depression as a 'wisdom tooth,' than to support the contrary point.

2) There is a broad continuum of mood states associate with the behavior of depression, from persistent sadness to depressive symptoms to depression to clinical depression to MDD. At the horrid end of the spectrum the mood state is a condition that itself is pathological and merits significant medical and therapeutic intervention (and it is appropriate to select appropriate medical and therapeutic options for any spot on the continuum). But again, the point that depression is biologically fit is not impaired by the severe consequences of clinical depression or MDD.

3) Even if depression is evolutionarily select for or is biologically fit, we don't not have to as a society choose to limit treatment for depression. The treatment decision reflects the moral choice to alleviate suffering. Who cares if depression is evolutionarily fit at these moments?

4) "Evolution" v "drugs" is a nonsensical construction. One has little to do with the other. We should explore the complexities of human nature and address the question "What purpose does depression serve?" Similarly, we should continue to improve treatment options for depression.

Retriever said...

Being born into a family that has suffered from mood disorders generation after generation, I can say categorically that depression sucks. Being depressed does not make one more creative. I tend to think that it is related to genes that promote creativity, but in my experience treating the suicidal despair enables greater creativity.

I have also taken care of relatives either so delusionally and violently manic or so suicidally depressed that I am grateful for even the inadequate meds we have, which help to moderate the destructive extremes and make a person available for treatment, for love, and the help of family members, church and friends.

Our family has been blessed by some gifted and compassionate doctors to whom many family members owe their lives. Psychiatry is a peculiar vocation: part MD, part minister, part wizard, part friend, part coach, part sage, part analyst. I can't imagine a more worthwhile specialty. To be in a position to reawaken hope, encourage growth, help a person balance between extremes. to help their search for meaning and purpose in life when the ignorant outsider dismisses them as wack jobs or losers...that is a great calling.

There may be some silver lining to depression (I tend to think that Eeyores are more realistic than Tiggers), but let the depressed and those who have recovered be the ones to describe it.

I have a young relative whose life has been hell because of treatment resistant depression. Frequent suicide attempts. Brilliant, a poet, great insights. I wish, and they wish, that they were a happy clod instead, without one original insight, if they had only been spared the depression. The dark night of the soul. With hindsight, one can see that the walk thru the valley of the shadow of death may have led one to somewhere wondrous. If one has not been destroyed getting there...

cactus wren said...

A few more thoughts:
Ok, a wisdom tooth isn't the best analogy. A better comparison would be sickle-cell anemia which persists because heterozygotes have increased resistance to malaria. I think a main point of the article is that mild forms of depression could be adaptive.

But, before you can even figure out how this could increase fitness, you have to figure out what on earth this mild but genetically similar form of depression would be. Does the spectrum go normal sadness, severe unhappiness that's not MDD, something diagnosable as MDD that's debilitating, to suicidal debilitating depression?

My guess is that even really bad versions of everyday suffering are not genetically related to severe depression, but I don't have a clue where to draw the line.

Battle Weary said...

I think it's important to note that not all evolutionary adaptations are beneficial! How many water plants and other creatures found their way out of the water only to die out because they were unable to stay moist in a dry environment?

I agree that their is a huge difference between "negative moods" and major depression! Negative moods encompasses so many different things...for example, anxiety. Mild to moderate anxiety helps me with my school work. Being unable to get out of bed or concentrate on anything due to depression, does not. I skimmed the article, and I was struck by the classification of Darwin suffering from depression. Having ""fits" brought on by “excitements,” “flurries” leading to an “uncomfortable palpitation of the heart” and “air fatigues” that triggered his “head symptoms.” In one particularly pitiful letter, written to a specialist in “psychological medicine,” he confessed to “extreme spasmodic daily and nightly flatulence” and “hysterical crying” whenever Emma, his devoted wife, left him alone", sounds a lot more like anxiety than depression to me!

The Alienist said...

The claim that major depression is beneficial rests on the naturalistic fallacy. Just because some trait or behavior exists in nature does not make it either good or right.

On the other hand, many in our culture seek to avoid sadness (even appropriate sadness) when it appears to be an adaptive behavior. I believe that the use of medications to avoid normal and appropriate emotions (even if unpleasant)is open to just criticism.

Anonymous said...

It may have been Archives of General Psychiatry that had the idea, or an article at least, that depression kept lower ranked monkeys from attacking the dominant monkey which might have an evolutionary advantage. Here is another idea. To make a perhaps too striking historical example, Christ had many insightful and inspiring observations but had opposition by the elite; if he had gotten depressed and not attacked 'the money changers in the temple,' he might have married Mary Magdalen and had descendants.

Clarissa said...

As a professional classical musician, I'd like to offer my perspective on the subject of major depression.

I was diagnosed with bipolar disorder some years ago - however, though I've overturned that diagnosis in favour (if possible?!) of Emotionally Unstable Personality Disorder, I also suffer with major depression and have done all my life.

I know that I have periods of intense creativity, where I become very productive. These periods could be described as hypomanic, but they seldom tip over into full blown mania. They do however signal the zenith of an impending nadir in mood, and more often than not are proceeded by a bad depression.

I want to dispel the myth that bipolar disorder, depressions and manias are in any way desirable or give way to any higher creative genius. This is terribly unhelpful to anyone who is associated professionally with being intrinsically creative.

But what I can add is that these periods of mental ill health DO contribute to the intense inner life that feeds creativity - but not while the illness is taking its course. Most of my best work is done when I am in recovery or well, and able to reflect upon my experiences with low or high mood. You cannot be a professional musician without having insight: which is something you lose in the depths of a major depression.

I am unable to be at all productive when severely depressed: it reduces me to a monosyllabic child-like state, so I believe that when people talk about creativity and depression being linked, I think there is a misapprehension of what real depression is actually like.

While I don't think that there is anything wrong with being a bit depressed or melancholic - even quite seriously so, I do believe there are places that the human mind can go to that are damaging, and should be avoided since there are some of these thoughts that lead to suicide or severe injury.

My view on medication is similar to this. I hate it - with a passion. But, because somewhere down the line the looney bin beckons without medication beyond a certain point, thank you very much, I'd rather take the drugs before I get there.

I hope this makes sense - there aren't very many professional musicians who are prepared to discuss their mental health out there - not even anonymously - even though there are many who suffer very deeply with mental ill health...

Sincerely,
Clarissa
www.justdifficult.com