Debating Depression

From 'Living with a Black Dog' by Mathew and Ainsley Johnstone

Is major depression an illness or malfunction of the brain that needs to be cured or is it somehow adaptive in our evolution? (Or even both). The traditional view of mental illness would suggest the former but there’s an argument to be made that depression has some benefits too. This is certainly what writer (and blogger) Jonah Lehrer puts forward in his recent and excellent article ‘Depression’s Upside’ in the New York Times Magazine.

Lehrer takes the work of a psychiatrist and an evolutionary psychologist, Andy Thomson and Paul Andrews, and presents it in a challenging and refreshing way. Their central hypothesis, the ‘analytic-rumination hypothesis’ suggests that being mildly depressed (or even majorly depressed) can help to focus our attention, which in turn makes us more analytical. Here’s an excerpt from Lehrer’s article:

This radical idea — the scientists were suggesting that depressive disorder came with a net mental benefit — has a long intellectual history. Aristotle was there first, stating in the fourth century B.C. “that all men who have attained excellence in philosophy, in poetry, in art and in politics, even Socrates and Plato, had a melancholic habitus; indeed some suffered even from melancholic disease.” This belief was revived during the Renaissance, leading Milton to exclaim, in his poem “Il Penseroso”: “Hail divinest Melancholy/Whose saintly visage is too bright/To hit the sense of human sight.” The Romantic poets took the veneration of sadness to its logical extreme and described suffering as a prerequisite for the literary life. As Keats wrote, “Do you not see how necessary a World of Pains and troubles is to school an intelligence and make it a soul?”

I’m tempted to take that last quote and put in on my business card but I’m sure there are many who would dismiss Keat’s sentiment as dangerously unscientific. What Lehrer (and Thomson and Andrews) don’t do is to downplay the seriousness of depression or to make light of people’s suffering. I’m sure they would have every sympathy for someone like Kay Redfield Jamison (a psychology professor who is herself one of the most well-known bipolar sufferers in the US) who writes the following in her memoir An Unquiet Mind:

Depression is awful beyond words or sounds or images; I would not go through an extended one again. It bleeds relationships through suspicion, lack of confidence and self-respect, the inability to enjoy life, to walk or talk or think normally, the exhaustion, the night terrors, the day terrors. There is nothing good to be said for it except that it gives you the experience of how it must to be old, to be old and sick, to be dying; to be slow of mind; to be lacking in grace, polish and co-ordination; to be ugly, to have no belief in the possibilities of life, the pleasure of sex, the exquisiteness of music, or the ability to make yourselves and others laugh.

She goes on to say that some people say that they know what it’s like to be depressed because they’ve gone through a divorce or lost a loved one or a job. But the intense sadness which most people would feel in such situations is qualitatively different from the suicidal despair of major depression, which Redfield-Jamison describes as “flat, hollow, and unendurable”. Depressed people, like the main character in David Foster Wallace’s story ‘The Depressed Person’, can be tiresome beyond belief, trapped in a seemingly endless loop of whining and pain. Redfield-Jamison again:

People cannot abide being around you when you are depressed. They might think that they ought to, and they might even try, but you know and they know that you are tedious beyond belief: you are irritable and paranoid and humourless and lifeless and critical and demanding.

How could this condition possibly have a plus-side? Well, one answer seems to lie in the fact that the disorder is such a broad one. For those with a milder form of depression or who have the support and intellectual skills to grow through their depressions, the analytic-rumination hypothesis (or ARH) could be more applicable. For many others, though, bouts of depression might just be simply awful with almost no benefits at all.

One of the scientists Lehrer quotes who is sympathetic to the analytic-rumination hypothesis is Randolph Nesse, who suggests that the hypothesis, while admirable, fails to reflect the heterogeneity of depression:

Andrews and Thomson compare depression to a fever helping to fight off infection, but Nesse says a more accurate metaphor is chronic pain, which can arise for innumerable reasons. “Sometimes, the pain is going to have an organic source,” he says. “Maybe you’ve slipped a disc or pinched a nerve, in which case you’ve got to solve that underlying problem. But much of the time there is no origin for the pain. The pain itself is the dysfunction.”

Andy Thomson himself responds to the major criticism of his hypothesis as follows:

“To say that depression can be useful doesn’t mean it’s always going to be useful … Sometimes, the symptoms can spiral out of control. The problem, though, is that as a society, we’ve come to see depression as something that must always be avoided or medicated away. We’ve been so eager to remove the stigma from depression that we’ve ended up stigmatizing sadness.”

This is such an important point and one of the big bugbears that I have with how the discipline of mental health is so often practised. It’s so tempting to stigmatise painful symptoms, be they intense sadness or anxiety or even paranoia.

What I also like about the analytical-rumination hypothesis (or ARH for short) is that it prompts a re-evaluation of depression. Depressives needn’t see themselves as weak and somehow deficient, just perhaps as people whose symptoms can spiral out of control when they are confronted with life’s problems.

Thanks to Ted at BookeyWookey for referring me to this article. It certainly affirms my view that the more I learn about mental health, the more I find out how complex it is.

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5 Responses to Debating Depression

  1. litlove says:

    What an interesting post. I tend to think of the analytical insight that come out of depression as a useful side effect, a sort of mental making the best of it. Certainly I know many, many academics with varying levels of depression. And I presume that it’s an adaptive function on their parts to find work that suits their mindset, rather than an adaptive function of the mind to seek melancholic reflection. But still, I am sure all these good psychiatrists are respecting the awfulness of the condition in its further reaches. I think Kay R-J is a wonderful writer, btw.

  2. It is an intriguing way to look at depression. I also think it’s important to distinguish between intense sadness and depression, between situational depression and non-situational. There is far too little tolerance in our society for sadness and depression, a desire to medicate it out of existence. On the other hand, when it is life threatening or soul destroying, it ought to be recognized as such.

  3. Grad says:

    One of my college roommates was, I am quite convinced, bipolar. I don’t think she was ever diagnosed as such however. I hate to admit this, but during her “down” times, she really was tedious. As a pediatrician once told me, when your infant is crying, you realize the infant can’t help it. But crying is still noise, and noise wears on you. It is difficult to live with someone who is depressed; one feels very helpless, and that’s hard for someone who likes to “fix” things. This was such a good post. BTW, my roommate and I are still friends, and we’ve been able to discuss those days with honesty.

  4. Fugitive Pieces says:

    Pete, I can hardly express how delighted this post and the linked article on ARH make me. I spent a lonely few years during my Psychology degree, arguing that sadness was not the same as depression (reactive or otherwise), that rumination was not just a self-indulgent downward spiral, and that the well-established link between melancholy and creative intelligence SURELY suggested that there might be something worthwhile, worth having, about this predisposition. For some of the people, some of the time. Mmm. Not a popular viewpoint. Apparently we’re all supposed to be happy, all of the time.
    Rumination can be an engine. The hunger to acknowledge the world you’re in, the compulsion to analyse it, the desire to re-imagine it (precisely, minutely, determinedly) – those are what afford some of us strength, whether to change our lives or just inhabit them fully. I like the opening lines of ‘The Noonday Demon’, Andrew Solomon’s book: “Depression is the flaw in love. To be creatures who love, we must be creatures who can despair at what we lose, and depression is the mechanism of that despair.”
    I wouldn’t live without that sense of fragility, of temporality; for despite the humiliations that illness has caused me, it has also given me humility, and a sense of exquisite gratitude for small delights, as well as large ones. Is it really so unlikely that something so prevalent as sadness might also have a purpose? Or even that its ugly big brother, depression, might teach you something worth knowing? Like the man says, wisdom isn’t cheap.

  5. Pete says:

    Litlove – Thanks. And that’s a good way of putting it, as a useful side effect. I’m sure there were many academics who read the Lehrer article and found its message very gratifying. Melancholic rumination as something almost to be proud of.

    Lilian – Yes, that’s a crucial distinction between situational depression and a more long-term, chronic condition. I’m all for more sensitivity to what people are experiencing.

    Grad – Thanks. I’m glad you managed to remain friends with your roommate but I agree about the tedium. And the manic or hypo-manic episodes can be pretty scary for friends and family too.

    Fugitive Pieces – Thanks for that great comment. I really like what you have to say about rumination and the desire to re-imagine the world and also humility. This article was also very encouraging for me. I agree about wisdom not being cheap. Now if I can only find a way to crank it out on a more regular basis 😉

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