Thursday, January 30, 2014

To Fight or Not to Fight Depression

The more we think about depression, the more we devote resources to curing depression, the more depression there is.

When Prozac arrived on the scene it was touted as a cure for depression. For many people it still serves to help, but it has certainly not put an end to depression. In fact, there seems to be more depression now than there was in the pre-Prozac era.

Psychologist Jonathan Rottenberg says that we seem to be losing the fight against depression:

Perhaps the most troubling and ironic thing about the toll of depression is that it has risen while more research and treatment resources have been poured into combating it. In fact, depression represents an $83-billion annual burden to the United States economy in lost productivity and increased medical expenses. Why aren’t we winning this fight?

What’s wrong with our approach to depression? Rottenberg suggests that we are failing to cure depression because we see it as a defect. He recommends that we understand depression as way an organism adapts to adversity. He sees it as a function of low mood.

He explains:

People in a low mood blame and criticize themselves, turn situations that went wrong over and over in their heads, and are pessimistic about the future. These characteristics, although uncomfortable, are also potentially useful. A keen awareness of what has gone wrong and what can go wrong again can help a person avoid similar stressors in the future….

If we had to find a unifying function for low mood across these diverse situations, it would be that it functions like a cocoon, a place to pause and analyze what has gone wrong. In this mode, we will stop what we are doing, assess the situation, draw in others, and, if necessary, change course.

A variety of experimental data have shown that low mood confers benefits to thinking and decision making. That lends credence to the idea that mood is part of a conservative behavioral guidance system that impels us toward actions that have been successful in the past—meaning, actions that helped our ancestors to reproduce and spread their genes. One way to appreciate why these states have enduring value is to ponder what might happen if we had no capacity for them. Just as animals with no capacity for anxiety were long ago gobbled up by predators, without a capacity for sadness, we and other animals would likely commit rash acts and repeat costly mistakes. Physical pain teaches a child to avoid hot burners; psychic pain teaches us to navigate life’s rocky shoals with due caution.

Of course, low mood is not the same as depression. We do well to keep in mind Martin Seligman’s definition of depression: it's the moment when you convince yourself that you are in a lose/lost situation and give up.

People who are depressed are not conserving their energy while planning their next move. They are demoralized to the point where they do not believe that they can do anything to improve their condition. There do not think that there will ever be a next move.

Rottenberg suggests that it’s a question of degree, but it does feel like a difference of kind.

I agree that there is value in learning from failure, in ruminating about what went wrong, but knowing why something went wrong tells you nothing about how to make things go right. The more you ruminate about what went wrong, the lower your morale will be. The lower your morale, the more difficult it will be to take decisive action.

If Prof. Rottenberg tells you that ruminating about what went wrong is a normal mental function, he might be making it more difficult to overcome depression.

Reflection can help you to plan for the future and to figure out how you are going to implement the plan. But, this type of reflection involves the use of imagination. It does not involve belaboring the future. It buttresses your confidence in order to give you the wherewithal to perform future tasks.

Depressed individuals are often assailed with self-deprecating thoughts that tell them that they never get anything right.  Thus, they believe that nothing is worth trying.

Rottenberg is suggesting that people should stop feeling bad about feeling bad. He wants them to stop punishing themselves for feeling depressed. I presume that he wants people to accept low moods as a normal part of life.

But, this assumes that depression results from a failure to embrace depression.

If that is his argument—his essay does not make it very clear—then he has simply redefined the defect. If you are depressed you have not dealt with your bad moods correctly.

That is not all. Rottenberg also suggests that the cultural environment contributes to the prevalence of depression.

Changes in the cultural environment magnify these problems. Triggers include mood-punishing routines—too much work, too much stimulation, and too little sleep—and even changes in our attitudes toward sadness. Ironically, our stratospherically high expectations about happiness have made low moods harder to bear.

I am not sure we have such stratospherically high expectations about happiness, but we have certainly been told that depression is easily curable by taking a pill. The medical profession has created the expectation. In and of itself, this expectation is likely to cause people to become more depressed when their illness does not respond to medication.

The medication-based model of treatment tells people that there is little they can do on their own, through their own efforts to treat their depression. Surely, this makes it more likely that people will give up on their efforts to treat their condition.

Obviously, too little sleep does contribute to depression, as might too much work. But the lack of career success, caused by not-enough-work, also contributes. We might say the same for social dislocation and disaffection.

In closing his article Rottenberg described his own experience with depression. He explained that none of the treatments he tried worked. The depression, he said, simply exhausted itself.

Is he suggesting that we do better to offer less treatment for depression? Is he saying that all efforts to treat it are futile?

If so, he is coming perilously close to saying that we should simply give up. Unfortunately, this is the mindset that causes depression in the first place.

Perhaps Rottenberg has lit on a paradoxical treatment for depression. Then again, he might have found one of the ways in which the culture sustains depression.

1 comment:

David said...

I heartily recommend Barbara Ehrenreich's book Bright-sided: How the Relentless Promotion of Positive Thinking Has Undermined America.

It seems to me that depression - the profound, de-motivating kind - is both an urgent psychological, perhaps psychosomatic, signal that one's values are misconceived as well as a form of guilt, guilt for not being able to live up to those misconceived values or for having failed to conceive appropriate ones. Guilt is a form of self-punishment. It is natural, and though it ought not to be mindlessly celebrated, it ought not to be automatically classed as a malfunction - as something to be squelched instantly, say by popping a Valium or saying an affirmation.

Rotterberg appears to be on to something: feeling "bad" has survival value; it is information we can turn to good account in improving our lives.

A good book would be one teaching us how to listen to depression productively. If I knew the answer to that for sure, then I would write this book myself.