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Jonah Lehrer is a contributing editor at Wired. He's also written for The New Yorker, Seed, Nature, and the New York Times and is a contributor to Radiolab. He's the author of Proust Was A Neuroscientist. His new book is How We Decide.

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More on Depression

Posted on: March 5, 2010 4:58 PM, by Jonah Lehrer

I thought it's worth addressing this article one last time. Dr. Ronald Pies (professor of psychiatry at SUNY Upstate Medical University in Syracuse) has written three eloquent and extremely critical blog posts about the article and the analytic-rumination hypothesis. Here's his latest riposte:

Writer Jonah Lehrer caused quite a stir with his recent article in the New York Times Magazine, with the unfortunate title, "Depression's Upside." I have a detailed rejoinder to this misleading article posted on the Psychcentral website. The fault is not entirely Mr. Lehrer's however; his sources included a psychiatrist and a psychologist, who have recently presented a strained and dubious argument claiming that major depression has certain "adaptive" advantages. Lehrer apparently spent little or no time talking to mood disorder specialists who see thousands of severely depressed patients each year.

I'd like to refute that last point. I talked to numerous working psychiatrists - several of which are quoted in the article - and, not surprisingly, got a wide range of reactions to the analytic-rumination hypothesis. Some thought it was interesting and might make sense for people with mild and moderate depression; others, like Peter Kramer, thought it was utter rubbish. (As Kramer says in the article, "It's a ladder with a series of weak rungs.") Dr. Pies implies that every psychiatrist shares his viewpoint, but that's clearly not the case. See, for instance, this recent Louis Menand review for more.

Let's take a seemingly straightforward fact that Dr. Pies has cited in all three of his critiques of the article:

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; eg, by increasing one's empathy toward others, which could be highly adaptive in obvious ways. [cf. "A broken heart prepares man for the service of God, but dejection corrodes service."-- Rabbi Bunam of Pzysha].
This could be true, in theory, for more severe depression, but there, the maladaptive aspects of the illness would likely outweigh any modest advantages by a huge margin; eg, the 15% mortality rate in major depression (naturalistic studies), mostly by suicide.

Dr. Pies doesn't cite the specific study, so it's unclear what he's referring to. But it's also worth pointing out that numerous studies have found no relationship between depression and increased mortality. See here, here and here. I'm not trying to dispute the correlation between major depressive disorder and mortality, which I think is pretty clear, especially when it comes to cardiovascular illness. I'm merely trying to show that even a fact as "obvious" as the link between depression and mortality gets complicated and contested very quickly. (Things get even more complicated, of course, when the conversation turns to things like the cognitive deficits of depression.) Here's the summary of a large review on the subject:

There were 57 studies found; 29 (51%) were positive, 13 (23%) negative, and 15 (26%) mixed. Twenty-one studies (37%) ranked among the better studies on the strength of evidence scale used in this study, but there are too few comparable, well-controlled studies to provide a sound estimate of the mortality risk associated with depression. Only six studies controlled for more than one of the four major mediating factors. Suicide accounted for less than 20% of the deaths in psychiatric samples, and less than 1% in medical and community samples. Depression seems to increase the risk of death by cardiovascular disease, especially in men, but depression does not seem to increase the risk of death by cancer. Variability in methods prevents a more rigorous meta-analysis of risk.

Dr. Pies has also argued that it was irresponsible to write about this speculative theory, since it might lead people to neglect treatment. Just to be clear: Neither I, nor Dr. Thomson, ever suggest that people shouldn't seek help for depression. That's just not in the article. Dr. Thomson is critical of what he regards as the "overprescription" of anti-depressants, but that's hardly a novel criticism of modern psychiatry. In fact, one can believe that the analytic-rumination hypothesis is a deeply flawed idea - and there are many good reasons for believing so - and still believe that we're too reliant on medications that aren't better than placebos for treating mild to moderate cases of depression. (Dr. Thomson, for instance, believes that we need more therapy, just better focused on solving real life problems.) But this was not an article about how to treat depression. This was an article about a new theory that attempts to explain why a disorder that feels so goddamn awful is also so common.

As I note repeatedly in the article, this hypothesis remains entirely speculative, with no direct evidence to support it. Given the dismal history of psychiatric speculations - we have no idea, for instance, why SSRI's work, when they do work - the odds are stocked strongly against it. But let's not pretend that modern psychiatry is such a settled science that it can't tolerate a controversial new idea.

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Comments (43)

The irresponsibility arises form overestimating the skepticism of the average lay reader. Though you nor Dr. Thomson recommend depressed patients should neglect treatment, when a controversial theory with little scientific backing beyond correlations and behavioral theory is given such high profile status, it's not such a leap to assume that many will see it as an authority. Given the public ignorance over the scientific process, I actually think it is a guarantee this will happen to some degree.

Posted by: Noah Gray | March 5, 2010 5:03 PM

As someone who has seen a lot of people suffer immensely from the treatment that Ronald Pies fears people might not seek after they read your article - some to the extent that they chose to end their life; sic -, I wonder which is more dangerous, to offer a new perspective that, as you point out, doesn't even advise against treatment, but merely offers an opportunity to find meaning with one's suffering, or to keep on confronting people with hypotheses about meaninglessly imbalanced serotonin levels in the brain that have shown to a) not hold water, b) leave the individual stuck in a state of helplessness and dependence, and c) consequently often prevent recovery, and lead to chronification. - No, actually I don't wonder. I know, from experience, which one is the more dangerous choice.

I don't have the authority of a neurologist, psychiatrist, psychologist... But from the perspective of someone who's lived the experience of suffering herself I want to thank you again for a brilliant and necessary article. For what it's worth.

Posted by: Marian | March 5, 2010 5:41 PM

I read this article with disbelief and anger. As one who has suffered from clinical depression for many years I wonder at the ignorance of the psychiatrist and a psychologist who came up and "tested" their theory. (Quoting Darwin) it is the sadness that informs as it “leads an animal to pursue that course of action which is most beneficial.” The darkness was a kind of light.
Sadness is not equatable with clinical depression and there is no light in the darkness of true depression.
"We’ve been so eager to remove the stigma from depression that we’ve ended up stigmatizing sadness.” Again the harmful comparison.
The medical field and society have began to accept clinical depression not as a stigma but a disease that requires treatment.
These "researchers" with their theories & study assumptions can set society's understanding back centuries.
In the deep disconnect of depression life stops, lifting a finger is beyond one's ability. For me? I just wanted the mist that was my life force to rise up out of my body and float away.
Was I seeking attention from loved ones? No, the guilt of the pain & helplessness my depression caused my loved ones was overwhelming.
Was I lazy? No I wasn't lazy - I was sick.
Minimizing depression with such a PollyAnnaic "ligitimate" conclusion minimizes all of us who struggle with this illness. And worse, Does nothing to encourage those with untreated depression to seek help.
Depression can be helped with the proper medications and therapy.
It can be helped but often lingers in the periphery.
So much to relate to in this article but I will end my comments here.

Posted by: Paula Wagner | March 5, 2010 6:43 PM

This is what I found most lacking in your article:

The first thing Andrews found was that nondepressed students showed an increase in “depressed affect” after taking the test. In other words, the mere presence of a challenging problem — even an abstract puzzle — induced a kind of attentive trance, which led to feelings of sadness. It doesn’t matter if we’re working on a mathematical equation or working through a broken heart: the anatomy of focus is inseparable from the anatomy of melancholy.

I've commented about this on my blog, but the basic issue is, how do they know that the "attentive trance" led to feelings of sadness? Would any college undergrad be happy right after taking a test? Couldn't they all have depressed affect just because they had to go to a lab to take a test, instead of doing something else more fun? Or am I missing something here?

Posted by: FunPsych | March 5, 2010 7:00 PM

I'm a psychotherapist and have suffered from depression, so I feel qualified to offer an opinion on this subject. I wonder for the state of the science when a new idea can make people so nervous and upset. I regard this as an interesting idea and it makes sense for some of my patients with situational depression. Its an evolutionary theory so it's going to be hard/impossible to test. But I don't think it diminishes the seriousness of depression or that we should ignore ideas because they might lead people to question certain avenues of treatment. It's also a very old idea. If it's so dangerous we are going to have start censoring Freud and Aristotle.

Posted by: Lee | March 5, 2010 7:04 PM

I thought your article took a very balanced approach, and made it clear that this is a speculative hypothesis whose validity is certainly in question and remains to be determined.

Posted by: Comrade PhysioProf | March 5, 2010 9:38 PM

I thank Mr. Lehrer for responding to my critiques in a civil fashion—a habit sorely lacking on the internet these days!

I am not surprised that Jonah Lehrer got “a wide range of reactions” to the analytic-rumination hypothesis from “numerous working psychiatrists.” I specifically opined that he did not consult much with “mood disorder specialists.” Psychiatrists come in all stripes—some have very little experience with severe mood disorders, others see almost entirely mood-disordered patients.

If Mr. Lehrer wants to engage in a wager, I’ll be happy to go along: if he can document to my satisfaction that five directors of U.S. medical-school based, mood disorder clinics agree that “DSM-IV defined major depression has significant adaptive value and positive psychological effects”, I’ll publish the data on the Psychiatric Times website; publicly apologize for my abysmal ignorance; and buy Mr. Lehrer dinner at his favorite restaurant!

Digging the journalistic hole even deeper, Mr. Lehrer now wants to sow controversy about “mortality” in major depression in roughly the way deniers of global warming want to claim that this is a “controversy” among specialists in atmospheric science. Let’s look at Mr. Lehrer’s literature citations:

The 1999 review by Wulsin et al, summarized by Mr. Lehrer, concludes by saying, “…The studies linking depression to early death are poorly controlled, but they suggest that depression substantially increases the risk of death, especially death by unnatural causes and cardiovascular disease.”

The 1987 Fredman study cited by Mr. Lehrer was a community survey of elderly community dwellers, which found “...that depression does not increase mortality in elderly adults.” However, these subjects did not receive a clinical diagnosis of major depressive disorder; so far as I can tell, they were not assessed by clinicians, but merely scored high on two measures of depression in a survey.

The study by Parmelee et al was again restricted to a small subgroup: institutionalized elderly subjects. In fact, the study found “…an increased death rate among possible major depressives as compared with other respondents”. After controlling for other variables, the study concluded that “…the effects of depression on mortality among this sample appeared to be attributable strictly to the correlation of depression with ill health.”

Can we agree, Mr. Lehrer, that this is hardly a ringing endorsement for the marvelous evolutionary advantages of depression?

Now, as to the figure of “15%” I cited in my editorial: I will acknowledge some controversy over this figure, for which I take responsibility. I intended it to reflect the lifetime risk of suicide in major depression; indeed, many older studies cite this figure.

For example, NIH and other government data state,
“ An often-quoted risk is that about 15% of patients with major depression will eventually die by suicide (Guze & Robins, 1970). This rate was further reinforced by a large-scale review of 30 studies (Goodwin and Jamison, 1990). These data derive largely from studies of severely depressed inpatients, whereas the majority of depressed people are treated as outpatients or not treated at all.” http://mentalhealth.samhsa.gov/suicideprevention/risks.asp

This same government website goes on to cite more recent data suggesting that the suicide rate in major depression is probably closer to about 2% for outpatients, and about 6% for inpatients. Nonetheless, averaging this out, a suicide rate of about 4 per 100 patients is surely not trivial. This is many magnitudes greater than the suicide rate in the general U.S. population, which is around 11 per 100,000 people in 2005 (Hu et al, Am J Prev Med 2008;xx(x):xxx)

I am not alone in this concern. See, e.g., the posting on: http://news.psydir.com/Psychology-Articles/depression039s-cognitive-downside/, which not only demolishes the analytic-rumination hypothesis, but which also states,

“The analytical rumination hypothesis even has the potential to be harmful. Belief in the glorious "upside" of their ailment could prevent some severely depressed individuals from getting proper treatment, placing them at greater risk of suicide and other adverse events. Needless to say, such an outcome would be of no evolutionary advantage.” [Go to psydir.com home page if you have trouble with the link].

Finally, while I agree that antidepressants—most of which are prescribed by primary care doctors-- may sometimes be overused for mild, transient depressive states that don’t meet DSM-IV criteria for major depression, Mr. Lehrer’s disparaging comments about antidepressants and placebos need to be carefully qualified.

The two meta-analyses usually cited as evidence against antidepressants’ efficacy (Kirsch et al and Fournier et al) both found the medications significantly more effective than placebo for precisely the condition one would want the drugs to “work for”: severe major depression. I have detailed reviews of these studies—both of which have many flaws—at the following websites:

http://www.psychiatrictimes.com/home/content/article/10168/1520550

and
http://psychcentral.com/blog/archives/2008/03/02/devil-or-angel-the-role-of-psychotropics-put-in-perspective/

Finally, I don’t blame Mr. Lehrer entirely for the unfortunate impressions created by his article; in a sense, he was the “messenger” for some very dodgy research. Unfortunately, the damage is now done, and it is very hard to unring the “bell” of the august New York Times. I would therefore respectfully urge Mr. Lehrer, a responsible journalist, to authorize a retraction of his piece in the Times; or at least to publish a letter in the NY Times Magazine that puts the original article in a more accurate and helpful perspective.

Sincerely, Ronald Pies MD

Professor of Psychiatry and Lecturer on Bioethics & Humanities, SUNY Upstate Medical University; Clinical Professor of Psychiatry, Tufts USM Boston; Editor-in-Chief, Psychiatric Times.

Posted by: Ronald Pies MD | March 5, 2010 11:41 PM

I have very strong feelings regarding the hypotheses discussed in your article. But then, I always have strong feelings when it comes to articles about depression. Of course I do. Depression is a brutal and isolating experience and it's difficult not to react emotionally when people express their own theories and opinions on it.

That said, the article was well researched, carefully considered, and [as always with your stuff] amazingly well written. Not to mention... the theory is out there. It's being discussed openly by prominent psychologists and hell, you're not even the first to mention it in a mainstream news article. So I've got to say I don't really get where a lot of the critics are coming from when they claim that the article was not sufficiently researched, or that it was somehow irresponsible.

The "irresponsible" bit, the accusations that this was somehow going to hurt people or keep them from getting treatment... that really gets to me. Because articles questioning the validity of psychiatry, of antidepressants, of depression as a disease...the list goes on...are EVERYWHERE.

Honestly, I'm just grateful that when one of those articles gets this much attention, at least it is a thorough one that attempts to take an honest and unbiased look at the science involved.

Posted by: Keely | March 6, 2010 12:01 AM

Part 2

“ An often-quoted risk is that about 15% of patients with major depression will eventually die by suicide (Guze & Robins, 1970). This rate was further reinforced by a large-scale review of 30 studies (Goodwin and Jamison, 1990). These data derive largely from studies of severely depressed inpatients, whereas the majority of depressed people are treated as outpatients or not treated at all.” http://mentalhealth.samhsa.gov/suicideprevention/risks.asp
This same government website goes on to cite more recent data suggesting that the suicide rate in major depression is probably closer to about 2% for outpatients, and about 6% for inpatients. Nonetheless, averaging this out, a suicide rate of about 4 per 100 patients is surely not trivial. This is many magnitudes greater than the suicide rate in the general U.S. population, which is around 11 per 100,000 people in 2005 (Hu et al, Am J Prev Med 2008;xx(x):xxx)

I certainly understand that neither Mr. Lehrer nor Dr. Thomson argues that “people shouldn’t seek help for depression.” My point was that when the newspaper of record in the U.S.—the New York Times—has a major story emphasizing the “adaptive value” of major depression, and its putative ability to enhance problem solving, this may have the unintended effect of discouraging people from seeking professional help when they are depressed. I am not alone in this concern. See, e.g., the posting on: http://news.psydir.com/Psychology-Articles/depression039s-cognitive-downside/, which not only demolishes the analytic-rumination hypothesis, but which also states,
“The analytical rumination hypothesis even has the potential to be harmful. Belief in the glorious "upside" of their ailment could prevent some severely depressed individuals from getting proper treatment, placing them at greater risk of suicide and other adverse events. Needless to say, such an outcome would be of no evolutionary advantage.” [Go to psydir.com home page if you have trouble with the link].

While I agree that antidepressants—most of which are prescribed by primary care doctors-- may sometimes be overused for mild, transient depressive states that don’t meet DSM-IV criteria for major depression, Mr. Lehrer’s disparaging comment about antidepressants and placebos needs to be carefully qualified. The two meta-analyses usually cited as evidence against antidepressants’ efficacy (Kirsch et al and Fournier et al) both found the medications significantly more effective than placebo for precisely the condition one would want the drugs to “work for”: severe major depression. I have detailed reviews of these studies—both of which have many flaws—at the following websites:
http://www.psychiatrictimes.com/home/content/article/10168/1520550
and
http://psychcentral.com/blog/archives/2008/03/02/devil-or-angel-the-role-of-psychotropics-put-in-perspective/

Sincerely, Ronald Pies MD
Professor of Psychiatry and Lecturer on Bioethics & Humanities, SUNY Upstate Medical University; Clinical Professor of Psychiatry, Tufts USM Boston; Editor-in-Chief, Psychiatric Times.

Posted by: Ronald Pies MD | March 6, 2010 12:25 AM

Part 2
Now, as to the figure of “15%” I cited in my editorial: I will acknowledge some controversy over this figure, for which I take responsibility. I intended it to reflect the lifetime risk of suicide in major depression; indeed, many older studies cite this figure. For example, NIH and other government data state
“ An often-quoted risk is that about 15% of patients with major depression will eventually die by suicide (Guze & Robins, 1970). This rate was further reinforced by a large-scale review of 30 studies (Goodwin and Jamison, 1990). These data derive largely from studies of severely depressed inpatients, whereas the majority of depressed people are treated as outpatients or not treated at all.” http://mentalhealth.samhsa.gov/suicideprevention/risks.asp. This same government website goes on to cite more recent data suggesting that the suicide rate in major depression is probably closer to about 2% for outpatients, and about 6% for inpatients. Nonetheless, averaging this out, a suicide rate of about 4 per 100 patients is surely not trivial. This is many magnitudes greater than the suicide rate in the general U.S. population, which is around 11 per 100,000 people in 2005 (Hu et al, Am J Prev Med 2008;xx(x):xxx)
I certainly understand that neither Mr. Lehrer nor Dr. Thomson argues that “people shouldn’t seek help for depression.” My point was that when the newspaper of record in the U.S.—the New York Times—has a major story emphasizing the “adaptive value” of major depression, and its putative ability to enhance problem solving, this may have the unintended effect of discouraging people from seeking professional help when they are depressed. I am not alone in this concern. See, e.g., the posting on: http://news.psydir.com/Psychology-Articles/depression039s-cognitive-downside/, which not only demolishes the analytic-rumination hypothesis, but which also states, “The analytical rumination hypothesis even has the potential to be harmful. Belief in the glorious "upside" of their ailment could prevent some severely depressed individuals from getting proper treatment, placing them at greater risk of suicide and other adverse events. Needless to say, such an outcome would be of no evolutionary advantage.” [Go to psydir.com home page if you have trouble with the link].
Finally, while I agree that antidepressants—most of which are prescribed by primary care doctors-- may sometimes be overused for mild, transient depressive states that don’t meet DSM-IV criteria for major depression, Mr. Lehrer’s disparaging comment about antidepressants and placebos needs to be carefully qualified. The two meta-analyses usually cited as evidence against antidepressants’ efficacy (Kirsch et al and Fournier et al) both found the medications significantly more effective than placebo for precisely the condition one would want the drugs to “work for”: severe major depression. I have detailed reviews of these studies—both of which have many flaws—at the following websites: http://www.psychiatrictimes.com/home/content/article/10168/1520550 andhttp://psychcentral.com/blog/archives/2008/03/02/devil-or-angel-the-role-of-psychotropics-put-in-perspective/
Finally, I don’t blame Mr. Lehrer entirely for the unfortunate impressions created by his article; in a sense, he was the “messenger” for some very dodgy research. Unfortunately, the damage is now done, and it is very hard to unring the “bell” of the august New York Times. I would therefore respectfully urge Mr. Lehrer, a responsible journalist, to authorize a retraction of his piece in the Times; or at least to publish a letter in the NY Times Magazine that puts the original article in a more accurate perspective.
Sincerely, Ronald Pies MD
Professor of Psychiatry and Lecturer on Bioethics & Humanities, SUNY Upstate Medical University; Clinical Professor of Psychiatry, Tufts USM Boston; Editor-in-Chief, Psychiatric Times.

Posted by: Ronald Pies MD | March 6, 2010 12:28 AM

Posted by: Ronald Pies MD | March 6, 2010 12:30 AM

Part 3
While I agree that antidepressants—most of which are prescribed by primary care doctors-- may sometimes be overused for mild, transient depressive states that don’t meet DSM-IV criteria for major depression, Mr. Lehrer’s disparaging comment about antidepressants and placebos needs to be carefully qualified. The two meta-analyses usually cited as evidence against antidepressants’ efficacy (Kirsch et al and Fournier et al) both found the medications significantly more effective than placebo for precisely the condition one would want the drugs to “work for”: severe major depression. I have detailed reviews of these studies—both of which have many flaws—at the following websites: http://www.psychiatrictimes.com/home/content/article/10168/1520550 andhttp://psychcentral.com/blog/archives/2008/03/02/devil-or-angel-the-role-of-psychotropics-put-in-perspective/
Finally, I don’t blame Mr. Lehrer entirely for the unfortunate impressions created by his article; in a sense, he was the “messenger” for some very dodgy research. Unfortunately, the damage is now done, and it is very hard to unring the “bell” of the august New York Times. I would therefore respectfully urge Mr. Lehrer, a responsible journalist, to authorize a retraction of his piece in the Times; or at least to publish a letter in the NY Times Magazine that puts the original article in a more accurate perspective.
Sincerely, Ronald Pies MD
Professor of Psychiatry and Lecturer on Bioethics & Humanities, SUNY Upstate Medical University; Clinical Professor of Psychiatry, Tufts USM Boston; Editor-in-Chief, Psychiatric Times.

Posted by: Ronald Pies MD | March 6, 2010 12:33 AM

Dr. Pies, I am sympathetic to your viewpoint (I'm a psychiatrist) but you are coming off badly here. This theory is probably false, but the article was a fair presentation of a speculative idea.

Posted by: Murray | March 6, 2010 1:23 AM

"Neither I, nor Dr. Thomson, ever suggest that people shouldn't seek help for depression. That's just not in the article."

Fine, good, except you initially wrote:
"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."

I don't think I'm drawing a long bow to call that irresponsible and to say that you imply in those two sentences precisely what you now disavow.

Dr Pies compares the reasoning to those of global warming deniers. Precisely correct. It's time for a mea culpa here.

There is another good article about the evidence for these claims here: http://neurocritic.blogspot.com/2010/03/depressions-cognitive-downside.html

I almost deleted this blog earlier this year because I was frustrated with the sloppiness of some of the pseudo-scientific claims regarding brain function, emotion and suchlike (interesting claims were presented as fact or at least likely to be true, when they were speculation with a probability of perhaps 0.001 of being right). When you extend this past interesting claims about dreams or emotional processing or whatever, and into the field of mental health where idle speculation can have immediate and damaging consequence, we go from frustrating to destructive.

Posted by: CM | March 6, 2010 1:43 AM

The doctor is making an ass of himself. You don't call someone a climate change skeptic because they quote a study you don't like. (when it's clear the 15 % figure was incorrect.) And why is it that every study Pies disagrees with is so "deeply flawed"? Such rigidness is sad to see in a researcher.

Posted by: Michael L | March 6, 2010 10:18 AM

I appreciated the article and found nothing offensive. I'm a mental heath consumer and advocate, survivor of two suicide attempts. Depression is a bloody awful, terrifying thing. We all know its deadly in its most severe clinical form. But that doesn't preclude the idea that there can be benefits related to its milder forms. We can learn an amazing number of things about ourselves and our world by studying our own thought processes. That, in my mind, is the most important thing about healthy therapy--we have to look not just at what our thoughts are, but how we came to those thoughts. What is healthy about those processes and what is not.

I would add that what I most appreciated in the article was the reflections on writing near the end. That's my field, my calling, my job--it's how I've kept myself alive. I responded to that aspect of the article on my own website's blog: http://paulajlambert.com/response-to-depressions-upside.aspx.

Thanks to Lehrer for opening up these ideas and this discussion...

Posted by: Paula J. Lambert | March 6, 2010 10:41 AM

The reason there are so many different views on treating depression is because depression is like a cloud layer. It has many different levels of density, and it changes from day to day. Sometimes the meds work, sometimes they don't. Sometimes I feel suicidal, sometimes I don't. Sometimes I'm sad; sometimes I'm bleak; sometimes the world is depressing in it's beauty, sometimes in its shades of black. Everything affects its texture, and it affects everything. Productive rumination is a useful sympton or side-effect, sometimes rumination is a black hole of despair. What are its roots? Any number of things. Would I trade it anyday for a bright, cheerful, social, positive nature? In a heartbeat.

Posted by: Holly Wilcox | March 6, 2010 11:03 AM

I can personally state that there is a definite connection between major depression and suicide. Untreated, I would have been dead by my hand two decades ago. Even with ongoing treatment it is a battle at times. And the death would have been entirely because of depression - no other cause.

As it is, I survive with great effort and my life is missing many of the accomplishments of others, because the effort to simply stay alive drains so much energy that could be used more productively.

Posted by: soa | March 6, 2010 11:18 AM

I think "proper treatment" and "help" need to be regularly interpreted to include more than dosage administration. You allude to the fever. When we have one, many if not most of us attempt to help our body heal with a few hundred milligrams of acetaminophen, a fever reducer and pain reliever, don't we? Medication dilutes the symptoms of illness, concealing the natural process of health restoration from the ill. Our own body ultimately heals itself though, which is something we often forget. We're like Pavlov's dogs; the bell rings when we're feeling unwell - physically and emotionally - and our drool is the reflexive reach for medicine.

And on the note of earth science mentioned in previous comments:
Perhaps the analytic-rumination hypothesis is a twenty-first century psych-version of Hess' seafloor spreading hypothesis. Novelty has its place in science; progress cannot be achieved without challenging traditional theory.

Posted by: Michelle | March 6, 2010 12:39 PM

Frankly, I'm not interested in the "truth" of depression, so much as the stories we tell about it. As a depressed person, I benefit more from the story that my life might not be a waste.

Posted by: Alison | March 6, 2010 3:25 PM

I found the article fair and stimulating thought and reflection about a topic that has no simple answers and creates such intense pain and suffering in so many people. As a provider of mental health services (I am an analytically trained Psychiatric Social Worker with 35 years of clinical experience) any idea or insight that will be of assistance to my patients is welcome. These kinds of articles, which have appeared regularly in the "Times", are a valuable resource for professionals and consumers alike. Keep them coming. I would offer the encouragement of all to read "Pain the gift no one wants" by Paul Brand a surgeon and experet in Leprosy and Diabeties (he started the Carvel Institue for the treatment of Leprosy and Diabeties). I also love the quote from Aeschylus "God who's law it is that even in our sleep, pain which cannot forget falls drop by drop upon the heart, until in our own despair, against our will, comes wisdom through the awful grace of God." Thanks Jonah for all your efforts. Ross

Posted by: Ross McCabe | March 6, 2010 5:28 PM

I was looking for a citation to this article because I found it so useful and was saddened to see such vitriol and mayhem in the blog.

I found it helpful to reconsider how the frontal lobe is involved in our "emotional" symptoms and dis-orders of mood. I welcomed the introduction to the ideas Jonah Lerher provided me and with this inspiration I have continued to explore them through reading and research.

I did not get the sense the author was diminishing depression but rather exploring the prevalence which is senselessly high if there isn't a potential value in certain ranges. The notion that pain can have value has become socially and culturally taboo. The social norm of pain as failure sets up the conditions that systematically perpetuate emptiness and depression among individuals.

Thanks for the questions. Sharon

Posted by: Sharon McDonnell MD MPH | March 6, 2010 6:55 PM

I am not a psychiatrist, but a pediatrician, and I see alot of teenagers who are depressed, and try my best to make sense of things with them, and decide who I can safely treat, and who to refer to a psychiatrist.

My own experience with depression after my husband's death affirms my belief that SSRI's can be helpful, especially with situational depression, but I have seen SSRI's fail with Major Depression.

I have a hard time, though with the concept that depression can be adaptive, other than in gaining empathy. I'm better now, but found the cognitive problems difficult: forgetting words, dysphasia and a feeling of inarticulateness were extremely frustrating in my job. The difficulty sleeping, and eating for no good reason, are sometimes still somewhat of a problem.

My daughter, a pretty, bright 18 year old 3 weeks from high school graduation, and my son, a tall handsome college student finishing his first year of college when their dad died, have also had their issues, both of them now lacking in self-confidence, nearly disabling in my daughter, who also has had on and off episodes of depression, for which she refused treatment with SSRI's because she doesn't like the way they make her feel. I feel that depression, or at least the bereavement state, causes cognitive dysfunction and inattention, and that this is due to stress, depletion of the brain's neurotransmitters, and disordered sleep. The disordered sleep can create a vicious cycle.

Again, these are just clinical observations, for what they are worth, and not scientific statements.

Posted by: Janet T Strausbaugh | March 7, 2010 8:56 AM

Can somebody please tell me why this topic is so disproportionately emotional for people? Especially for apparently older psychiatrists?

Lehrer's article never gave off an aota of the brain-dead, false sentiment pinned to it -- "stand around, and think, don't attempt to get help with your depression" -- "Your depression isn't real." If someone is left with this massively distorted distillation of the article after reading it (which i don't think anyone would), depression could in all seriousness, very well be one of many problems for them.

More importantly, I'm so astounded how people who have scientific training find it so impossible to believe there are or were any adaptive functions of depression. It seems obvious on its face.

Can Dr. Pies explain why so many mammals and even some nonmammals display depressive behavior? Especially as a result of situations that we would expect to elicit such behavior? It's ubiquitous.

Would anyone not assume joyous feelings and behavior have an adaptive function? They probably do, just like depressive feelings and behaviors. Dr. Pies?

The adaptive functions certainly change according to changes in space and time, and depression can easily get out of control, but that doesn't mean it never had some advantage. Our environments have changed so rapidly and massively, that depressive responses are likely not well suited to the environments we live in, and the environments we live in are probably not well suited to responding to a depressive response.

Would a prehistoric man be any better of with a 6 month supply of Paxil when depressed, or the care and affection of concerned persons in his close social group? -- who recognize his behavior and were probably inclined naturally to do the most effective things for depression, offer affection, close attention, and care for basic daily needs.

I think the way we treat depression, as a disease, as a random aberration of feeling and behavior that is only loosely grounded in reality actually perpetuates the awful toll it takes on us, and I think it is precisely this implied outcome that Dr. Pies is so reflexively defensive to. I'm not trying to malign him or what he does, I can't imagine the number of people he has helped, but as someone said before, you have to wonder about the state of the science when an idea such as this provokes such intense feelings and opinions from people.

People become depressed most of the time for very real reasons, and in my vast experience of meeting many, many depressed people and having had very serious depressive episodes myself, I know it can even be for very real reasons that are simply out of their/our awareness. Some people are just extremely out of touch with their emotions even before they become depressed, so they really "don't have any reason to be depressed".

The standard of care in this country right now, if you go to a psychiatrist or any physician is to get antidepressants. To be suggested therapy first is the exception. There's just no way of cutting around that fact by lamenting that it should be the other way around or that psychiatrists should get more psychotherapy training.

Depression is an awful, horrendous experience, that I would gladly trade in even if there were very clear benefits, but looking at the state of how it is treated now, which is woefully inadequate and not very coherent, I'm open to possibilities of thinking about it that make more sense, and that could possibly serve as the basis to more effective approaches in treating it, even if it seriously violates our cultural narrative about it.

Posted by: JC | March 7, 2010 10:40 AM

When the form is right you don't have to go looking all over the place for---justifications. Mr. Leher is dead on and he could have used a ton of sources if he wanted to--he used just the right amount. There is nuance here and those capable of cutting edge thought will take notice.

Posted by: carol forrest | March 7, 2010 12:12 PM

I think Jonah's fever analogy is actually quite brilliant. Say, for example, that we hypothesize that the immune system is an evolutionary adaptation to help us deal with harmful microbes. This doesn't mean that when the immune system malfunctions and someone develops, say, an autoimmune disease, that they shouldn't be treated for it. On the flip side, not every fever (which, although uncomfortable, is actually a very helpful adaptation) should be treated with antibiotics or even antipyretics.

I'm not sure exactly why Dr. Pies is so afraid of considering an interesting new theory, but, as a fellow psychiatrist, I don't think broadening the way we view the mind in the context of psychiatric illnesses is such a bad thing...and I certainly don't think it threatens our jobs in any way. Just like every other specialty in medicine, there is definitely some corruption in psychiatry. So my question to Dr. Pies is...what drug company is it that you are working for?

Posted by: CSS | March 7, 2010 2:30 PM

Lets consider the hypothesis in more detail, and then we might see more where both Jonah Lehrer and Prof. Pies are coming from.

Consider the immune system analogy - its true that our immune system is adaptive, but autoimmune diseases are clearly maladaptive. Likewise, the ability to experience a depressed *mood* is adaptive, because organisms need a reason to avoid negative experiences (negative mood) just as much as they need a reason to want to have positive experiences (positive mood).

If someone evolved to always be happy, they wouldn't be motivated to avoid negative experiences, which would reduce their chances of survival. This is one of the reasons why people can experience very negative outcomes when their mood is extremely high (e.g. during the manic, elevated mood of bipolar depression).

So, if we agree that depressed mood is adaptive, is clinical depression adaptive? If we look at the list of symptoms associated with a major depressive disorder (e.g. DSM-IV symptoms, which are viewable in places like the Wikipedia depression article) I think there are very few people that would agree that they are advantageous from an evolutionary perspective. Remember that in order to be adaptive, a behaviour has to advantage people in terms of survival and reproduction.

I'd quite happily conclude that negative *mood* IS adaptive, which is why we are not all ridiculously happy all the time, but that clinical depression/major depressive disorders are clearly maladaptive. This is especially true if we consider the most severely depressed individuals (such as those a psychiatrist may see in their practice).

I feel that this is why Dr Pies may have so vigorously responded to the article - it wasn't a hypothesis being floated in an academic journal (originally it was, but Jonah Lehrer's article was in a national newspaper). The problem is that the general public is not very good at distinguishing scientific hypotheses from science with good evidence - and to me, there is little evidence that depressed individuals are surviving and outbreeding their non depressed counterparts.

Jonah - Please could you consider writing a longer article on depression, which takes into account both evolution type arguments, and also considers depression from a biopsychosocial perspective?

Posted by: Tom Michael | March 7, 2010 5:07 PM

Edit - Above, I should have pointed out that I was arguing that *occasional* depressed mood is adaptive - clearly always having a depressed mood is not adaptive in my example - and this is the main symptom of clinical depression.

Also, if clinical depression/major depressive disorder were adaptive, wouldn't we expect it to be the norm? Surely those happy people would be the unusual ones, with less chance of surviving t pass on their genes?!?

Posted by: Tom Michael | March 7, 2010 5:11 PM

Having re-read the NYT article, I think that the problem stems with a poor choice of language by the authors of the original scientific paper, which has followed over into Jonah's article.

The analytical-rumination hypothesis is valid (although, like much evolutionary psychology, lacking in evidence). Being able to think long and hard, and analytically about a problem is useful, even advantageous. But clinical depression is a malfunction of this process. Thompson almost says this when he says he use talking therapies to help patients to think through their problems. If depression were advantageous to problem solving they wouldn't need his help!

Hence I feel it boils down to this:

1) A small measure of analytic rumination is useful for problem solving (e.g. mood and cognition studies as evidence)
2) Such analytic rumination MAY be evolutionarily advantageous, hence this is why it is present in the population
3) However advantageous it may be in small doses, too much analytic rumination can lead to clinical depression, which is not advantageous, which explains why humans have not evolved to be depressed most of the time (as one would expect if the condition were truly evolutionarily advantageous).
4) This implies that a solution to depression should be to help people to think through their problems and find real life social solutions to them, rather than trying to anaesthetise their pain away with antidepressants (except in the most severe cases).

Maybe it doesn't imply point 4, and I admit my bias there as a psychologist. Prof Pies is correct about Antidepressants helping the most severely depressed persons. I think points 1-3 sum up the argument pretty well though.

Posted by: Tom Michael | March 7, 2010 7:48 PM

The analytical-rumination hypothesis is valid (although, like much evolutionary psychology, lacking in evidence). Being able to think long and hard, and analytically about a problem is useful, even advantageous. But clinical depression is a malfunction of this process.Its true that our immune system is adaptive, but autoimmune diseases are clearly maladaptive. Likewise, the ability to experience a depressed mood is adaptive, because organisms need a reason to avoid negative experiences (negative mood) just as much as they need a reason to want to have positive experiences (positive mood).

Posted by: Texas breast reduction | March 7, 2010 11:58 PM

[second attempt to send]

In what will be my final comments on this site, I'd like to thank all those who submitted thoughtful, balanced views on this obviously contentious and emotional topic. These more than make up for a few anonymous slurs, one of which purports to be from a "psychiatrist".

First, I'd like to say that I have no objection at all to "considering" the hypothesis that major depression has some adaptive functions. My strong objection to Mr. Lehrer's piece was that it evinced a kind of
"gee-whiz!" credulity, and did not dig deeply into theinnumerable studies that argue against the Thomson-Andrews hypothesis. One such critique, by Prof. Jerry A. Coyne, may be found at
http://whyevolutionistrue.wordpress.com/2009/08/30/is-depression-an-evolutionary-adaptation-part-2/.

From a more personal perspective: having spent almost 30 years struggling to keep hundreds, perhaps thousands, of severely depressed patients alive and functioning;
having nevertheless lost a couple to suicide; and having never heard once from any of these patients that their major depressive episodes were of any benefit at all, perhaps I do get a bit "emotional" when I read articles
such as Mr. Lehrer's. (Incidentally, I am no longer seeing patients in private practice, as I now do full-time editing, writing and teaching; nor have I any personal affiliations at all with any pharmaceutical companies).

That said, I do not deny that in both animals and in humans, there might be some components of mild-to-moderate depressive bouts that could have short-term adaptive value; e.g., increased sleep during some types of depression could allow for some physiological "recovery" of certain
functions. But by far the most common description of depression I get is nicely summarized by John, writing on
the website Storied Mind http://www.storiedmind.com/2010/03/05/depression-creative-force-human-evolution/.
I highly recommend reading his essay:

"If [the analytic-rumination hypothesis] is true, I’ve really bungled the gift of my genetic inheritance. In all the decades of dealing with severe depression I never solved a single complex social problem. Amazingly enough, my mind was infinitely distractable, incapable of
clear decisions and subject to aimless drift into a cloud of nothingness. At other times, I obsessed about my failings and worthlessness in prolonged self-torture and often thought of suicide. Perhaps, though unaware of it, I did sharpen my analytical abilities while sleeping all the time. However, my isolation from my family, if you can believe it, seemed to create problems rather than solve them."

Similarly, this from Lynn, writing on the Psychcentral website:
“As someone who has been severely depressed before, and have recently recovered and as a clinical psychology student…I see no benefit to moderate to severe depression. All your energy is focused on self-preservation and minimizing damage, and there is little time and energy for creative pursuits, self-refection, or problem-solving,
if there is even a clearly identifiable problem driving the depression."
http://psychcentral.com/blog/archives/2010/03/01/the-myth-of-depressions-upside/#comments

I will now hope that the good sense of readers will prevail in this debate, and that those who suffer from severe depression will quickly avail themselves of professional help.

Ronald Pies MD

Posted by: Ronald Pies MD | March 8, 2010 12:28 PM

@Noah Gray: In terms of my understanding of brain function or psychiatry, you can consider me "average lay reader #1"; However, as a civil engineer with a practical science background, I can clearly see the direction that Jonah was taking in his original article. There may be some controversy in the theory, but that's part of the reason for such a post being made on a public blog -- to initiate discussion that might lead to a better understanding of an important issue.

All of the claims that this theory is irresponsible or unfair are coming across as if they are the absolute authority on the subject. That's funny, because Jonah clearly did not make that same claim. He sums it up best at the conclusion of this last post "let's not pretend that modern psychiatry is such a settled science that it can't tolerate a controversial new idea." Controversial ideas are exactly what advances science. Just ask Copernicus, Newton, or Einstein. I think George Bernard Shaw put it best: "All great truths begin as blasphemies."

Keep up the good work, Jonah.

Posted by: Lenny C | March 8, 2010 1:06 PM

For Dr. Pies - I've suffered from situational depression repeatedly in the last ten years. I've tried numerous meds, mostly to no avail. This article and theory make perfect sense to me. I do think my major depressive episodes have led to new perspectives on life. The mental illness was especially important for me after my mother died, when I was grieving for a long time and was prescribed an SSRI by my doctor. It didn't work, but i came out the other end better off I think.

Posted by: WM | March 8, 2010 1:17 PM

JC; I laughed at the irony when you asked. . . how could such a discussion be so emotional?

Of course it's emotional. Not just for the sufferers, but for people who know (or have lost someone) who suffers from this disorder. . . and, I don't care how "professional" or "educated" you are. If one deals with depressed people for a living, one has feelings, and it *has* to weigh on one. It simply MUST. I don't care what your training is. I know for a fact that EMT's suffer from emotional trauma. Emergency room doctors and nurses. We're emotional beings. It's just forbidden in our culture to discuss it.

Now: keeping in mind, I'm talking about Adjustment Disorder (with a side of depression), not "Major Depressive Disorder" - and that I don't really have a clue what the difference is, clinically.
When I've ruminated about ruminating. . . and what depressed person hasn't? At 3am. What else is there to do? My memory of this is that my internal dialog becomes sort of like a noisy crowd. Instead of your one mental voice, you begin to think about several things, almost simultaneously - and you can't complete ANY of those thoughts. And if you try to focus on one of them, you'll begin a thought, a sentence, and you'll get almost through it, and it will cycle through, over and over again.

The same goes with visualizations, or running through mental scenarios related to the trauma (what's termed a "flashback" for people with PTSD).

It's one way we learn new things, by repetition. It's also a way we solve technical problems - by iteration.

And this is why I agree with the "maybe it's adaptive" theory. The primitive part of the brain is going into a highly active state, attempting to solve, what it perceives to be a survival issue. The rational mind may know it's not. But the primitive, emotional brain doesn't know any better. And you can't convince it with logic.

Perhaps it's attempting to solve a problem in ways that the rational mind might otherwise not be able to solve. Or maybe - there's no solution for such problems; and the primitive structures of the brain are stuck in a fruitless search for a solution it does not know it can not solve; (like, how to move on with life after the loss of a loved one, or a couple of limbs, etc.)

Would I say that any of this is helpful in any way? No. It hasn't been to me. "Adaptive" is a word that has some positive spin on it, and so is "Upside". And the story about Darwin, in the previous story implied that maybe the condition is helpful in some way. I suppose the "disorderly thinking" at times, has led to some insightful thinking. Maybe? Would I have had such insights - BETTER insights, with more orderly thought process? There is no experimental control that could ever verify that.

Posted by: NDP | March 8, 2010 2:05 PM

Just some anecdote and observations--As a person whose mental illness started with severe MDD since about the age of 12 (maybe even earlier), I can confidently say that this premise seems entirely absurd except for in the case of life's normal ups and downs. I'd like to echo the sentiment of others here that the only rumination that takes place is an obsession with how worthless you are. I don't see how ruminating on the most effective method of removing yourself from the gene pool is any sort of helpful adaptation to the individual, which is what it seems like the point of this hypothesis is, as opposed to any sort of group benefit.

I further question the plausibility of this hypothesis in that depression not only affects the ill individual, but also the family unit and beyond. It is assumed one's progeny is not as likely to reach childbearing age when their caretaker(s) lose as much functionality as is associated with MDD. If you don't even have the will or energy to get up and get food for yourself, the drive to do so for your children does not likely exceed the ability to get food for one's self by much. Further,while there may be other caretakers involved in the upbringing of the children, I'm inclined to postulate that the self-loathing and detachment that comes with this terrible affliction is more likely to alienate those who would be of assistance otherwise.

I can understand, say, bipolar having a positive effect in that hypo/mania commonly results in a highly increased desire for sex, which results in more babies--but how can something that does not increase the number of births (due to low sex drive among other things), and too often ultimately results in the removal of yourself from the gene pool have any sort of advantage? To keep in line with that example, bipolar has a higher incidence of suicide, but in part "makes up for it" with a higher likelihood of pregnancies (among other positive factors).

I'm no professor, but to me it always seemed likely depression was still around in such high numbers because the large majority of those with it somehow still manage to have families & don't kill themselves.

Thoughts?

Posted by: Anodyne | March 8, 2010 3:14 PM

I read about a similar theory as an undergraduate which I thought made more sense. In that case the regular feeling of depression people get from everyday unpleasantness is what has an evolutionary purpose. You stand up to the bully and get beaten (and depressed) and the depression essentially leads you to withdraw and not try again - the same way physical pain may lead you to stop doing whatever it is that's causing the pain. Major Depression would be a kind of side-effect of having that wiring in place. Becoming depressed would be a normal part of human emotion, but Depression (with a capital D) would be the pathological side, where a person's response is out of proportion to what's going on, lasts for much longer than would be expected (years, decades) or is simply inappropriate (nothing bad happened).

This makes more sense to me because we can easily imagine how emotion in general can be helpful in directing our behavior towards behavior that is more beneficial (it feels good to have sex, eat, take care of our offspring and it feels bad when we are in danger, are hurt or malnourished). However, I can't imagine how the excessive social withdrawal and pain of Major Depression could be good in any way - even in terms of evolution. Major Depression may lead an individual to withdraw and protect himself just as much as the normal feeling of depression might - the one we might get when, say, someone rejects us. However, Major Depression doesn't exactly last a week and then go away. And when it is present it is far, far more destructive.

Posted by: Hope | March 8, 2010 4:44 PM

@Tom Michael: You wrote: "I'd quite happily conclude that negative *mood* IS adaptive, which is why we are not all ridiculously happy all the time, but that clinical depression/major depressive disorders are clearly maladaptive."

As someone who works professionally with horses the words of internationally renowned expert Hans-Joachim Köhler come to mind: "There are no horses who are too short-legged, too sway-backed, or too old. They are short-legged, sway-backed, or old." Hans-Joachim Köhler contrasts true horsemen to nit-pickers.

It may come off a bit crude, but IMO the DSM is the book of nit-picking in regard to human behavior. Too sad, too angry, too scared, too this, too that. Even too happy ("mania"). "Too" is the crucial term. "Too" in regard to what? The norm? Of course. But what if we looked beyond the norm, and at the life events that all these "toos" are a response to? When I was what is called "psychotic", I clearly was too scared, despaired, confused, angry... to fit the norm of our culture. But you know what? The amount of fear, despair, confusion, anger, etc. I experienced actually fitted perfectly in with the amount of trauma these emotions were a response to. There wasn't the least dopamine, serotonin, or whatever other neurotransmitter, too much or too little in my brain.

Let's face it, it is not about too this or that to be healthy. It is about too this or that to be comfortable for society. The thing is, though, that we do not truly acknowledge someone's suffering by calling it "too", and labelling it "clinical depression" or "major depressive disorder", an imbalanced brain chemistry. Although we pretend this to be true acknowledgement, and a lot of people buy into it. -- At first sight, some pseudo-acknowledgement in the shape of a psych-label seems better than no acknowledgement at all. Unfortunately it takes a lot more to fool the unconscious, if it can be fooled at all. I doubt it. And when it comes down to it, the label adds insult to injury. -- Truly acknowledging someone's suffering is to accept it as a perfectly balanced response to the life events that have caused it.

Someone's said it here before, not at this entry, but at this blog: we live in a shitty world. There's a lot to feel depressed, sad, even despaired about. That not everybody feels as sad as to qualify for a label of "clinical depression" or "major depressive disorder" -- and the profoundly pathologizing and alienating sound of these labels make me shudder; why can't we just call it what it is: sadness, grief, despair -- is mainly due to to the subtle but nevertheless decisive differences between each and every individual life story. If it wasn't for these differences, then yes, then everybody could and should be expected to react with exactly the same amount of sadness (or whatever else emotion).

So, IMO, there's no amount of sadness, grief, despair, or whatever, that is too big (or too small), or maladaptive. There's only a profound lack of true acknowledgement -- probably out of fear of extreme emotions/states of mind -- which in its turn prevents people from overcoming their suffering.

Posted by: Marian | March 8, 2010 4:47 PM

Marian stated:

"It may come off a bit crude, but IMO the DSM is the book of nit-picking in regard to human behavior. Too sad, too angry, too scared, too this, too that. Even too happy ("mania"). "

Mania is not "too happy". You have no idea what you're talking about. Do some research.

"So, IMO, there's no amount of sadness, grief, despair, or whatever, that is too big (or too small), or maladaptive. There's only a profound lack of true acknowledgement -- probably out of fear of extreme emotions/states of mind -- which in its turn prevents people from overcoming their suffering. "

No amount is too big or too small or maladaptive?
Care to explain suicide? I'd count that as pretty maladaptive.

Your explanation of "too" big/small completely misses the point. The problem IS that it's too much. That is what diagnosis is based on. It's not just "oh, poor me, I feel sad, life sucks" as you seem to imply. It permeates every aspect of your life. Do you suggest we do away with disability benefits for people whose illness(es)are so severe that they can no longer hold down a job? (I'm in the US...not sure where you're from or if they have the same sort of benefits there.)

If you had a doctor that said "Your pancreas is producing too much insulin. You need to acknowledge the issue and deal with it, then it'll go away" would you EVER return to his office? I'd hope not. This premise is every bit as ridiculous as what you stated. The brain is an organ too. If part of it isn't working correctly, you can't just will it to fix itself. While the brain is plastic and can learn new ways of dealing with things, it doesn't mean you can just will things to be better as you've implied. Talk to someone with severe issues that has undergone CBT. It's nowhere near that simple!
(And to clarify for anyone that may not be familiar with the term, CBT is cognitive behavioural therapy, not cock & ball torture. :] )

Do you believe that schizophrenics are just people that let their imaginations run a little too wild? How do you recommend they "fix" themselves?

Posted by: Anodyne | March 8, 2010 5:18 PM

@NDP

I just want to say that I don't have much of a formal education at this point and certainly no training, just an interest in science. On second thought, I do have a lot of training on how to be a mental patient.

I try to respect everyone's opinions and I can definitely see where youre coming from, the sort of "maybe" middle ground I assume.

I also agree with your feeling about the rather absurd question that started off my last comment. We are emotional beings, and even more ironically I think the mental health systems' modus operandi often, or largely, ignores any substantive implications of that truth. And I feel that the "disease" model of depression particularly ignores that, which takes us to this question of evolution.

I certainly see where you're coming from near the middle ground on this topic. I personally believe it is not a disease, but I am also maybe closer to you middle ground people than you realize in being the first to say -- in limited contexts, in limited circumstances, encompassing perhaps a certain range, depressive feelings and behaviors can be adaptive. Probably less so now -- without a doubt -- but it's also probably more likely many thousands of years ago such reactions were more suited to the time and space.

I'll be the first to say depression can get very out of control. Mine has many times, and frankly, I've had severe suicidal episodes even. So I'll be the first to say it is a horrible experience, an awful experience that only takes from you.

That being said, did my depression start out like that many years ago as a kid? No. Could I probably have been helped if a number of ongoing, severe issues in my family were addressed (and not medicated by Harvard psychiatrists)? Yes.

Even though depression has taken a lot from me, been only a burden, with absolutely no net gain, I have nothing invested in it. To acknowledge that it is imprinted in our human experience from tens of thousands of years ago because of some adaptive functionality inherent in its experience then, doesn't negate or diminish anything about my experience now, I feel.

And in general, I just wanted to say that I personally don't distinguish between "mild" "moderate" "severe" or "clinical" etc depression. In my mind there are many flavors and varieties that are distinct to the person in the time and space experiencing it that to make any distinction is arbitrary. I also feel like it is really just a continuum that is experience and the "variety" displayed is contingent upon all the factors I just mentioned. I don't think it is a discrete entity, a "disease" that must be assumed.

Obviously, what is termed "mild" depression has more potential to be adaptive than the other "forms", but to say mild-moderate but "clinical" no, is just so arbitrary. I also feel that depression is a continuum of response is obvious on its face too. And that what gets called "severe" or "clinical" is just the same response, but dysregulated. Because severe or dysregulated depression imparts absolutely no advantage to the person experiencing it, bears nothing on the contention that depression is an evolved experience with some adaptive function or functions.

Is joy not also experience on a continuum?

Thats my opinion. I have avoided getting into specifics about which functions it might serve and how etc. Because unfortunately it is not something we can every prove adequately. Its a bigger question, but on the same token, it really can't be disproven either. And more importantly, for me, it just seems obvious on its face.

So NDP, I just wanted to clear some stuff up, especially if you thought I was trivializing the experience or anything, because believe me Ive been past bottom and back. And I hope 50 years from now, we'll have really coherent, effective ways of treating this awful experience and there will never be any people among us, walking around with out of control depression. My hope is whatever that might look like, it prevents any one of us from falling through the many cracks the experience opens up at its start, despite our best efforts and the efforts of others.

peace

Posted by: JC | March 8, 2010 5:22 PM

Anodyne: Did I say it was just? I'm pretty much aware that it's not just, and that it affects every aspect of one's life. Anyhow, therefor it still is sadness, grief, despair, you name it, and its intensity still fits perfectly in with the intensity of life events it's a response to. Just as "schizophrenia" is not imagination run a little too wild, but exactly as "wild" as the life events are that caused, well, not imagination, but emotions and thoughts to "run wild".

Do I think, that human beings are potentially capable of making conscious choices? I know that they are. Do I think, that "schizophrenics" -- us and them, nice, thank you! -- are potentially capable of making conscious choices? Well, "schizophrenics" are human beings (although the term "schizophrenic" usually is applied to indicate that the so labelled are not, that they are some sort of lesser-than-human beings), so, of course they are potentially capable of making conscious choices. The thing is, it needs consciousness to make conscious choices, and we live in a culture that promotes unconsciousness rather than consciousness. That's what constitutes the shittiness of this world. Because unconsciousness always results in existential suffering. Suppress the suffering, and you'll remain unconscious, a prisoner of your suffering, and dependent on others (the professional carers) to make choices for you, to run your life for you. Or accept the suffering, and you have a good chance to overcome it by making a conscious choice. If supported in the right way, rumination, that is analysing one's suffering and its causes, may very well lead to an increased consciousness.

Before you fly in my face with indignation: no, it's not something you just do, become conscious. It's a process, and especially when you've been actively prevented from becoming conscious right from the start, which usually is the case for people labelled "psychotic"/"schizophrenic", it takes a hell of a long time, a huge amount of effort, and mostly also a conscious guide to support the person. And then, there's a drawback: the freedom to make your own conscious choices means that you are responsible for whatever you do, for every aspect of your life. This is where the concept of "mental illness" as something that just happens to you, that you have no control over, comes in handy. It relieves you of the heavy burden of having to take responsibility for yourself.

Anyhow, if you want to overcome suffering, if you want to liberate yourself, and be in charge of your own life, you'll have to put up with being responsible. Otherwise, you will suffer.

I know CBT. CBT wouldn't work if we weren't capable of making conscious choices. Unfortunately, CBT in most settings today is abused to have us choose unconsciousness (like in: "I'm mentally ill, it's a chronic brain disease, I can't recover, I have to take my meds for the rest of my life." = I can never be free, I will always depend on others.) rather than consciousness.

Posted by: Marian | March 9, 2010 6:40 AM

Do I think, that human beings are potentially capable of making conscious choices? I know that they are. Do I think, that "schizophrenics" -- us and them, nice, thank you! -- are potentially capable of making conscious choices? Well, "schizophrenics" are human beings (although the term "schizophrenic" usually is applied to indicate that the so labelled are not, that they are some sort of lesser-than-human beings), so, of course they are potentially capable of making conscious choices.

This is stupid. How does calling something by its name imply some sort of insult? If you'll read my post, nothing I said had anything to do with measuring the worth of a human being by their brain chemistry--or denying someone's humanity due to mental illness. You've imbued simple terminology with your own strong emotions. Your interpretation of my words is divorced from reality, and you're creating points of contention based on nothing but a desire to distract the subject.

It would seem you believe that positive thinking and laborious self-control are all you need to conquer mental illness.

Woo is no panacea.

Posted by: Anodyne | March 9, 2010 10:05 AM

Anodyne: "Once you label me you negate me." -Kierkegaard. The Dane, you know. And I never said anything only remotely near to what you insinuate.

You don't get it because you don't want to get it. So be it.

Posted by: Marian | March 9, 2010 2:38 PM

A strange phenomenon I observe time and again, virtually everywhere where "mental illness" is discussed, is that a whole lot of people immediately react with an outcry of resentment as soon as anyone dares to suggest that maybe, just maybe, the whole situation isn't quite as bleak, that maybe, just maybe, recovery is a possibility, and that maybe, just maybe, all the suffering isn't only horrible but has some value to it in terms of this recovery. I try to imagine someone with a somatic illness, who's told they have a good chance to recover, shout and scream: "No no no! It's not true! I can't recover! It must not be true! I'll be suffering most horribly for the rest of my life, and don't you dare to tell me something else!"

What is so attractive about pain and suffering that makes letting go of it almost an inconceivability, and everyone/everything suggesting that it can be overcome, a threat? That it provides an identity? "I am mentally ill"? "I suffer, therefor I am"? Mind-boggling.

Posted by: Marian | March 9, 2010 3:16 PM