NYT: Depression Defies Rush to Find Evolutionary Upside
Frank Forman
http://www.nytimes.com/2012/01/17/health/depression-defies-rush-to-find-evolutionary-upside.html
By RICHARD A. FRIEDMAN, M.D.
In certain quarters of academia, it's all the rage these days to
view human behavior through the lens of evolutionary biology. What
survival advantages, researchers ask, may lie hidden in our actions,
even in our pathologies?
Depression has come in for particular scrutiny. Some evolutionary
psychologists think this painful and often disabling disease
conceals something positive. Most of us who treat patients
vehemently disagree.
Consider a patient I saw not long ago, a 30-year-old woman whose
husband had had an affair and left her. Within several weeks, she
became despondent and socially isolated. She developed insomnia and
started to ruminate constantly about what she might have done wrong.
An evolutionary psychologist might posit that my patient's response
has a certain logic. After all, she broke off her normal routine,
isolated herself and tried to understand her abandonment and plan
for the future. You might see a survival advantage in the ability of
depressed people like her to rigidly and obsessively fix their
attention on one problem, tuning out just about everything and
everyone else around them.
Certain studies might seem to support this perspective. Paul W.
Andrews, a psychologist at Virginia Commonwealth University,
reported that normal subjects get sadder while trying to solve a
demanding spatial pattern recognition test, suggesting that
something about sadness might improve analytical reasoning.
In a similar vein, Joseph P. Forgas, a psychologist at the
University of New South Wales in Australia, found that sad subjects
were better judges of deception than happy ones. After subjects were
shown a video intended to induce a happy or a sad mood, Dr. Forgas
had them view deceptive or truthful interviews with people who
denied committing a theft. Subjects in a sad mood were more
skeptical and more accurate in detecting deceptive communication,
while subjects in a positive mood were far more trusting and
gullible.
Findings like these may suggest some benefits to sadness, but lately
they have been generalized to patients with full-blown depression.
For example, Dr. Andrews and Dr. J. Anderson Thomson Jr., a
psychiatrist at the University of Virginia, have proposed that the
rumination of depressives is an adaptive strategy to solve a painful
problem. Clinicians, on the other hand, continue to maintain that
the grim outlook of depressives is evidence that their thought
process is distorted and erroneous. It must be fixed, not embraced.
There is strong evidence from neuropsychological and brain imaging
studies that clinical depression is linked with various types of
memory impairments in all age groups and at all levels of depressive
severity. Challenging and changing the dysfunctional thoughts of
depression are the exact aims of cognitive-behavioral therapy, one
of the most empirically validated and popular forms of
psychotherapy.
So who's right about depression, the evolutionary biologists or the
clinicians?
To start, the subjects in the above studies were normal controls
whose moods were manipulated to be transiently sad. They do not
really resemble people with clinical depression, whose condition can
last months or even years.
Indeed, as Dr. Forgas said by e-mail, "I never worked with
depressives, and I do not think that the experiments we have done
looking at mood effects on cognitive processes in normal populations
experiencing minor, everyday mood differences can be readily
generalized to depressive cognition."
Under close scrutiny, the case for depression's adaptive benefits
has problems--big ones. For one thing, the ruminative thinking of
depression is often not particularly effective in solving problems.
As another patient of mine once said: "I would think the same things
over and over and could never decide what to do. It's not a creative
way of thinking."
More critically, depression can arise without any psychosocial
stressor at all, which makes it hard to argue that depression is a
response to a difficult situation or problem. Dr. David J. Kupfer, a
psychiatrist at the University of Pittsburgh, has found that a major
life stressor almost always precedes a first episode of depression,
but that episodes recur with milder stressors, or even none at all.
If depression conferred a problem-solving benefit, it should not
become a chronic or autonomous condition--which it is for about
half the patients.
According to the World Health Organization, depression is the
leading cause of disability and the fourth leading contributor to
the global burden of disease, projected to reach second place by
2020. There is also strong evidence that it is an independent risk
factor for heart disease, and several studies show that prolonged
depression is associated with selective and possibly permanent
damage to the hippocampus, a region of the brain critical to memory
and learning.
Add the fact that 2 percent to 12 percent of depressed people
eventually commit suicide, and the "advantages" of depression
suddenly don't look so good.
Why, then, does the notion persist that depression confers special
insights and benefits?
I got a clue recently from one depressed patient. He was an educated
and articulate young man, unhappy because the world was such an
awful place, he said. Because he had so many other symptoms of
depression--insomnia, fatigue, low libido and poor self-esteem--
I told him that he was clinically depressed and that his Hobbesian
worldview was probably a result of depression, not its cause.
He scoffed, but he was willing to try a course of
cognitive-behavioral therapy and antidepressant medication, if only
to feel better. Months later, when he had recovered, I asked him
again about his worldview.
The world was just as dire, he said, but he felt better. Still, he
speculated wistfully that his newfound cheerfulness was not his
authentic self, which he described as brooding and creative.
This cuts to the heart of why depression is increasingly
romanticized. What is natural, the thinking goes, is best. If we are
designed to suffer depression in response to life's ills, there must
be a good reason for it, and we should allow it to take its painful
and natural course.
But unlike ordinary sadness, the natural course of depression can be
devastating and lethal. And while sadness is useful, clinical
depression signals a failure to adapt to stress or loss, because it
impairs a person's ability to solve the very dilemmas that triggered
it.
Even if depression is "natural" and evolved from an emotional state
that might once have given us some advantage, that doesn't make it
any more desirable than other maladies. Nature offers us cancer,
infections and heart disease, which we happily avoid and do our best
to treat. Depression is no different.
Noah Heninger
When I was younger I was on an anti-depressant (not for depression, ironically). I took it for a number of years and hadn't realized it was causing pretty significant mood instability. I was eventually diagnosed with Bipolar II disorder. I can't explain why I didn't make the connection, only that I was on the anti-depressant for a long time before the mood instability progressed to a level where it could be labelled a disorder. That is, after a number of years the Bipolar had become very debilitating. It was only after I went off the anti-depressant "just to see what will happen" that the mood instability disappeared. I was shocked. Being free of bipolar disorder was the last thing I expected. I was in my twenties at the time, which is when bipolar can kick in for some people. It just never occurred to me that the anti-depressant was giving me bipolar disorder.
The point is, I may be able to speak from personal experience here. I still have some mood instability (and did before the anti-depressant), but it is very mild and couldn't even be classed as cyclothymia I don't think. I would get so depressed that there were physical manifestations. I would get muscle aches and headaches whenever I was depressed. The depression was horrible. The upside was that my bipolar was rapid cycling. I would have a bout of depression about three times over a two month period, but they only lasted for about a week. On the other hand, bouts of mania came with the same frequency. I didn't usually do anything reckless when I was high. Highs actually felt very spiritual, like God was very close to me. (note: You would have been fooled, too. Remember that)
One thing to remember is that there is no objective reality. If you're high, you believe the world is wonderful, and nobody can convince you otherwise. If you're low, you believe the world is terrible (and nobody can convince you otherwise). The longer you remain in one of these manic or depressive states, the more your beliefs reflect the way you feel. Remember, I was rapid cycling, perhaps even ultradian, and I was still very forgetful. I was fooled again and again...and again.
And that's why I think the article is very misinformed. You're perspective on the world, I believe, is not based on objective reality; it is based on your prolonged mood state. People who are inclined towards pessimism see the world in colors that those who are inclined towards optimism don't see. The reverse is also true. I'll put it this way: Optimists get more done, but pessimists are more critical. In other words, they see problems--potentially serious problems--when others don't. You'd think someone with bipolar would have the best of both worlds, but honestly, I was just confused as hell most of the time (and still very jaded from the experience).
What this article doesn't realize is that OF COURSE severe depression is always going to be debilitating. Of course there is no net benefit to something so extreme. However, if a depressed person can get his disorder in check (i.e., not completely miserable or suicidal), I think he or she benefits (or benefits others) from having insights into the world that most aren't privy to. They are better artists, too--if they can motivate themselves to actually make art. Lol.
This is a note I wrote to a friend suffering from bipolar while I was also suffering from bipolar. Yes, it sounds like it was written by somebody with bipolar, and that's sorta the point. I held onto it because I think the note was pretty insightful--but also something that only a person with bipolar could come up with:
"There's a lot wrong with the world, and it's hard when you have a disorder like yours to know when the problems you struggle with are inherently inward or outward based. It's virtually impossible to draw that line. I believe medical professionals can only help you to a certain extent. You’re suffering from a spiritual illness as well, or to put it another way, you’re suffering spiritually from the world's illness. The world tries to make everything and everybody look and act the same, but Christ created everything to serve a different purpose. In the body of Christ, everybody serves a unique function--not so in the world. That's a big part of what you’re struggling with and what many people with mood disorders struggle with. I've crossed paths with some very callous health professionals, how they try to tear down and challenge your concept of reality (to build it back up again). The problem of course, is that it's rooted in dogma: The patient MUST be wrong and the professional MUST be right, and only after the patient accepts this dogma can so-called progress be made."
I also want to point out that cognitive behavioral therapy does not cure depression (or bipolar)...it can help you manage it...assuming the person administering it isn't a retard. People with bipolar are usually pretty intelligent (above average, actually), so in many cases, the therapist will seem like a retard. What a depressed or bipolar person needs to do is safeguard their beliefs (which makes up their worldview) from their feelings/moods. Hardly anyone has this skill, but bipolar/depressed people need it vitally. That's what prevents them from committing suicide when they're depressed, or likewise, declaring that they're the second incarnation of Jesus Christ when they're manic.Noah Heninger
My past experiences with depression have led me to believe that severe depression is not non-feeling, but a form of pain that makes feeling pleasure more difficult. When I was depressed, pain was more painful, and pleasure was less pleasurable.
This article is asking whether or not there are advantages to being depressed--concluding that there are no advantages. While nobody wants to be depressed, I would argue yes, there are advantages, but only for mild depression. I think that's all that can be said.
But really...I don't know. I'm not an expert either...haven't even read the Wikipedia article.
-Noah
Might a clinically diagnosable (toward the suicidal/catatonic degree)
depressive neuro-psychological state be a cascade of brain signals
ordinating one unconsciously toward and coordinating a system-wide
pattern for what must be the brain's detachment from sensory and
logical reality in order to facilitate a deep healing? For a
depressive "not to feel" or be able to "feel" is their genuine state
of reality, the brain has made a disconnect from the "outside" in
order to effect what it has deduced as an emergency, "last-ditch" full
attempt to initiate understanding of the traumatic causal and apply
remedy thereto, almost akin to an electronic computer system's "hard"
reboot (ECT has some record of success in this area/context, probably
more being understood about this as effectual regimen than in decades
past). I draw as an example, without citation here, the not uncommon
catatonia experienced by late 19th Century/early 20th Century American
pioneer mothers, who would experience what would be referred to as the
woman having one of "her spells", where she might be in this state for
2 to 3 days before coming out of it and going back to work (becoming
"normal" again). I am not a medical professional and am not qualified
to write here as one, these thoughts expressed above are only my
opinion. Thank you for allowing me to reply and look forward to same.
On Jan 17, 6:01 pm, Frank Forman <chec...@panix.com> wrote:
> Depression Defies Rush to Find Evolutionary Upsidehttp://www.nytimes.com/2012/01/17/health/depression-defies-rush-to-fi...
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David Foster
Noah Heninger
-Noah
Carl Youngblood
> hallucinogenic drugs to bring on mystical experiences. I assume nobody
> responded because they knew I was totally right and so had nothing more to
> add.
Another explanation could have been that people were just busy :-P