Wednesday, March 3, 2010

Ruminating Depressions - Is There a Purpose to Our Suffering?

I’m taking time out from my DSM-5 Report Cards to comment on a thought-provoking article in the NY Times Magazine by author Jonah Lehrer, Depression’s Upside.  Don’t be fooled by the title - depression sucks. The true issue is whether our suffering has a purpose.

Here’s the deal: Depression is endemic in the population. Every year, seven percent of us get taken down by what William Styron described as a “gray drizzle of horror ... a storm of murk.” But:

If depression was a disorder, then evolution had made a tragic mistake, allowing an illness that impedes reproduction ... to spread throughout the population.

So does depression have some kind of secret purpose, like a fever that helps the immune system fight off infection? Enter Andy Thompson and Paul Andrews, a psychiatrist and evolutionary psychologist respectively from the University of Virginia, who came up with the “analytic-rumination hypothesis.”

Start with the proposition that depression is characterized by over-ruminating. Our brain gets locked into “a recursive loop of woe.” We can’t think about anything else. What is good about that?

Nothing, according to prevailing opinion, which strongly suggests that our malfunctioning brains are genetic accidents.

But the evolutionary perspective forces us to consider depression as an adaptation (however painful) to our environment. We typically ruminate in response to a bad setback, such as death in the family or loss of a job. A rumination about a bitter divorce may take the form of regret, second-guessing, and concern about the future.

These are the type of thoughts that fuel depression, which meds and talking therapy aim to stop dead. But suppose this type of rumination forces us to focus on the things we need to be dealing with right now? To learn from our experience and reject the type of rationalizations that may have gotten us into this very type of mess in the first place? So, quoting Andrews:

I started thinking about how, even if you are depressed for a few months, the depression might be worth it if it helps you better understand social relationships. Maybe you realize you need to be less rigid or more loving. Those are insights that can come out of depression, and they can be very valuable.

Bullshit, says Peter Kramer, author of "Undoing Depression." Depression sucks, and that’s all there is to that. How does the hypothesis account for chronic depression, for instance? Or late life depression?

Ed Hagen, an anthropologist at the University of Washington who is sympathetic to the hypothesis, also has some quibbles. For instance, individuals with major depression often don’t groom, bathe, or sometimes even use the toilet. This is one helluva price to pay for quiet reflection.

But evolutionary psychiatry and its critics are essentially coming from the same starting point. Depression is a hugely complex illness. Multifactorial and heterogeneous are the terms used to describe its many causes and seemingly infinite variations. No one theory is going to account for every single depression.

Randolph Nesse, an evolutionary biologist at the University of Michigan, offers a list of possibilities (see Darwin and the Psychiatric Advantage and Randolph Nesse Interview), including a plea for help, signal of defeat (to prevent future attacks), and removing the rose-colored glasses. Nesse compares depression to pain, which can arise from a variety of sources, as well as being an affliction in its own right.

In the meantime, though, something observable is going on in the brain. Researchers investigating depressed individuals have picked up heightened activity in the ventrolateral prefrontal cortex (VLPFC), which is especially important for maintaining attention. (Deficits in the VLPFC have been linked to ADHD.) One possibility is the VLPFC underlies rumination, allowing individuals to stay focussed.

The downside to this type of focus is individuals are too wrapped up in their own shit to concentrate on other things, such as work and relationships or even the most basic cognitive tasks. But, “human attention is a scarce resource — the neural effects of depression make sure the resource is efficiently allocated.”

Moreover, “if depression didn’t exist — if we didn’t react to stress and trauma with endless ruminations — then we would be less likely to solve our predicaments. Wisdom isn’t cheap, and we pay for it with pain.”

This same unrelenting focus may help account for the unbelievable creativity found in the depressed population. As neuropsychiatrist Nancy Andreasen of the University of Iowa describes it, “if you’re at the cutting edge, then you’re going to bleed.”

In the meantime, there is a growing body of opinion that meds may interfere with the rumination process. Yes, there is a use for meds, but the high relapse rate (76 percent according to one study) when antidepressants are discontinued indicates a host of underlying personal problems that haven’t been resolved. 

Even strong supporters of antidepressant therapy acknowledge that these meds are treating the symptoms rather than the cause. But do we do nothing while over-rumination works its destructive course? Of course not. Certain kinds of talk therapy are extremely helpful, and further refinements may speed up the rumination process.

Often, when the ruminator solves his or her problem and comes to a decision (such as to find a new career), the depression lifts. But can we afford to wait that long? As the article concludes:

To say that depression has a purpose or that sadness makes us smarter says nothing about its awfulness. A fever, after all, might have benefits, but we still take pills to make it go away. This is the paradox of evolution: even if our pain is useful, the urge to escape from the pain remains the most powerful instinct of all.


Dawn said...

Thank you for this thoughtful post on depression-purpose? The tricky thing about finding the purpose in depression is that you can spend an awful long time trying to figure out the reason you hurt so much. After all, you don't hurt for no reason? Right? Maybe a different job, better weather, different spouse? Better hair style?

Just yesterday I wrote in my journal, I still wish I had a nasty barely healing wound on my neck, which when it wasn't healing, would pus and run and maybe even smell, because then, well, we would know. Depression clouds, muddies, distorts and sneaks around silently-till it has done considerable damage.

Julia said...

Hi, John. Thanks for posting this. There certainly has been a lot of debate about this recently, it seems.

By biggest problem with pro-depression-for-the-sake-of-hard-earned-wisdom is that what comes from my head when I'm at my most depressed is pretty worthless when it comes to solving problems. Ruminating (in the depressive sense) is pretty different from the kind of contemplation that results in positive solutions. Perhaps there's a quiet place in between our highs and lows that encourages calm thought and realistic evaluation of our lives (or the world's problems), but it's not sitting all the way at the bottom. It's one thing to think about how to make the best of depression and cull what wisdom you can from your experiences, but I would hardly call it a path to wisdom. Learning to live with depression? Maybe...

And all that creativity seems to stop at a certain point, too. Again, there are places on the up- and downswings that are pretty fertile ground, but once at the very bottom, I, for one, am pretty useless and trying to force myself to engage in creative tasks only make things worse. There just isn't the energy and focus available to connect the dots.

Dunno about all of this. I want to look for the "bright side" of depression, too, but I don't know that the light quite reaches the bottom.

John McManamy said...

Hey, Dawn. I think you perfectly described "the ninja illness." :)

John McManamy said...

Hey, Julia. I agree. When serious depression hits me, my brain completely shuts down. My "evolutionary" take on this is my depression is forcing my brain into protective hibernation. It's as if I would kill myself thinking, otherwise.

My ruminating depressions are usually much milder versions. Maybe if I'm left to stew in my own juices that's supposed to be good for me.

When my mind is settled but mildly depressed I can get in a lot of good serious thinking.

Hmm - you've given me something to think about ...

Tony said...

I think Julia has hit it on the head. I didn't find Jonah Lehrer's article insightful; all I saw were a bunch of holes. First, he treats all depression as the same: there is no distinction between milder states and melancholic states. When one discusses the merits of a fever, he or she differentiate between a low-grade fever which boosts the immune system and a severe fever which is life-threatening. The same may apply to depression, if one buys into this "benefit" argument.

(Aside: I disagree on another level that because depression is "common" it must have an evolutionary purpose (the supposed rumination which I will touch on in a moment). But heart attacks are common; asthma is common; allergies are common. Who in their right mind would argue those who have these are at an "advantage"? But when it comes to mental illnesses, people are more than eager to discount that pain and suffering to declare "it is good pain for you, so shut up and endure.")

As for rumination, the only way I would see it being advantageous is if it led to a thorough evaluation of past events, looking not only on the bad side, but also the good side. But depressive rumination doesn't allow that: it is very one-sided where the sufferer looks at the negative side ad nauseum to an extreme degree. I would argue that past events, which really weren't so bad, are seen as unbearable in the twisted light of depression. This does not allow for rational introspection of those events. In fact, it does the opposite. So their argument that depressive rumination leads to useful enlightenment does not hold water.

Anonymous said...

I am patiently waiting for an increase in anti-depressant to get me back to where I was last month..Not having the energy or cognitive ability to get to the end of reading or understanding a sentence is horribly debilitating.
My husband is crap at me being ill too, which makes it worse.
I may be able to write a poem step by slow step, but that is not what I call purpose in life. That would make me slit my wrists.
(figuratively speaking).....

John McManamy said...

Hey, Tony. Bingo! You nailed it. As I said to Julia, my severe depressions shut me down completely. If there is a protective hibernation thing going on that we may have inherited from our cave man ancestors, I'm prepared to entertain that. But no way do these depressions help me think better. Au contraire, my "thinking" is totally messed up.

But your light fever-heavy fever analogy makes sense, and I think this was where Randolph Nesse was coming from when I heard him talk a few years ago. In my blog (see the link in my post), he compared anxiety to a smoke alarm that is programmed to deliver say a 100 false alarms for every genuine one. The false alarms are a small price to pay to stay alive long enough to pass on one's genes. Light fever, so to speak. Maybe even normal.

Heavy fever - the smoke alarm goes off all the time. Hardcore anxiety, panic attacks, phobias, etc etc. No evolutionary purpose, or the evolutionary wiring gone wrong. Or possibly the changed situation of modern times - an appropriate limbic response at an ancient watering hole is not appropriate at the modern water cooler.

So, light depression - Thinking deep, introspection, rumination, creative insights.

Heavy depression - a serious malfunction in the brainworks. Like a heart attack. As I said, if this was a mechanism to keep our ancestors from venturing out of their caves, then fine. It certainly keeps me from venturing out of bed.

40,000 years ago, to conserve energy and not draw attention to creatures who would like to have me for lunch (and not socially) severe depression may have come in handy. But today, where getting out of bed is a mandatory survival requirement - only in one situation I can think of: If depression actually forces me to STOP thinking about the shit that may be driving me crazy then maybe there is a reason for these depressions.

In other words, severe depression may be nature's way of shutting down our overactive brains before we truly go crazy. Like a safety switch. Mind you, this is just me wildly speculating, but that's what bipolars do when we have too much time on our hands. :)

So, major question - as we better learn to cope, are we better able to benefit from heavy versions of light depressions? Like an athlete enduring pain and fatigue? Or is this total nonsense?

I don't have any answers, which is one reason I'm putting out the questions. I think the best insights come from those who have been through depression, not the so-called experts, so please, everyone, keep posting.

Julia said...

Thanks, John. I think you can guess my first response to your last question (whether learning to better cope with the low lows makes it more possible that I'll be able to "benefit" from them): that is a rousing Heck, No. If anything, one of my strategies for better dealing with them is to not get caught up in my thoughts so much. The more I let myself swirl down in the vortex, the worse it gets and the longer it'll likely take to recover. Even if I were able to tap into my inner sage at those times and solve all my (or the world's) problems, I think I would literally have to sacrifice myself to do it. Who can take purposefully staying in that place to figure something out?? Not I, said the hen.

As we've all agreed, thinking is pretty distorted when we're in the emotional throes of our worst depressions. But that's not to say that we can't learn from the experience afterward. Maybe that's the one Yea I can give to your question. A wisdom-seeking strategy that incorporates (not focuses on) my depression would be to try to get through them with as little pain as possible and take a look at the experience once it's over--when I have a clearer eye and sharper mind, not to mention a more forgiving heart.

That's my take :)

Louise Woo, CABF- Los Angeles said...

John, I just can't find the safety aspect in depression's brain shut-down. Unlike a computer going to "sleep," too often depression prompts a complete and permanent shut-down: death.

I am extremely troubled by the spate of artist suicides that have taken place this winter. First, the singer-songwriter Vic Chesnutt, on Christmas Day. He'd even written a "love song" about death called "Flirted with You All My Life." Then, last month, the death of Mark Linkous, founder of the band Sparklehorse. And the death of Marie Osmond's 18 year-old son, Michael Blosil, who was a freshman at the Fashion Institute of Design & Merchandising in L.A..

You can't learn anything from a severe episode if you don't survive it. This is the terror that strikes the hearts of family members who love someone afflicted by depression. There's nothing "romantic" about it.

John McManamy said...

Hey, Louise. Check out the pic of the young guy in the right column. He was a good friend of mine. He was in my support group in NJ. I mentored him. Even though he was half my age, he was great company, he was a special person who touched everyone he met. 18 months ago, he threw himself in front of a train. He was 28.

Trust me, I think of him every day.

About 4 months ago I did a Google search of someone from my past only to find he had put a gun to his head. He had dedicated his life to helping others.

Then I think of my own lost years - my death in life that I miraculously lived through. Those experiences, too, haunt me. I keep looking for a purpose, a reason, even though none may exist. I look at what those close to me are going through. I look for answers. There aren't any, but I'm not going to stop asking questions.

John McManamy said...

Hey, Julia. I never want to experience another severe depression, and I can assure you I can do without any more wisdom. Occasionally, I enter into a moderate and short depression, and memories of the severe long ones come back. I honestly don't think I could survive another one of those.

But I can't help but wonder - my brain goes out of control in the other direction, too. Crazy crazy thoughts, intense jangled feelings. I don't think I could survive another one of those, either.

Do I have to extinguish myself in one direction to avoid blowing myself up in the other? Thankfully, these days my brain doesn't have to make those choices.