Saturday, February 18, 2017


The problem with depression—the thing that makes it so hard to describe, and gives its sufferers a bad conscience—is its resemblance to unhappiness. Unhappiness is part of every life, and most people learn how to cope with it: by changing the conditions that cause it, or by distracting themselves, or by actively repressing it. A person who can’t deal with being unhappy is seen as a moral failure—childish, selfish, “difficult.” It is all too easy to apply the same judgment to a depressed person, as if depression just meant luxuriating in unhappiness. David Foster Wallace wrote a brilliant story, “The Depressed Person,” in which a woman worries that by describing her suffering she will only disgust her friends and even her therapist—a worry which itself feeds into her suffering.

But depression is actually the opposite of unhappiness, because it is precisely not “a part of life.” When you are unhappy, life is pressing you, hurting you, and you are forced to respond to it. An unhappy life is a problem, and to be absorbed in a problem is to be absorbed in existence. When you are depressed, on the other hand, there is no problem, because there is nothing to be solved. Existence itself seems to retreat, to leave you stranded, without purchase on things, people, yourself. In her new memoir, This Close to Happy: A Reckoning with Depression, Daphne Merkin describes it this way:
Now you can no longer figure out what it is that moves other people to bustle about out there in the world, doing errands, rushing to appointments, picking up a child from school. You have lost the thread that pulled the circumstances of your life together. Nothing adds up and all you can think about is the raw nerve of pain that your mind has become—and, once again, how merciful it would be to yourself and others to extinguish this pain.
This is the situation that Heidegger called anxiety, and that Sylvia Plath describes as being covered with a bell jar. Nothing matters—not obligations, or commitments, or challenges, or pleasures. It is this failure of mattering that feels so impossible to remedy, and which leads the depressed person to thoughts of suicide. (...)

For Merkin... depression is something that emerges from within, the medium in which she lives. She experiences it as “a yawning inner lack—some elusive craving for wholeness or well-being.” Writing about a lack is difficult, and perhaps no one has ever captured exactly what it feels like to be depressed, simply because one can’t describe a negative. Merkin avoids this problem by writing less about the feeling of depression than about its causes and its remedies. What, she asks, made her so miserable? And what happens when she tries—through therapy, medication, or hospitalization—to cure that misery?

The answer to the first question—what causes depression?—depends largely on the vocabulary you use to ask it. Is depression understood philosophically, as a response to the true nature of reality—its futility, loneliness, despair? Or is it understood medically, as a deficit of certain brain chemicals, which turns it into a disease like diabetes?

by Adam Kirsch, Tablet | Read more:
Image: uncredited
Depression is pervasive: In 2015, about 16 million — or 6.7 percent of — American adults had a major depressive episode in the past year. Major depression takes the most years off of American lives and accounts for the most years lived with disability of any mental or behavioral disorder. It is also expensive: From 1999 to 2012, the percentage of Americans on antidepressants rose from an estimated 6.8 to 12 percent. The global depression drug market is slated to be worth over $16 billion by 2020.

The National Institute of Mental Health defines a major depressive episode as “a period of two weeks or longer during which there is either depressed mood or loss of interest or pleasure, and at least four other symptoms that reflect a change in functioning, such as problems with sleep, eating, energy, concentration, and self-image.” This falls in line with what Matthew Hutson, in a new feature for Nautilus, describes as the disease model of depression: that depression is “a breakdown, a flaw in the system, something to be remedied and moved past.” In his compelling and challenging piece, Hutson profiles several researchers who advance an argument that depression can serve a possibly positive purpose in the lens of evolution. But rather than deifying evolution and trying to scry out what it meant for us, let’s focus on what’s more immediately useful for lived human lives today: that, in some circumstances, depression may be, in the arc of a life, yielding of insights and personal meaning. All of this is in no way meant to minimize the suffering that depression can cause — but to suggest the uses that it may serve.

At the center of Hutson’s piece is Paul Andrews, an evolutionary psychologist at McMaster University in Canada. Andrews argues that depression may be “an adaptation for analyzing complex problems.” He sees it in the condition’s bouquet of symptoms, which include “anhedonia,” or an inability to feel much pleasure; people who are depressed ruminate frequently, often in spirals; and they get more REM sleep, a phase associated with memory consolidation. This reflects an evolutionary design, the argument goes, one that’s to, as Hutson summarizes, “pull us away from the normal pursuits of life and focus us on understanding or solving the one underlying problem that triggered the depressive episode.” Like, say, a “failed” relationship. The episode, then, is a sort of altered state, one different from the hum of daily life, one that’s supposed to get you to pay attention to whatever wounding led to the upset. For example, 80 percent of subjects in a 61-person study of depression found that they perceived some benefit from rumination, mostly assessing problems and preventing future mistakes.

For now, Andrews’s “analytical rumination hypothesis” is just that, a hypothesis, a term that combines the Greek hypo (under) with -thesis (placing). It’s a concept, an observation, one that acts as a structure for further inquiry. Still, already, there is something very powerful, and even actionable, in reconceptualizing (some) depressive episodes as having a function, as presenting a quest toward understanding for the sufferer to undertake. Other research helps to refract the light being shined here: Laura King, a psychologist at the University of Missouri, has spent a couple decades studying people’s experiences of meaning in life, and she told me in an interview at this year’s Society for Personality and Social Psychology meeting that the meaning people derive from difficult experiences depends not on the amount that they’re suffered, but the extent of reflection — or meaning-making — they’ve done on what prompted a given nadir. Following this logic, if the job of a depressive episode is to figure out what’s gone awry, what emotional knots need to be untangled, what attachment patterns need to be identified and addressed, then antidepressants are an incomplete treatment, just like you wouldn’t prescribe Percocet to a heal a broken ankle without also supplying a cast.

by Drake Baer, Science of Us |  Read more: