"Depression" - The Fight
▲ "I do not think it means
what you think it means" ▼
Ronald Pies:
Now, with all due respect to Dr. Thomson, I am inclined to ask, “Worth it to whom?” Perhaps the patients Dr. Thomson has treated emerge from their three-month bouts of depression saying, “Ya know what, Doc? It’s been a bad three months—lost my job, almost killed myself, and couldn’t get a damn thing done—but overall, it was worth it!” The depressed patients I evaluated over the past nearly 30 years almost never reported that their major depressive episodes had a “net mental benefit,” to quote Lehrer’s article. Most felt that their lives and souls hand been stolen from them for the duration of their depressive episode...
The notion that severe depression may bring forth good things reminds me of a lecture I once attended on “fire safety” in the hospital setting.
and,
As Borchard [@thereseborchard] wisely counsels, we should not renounce or disown the part of us that produces depression—it is a piece of our messy, complex, and wondrous humanity. And, to be sure: ordinary sadness or grief may indeed be a good teacher. We should not rush to suppress or “medicate” what Thomas a Kempis called, “the proper sorrows of the soul.” At the same time, we should be under no illusion that severe clinical depression is a “clarifying force” that helps us navigate life’s complex problems. That, in my view, is a well-intentioned but destructive myth.
Clinical Depression is pathological, awful, destructive and without recompense. The discussion at hand, however, is not "Clinical Depression's Upside," or "Pathological Depression's Upside." Because the word "Depression" is used, everyone responds with made-up minds and a sense of moral outrage. Pies' post is full of invective and outrage.
What if the discussion were labelled "The Upside of Persistent Sadness?" Not nearly as catchy a title. What writer would forgo grabbing attention. Yet to me, the upside of persistent sadness is the topic at hand. Only a small subset of people who experience persistent sadness are clinically depressed.
Pies:
Finally, it is time to challenge the dubious notion that if a condition, such as depression, is highly prevalent in the general population, this must mean that the condition confers some kind of evolutionary advantage, or represents a useful “adaptation.” (Following that line of logic, ignorance and superstition must also have some adaptive advantages, since they are both so widespread throughout the world!). It is more likely that the tendency to develop depression remains “conserved” in the human genome as a spandrel—a kind of genetic hitchhiker that does nothing to improve the ride.
Pies declares depression is a spandrel. It's a convenient way to avoid a very significant question: why is the behavior of depression biologically fit? Hibernation is a form of "depression," and many mammals hibernate. We can observe long periods of diminished activity in many species. Low energy states - the behavior of depression - are pervasive. The feelings of these low energy states might be labeled "persistent sadness" or "depression." In some cases, these feelings undoubtedly have tremendous and unacceptable cost, but the behavior can still be adaptive.
"Spandrel" avoids the central question. What is the literature about depression and spandrel anyway?
After I asked my son, "please stop humming," he continued to make noise. I barked, "Stop humming!"
He said, "I wasn't humming."
This debate has changed into a moral debate unfortunately. The quickness of my response reflect such qualities. The problem is the word "depression" is used to describe many different conditions.
I did see this style of argument brewing: Big- and small-d Depression. Personally, I hope the food fight continues.
The subtitle quote is from Criminal Minds Special Agent Jason Gideon back when he was Inigo Montoya in The Princess Bride
[Vizzini has just cut the rope The Dread Pirate Roberts is climbing up]
Vizzini: HE DIDN'T FALL? INCONCEIVABLE.
Inigo Montoya: You keep using that word. I do not think it means what you think it means.
Musings
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Reader Comments (3)
Interesting article, I read Ronald Pies' too, but what exactly do we mean by seeing the "upside to depression?"
The "fire safety" analogy I believe is hogwash. "Oh the whole house burnt down but at least we have these muffins!" That to me is not a good strategy if by focusing on the muffins you mean ignoring the truth of everything else.
Does it mean seeing depression as a learning experience? Perhaps, and why attack such a view? What detriment does it have? What is wrong with learning from our experiences? A stupid criticism in my honest opinion, and very frustrating to read.
What exactly do these people propose as an answer? Do they not think most psychotherapy uses similar techniques?
The whole "rumination hypothesis" debunk is also very premature.
Okay, so they look into some brains and see "increased activity" in the frontal cortex and then look into other brains and see "decreased activity" in the frontal cortex. What does this at all tell us about seeing the upside to depression? Absolutely nothing, especially since we have no idea about the CONTENT of these thoughts.
People can dig themselves into a hole with their minds and they can also build a ladder out. Without discussing WHAT and HOW people actually think about their depression then we have nothing to really say about these mental strategies, since WE DON'T KNOW WHAT THEY ARE.
I'm not saying depression is the cure to depression; it is just a tool, and we need to learn how to use it properly.
On top of all that I just want to add that our minds can be our greatest allies and also our greatest foes. It is all about how we use them.
As a mental illness, depression probably affects the greatest number of people. It is also one of the harder qualities of our complex human nature to justify or explain. Because so many suffer, it feels just wrong.
Depression is a focus in the following fields of study: psychopharmacology, psychiatry, neuroscience, psychology, sociology, anthropology and economics. The common term "depression," have varied means across all these fields. Many people are very reactive when they read that their field A, is being diminished or dismissed because of a published article from filed B. This issue is true within disciplines and across disciplines. We're all jumpy when the New York Times appears to take sides.
Finally, depression cause tremendous suffering and it presences engages moral reasoning. Also, depression is a condition with costs and benefits. Some people conflate the indications that a) depression has benefits, with b) moral requirement to treat the suffering. We treat because it's morally responsible. We study because it's intellectually fascinating. We shouldn't deny B because of A.
This debate has worked it's way down to moral tail-chasing.
I take you comment to mean we can either be caught up in the experience of depression, or we can watch the experience of depression. The second point of view is hard particularly during depression, but it provides for the best regulation, including the decision to go see medical attention.