Tyler Cowen described the book as one that “stresses the (partial) cognitive advantages of having a tendency toward depression“. He also lists it as one of the best non-fiction books of 2014. This immediately grabbed my attention as I had enjoyed Cowen’s similar treatment of autism/neurodiversity in his book “Create Your Own Economy” [short review by moi].
Jonathan Rottenbergs reason for the book comes from the fact that nearly thirty million adult Americans are suffering from depression. Furthermore, this number is increasing rapidly. For him it demonstrates that depression is not abnormal, but instead a common disease which needs to be addressed properly, especially because the medical possibilities to cure depression are still very few and not very effective. The fault lies in its wrong definition as a simple cognitive defect – some wires going crazy in our brain – and not a more nuanced position. The author wishes to change the reader’s opinion by using the mood approach where depression is a persistent low mood and a natural behavioral response.
For him changes in mood reflect changes in the environment with each mood (anxious, sad, good, normal, etc.) having different evolutionary costs and benefits for specific situations. It is a system to motivate and monitor our progress in achieving a certain goal. If low moods had not provided us with some evolutionary advantages in the past it most likely would’ve been removed from our genetic pool or at least would not be quite as common in humans (and animals). As experiments with humans and animals show, this might be the case.
Negative mood, for example, is particularly important in conserving energy and not wasting any more effort on (seemingly) impossible tasks, while at the same time most tasks get solved more quickly. Rottenberg (2014: 15) writes that “[m]ood flexibility tunes behavior to situational requirements, which is what makes it so effective as an adaptation. When a situation is favorable, high moods lead to more efficient pursuit of rewards. Reward-seeking behavior is invigorated (eat grass while sun shines). In an unfavorable situation, low mood focus attention on threats and obstacles, and behavior is pulled back (hunker down until the blizzard ends)“. Basically, evolution is the reason why humans and animals can have low moods with the side-effect that they can develop into deep and costly depressions.
Experiments using animals, as well as humans show, how helpful short spurs of low/depressed mood can be in specific situations (i. a. it makes us think clearer), and how resilient humans and animals tend to be against persistent low moods (we still need more knowledge on when and how low moods become costly). The real problem arises when a shallow depression transforms into a maladaptive disease, a deep depression. Here, instead of a clear-cut difference we have a continuum of moods with deep depression as the most extreme form of low moods.
One of the most frequent triggers of depression is the death of a close friend or family member (for animals and humans). Since many of our ancient funeral rituals have fallen out-of-favor, a death of a significant other might have a bigger impact on mood than ever before. Strangely, sad and depressed moods due to bereavement had been excluded from the analysis and the similarities were only recently researched. The result: “depression is depression is depression” (63). And while most sad and low moods are short, multiple stressful life events (reality of rejection, failure, or humiliation) increase the chance for a depression exponentially (depending on timing, temperament, routine and cultural background).
Yet, the role of internal reasons should not to be underestimated. Rottenberg describes it as a “low mood spiral”. By trying to solve our low mood on our own, we only dig deeper and deeper into depression: the ice-cold hand of despair pulling us under because we can’t solve this problem on our own, leading to more and more self-accusations; ultimately, self-branding ourselves as failures. This might also explain why perfectionists are more prone to depression than non-perfectionists. As Rottenberg (103) writes: “Depressed people don’t end up lying in bed because they are undercommitted to goals. They end up lying bed because they are overcommitted to goals that are failing“. Combined with America’s (and Europe’s?) preference for high arousal positive states, like enthusiasm and excitement, one is bound to be disappointed with oneself. Euphoria fades all too quickly and the next kick is not in sight.
The last chapters are about how to get better, beat depression and fend off its ever-lasting and lingering effects. And while “To Prozac, or not to Prozac?” is clearly not the right answer; a combination of anti-depressant medications, cognitive-behavioral, and interpersonal therapy have shown to speed up improvement considerably. However, treatment takes time and patience. It’s hard to know how and when depression gets better – so far we only have clues how improvement actually works. This is worrying as a chance of relapse is quite high.
Mindfulness-based cognitive therapy hopes to change that. And it is able to “decouple sad mood from the tendency to engage in negatively toned thoughts about the self” (176) and therefore prevents relapses. It manages to distort the filter of negativity that has settled over the perception. This also “speaks against the existence of a permanent, brain-based vulnerability to depression” (176), as purported by many. It is important to not only listen to Prozac, but encourage people to make sense of their depression themselves. More research is needed though.
His last finale point is a plea. A plea to have a honest and balanced conversation about depression, to remove the stigma surrounding depression and the depressed. People suffering from depressions should be able to talk about it as “easily” as others can about cancer. We should acknowledge the hardship they are going through and instead of “assuming permanent debility, we should recognize that some depressions are followed by thriving” (200) and the strength necessary to fight it.
Overall, I thoroughly enjoyed the book. It provided me with a fresh and intriguing perspective. It managed to make me pause, lay down the book, and think, think and think some more. It uses an interesting theoretical approach, as well as empirical evidence won by cleverly designed experiments to underline its cause. The author was very thorough in his research and the text is very easy to read and understand.
I have no way to ascertain the rightness of every study cited or his own claims, but the book appears to be genuine. As usual, my criticism would lie within the repetitiveness of some aspects and the weird choice of “real-life stories”. Leave them out. Don’t go all personal on ME!
What I do know, is that his alarming title “depression epidemic” lies in stark contrast to WHO’s evaluation. The WHO states that “[u]nlike many large scale international problems, a solution for depression is at hand. Efficacious and cost-effective treatments are available to improve the health and the lives of the millions of people around the world suffering from depression” (WHO 2012). Although, I’m not sure one should trust the WHO…
Be that as it may… I recommend you buy the book. Not only if you know somebody (who knows somebody who knows…), but purely because it’s a fascinating and entertaining read. NOW GO FORTH!
YOU CAN BUY THE BOOK HERE. OR IN ANY BOOK SHOP (PROBABLY). BUYING BOOKS IS NOT HARD. IF I CAN DO IT, YOU CAN DO IT TOO!
AND FOLLOW HIM ON TWITTER: Jonathan Rottenberg.