---
created_at: '2015-06-15T17:58:37.000Z'
title: Depression's Upside (2010)
url: http://www.nytimes.com/2010/02/28/magazine/28depression-t.html
author: SuperChihuahua
points: 79
story_text: 
comment_text: 
num_comments: 72
story_id: 
story_title: 
story_url: 
parent_id: 
created_at_i: 1434391117
_tags:
- story
- author_SuperChihuahua
- story_9720903
objectID: '9720903'

---
The persistence of this affliction — and the fact that it seemed to be
heritable — posed a serious challenge to Darwin’s new evolutionary
theory. If depression was a disorder, then evolution had made a tragic
mistake, allowing an illness that impedes reproduction — it leads people
to stop having sex and consider suicide — to spread throughout the
population. For some unknown reason, the modern human mind is tilted
toward sadness and, as we’ve now come to think, needs drugs to rescue
itself.

The alternative, of course, is that depression has a secret purpose and
our medical interventions are making a bad situation even worse. Like a
fever that helps the immune system fight off infection — increased body
temperature sends white blood cells into overdrive — depression might be
an unpleasant yet adaptive response to affliction. Maybe Darwin was
right. We suffer — we suffer terribly — but we don’t suffer in vain.

**ANDY THOMSON IS** a psychiatrist at the University of Virginia. He has
a scruffy gray beard and steep cheekbones. When Thomson talks, he tends
to close his eyes, as if he needs to concentrate on what he’s saying.
But mostly what he does is listen: For the last 32 years, Thomson has
been tending to his private practice in Charlottesville. “I tend to get
the real hard cases,” Thomson told me recently. “A lot of the people I
see have already tried multiple treatments. They arrive without much
hope.” On one of the days I spent with Thomson earlier this winter, he
checked his phone constantly for e-mail updates. A patient of his on
“welfare watch” who was required to check in with him regularly had
not done so, and Thomson was worried. “I’ve never gotten used to
treating patients in mental pain,” he said. “Maybe it’s because every
story is unique. You see one case of iron-deficiency anemia, you’ve seen
them all. But the people who walk into my office are all hurting for a
different reason.”

In the late 1990s, Thomson became interested in evolutionary psychology,
which tries to explain the features of the human mind in terms of
natural selection. The starting premise of the field is that the brain
has a vast evolutionary history, and that this history shapes human
nature. We are not a blank slate but a byproduct of imperfect
adaptations, stuck with a mind that was designed to meet the needs of
Pleistocene hunter-gatherers on the African savanna. While the specifics
of evolutionary psychology remain controversial — it’s never easy
proving theories about the distant past — its underlying assumption is
largely accepted by mainstream scientists. There is no longer much
debate over whether evolution sculptured the fleshy machine inside our
head. Instead, researchers have moved on to new questions like when and
how this sculpturing happened and which of our mental traits are
adaptations and which are accidents.

In 2004, Thomson met Paul Andrews, an evolutionary psychologist at
Virginia Commonwealth University, who had long been interested in the
depression paradox — why a disorder that’s so costly is also so common.
Andrews has long dark brown hair and an aquiline nose. Before he begins
to talk, he often writes down an outline of his answer on scratch paper.
“This is a very delicate subject,” he says. “I don’t want to say
something reckless.”

Andrews and Thomson struck up an extended conversation on the
evolutionary roots of depression. They began by focusing on the thought
process that defines the disorder, which is known as rumination. (The
verb is derived from the Latin word for “chewed over,” which describes
the act of digestion in cattle, in which they swallow, regurgitate and
then rechew their food.) In recent decades, psychiatry has come to see
rumination as a dangerous mental habit, because it leads people to
fixate on their flaws and problems, thus extending their negative moods.
Consider “The Depressed Person,” a short story by David Foster Wallace,
which chronicles a consciousness in the grip of the ruminative cycle.
(Wallace struggled with severe depression for years before committing
suicide in 2008.) The story is a long lament, a portrait of a mind
hating itself, filled with sentences like this: “What terms might be
used to describe such a solipsistic, self-consumed, bottomless emotional
vacuum and sponge as she now appeared to herself to be?” The dark
thoughts of “The Depressed Person” soon grow tedious and trying, but
that’s precisely Wallace’s point. There is nothing profound about
depressive rumination. There is just a recursive loop of woe.

The bleakness of this thought process helps explain why, according to
the Yale psychologist Susan Nolen-Hoeksema, people with “ruminative
tendencies” are more likely to become depressed. They’re also more
likely to become unnerved by stressful events: for instance,
Nolen-Hoeksema found that residents of San Francisco who self-identified
as ruminators showed significantly more depressive symptoms after the
1989 Loma Prieta earthquake. And then there are the cognitive deficits.
Because rumination hijacks the stream of consciousness — we become
exquisitely attentive to our pain — numerous studies have found that
depressed subjects struggle to think about anything else, just like
Wallace’s character. The end result is poor performance on tests for
memory and executive function, especially when the task involves lots of
information. (These deficits disappear when test subjects are first
distracted from their depression and thus better able to focus on the
exercise.) Such research has reinforced the view that rumination is a
useless kind of pessimism, a perfect waste of mental energy.

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That, at least, was the scientific consensus when Andrews and Thomson
began exploring the depression paradox. Their evolutionary perspective,
however — they see the mind as a fine-tuned machine that is not prone to
pointless programming bugs — led them to wonder if rumination had a
purpose. They started with the observation that rumination was often a
response to a specific psychological blow, like the death of a loved one
or the loss of a job. (Darwin was plunged into a debilitating grief
after his 10-year-old daughter, Annie, died following a bout of scarlet
fever.) Although the D.S.M. manual, the diagnostic bible for
psychiatrists, does not take such stressors into account when diagnosing
depressive disorder — the exception is grief caused by bereavement, as
long as the grief doesn’t last longer than two months — it’s clear that
the problems of everyday life play a huge role in causing mental
illness. “Of course, rumination is unpleasant,” Andrews says. “But it’s
usually a response to something real, a real setback. It didn’t seem
right that the brain would go haywire just when we need it most.”

Imagine, for instance, a depression triggered by a bitter divorce. The
ruminations might take the form of regret (“I should have been a better
spouse”), recurring counterfactuals (“What if I hadn’t had my affair?”)
and anxiety about the future (“How will the kids deal with it? Can I
afford my alimony payments?”). While such thoughts reinforce the
depression — that’s why therapists try to stop the ruminative cycle —
Andrews and Thomson wondered if they might also help people prepare for
bachelorhood or allow people to learn from their mistakes. “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,” Andrews says. “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.”

This radical idea — the scientists were suggesting that depressive
disorder came with a net mental benefit — has a long intellectual
history. Aristotle was there first, stating in the fourth century B.C.
“that all men who have attained excellence in philosophy, in poetry,
in art and in politics, even Socrates and Plato, had a melancholic
habitus; indeed some suffered even from melancholic disease.” This
belief was revived during the Renaissance, leading Milton to exclaim, in
his poem “Il Penseroso”: “Hail divinest Melancholy/Whose saintly visage
is too bright/To hit the sense of human sight.” The Romantic poets took
the veneration of sadness to its logical extreme and described suffering
as a prerequisite for the literary life. As Keats wrote, “Do you not see
how necessary a World of Pains and troubles is to school an intelligence
and make it a soul?”

But Andrews and Thomson weren’t interested in ancient aphorisms or
poetic apologias. Their daunting challenge was to show how rumination
might lead to improved outcomes, especially when it comes to solving
life’s most difficult dilemmas. Their first speculations focused on the
core features of depression, like the inability of depressed subjects to
experience pleasure or their lack of interest in food, sex and social
interactions. According to Andrews and Thomson, these awful symptoms
came with a productive side effect, because they reduced the possibility
of becoming distracted from the pressing problem.

The capacity for intense focus, they note, relies in large part on a
brain area called the left ventrolateral prefrontal cortex (VLPFC),
which is located a few inches behind the forehead. While this area has
been associated with a wide variety of mental talents, like conceptual
knowledge and verb conjugation, it seems to be especially important for
maintaining attention. Experiments show that neurons in the VLPFC must
fire continuously to keep us on task so that we don’t become sidetracked
by irrelevant information. Furthermore, deficits in the VLPFC have been
associated with attention-deficit disorder.

Several studies found an increase in brain activity (as measured
indirectly by blood flow) in the VLPFC of depressed patients. Most
recently, a paper to be published next month by neuroscientists in China
found a spike in “functional connectivity” between the lateral
prefrontal cortex and other parts of the brain in depressed patients,
with more severe depressions leading to more prefrontal activity. One
explanation for this finding is that the hyperactive VLPFC underlies
rumination, allowing people to stay focused on their problem. (Andrews
and Thomson argue that this relentless fixation also explains the
cognitive deficits of depressed subjects, as they are too busy thinking
about their real-life problems to bother with an artificial lab
exercise; their VLPFC can’t be bothered to care.) Human attention is a
scarce resource — the neural effects of depression make sure the
resource is efficiently allocated.

But the reliance on the VLPFC doesn’t just lead us to fixate on our
depressing situation; it also leads to an extremely analytical style of
thinking. That’s because rumination is largely rooted in working memory,
a kind of mental scratchpad that allows us to “work” with all the
information stuck in consciousness. When people rely on working memory —
and it doesn’t matter if they’re doing long division or contemplating a
relationship gone wrong — they tend to think in a more deliberate
fashion, breaking down their complex problems into their simpler parts.

The bad news is that this deliberate thought process is slow, tiresome
and prone to distraction; the prefrontal cortex soon grows exhausted and
gives out. Andrews and Thomson see depression as a way of bolstering our
feeble analytical skills, making it easier to pay continuous attention
to a difficult dilemma. The downcast mood and activation of the VLPFC
are part of a “coordinated system” that, Andrews and Thomson say, exists
“for the specific purpose of effectively analyzing the complex life
problem that triggered the depression.” 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.

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Consider a young professor on tenure track who was treated by Thomson.
The patient was having difficulties with his academic department. “This
guy was used to success coming easy, but now it wasn’t,” Thomson says.
“I made it clear that I thought he’d need some time to figure out his
next step. His problem was like a splinter, and the pain wouldn’t go
away until the splinter was removed.” Should the patient leave the
department? Should he leave academia? Or should he try to resolve the
disagreement? Over the next several weeks, Thomson helped the patient
analyze his situation and carefully think through the alternatives. “We
took it one variable at a time,” Thomson says. “And it eventually became
clear to him that the departmental issues couldn’t be fixed. He needed
to leave. Once he came to that conclusion, he started feeling better.”

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**The publication of** Andrews and Thomson’s 36,000-word paper in the
July 2009 issue of Psychological Review had a polarizing effect on the
field. While some researchers, like Jerome Wakefield, a professor at New
York University who specializes in the conceptual foundations of
clinical theory, greeted the paper as “an extremely important first step
toward the re-evaluation of depression,” other psychiatrists regarded it
as little more than irresponsible speculation, a justification for human
suffering. Peter Kramer, a professor of psychiatry and human behavior at
Brown University, describes the paper as “a ladder with a series of weak
rungs.” Kramer has long defended the use of antidepressants — his
landmark work, “Listening to Prozac,” chronicled the profound
improvements of patients taking the drugs — and criticized those who
romanticized depression, which he compares to the glamorization of
tuberculosis in the late 19th century. In a series of e-mail messages to
me, Kramer suggested that Andrews and Thomson neglect the variants of
depression that don’t fit their evolutionary theory. “This study says
nothing about chronic depression and the sort of self-hating,
paralyzing, hopeless, circular rumination it inspires,” Kramer wrote.
And what about post-stroke depression? Late-life depression? Extreme
depressive condition? Kramer argues that there’s a clear category
difference between a healthy response to social stressors and the
response of people with depressive disorder. “Depression is not really
like sadness,” Kramer has written. “It’s more an oppressive flattening
of feeling.”

Even scientists who are sympathetic to what Andrews and Thomson call the
“analytic-rumination hypothesis” remain critical of its details. Ed
Hagen, an anthropologist at Washington State University who is working
on a book with Andrews, says that while the analytic-rumination
hypothesis has persuaded him that some depressive symptoms might improve
problem-solving skills, he remains unconvinced that it is a sufficient
explanation for depression. “Individuals with major depression often
don’t groom, bathe and sometimes don’t even use the toilet,” Hagen
says. They also significantly “reduce investment in child care,” which
could have detrimental effects on the survival of offspring. The steep
fitness costs of these behaviors, Hagen says, would not be offset by
“more uninterrupted time to think.”

Other scientists, including Randolph Nesse at the University of
Michigan, say that complex psychiatric disorders like depression rarely
have simple evolutionary explanations. In fact, the analytic-rumination
hypothesis is merely the latest attempt to explain the prevalence of
depression. There is, for example, the “plea for help” theory, which
suggests that depression is a way of eliciting assistance from loved
ones. There’s also the “signal of defeat” hypothesis, which argues that
feelings of despair after a loss in social status help prevent
unnecessary attacks; we’re too busy sulking to fight back. And then
there’s “depressive realism”: several studies have found that people
with depression have a more accurate view of reality and are better at
predicting future outcomes. While each of these speculations has
scientific support, none are sufficient to explain an illness that
afflicts so many people. The moral, Nesse says, is that sadness, like
happiness, has many functions.

Although Nesse says he admires the analytic-rumination hypothesis, he
adds that it fails to capture the heterogeneity of depressive disorder.
Andrews and Thomson compare depression to a fever helping to fight off
infection, but Nesse says a more accurate metaphor is chronic pain,
which can arise for innumerable reasons. “Sometimes, the pain is going
to have an organic source,” he says. “Maybe you’ve slipped a disc or
pinched a nerve, in which case you’ve got to solve that underlying
problem. But much of the time there is no origin for the pain. The pain
itself is the dysfunction.”

Andrews and Thomson respond to such criticisms by acknowledging that
depression is a vast continuum, a catch-all term for a spectrum of
symptoms. While the analytic-rumination hypothesis might explain those
patients reacting to an “acute stressor,” it can’t account for those
whose suffering has no discernible cause or whose sadness refuses to
lift for years at a time. “To say that depression can be useful doesn’t
mean it’s always going to be useful,” Thomson says. “Sometimes, the
symptoms can spiral out of control. The problem, though, is that as a
society, we’ve come to see depression as something that must always be
avoided or medicated away. We’ve been so eager to remove the stigma from
depression that we’ve ended up stigmatizing sadness.”

For Thomson, this new theory of depression has directly affected his
medical practice. “That’s the litmus test for me,” he says. “Do these
ideas help me treat my patients better?” In recent years, Thomson has
cut back on antidepressant prescriptions, because, he says, he now
believes that the drugs can sometimes interfere with genuine recovery,
making it harder for people to resolve their social dilemmas. “I
remember one patient who came in and said she needed to reduce her
dosage,” he says. “I asked her if the antidepressants were working, and
she said something I’ll never forget. ‘Yes, they’re working great,’ she
told me. ‘I feel so much better. But I’m still married to the same
alcoholic son of a bitch. It’s just now he’s tolerable.’ ”

The point is the woman was depressed for a reason; her pain was about
something. While the drugs made her feel better, no real progress was
ever made. Thomson’s skepticism about antidepressants is bolstered by
recent studies questioning their benefits, at least for patients with
moderate depression. Consider a 2005 paper led by Steven Hollon, a
psychologist at Vanderbilt University: he found that people on
antidepressants had a 76 percent chance of relapse within a year when
the drugs were discontinued. In contrast, patients given a form of
cognitive talk therapy had a relapse rate of 31 percent. And Hollon’s
data aren’t unusual: several studies found that patients treated with
medication were approximately twice as likely to relapse as patients
treated with cognitive behavior therapy. “The high relapse rate suggests
that the drugs aren’t really solving anything,” Thomson says. “In fact,
they seem to be interfering with the solution, so that patients are
discouraged from dealing with their problems. We end up having to keep
people on the drugs forever. It was as if these people have a bodily
infection, and modern psychiatry is just treating their fever.”

Thomson describes a college student who was referred to his practice.
“It was clear that this patient was in a lot of pain,” Thomson says.
“He couldn’t sleep, couldn’t study. He had some family issues” — his
parents were recently divorced — “and his father was exerting a
tremendous amount of pressure on him to go to graduate school. Because
he’s got a family history of depression, the standard of care would be
to put him on drugs right away. And a few years ago, that’s what I would
have done.”

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Instead, Thomson was determined to help the student solve his problem.
“What you’re trying to do is speed along the rumination process,”
Thomson says. “Once you show people the dilemma they need to solve, they
almost always start feeling better.” He cites as evidence a recent study
that found “expressive writing” — asking depressed subjects to write
essays about their feelings — led to significantly shorter depressive
episodes. The reason, Thomson suggests, is that writing is a form of
thinking, which enhances our natural problem-solving abilities. “This
doesn’t mean there’s some miracle cure,” he says. “In most cases, the
recovery period is going to be long and difficult. And that’s what I
told this young student. I said: ‘I know you’re hurting. I know these
problems seem impossible. But they’re not. And I can help you solve
them.’ ”

**IT’S TOO SOON** to judge the analytic-rumination hypothesis. Nobody
knows if depression is an adaptation or if Andrews and Thomson have
merely spun another “Just So” story, a clever evolutionary tale that
lacks direct evidence. Nevertheless, their speculation is part of a
larger scientific re-evaluation of negative moods, which have long been
seen as emotional states to avoid. The dismissal of sadness and its
synonyms is perhaps best exemplified by the rise of positive psychology,
a scientific field devoted to the pursuit of happiness. In recent years,
a number of positive psychologists have written popular self-help books,
like “The How of Happiness” and “Authentic Happiness,” that try to
outline the scientific principles behind “lasting fulfillment” and
“getting the life we want.”

The new research on negative moods, however, suggests that sadness comes
with its own set of benefits and that even our most unpleasant feelings
serve an important purpose. Joe Forgas, a social psychologist at the
University of New South Wales in Australia, has repeatedly demonstrated
in experiments that negative moods lead to better decisions in complex
situations. The reason, Forgas suggests, is rooted in the intertwined
nature of mood and cognition: sadness promotes “information-processing
strategies best suited to dealing with more-demanding situations.” This
helps explain why test subjects who are melancholy — Forgas induces the
mood with a short film about death and cancer — are better at judging
the accuracy of rumors and recalling past events; they’re also much less
likely to stereotype strangers.

Last year Forgas ventured beyond the lab and began conducting studies in
a small stationery store in suburban Sydney, Australia. The experiment
itself was simple: Forgas placed a variety of trinkets, like toy
soldiers, plastic animals and miniature cars, near the checkout counter.
As shoppers exited, Forgas tested their memory, asking them to list as
many of the items as possible. To control for the effect of mood, Forgas
conducted the survey on gray, rainy days — he accentuated the weather by
playing Verdi’s “Requiem” — and on sunny days, using a soundtrack of
Gilbert and Sullivan. The results were clear: shoppers in the “low mood”
condition remembered nearly four times as many of the trinkets. The wet
weather made them sad, and their sadness made them more aware and
attentive.

The enhancement of these mental skills might also explain the striking
correlation between creative production and depressive disorders. In a
survey led by the neuroscientist Nancy Andreasen, 30 writers from the
Iowa Writers’ Workshop were interviewed about their mental history.
Eighty percent of the writers met the formal diagnostic criteria for
some form of depression. A similar theme emerged from biographical
studies of British writers and artists by Kay Redfield Jamison, a
professor of psychiatry at Johns Hopkins, who found that successful
individuals were eight times as likely as people in the general
population to suffer from major depressive illness.

Why is mental illness so closely associated with creativity? Andreasen
argues that depression is intertwined with a “cognitive style” that
makes people more likely to produce successful works of art. In the
creative process, Andreasen says, “one of the most important qualities
is persistence.” Based on the Iowa sample, Andreasen found that
“successful writers are like prizefighters who keep on getting hit but
won’t go down. They’ll stick with it until it’s right.” While Andreasen
acknowledges the burden of mental illness — she quotes Robert Lowell on
depression not being a “gift of the Muse” and describes his reliance on
lithium to escape the pain — she argues that many forms of creativity
benefit from the relentless focus it makes possible. “Unfortunately,
this type of thinking is often inseparable from the suffering,” she
says. “If you’re at the cutting edge, then you’re going to bleed.”

And then there’s the virtue of self-loathing, which is one of the
symptoms of depression. When people are stuck in the ruminative spiral,
their achievements become invisible; the mind is only interested in what
has gone wrong. While this condition is typically linked to withdrawal
and silence — people become unwilling to communicate — there’s some
suggestive evidence that states of unhappiness can actually improve our
expressive abilities. Forgas said he has found that sadness correlates
with clearer and more compelling sentences, and that negative moods
“promote a more concrete, accommodative and ultimately more successful
communication style.” Because we’re more critical of what we’re writing,
we produce more refined prose, the sentences polished by our angst. As
Roland Barthes observed, “A creative writer is one for whom writing is a
problem.”

This line of research led Andrews to conduct his own experiment, as he
sought to better understand the link between negative mood and improved
analytical abilities. He gave 115 undergraduates an abstract-reasoning
test known as Raven’s Progressive Matrices, which requires subjects to
identify a missing segment in a larger pattern. (Performance on the task
strongly predicts general intelligence.) The first thing Andrews found
was that nondepressed students showed an increase in “depressed affect”
after taking the test. In other words, the mere presence of a
challenging problem — even an abstract puzzle — induced a kind of
attentive trance, which led to feelings of sadness. It doesn’t matter if
we’re working on a mathematical equation or working through a broken
heart: the anatomy of focus is inseparable from the anatomy of
melancholy. This suggests that depressive disorder is an extreme form of
an ordinary thought process, part of the dismal machinery that draws us
toward our problems, like a magnet to metal.

But is that closeness effective? Does the despondency help us solve
anything? Andrews found a significant correlation between depressed
affect and individual performance on the intelligence test, at least
once the subjects were distracted from their pain: lower moods were
associated with higher scores. “The results were clear,” Andrews says.
“Depressed affect made people think better.” The challenge, of course,
is persuading people to accept their misery, to embrace the tonic of
despair. 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.**

**Correction: March 14, 2010**  

An article on Feb. 28 about the benefits of depression misstated the
name of a university in Australia where studies have been done on the
subject. It is the University of New South Wales, not South Wales.

[Continue reading the main story](#whats-next)
