Depression's Upside, Down

Last week The Headcase touched on the usefulness of sadness—a topic so uplifting that I couldn't resist having another go at it, after reading Jonah Lehrer's piece, "Depression's Upside," in this Sunday's New York Times Magazine.

Most of Lehrer's article is dedicated to the work of two researchers (psychiatrist Andy Thomson of U. Virginia and psychologist Paul Andrews of Virginia Commonwealth) who have set out to address the "depression paradox." The basic idea, rooted in evolutionary psychology, is that depression must have a "secret" beneficial purpose, or else it would have been selected out of the population.

Thomson and Andrews have studied depressed brains and found increased activity in a region of the prefrontal cortex associated with rumination and analytical thought. As a result they have created an "analytic-rumination hypothesis" of depression. Lehrer explains:

"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. ... 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."

It's a bold hypothesis, the type that invites criticism, and Lehrer lists several caveats in his thorough piece. (He even goes a step further and responds to additional criticisms on his blog, The Frontal Cortex.)

But in discussing the theory with a younger brother of mine who will soon begin a residency in psychiatry—The Lil' Headcase, we'll call him—a rather basic problem emerged that I wish Lehrer, or someone out there, might illuminate for me.

The depression paradox asks why the disorder persists despite leading to a low sex drive and, in extreme cases, suicide. After all, survival of the fittest requires reproduction, and these two effects of depression would impair its ability to be passed down. But major depression typically presents later in life, well past the age when one begins to beget. It would seem to me that the ingredients for any disorder that reveals itself beyond reproductive age will remain in the gene pool whether it has a "secret purpose" or not.

No one would argue that Alzheimer's has a hidden benefit. What's so different about major depression?

Despite this flaw in the theory, there does appear to be at least one key difference between this affliction others—the high correlation that's been found over the years between depression and creativity. A solid history of evidence has linked artistic success and affective disorders, which include major depression and bipolar disorder.

The "landmark" study in this area was published in a 1987 issue of the American Journal of Psychiatry. Nancy Andreasen compared the mental profiles of thirty faculty members from the Iowa Writer's Workshop with those in a control group. All told she found a "strong association" between creativity and affective disorders.

Her key findings include:

• 80% of the writers had an affective episode at some point in their lives, compared to 30% of a control group
• 37% of the writers had suffered from major depression, compared to 17% of the control
• 2 of the 30 writers killed themselves during the course of the 15-year study

In conclusion, Andreasen wrote, "these results do suggest that affective disorder may produce some cultural advantages for society as a whole, in spite of the individual pain and suffering that it also causes."

Subsequent studies have supported Andreasen's claims. Kay Redfield Jamison reached a similar conclusion after studying distinguished British writers. Established artists in her study population met DSM-IV criteria for manic-depression or major depression at a rate far greater than chance. "In fact, it seems that these diseases can sometimes enhance or otherwise contribute to creativity in some people," she wrote in Scientific American.

Arnold Ludwig offered some nuance to the connection in his 1995 book, The Price of Greatness. He found that creative professionals who rely on "precision, reason, and logic," such as architects and journalists, were less prone to mental disorders than those whose craft required more emotional expression, such as poets, novelists, and musicians.

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In short, researchers have built a strong case for some "beneficial" component to depression—a reason for it to persist despite whatever evolutionary drawbacks it may possess.

In going back through Andreasen's paper, however, I found a qualification to this argument that seems important to explore more closely. (Actually, I read an adaptation of Andreasen's paper in the 1997 book Eminent Creativity, Everyday Creativity, and Health.)

Toward the end of her paper, Andreasen mentions that writers in her study pool said they typically waited out their manic highs and depressive lows before going back to work. "Most writers reported that they tended to write during these normal periods rather than during highs or lows," she reported.

I dug up several quotes on depression by celebrated writers who suffered from the disorder and found that, far from inspiring their creativity, depression seems to have impeded it.

Sylvia Plath said she couldn't write at all during her lowest days: "When you are insane, you are busy being insane—all the time." Truman Capote sought psychiatric help for severe depression later in life. A comment he made about writing In Cold Blood suggests that the writing led to the disturbance, not the other way around: "It nearly killed me. I think, in a way, it did kill me. Before I began it, I was a stable person, comparatively speaking. Afterward, something happened to me."

Ernest Hemingway, who suffered depression and later committed suicide, once said: "That terrible mood of depression of whether it's any good or not is what is known as The Artist's Reward." Once again, such a comment—to me at least— suggests a separation between the process of writing and the experience of being depressed. In A Historical Guide to Ernest Hemingway, Linda Wagner-Martin supports a distance between Papa's gloom and his work:

"At the peak of his career, the foremost American male novelist went six years without writing any new fiction. Only later would he recognize this hiatus as the onset of the severe depression that would eventually destroy Hemingway..."

More recently, David Foster Wallace was quite prolific despite suffering major depression much of his life; he wrote two lengthy novels and multiple books of short stories and essays, including one story titled "The Depressed Person." Yet when he went off antidepressants after twenty-some years he too became less productive and, according to a posthumous profile in the New Yorker, "rarely returned" to his novel-in-progress before hanging himself.

It's an uplifting theory to consider, despite its flaws—that depression has a secret purpose; that it makes "people think better," in the words of Andrews; that it helps create good writing, instead of stopping good writers from creating more. Uplifting and, I suspect, far easier to consider from the upside.