My rating: 5 of 5 stars
Hands down the best book I’ve ever read about depression.
Rottenberg introduces the concept of depression as an evolutionary valuable response by distilling it down to low mood and lack of responsivity, then examining where it would be adaptive. Depression can spontaneously occur in an otherwise psychologically healthy individual in response to grief, and that makes adaptive sense.
In the Paleolithic, if someone you knew died, there was a reason, and that reason endangered you too. The most likely culprits were poison or predation; this was before metabolic syndrome and car crashes slaughtered us by the million. Your odds of getting got by predators massively decreased if you never left the cave. There’s the depressive malaise, the inability to even get out of bed. It’s safe in bed. Why risk it?
As for poison, we weren’t big on cause-and-effect back then, so instinct had to phone it in. Something we ate, something accessible, killed one of our own. The most adaptive move is waiting for this particular storm to pass; the grieving individual is already less likely to be moving around, so their metabolic requirements have dropped to just above basal, and the loss of appetite both corresponds to the reduced energetic expenditure and the increased danger potential of available food.
Fast forward a couple million years, and we are now sophisticated thinking machines running on antiquated unga-bunga hardware. When we lose someone close to us, we still get acute depression. It would be unnatural not to undergo a loss pf appetite and joie de vivre following the death of a loved one.
The implication in The Depths is different people have grief thresholds, calibrated neuroanatomically over our lifespans, nature and nurture both playing their role. Hereditarily, this is in keeping with the research on the hedonic treadmill that keeps us screeching back to our happiness (or misery) baseline.
The nurture aspect complicates things. While a high happiness baseline can improve an individual’s natural resilience, a traumatic childhood can mess with that resilience manifesting in the first place. Extending our reductionist beep-boop analogy from earlier, it can lead to the grief switch getting stuck in the “On” position, because the brain never got the opportunity to learn how to turn it off.
I like this perspective on depression more than the disease model for the empowerment and autonomy it provides those afflicted.
Depression not as a spiritual cancer, a personal failing, or a lack of grit or whatever, but as a naturally occuring evolutionary response that once saved our ancestor’s lives. It isn’t a signal of weakness, it’s a signal that something is wrong. That the individual is mourning some sort of loss.
At this point, we get into the weeds, and it’s better handed off to an individual psychotherapist on an individual basis. You can grieve anything, from a loved one to getting fired to an abstract “loss of innocence” that was never addressed at the appropriate time. You’d be amazed at the wackadoo physical symptomology the body will manufacture in response to these psychologically seismic experiences you didn’t realize (or didn’t let yourself realize) were significant at the time.
It makes more sense to view depression as a signal, the same way we view pain. Something is wrong. From there, it’s just a matter of finding out what.
And considering inert placebos are 82% as effective as antidepressants (as per Irving Kirsch’s 2010 research), it’s probably not “a lack of medication” that’s wrong.