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.
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.
Source:Â http://www.psychologytoday.com/blog/headcase/201003/depressions-upside-down
Major Depression More Than Doubles Risk of Dementia Among Adults With Diabetes
ScienceDaily (Mar. 8, 2010) — Adults who have both diabetes and major depression are more than twice as likely to develop dementia, compared to adults with diabetes only, according to a study published in the recent Journal of General Internal Medicine.
Dementia is the progressive decline of thinking and reasoning abilities. These can include memory loss, difficulty with basic math, wandering, living in the past, personality changes, and not recognizing familiar people.
“Diabetes alone has shown to be a risk factor for dementia, as has major depression by itself,” noted the lead author of the study, Dr. Wayne Katon, University of Washington (UW) professor of psychiatry and behavioral sciences. Also on the study team were researchers from the Group Health Research Institute in Seattle and the Veterans Affairs (VA) Puget Sound Health Care System, as well as UW researchers in medicine and in epidemiology.
Various other population studies, Katon and the other authors noted, have shown that the risk of Alzheimer’s disease, vascular dementia, and other types of dementia is from 40 percent to 100 percent higher in people with diabetes, compared to people without diabetes. A history of depression more than doubles the subsequent risk of Alzheimer’s disease and other forms of dementia in the general population.
“We wanted to determine the effects of both conditions — diabetes and major depression–occurring together,” Katon said. “Our analysis suggests that major depression more than doubles the risk of dementia in adults with diabetes.”
The research team on this project, which is part of the Pathways Epidemiological Follow-Up Study, tracked the outcomes of adults from the Group Health Cooperative’s diabetes registry who agreed to participate. They were patients from nine Puget Sound area primary-care clinics in western Washington state. The clinics were chosen for their socioeconomic and racial/ethnic diversity and were demographically similar to the area’s population. Initial enrollment of patients took place between 2000 and 2002, and the patients were studied for five years. Patients already diagnosed with dementia were excluded from the study.
Over the five-year period, 36 of 455, or 7.9 percent, of the diabetes patients with major depression were diagnosed with dementia. Among the 3,382 patients with diabetes alone, 163 or 4.8 percent developed dementia.
The researchers calculated that major depression with diabetes was associated with a 2.7-fold increase of dementia, compared to diabetes alone. Because the onset of dementia can sometimes be marked by depression, the researchers also adjusted their hazard model to exclude patients who developed dementia in the first two years after their depression diagnosis.
The team’s previous findings from earlier studies showed that depression increases the mortality rate among people with diabetes, as well as the rate of complications such as heart, blood vessel, kidney and vision problems.
The exact manner in which diabetes and depression interact to result in poorer outcomes is not certain. Some studies suggest that a genetic marker for dementia is associated with a faster cognitive decline. Depression may also raise the risk of dementia, the authors noted, because of biological abnormalities linked to this affective illness, including high levels of the stress hormone cortisol, poor regulation in the hypothalamus-pituitary system, or autonomic nervous system problems that can affect heart rate, blood clotting, and inflammatory responses.
Depression, they added, might also raise the risk of dementia because of behaviors common in the condition, such as smoking, over-eating, lack of exercise, and difficulty in adhering to medication and treatment regimens. In the current study, patients with both diabetes and major depression were more likely to be female, single, smokers, physically inactive, and treated with insulin. They also had more diabetes complications and a higher body mass index, a ratio calculated from height and weight. However, these differences were controlled for in the analysis and depression remained an important risk factor.
Diabetes, the authors noted, is a risk factor for dementia because of blood vessel problems and also may accelerate the decline of Alzheimer’s disease. Many factors linked to diabetes might also increase the odds of developing dementia, including tissue damage from high blood sugar levels, episodes of low blood sugar and insulin resistance.
Depression is common among people who have diabetes. Until more research is available on the exact mechanisms behind the links between depression, diabetes, and dementia, the researchers say, “It seems prudent for clinicians to add effective screening and treatment for depression to other preventive measures such as exercise, weight control, and blood sugar control to protect against the development of cognitive deficits in patients with diabetes.”
In addition to Katon, members of the research team were Elizabeth H.B. Lin, Evette Ludman, Carolyn Rutter, Malia Oliver and Michael Von Korff, all from the Group Health Research Institute; Lisa Williams from the UW Department of Medicine and the Epidemiologic Research and Information Center at the VA Puget Sound Health Care System; Paul Ciechanowski from the UW Department of Psychiatry and Behavioral Sciences; Susan R. Heckbert, from the Department of Epidemiology in the UW School of Public Health; and Paul K. Krane from the UW Department of Medicine.
Grants from the National Institute of Mental Health, National Institutes of Health, supported the study.
Source:Â http://www.sciencedaily.com/releases/2010/03/100305163038.htm
By Therese J. Borchard
Divorce is the second most stressful life event, preceded only by the death of a spouse. And what is stress capable of? Expediting a severe bout of depression and anxiety to your limbic system (the brain’s emotional center) if you’re not careful. Acute and chronic stress, especially, undermine both emotional and physical health. In fact, a recent study published in the Journal of Health and Social Behavior suggests that divorced or widowed people have 20 percent more chronic health conditions such as heart disease, diabetes or cancer than married people.
Another study in Psychological Science claimed that a person’s happiness level drops as she approaches divorce, although there is rebounding over time if the person works at it. That’s what these 12 tips are: suggestions for preventing the devastating depression that often accompanies divorce, and techniques that you can use to keep your happiness level steady or maybe even higher!
1. Lose yourself in a book (or an afghan).
I think the one thing that kept my mom sane the years after she and my dad split were the 75 afghans she knitted for me, my sisters, and anyone who got married during between 1982 and 1985. The mundane, repetitive gesture, she told me later, kept her brain on the loop that she was making with her big plastic needles, away from all the sadness in her heart. Swimming is the same type of activity for me. I count each lap, so if I start to ruminate too much, I lose track. For an OCD gal who needs to burn calories, it’s a tragedy when that happens. A friend of mine who divorced last year said that losing herself in a juicy novel was a helpful diversion. Or I guess you could also watch reality TV, although I’d hate for you to sink that low.
2. Change your routine.
The year after my dad left, a counselor recommended to my mom that she go back to work. So she took a part-time job as a hostess at a nice restaurant downtown, working lunch hour. The job forced her to smile, meet new people, and be part of a fresh environment—all of which helped her to get out of her head for several hours of the day and gave her hope that there was new life out there, that her life wasn’t over just because her marriage had ended.
3. Plan, plan, and plan some more.
In her book Solace: Finding Your Way Through Grief and Learning to Live Again, psychotherapist Roberta Temes suggests a few activities that are therapeutic during bereavement (and divorce is a kind of bereavement). One of them is planning. That is, planning everything. I know this works because I did it during the really low months of my severe depression. I planned when I would eat my bagel, when I would shower, and when I would relieve my bladder. I planned when I’d write my distorted thoughts into a journal, and when I would try to count my blessings. All the planning cut down on my ruminations. You think I’m crazy? Temes writes:
Use a calendar to make your plans. Plan when you will go somewhere new. Plan when you will buy yourself a new outfit. Plan to learn to knit and decide when you’ll go to the yarn store. Plan to go fishing and call a buddy who likes to fish. Or, learn how to frame a favorite photo and plan when you will venture to a craft shop or to an art supply store. Plan to repair something in your house and plan to go to Home Depot or to Lowe’s or to your local hardware store. Planning activities for your future will help you reach that future.
4. Clean out and organize.
A productive way to grieve the end of a relationship is to clean out the drawers, closets, and other corners of your house that may still contain your spouse’s possessions, and replace them with new stuff. Your stuff. You don’t have to do it all at once, of course. As I said in the last point, you can plan each stage of the excavation. By manually picking up each item, recalling certain memories, and ever so tidily boxing them up for either him, Goodwill, or bulk pickup, you are acknowledging and bidding adieu to the marriage, while creating a space in your life for something new.
5. Preserve your energy.
In her book, Ready to Heal, Kelly McDaniel urges people who have just ended a relationship to preserve their energy, to avoid cluttering their days with too much activity. She writes, “The energy it takes to endure withdrawal [of a relationship] is equivalent to working a full-time job. Truthfully, this may be the hardest work you’ve ever done. In addition to support from people who understand your undertaking, you must keep the rest of your life simple. You need rest and solution.†You feel tired? You’re working two jobs … that’s why!
6. Defy the stereotype.
Mary Jo Eustace will make any reader, but especially those who have lived through divorce, laugh out loud with her memoir, Divorce Sucks. I loved the part where she challenges the divorcee to debunk the hurtful stereotypes of divorced people. Writes Eustace: “Our marriages didn’t work, so people assume we don’t quite work. And this is why it’s very important for those of us who have survived the hell of divorce to start redefining what the landscape of the divorced woman [or man] can look like. People can have us over for dinner, even a couple’s dinner party, and we promise we won’t seduce anyone’s husband or dance on the table, expressing ourselves through modern movement and our ability to do the splits.”
7. Take the high road.
My friend and mentor Mike constantly reminds me that it’s better to be happy or at peace than it is to be right. So, as I’m loaded and ready to fire off a nasty email to some jerk who could potentially make my life hell, I will stop and consider Mike’s pearl of advice. Then I drag the email over to the cute trashcan on my monitor.
I have no doubt your ex-spouse is responsible for a mother load of terrible things, legal pad after legal pad of inexcusable grievances you could report to your attorney. And you would be absolutely entitled to seek revenge (or even justice) for his all of his misjudgments. But is it worth it? That’s the question you might need to stick to your bathroom mirror on a sticky note. A friendly divorce isn’t necessarily a fair divorce. Which one do you want?
Want to learn more?
Check out these five additional ways to beat depression after a divorce.
http://psychcentral.com/blog/archives/2010/02/28/7-ways-to-beat-depression-after-a-divorce/