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a theory of depression - helen-louise
a theory of depression
I have a doctor who has been treating me for mental health stuff for years, who I trust with my life and medication even though he's "only" a GP with a special interest in mental health rather than a psychiatrist. He's a remarkably intelligent and perceptive man, and he likes to say things to patients like me to provoke us into taking charge of ourselves.

One of the things my doctor said a while ago that made me angry was this: there's a theory that only people who live in relatively safe situations experience depression. If you live in a country where you can't afford to eat and there's no other way of getting food; and you don't have access to clean water; and you don't know when you might get killed by a disease that modern medicine can cure, that you can't afford the treatment for; or when your government might decide to kill you for speaking out against it... then it would be normal to be angry, frustrated, anxious and depressed. Except the definition for clinical depression specifically excludes being upset because of those sorts of situational things, because they're perfectly reasonable things to be angry, frustrated, anxious or depressed about! Even if people there do feel depressed, you wouldn't necessarily experience the depression of people in more developed countries, because they don't have time - they're too busy trying to survive to be depressed. While the people who can't cope and decide to stop struggling don't have to seek death through active suicide, it will just happen.

It's a thought that makes me angry because I didn't choose to be depressed, and if a simple change of perspective would make my brain biochemistry work the way it's supposed to, I'd embrace it with all my heart and soul. Now I can make myself depressed just thinking about the fact that I'm so lucky in my daily life, and the worst I'm likely to experience on any given day is DRAMA on TEH INTARNETS! But there must be some truth that most living things in the wild undergo a daily struggle to survive; while some of us humans are now lucky enough to live in situations where we have no daily struggle to find food, shelter, warmth or companionship. Was our depression borne from us turning that struggle inwards? Do we, in fact, need some sort of struggle for survival in order to feel properly alive?

If only the depression didn't come with a general dampening down on positive emotions, it'd be great :/

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quiet000001 From: quiet000001 Date: 25th September 2007 01:01 (UTC) (Link)
I don't know if I'd class it as needing some sort of struggle- just that different situations produce different levels of chemicals in the brain, and in some cases those levels may be sufficent to overcome an inherent imbalance. (I.e. if your typical level is below normal, but your situation ramps it up a bunch, then your functional level would be above what would be 'normal' in an ordinary situation, allowing you to function. It just wouldn't perhaps be as high as in someone in the same situation without the innate chemistry difference.)

Also, I don't think you can just point to living conditions. We know very well that diet can effect the body in all sorts of ways, and there is some research to indicate that things like omega 3 oils really have quite a lot to do with the functioning of the brain. So I think you'd also need to look at both the typical diet and the heritage of people eating that diet. (Someone descended from a long line of folks from an area where fish is a staple may well do much better on a diet very high in omega 3s, whereas for someone who comes from ancestors from a place where fish is a rarity may not need so much dietary omega 3 because the system doesn't expect to be getting it, you know?)

Lastly, that theory is overlooking the question of what happens if you take those folks and remove them from that environment. For example, I didn't really start seriously suffering from depression until Neph and I were in a very emotionally difficult and stressful situation- the kind of thing where situational depression is NORMAL. The problem for me was that the depression didn't go away when the situation did- so quite possibly I was in a depressing situation AND clinically depressed from a biochemical standpoint- but I wouldn't've been diagnosed as clinically depressed at that time, due to the nature of the definition for clinical depression.
baratron From: baratron Date: 25th September 2007 01:31 (UTC) (Link)
I'm not sure that the theory is supposed to have a definite right or wrong answer so much as being a place to start a discussion. I'm also not sure to what extent I believe in it. It's interesting and it explains some things, but it's rather impossible to prove.
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baratron From: baratron Date: 25th September 2007 01:36 (UTC) (Link)
What I wonder is how many people spontaneously develop the brain chemicals going awry WITHOUT some sort of external trauma?

What tends to happen is that something which is actually fairly minor in the Grand Scheme of Things becomes important to us, because we're not having that daily struggle for survival, or because societal pressures have made us conflate things that won't actually kill us with things that will. So for me, the start of my depression was not coming top of my class at university! and having to actually WORK rather than just understanding everything! (There were other issues as well, but they were mostly adolescent growing into young adult angsts.) My brain conflated "doing well at studies" with "being good at surviving", because I didn't need to be a good hunter-gatherer in my safe, modern life.

Many, many people with depression have good reasons to be depressed - but a lot of the reasons only make sense from a modern life point of view. I wonder to what extent depression is a modern disease?
redbird From: redbird Date: 25th September 2007 02:15 (UTC) (Link)
It's also possible that people in those contexts do suffer depression, but tend not to notice it, because of what else is going on, just as someone who is seriously ill with, say, malaria or, as you suggest, starving to death, will probably never know that they have high blood pressure that puts them at risk for heart attack.

Hypothesis the third: some of the people your doctor refers to are depressed, but as long as depression is a diagnosis of exclusion, we'll never be aware of it. They could still be having a harder time coping with their admittedly difficult situation than a non-depressed person in the same context, perhaps be more likely to give up rather than make heroic efforts to find a meal.
clawfoot From: clawfoot Date: 25th September 2007 04:42 (UTC) (Link)
That theory kind of strikes me as analagous to putting a person with a cold in a room full of allergy sufferers. Yes, in that context, the sneezing and stuffy noses is a perfectly natural and normal thing to suffer, but the person with a cold still has a disease. Just because the symptoms disappear into the "background noise" of all the other people suffering from hay fever around them doesn't mean they don't still have a cold, and it doesn't mean that their symptoms magically become caused by allergies.

I think there are likely just as many clinically depressed people in disadvantaged societies. They just don't stand out, because everyone around them is displaying the same symptoms due to environment.
alexmc From: alexmc Date: 25th September 2007 06:13 (UTC) (Link)
The GP is largely stating a "fact" but perhaps not explaining it very well.

It is (I think) far more difficult to diagnose depression in people who have good reason to be depressed.
aardvarkoffnord From: aardvarkoffnord Date: 25th September 2007 07:11 (UTC) (Link)
All this, of course, is talking about clinical depression. Bipolar disorders are even more diffifcult to diagnose, since the patient sometimes is very happy.

The bitch about bipolar disorders is that they are progressive. In the developing world (as in the "developed" world), many turn to alcohol, and thus are just seen as drunkards.
thekumquat From: thekumquat Date: 25th September 2007 10:39 (UTC) (Link)
The WHO disagree with him.

"Depression is the leading cause of disability as measured by YLDs and the 4th leading contributor to the global burden of disease (DALYs) in 2000.
Depression is common, affecting about 121 million people worldwide.
Depression is among the leading causes of disability worldwide. "

He might be trying to make the point that activity can help distract some people from their depression, but you knew that.
From: judiff Date: 25th September 2007 11:34 (UTC) (Link)
so it's like a choice between having depression and having PTSD then?
That's like a big lose/lose situtaion.
barakta From: barakta Date: 25th September 2007 17:24 (UTC) (Link)
Crap. Basically someone in a 3rd world might not get treatment or diagnosis of depression, but they may still have depression being masked by day to day survival.

Perhaps those who are less successful at survival are less successful because of 'depression'. Also the depression may manifest as other things like addictive behaviour or 'mad' behaviour and those people will be the tramps or equivalents or will perhaps die because they are too depressed to fight and survive...

That sort of conjecture is taught in management lectures, one of those shoddy pyramid 'models'... I remember thinking it was like comparing apples and oranges then and my view hasn't changed.
ailbhe From: ailbhe Date: 25th September 2007 21:24 (UTC) (Link)
I sometimes think that depression *is* my family's survival mechanism - cope with the unbearable by turning all the emotions down to nothing. We seem genetically predisposed to it, anyway.

I was diagnosed with clinical depression in my teens; the diagnosing consultant psychiatrist was not in possession of all of the facts, though, so who knows what I had or how long I'd had it?

And I am *absolutely certain* that we don't *need* struggle or pain to feel alive. My babies have taught me that.
aquaeri From: aquaeri Date: 28th September 2007 02:25 (UTC) (Link)
I could definitely have a bit of a vote each way.

On the one hand, it reminds me of the currently popular theory of asthma and other allergies - that we're living in environments that are unexpected clean and disease-free, and the immune system overreacts to relatively innocuous things because it's expecting smallpox and tb and so forth.

On the other hand, as others have pointed out, there may be a lot of variation in how people in survival situations cope, and how do you determine if some of that might be a sign of underlying depression if you've already decided that any depressive symptoms are perfectly explainable by the situation?
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