This book is not a self-help book. However, I do believe the information it contains should useful for those currently suffering from depression and those hoping to stave off a relapse or minor depression turning into major.
The premise of this book is that we need to move beyond defect models of depression - either the "low serotonin" biochemical explanation or the "defective thinking" explanation. Neither of these models can explain why rates of depression are on the rise and the treatments for either model (either SSRIS/medications or cognitive behavioural therapy), while useful on average have a wide variability in how effective they are. Traditional therapy focuses on "repairing defects" which are actually side effects of the true underlying cause. Unfortunately, traditional therapies often misguide attention away from what triggered the depression in the first place.
The core thesis of this book is that depression is a state of extremely low mood - it is the mood system gone haywire. Variations of mood serve an evolutionary purpose. However, just as being warm blooded serves animals well but comes at a cost, so too does having a mood system. Low mood leads to anxiety / brooding / rumination / introspection / and "hunkering down", and very low moods lead to depression. High mood, by contrast, leads to novelty seeking and exploratory behaviour, and very high moods can also have a dark side such as impulsiveness or excessive risk-taking. As an example of the mood system at work, the loss of a romantic partner typically results in low mood for some time, and this causes the brain to focus on the loss and what caused it to help ensure a similar thing doesn't happen again. The key thing that ties together low moods is loss - loss of status, social connections, sexual partners, health, etc. 9/10 people who are depressed can point to a loss that triggered the depression. Nearly 1/4 of depressions are caused by loss of a loved one. Somewhat oddly, for a long time the DSM had a "bereavement exception", stating that depressions from bereavement were somehow different in nature from other depressions - but this is not supported by the science.
Animal models of depression confirm the hypothesis that depression is an exceptionally low mood state triggered by loss. In animals, depression can be induced by repeated repeated stressors or loss, such as removing a rat from its social group. There is a connection to the phenomena of learned helplessness, such as when a rat realizes it can't escape from a tank of water and floats on the surface. Learned helplessness is a short term very low mood state, while depression is a long term one. The basic idea is that depression acts is an evolutionary system which stops people from continuing to pursue things where they are failing. This explains why depressed people have psychomotor retardation and extreme fatigue. This challenges the idea that depressed people are 'apathetic". Rather, Rottenberg writes, depressed people become depressed because they've been too attached to a particular goal even after failure.
Humans are much more complicated, since how well we are achieving evolutionary goals is can be related to high level abstract concepts, such as goals. For many teenagers or young events, failure to achieve a long-sought after goal can trigger a depression - for instance failure to fine one's "dream job" after college. Perversely, self help books can backfire - by having people focus on the goal of "being happy" they can actually lead to low mood and depression when the sought after happiness fails to materialize. Happiness, Rottenberg writes, is a biproduct of progress towards evolutionarily relevant goals, not a sensible end goal in itself.
Rottenberg points out that ruminations during depression often have evolutionary themes, such as finding a mate, protecting or caring for children, and fretting about social status. Depression warps the mind, biasing memory towards negative events, and often making it impossible for the depressed to remember what it was like to be happy. While this is extremely unpleasant, it serves an evolutionary purpose, by focusing the brain on negative events and their causes, to help prevent them from happening again. An interesting tidbit is that depressed people are not more likely to cry in response to sad movies - actually, they exhibit emotional flattening. The reasons for this are not fully understood, as with many other observations, such as that fact that depressed people have higher levels of cytokines, which cause inflammation, higher cortisol, and highly messed up Circadian rythmns.
Another key idea is that depression can serve as a form of "creative destruction" - forcing the sufferer to abandon old goals and re-align their lives in a different direction. The concept of "purpose" is important here - the depressed often loose their sense of their life's purpose, and recovery from depression requires finding a new one.
Overall, this was an excellent read. My only disappointment was that he never directly addressed the particular reasons behind the current depression epidemic in the developed world, as was advertised in the subtitle. Yet, after reading the book, it is not hard to piece together some possibly relevant causes which exist current cultural milieu - the breakdown of traditional community structures, increased social isolation among young adults and the elderly, and people having the goal of "being happy".
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Top reviews from other countries
- Mrs. Colleen M. PaulReviewed in Canada on June 8, 2014
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