Depression and the self-help book disaster: Talking with ‘The Depths’ author Jonathan Rottenberg (part I)
Look out. We’ve both seen the inside of the psych ward, we survived, and now we’re talking about it in public.
This is the start of a special three-part conversation with psychology professor Jonathan Rottenberg, Ph.D., author of The Depths: the Evolutionary Origins of the Depression Epidemic, published in 2014 by Basic Books.
Jon takes a fresh approach, arguing that the prevailing “defect model” of studying and treating depression is all wrong. We should not be trying to find and fix some fatal personal or biological flaw that leads to depression, but trying to understand the deep evolutionary roots of depression, and how low mood can be a natural signal to stop throwing ourselves against goals we can’t achieve.
He brings a lot to light, from how depression may have evolved in our animal forebears, to how people overcome depression (that’s right, you can recover, he should know), to how deep its stigma actually goes. Here are excerpts of our conversation.
I told Jon that I knew his book was good because I had a lot of questions as soon as I’d finished it.
Jonathan Rottenberg: I’m glad you had that reaction, and I’m hoping that other people will, because I think we need to shake up our ideas and our whole approach to depression, because we’re not making a whole lot of progress as far as I can tell.
Alaina Mabaso: Can you tell me a bit about the reception of your book? You’re coming out with some pretty fresh ideas, so what has been the response?
JR: I’ve been waiting for someone somewhere to throw rocks at me or call me horrible because [of] the implications of [the idea] that a lot of people are wasting their time, and are misguided with respect to depression, and I’m still waiting for [Listening to Prozac author] Peter Kramer to firebomb my house or something.
I get nice messages from people who read the book, who are like, “wow, this really changed how I think about depression, and thanks.”
AM: You mention a lot of lab studies about human moods in your book. Can studies which artificially and temporarily affect participants’ mood really tell us about the true-life experience of low mood and depression?
JR: I think that the lab literature is helpful. I think the whole discussion about the effects of low mood [has] gotten kind of silly in the sense that people seem to want or argue that low moods are unhelpful and destructive. [But] they’re fine; evolutionarily selected for, when it really does seem to be the case that there are all kinds of benefits, but also costs to these [low mood] situations. You don’t have to decide whether they’re bad or good to see that they have potential. I would submit to you that any negative emotion that you could think of, it’s sort of absurd to say that it’s bad. Is anger bad?
AM: Well, it depends on the context.
JR: Right. It’s certainly useful if you’re trying to rally people against a perceived injustice. Is it good to be chronically angry? Does it help your chances of mating and winning status? Maybe not. But for some reason, people have a much more nuanced appreciation for things like fear or anxiety: people can understand that without a capability for anxiety, you’re not going to make it out for very long, but that too much anxiety or anxiety in the wrong context can be destructive. We don’t apply that same kind of thinking to depression and sadness. That’s one thing that I was trying to do in the book.
AM: This really jives with my personal experience, and I think it also has to do with being a woman, too. If I write passionately about something that I’m angry about, some people say, why are you angry? Don’t be angry! And I say there are reasons to be angry in the world.
JR: Is the goal for there to be no depression, or no sadness? That seems like a pretty absurd goal.
I agree…that there’s too much depression, and that a lot of people who have depression have bad outcomes: not just that they’re unhappy, but [because their] health can be impaired [or they’re at risk for suicide], and I think that the goal can be to better manage these states and see where they come from…They do have some value, but that doesn’t mean that we shouldn’t encourage people to learn how to cope with these effects. And paradoxically, that being better able to accept some degree of depression or sadness is increasingly thought of as a way in the long run to be less tormented and ruled by these kinds of states. [But] it’s not the typical position. You see a lot of how-to books which are often about –
AM: “How to be happy!” “Live your best life!”
JR: Banish depression from your vocabulary; don’t think negatively, things like that.
AM: “Think positive.”
JR: A lot of those books, I think, are really misguided, and I think do a lot of harm. I think I was diplomatic in [The Depths], but my true feeling is that most of self-help is a disaster, and really it doesn’t help people much at all. Some of the problem is that most of these programs are such cartoons: they’re not a valid representation of science, they’re oversimplified. It’s not that it’s bad in principle; most of the execution of these things is disastrous and it’s really driven by commercial interests more than anything else.
AM: I want to get to what was one of my favorite lines in your book, and ask you to expand a little bit on it. I was really interested in your point about the relative silence around the reality that people do recover from depression, and they don’t go on to a life of being debilitated and broken. You write, there’s this unspoken view that depressed people “should not bother to aim so high,” as if they’re never going to climb out of these depths.
So we do hear a lot about the stigma against depression, but in my experience, it’s framed as a social stigma or a public stigma, and you seem to be saying that there is a deep stigma in the medical field as well, that doctors are actually applying to their patients. Do you want to say more about that?
JR: You mean in the sense [of] recommendations that you’re going to need therapy for the rest of your life; you’ll need medication for the rest of your life?
AM: “It’s chronic, you’re just never going to get better.”
JR: It’s clearly not true. We really don’t know very much about the 40% of [depression sufferers] who have one episode of depression… Whether it’s because these people learn things, whether it’s because these people have other countervailing strengths that become more important than whatever liability they had to depression…I think we should be studying these people a lot more, and also I think that these people have a lot to offer the 60% of [depression sufferers] who have repeated [episodes of] depression, not just for raw inspiration (although that’s nice), but [because] their experience is helpful and we don’t hear from them that often.
I think there’s a difference [between our approaches to addiction and depression], where there’s this [idea of addiction relapse] as a big issue. People who have overcome addictions are often very public in reaching out to people who are still struggling, and for whatever reason, that doesn’t seem to happen as much with depression… Maybe [sufferers] are afraid of depression returning; they’re embarrassed about it; they have a fear that they won’t get a job [or] friends.
We are still dominated by this defect model, so it’s all about, “let’s find the defect; when we find the defect, the problem is solved.” [We should be looking at it differently]: why some people, even if they have a supposed defect, have these really good outcomes. It’s not a small number. What is that about? I think that would be a good book.