A new way of looking at words like cure and recovery: Book review of “The Depths” by Jonathan Rottenberg

I recently finished Jonathan Rottenberg’s “The Depths: The Evolutionary Origins of the Depression Epidemic.” I recommend it, it’s straightforward and while it’s clearly written for a lay audience the science and studies he uses to back up his argument is well documented throughout.  Rottenberg challenges the more conventional way of thinking about depression, as a chemical imbalance in the brain, or as a disease, by exploring depression as a consequence of negative mood, an evolutionary adaptation that actually may have been very helpful to our survival as a species. Briefly, and I’m certainly not doing the argument full justice, being in a negative mood can be a useful tool in that it makes us question ourselves, our decisions and replay events in our head- in other words, for learning and analyzing outcomes. Being able to say to yourself “Next time I’ll do it this way instead…” makes you a better survivor, and a negative or low mood has it’s evolutionary advantages. This is certainly useful when problem solving for what went wrong with a mammoth hunt. Even in modern times it’s a useful adaptation- Rottenberg gives the example of someone laid off- their negative mood over having been fired can cause them to analyze their own skill set, reflect on what they can do differently next time, and perhaps re-evaluate their priorities to find a job better fitted to their skills and interests. Basically low mood is something everyone experiences, and it exists on a sort of continuum, so that while some experience what Rottenberg calls “shallow depression,” others will slip into “deep depression,” and because it’s on a continuum, people can move in between these states and states of elevated mood. People who experience deep depression though can find it difficult to move between these states, particularly once they move into a deep depression state. So the question for whether or not people can get better is really a question of how can people who are depressed move towards the positive or elevated mood side of the continuum?

This is where Rottenberg calls for a different understanding of what better is- by looking at depression as a disease or as a simple (relatively speaking) chemical imbalance, we’re setting ourselves up for disappointment. Diseases can have cures (even if we haven’t found them yet) and if depression is nothing more than a chemical imbalance, than somewhere out there is just the right formula to balance everything in the brain. By narrowing the lens through which we view depression, we narrow the options for treatment and recovery. By looking at depression as part of our evolutionary development, we allow ourselves to keep open a range of options for treatment, because the goals have changed.

Instead of making the depression “go away,” the goal becomes understanding how to live with it. We evolved to have mostly hairless bodies, which made sense for regulating our body temperatures on the African savannah. When humans began moving out of Africa to other climates we learned that adaptation could be a negative in cold places like Europe, and so we learned to live with the adaptation by wearing clothes. If we evolved to experienced low mood and depressed states, we need to learn to mitigate the negative consequences of deep depression- to figure out how we can avoid slides to the deep end of the scale and how to move ourselves back up towards the positive end.

We also then must redefine what mean by words like better and recovery. If I’m depressed because it’s part of my evolution, then there is no “cure” (other than, I suppose, the continued process of evolution, which, frankly I don’t think I have enough time for…). One of the things I liked best about the book is that by viewing depression this way and your recovery goals, you have a number of tools at your disposal to get out of a deeply depressed state. Rottenberg doesn’t argue against anti-depressant medication- as he notes, they can be very effective for certain people, just as cognitive behavioral therapy (CBT), or mindfulness meditation, or some combination of these can be. Why does medication work for some people but not for others? Why cognitive behavioral therapy? Why mindfulness meditation? None of these are a silver bullet, but are tools that can help us elevate our mood, slow down negative thinking patterns when they become destructive and help us to see the situations we find ourselves in a lucid way.

I say let’s throw the word “cure” out when it comes to depression. There isn’t a pill, there isn’t a 12 step program or a mantra that will make it so you never experience depression or a depressed mood ever again. Instead, lets look at recovery and treatment. Recovery becomes a way of describing the process of moving yourself out of a deep depression, and treatment is how to describe the steps you take to move yourself along on the continuum. I can live with that.

P.S.- I’m guilty of looking at depression through a fairly narrow lens myself until this book helped me see that I didn’t need to anymore. I’m thinking a discussion of how I viewed depression and how I feel about changing my perspective may make for an interesting topic for the podcast. Look for it later this week.