Book Review: The Depths
/The Depths: The Evolutionary Origins of the Depression Epidemic
Fantasizing about a world without low mood is a vain exercise. Low moods have existed in some form across human cultures for many thousands of years. One way to appreciate why these states have enduring value is to ponder what would happen if we had no capacity for them. Just as animals with no capacity for anxiety were gobbled up by predators long ago, without the capacity for sadness, we and other animals would probably commit rash acts and repeat costly mistakes. Physical pain teaches a child to avoid hot burners; psychic pain teaches us to navigate life's rocky shoals with due caution.
This picture is almost certainly accurate in all its details, and it firmly situates what Rottenbeg calls "low mood" in the natural human emotional ecosystem, right alongside learning aptitude. In the ruling social viewpoint of the time, low mood pathologizes into depression, and Rottenberg frequently lists the symptoms, which include difficulty concentrating, feelings of guilt, problems sleeping, occasional sadness.It's possible that few of Rottenberg's readers, so thoroughly indoctrinated in the last twenty years into the talk of sadness as a medical condition, will read that list of symptoms and think: "well, who hasn't felt all those things?" (they will not think this about the symptoms of acute gastroenteritis or pancreatic cancer). That the presentation of what's now known as clinical depression is virtually identical to the normal everyday conditions of human existence, its advocates often say, makes it that much more difficult to treat, but the same state of affairs also makes it exceedingly tempting to medicate (as massive drug companies such as GlaxoSmithKline have avidly noted, to the tune of billions of dollars a year). The abuse inherent in this dichotomy is the elephant in the room of Rottenberg's enlightened analysis. It intrudes. It can't help but do so. At a couple of points, for example, Rottenberg cites the National Comorbidity Survey-Replication, a large study that he uses as a springboard to discuss the demographic aspects of his inquiry - like the large incidence of depression among the young:
A large nationwide survey, the National Comorbidity Survey-Replication, which assessed lifetime depression risk in younger, middle aged, and older age groups, found that eighteen-to twenty-nine-year-olds are already more likely to have experienced depression than those sixty and older, even though they have been alive for less than half as long. Rampant rates of depression in younger people are worrisome, not only because youth should be a time for blossoming and development but also because such high rates signal a bleak future for this cohort.
That rates of reported depression among younger people should be rampant is not only worrisome but intensely predictable; these are the people who've been bludgeoned with diagnoses since before they could effectively understand their so-called symptoms on their own, who've been inculcated in the idea (often while still in grade school) that sadness, guilt, or difficulty sleeping or concentrating are all medical conditions, and most importantly who've been dosed to their eyeballs in "anti-depressants" that do nothing to alleviate the hard-wired "symptoms" for which they were prescribed but in the process cause a host of very real and often appalling side effects. None of these drugs have been clinically assessed by parties uninterested in their widest possible marketing; their near-complete lack of actual medicinal effectiveness is by now well-documented. It's difficult to avoid the impression that a very large part of the "depression epidemic" mentioned in Rottenberg's sub-title has been created by the same drug companies who peddle the snake oil then used to combat it.Rottenberg's book is endlessly compassionate and insightful - this is as good as popular biomedical writing gets - but his core subject, the evolutionary origins of "low mood" and the subtle ways in which, like other mental attributes, it can become morbid in some people, is constantly undercut by its own gigantic over-reportage. There are many case study examples in The Depths, and too many of them read like that of Stacy Murette, a young woman in Wisconsin who fell into depression when her long-term marriage ended in divorce. "The divorce was cataclysmic," we're told, "shattering her ideal of family and that of her two boys and two girls ..." Or the book's opening example of a young man who becomes depressed after entering the job market for the first time:
Take a young adult's depression that starts after he starts working at an ordinary job after college; the depression might be related to the fact that taking a less-than-ideal job meant giving up on a childhood career dream, even if the loss of the dream is not discussed explicitly and the young adult is only dimly aware of the connection between the loss and the symptoms.
It doesn't take much scrutiny to notice that the same damning word, ideal, shows up in both examples, and it and its equivalents occur with disquieting frequency throughout Rottenberg's book. Far too many of the case-study individuals in these pages are clearly under the impression that if their lives were normal they would never be unhappy, or distracted, or disinclined to work. And most of those individuals have been taking heavy medication and enduring its nearly crippling (and often psychologically deranging) side-effects for years or even decades. Our author is an eloquent expert on the workings of both healthy and unhealthy emotions, and his attempt here to craft a more holistic concept of emotions gone off-balance deserves wide attention. But as long as all such attempts are mired in a fantastically exaggerated description of the subject - as long as we don't know what we're actually talking about when we talk about depression - these depths are going to remain impenetrable.