Dr. Ronald Pies Responds to Jonah Lehrer's Article on Depression's Upside

This is an interesting rebuttal to Lehrer's recent article on Depression's Upside. Dr. Pies was kind enough to share some of his thoughts in the comments on my reposting of Lehrer's article, so please check that out as well.

The Myth of Depression’s Upside

By Ronald Pies, M.D.

Jonah Lehrer’s essay “Depression’s Upside” in the Feb. 28, 2010 New York Times Magazine raises many important questions about depression, and what, if anything, we can “learn” from suffering a bout of serious depression. Alas, the article obscures almost as much as it illuminates, and I fear that its net effect may be to perpetuate what I call “The Myth of Depression’s Upside.”

But first, let’s be clear: a “myth” is not the same thing as a lie. A myth is a transgenerational story we tell ourselves, which often has a grain of truth to it, and which usually serves some unifying function in our culture. It is a myth that George Washington threw a silver dollar across the Potomac River — there were no silver dollars at the time — but the story usefully reminds us, across many generations, that our first President was a powerful man capable of great accomplishments. No lie in that!

So, too, we have the myth of depression as a “clarifying force,” or as an “adaptive response to affliction” — notions being advanced by a number of psychologists, psychiatrists, and sociologists. Thus, Lehrer quotes psychiatrist Andy Thomson as saying, “…even if you are depressed for a few months, the depression might be worth it if it helps you better understand social relationships… Maybe you realize you need to be less rigid or more loving. Those are insights that can come out of depression, and they can be very valuable.”

Now, with all due respect to Dr. Thomson, I am inclined to ask, “Worth it to whom?” Perhaps the patients Dr. Thomson has treated emerge from their three-month bouts of depression saying, “Ya know what, Doc? It’s been a bad three months—lost my job, almost killed myself, and couldn’t get a damn thing done—but overall, it was worth it!” The depressed patients I evaluated over the past nearly 30 years almost never reported that their major depressive episodes had a “net mental benefit,” to quote Lehrer’s article. Most felt that their lives and souls had been stolen from them for the duration of their depressive episode. Many would have understood and endorsed Willam Styron’s description of his own depression, in his book Darkness Visible:

“Death was now a daily presence, blowing over me in cold gusts. Mysteriously and in ways that are totally remote from normal experience, the gray drizzle of horror induced by depression takes on the quality of physical pain… [the] despair, owing to some evil trick played upon the sick brain by the inhabiting psyche, comes to resemble the diabolical discomfort of being imprisoned in a fiercely overheated room.”

The notion that severe depression may bring forth good things reminds me of a lecture I once attended on “fire safety” in the hospital setting. We were shown a movie of a house that had burned down in such ferocious heat that a package of frozen muffin dough had been completely baked. “So, the house wasn’t a total loss!” quipped one of the world-weary attendees. Yes, of course—people can learn from their severe depressive episodes, but often at the cost of emotional and spiritual conflagration.

Similarly, Lehrer trots out the old war-horse claim that there is a “…striking correlation between creative production and depressive disorders.” But such a correlation hardly proves that depression itself heightens creativity. Psychiatrist Richard Berlin, M.D., editor of Poets on Prozac: Mental Illness, Treatment, and the Creative Process, has summarized his experience as follows:

“The idea that depression might enhance creativity is a myth, often based on the life stories and statements of deceased artists and writers… Contemporary poets who are alive and can tell us about their experience with depression are consistent in reporting that it was only after effective psychiatric treatment that they were able to create at their highest levels.” (R.M. Berlin M.D., personal communication, 1/27/08).

One of the other notions put forward in Lehrer’s article is that depressive “rumination” may actually help us analyze our way out of difficult dilemmas — the so called “analytic-rumination” hypotheses. To support this claim, Lehrer cites several studies showing that depression leads to increased activity in the “problem-solving” part of the brain, the prefrontal cortex.

But there are also numerous studies showing the precise opposite, which Lehrer fails to note.

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~ Ronald Pies MD is a psychiatrist affiliated with Tufts University School of Medicine and SUNY Upstate Medical University. He is also Editor-in-Chief of Psychiatric Times and author of Everything Has Two Handles: The Stoic’s Guide to the Art of Living. Disclosure information for Dr. Pies may be found at www.psychiatrictimes.com.

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Tags: depression, Psychology, brain, consciousness, PsychCentral, World of Psychology, Dr. Ronald Pies, Jonah Lehrer, Depression's Upside, The Myth of Depression’s Upside, New York Times Magazine, Andy Thomson, creativity, “analytic-rumination” hypotheses