Winston Churchill called it his “black dog,” while the novelist Joseph Conrad thought of it as a demon. Indeed, the list of famous people to have suffered from depression is long: Sigmund Freud, Abraham Lincoln, Emily Dickinson, John Lennon, T.S. Eliot, Buzz Aldrin and countless others. But what is depression? Surprisingly, there is no clear answer, only different theories.
People are often surprised to learn that depression was first diagnosed over two thousand years ago. The ancient Greek philosopher and physician Hippocrates, born around 330 B.C., not only recognized depression but also identified the subtypes “mania,” “melancholia,” and “phrenitis” (known today as “brain fog”).
In 1621, just five years after Shakespeare’s death, the English author Robert Burton published The Anatomy of Melancholia. This remains a classic even today (the novelist Anthony Burgess once remarked that it was one of the few books to never bore him). Burton himself suffered from depression, eventually committing suicide at his Oxford college in 1640.
Towards the end of the 19th-century, the psychoanalysts turned their attention to the disorder, which they explained through repression. Freud himself suffered from depression, as did several other analysts. To the analyst, depression is a symptom of something deeper, something the victim denies. We repress the memory of rape, parental neglect, violent assault, sexual abuse, etc. But instead of making us feel better, this repression causes chronic pain.
The Biological Explanation
In recent years, biological explanations have also been put forward. Ever since the completion of the human genome project, people have tried to link various physical and mental illnesses to specific genes. For example, studies on twins and adopted children suggest that genes play a role in bipolar disorder, though it is unclear whether that is a single gene or multiple ones. A study on bipolarity among the Amish identified a dominant gene at the tip of chromosome 11. Neurotransmitters have also been implicated in depression. So popular is this theory that even the general public are now aware of serotonin and dopamine.
Critics point out that big money is invested in the biological explanation. SSRI anti-depressants, for example, work by increasing the amount of serotonin in the brain. Huge numbers of people take them (in some countries, the most popular brands are detectable in the drinking water), and it is therefore in the interests of the big pharma companies to fund and promote the neurotransmitter theory. If depression is the result of low serotonin, all you need is a pill to correct it. And a pharmaceutical company can make big money out of this.
In the 1970s, the American psychologist Martin Seligman used the theory of “learned helplessness” to explain depression. Seligman based this on the observation of animals. When an animal is trapped in a painful situation from which it cannot escape, it becomes unresponsive. In effect it surrenders or gives up. Seligman noted the similarity between this behavior and that of depressives.
When human beings feel no sense of autonomy, in other words when they cannot alter their situation, they also feel hopeless. And when people feel hopeless, they become passive. Life has taught them to be helpless. To put it another way, they have learned to be helpless. In turn, that affects their brain and nervous system, causing the hormonal and neurotransmitter changes that lead to depression.
Thoughts and Beliefs
The psychiatrist Aaron Beck argued that depression begins with negative patterns of thought. You become negative and self-destructive. But the reverse is also true: thinking in a negative, self-destructive way makes you depressed.
During research, he found that depressed people tend to hold a “negative triad” of beliefs. First, they consider themselves worthless and incompetent. Consequently, they feel unable to cope with life’s challenges. Second, they think of the world as dangerous, cruel and difficult. And, finally, they look to the future with despair. Not only are their thoughts about the present dark and destructive, they haven’t any hope to keep them going.
These basic assumptions then distort their experience of the world. For example, they tend to think in stark, black and white terms: people are either good or bad, situations either successful or catastrophic. And they will use trivial setbacks to confirm the futility of their efforts. They also minimize the positive and maximize the negative. In a sense, they become trapped in a downward spiral: they feel sad, or maybe grow up around depressed, negative people; that leads to patterns of negative thought; these negative thoughts then influence their behavior, which becomes avoidant, passive, and sometimes aggressive; the negative thinking and avoidance lower their mood still further, triggering depression and leading to even darker and more negative patterns of thought, and so on.
Status Anxiety and Low Self-Esteem
A sense of failure and inadequacy is also common. The British philosopher Alain de Botton refers to this as “status anxiety”. Unfortunately, as societies become richer this increases. Research suggests that the average inhabitant of a rich but unequal society is less happy than the citizen of a poor but equal one. Imagine life in a country like Germany in 1900. If you were born into a working-class family (which most people were), you expected very little. You went to work in a factory, married, and spent your leisure time in the local bar. Life was hard but simple. And most people you knew were on a roughly similar income, living in similar sized houses, with little hope of change or advance.
Today, things are different. Society is no longer made up of clearly defined classes. Instead, in a modern, developed country like Germany, Australia, or the UK, most people live in towns and cities, work in a huge variety of jobs and earn a wide range of incomes. Life is also more materialistic and competitive than ever. Religion and ritual play a smaller role in people’s lives, as does national pride. In other words, people find it harder to lose themselves in collective identities. So you have lots of lonely, isolated individuals competing with one another for money and possessions.
And such anxiety is constantly reinforced by social media. We live much of our lives online, and many people check their social media accounts before even getting out of bed. But social media isn’t real life. Most people only post photos of the good times: smiling and sun-tanned on vacation, hugging their partner and children on their birthday, celebrating their promotion at work, etc. Few post photos with a caption like “me feeling lonely and depressed,” or “me worried about retirement”!
Society and Culture
Depression is often a consequence of the culture or society in which someone lives. An obvious example is the individual from a religious community who attends a liberal college in London or New York. Her fellow students dismiss religion as nonsense and live their lives accordingly. Suddenly, she finds the whole foundation of her life challenged and undermined. Either she maintains her faith, leaving her cut off from her peers, or she abandons it, cutting her off from her family.
More generally, depression can be caused by despair at the state of the world. That is especially true of people with small children. One of the great curses of modern life is 24-hour-news, which is in fact 24-hour bad news. From the moment we wake up, we are pumped full of fear: exposed to stories about famine, resource depletion, global warming, overpopulation in Africa, mass migration, and so on. And there is no escape. Even if you do not watch the news or buy a newspaper, such stories flash up on your social media accounts.
Life in the 21st-century is overwhelming. Unfortunately, some are better at coping with this than others. That in itself may be explained by genetics. The Norwegian journalist Lone Frank, herself a lifelong victim of depression, had her genome tested and even wrote a book on the subject. She discovered that genetically she was poorly equipped to deal with stress. In other words, she was overwhelmed more quickly than the average person.
But even the toughest did not evolve to live in a world of flashing screens and speeding cars. On the contrary, our nervous system evolved to help us survive on the grassy plains of East Africa. And though life as a hunter-gatherer was certainly dangerous, we did not endure constant, low-level stress. A rival tribe may attack us, or we may be terrified by an earthquake, but these were one off events. The fight or flight system kicked in and then the event was forgotten. Today, our fight or flight system is triggered constantly.
Though we still have no simple explanation, knowledge and understanding is improving. And over the coming decades that should mean ever more effective treatments.