Rethinking Depression

This is Hidden Brain. I'm Shankar Vedantam. For centuries, physicians regarded fever as a dangerous disease, an enemy to be crushed. In ancient and medieval medicine, fever was thought to represent an excess of heat or humor in the blood, a sign that the body's internal balance had gone dangerously askew. Treatments aimed to drive out the heat, Patients were bled, purged, or doused with cold water. Some were packed in ice or fed diets designed to cool the blood. Well into the 19th century, fever was still widely feared as a destructive force that could consume a person from within. Doctors prescribed mercury-based compounds, quinine, or alcohol in large quantities. Patients were subjected to fever cures in which they were submerged in prolonged cold baths or were wrapped in vinegar-soaked sheets, all in the hope of forcing the body's temperature back down. It wasn't until the late 19th and early 20th centuries that scientists began to recognize fever not as a disease, but as a natural response of the body's immune system. Research showed that infections, not fever, were the real enemy. Studies showed that moderate fever actually helped the body fight infection by slowing the growth of bacteria and enhancing immune function. This shift marked a profound change in medical thinking. Instead of reflexively suppressing fever, physicians began to see it as evidence of the body's vitality and capacity for self-defense. Today, while very high fevers are still considered dangerous and treated, mild to moderate fevers are often allowed to run their course, a quiet acknowledgment that what was once seen as a deadly illness is, in fact, a sign of the body's strength. Today on the show, we investigate the possibility that what is true of our physical health may also be true of our mental health, that even a scourge like depression may have its roots in our powerful drive to survive and flourish. The origins of depression, this week on Hidden Brain. Support for Hidden Brain comes from Planet Visionaries. Professional climber and environmental advocate Alex Honnold hosts Planet Visionaries, a podcast spotlighting the people tackling climate challenges with real, hopeful solutions. Throughout season 6, Alex brings together extraordinary changemakers for powerful conversations about grit, determination, and the power of hope to fuel our fight for a better future. In partnership with the Rolex Perpetual Planet Initiative, This is Planet Visionaries. Listen or watch wherever you get your podcasts. Support for Hidden Brain comes from Southern New Hampshire University. Science consistently tells us learning starts with motivation. That's why SNHU offers over 200 flexible, affordable online programs to help you get where you want to go. Take classes that spark your curiosity, shape your skill set, and prepare you for what's next. A degree can help move you forward, no matter what motivates you. Start yours at snhu.edu/brain. Support for Hidden Brain comes from Progressive. Whoever says saving money is hard doesn't know that new customers who bundle and save with Progressive save hundreds. Because switching your home and auto insurance is better than cutting down on those iced lattes you love. Switch to Progressive and see if you could save. Get your quote today at progressive.com. Progressive Casualty Insurance Company, affiliates, and other insurers. Not available in all states. A note that this story includes a discussion of suicide. If you or someone you love is struggling with thoughts of suicide, there are people who can help. Call or text the Suicide and Crisis Lifeline at 988. If you're outside the US, we've included a link in our episode notes where you can find mental health support in your country. We live in a culture that prizes strength and confidence and that celebrates happiness and high mood. So when those things slip away, when our energy disappears, when joy goes missing, We naturally assume that something must have gone very wrong. We look for a problem to fix, a disease to cure. At Cornell University, psychologist Jonathan Rottenberg has long asked if this is the right way to think about depression. Jon Rottenberg, welcome to Hidden Brain.

Thank you. It's wonderful to be here with you.

30 years ago, Jon, you were a confident, self-assured college graduate preparing to get married and to start a career. What was your life like at the time and what were your plans for the future?

I was studying. I was in a PhD program in history, living in Baltimore at Johns Hopkins University. I studied American history and I thought I was the smartest guy in the room. And I was then struck by a series of very bizarre experiences that I had no framework for understanding.

Tell me what happened. In many ways, you had all of your life before you. You had graduated from an Ivy League school. You were about to get married. You were doing this PhD, and you thought you were the smartest person in the room. It felt like everything was going your way. Yes.

And so when I started to feel unwell, I didn't have really much of a framework to, to go on. I first noticed physical symptoms that didn't make a whole lot of sense. I had pain on the left side of my body. I thought there might be something wrong with my heart. I felt physically weak. Like, I thought I might have a fever or some kind of flu-like illness.

Hmm.

I felt incredibly run down. And I thought that it would just go away on its own. And then other problems started. So rather than it getting better, it got worse. So What started to change was that my ability to focus, read, think, that degenerated pretty rapidly. So this tool that I used to understand the world, this tool that really defined who I was, my brain, my mind, was not working right. So here I am in a history program, and I'm working on a dissertation, And I can't read a book. I mean, I can look at a page and I see the words, and my ability to concentrate is getting to be close to zero. So I started to get scared. What could explain this? So I was even more baffled, and I felt like Something terrible was happening to me, but I didn't know what it was.

At what point did this clarify itself? At what point did doctors come up with a diagnosis, John?

It took months. I remember going home. I was living in Baltimore. Driving home, and that was very difficult, to Connecticut and meeting with a psychiatrist who was a colleague of my father's. And I believe that colleague was the first person to suggest that this might be depression. And that rocked my world. The sensations I was experiencing were not what I understood to be the symptoms of depression, which were feeling sad or just losing interest in things. I was really more experiencing this terrible fatigue, this inability to concentrate. And so I did get a referral to see a psychiatrist in Baltimore, and I was started on medication. And unfortunately, It didn't— it didn't help me. And I continued to struggle and become more and more distraught over the situation and less and less functional. So I was spending large parts of the day lying on the ground.

Well, for someone who was so proud of his own mind and how his mind worked, I'm wondering if there was an element of shame that you felt as you were experiencing this.

Yes, I felt humiliated, and I felt completely like I didn't know who I was if I couldn't think, that I had no— I had no reason I had no reason for being. I had no purpose in life. And it was very scary. And the fact that the treatment did not initially help me made it worse. And, you know, I had support of my then-girlfriend, and she stayed with me. But I became more and more difficult to be around. I became more emotionally volatile. I spent hours and hours crying. I started to experience suicidal fantasies of not wanting to be alive or even believing that I simply wouldn't have a future. It became more and more difficult for me to imagine that I would have a future. I didn't see myself as ever being able to emerge from this because the depression felt like it was bigger than me. It was stronger than me. It was more powerful than me. And that was a horrible feeling of powerlessness.

I'm wondering how you viewed your future at this time, John. Did the path that seemed so bright some months earlier, did it seem that it had closed off for you?

Completely. By this point, I had gone on leave from my history program. I had told my advisor that I was probably not coming back to the program, which was very, very difficult. And the path forward was very unclear. I knew that I was somehow continuing with my relationship with Laura, which was incredible that she was staying with me. But I wasn't sure that I was going to make it to the other side. I really had a lot of doubt that I was going to make it to the other side.

Hmm.

And I was at my limit. Every day I felt I was at my absolute limit of what I could possibly bear. I thought that no Person— no person can bear this. I mean, I felt completely obliterated.

How long did your depression last, John, and how did it finally come to an end?

It lasted, I guess you could say, 4 years, and it involved my really dedicating myself and sinking myself into the study of psychology and into the study of mood disorders. I applied to graduate school. I thought maybe I can rehabilitate myself, maybe I can rehabilitate my mind. And miraculously, I was admitted to a PhD program, actually a really tremendous PhD program at Stanford University. And that was where my wife's family was from, and so she was overjoyed. By that point, we were married and expecting a child, so there were things— I could imagine that there were things to live for, even if I felt like I was faking it every day. I was still struggling to concentrate. I did not feel confident in my ability to do this PhD program.

Right.

But I was gonna try. And the idea that I would have the opportunity to understand depression, it felt like in my heart, my only chance. I think it was enough to gradually move me in the direction that I needed to be. And I sort of returned to the land of the living, but it was a gradual process.

When John Rottenberg first fell into a severe depression, he saw it through a particular lens. Like many of us, he had absorbed the notion that depression was a flaw in character or in brain chemistry. It took years for him to see his experience in a different light. That's when we come back. You're listening to Hidden Brain. I'm Shankar Vedantam. Support for Hidden Brain comes from Progressive. Whoever says saving money is hard doesn't know that new customers who bundle and save with Progressive save hundreds. Because switching your home and auto insurance is better than cutting down on those iced lattes you love. Switch to Progressive and see if you could save. Get your quote today at progressive.com. Progressive Casualty Insurance Company affiliates and other insurers. Not available in all states. Support for Hidden Brain comes from Quince. We all have those pieces in our closet that we can count on. The versatile jacket, the perfect t-shirt. These are the pieces that make getting dressed easy. And that's what Quince does best. Quince makes elevated everyday essentials using premium materials in designs that are timeless, thoughtfully crafted, and made to be worn again and again. And when the temperatures start to drop, Quince makes it easy to build on these everyday staples with versatile layers designed to keep you warm and comfortable all season long. Find your next fall favorites at Quince. Download the Quince app for app-exclusive offers, Or go to quince.com. Get free shipping on your order and 365-day returns. Now available in Canada and the UK too. And when Quince asks where you heard about them, let them know it was Hidden Brain. This is Hidden Brain. I'm Shankar Vedantam. For several decades now, we've been told that depression is a malfunction. a glitch in our brain chemistry, a flaw in our cognitive wiring. But at Cornell University, psychologist John Rottenberg says this account may be wrong, or at least incomplete. John, how would you describe the prevailing model that we have of depression?

The prevailing model that we have of depression is that depression reflects some fundamental defect that is inside the depressed person. That defect might be in the person's mind, like the way that the person thinks, or that defect might be in the person's brain, like in the chemicals that are circulating between the neurons.

Hmm.

Or that defect might be in how the person is interacting with other people. But in the final analysis, the reason that people are depressed is that they have some fundamental defect or defects inside themselves that explain why they are subject to episode or repeated episodes of depression.

You say that the defect model often blames depression on faulty brain chemistry and claims that antidepressants are the solution, but that the evidence doesn't fully support this idea. How so, John?

People have been studying the biological contributions to depression for 50, 60, 70 years. And I do believe that part of depression involves biological factors, but that's very different from saying that there is a biological cause, a single cause, in the brain. And the search for antidepressants has led to a large number of therapies. There's over 20 different antidepressants, but none of them could be called a cure. And I do think it's a bit misleading, this metaphor that's often used to talk about a chemical imbalance, because that imbalance has never been isolated. It's never been fully characterized. It can't be measured. And so what you have are treatments which are useful for many people, but it relies on a metaphor. I mean, the patient comes in and wants help. The physician or psychiatrist might tell them that they have a chemical imbalance, but the problem is you can't present to them their number, and you can't show that the treatment is changing that number.

Hmm.

So you're really engaging in hand-waving. And I don't think that's doing a full service to our level of knowledge and being fully candid with people who are really struggling.

So this would be in contrast to something like, you know, if a physician worries that you have high cholesterol, you can take a blood test and actually show what your cholesterol levels are. And with the right medications, you can then show that your cholesterol levels are changing. You're saying that no similar system exists when it comes to something like depression.

Correct. So one of the One of the main neurotransmitters that's implicated in this disease model or defect model is serotonin. There's no way to assay serotonin and give a— your reading where you are with respect to serotonin right now in your brain like you can with cholesterol or you can with insulin. So depression involves biology, but it's not a disease in the same way that diabetes is a disease or Huntington's disease is a disease. I mean, in that case, we know what genes are responsible, and we understand what those genes are doing and how it relates to the symptoms of this neurological disorder.

Hmm.

Depression, the understanding is much more diffuse. Like, maybe it has something to do with serotonin. Maybe it has something to do with dopamine. That's a very different level of understanding.

Another way to think about the defect model blames depression on faulty cognition and claims that the solution is the right kind of psychotherapy. But you say that the evidence doesn't fully support this explanation either?

Well, I think that all of these are valid therapies. So if you're struggling with depression, medications are an option and cognitive behavioral therapy is an option. And that's a good thing to have multiple options. But again, that's very different from saying that the reason that people become depressed in the first place is because there is something fundamentally deficient in their cognition in the way that they're thinking. It could be instead that these changes in cognition are part of what's maintaining the depression, which is why the therapy can be useful. So I do believe that cognitive behavioral therapies can be really helpful, not only in helping people resolve a depression episode, but the skills that are learned in cognitive behavioral therapy can be useful in keeping people well. So I do believe that cognition is a contributing factor. to depression. But that, again, is different than saying that people who are depressed all are somehow defective or deficient in how they think about the world.

John's point is not that medications and psychotherapy are ineffective and should be discarded. He thinks they have helped millions and could help millions more. His point is only that depression is not necessarily evidence that there is something wrong with the brain. In fact, he believes the capacity for depression is wired into the brain.

There's no question that nature built us with the capacity for low mood. And once you have that capacity for low mood, you have the capacity for more serious, more severe, more long-lasting low mood. And so that is a very important adaptation. Mood is what is integrating all of the inputs, both inside of your body and outside in your environment. And mood is the thing that's asking the question, what should I do next? Should— is this environment that I'm in good for action or is it bad for action?

Hmm.

And so low moods are unpleasant, just as pain is unpleasant, anxiety is unpleasant. But I think it's easier for people to see that pain is an evolved mechanism that allows us to protect our body from physical damage.

Hmm.

And anxiety is a mechanism that allows us to avoid threats. But what is the purpose of mood? It's harder for people to see that mood itself could have a purpose, but it actually is sharing a great amount of similarity with anxiety, with pain, and with other mechanisms like fever that are protecting us.

From an evolutionary perspective, John, what do you think mood is actually doing for us?

It's telling us, should we proceed or should we stop? So if you think at the most basic level of a little foraging animal where it's reached a patch of grass where there are no— there are no leaves of grass to eat, and everywhere it looks, there's no leaves of grass to eat, should the organism keep moving or should the organism stop? Writ large, imagine there's a famine and there's no food available. Mood is a stop mechanism. And when we come to humans, the situations that can prompt low mood become much more complicated than threats to your physical well-being. They involve also your future prospects for survival and reproduction. You experience low mood when there is a dilemma and it is uncertain whether or not you should proceed or whether you should stop. And low mood forces you to think about the situation maybe longer than you would like.

Hmm.

But without it, we would subject ourselves to harm and we would be moving forward rashly. I mean, think about what happens after someone dies. There's a funeral, everyone comes together. They do not feel Good, but they mark this as an important moment where I have to figure out who am I and how will I continue without this person in my life.

Hmm.

And I think everyone would see that grief is a natural process, an inevitable process. It's a cross-cultural process. It's even observed in other species. And it, again, like depression, is very unpleasant. It's a very difficult state. Nature is not optimized for our happiness. Nature really cares more that we survive and reproduce than that we experience joy. You know, my depression actually fits some of these parameters in that I had invested so much in this life plan to become a historian. And that— I think I sensed that I was gonna have difficulty getting a job as a historian. And my body was kind of saying, you're not going to pursue this. And so I was forced to stop and reconsider, kind of against my will, and come up with a new life plan, which was not an easy process at all, but did ultimately put me on a path towards a more viable future for myself.

Hmm.

We talked with Lisa Feldman Barrett at Northeastern University some time ago on Hidden Brain. And one of her interesting and provocative ideas when it comes to the world of emotions is she argues that emotions are predictions about the world rather than reactions to the world. They're basically guides that tell us, go forward, seek this out, this is going to be fun, be excited, have high energy.

Right.

Or on the other hand, withdraw, be careful, be afraid, something is dangerous here. So when we think about emotions as predictors as opposed to reactions, that fits very well with your thesis that moods in some ways are a guide telling us what to do next.

I completely agree with that. What's already happened is spilled milk. From the perspective of evolution, it doesn't matter. To give an example, I remember 9/11. in watching the planes hit the towers, and I felt immediate terror, and I felt immediate sadness, and I felt immediate rage. But it was about the future. It really was. Those feelings were about the future because there were the questions about who had done this and what would happen next, and were we safe where we were right now? And Whoever did this had to pay. I think that people thought that they were reacting against what had happened, but it was really the implications for the future that made those feelings so strong. So I agree that our feelings are there to help us do what we need to do in the moment, and that's a future-oriented system.

To bear down on this just a moment longer, you told me how debilitating your depression was, how you felt like there was no end in sight. You even had thoughts of ending your own life. How could a condition that is so disabling, a condition that You know, prompted you to consider suicide, how can this be understood as a beneficial adaptation?

Well, I think that there's many things about depression in our contemporary life that are not serving us well. My point only is that the original adaptation is useful, not that every instance of depressed mood is useful. And in fact, there can be Mismatches between the environment in which the adaptation emerged and our current environment. Another thing that I really want to bring up that is unique to humans in human depression is the power of language and what that does to depressive episodes. Because I think in an evolutionary perspective, it's important to keep in mind that this adaptation is seen across species. And so we can talk about mouse depression or dog depression, But my dog, I had a dog Cyrus, and I think that, you know, there probably were times in his life when his environment was unpropitious and maybe he was depressed. But Cyrus did not get down on himself. He did not say that he was failing as a dog. He didn't say that he should never have been born, right? And I mean, I mean this, it's funny, but I mean this in all seriousness, that these are some of the things because of our unique ability to use language and to have a—

Yeah.

to have a self-view and a self-story that human depression can be much, much more deep and terrifying. We're using some of the tools that enabled us to differentiate ourselves from other species and have, in a sense, mastery of the entire Earth. But these are some of the tools that are also used against ourselves. So again, a perfectly good adaptation, but in— In the hands of a highly intelligent person, Using language, we become our own worst enemies.

So in some ways, what I hear you saying, Jon, is that, as you discussed, the capacity for anxiety is a good thing, which is that it's important to be on the lookout for predators or threats. And in our evolutionary history, this was a very useful adaptation. But in the modern world in which we live, we are inundated with stories about things that could be threatening. We're reading blog posts. We're reading newspaper articles. We're watching cable television. We're on social media. And we're constantly being told about all the threats that are in our environments. And this natural, healthy adaptation to experience fear, to be wary of threats, now gets put into hyperdrive.

Right.

Because we are in an environment that is constantly pressing that button over and over again. Is that the point that you're making?

It is the point that I'm making. And I make it a little bit different for depression because some of the environmental factors involve our culture. So for example, we don't simply experience our mood. We also experience our mood relative to what we believe we should be experiencing or what we believe other people are experiencing. So this phenomenon of social media has really changed how people experience their mood, because what people often project on social media are lives where I am leading an ecstatic existence of a series of amazing experiences. And if you witness other people's social media feeds, you may come to believe that other people are experiencing off-the-charts positive affect.

Right.

Which leads you to ask the question, why am I not experiencing this? So you're experiencing a big discrepancy between what you believe you ought to be feeling and what you are feeling and what you believe other people are feeling. So your mood becomes a big problem in this environment. And then you start to ask the question, what is wrong with me? That I feel this way? And I believe that more people are asking that question right now than have ever asked that question in human history. Certainly, if I think about my Russian and Eastern European peasant ancestors in the 19th century, who were living in villages, I do not think that they were all the time thinking, What is wrong with the way that I am feeling? I think there was a greater acceptance that negative emotions perhaps were par for the course, to be expected. So there's a number of things that are going on in our contemporary environment that are probably exacerbating low mood.

So here again, the problem might not be social comparison per se, because again, as you point out, in our ancestral environments, perhaps some social comparison was useful. If somebody figured out how to build a better hut than your hut, then you learned to build a better hut yourself. But now we're confronted with social comparison with millions of other people, people who are better athletes, people who are eating nicer dinners, people who are in happier relationships. And we're constantly asking ourselves the question, why is it that I have fallen short?

Completely. You know, as opposed to the example of the hut, where you see what the hut looks like, but the truth is we don't know what anyone is experiencing. So we're really in the dark fundamentally when we make these comparisons. All we have are other people, what other people say or what other people look like. And unfortunately, in our culture, there isn't a lot of transparency about low mood. People don't want to post on their Facebook profile, I'm having a low mood day.

Right.

And people often don't know how to react when they do post such a thing.

You also observe, Jon, that our modern culture leads people to pursue happiness in ways that may set themselves up for unhappiness. What do you mean by this?

Well, I believe in our contemporary environment, a lot of people have developed very unrealistic goals for themselves. For example, in young people saying, I'm going to be a billionaire, or I'm going to amass 10 million followers on social media, or I'm going to be the most beautiful so that I will be a fashion model and people will follow me all around the world, that unfortunately Very few people will succeed at these very unrealistic goals. And consequently, if your happiness is contingent on reaching these goals, you will tend to feel depressed.

Can you talk a moment, John, about how in the United States we've actually written the pursuit of happiness into one of our foundational What do you think that does to our mental states?

Well, the idea of pursuing happiness obviously is very old, and you're right, Thomas Jefferson included that in the Declaration of Independence as a fundamental human aspiration. I think the question is how to pursue happiness, right? So is it that happiness is something that you experience along the way? As you pursue other things that are meaningful in your life? So for example, starting a family or meaningful work or helping others? Or is happiness an end in itself? Meaning, I want happiness now and I need to figure out what I will do today to feel happy right now. Those are very different. And I think many people have started to train themselves on thinking about happiness as a short-term phenomenon. And I'm not sure that Thomas Jefferson was thinking that the pursuit of happiness meant that the 18th-century farmers needed to find a way to experience euphoria today.

Our culture has embraced the idea that depression is a sign of something broken within us. But John's research in affective science suggests that depression might emerge from the same mood system that helps us to adapt and survive. When we come back, writing a new story about depression, one that offers greater understanding and hope. You're listening to Hidden Brain. I'm Shankar Vedantam. Support for Hidden Brain comes from Instagram. Instagram Teen Accounts' automatic protections limit who can contact teens, the content they can see, and the time they spend on the app. Teens are automatically placed into Teen Accounts. Teens under 16 will need a parent's permission to change any of those settings to be less strict. Learn more about Teen Accounts and Instagram's ongoing work to protect teens online at instagram.com/teenaccounts. Support for Hidden Brain comes from Air France. Air France Business Cabin offers comfort throughout the journey with priority check-in, boarding, and lounge access. Onboard, enjoy menus from renowned French chefs, wines and champagne selected by a sommelier, and free high-speed Wi-Fi. When it's time to rest, settle into a fully adjustable lie-flat bed with added mattress comfort. The art of travel elevated, because Air France Business Cabin goes further in every detail to make your journey exceptional. This is Hidden Brain. I'm Shankar Vedantam. Psychologist John Rottenberg studies depression and where it comes from. If you have a personal story about your own battles with your moods, or follow-up questions or comments that you would be willing to share with the Hidden Brain audience, please find a very quiet room and record a voice memo on your phone. Email it to us at feedback@hiddenbrain.org. Use the subject line, depression. That email address again is feedback@hiddenbrain.org. John, you say that part of your effort to push back against the defect model of depression is to investigate what you call silver linings in depression and other psychological disorders. What do you mean by silver linings?

Well, historically, the idea has been that As people experience depression, they experience further damage. Each episode of depression damages your relationships, damages your body, damages your mind. And that leaves out the active ways that people adapt and learn from their depressive episodes.

Mm-hmm.

And the ways that these episodes can actually be Engines of meaning, engines of change, engines for a better future. And the person is actually, I hate to say it because I think many people find this difficult to accept, the better for it.

In the course of your own depression, you learned some important things yourself. One of them is that people were really there for you.

That's deeply true. I started out, I think, as a 24-year-old, laudably, as an independent person. But I learned through my depression how much it's okay to lean on other people and that everyone gets a turn.

I'm wondering whether you felt greater empathy for others who've been through the same thing as a result of going through so much suffering yourself.

I did. And I don't think it's only me. I think another, you could say, silver lining of depression is that you do develop compassion for other people's suffering. And because you have, it could be that other people are suffering for a different reason, or it may be a different variety of suffering, but you are a little bit more attuned to that pain. And that is in some ways, in some ways, it's a good thing because—

Mm-hmm.

It's a way that you're in touch with a part of your fundamental humanity in a deeper way.

Mm-hmm.

But that's not the only kind of irony of suffering. I think that also from suffering deeply, you can come to appreciate not suffering in a more profound way, meaning that I wake up today and I'm not in pain. And that is beautiful in a way that I don't think I could appreciate before I struggled with depression.

Hmm.

And not to say that everyone who's going through life who hasn't experienced depression or some other mental health crisis is sleepwalking through life. I wouldn't say that. But I do think that the experience of being depressed, of being suicidal, is something that can make you appreciate normality, if that's a phrase, in a more robust way than if you hadn't had this experience in the first place.

You told me when you were describing your depression that at times it felt like it was bigger than you, that it was stronger than you, that you were dealing with a force that in some ways was much more powerful than you were. But at the same time, John, you are here today. Your depression isn't.

I know. This is one thing that keeps me going, the knowledge that I was able to persevere. And none of us, I hate to say, is immune from depression or even suffering. Suffering is inevitable. It's really how we are able to tolerate it and work with it and hopefully integrate it into our lives that really enables us to move forward.

There have been a number of studies that have also found that people who are experiencing depression in some ways can have a more accurate view of reality than people who are not depressed. That when we are in a low mood, in a bad mood, sometimes we might actually be able to see ourselves, to see the situation more clearly. And in some ways, this aligns with Your thesis that if a low mood is designed to make us stop and think and ponder, perhaps we're able to stop and think and ponder better than when we are in a euphoric mood.

It's probably true. I'm not arguing that we should all encourage ourselves to be depressed so we'll process the world in a more accurate way, but I think we should also be attuned to the ways that being in a good mood is consistent with having some, you could say, positive illusions. So we temporarily suspend or put to the side big things like that we are mortal, that we are all going to die.

Right.

And that all the people that we care about are going to die too. That we temporarily don't focus on the suffering and the bad news that's happening on every continent and That's totally understandable in that when you're depressed, you become much more attuned to these hard truths. It is very much a mixed blessing, but it is something that is a part of this low mood syndrome that we think about things. We think about things deeply and that we don't look away from the pain or the painful things. In fact, we immerse ourselves In the pain and the difficult things.

You've also indicated that in some ways your own depression was the origin story of your research career as a psychologist. In some ways, It seems odd to say this, but depression helped you find your purpose in life.

Oh, it definitely helped me find my purpose in life. There's no question about that. And strange thing to say, but I think truthful thing to say is that I feel grateful that I was able to make this big change in my life, even though it was extraordinarily painful and It put me at risk. I think I was at grave risk for not making it to the other side. But I have now been on the other side for some decades, and I don't think any of this would have happened if I had continued in history.

I want to take a moment and underline something really important. You've studied some of the silver linings that come with depression. You've challenged the idea that depression is a brain disorder or merely about errors in cognition. Some people might listen to this and say, okay, John Rottenberg thinks that the enterprise of treating depression with psychotherapy or medications is flawed. They should be discarded. That is not what you are saying, right, John?

Absolutely. I would love for there to be less depression in the world, and I'm very interested in trying to understand how people can experience well-being despite a history of depression, how people can avoid having future episodes of depression. Depression is demoralizing, and it often leads people to be profoundly hopeless, so I am delighted To be able to say that there are treatments, and people should absolutely try psychotherapy. They should absolutely try medications if they've found that they're not able to resolve the episode on their own. And they should also rely— they should also try to get help from the people around them, because it often is an all-of-the-above approach that really enables people to make the kinds of changes that are needed in order to fully recover from depression. So I believe that treatment is often a critical first step towards recovering and ultimately thriving after depression.

I understand, John, that a few years ago, you reached out to one of the psychiatrists who treated you when you were depressed. Why did you reach out, and how did the conversation unfold?

I did. It was something that I thought about a lot. This was actually the psychiatrist who admitted me to the hospital at Johns Hopkins for a month. And he had been working with me for over a year. We had tried, I don't wanna say everything, but we had tried many medications together and in combination. And I felt that he had done his absolute best. but also that he hadn't been able to make me better. And I felt a certain amount of guilt that I wasn't a good patient at the time. And I also felt like he didn't know me, despite the fact that we had the most intimate conversations for like 18 months. And so when I finally did recover, I thought about Dr. McGinnis, and he had become a pretty eminent research psychologist. at the University of Michigan. And I just wondered, what would it be like if I reached out to him? Like, would he remember me?

Hmm.

Would he be surprised that I had not only gotten out of the depression, but that I was now in the field? And not only I was in the field, I was studying depression, and I was a faculty member like he was. And so I wrote him with really very little expectation. Just, I really wanted to say that I knew that he had done his best. He was a very kind, is a very kind man, in that it was just a really difficult depression that really, I don't know if anyone could have done better than he did. And just see, just see what he said. And he not only did he write me back, he wanted to to talk with me. And we continue to be in contact, and I've seen him in person. And to me, this was very gratifying because he is someone who knew me as the depressed John, but also as the person who's on the other side of depression. And he's one of the few people who really knows all of those parts intimately. And he also is someone who really understands depression. So I think In addition to it being very gratifying for me, I think it was also gratifying for him to see that his patient finally was able to get out of it and turn his life into something that is an asset to the world.

In our companion story to this episode, available exclusively to subscribers to Hidden Brain Plus, we explore John's ideas about how it's possible to live a good life, even to flourish, if you or someone you know has depression. If you're a subscriber, that episode is available right now. It's titled Flourishing After Depression. If you're not yet a subscriber, please visit support.hiddenbrain.org.

Thank you.

If you're using an Apple device, go to apple.co/hiddenbrain. You can get a free 7-day trial in both places. You'll instantly have access to all our subscriber-only content, including past episodes. Again, that's support.hiddenbrain.org or apple.co/hiddenbrain.

John Rothenberg.

John is a psychologist at Cornell University. He's the author of The Depths: The Evolutionary Origins of the Depression Epidemic. John, thank you so much for joining me today on Hidden Brain.

Thank you for having me. It was such a pleasure.

If you have a personal story about your own battles with your moods or follow-up questions or comments that you would be willing to share with the Hidden Brain Please find a very quiet room and record a voice memo on your phone. 2 or 3 minutes is plenty. Email the file to us at feedback@hiddenbrain.org. Use the subject line Depression. That email address again is feedback@hiddenbrain.org. Also, if you or someone you love is struggling with suicidal thoughts, there are people who can help. If you're in the US, you can call or text the Suicide and Crisis Lifeline at 988. That number again is 988. If you're outside the US, check the episode notes for today's conversation to find information about support in your location. Hidden Brain is produced by Hidden Brain Media. Our audio production team includes Annie Murphy Paul, Kristin Wong, Laura Querelle, Ryan Katz, Autumn Barnes, Andrew Chadwick, and Nick Woodbury. Tara Boyle is our executive producer. I'm Hidden Brain's executive editor. Thank you to Loom by Atlassian for sponsoring the Hidden Brain Perceptions Tour. With Loom, teams move work forward faster, replacing endless meetings and slow approvals with quick, clear video messages. Today, we'll hear from Dr. Molly Sands, head of the Teamwork Lab at Atlassian, about how Loom is transforming the way teams work.

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