What 4 Years of Depression Taught a Psychologist

Think about the last time you had a fever. Your body ached. You could barely get out of bed. For centuries, doctors believed that fever was the disease. They bled patients, packed them in ice, dosed them with mercury. They fought fever with everything they had. They were wrong. The immune system was raising the body's temperature on purpose, slowing bacteria, supercharging its own defenses. Fever was the body fighting back. We spent centuries Trying to destroy the very thing that was trying to save us. Today, I want to ask you a question. What if we've been making the same terrible mistake with depression? Let me explain. Picture yourself walking through a thick fog. Your limbs feel heavy. You're exhausted. You want to feel something, anything. But instead, you're trapped in a terrible numbness. If you've ever lived with depression, maybe this captures some of what you've experienced. Over the past century, humans have made great leaps in understanding depression. Millions of people around the world have received treatment and recovered from this often debilitating condition. But what if we are still missing a key piece of the puzzle, one that could fundamentally change how we think about depression and help those struggling with it? At Cornell University, psychologist Jonathan Rottenberg has spent decades asking this question. His research suggests that our framework for understanding depression, the story we've told ourselves about broken brains and chemical imbalances, this story may be built on a flawed premise. John has a personal stake in the answer because before he became one of the leading researchers in the field, depression nearly ended his life. In the early 1990s, John Rotenberg was a graduate student at Johns Hopkins University. He was working toward a PhD in American history. He was in a relationship with a woman named Laura, and he was certain he was the smartest person in the room. Then something started going wrong.

I had pain on the left side of my body. I thought there might be something wrong with my heart. I felt physically weak. I thought I might have a fever or some kind of flu-like illness. I felt incredibly run down, and I thought that it would just go away on its own.

John's symptoms didn't go away. They got worse.

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 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.

John's entire identity was built around the power of his mind. And now that mind had stopped working. It took months before a psychiatrist gave a name to his affliction: depression. John started taking medication. It didn't help. His condition got worse. He grew more volatile, spent hours crying. His partner, Laura, stayed with him through all of it. He went on leave from his PhD program and told his advisor he probably wasn't coming back.

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.

John's depression lasted 4 years. During that time, he was hospitalized for a month. He tried medication after medication. The life he had planned collapsed around him. But somewhere in the middle of it all, something shifted. John decided that if he couldn't escape depression, he would try and understand it. He applied to graduate school in psychology and was admitted to Stanford. Slowly, John rebuilt his life. He completed his doctorate. He began a career studying the very condition that had nearly killed him. He's now the author of a book called The Depths, The evolutionary origins of the depression epidemic. And what he found in his research would change the way he understood his own suffering. For decades, we've been told a story about depression. You're depressed because something inside of you is broken. Maybe the chemicals in your brain are out of balance. Maybe the way you think is distorted. The details vary, but the premise is always the same.

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, 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.

This model has given us useful tools: antidepressants, cognitive behavioral therapy, a vocabulary that millions of people use to describe their experience. John is not arguing that these tools should be discarded. He believes they've helped millions of people. What he's questioning is the premise beneath them. Take the most familiar version of the story, that depression is caused by a chemical imbalance in the brain, specifically an imbalance involving the neurotransmitter serotonin. You've probably heard this explanation from a doctor or seen it in a commercial or read it in an article.

People have been studying the biological contributions to depression for 50, 60, 70 years, and I 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 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? If you go to a doctor about your cholesterol, they can draw your blood, run a test, and tell you your cholesterol level. If it's high, your doctor can prescribe a medication and then measure your cholesterol level again. If the medication is effective, the number from the second test should be smaller than the first. Depression has no equivalent. There's no blood test that measures serotonin levels in your brain. The serotonin hypothesis has become one of the most widely repeated claims in modern medicine. But serotonin levels in a living brain are not directly measured in clinical practice the way that cholesterol is measured in blood.

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. 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.

Now, to be fair, the brain is a far more complex organ than your heart. We know a lot more about your heart than we do about your brain. And just because you cannot measure something That doesn't mean it doesn't exist. You don't have a blood test to confirm your partner loves you, but they do love you, right? Right? Kidding. Of course they love you, but it won't show up on an X-ray. There are lots of aspects of human behavior that cannot be measured the way that you measure cholesterol. Jon, in fact, is not disputing that biology matters. If you feel sadness, or any emotion for that matter, it's the result of neurochemical changes in your brain. What worries John is that calling depression a chemical imbalance gives us a false sense of scientific precision. It covers over a gap between what we actually know and what we claim to know. And in turn, the story we tell about why people get depressed shapes how they see themselves and how the world sees them. John challenges the theory that having depression necessarily means that you have a defect. He begins with a simple observation: nature built us with a capacity for low mood. Every human who has ever lived has experienced it, and that fact alone is worth pausing on because evolution does not tend to preserve things that are costly and serve no purpose.

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?

Think about pain. Nobody enjoys it, but pain exists because it protects us. Touch a hot stove and pain yanks your hand away before you get burned. Anxiety works the same way. It floods your body with alerts, warning you to pay attention to potential risks. Jon argues that low mood belongs in the same family. He thinks of it as a signal, and its message is simple.

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, but without it, we would subject ourselves to harm and we would be moving forward rashly.

When the path forward is dangerous or uncertain, low mood slows us down and forces us to think about where we are headed. Other difficult experiences have a similar purpose. Consider grief. When someone you love dies, you feel terrible. Your whole body slows down. Your energy is drained. The world contracts. And yet, we don't typically think of grief as a disease. We understand it as something necessary, a period where we have to figure out who we are and how we continue without this other person in our lives.

And I think everyone would see that grief is a natural process, inevitable process. It's a cross-cultural process. It's even observed in other species, and it And again, like depression, it's very unpleasant. It's a very difficult state. So nature is not optimized for our happiness. Nature really cares more that we survive and reproduce than that we experience joy.

Nature is not optimized for our happiness. It's optimized for our survival. And sometimes survival requires discomfort. Sometimes it requires stopping, turning around, changing direction. When John looks back at his own depression through this lens, he sees something surprising.

You know, my depression actually fits some of these parameters in that I had invested so much in this life plan to become historian, and that I think I sensed that I was going to 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.

John's depression forced him to stop, and in stopping, he found a new direction. Now, he's grateful he found this new direction, but his depression still felt terrible while it was happening. There's an important question you should be asking about the evolutionary model that John proposes. If low mood is an adaptation shared across species, why is human depression so uniquely devastating? John says we can find clues by looking at animals who share our homes. Think about how depression might manifest in your pets compared with how it manifests in you. A dog can feel sad, but it can't tell a story about why it deserves to feel sad, why it's always felt sad, and why it will never stop feeling sad. It's absurd to think that dogs have these thought patterns, but they're common among humans who experience depression.

These are some of the things, because of our unique ability to use language and 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 the hands of a highly intelligent person using language, we become our own worst enemies.

The brains that give us the capacity to innovate, to dream, to create complex civilizations, they also give us the ability to build a case for our own worthlessness. That narrative layer can make depression in humans especially painful. And our modern world makes it easier for us to tell ourselves damaging stories.

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, which leads you to ask the question, why am I not experiencing this?

We compare ourselves to the curated versions of other people's lives and then ask what's wrong with our lives because we feel like we've fallen short. And the comparison never ends because the feed never ends. So to recap John's argument, Depression is an ancient signal, honed by evolution. It's designed to force us to pause, to reflect, and perhaps pursue a different path. It's a system that we share with other species, but our ability to ruminate, combined with our tendency to compare ourselves to others, these uniquely human traits have put that alarm system into overdrive. It's creating an affliction that is both more terrible and perhaps more widespread Than nature intended. John has studied what he calls the silver linings of depression. He's cautious with that phrase. He knows how it will sound to someone in the middle of a depressive episode, but he believes it's a mistake to think depression only leaves damage in its wake.

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, 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, I, I think many people find this difficult to accept— The better for it.

To be clear, John is not saying that depression is a good thing, nor is he saying that people should just grin and bear it when they're in pain.

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 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.

John Rottenberg's research asks us to look at depression differently. The capacity for low mood, the deep biological signal that slows us down when the path forward is dangerous, that capacity is ancient. The trouble is we live in a world today that activates that capacity all the time. A world of infinite comparison and fake signals of happiness, unhealthy cultures around work and relationships, a rat race that never seems to end. John Rottenberg doesn't buy the idea that depression always means there is something wrong with He spent 4 years believing that story, and then he spent the next 30 trying to replace it with a better theory.

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.

Thank you for watching this video. If you or someone you know is struggling with depression or suicidal thoughts, please call or text 988 to reach a trained mental health counselor. Every week on the Hidden Brain audio podcast, I bring you new ideas about the science of the mind. Over the years, many listeners have told us that these ideas have changed their lives. If you are not already subscribed, please check us out on Apple, Spotify, and at hiddenbrain.org. Thank you. I'm Shankar Vedantam. See you soon.