Depression is among the most common problems encountered in clinical practice, yet most psychotherapists still accept the cultural assumption that it’s primarily a problem of the individual. Best estimates are that about 35 million American adults will, at one time or another, struggle with depression. That’s nearly 1 in 5 people, so it’s no hyperbole to say that we’re the midst of a depression epidemic.
And yet one paradox about depression is that, while more research and treatment resources have been poured into combating it than ever before, its personal and economic toll has actually grown. How can it be that—despite all the efforts aimed at understanding, treating, and educating the public about this condition—rates of depression continue to rise? Why have our treatments plateaued in their effectiveness, and why does the stigma associated with this condition remain very much with us?
Perhaps it’s because we’ve come to accept the clinical view of depression as an individual’s defect. This view is partly enshrined in the biomedical model’s assertion that depression is a brain- or genetic-based illness, despite the fact that there’s no biological test to diagnose depression, nor do any genes predict its occurrence.
Clinically, the biomedical model has failed to produce the results that billions of dollars of pharmaceutical advertising has promised. While 75 percent of those treated for depression receive antidepressants, the results remain disappointing. Despite 26 different antidepressants to choose from, only a third of patients with major depression experience full remission after a round of treatment.
Psychotherapists may not like the reductionism of the disease model, but their basic assumptions often overlap with it, still holding to different versions of a deficiency view of depression. Instead of residing in the person’s brain, as the psychiatrist claims, the deficiency may reside in thoughts (says the cognitive therapist), in childhood (says the psychoanalyst), or in the person’s relationship with a significant other (says the marital or family therapist). But I’d argue that this very premise—that depression and its symptoms are proof that something fundamental is wrong with an individual—is itself fundamentally wrong. No perspective based on finding deficiencies within individuals can equip us to understand why a depression epidemic is at hand, or can give us the best set of tools to combat it.The Rise of Mood Science
Depression has clearly been a tough nut to crack, but we haven’t focused much on what’s at the center of that nut: mood. The main approaches to depression have instead focused on other domains, such as cognition, biology, or social functioning. Diagnostically, though, the defining feature of depression is persistent low mood, and the typically depressed person reports moods that are excessively dull, empty, and sad, as well as lacking joy, excitement, or cheer.
A problem throughout most of the 20th century was that researchers doubted that something as evanescent as mood could be studied with precision or objectivity. Fortunately, this has changed. Just as CAT scans and functional magnetic imaging allowed physicians to see the innermost recesses of the body, so, too, in the last 30 years, an increasingly sophisticated assessment methodology has enabled us to measure mood and emotion. The emerging field known as affective science now benefits from a wealth of measurement tools, with techniques for measuring the moods that people report, systems for measuring behavior in the lab and in the field, and ways to monitor the physiology of mood and emotion, from functional brain scans to miniature sensors that monitor the body as people go about their everyday lives. The result has been a wealth of insights about “normal moods” that we can use to understand why we have a depression epidemic—an important first step in bringing it under control.
One fundamental question is why we have moods at all. What possible evolutionary purpose could they serve? In recent years, it’s become increasingly apparent that moods are a key adaption that we share with other animals. The architecture of the ancient mood system influences what we feel, think, and do, as well as guiding our bodily responses to the world. So what do moods do? Moods take in information about the external and internal worlds. They summarize what’s favorable or unfavorable with respect to accomplishing key evolutionary goals, such as survival and reproduction. They’re a clever adaptation because they integrate multiple aspects of how well or poorly we’re doing. They track key resources in our external environment (like food, allies, potential mates) and our internal environment (like fatigue, hormone levels, adequacy of hydration).
Our moods are integral to understanding what motivates us. They tune behavior to situational requirements, getting us to do the right thing at the right time. High moods energize behavior and activate us to pursue rewards more vigorously, to “make hay while the sun shines.” Low moods are best understood as a stop-and-think mechanism, which restrains behavior and focuses attention on threats and obstacles. When a bear spends hours fishing for salmon at a favorite bend of the river and finds no fish, low mood helps the bear pull back and move on. The value of low mood in humans is particularly clear when people face serious dilemmas in which rash action could be dangerous or lead to further losses. In fact, a rich and expanding vein of psychological research shows how low mood can be a boost to realistic appraisal, improving the accuracy of perception and judgment.
While low mood can be a vital adaptation, like any adaptation, it’s not perfect. Anxiety both saves us from legitimate dangers and sets us up for disabling forms of fear, sometimes when no dangers are present. Similarly, low mood brings with it the possibility for the chronic and severe forms of depression we see occurring at increasing rates around the world today.
Although low mood is a primitive adaptation built into our very makeup, the conditions of modern life can set it into overdrive, creating a perfect storm for mood. In just a few hundred generations, humans colonized the planet, built cities, and invented technologies beyond the wildest dreams of earlier times. Today, the dizzying speed of change in our physical and cultural environment has outmatched the pace of evolution of our nervous systems to keep up. What was once a perfectly good adaptation to a less revved-up and stimulating world is out of step with the demands of modern life.Psychotherapy and Mood Science
Mood science presents new ways to understand the depression epidemic by taking a fresh look at the big picture. In other words, we can’t understand why depressed mood is so prevalent until we understand the design of the mood system and why we evolved the capacity for low mood. Of course, this doesn’t mean we’ve found a single cause for the depression epidemic; there’s no single villain. And mood science is a body of theories and empirical findings, not a therapy. Nevertheless, insights from the evolutionary psychology of mood have clinical utility. Psychotherapists are in a position to harness these insights to enrich their approaches. The findings of mood science are already converging with principles behind therapy models that emphasize understanding the brain, the mind-body connection, and the psychological impact of broader cultural forces.
It’s important for therapists to become more systematic in assessing the factors that shape mood. An inventory of a client’s mood environment would include lifestyle choices, sleep regimen, light levels, physical-activity levels, stressors, and progress toward major goals. But it would also include a client’s expectations for mood and how he or she reacts to and copes with negative feeling states.Read the full article in the November/December issue of Psychotherapy Networker!>>Want to read more articles like this? Subscribe to Psychotherapy Networker Today!>>