A great deal is made about depression these days. Depression is on the rise. Suicide is on the rise. Anxiety is on the rise. It's alarming, and news of this often dominates the headlines. Most egregious is the claim that 'perhaps young people these days are too fragile'. It's not just a deflection of responsibility. What these media narratives often miss is that it's OK to be sad sometimes. In fact, some would say that being sad can actually be a good thing.
Depression is a real thing, and being sad is not the same
Depression is a clinical term. Like many clinical terms it has been abused. Depression describes a persistant state of sadness that interferes with functioning. That can manifest in many different ways. The DSM V (the most commonly used, US-based mental health diagnostic tool) identifies 8 variations, as does the European version, the ICD 10 (pdf). None of those variations include myriad subtypes, like depression with comorbid mania (an example of which would be bipolar disorder). Depression is varied. It is complex. It is not often well understood. But it is absolutely not just sadness.
But the very fact that there are so many different kinds of depression hints at something deeper. Why do different people experience it differently? A common analogy for many mental health issues is the cup. Picture a cup. It's got some water in it. That water is your genetic predisposition toward a given mental health problem (in this case, depression). When a stressful life event comes along, it fills that cup with more water. If it's big enough, or if enough of them happen at once before you can deal with them (drink that water up) then the cup runneth over. It's a useful analogy, but it doesn't help us capture the nuance. So let's extend that cup analogy a little further and explain why depression might look so different from person to person.
Being sad is normal
In 2006, two psychologists by the name of Keller and Nesse came up with a theory so straightforward that it makes you grit your teeth. They called it the situation-symptom congruence hypothesis. Basically, they argue that depressive symptoms are an adaptive evolutionary response to characteristic challenges of adverse life events. They suggest that as we go through life, a number of events are likely to crop up repeatedly. We're going to fail. We're going to lose people we love. We're going to have our hopes dashed. It makes sense, then, that we may have developed stereotypical responses to these common events: automatic survival mechanisms. The implication of this account is that the kind of stressful life event we have will determine what kind of sad we get.
For a long time now, Nesse has theorised that moods (persistant feelings, as opposed to more fleeting emotions) are a mechanism developed over the course of evolution that motivates us to manage our resources better. In this case, low mood (sad-type feelings) is a motivator to “conserve resources and reconsider options”. These kinds of feelings are triggered by a loss of- or some kind of percieved threat to things that matter to us.
Keller and Nesse build on this by saying that different kinds of low mood are patterns of feelings that help us to respond to specific kinds of threat or loss.
Different situations lead to different kinds of sadness
Keller and Nesse identify 11 different situation-mood type matches. For example guilt, fatigue, and pessimism seem to come after we've failed at something. Crying and sadness seem to follow social losses (like a death in the family). More interestingly, the research they've conducted on the theory seems to show that these specific patterns of feelings are quite stable in relation to the type of situation. The point of these specific types of depressive symptoms are thought to motivate us to behave in ways that help us claw back those lost resources, or sort our situation out. Take our example of failure from earlier. Guilt- and fatigue-type symptoms are thought to encourage us to take time to reflect more conservatively on our failure and so make us more successful in future. The crying and sadness after a loss motivate us to seek out social support and draw others to us.
Others have since taken this baton and run with it. Another researcher by the name of Nettle thoughtfully notes that while depressive symptoms may assist one to conserve resources in a time of loss, the severity of an event may at times require us to jump into action. He suggests such symptoms as restlessness, dysphoric mania and impulsive urges which could act in this way. This neatly extends the theory to cover those more complicated subtypes of depression, like bipolar-type disorders, as well as some of the symptoms that have been more problematic for researchers to explain.
Similar kinds of thinking have already started to pervade anxiety research; we know that anxiety is a normal emotion that focuses us on threatening situations. If you didn't feel anxious, you wouldn't get much of anything done. A good example for this situation-symptom congruence case would be something like rejection sensitivity. Being particularly sensitive to when people shut you down could probably help you figure out when you're getting excluded from your social circles (something that's incredible important to us).
Let's go back to the cup analogy. If we imagine that we can fill the cup with different liquids we can start to see why some people experience depressive symptoms differently. Fill that thing up with olive oil and you'll spend ages trying to clean that spill up. Fill it with cordial and it'll smell fruity for days to come. Different events have different consequences.
Why are people more sad these days, you ask?
So let me put it to you that maybe 'kids these days' aren't all depressed. Some are just sad and anxious. We live in a time where information floods in at a rate much faster than we can process it. It's not just social media. It's all media. That very same flood of information has also been responsible for the change in the content of that information, from informative to alarmist. It's a surefire way to drag our attention away from the torrent. It's not inconcievable that many cups are being filled with many kinds of loss-signalling information, and people are responding sensibly. Well, sensibly, if the media was being sensible. It's also not inconcievable that many more cups are overflowing.
As I write this article, we are in the midst of the second SARS epidemic in a decade, and this one, SARS-CoV-2 has been much worse from a media standpoint. Three months of uninterrupted fear with a stranglehold on my newsfeeds. Before that a bushfire catastrophe that ravaged my homeland and dominated my newsfeed even in the UK (and Australia rarely makes it into the news here). Before that, rising tensions in Iran. The Syrian crisis. The Crisis in Yemen. ISIS. Throughout it all, assertions that Donald Trump would end the world as we know it.
All of these things are serious issues. And all of these things are reasonable for people to be concerned about. But now there is no escape. This effects young people more than most, because they don't have a conception of 'before'. They were born into fear. They were raised by it. And now we expect them to fix it. Doesn't seem quite right to me.
But it's not the whole story - remember, depressive symptoms aren't depression
The whole premise of Keller and Nesse's argument is that depressive symptoms are evolutionarily based. That over time, these kinds of reactions to situations have helped people overcome adversity in times gone past. But not all depressive symptoms intuitively lend themselves to loss-type situations and these symptoms are conspicuously absent from their research. More to the point, they don't explain why some people experience these symptoms to the point that they can't function at all anymore (what we'd call a depressive disorder or episode). If depressive symptoms are supposed to be helpful, this is kind of counter-intuitive.
I like evolutionary theories. I hate them. They're so informative. But they're also often too easy. There's no doubt in my mind that this situation-symptom hypothesis isn't the full answer to the rise of depression and anxiety.
And to give credit where credit is due, young people are thriving despite these rising mental health concerns. The very fact we know so much more now about anxiety and depression than ever before as a society is because they are sharing this information with each other, and growing from it. I just think that we could all be a little more understanding.
The old adage 'is the cup half empty or half full' takes a whole new light doesn't it? Seems like it's less about the content, and more about whether that level is starting to rise. Many situations can be enough to fill our cups up too fast to deal with and when the cup starts to spill, it's time to get help. That different situations make people sad in different ways means that we might take the time to think about what kind of help we might need, or what kind of help to provide others.
Maybe it's because we can't fly anymore, but the airline safety brief comes to mind. Put your oxygen mask on before helping others. There's always time to be a little selfish every now and then.