The Depression Epidemic
Browse any major psychiatric journal and you will read that our genes are the first cause of depression. Given certain environmental challenges, depression emerges. This is true, but it does not go far enough. Most have heard that depression can be caused by a chemical imbalance (such as a deficit in serotonin). Though the biological aspect of depression is more complex than a simple chemical imbalance, depression is nonetheless associated with poor regulation of the chemical messengers in our brains. This is why certain medications can relieve symptoms of moderate to severe depression. But this is not a new biological development; our bodies have not changed significantly over the past 100 years.
We also know that distorted thoughts contribute to depression. Those who are depressed do not evaluate themselves accurately (i.e., I am not as good as others). They fear that their selves are disintegrating (i.e., I am falling apart). They depreciate their value to others (i.e., I am of very little benefit to my family). And they believe they do not have control over their bodies (i.e., I just cannot make myself eat). Aaron Beck, the father of the most popular psychotherapy today, cognitive behavioral therapy (CBT), proposes that depression derives in large part from these cognitive distortions. Depression is relieved by bringing the distorted views more in line with reality. Evidence supports Beck's contention, though not in all cases.
But cognitive behavioral therapies have been criticized for focusing on the person as such and ignoring the context of the person within society. Psychotherapist Robert Fancher believes the CBT approach "devalues those attributes of mind most likely both to create culture and to take us beyond the status quo—imagination, passion, and the courageous, painful process of bringing new ways of thinking and living to birth. It amounts to an endorsement of the middlebrow life under the authority of 'good mental health.' " To put it more simply, cognitive therapy tends to reinforce the social norm, focusing almost exclusively on assisting the individual to adapt to the environment.
We now know much more about the neuroscience and cognitive patterns associated with depression, and have found fairly effective biological and therapeutic treatments. But we still do not have an answer to the pressing question behind this virtual epidemic: Why now? In order to get at this question, we must look beyond biological and psychological factors.
Things fall apart
"Life's tough," said one of my professors of medicine, and I knew what he meant. A young intern, I was seeking empathy after surviving a night on call without a wink of sleep. I had forgotten to look up a reference he had recommended the day before. He wanted the reference, not an excuse. But life was busy, chaotic, and demanding, and I was having trouble holding everything together.
Everyday life in 21st-century American society can be tough. The constant pressure of negotiating increasingly complex and sometimes harsh social realities takes a toll. Depression is in part a withdrawal by the weary into an inner world, an attempt to create a protective cocoon against real-world demands. Whatever personal factors contribute to an individual's depression, the broader epidemic suggests that living in disordered social conditions makes things worse.