Why do we eliminate cancer cells, but not depression symptoms? Talking with author Jonathan Rottenberg (part III)

by Alaina Mabaso

Welcome to the last installment of our chat with author and psychology expert Jonathan Rottenberg. (Here are part I and part II if you missed them, or want to learn more about The Depths: The Evolutionary Origins of the Depression Epidemic, and the writer.)

Today, we look towards recovery from depression: what do we know? What don’t we know? And how can ordinary folks help? Here are excerpts of our conversation.

Adenocarcinoma cells. If you had them, wouldn't your doctor try to get rid of them all?

Adenocarcinoma cells. If you had them, wouldn’t your doctor try to get rid of them all?

Alaina Mabaso: Psychiatrists are doing a really hard job obviously, and I’m interested in the practical application of what you say in The Depths about “wellness.”

You write “the vast enterprise of depression treatment research inspired by defect models has virtually nothing to say about wellness or thriving.” So does that mean that most therapists and doctors are kind of only doing half of what their job should be, or does it mean we need a different kind of practitioner or coach to oversee the latter stages of someone’s recovery into that actual stage of well-being?

Jonathan Rottenberg: There certainly are psychotherapists…who would be interested in broader visions of wellness.

It isn’t really studied very much in any formal sense, that’s one problem, and definitely, when we’re talking about treatment and evaluating treatment, the only outcomes are whether or not the symptoms decrease, which is great, but I challenge you to find any treatment studies that look at broader measures of human functioning, let alone the squishy things like “purpose” and “meaning in life,” even just things like interpersonal functioning or the broader measures of psychosocial functioning.

Ninety-nine or 100 percent of the time, they’re just measuring how much do the symptoms go down, which I think is a good place to start; but there can be two people who have low symptoms who are very very different, and til recently, there hasn’t been a lot of interest in differentiating between low symptoms and total extirpation of [an episode of] depression. Turns out it really is very important, because people who have residual symptoms tend to have depression that comes back a lot sooner, and the longer that someone can be in an asymptomatic state, that is going to predict that the recovery is going to take, it’s going to last; [the depression] may not even come back ever.

Certainly in other branches of medicine…they’re very interested in those residual cancer cells, you know, we can’t have those; but with depression, basically the standard [in recovery] is when they say someone has responded with greater than 50 percent symptom reduction. If you were spectacularly depressed, you’re still pretty depressed… That [outcome is] not good enough.

I’m not doing psychotherapy, but I do know of psychotherapists, and there are not a lot of people who can afford to pay for psychotherapy on an ongoing basis, so that it would be useful… Insurers [are] not convinced that people should have treatment once their symptoms have substantially improved; there’s limits to how long you can see a therapist and so forth.

To me, [wellbeing] is just a far more logical goal than simply “my goal in life is to not be depressed.” That’s not going to be enough.

AM: It’s a negative statement. It’s not what you want; it’s what you don’t want.

JR: Right.

AM: I want to come back to what you said about the importance of speaking to people who are in that struggle, instead of clamming up. Some writers or filmmakers or whoever, they might address the topic of depression as you have, in this hindsight model: I was depressed; I came through it, now I’m better, and I’m going to stand up and talk about it. What about doing that in the public forum when you’re still in the mess of treating it and trying to figure it out? Not coming at it from the perspective of “I battled this, and here’s my wisdom,” but “I’m in this right now.” [I was first inspired in this line of thought by Terry Gross’s excellent Fresh Air interview with author and blogger Allie Brosh.]

JR: Well, that takes even more courage, I think, and it’s beyond a lot of people’s capabilities in the sense that when someone feels really depressed, they feel that they have nothing of value to say and…usually retreat from other people rather than approaching other people. There aren’t a lot of forums for these kinds of things.

AM: That’s what I’m finding.

JR: In my own case, I would say that I certainly have a tremendous amount of shame, and felt that I didn’t have anything to say during the depression…I think that one thing that would be terribly therapeutic is if we could change how other people typically react to depressed people.

A person thinks, “I’m socially toxic because I’m depressed,” and if just enough people in the environment affirm that by acting weird and unable to cope with the fact that their friend or acquaintance is depressed, that reinforces this view that “I’m defective, I’m not worthy,” and makes the person even less willing and able to share this part of their experience. I think that the solution to depression in the US is going to involve social change a lot more than it’s going to involve a new drug, and part of that is changing the social field around the depressed person. Not to say, hey, it’s great, join the land of depressed people, but just acknowledge that this is a part of life that almost anyone might have.

If everyone in the person’s social field said, “look, I know this is really hard…I know a lot of people with depression,”… it would make the burden of having depression a lot [lighter]. I feel like part of why people don’t get better is they get socially isolated, and they end up 100 percent in their own head.

If someone had the strength to talk about their depression while they’re still depressed, that can be great, but that’s going to be more than a lot of people can do, and enough people are going to experience really bad reactions [from] other people.

But I agree with you that often the dialogue is that the [former sufferer] is in a really safe place and they have a narrative of having overcome: that’s kind of more easily assimilated by other people [than the question of] whether or not the treatment was important.

AM: Like getting over the flu or something.

JR: Yeah… I have deep respect for severe depression, and think that it is quite scary…and I don’t think that just talking about it makes these states evaporate…but there’s a whole bunch of things that are sustaining these states, and the social environment in our culture is definitely one of the substrates for why there’s such a ridiculous amount of depression now in our country.

AM: My experience, and the experience of some people whom I know who have struggled with this, is a sort of cut-off, like, “you’re in this state, obviously I can’t talk to you, and I’m just going to let you alone until you come out of this,” which is just devastating to the person who’s already in a fragile place.

JR: I think [this topic has] a lot of potential, in spite of all the negative things that I would say about the current state of play… I’m hoping that there’ll be other things besides my book that will shake things up… I think that we haven’t yet had the kind of mobilization that the problem deserves, but I think that there will be more. I’m just not sure what it’s going to take.

AM: I’ve struggled with these problems for many years, and I think if people can see someone else talking honestly about how rotten this place really is, that really does help everyone.

JR: I admire what you’re doing, and I think it really does have good effects, so keep it up.

Thanks for reading this special interview series with The Depths author Jonathan Rottenberg, and thanks to Jon for chatting with us. You can find out more about his book at www.thedepthsbook.com, and follow him on Twitter and Facebook.

If you missed them, here are part I and part II of the interview.

Also of interest:

I apologize for this outbreak of the total jerk who lives inside my head.

It’s not always interviews, and it’s not always depression, but the conversation from readers is always interesting. Scroll down to the bottom to subscribe to the blog, or keep up on Twitter

 

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