Depression seems to be the plague of the 20th and 21st centuries. There is no physical or mental dysfunction that has such an ubiquitous and deleterious impact. The World Health Organisation has predicted that by 2020, unipolar depression will be second largest health problem in the world.
Unfortunately, psychiatrists and psychologists have overwhelmingly come to the conclusion that depression is a result of an imbalance in the chemicals that fashion the functions of our minds.
This is not an unexpected outcome when so much of the research into such matters is sponsored by drug companies who have a vested interest in linking mental dysfunction with chemical imbalance.
But perusal of the research shows us that depression is much more complex than that. It has been shown to be shaped by genetic, social, emotional and environmental factors.
Defining depression has been extraordinarily difficult for psychiatrists. Perhaps the most difficult distinction was between grief and depression. Those people who suffered some of life’s most egregious circumstances displayed symptoms analogous with those that are otherwise defined depression. This dilemma was heightened by the fact that psychiatrists have been trained to look for symptoms and not to consider a person’s life circumstances.
In the Diagnostic and Statistical Manual of Mental Disorders (DSM) there was initially a provision to exempt people who were grieving from a diagnosis of depression. But because the symptoms of grief and depression are so similar recent editions of the DSM have dropped this distinction.
Of course another incentive to categorise abnormal mental function as a disease was to destigmatise the problem. I am not sure this has proven too successful. After all, some diseases attract stigma. In recent times AIDs has and certainly in the past leprosy has.
But I want to raise the conjecture in this essay that the mental illness we have come to know as depression, or at least a significant proportion of such cases, may in fact be due to social or cultural influences.
To understand this precept it is worth evoking some of the findings of evolutionary psychology.
The arrival of civilisation, where mankind lives in cities, is a relatively recent phenomenon in evolutionary terms. Cities have only been part of the social landscape for a few millennia at the most. But for hundreds of thousands of years prior to that mankind lived as tribes of generally no more than a hundred or so individuals and for those that were not nomadic, occupied small villages.
The communities of these hunter/gatherer societies were very close knit. Indeed they had to be to survive. The large prey that was a significant part of their diet required cooperation and coordination to slay. The constant incursions of other tribes also required such concerted effort to repulse. In these communities many individuals had to contribute their varied skills to aid the survival of the tribe. Such tribal communities were necessarily close-knit. Those that could contribute to the common good did what they could. On the other hand when tribal members fell ill or were injured they relied on the ministrations of the tribe to aid their recovery.
John Cacioppo was the director of the Centre for Cognitive and Social Neuroscience at the University of Chicago. He was intrigued, as a young researcher in the 1970’s, that his professors insisted on looking inside the brain to explain human emotions. Cacioppo was convinced that any such analysis should also consider the impacts of factors outside the brain such as a person’s social and cultural context.
Cacioppo was also intrigued by the relationship between loneliness and depression. Most of those suffering from depression also suffered from loneliness. But loneliness he found did not necessarily mean that the sufferer was physically isolated. Many people who had copious relations with other humans, admitted of experiencing loneliness. Loneliness, he came to understand, was not a reflection of physical isolation but psychological disconnectedness.
It was difficult to ascertain whether loneliness was a precursor to depression or that once people became depressed they were harder for others to connect with leading eventually to loneliness. But after some sophisticated research studies Cacioppo was able to demonstrate that loneliness most often preceded depression.
Being disconnected from the tribe is obviously very debilitating. We know, for example, from Aboriginal folklore that banishment from the tribe often resulted in death.
Cacioppo’s research found that people who felt lonely had both elevated heart rates and levels of cortisol in the blood absolutely soared. Being lonely , in fact, was as stressful as a physical attack.
In his book, Lost Connections, Johann Hari relates how another scientist, Lisa Berkman followed both isolated and highly connected people over a period of nine years, to see whether one group was more likely to die than the other. Hari reports:
She discovered that isolated people were two to three time more likely to die during that period. Almost everything became more fatal when you were alone: cancer, heart disease, respiratory problems.
After further research which I won’t elaborate on here, Cacioppo had this to say:
The stunning thing was that loneliness was not merely the result of depression, indeed it leads to depression.
So we might argue that a tribal environment promoted psychological connectedness which tended to inoculate our predecessors from the debilitating effects of depression.
I have read research which supports this conclusion from another cohort of people – those who live in small rural villages. Such people have retained much of the connectedness that once was the province of the tribe. Everybody seems to know everybody else. There are embedded personal support mechanisms such that help is provided to those in need. There is a rich social life which is inclusive of most of the inhabitants.
Typically when the residents of such communities are forced to relocate to a city environment they experience a sense of loss. They are used to an environment where everybody knows everybody else. But in the city they typically know few people and people don’t just stop and talk like they do in the village.
So it seems that many of our human instincts are honed by life in the tribe. When taken away from such a social context, humans feel disconnected and lonely and are then disposed towards depression.
It has been shown that such people, deprived of the support and nurture of others begin to fear their environment more and become hypervigilant.
Now, of course in modern times social technology has depersonalised much of our communication. This has helped further disconnect ourselves from one another. A text message or a Facebook post can hardly replace a handshake or a hug followed by concerned conversation.
It is easy to conclude that our brains are hard-wired for living in a tribal environment. Evolution built up this facility over hundreds of thousands of years. The displacement of tribes by the growth of cities has occurred only over the past couple of millennia. It is not surprising that we have yet to adapt evolutionarily to this recent development. One of the distressing outcomes of this history seems to be a greater propensity for loneliness and subsequently depression for those caught in the midst of this historical change.
It also encourages us to look further than assigning the cause of depression to a chemical imbalance in the mind. Surely we will never truly understand depression unless we recognise the external impacts of the social and historical context as well.