I can’t complain about my existence in modern culture. My life is great. I have a loving family. My kids are happy and successful. My wife is a friend and lover and confidante and partner. Business is good and interesting. I care about what I’m doing. Every day is meaningful—and unburdened by concerns around mental well-being. Depression isn’t an issue for me.
But it’s not the case for everyone. The numbers don’t lie. Depression rates are climbing. Antidepressants are among the most common drug prescriptions, even among children. And because it can be embarrassing to admit you’re depressed—like there’s “something wrong” with you if you say as much—many people with depression never seek help, so the real numbers could be even higher. Depression isn’t new of course. The ancients knew it as “melancholia,” or possession by malevolent spirits. But all evidence suggests that depression is more prevalent than ever before.
What’s going on?
First of all, the way we speak about depression makes getting to the root of the issue harder.
“It’s all brain chemicals.”
“You have a neurotransmitter imbalance. There’s nothing you can do but take this pill.”
“You were born with it.”
This is an admirable attempt to de-stigmatize depression, turning it into a medical condition that “just happens” and “isn’t your fault.” Some people get brain tumors, some have type 1 diabetes, some have depression. There’s no shame in getting treatment for legitimate medical condition. This is an important development, but there’s a cost: It removes agency. If depression is just something you get or have from the outset, many (certainly not all) people believe there’s no reason to investigate the root cause or pursue alternative solutions.
While there’s definitely a genetic component to depression, and neurotransmitters play key roles, most depression requires some precipitating series of environmental inputs. The vast majority of babies with “depressive genes” don’t come out of the womb listless and morose with “bad brain chemicals.” They may be more or less susceptible to the environmental factors that can trigger depression later in life, but they still require those factors.
What’s happening? Clearly, something novel is afoot. Although we don’t have data on the mental health of paleolithic hunter-gatherers, extant hunter-gatherers exhibit an almost complete lack of depression.
What might help fill in one neglected dimension is to examine what’s unique about modern society.
People exist in their own bubbles. We sit in cars, in cubicles, in houses, in separate rooms. Even friends out to lunch are often seen gazing into their smartphones, half-ignorant of the normal waking reality occurring around them. Families gather in the living room not to play board games and chat about the day, but to access their personal portals into cyberspace. Together but apart. It may feel like we’re connecting, but we’re really just lonely. Like something out of a post-Sergeant Peppers Beatles dystopian concept album, the UK even just established a Ministry of Loneliness.
Loneliness has stronger associations with depression than any other social isolation indicator.
Robin Dunbar came up with Dunbar’s Number after studying disparate tribes and communities across the world: The maximum number of fulfilling, meaningful social relationships a person can reasonably maintain is about 150. We’re geared to desire social acceptance from our tribe, because social acceptance in a tribe of 150 people is both feasible and desirable. It increases survival. If “desire for social acceptance” is mediated by genes to at least some extent, it undergone positive selection; it was helpful and beneficial and supported species survival. Consider what the tribe originally meant: these are the people you grew up with, the people who will have your back. It’s important that your tribe accept you, and that you accept them. Things work better that way.
Today, our tribes are enormous and unwieldy. There’s the city. The state. The nation. The globe. Twitter. Our social media feeds. We can’t know everyone in our city, state, or Twitter feed, yet we get feedback from them. We see the best parts of their lives—what they show to the world—and compare them to the lowest parts of ours—what we hide from world but cannot escape internally. And then ironically, many of us feel estranged from or ignore the people who could actually comprise our true tribes—family, friends, loved ones, neighbors—even when they’re in the same room in favor of the larger, faker tribe. Yet the desire for social acceptance from this sprawling “tribe” persists. And it’s impossible to achieve for most people. Letting your tribe down hurts. We have tribes. They’re just not real or realistic.
The roles of religion and other binding schools of philosophy and morality in society are waning. Most people can’t lean on the church or patriotism to find meaning or direction anymore. They must create their own, or discover it. That isn’t easy. It’s far simpler to ignore the void within, flip through your Netflix feed, and obsess about the latest superhero movie than it is to find your purpose.
Having a sense of life meaning is inversely associated with depression.
Most people (most reading this, anyway) aren’t walking three miles each way just for moderately fresh water that they still have to dose with iodine tabs or risk parasitic infection, slaving away their entire lives just to produce enough calories for their feudal lord and family, building their own homes out whatever they can manage and fixing whatever breaks (or not). They just turn the tap, order food from Thrive Market, call the plumber.
Rather than manipulate material objects in the world, we’re manipulating data, filling spreadsheets, fiddling with abstract numbers. Information work is no less real, but it doesn’t feel like that to our psyches.
There are fewer “classic tragedies.” Fewer people lose loved ones to warfare, babies to disease. While we still have plenty of wars going on, they aren’t logging death counts like the World Wars or Genghis Khan’s conquests. Major civilian centers aren’t being leveled regularly by bombing raids. This is a positive development, but there’s a catch: Research shows that real life disasters strengthen bonds between friends, the neighbors, and the community. If we aren’t facing difficulties, we may not be living to our fullest potential.
You can follow Maasai herders on Twitter. You can engage in live video chat with anyone in the world. No need to visit Grandma in Del Boca Vista; you can Facetime her!
Most people get enough to eat, can get from here to there, can access the Internet, and get medical care if required. You have to try really hard in a modern Western society to die in the street. Even worldwide, poverty is falling. In 1981, nearly half the world’s population was “extremely poor.” As of 2016, it was under 10%. All that’s left are psychological problems.
Why am I here?
What’s the purpose of life?
Why should I continue working this job I don’t really like just to support the same boring routine?
This kind of rumination is a major factor in depression.
In Tribe, Sebastian Junger shows how veterans returning from war—on paper, a hellish experience no one would ever miss—feel suddenly lonely, lost, and often depressed back home. War compresses human experience and intensifies human bonding like nothing else. When these men and women leave war, they’re leaving the strongest, most cohesive tribe they’ve ever known. They’re leaving people who’d die for them and for whom they’d die. What, are they supposed to stand in line at Starbucks, staring at their phones like everyone else and think everything is just fine?
Why are potential root societal causes ignored?
For one, they’re huge problems. A pill is way easier than restructuring the fabric of modern society. If you did that, you’d have to get it right the first time. You can’t exactly run an RCT on social upheaval.
Two, we assume a shared environment. Most of the people you see walking around eat the same basic diet, do the same basic exercises (or don’t), and deal with the same societal pressures and conditions. If you look at things wrong, it seems immutable and unavoidable. Even if they’re aware on some level that modern living is involved in the etiology of depression, most clinicians are assuming, based on prior experience with patients and their own misconceptions about what’s possible and what’s not, that we just have to accept it and apply the best band-aids we have. But if you’ve approached diet and exercise from an evolutionary angle and had incredible results where nothing else had ever worked—you know that common is not normal. You know that the environmental inputs shared by so many in the industrialized world might be persistent and tempting and hard to avoid, but they are avoidable. You can change your surroundings, your inputs, even your mindset.
Three, it isn’t clear what the solutions even are. The world is better today in many ways. Just because many veterans find their tribe in war and suffer upon returning, it doesn’t follow that we should go to war more often for our mental health.
We can’t rely on technocratic overlords to engineer the perfect utopia. Those always end in dystopias—more Brave New World than 1984. No, any change has to start within each individual, at dinner tables, in friend circles, in one person—you—deciding to do things differently.
I won’t get much into diet or exercise or sunlight or sleep today. Those are major parts of the equation, but I prefer to focus on how the structure of our society impacts depression and how we can transcend it.
These are some ideas. They’re not perfect. They’re not the whole story. And they’re not meant to replace medication or therapy or anything like that. But they won’t hurt….
Listen to the “first voice.” Every time you get that little voice saying “I should finally pick up that book” or “I should walk the dog” or “I wonder what my friends are up to,” DO IT. Don’t let the other voice override you and say “Nah, let’s just stay inside today.” That second voice is destroying you. Do everything you can to ignore it.
In low moments, rather than try to cheer yourself up, be of service to someone. A concerted effort to cheer oneself up often produces the opposite effect. We’re not great at doing it for ourselves, perhaps because at some level we sense it’s all a sham, a ploy to shift around neurotransmitters. But when you help someone else, you’re truly helping them. They feel good, you feel good, and everyone wins.
Chase meaning, not happiness. “Being happy” is hard work. You can’t get there by trying. Figure out what you care about at the deepest level of your being. What stirs you. What, most importantly, you can actually affect with your skillset. If you can manage to imbue every fiber of your being with that purpose, you’ll get going after it. You’ll have something to do, and maybe you’ll have less time for rumination and other things that make your depression worse.
Easier said than done, you might say. Definitely. I haven’t been there myself, but I’ve helped people close to me who have. Clinical depression isn’t just sadness. It’s profoundly demotivating, where taking even the smallest act like getting dressed can be a struggle. Dopamine, the neurotransmitter involved in movement and achievement and motivation, tends to plummet in major depression.
Still, what else is there? You are an individual, not an atom. An atom is separate but unconscious. It has no agency. It simply is. An individual is separate from other individuals but conscious. It has agency. It can form communities, strong bonds. Revel in your personal sovereignty but don’t forget that you’re a social animal who will probably be much happier with a few good friends (who aren’t all wielding smartphones 24-7).
There are other specific things to try. Trawl the scientific literature and you’ll find hundreds of studies showing efficacy for any number of medication-free depression therapies and interventions. None of them are the final answer, though, as much as they can help. Ballroom dancing isn’t going to fix things. Gardening isn’t enough. Heavy squats won’t do it. Plunging into cold water isn’t everything.
It has to be a comprehensive shift.
The common theme running through most of these “alternative” interventions is that it places you square in the midst of cold hard reality. You’re on your knees, handling soil and planting vegetables. You’re dancing, immersed in the music and managing the dynamic interplay between you and your partner. You’re lifting something very heavy. You’re completely submerged in freezing water. These are real. They cannot be escaped or negotiated with. They aren’t running on perpetual loops inside your head. They’re actually happening.
Get as much of that in your life.
In the future, I’ll discuss this topic further. I’ll talk about dietary, exercise, lifestyle, supplement, and psychological modifications we can make.
For now, I’d love to hear from you. Those who’ve dealt with or who currently deal with depression, what’s helped? What hasn’t? What’s your take on the list of social factors that may explain the rise in depression—or the severity of symptoms as you experience them? What do you think we can do—as individuals and as a society—to make things better?
Thanks for reading. Take care.