The 'Sunny Side' of Depression: How Depression May Benefit Society

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"Why is it that all men who are outstanding in philosophy, poetry or the arts are melancholic...?" -- Aristotle

Depressed? You have company. Nervous? More company. In a large national study of adults, the lifetime prevalence of mood disorders (e.g., depression) was 21 percent and of anxiety disorders, 29 percent. Anxiety and depression are close cousins, as both can respond to the same medications. Some will never receive a medical diagnosis and go uncounted in statistics.

According to Abraham Lincoln: "God must love the common man; He made so many of them." By the same reasoning, God must also love the anxious and depressed, as our society is replete with them. My interest is why? Does the misery of depression benefit the sufferer in any way? Or does this sizeable bloc of disaffecteds serve any purpose in society?

Ask Confucius, who said: "The cautious seldom err." Not all of the cautious are depressed, but pretty much all of the depressed and anxious are cautious. Throwing caution to the wind may have its delights, but looking prior to leaping confers a survival benefit, evolutionarily speaking.

And society? Remember Alan Greenspan's comment that "irrational exuberance" might be driving up asset values? The December, 1996 remark foretold the lead up to the 2000 dot-com crash. But it has universal applicability: Most market crashes are preceded by manias culminating in panics. Perhaps the depressed, who could be said to have irrational non-exuberance, provide a certain equipoise.

Or war. Perhaps cockeyed optimism that leads a country to war, when war isn't absolutely necessary, can be tempered by a sizeable proportion of the populace that is willing to wonder: "Did you think this through?" What if all the lemmings didn't jump off the cliff?

Many great minds suffered from great depression. Isaac Newton, Winston Churchill, Ralph Waldo Emerson, Edgar Allen Poe, Martin Luther -- to cite a few. Aristotle made the connection: Mood disorders and creativity seem to be traveling companions. Societies need creative and innovative thinkers, even though they suffer for their gifts. This was true in Aristotle's era, and in ours.

So who, in modern times, is depressed -- officially? Surprisingly, this is not an easy question for psychiatrists to answer. Psychiatric diagnosis is subjective, in that it is based on symptoms rather than lab or imaging results. I remember a patient, decades ago, who had been hospitalized four times in psychiatric hospitals in the area over a 10-year period. I obtained the discharge summaries. There were four different final diagnoses (major depression, manic depressive psychosis, personality disorder, schizophrenia). She had been my patient all during this time, and I can tell you she was the same person every time I saw her. This type of arbitrary diagnosis was addressed by the creation of a Diagnostic and Statistical Manual of mental disorders, the DSM. It was noted by the editors of the DSM-III, published in 1980, that two psychiatrists evaluating the same patient generally did not agree on a diagnosis. The DSM contains symptom lists and criteria, in the hope of creating some standardization.

In its most recent incarnation, the DSM-5 uses clinician evaluation supplemented by scores on a questionnaire known as the PHQ-9. This is a crude tool which measures your desire to get under the covers and stay there, evidenced by answers to nine questions. You have to have felt this way for at least two weeks; a few bad days doesn't qualify. People with a good reason to be depressed, such as a recent death in the family, or big-time money problems, are excluded. The PHQ-9 is a convenient office tool, but is no substitute for a person-to-person evaluation. A related tool is the GAD-7, which gauges your anxiety. People with debilitating anxiety may not score as "major depressive disorder," but often respond beautifully to anti-depressant medications.

Complicating things further is bipolar disorder, formerly manic-depressive disorder. Identical depressive symptoms occur, but occasional episodes of hyperactivity -- mania in its full-blown expression -- re-define the depression as bipolar depression. Medications are somewhat different, particularly when mania is involved. Bipolar sufferers can spend over 90 percent of their time depressed, so it may not be obvious when depression is part of a bipolar spectrum or "unipolar." Some depressed people have a first manic episode in their 60s and a lifelong "major depressive disorder" suddenly becomes, in retrospect, bipolar depression. Some psychiatrists don't believe there's a difference. The smattering of manic episodes in many depressive-types often exists as hypo-mania, which falls short of the psychotic, reality-disconnected true mania. In fact true mania defines Bipolar I disorder, while hypo-mania renders it bipolar II.

Hypomanic bursts of energy, often euphoric, productive or creative, may engender art or literature. Think Van Gogh or Virginia Woolf. It's a long list of creative thinkers who suffered from what is now called bipolar disorder. While many who impacted society were not also mentally ill, and most of the mentally ill do not produce art, literature or theories of gravity, one cannot ignore the vast contributions to society made by those who would nowadays be classifiable within the reaches of the DSM-5. The misery of individuals may at times benefit them, and confers an aggregate benefit to society. So relish your own unhappiness, as well as that of others. It may serve a purpose.