Is there a Silver Lining in the Abyss? An Examination of Depressive Realism

​Depressive realism, the concept that depressed people are more accurate in their judgments, is provocative.  Many historians advocate that great political and social leaders became great not instead of their depression but because of it and that happiness is an intentional state of self-delusion.  This week's column investigates the possible presence of a positive aspect in the dark abscess of the world's most miserable human affliction.

Depression is the World's Most Miserable of Ailments

Depression, otherwise known as major depressive disorder or clinical depression, is a severe mood disorder.  Depressives experience persistent feelings of sadness, hopelessness, and lose interest in activities they once enjoyed. In addition, depressed people exhibit irritability, brooding, obsessive rumination, anxiety, phobias, excessive worry over health, and chronic pain.
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Major depression is a complex disorder that does not result from either genetic or environmental influences alone but rather from a combination of both.  Genetic studies and evaluation of resultant treatments are in their infancy, but there is strong evidence of genetic predisposition to depression. In addition, research confirms a strong relationship between childhood maltreatment and depression.

Relapses and recurrences following major depressive incidents are common.  Results indicate that after discontinuation of acute-phase treatment, about 29% of people relapse within one year and about 54% within two years.  These facts suggest that depression may often be a chronic condition requiring ongoing management.

Depressive realism hypothesizes that depressed individuals tend to be more accurate or realistic than non-depressed persons in their judgments.  An ​optimism bias is a mistaken belief that one's chances of experiencing adverse events are lower and one's chances of experiencing positive events are higher than those of one's peers.   Research suggests that non-depressed people are vulnerable to cognitive illusions, including unrealistic optimism, overestimating themselves, and an exaggerated sense of their capacity to control events.

Robust scientific evidence about depressive realism is sparse.  Studies are small in sample size and often poorly conceived.  The largest this investigation uncovered was a 2012 meta-analytic review that included 75 relevant studies representing 7,305 participants from across the United States and Canada and England, Spain, and Israel.  Results indicated a small overall depressive realism effect.  Cherry-picking from the group of small studies, one can find results to support a variety of conclusions.
 
One of the other problems with studies of depressive realism is that they rely on elementary models, such as predicting when a green light will come on when the subject pushes a button.  Human interactions are often complex, and so these models are unlikely to translate into accuracy in those endeavors.  Imagining a research protocol to measure such seems well impossible.

Depressive realism presents a challenge to cognitive theories of depression.  The cognitive-behavioral approach advocates that depressed people think differently than non-depressed people.  It is this difference in thinking that causes them to become depressed. According to cognitive-behavioral theories, depressed individuals assess themselves negatively and develop unrealistic, extreme, and unsound self-narratives.  Following the cognitive credo, these mistaken beliefs then lead to depression.  The way out, according to those same people, is a new, more positive narrative.
 
Another exciting concept, at least for depressives, is that depression can lead to creativity, and it is hard to argue that many creatives are not also depressives. Unfortunately, although the belief that invention is related to psychopathology is prevalent, studies are difficult to come by.  There is good empirical evidence that cognitive therapy works to alleviate depression, but it may work by training patients to construct optimistic misconceptions about themselves rather than by coaching them to think more credibly.

Regardless of the murky evidence of the hypothesis of depressive realism, chronic depressives have played an outsized role in history, literature, and art. Thus, it seems possible the 'illness' may not be an illness at all, but properly managed can contribute to extraordinary lives and accomplishments.

Abraham Lincoln in 1864

​A 2005 work, Lincoln's Melancholy: How Depression Challenged a President and Fueled His Greatness, made an argument that depression fueled Abraham Lincoln's performance as President.  Lincoln, perhaps the most consequential President in the United States history, was also a chronic depressive.  Lincoln had two known depressive breakdowns at age 26 and 31, which included suicidal statements that frightened friends enough to form a suicide watch.  The book describes Lincoln's history of depression in detail and discusses two other depressives, Ulysses S. Grant, and William Tecumseh Sherman.  

General William Tecumseh Sherman, the Father of Modern War

​Sherman invented modern warfare with his March to the Sea through Georgia in 1864.  In this campaign, Sherman unleashed his own self-loathing on the Confederate armies and civilian populations, gutting the Southern part of the Confederacy and its capacity to supply its war effort.  Retrospective diagnosis of mental illness is problematic, but Sherman was a depressive and likely also had manic phases.  

General Ulysses S. Grant

​Grant, a chronic depressive who medicated his issues with alcohol, was a Union general known for leading the knockout blow in Northern Virginia in 1864 and 1865 to force the Confederate surrender.  In 1854, Grant had to resign from the Army in California because of excessive drinking.  The Union Army reabsorbed Grant into its ranks in 1861 as it was desperate for experienced soldiers.  Sherman’s quote about Grant – ‘Grant stood by me when I was crazy, and I stood by him when he was drunk, and now we stand by each other’ – wraps the conditions of both into a neat package.  After a failed Presidency and financial ruin, Grant died of throat and tongue cancer, likely attributable to his drinking.

Winston Churchill

Consequential figures known to be depressives include:

• Winston Churchill referred to depression as the ‘black dog’ and medicated it with alcohol.
• The famous artist Georgia O’Keeffe suffered significant periods of depression.
• Sigmund Freud suffered from periodic depression, neuroses, and anxiety attacks.
• The famous author William Styron said about his depression  ‘Of the many dreadful manifestations of the disease, both physical and psychological, a sense of self-hatred—or, put less categorically, a failure of self-esteem—is one of the most universally experienced symptoms, and I had suffered more and more from a general feeling of worthlessness as the malady had progressed.’
• Ernest Hemingway was a chronic depressive, sometimes to the point of delusion, who medicated his depression with alcohol and ultimately killed himself with a shotgun.

​Facts to substantiate the idea that depression is associated with particularly sharp insights or creative abilities are hard to come by.  Research would be exciting, but as results would be difficult to monetize, it appears such efforts will continue to be small and somewhat prone to self-reporting by subjects, thereby altering the outcomes and making conclusions specious.