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Sep 30 2013

“What do you have to be depressed about?”

If you have experienced depression while living what appears to be a fairly nice life, you’ve probably had someone ask you, “What do you have to be depressed about?”

Sometimes people who ask this question are genuinely curious because they think that depression is necessarily “about” something and they just don’t understand what, in your case, it could be “about.” Sometimes, though, people who perceive your life to be better than theirs feel resentful and jealous and, upon hearing that you are suffering from depression, demand to know what could possibly be wrong with your life that could cause a mental illness.

The origins of depression are complicated and still not very well-understood. One model that’s gained ground lately is called the diathesis-stress model. The term “diathesis” refers to a vulnerability, which could be genetic, biological, environmental, or psychological. “Stress” refers to a catalyzing event, a life stressor that can increase one’s chances of developing a disorder (the diathesis-stress model has been used to describe more than just depression).

One specific type of diathesis that has been researched concerns a specific gene, known as the serotonin transporter gene or 5-HTTLPR. Some studies suggest that people with a particular variant of the gene are more likely to develop depression, but only if they have a significant life stressor. If not, then there’s no difference between people with the different variations of the gene.

The results are mixed so far, but this is just one example of a way in which having “something to be depressed about” can indeed provoke depression. But it’s not the whole story. People without significant life stressors can still get depression, and people who do have life stressors are still much more likely to get depression if they have that genetic predisposition–the diathesis.

Diathesis can come in all sorts of forms. Having learned poor cognitive coping skills as a child could be a diathesis. Having abnormalities in the brain’s neurochemistry could also be a diathesis, although the “chemical imbalance” theory of depression as we’re used to seeing it is more or less bullshit.

Some types of diathesis might be considered to count as “something to be depressed about,” such as living in poverty, having a chronic health condition, or having an unstable or abusive family life. Others, such as having genetic predispositions or brain abnormalities, would not count as such for most people. Asking someone what they have to be depressed about is therefore not very useful.

But moving away from the science of depression’s origins, I’ll state the obvious: no matter how well you know someone, you never know everything that’s going on in their life. Not even if it’s your kid. The person may have a significant life stressor that’s triggering their depression that they just haven’t told you about, and they probably won’t if you sarcastically ask them what they have to be depressed about. If you’re genuinely curious, a better way to phrase that question is, “I’m sorry to hear you have depression. Is there anything that’s triggering it for you?”

The important thing with that is to never ask questions like you already know the answers. The question, “What do you have to be depressed about?” comes along with the implied answer, “Nothing.” Even if you don’t think it does. That’s how many people are going to hear it. So don’t get too caught up on the literal meaning of the words you are saying, and think about how they’re going to be interpreted.

The hypocrisy of the “What do you have to be depressed about?” question becomes blatant when you consider our typical response to those who do, by all accounts, have something to be depressed “about.” What tends to happen is that when we feel that depression is to be expected in a given situation, we also frame it as “okay.” Normal. Natural. It’ll pass on its own and we shouldn’t interfere.

This might explain the controversy over the decision to remove the bereavement exception from the newest edition of the DSM. Previously, people who were grieving had a two-month “window” during which they could not be diagnosed with depression, which often looks very similar to bereavement. With the publication of the DSM-5, this exception was removed. Lots of people were Very Concerned that this means that we’re “medicalizing” a “normal” process such as grieving.

I know I probably over-rely on comparisons to physical health, but that’s because they can be very illuminating. If you’re subjected to a some loud noise and you get a headache, or you work out strenuously and get extremely sore muscles, few people would suggest that you shouldn’t take medication to ease those pains just because they happened “naturally” (whatever that means). Being extremely sad, even “depressed,” as a response to a loved one dying is definitely “natural,” but that doesn’t mean it can’t interfere with your functioning as a person, and that you don’t deserve help dealing with it.

I’m not necessarily saying that high levels of grief should be diagnosed as depression, though. I’m just pointing out the hypocrisy of expecting people to produce compelling “reasons” for being depressed, but then refusing to consider people who do have compelling reasons to be depressed, even if they show all the symptoms.

My final gripe with the “What do you have to be depressed about?” question is that it’s often a way of trying to rank human suffering. What do you have to be depressed about? Some people are abused by their parents. What do you have to be depressed about? Some people are starving. What do you have to be depressed about? Some people have cancer.

Well, if you, personally, were abused by your parents, are starving, or have cancer, I wouldn’t fault you for feeling that the concerns of people with depression aren’t as serious as yours. That’s your right. But there are no measurements with which we can assess how bad someone has it. There is no Standard Life-Shittiness Unit. We need to stop looking for one, and treat every individual’s pain as legitimate.

20 comments

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  1. 1
    Greta Christina

    Yup. Asking “What do you have to be depressed about?” is a little like asking, “What do you have to be diabetic about?”, or, “What do you have to have lupus about?”

    Mixed feelings about the grief/ bereavement thing. My big question is whether the treatments for depression not caused by bereavement would have the same effectiveness for depression caused by bereavement. And in my experience, grief and depression, while they can overlap, are not the same. But yeah, if the same treatments are effective, then I’m not sure what benefit would be gained by not treating. (Might be interesting to run this question by the folks at Grief Beyond Belief…)

  2. 2
    Jenna Stewart

    I always hated the question, especially when it was asked of me. I never feel like I actually -have- anything to be depressed about (even with the whole gender dysphoria thing and the social-shit-induced stress of being a teenager), so it just makes me feel like an idiot for being depressed, then I feel worse about it, rinse and repeat ad nauseam.

    …so yeah, it’s not only a stupid question to ask, it’s sometimes a hurtful one.

  3. 3
    smrnda

    I suspect that the question is part of the mentality that believes that a *positive attitude* can fix everything, which is totally obnoxious since if people are depressed, it’s probably over something going on in their life, either stress, some event, or physical/biological causes.

    Perhaps there is some way to politely ask if there is anything negative or stressful going on, making sure that it’s *okay* if the depression doesn’t have a clear trigger. Any advice? I’ve been depressed but most of the feedback I got was just a ‘are you taking your meds’ to which I’d always respond yes (and I have also had hallucination and delusions while on meds, so they make things better but don’t fix everything.) People seemed puzzled, but they at least didn’t try to tell me to *be positive.*

  4. 4
    simon

    So… i’ve actually used this on myself rather distressingly often. Especially the comparative “Life-Shittiness Unit” application… mostly to engage in emotional self-flagellation for having the unmitigated gall to even feel depressed when other people are in such worse living conditions than i am. Then again, i’ve always had a particular talent for kicking my own ass.

  5. 5
    Jadehawk

    although the “chemical imbalance” theory of depression as we’re used to seeing it is more or less bullshit.

    I’m always so ridiculously happy when I see people (esp. people with even remotely the right educational background for this) say this. When I used to go to campus counselor/campus clinic, having tho sit through the “chemical imbalance” spiel always gave me cognitive dissonance: on the one hand, I felt pretty certain that was BS; on the other, I was pretty certain naive anti-vaxxers also are pretty certain about their “knowledge” of medicine.

    And aside from that: It doesn’t inspire confidence in my healthcare providers to be told incorrect things. I really wish they’d stop telling the “chemical imbalance” story…

    1. 5.1
      Miri, Professional Fun-Ruiner

      Yeah, I think the issue there is twofold: researchers aren’t always the best at promoting their research, especially when it’s “whoops we were wrong” rather than “LOOK AT THIS COOL NEW SHIT,” and practitioners aren’t always the best at proactively seeking out research. Besides, if you have no reason to suspect that a favored hypothesis has been disproven, why would you seek out more research about it? (Well, you SHOULD, but you probably wouldn’t.)

      Add to that the fact that antidepressant advertisements still use that myth, and it gets even worse.

      1. 5.1.1
        Hunt

        My theory about the origin of the “chemical imbalance” thing is that antidepressants work in pretty much a shotgun approach, despite the “selective” in SSRI, so it was convenient to think of what they were addressing was a global, well, chemical imbalance in the brain. Hence the trend gained favor and continued, and while it is true that the shotgun approach does work to alleviate depression and anxiety, it does so by strong arming all the levels of serotonin, etc. up or down. It’s still a dumb way to address the issue, since the brain is not a vat of chemicals. Great post, btw.

  6. 6
    lpetrich

    I’ve seen some speculation that depression had evolved as a sort of unlearning response. That could explain bereavement and painful breakups and the like, but it’s normally short-term, because that’s all it has to be.

    Long-term depression would thus be a case of this mechanism getting stuck. Depression with nothing to be depressed about would thus be this mechanism getting activated by something other than a need to unlearn something.

    I’m sorry if this speculation seems insulting or whatever :(, but it seems like something that can explain why we experience depression-like responses to certain events.

  7. 7
    Dirty Nerdy

    “Having abnormalities in the brain’s neurochemistry could also be a diathesis, although the “chemical imbalance” theory of depression as we’re used to seeing it is more or less bullshit.”

    I still sometimes use the “chemical imbalance” as shorthand when explaining my depression with somebody, especially if I don’t have the energy to get too technical at the moment. Maybe I’m contributing to confusion on the subject, but sometimes people just don’t get it until I use that.

    1. 7.1
      Nicole Introvert

      @Dirty Nerdy – I agree that it’s very helpful shorthand to explain to people you come out to. Or I say something like, “My brain just doesn’t respond to every day situations the same way as others.” (Being that I have more anxiety than depression.) It may be technically inaccurate but I don’t have the time/energy give a science lesson to my co-workers. Especially when I’m being open about something making me completely vulnerable.

  8. 8
    Alethea Kuiper-Belt

    I found grieving and depression to be totally different experiences, myself.

    The title question, though, is so rude and uncompassionate it makes me spit. And makes no sense to me – personally, when I *do* have something “to be depressed about” I’m much less likely to be depressed than when I don’t. I don’t really understand this, but it’s as if my jerkbrain goes “OK, you’re suffering enough, job done” and lets up on the vicious self-criticism.

  9. 9
    Giliell, professional cynic -Ilk-

    Being extremely sad, even “depressed,” as a response to a loved one dying is definitely “natural,” but that doesn’t mean it can’t interfere with your functioning as a person, and that you don’t deserve help dealing with it.

    Not all grieving is depression or leads to it, many people do experience those two things very differently, grieving is a natural process yadda, yadda, but that as sure as hell doesn’t mean that in some cases grieving can’t actually trigger depression. It doesn’t makes sense that we ban those for whom that is true from treatment and help for two months.
    Not every cold you catch leads to pneumonia, but it also doesn’t make sense to deny somebody medical care for pneumonia for two weeks because most colds are over by that time.
    And the question? It is this confusion of “depressed” with “sad”. Just because there is nothing but first world problems to be sad about it doesn’t mean there is no depression.

  10. 10
    CaitieCat, in no way a robot nosireebot

    Well-said, Miri. There’s also the converse of this question, which is “well, if we just make sure you’re not financially stressed, you’ll be fine again!”. Unfortunately, just taking away the stressor doesn’t make things better necessarily. If I’ve had a large rock fall on me, and break a leg, removing the rock will help some, but the leg is still broken, and will take its own treatment to deal with.

  11. 11
    fmcp

    Miri, I really like the way you rephrased the question as “is there anything that’s triggering it for you?”. When I get depressed, the stressors in my life may or may not be the immediate cause, but if someone wants to offer a hand in dealing with them (or just a broad shoulder to cry on) then they’re giving the help they can give – my various medical folk can handle the rest.

    As for grief and depression, I had a really clean experience of the difference several years ago. I went though an enormous and unexpected loss at a time when I was already vulnerable, and plunged immediately into a paralyzing depression. About three months later, my mood normalized enough for me to actually process the event, which was when I actually grieved in a productive way. I remember a friend asking me how I was doing at the time, and my response was, “I’m not depressed anymore, so now I get to be really, really sad.”

  12. 12
    MaryL

    I’ve had a few bouts of depression and still bristle over this question. I wanted to hurt anyone who asked this but was too civilized and exhausted to do so. So, I put them on my mental list of people to be wary of. Why should I give that person more chances to undermine me? Or to add more pressure? I was already under pressure trying to accomplish normal, everyday activities (work, write checks, wash clothes, etc.) while I dealt with something that wasn’t understood and there was very little help for. It was as if the hell I was living in wasn’t hot enough and others, with no justification, had to increase the heat. Or, so help me, they sniped at me with, “You just want attention.” I’ve always withdrawn during depressive episodes. I can’t handle too much “attention” at those times.

  13. 13
    Caru

    Can you please explain how the “chemical imbalance” theory is bullshit? I thought depression was largely caused by the brain not producing enough of the happy chemicals like serotonin – but that this could be caused by worry and then lead to lack of sleep which causes more worry and it’s just a vicious cycle. This is my first time hearing otherwise.

    1. 13.1
      keri

      Yes, I’m also curious! I’ve never heard otherwise, but would love to learn more. All I’ve heard is from people with an agenda, talking about how we’re shills for the pharmaceutical industry because we rely on medication, or that if we just do deep breathing and exercise and whatever we’ll be fine (though several experiments with otherwise successful therapy has shown that i do require some sort of medical intervention to keep depression at bay, except I think it’s more complex than just depression in my case, and the pills may be suppressing other things that result in depression, not the depression itself).

  14. 14
    daedalus2u

    Depression is a complex mental state. Like all complex mental states it requires the concerted action of billions of brain cells working together “in sync” to instantiate that mental state.

    The “chemical imbalance” hypothesis is naive, simplistic and wrong (like all models are wrong) but it is useful.

    Fluctuations in mood are useful to an organism because they can be used to differentially regulate what actions that organism does. If you don’t have the resources to do something, it is better to not start it.

    “Sickness behaviors” (behaviors invoked by feeling sick) are useful because they conserve resources (mostly ATP) for the immune system to use to fight what ever “sickness” has invoked those sickness behaviors. When you are sick and feel like lying in bed all day, what is your body doing? It is fighting what ever sickness is making you feel sick. What if instead of lying in bed you were running a marathon? Your body would “let you” run a marathon, but that would divert resources away from dealing with the sickness and you would not get well, it might even kill you.

    I see depression as the necessary aversive step between the normal “at rest” state, and the euphoric near death state that physiology invokes when you are running from a bear (where to be caught is certain death). Organisms can run themselves to death trying to escape from a predator. This is a “feature”. The “feature” is not dying while running from a bear, the “feature” is having all resources available to do so, even the resources that are keeping you alive. Running yourself to death while escaping from a bear and being caught by the bear are “the same”, an evolution fail. Physiology invokes feelings of euphoria during existential threats so that organisms can run themselves to death. That euphoria is the Euphoria of Near Death State, ENDS. I think this is the same as the euphoria reported in near death experiences, the euphoria of autoerotic asphyxiation, the euphoria of solvent huffing, the euphoria of the stimulant drugs of abuse. I think they are all “the same”, euphoria brought on by near death metabolic stress.

    In order to compel organisms to run themselves to death, the euphoria has to be pretty severe, severe enough that a few more steps are worth as much as the rest of your life.

    Evolution has minimized the sum of deaths from being caught by the bear and from running yourself to death uselessly. To prevent uselessly entering that euphoric state, there has to be an aversive state between the normal “at rest” state and the euphoric near death state. I am pretty sure that aversive state is depression. Depression has to be so aversive that people kill themselves from it because it is “protecting” them from entering a state where you must be willing to gladly run yourself to death to try and escape from a bear.

    Evolution has minimized the sum of deaths from being caught by the bear, from running yourself to death uselessly and from suicide. To minimize the sum, there have to be deaths in all categories. That is what I see depression as, an aversive state where you have to be willing to kill yourself because it is protecting you from a state where you have to want to run until you have escaped even if it does kill you.

  15. 15
    afred

    Thank you for this blog. Thank you so much.

  16. 16
    Redpeachmoon

    Love your site. Thanks for sharing.

  1. 17
    'Duck Dynasty': Miss Kay says, 'Ask me anything' | Overcome Depression

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