7 dimensions of depression, explained | Daniel Goleman, Pete Holmes & more | Big Think
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7 dimensions of depression, explained Watch the newest video from Big Think: https://bigth.ink/NewVideo Learn skills from the world's top minds at Big Think+: https://bigthink.com/plus/ ---------------------------------------------------------------------------------- According to the World Health Organization, more than 264 million people suffer from depression. It is the leading cause of disability and, at its worst, can lead to suicide. Unfortunately, depression is often misunderstood or ignored until it is too late.
Psychologist Daniel Goleman, comedian Pete Holmes, neuroscientist Emeran Mayer, psychiatrist Drew Ramsey, and more outline several of the social, chemical, and neurological factors that may contribute to the complex disorder and explain why there is not a singular solution or universal "cure" that can alleviate the symptoms.
From gaining insight into how the brain-gut connection works and adopting a more Mediterranean diet, to seeking help from medical or spiritual practitioners, depression is a personal battle that requires a personalized strategy to keep it at bay, as well as more research and understanding.
Check Drew Ramsey's book "Eat to Beat Depression and Anxiety: Nourish Your Way to Better Mental Health in Six Weeks" at https://amzn.to/3b1jtuU ---------------------------------------------------------------------------------- TRANSCRIPT:
JOHANN HARI: When I feel depressed, like loads of people, I say I feel down, right? And as I was learning about the causes of depression and anxiety for my book, "Lost Connections," I started to realize, I don't think that's a metaphor. There is this amazing Professor at Stanford called Robert Sapolsky who in his early '20s went to live with a troop baboons in Kenya. And it was his job to figure out when are baboons most stressed out. So his job was to hit them with little tranquilizer darts and then take a blood test and measure something called cortisol, which is a hormone that baboons and us release when we're stressed. And baboons live in this hierarchy, so the females don't interestingly but the men live in a very strict hierarchy. So if there's 30 men, number one knows he's above number two, number two knows he's above number three, number 12 knows he's above number 13. And that really determines a lot. It determines who you get to have sex with, it determines what you get to eat, it determines whether you get to sit in the shade or you're pushed out into the heat. Yeah, it's a really, really significant where you are in the hierarchy.
And what Professor Sapolsky found is baboons are most stressed in two situations. One is when their status is insecure. So if you're the top guy and someone's circling which comes for you, you will be massively stressed. And the other situation is when you feel you're at the bottom of a hierarchy, you've been kind of humiliated. And what Professor Sapolsky found is when you feel you've been pushed to the bottom, what you do is you show something called submission gesture. Baboon will put its body down physically or put its head down, it will put its bottom in the air and it will cover its head. So it clearly seems to be communicating, "Just leave me alone, you've beaten me. Okay, you've beaten me." And what lots of scientists, people like Professor Paul Gilbert in Britain and Professor Kate Pickett and Professor Richard Wilkinson also in Britain have really developed is this idea that actually what human depression is in part, not entirely, but in part, is a form of a submission gesture. It's a way of saying, I can't cope with this anymore, right? Particularly people who feel they've been pushed to the bottom of hierarchies or who feel remember the other stressful situations when you feel your status is insecure it's a way of just going, "Okay, can I retreat?" "I don't want this fight anymore." "You've beaten me." It's a kind of very strong evolutionary impulse where you feel you're under attack to just submit in the hope that the stress and anxiety will then go away. The sources of the stress and anxiety will then go away.
And one thing that is so important, Kate Pickett and Richard Wilkinson really developed this, is they've shown so as inequality grows, depression and anxiety grow. They've shown, this is very robust effect, right? This helps us to explain it. One in five Americans will take a psychiatric drug, one in four middle-aged women in the United States is taking a chemical antidepressant in any given year. And I began to think, could it really be that just so many people are just mysteriously lacking a specific chemical in their brain? Why does it seem to be rising so much if that's the cause? If you live in Norway, your status is relatively secure, right? No one's that high, no one's that low, movement between where you are is not so extreme. If you live in the United States, especially today which is...
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Depression and anxiety are not primarily caused by chemical imbalances but are adaptive responses to social hierarchy, inequality, and environmental stress; effective treatment requires addressing social conditions alongside lifestyle and psychological interventions.
- Depression functions as a submission gesture evolved from primate hierarchy stress, exacerbated by inequality rather than individual neurochemistry
- Lifestyle factors (diet, sleep, exercise, social connection) and psychological practices (mindfulness, cognitive reframing, neuroplasticity) are as effective as medication for depression
- Mental health is produced socially and requires social solutions, not just individual pharmaceutical intervention
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Food should be part of the conversation when it comes to mental health because we have more science showing that nutrients have very clear data that can help in prevention and treatment of illnesses like depression and dementia.
“it's a time when we have more science that tells us food should really be part of the conversation when it comes to our mental health... the amount of science showing a course that our nutrients actually have very clear data that can help in the prevention and the treatment of illnesses, again, like depression and dementia”
Spiritual mystics across traditions (St. Francis, etc.) practice non-identification with the body and ego; they separate the observing self from the experiencing self to reduce identification with suffering.
“And this is every great spiritual mystic through all time, they've all been doing this. St. Francis called his body his corpse. He was like, 'I drag my corpse around.'”
If we talk less about chemical imbalances and more about power imbalances, we will get more at the heart of depression and anxiety and find better solutions.
“if we talk less about chemical imbalances and more about power imbalances we will get more at the heart of depression and anxiety and we'll find better solutions”
More than 95% of all serotonin in the human organism is produced and stored in the gut in specialized cells called Enterochromaffin cells, making the gut the largest store of this mood-modulating molecule.
“more than 95% of all our serotonin we have in our organism is really produced and stored in the gut in specialized cells, so-called Enterochromaffin cells. So our major by far the largest store of that molecule that plays such a big role in modulating our mood and our wellbeing—also appetite, pain sensitivity—is stored in the gut.”
Serotonin is synthesized in the gut from precursors that come from ingested food, and microbes in the gut can produce chemicals that stimulate serotonin production.
“this serotonin is synthesized in the gut from precursors that come from our food that we ingest and the microbes that live in the gut are actually able through chemicals that they produce to stimulate the production of serotonin”
When you name a feeling ('I'm depressed again'), neurological activity shifts from the limbic system (where depression occurs) to the prefrontal cortex (the aware, noticing part), which diminishes depression and enhances your ability to understand it.
“There's actually research at UCLA that shows when you can name that feeling, 'Oh, I'm feeling depressed again.' You have shifted the activity levels neurologically in the part of the brain which is depressed to the part of the brain which notices, which is aware, the prefrontal cortex and that diminishes the depression and enhances your ability to be able to understand it or to see it as just a feeling.”
As inequality grows, depression and anxiety grow in populations, a very robust effect that helps explain why depression rates are rising in wealthy countries if the cause were merely individual chemical imbalance.
“And one thing that is so important, Kate Pickett and Richard Wilkinson really developed this, is they've shown so as inequality grows, depression and anxiety grow. They've shown, this is very robust effect, right?”
A Mediterranean diet augmented with red meat has been shown in the first clinical trial to treat clinical depression and major depressive disorder, marking an exciting moment for nutritional psychiatry.
“the first clinical trial that is just being reported, showing that a Mediterranean diet augmented with some red meat actually can treat clinical depression, major depressive disorder. And it's a very exciting moment for nutritional psychiatry”
When baboons feel pushed to the bottom of a hierarchy, they display a submission gesture—putting their body down, lowering their head, raising their bottom, and covering their head—which communicates 'you've beaten me, just leave me alone.'
“Baboon will put its body down physically or put its head down, it will put its bottom in the air and it will cover its head. So it clearly seems to be communicating, 'Just leave me alone, you've beaten me. Okay, you've beaten me.'”
The first thing people should do to address depression and anxiety is look at how they're living their life: sleep quantity, diet quality, physical movement, sunshine exposure, and social connection—the basic things social primates should be doing.
“So there's quite a few things you can do that aren't prescription medicine. The first thing is to really look at how you're living your life. How much sleep are you getting? What is your diet like? Are you moving your body? Are you getting sunshine? Sort of the basic things that we as social primates should be doing. Which also includes being social, being interactive and not being isolated and withdrawn.”
Depressive thoughts ('I'm no good, my life is worthless') are not facts but triggers that make us depressed; cognitive therapy teaches people to talk back to thoughts with evidence from their lives that contradicts the thought.
“The basic realization in cognitive therapy is 'I don't have to believe my thoughts.' This is extremely important in people with chronic anxiety or chronic depression, because it's our thoughts that trigger the anxiety, that trigger the depression... Those thoughts actually make us depressed. So if you use mindfulness based cognitive therapy on the one hand you can see, 'Oh, there's that thought again!' On the other hand, cognitive therapy lets you talk back to that thought, 'Oh, I'm not so worthless, I've done some pretty good things in my life.' There are people who love me.'”
Robert Sapolsky found that baboons are most stressed in two situations: when their status is insecure (like a top-ranking male facing a challenger) and when they feel pushed to the bottom of a hierarchy and humiliated, measured through elevated cortisol levels.
“And what Professor Sapolsky found is baboons are most stressed in two situations. One is when their status is insecure. So if you're the top guy and someone's circling which comes for you, you will be massively stressed. And the other situation is when you feel you're at the bottom of a hierarchy, you've been kind of humiliated.”
When people eat poorly, their risk of depression goes up 70–80%, and when they eat a traditional diet like a Mediterranean or Japanese diet, their risk of depression can go down by as much as 50%.
“When you eat poorly, your risk of depression and illnesses like depression, just go up 70, 80%. And when you eat a more traditional diet, like a Mediterranean diet or Japanese diet, your risk of an illness like depression can go down by as much as 50%.”
Neuroplasticity is the fact that you can change the wiring in your brain by changing how you think, and genes that develop the brain keep changing because they are dependent on experience; it's like being handed a blueprint and deck of cards where how you play them is up to you.
“this thing called neuroplasticity, which I don't understand why it's not shouted from rooftops. That you can change the wiring in your brain by changing how you think. Basically, we used to think we were at the mercy of our genes... But the genes that develop your brain they keep changing because they're dependent on experience. So it's like they hand you a blueprint and a deck of cards, but how you play them is up to you.”
Holland's patients who have gotten off their medication for the most part are people who have adopted regular cardio exercise practice.
“My patients who have sort of gotten off their meds and left me for the most part, are people who have adopted regular cardio practice, where they're exercising regularly. I think that's really important.”
Mindfulness and meditation combined with cognitive therapy work just as well for anxiety and depression as medications do, but without the side effects.
“mindfulness and other meditations particularly combined with cognitive therapy worked just as well for anxiety or depression as the medications do, but they don't have those side effects.”
Many patients with depression complain of constipation and gastrointestinal dysfunction, and medications like SSRIs (Prozac and similar drugs) often cause transient gastrointestinal side effects, indicating a clinical connection between gut and mood.
“there's a connection because many patients with depression also complained of constipation, so a distinct dysfunction of the gut. And often the medications that people with depression take particularly serotonin re-uptake inhibitors, such as Prozac and all the other drugs in this category. They often cause transient gastrointestinal dysfunction”
In Norway, status is relatively secure with less extreme inequality and less movement between status positions, whereas in the United States at current inequality levels (greatest since the 1920s), there is a precarious middle class and a huge swelling bottom, leading to more people showing submission gestures.
“If you live in Norway, your status is relatively secure, right? No one's that high, no one's that low, movement between where you are is not so extreme. If you live in the United States, especially today which is we're now at the greatest levels of inequality since the 1920s, there's a few people at the very top, there's a kind of precarious middle, and there's a huge and swelling bottom, right?”
Paul Gilbert, Kate Pickett, and Richard Wilkinson have developed the theory that human depression is in part (not entirely) a form of submission gesture—an evolved response signaling inability to cope, particularly when pushed to the bottom of hierarchies or when status feels insecure.
“And what lots of scientists, people like Professor Paul Gilbert in Britain and Professor Kate Pickett and Professor Richard Wilkinson also in Britain have really developed is this idea that actually what human depression is in part, not entirely, but in part, is a form of a submission gesture.”
A simple intervention like growing an herb pot on a fire escape or front yard and consuming fresh herbs with meals significantly increases nutrient density and moves eating patterns toward the Mediterranean diet.
“one of my favorite interventions is helping people do like even a little herb pot on their fire escape or in their front yard. Cause you can just walk out in the morning grab some chives, grab some basil, chop it up, have it with your scrambled eggs. You've just increased the nutrient density of that meal. And you've made it a little bit more like the Mediterranean diet.”
When depressed, if Holmes can access a 'quiet space'—the part that notices thoughts rather than being identified with them—he experiences relief because this witness is impartial, neutral, not connected to life circumstances.
“When I'm depressed, if I can get into that quiet space, it's the space that's noticing the thoughts... Who's talking to who, really? I would say that the thought is talking to your awareness, your base awareness, your witness. So that's what's watching your thoughts. And if you can get into that, you see how impartial and unswayed by your life circumstance this witness really is. It's just there, it's neutral.”
We are facing an incredible mental health epidemic; Ramsey has been a psychiatrist in New York for 16 years and the amount of distress and mortality he is seeing is at levels never seen before.
“We are facing an incredible mental health epidemic. I've been in New York as a psychiatrist now for 16 years and the amount of distress and the amount of mortality that we're seeing is just like levels we've never seen before.”
One in five Americans will take a psychiatric drug, and one in four middle-aged women in the United States takes a chemical antidepressant in any given year.
“One in five Americans will take a psychiatric drug, one in four middle-aged women in the United States is taking a chemical antidepressant in any given year.”
When eating, the organ you should be most worried about is your brain because it is your biggest asset and consumes more energy and food than any other organ; focusing on brain nutrients leads to a different food selection than focusing on calories, saturated fat, or cancer prevention.
“We think about a lot of illnesses when we eat heart disease, cancer, diabetes, and it's always struck me that really the illness you should be worried about or the organ you should be worried about when you're eating is your brain. Because that is by far your biggest asset. It consumes more of your energy in your food than any other organ you have. And so focusing on the nutrients your brain needs guides you to a slightly different set of foods than if you focus on just things like calories, or saturated fat, or preventing something like cancer.”
Depression carries a sense of shame because external circumstances (status, security, appearance) seem to contradict the internal despair, creating a perception that the depression is unjustified, leading to silence.
“I didn't tell anybody, I didn't tell my friends. Because you know what comes with this disease is a real sense of shame, because everybody thinks, 'We'll look at you, you have everything. You're not in a township, you're not being carpet bombed.' So I always say you get these abusive voices. But not one voice—but a hundred thousand voices.”
When someone is suffering with depression, the last thing they want is for you to offer them alternative ways to think about their suffering; they may need space, love, companionship, or distraction without coaching through ideologies.
“I had a friend who was very depressed. And I remember talking to him, out of love trying to explain some of these ideas, some of these ways that we can think and interpret our suffering. And sometimes when someone is suffering, the last thing they want is for you to go, 'Hey, there's another way to look at this.' Maybe that's later. None of this is to be imposed on anybody... We can give space to someone's depression, we can love them, we can honor them, we can just eat some noodles, we can watch some movies, whatever it is we can just sit and not talk.”
Wax pursued understanding how the brain works through research and study of mindfulness-based cognitive therapy because she wanted empirical knowledge about controlling 'her chemicals' and 'cooling the engine,' not engaging with 'fluffy' approaches.
“I was really interested in how the brain works because I thought well, every other organ in your body can get sick and you get sympathy except your brain... So I gave up my career... I researched it in mindfulness based cognitive therapy had the best results. Otherwise I would have gone in a workshop for how to hug your inner elf. You know, I'm not into the fluffy stuff. So because of the empirical evidence, I studied.”
Through meditation, mindfulness, contemplation, and study, one can practice witnessing depression in real-time rather than only in hindsight, and with practice, identify less with emotions and life circumstances.
“with practice, with meditation, with mindfulness and with contemplation and study, literally like reading about it, talking about it like this, when we're in it in real time not necessarily later. At the beginning it goes like this, you're depressed and then later you look back and go, 'Oh, I think I was still this watching me.' And then with practice when it's happening you can go, I can witness this in real time.”
Ruby Wax experienced severe depression that lasted several months; it is not sadness but involves a complete personality change where you're left with 'a block of cement' in a state like hibernation you cannot wake from.
“I had a depression, it doesn't define my life. Seven years ago, I had a really bad one. I ended up on a kind of a chair for a few months... depression is about having a bad hair day or your cat left out. It isn't sad, nothing to do with sadness. It's like your old personality slowly leaves town and you're left with a block of cement, which is you. I mean, it's like being in hibernation, but you can't wake up.”
Thoughts (like 'I'm hungry') are communications directed at awareness or base consciousness, not self-evident truths; awareness is the witness that observes these thoughts.
“So if you think 'I'm hungry,' we always just think that I'm hungry is the thought in the animal and then we eat and then it goes, 'Thank you.' Who's talking to who, really? I would say that the thought is talking to your awareness, your base awareness, your witness.”
Humans are born with base consciousness—pure awareness like a newborn infant—but slowly build a 'false self' with stories about identity (gender, nationality, personality traits, preferences) that often becomes the locus of suffering.
“If you think about when you were born, I have a baby girl now, she's not thinking in ideas yet. She doesn't know she's American, she doesn't know she lives in California. Just like a ladybug doesn't know it's Italian... It's just awareness. So she's just there. And, but slowly over time, we build up what Young and others called the false self, right? So we have the story of who we are, and I'm a man, and I'm a comedian, and I'm a tall man, and I have big teeth and all these things.”
Gloria Gaynor's 'I Am What I Am' is wrong—you're not fixed, you have many possibilities for changing through neuroplasticity.
“So I always say Gloria Gaynor was wrong when she sang that song, 'I Am What I Am', you're not, you have many possibilities.”
The Mediterranean diet is plant-based with lots of nuts, seeds, whole grains, seafood, and treated meat and dairy primarily as flavorings rather than as main dishes as in Western diets, with abundant spices and fresh herbs.
“Mediterranean diet is a plant-based diet, you're gonna see lots and lots of nuts and seeds whole grains, gonna see seafood. You're gonna see meat and dairy treated differently... they're used more as flavorings... You don't see what we see in a Western diet of, a giant steak and a baked potato. You see a lot more spices in the Mediterranean diet, and fresh herbs.”
Depression for Pete Holmes manifests as irrational bouts of anxiety and sudden episodes of despondency that arrive unexpectedly, requiring him to withdraw from activities.
“when I've been depressed and I get depressed, I have irrational bouts of anxiety, I have random like FedEx deliveries of despondency just like, 'I didn't order this.' Oh, well, keep the PJ's on, cancel everything you're doing today, it's time to take a sad shower, like that happens to me, right?”