Article XXVI — Depression Isn’t Always Biological: The Role of Environment and Life Circumstances —  Dr. Jordan B. Peterson

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What is depression exactly? Well, it’s a preponderance of negative emotion, which seems self-evident. Depressed people are sad and frustrated and disappointed and grief-stricken. They have low self-esteem. They tend to feel all negative emotions simultaneously in a manner that’s paralyzing.

If you have the proclivity to feel one negative emotion more intensely, you have the proclivity to feel them all, because they co-vary, because they tend to occur together. And that’s because all negative emotions are the manifestation of the abstraction of the behavioral system that stops you from moving forward, or moves you backwards, or, in another variant, prepares you to fight. Anger is a mix of positive and negative emotions, so it’s a bit more complicated.

If you feel a preponderance of negative emotions, you tend to be paralyzed and to withdraw, to be frozen in place and to withdraw.

If you are depressed, you also experience an absence of positive emotions, and this is linked to moving forward. And it manifests itself in curiosity and in a desire to play, and more particularly in hope. And it makes itself known as a marker that you are moving towards valuable goals. And so depression takes out, in a sense, such that you don’t feel any positive emotion in relationship to goals. There’s nothing that seems worthwhile, which is the absence of goals. And it also floods you with negative emotion. And treatment for depression, pharmacologically or behaviorally, psychologically, can address either the deficit of positive emotion or the excess of negative emotion, or both.

So antidepressants known as serotonin reuptake inhibitors tend to modulate the degree in which negative emotion propagates neurologically, where antidepressants like bupropion or Wellbutrin tend to increase the probability that positive emotion will make itself manifest. And sometimes people who are treated biochemically for depression are treated with “SSRIs” (Selective Serotonin Reuptake Inhibitors) and with drugs like Wellbutrin. There are mixed antidepressants, and so, because antidepressants work upon occasion, people also tend to think, or make the claim, that depression is fundamentally a biochemical disorder. And that begs the question, “What do you mean by fundamentally? And do you mean by biochemical?” And the situation is much more complex than the mere reduction of the condition to a biochemical abnormality might indicate.

When I was doing differential diagnoses for depression—and differential diagnosis means specifying the nature of the problem, distinguishing it from the other similar problems, and then formulating something approximating a treatment—one of the things I tried to determine as a good behaviorist was whether the person who was suffering a deficit of positive emotions and an excess of negative emotion was suffering because they were ill, in the strictly physiological sense, which might also mean that something had gone wrong biochemically, let’s say, with the serotonin production system, or whether they were suffering the cumulative micro and macro catastrophes of life. And so one question might be, “Well, are you depressed, or do you just have a terrible life?” And my belief is that, although this hasn’t been well delivered in the research literature, it’s because the diagnoses aren’t done carefully enough.

My strong intuition is that, and it makes sense theoretically and biochemically as well, is that antidepressants work quite well, often for people who don’t have terrible lives but are depressed, whereas, to people who have terrible lives, these antidepressants might help stave off the worst manifestations of suicidal self-destruction but can’t put in place the behavioral and psychological structures that are necessarily put in place in order for them to thrive, or in order for them to be thrust against negative emotion, which is generally manifest in response to genuine crises, and to help them gather the sense of positive movement towards a goal that might be necessary to live in the absence of depression.

And so you can say, “So, to have a good life, and therefore not to be depressed, you need a goal, and maybe you need an overarching goal, and maybe you need an overarching goal that unites all the impulsive goals that might otherwise preoccupy you, and you need to have enough stability in your immediate environment and in your conception so that you’re not flooded with anxiety and negative emotion.” And so, well, how might you understand that in a more differentiated manner if you were trying to address your own proclivity for depression?

One might say, “Well, you need to be engaged in some meaningful life pursuits, you need to know what to do with your life, you need to have some day-to-day routines, you need to engage in something that is productive and can sustain you and that simultaneously makes you grow.” And then you might ask more concretely, “What might you engage in if you wanted to set your life up so that you weren’t depressed and nihilistic?”

Now, one answer to that is, you could look for meaning and significance in what other people have found. So I would often go through people’s lives, and what a behaviorist does is differentiate the problem set into microproblems. So you imagine, “Well, I’m miserable.” That’s a very global statement, a very high statement. You might say, “Well, if you are miserable, a serotonin uptake inhibitor might help you.” But if you are a behaviorist, you think, “Well, let’s differentiate the misery. What do you mean by miserable?”

You might say, “Well, do you have an intimate relationship?” Because often in life, people would like to establish a productive, generous, and mutually sustaining intimate relationship. And so the person might say, “Well, I’ve never had a partner. I don’t have a partner now. I’m really lonesome. I really liked to have someone, but I’ve never been able to make it happen.” Or they might say, “Well, I do have an intimate relationship. I’m married, but my marriage is a complete bloody disaster.” So it’s, okay, so now one source of misery and one domain that could conceivably be proved.

So you might say, “Well, do you have any friends?” And the person might say, “Well, I spend almost all my time online or alone. And yeah, I have a couple of friends, but we don’t see each other much.” So then you say, “How often do you see them?” They say, “Well, my best friend, I spoke to him on my phone two months ago for about half an hour, and we didn’t really talk about anything important.” It’s like, okay, friendship not doing so well, another box of misery.

“Well, do you have a job or a career that sustains you?” And someone in really desperate states might say, “Well, I’ve been fired from the last 3 jobs, and right now I’m collecting unemployment, and that’s gonna run out in 3 months, and I really haven’t been able to get a handle on my productive labor, so I spend a lot of my time just laying around wondering what in the world should I do, or I’m online looking at porn, or I’m…” I’m like, okay, that is a whole catastrophe too.

“How about your education and your background and your plans for education?”

“Well, I have had a pretty spotty education path. I didn’t finish high school, or I went to college but I dropped out, or I’m embarrassed by my academic record, and I’m really not doing anything to expand my horizons on the educational front.”

It’s like, “Okay, got that. What do you do with your time outside work?”

“Well, as I said, I don’t really work.”

“Okay, what do you do with your time?”

“Well, I waste a lot of time on social media, maybe 8 hours a day.”

Which, by the way, was the medium amount of time that my students claimed to spend when they were going to university: 8 hours a day.

“And do you feel any better about the things you do online?”

“No, usually it just makes me feel worse. I see wonderful lives other people are having, and it just reflects back to me how miserable and useless I am. Or I spend a lot of time reading comments from demon trolls, and that just makes me feel hopeless about the human race.”

It’s like, “Okay,” new thing productive in terms of time outside the work, we put it also on the box.

“What about your resistance to temptation?”

“Well, I use a lot of pornography, and twice a week I go out and get so drunk that the next day I’m pretty useless. And I would probably do that more except I don’t have enough money. And now and then I also have a cocaine habit, but that’s expensive too.”

“Okay, alcohol and drug problem, that could conceivably rectify. Do you take care of yourself mentally or physically in any manner? Do you treat yourself like you are worth caring for or attending to?”

“No, not really. I don’t really get any exercise. I spend a lot of time in bed.”

“Okay. Are you engaged in any civic enterprise of any sort? Do you belong in a church or club or a political party?”

“No. You know, I don’t go to church because I don’t believe what the church says, and that’s all corrupt anyways. And what the hell can someone like me do about the political situation?”

And it’s like, “Okay, you are not depressed! You have a terrible life.”

Now, you also might be depressed because of it, but the probability that tossing an antidepressant in the mix is all of a sudden going to fix these 8 domains of your life that are absolutely catastrophically out of order is 0.