Study looks at loss, its role in depression
Finds humiliation triggers worst cases
In their search for the roots of depression, psychiatrists have long focused on the experience of loss -- the jarring loss of a loved one, the lost haven of a relationship, or the more primal feelings of loss that can be traced back to the mother's breast.
But a new study of more than 7,000 adult twins calls into question assumptions about depression that date to Sigmund Freud. The events that send people into major depression, the authors found, are not merely losses, but humiliating ones that drive at a person's self-esteem -- most typically, being abandoned by a romantic partner.
The classic experience of pure loss -- the death of a family member -- is only about half as likely to lead to depression, according to the study, published this week in Archives of General Psychiatry.
"When your father dies, it doesn't directly address who you are. You can still love yourself after your dad dies," said Dr. Kenneth Kendler, a psychiatric geneticist at Virginia Commonwealth University and the study's lead author. Blows to a person's status, like the experience of marital abandonment, "hit you at a more basic level. Boy, this is a vulnerable part of our psychological anatomy. So much of human life is built around this."
Depression affects nearly one in 10 Americans in a given year, and scientists contend that many people inherit a biological vulnerability to the disorder. But relatively few studies have examined the triggering events that can mark the beginning of a long slide into major depression.
Kendler followed 7,322 adult twins -- whose genetic similarities made the environmental differences stand out -- and noted the major difficulties they faced, such as the loss of a loved one, major financial trouble, serious illness or injury, job loss, legal problems, or divorce. When he divided the events into categories, his conclusion called into question time-honored psychiatric theories: While the experience of loss put a twin at a higher risk for depression -- about 10 times the risk of one who had not experienced loss -- being humiliated was about as important. The two experiences together were by far the most dangerous kind, increasing the risk of major depression by a factor of 20. In one out of five cases, these individuals showed signs of major depression within a month.
A good example of such an experience, he said, is if a lover "leaves you, but he doesn't move out of the neighborhood and parades his new girlfriend, who may be more attractive than you, up and down the street."
Kendler suggests that depression has evolutionary roots: It is a survival mechanism for an individual whose status has dropped dramatically. Depression suppresses a person's desire for food, companionship, or other basic needs -- an accommodation that makes sense for someone with a low social status.
"You are less demanding of your environment when you are in a low-status position," Kendler said. "You become nonthreatening, more pathetic, so that instead of incurring greater hostility," others will care for you.
In 1917, Freud began searching for the seeds of depression in a landmark essay, "Mourning and Melancholia," which distinguished between normal grieving at the loss of a loved one and a sustained sickness in which anger at the loved one is redirected toward the self. Thirty years later, John Bowlby observed the pain of children separated from their mothers and developed his "attachment theory," which held that the loss of the affectionate infant-mother relationship is the root cause of most adult mental illness.
Today, researchers have been closing in on the mysterious interactions between the neurobiology of the brain and the powerful human experiences that can throw it out of balance. In a study published last month in the journal Science, researchers Terrie Moffitt and Avshalom Caspi identified a gene that, depending on its shape, can make people especially vulnerable to depression when a traumatic event occurs -- or especially resilient.
Kendler said his study's main contribution is the idea that humiliation, not pure loss, is a triggering event. The need to maintain one's self-respect may be more central to the personality than widely believed. "We are built to be status-protecting organisms," he said.
With a better understanding of genetic predisposition and environmental triggers, doctors hope to apply preventive medicine to mental illness.
"We puzzle about these things: What does it mean to have bad things happen to you? . . . You have some kind of risk determined by your genes, and then you ask yourself what it is in the environment," said Dr. Bruce Cohen, who is president and psychiatrist in chief at McLean Hospital in Belmont.
Ellen Barry can be reached at firstname.lastname@example.org.
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