This is the first article in a new column written by Hans Schroder, Ph.D.
In my last article, I wrote about the chemical imbalance explanation of depression that has been widely disseminated in public and medical settings. I noted how these types of biomedical explanations have benefits and costs, including less hope for recovery and less agency (the belief that you can, with your own efforts, change depression). I will now introduce an alternative way of thinking and talking about depression that may have some different psychological impacts.
Framing depression as a signal
A different way of thinking and talking about depression is to focus on its potential functions. By “function” I mean that it may in fact be trying to tell us something that is ultimately useful for us to know. In therapy, we talk about the functions of emotions all the time: the function of fear is to alert us to danger; the function of sadness is to let us know we’ve lost something important to us; the function of anger is to let us know that a boundary has been crossed or that something unjust has happened to us or someone we love. We talk about these functions so to better relate to our uncomfortable feelings. Pixar’s Inside Out movies do an exceptional job portraying the functions of our emotions.
Less commonly discussed is the function of depression. The popular “chemical imbalance”-type narratives actually suggest that depression has no function whatsoever (it is an “imbalance” after all). But it turns out that there have been theories about the function of depression dating back nearly 100 years (Nesse, 2019). Evolutionary psychiatrists have suggested that depression may have multiple functions to us – including letting others know we need help (Lewis, 1934), trying to maintain membership with the group (Hartung, 1988), acknowledging that our goal pursuits are in fact unattainable and unrealistic (Nesse, 2019), trying to solve complex social situations (Hollon, 2024), and a normal process when dealing with unimaginable loss (Horwitz & Wakefield, 2007). Psychodynamic therapists have long suggested that most mental experiences serve a function, and that depression is about grappling with profound loss (Freud, 1914).
As a clinical psychologist, I am interested in how people with depression respond to this way of thinking about depression. For the last 7 years, I have led a group at a Partial Hospital Program, first at McLean Hospital in Massachusetts and now at the University of Michigan, that teaches participants about this idea. Specifically, in the group we define depression as a “signal that something in your life needs more attention.” We talk about how depression may be telling us that something in our relationships may not be working for us, or that we have unresolved or unprocessed trauma. After leading the group to well over 1,500 patients now, I have been fascinated with the responses I get from group members. Some people hate this idea and say "no, I have a chemical imbalance." Other people, however, have said that they have never heard of this idea and for the first time in decades have some hope for their recovery as it helps them feel less "abnormal."
We have now been able test how people think about this framing using research. In two experiments (Schroder et al., 2023; Schroder et al., under review), we invited participants with some experience of depression to watch a series of videos where a psychologist describes depression as “signal” in one condition, or as a medical disease (more akin to the chemical imbalance message) in the other condition. More details are in these scientific papers, but overall, we find that people with depression have more hope for their recovery when they learn that depression has a function to it. However, we also find that participants blame themselves more for having depression when they view it as a signal. Although the effect sizes are quite small, this suggests that the depression-as-a-signal framing may have one consequence of having people feel more blameworthy.
We are continuing to explore different ways of talking about depression. One avenue for our future work is to acknowledge the biological aspects of depression but also suggest that our biology is also trying to “do its job” by letting us know our needs are not being met. In other words, we might start to ask “where did this chemical imbalance come from and what is it trying to tell me?”
Ultimately, the goal of this research is to offer people a different way of understanding their emotions, their depression, and themselves. In my clinical practice, I find that some metaphors (“chemical imbalance”) tend to reduce curiosity and motivation to acquire and apply new skills that help manage difficult emotions. My hunch is that it won’t be a one-size-fits-all message that works for everyone, and that some people can rightfully cling onto the idea that they suffer from a chemical imbalance. As a therapist, that is totally fine by me as long as they are getting their needs met and living a value-driven life. It’s my hope that our research can identify more empowering ideas about depression for the others that feel less hopeful.
References:
Freud, S. (1914). Mourning and melancholia. In Standard edition of the complete psychological works of Sigmund Freud (Vol. 14). Hogarth Press.
Hartung, J. (1988). Deceiving down: Conjectures on the management of subordinate status. In Self-deception: An adaptive mechanism (pp. 170–185). Prentice-Hall, Inc.
Hollon, S. D. (2024). What we got wrong about depression and its treatment. Behaviour Research and Therapy, 180, 104599. https://doi.org/10.1016/j.brat.2024.104599
Horwitz, A. V., & Wakefield, J. C. (2007). The loss of sadness: How psychiatry transformed normal sorrow into depressive disorder. Oxford University Press.
Lewis, A. J. (1934). Melancholia: A clinical survey of depressive states. Journal of Mental Science, 80(329), 277–378. https://doi.org/10.1192/bjp.80.329.277
Nesse, R. M. (2019). Good reasons for bad feelings: On the frontier of evolutionary psychiatry. Dutton.
Schroder, H.S., Devendorf, A., Kneeland, E.T., Moser, J.S., & Zikmund-Fisher, B.J. (2024). Comparing biogenetic with functional descriptions of depression: Impacts on stigma and treatment attitudes. Manuscript under review.
Schroder, H. S., Devendorf, A., & Zikmund-Fisher, B. J. (2023). Framing depression as a functional signal, not a disease: Rationale and initial randomized controlled trial. Social Science & Medicine, 328, 115995. https://doi.org/10.1016/j.socscimed.2023.115995
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About the author:
Hans Schroder, Ph.D.
Dr. Schroder’s research focuses on how people think and talk about mental health. He studies common explanations such as the “chemical imbalance” narrative and how people interpret such messages. He also studies alternative frameworks for understanding mental health that may promote less stigma and more hope for recovery.
