depression as a system

A recent NY Times Magazine article about depression got me thinking.  Here is an excerpt:

The mystery of depression is not that it exists — the mind, like the flesh, is prone to malfunction. Instead, the paradox of depression has long been its prevalence. While most mental illnesses are extremely rare — schizophrenia, for example, is seen in less than 1 percent of the population — depression is everywhere, as inescapable as the common cold…

The persistence of this affliction — and the fact that it seemed to be heritable — posed a serious challenge to Darwin’s new evolutionary theory. If depression was a disorder, then evolution had made a tragic mistake, allowing an illness that impedes reproduction — it leads people to stop having sex and consider suicide — to spread throughout the population. For some unknown reason, the modern human mind is tilted toward sadness and, as we’ve now come to think, needs drugs to rescue itself.

The alternative, of course, is that depression has a secret purpose and our medical interventions are making a bad situation even worse. Like a fever that helps the immune system fight off infection — increased body temperature sends white blood cells into overdrive — depression might be an unpleasant yet adaptive response to affliction. Maybe Darwin was right. We suffer — we suffer terribly — but we don’t suffer in vain.

This isn’t OR, but it piques my interest in systems modeling and in making sure our paradigm is aligned correctly.

I recently attended a seminar by Dr. Paul Andrews at VCU about approaching depression as an evolved adaptation for analyzing complex social problems.  This seminar was part of the Science Technology and Society program here at VCU.  Dr. Andrews has a background in biology, law, and engineering, and summarized some counterintuitive depression findings that were echoed in the NY Times magazine.  His eclectic education and experience made for an excellent talk that touched on many aspects of depression.

Depression is complex and has many costs. Finding good ways to prevent and treat depression has been elusive.  In his talk, Dr. Andrews examined how to approach depression by using the following paradigm. He argues that when we carve up nature the wrong way, we see disorder.  We shouldn’t conclude that nature is disordered, since maybe we are looking at it the wrong way.  When we realign our view, we can see order. Disorder hypotheses don’t explain analytical processing styles and why some of the treatments work or do not work.

Paradigms for depression are not able to accurately describe aspects of depression or predict which treatments actually work.  Some research has suggested this counterintuitive finding:  disrupting depression through cognitive techniques (temporarily distracting the depressed patients) actually makes depression worse, not better.  Writing therapy sometimes works when depressed patients routinely think about their depression.  When it does, depression temporarily spikes during recovery, eventually giving way to recovery.  This occurs when the depressed patient reflects about why they are depressed, resulting in a temporary relapse.  Since this occurs due to the patient gaining understanding and insight, they can use these tools to work through the relapse and to head toward recovery.

Depression paradigms also have trouble explaining relapse rates.  Relapse rates are 23-35% when taking a placebo.  Relapse rates are much higher (76% in one study) when SSRIs are discontinued, and they are higher the longer the patient takes meds.  This is troubling.

If depression is a disorder, why is it so common?  Clinical criteria for diagnosing depression find that 30-50% of people will be clinically depressed at least one during their lifetimes.  Is there something wrong with how we are defining depression?  Maybe it has some competetive advantage (as suggested in the NY Times magazine)? I have often wondered about this, and was glad that Andrews addressed this topic during the talk.

Side note: I hypothesize that depression might be like crime.  Depression, like being arrested, is something that many people experience over their lifetimes, largely because we are looking at a cumulative effect.  As a result, there is a large proportion of people who will be depressed—or arrested—at least once over a lifetime.

Certainly, many applications of OR benefited from a better alignment.  One example is elevator waiting times (which I first heard about from one of Dick Larson’s talks). Rather than reducing elevator waiting times, mirrors were put up to reduce waiting anxiety. Complaints plummeted while the slow elevators continued to make people wait.

Another example is on the psychology of queues.  To deal with airport passenger complaints about inequities in getting their checked baggage after their flights, extra distance was added in the walking time from disembarkation point to the baggage carousel.  Everyone had to walk further but complaints reduced:  the equitable/inefficient solution worked!

Have you realigned an OR problem?