Despite the bright ads for Zoloft and Paxil, depression remains taboo. It's the emotion that shouldn't be mentioned, the all-encompassing feeling we're not supposed to have. In a society that prizes flawlessness, and that relentlessly assures us that all our needs are being met, personal pain in the form of depression emerges as a failing, as an emotional mistake we have to correct.
The idea of a depression as a problem in need of a cure is driven home by Dr Peter Kramer, the best-selling writer and psychiatrist, in his new book, Against Depression. In it, Kramer emphasises that depression has nothing to tell us about ourselves or the world we live in. For Kramer, depression is 'illness merely', much like psoriasis or diabetes, and if you fail to understand this, it's because your thinking is badly out of date. You don't realise that there's now evidence of a 'physical substrate' to depression - abnormalities in the hippocampus and prefrontal cortex - and that this pathology is incompatible with meaning. If you wouldn't listen to syphilis, Kramer asks in a cute aside, why would you do so with depression?
Kramer's attempt to shoe-horn depression into the physical illness camp could be dismissed as more public relations for the drug industry - if depression is a disease, then treatment becomes both a duty and a right - but his message is more complex and troubling than that. Kramer raises the possibility of a depression-free future - one achieved through an as-yet unrealisable mix of medication and genetic engineering - and he urges us towards this goal with the zealousness of a southern preacher. He never once stops to ask whether, in stamping out depression, we might be losing one of the strongest messages we have about our current, unstable relationship with the earth.
Everyone knows that depression rates are high; most of us know someone who's been or is on antidepressants. Kramer cites an estimated clinical depression rate in the United States of six to seven per cent of the population per year, and even this figure seems low. One US study found depression rates for children to be hovering between seven and 14 per cent and, at some American colleges, at least a quarter of the student body will be taking anti-depressants before graduation.
Since he's positioning depression as a disease, Kramer needs to argue that the illness isn't specific to our era. To this end, he includes an odd fictional vignette featuring depressive hunter-gatherers on a far-off savanna. However, a recent study of 40,000 people in North America, the Middle East, Europe, and Asia showed an overall increase in the rates of major depression over time and across all countries, a finding that confirms what most people intuitively know: that we're more depressed than we used to be, and that clinical depression - with its exhaustion, monotony, and fearfulness - has become the signature ailment of life in an environmentally-stressed world.
In touch with nature
The idea that ecological strain might translate into psychic distress is something that forwardthinking biologists and psychologists have been trying to point out for the past two decades. EO Wilson coined the word 'biophilia' to describe our innate affiliation with the natural world, and he noted that having been 'totally and intimately involved with other organisms' for over 99 per cent of our history, it would be extraordinary to think of the human need for nature as simply disappearing within a few generations.
We know that we have sharp physical and psychological reactions to images of environmental loss - we experience this every time we open the paper to see a photo of a snake choking on plastic, or a gull with a misshapen beak - but research on the connection is lacking. Conservationists such as Wilson have spent years arguing that we're allowing the world to lose biodiversity without understanding the extent of our psychic and emotional need for what's being lost. Letting this happen is a lot like starting an experiment by burning down the lab. Once something is lost, it's lost. And once that something - either a brightly coloured bird or miles of undeveloped land - is gone, it becomes impossible for us to understand the positive ways in which it might have affected us.
The result, which University of Washington psychologist Peter Kahn calls 'environmental amnesia', can leave us with a lack of flourishing or stunted emotional development that we don't even recognise as unnatural. 'It's like we're animals in a zoo,' says Kahn. 'It's not that we're not surviving. You know, animals in a zoo often adapt and they live long lives. And, surprisingly, if you open the gates, they often prefer the zoo, because that's where they've been born. But that doesn't mean you have a full account of what an animal's life can be like, if it's fully thriving as the species can.'
Nature and psychological health
Dr Aaron Katcher, professor emeritus of psychiatry at the University of Pennsylvania, is one of the only psychiatrists in North America to study the relationship between natural forms and psychological health. His work - with autistic children, the elderly, and patients suffering from organic brain disease - has demonstrated that the introduction of animals into a school or clinical setting will lead to improved attention, increased laughter, more speech, improved sociability, and decreased aggression, even among the most withdrawn. 'We've been chasing them for four million years,' Katcher says bluntly, referring to the strong response animals trigger in us. 'In the course of those four million years, I think our brains have been programmed to pay close attention to animals and nature. Our survival depended on it.'
When animals and nature are taken away, the result, according to Katcher, is 'a psychic constriction, a lack of richness'. Katcher notes that our current lack of involvement with the natural world is historically unprecedented, and that we don't know what the results of our experiment in denuding nature are going to be. We might be psychologically fine in a world stripped of biological diversity, or 'the results might be more serious than we think'. Katcher is especially concerned about the huge number of children being raised without rich contact with the natural world. 'These are children who've lost something, but don't know they've lost it - children who are inured to their losses. No one is looking at the effect on their emotional lives.'
And, unless our priorities change, no one is going to be investigating these matters for some time to come. Funding for psychiatry research is already being directed towards studies that accept the medical model. Kramer notes that, by the 1990s, 'every research dollar' was being funnelled in this direction - and the prospect of a drug cure will start to seem even more alluring as depression and disability rates climb upwards. By 2020, for instance, when the WHO predicts that depression will be second only to heart disease as a cause of disability, many people will be clamouring for a 'cure'. But while the medical model might nudge us towards pharmaceutical treatments and other interventions, it fails to take account of the ways in which our very physiology is affected by nature.
Dr Robert Ulrich, a planner and environmental psychologist at Texas A & M University, has shown that nature restores us, both physically and mentally. Some of us still intuitively understand this: when distressed we might reach out for nature, either grabbing the cat for a cuddle or heading to a nearby park to relax. What Ulrich has done is prove that the improved moods we experience at such times are consistent and real. In study after study, Ulrich has shown that when exposed to pictures of natural settings, people's blood pressure drops, their heart rate falls, and muscles relax. Emotionally, people report feeling less stressed and anxious, less fearful, less aggressive, more focused, more alert, and better able to concentrate. Ulrich has also shown that if you split post-operative patients into two groups, giving one a view of trees and the other a view of a brick wall, the group that was exposed to the trees will need fewer painkillers, develop fewer complications, and will check themselves out of hospital more quickly than the group with the urban view. And in a long-term study that looked at which pieces of wall-art were being destroyed by psychiatric patients, researchers found that while patients attacked the abstract art, not once in 15 years had a patient destroyed a picture of a natural scene.
Since we don't yet understand the extent of our emotional and physical ties to the natural world, Ulrich suggests that it would be sensible to hang on to the few wild places we have left. But, despite the work and urgings of a few smart researchers, conservation is not part of the picture when it comes to thinking about our mental health. Many of us take walks when we're blue - a study of college students showed that 75 per cent sought out natural settings when stressed or depressed - but the direct healing experiences we have in nature aren't being translated into research or action. Instead of studying the links between depression and ecological degradation, we're encouraged to see depression as an internal and almost secretive matter: as something to be discussed, in private, with a clinician, and then treated, again in private, with tranquilisers and SSRIs.
To suggest that rising rates of depression might be tied to environmental losses is not to deny or trivialise pharmaceutical treatment: pills can save lives, and they can smooth over some of depression's most ragged edges. But too heavy an emphasis on medication can make depression seem like a strictly internal event: it's hard to swallow a pill every night and not come to believe - with a greater or lesser degree of certainty - that you alone are the source of the problem under treatment. While personal factors play an important role in depression, we need to broaden the lens and start to recognise that losses in the natural world can make us depressed as well.
The restorative power of nature
'If you read any novel of the 19th century,' says Aaron Katcher, 'there is such a thing as "missing your country". It was accepted that people would become depressed when they were taken away from their countryside, and that it was natural to mourn a lack of contact with the paysage you've been raised with.' In our rush towards a medicalised model, we've lost this idea of depression as a legitimate response to the loss of places we need to be joyful. Recognising that depression can filter in from outside - from the paving of fields and photos of frogs with too many legs, from endless messages about how we fail to measure up, from exhausted friends, the glare of headlights, polluted air, and the constant low-grade hum of engines - is not positioning yourself somehow 'for depression'. It's simply accepting that some of the distress we currently feel is tied to the world beyond the consulting room, to this planet of ours that's become so stripped and bare.
I learned this first-hand, after being transferred from a law firm in downtown Toronto to a government office in Iqaluit, on the southern edge of Baffin Island in the eastern Arctic. I arrived with SSRIs and with the conventional explanations about my depression, about it being caused by neurotransmitters and by my inability to express myself. Since the sun never set in Iqaluit, I was able to hike for hours every day, and I spent month after month fiddling around on the tundra, taking pictures of wildflowers and jumping from rock to rock across clear streams. As time went on, I noticed that I was less distressed and less anxious, more sure of myself and more interested in the world around me. My improved mood wasn't simply the result of getting more exercise. It was that the landscape around me was so vibrant and solid that I began to feel that way as well.
When I came back to Toronto, it was as though a piece of film had been tacked to the front of my glasses: the world around me felt duller, and I felt further away from it. But there was nothing in mainstream culture to help me understand this emotional flattening. Instead, I saw ads for anti-depressants and books such as Kramer's, all of which were eager to assure me that the distress I'd experienced - the jumpy emptiness, the nights spent pacing the floor and the days spent half-asleep - was the result of illness, a disease like diabetes, and was unconnected to the rushed and paved place I'd lived in for so long.
It's easy to criticise Kramer and the slightly daffy, half-baked culture he's tapped into. Anyone who writes 300 pages about an affliction he's never experienced is setting himself up as a target. But Kramer is able to do this precisely because he's got the ammunition. He can point to countless studies about drugs and neurology, while someone trying to explore the links between mood and the environment is faced with a stack of little used, decade old textbooks. It's as though our culture has so trivialised the natural world that we no longer realise how important it is. Compared with medication and the possibility of genetic splicing, fields and forests seem insignificant; we don't even bother to study their effect on us.
Understanding the link
We need to start understanding the extent to which our minds are linked to the natural world, and we need to do it now, before more biodiversity disappears. There's no money for drug companies to make from such an approach to depression, but it's one that would benefit both us and the planet. Recognising that not only our physical health, but also our mental and emotional health are tied to healthy ecosystems would give us a stronger incentive to save wild places. It would also help us situate depression in a broader cultural context, giving us a better understanding of the affliction and possibly opening up new methods of treatment.
'The time to interrupt the illness is yesterday,' proclaims Kramer in Against Depression; he wants us all to take up arms forthwith in an 'opposition to mood disorder.' We'd all like to rid ourselves of depression, with its sharp hopelessness and jagged bouts of despair, but the idea that we might defeat depression while living on an exhausted planet is more fantastic than anything else that's been written on the subject.
'Our minds came of age with these daily rich interactions with nature,' says Peter Kahn of our affiliation with the natural world. 'And when we cut ourselves off from that, we suffer.' Pharmacology has pushed this idea off the table. We know that contact with the natural world is good for us: the work of Katcher and Ulrich, as well as our own instincts - when we take the time to listen to them - demonstrate this. We now need to go one step further and ask how the loss of the natural world is affecting us emotionally. Kramer believes that depression has nothing to tell us, that any messages we think we're receiving from it are illusory. But depression has been speaking to many of us for a long time now. Placing it against the landscape of loss that surrounds us - rooting it in the stressed and distressed world that's ours - might help us start to decipher what it has to say.
This article first appeared in the Ecologist October 2005