So many are depressed because they're expected not to be
Depression is listed as the leading cause of disability worldwide, a standing to which it has progressed steadily over the past 20 years.
Yet research shows a rather interesting pattern: depression is far more prevalent in Western cultures, such as the US, Canada, France, Germany and New Zealand, than in Eastern cultures, such as Taiwan, Korea, Japan and China.
This shows that depression is a modern health epidemic that is also culture-specific. Yet we mostly continue to treat it at the individual level, with anti-depressants and psychotherapy. This assumes treatment lies in correcting individual biological and psychological imbalances.
Read more – Explainer: what is depression?
Public health experts know living in an environment where fast food is readily available is a large contributor to the modern epidemics of diabetes and heart disease – we need to understand the context, not individual behaviour alone. In the same way, as depression reaches epidemic proportions, the sole focus on individuals no longer makes sense.
We have been investigating whether Western cultural values play a role in promoting the depression epidemic for several years now. In a series of experiments, we found the high value we place on happiness is not only associated with increased levels of depression, it may actually be the underlying factor.
Cultural ideas of happiness
That happiness is a highly prized emotional state in Western culture is not hard to defend. Whether it is the smiling faces on billboards, television, magazines or the internet, advertisers are constantly pairing their projects with feelings of happiness. This makes their products seem desirable and the associated positive feelings appear ideal.
Social media – or more accurately the way we have learnt to use it – is also a constant source of idealised happy faces. This leaves us with the distinct impression that what counts as an indicator of success is whether or not we are feeling happy.
Valuing feelings of happiness or wanting others to be happy is not a bad thing. The problem arises when we come to believe we should always feel this way. This makes our negative emotions – which are inevitable and normally quite adaptive – seem like they are getting in the way of an important goal in life.
From this perspective, sadness is no longer an expected feeling you have when things go wrong. Rather, it is interpreted as a sign of failure; a signal something is wrong emotionally.
To examine the downside of culturally valuing happiness, we developed a questionnaire to measure the extent to which people feel others expect them not to experience negative emotional states such as depression and anxiety. Our first studies showed people who scored higher on this measure had lower levels of well-being.
In follow-up studies, we found when people experienced negative emotions and felt social pressure not to, they felt socially disconnected and experienced more loneliness.
While these studies provided evidence that living in cultures that value happiness, and devalue sadness, is associated with reduced well-being, they lacked clear causal evidence these values might be playing a role in promoting depression.
Do cultural values of happiness cause depression?
Next, we selected around 100 participants who met the clinical cut-off score for depression to take part in a month-long daily-diary study. They were asked to complete a survey at the end of each day about their depressive symptoms that day, as well as whether they had felt socially pressured not to experience such feelings.
We found perceived social pressure not to feel depressed reliably predicted increased depressive symptoms the next day. However, this perceived social pressure was not predicted by prior feelings of depression. This provided evidence it was not that depressed people thought others expected them not to feel that way, but that this felt social pressure itself was contributing to symptoms of depression.
We then tried to recreate the kind of social environment that might be responsible for the pressure we observed as a central feature of depression. We decked out one of our testing rooms with some happiness books and motivational posters. We placed some study materials in there, along with sticky notes with personal reminders such as “stay happy” and a photo of the researcher with some friends enjoying themselves on holiday. We called this the happy room.
As study participants arrived, they were either directed to the happy room – and told the usual testing room was busy so they would have to use the room the researcher had been studying in – or to a similar room that had no happiness paraphernalia.
They were asked to solve anagrams, some sets of which were solvable while others were largely not. Where participants had solved few anagrams (because they had been allocated the unsolvable ones), the researcher expressed some surprise and disappointment saying: “I thought you may have gotten a least a few more but we’ll move on to the next task.”
Participants then took part in a five-minute breathing exercise that was interrupted by 12 tones. At each tone, they were asked to indicate whether their mind had been focused on thoughts unrelated to breathing and, if so, what the thought was, to check whether they had been ruminating on the anagram task.
What we found
Participants who had experienced failure in the happy room were three times more likely to ruminate on the anagram task – the cause of their failure – than those who had experienced failure in the room without any happiness paraphernalia. Participants in the happy room who had solvable anagrams, and therefore experienced no failure, did not ruminate on the anagrams at all.
We also found the more people ruminated on the anagram task, the more negative emotions they experienced as a result. Failing in the happy room increased rumination and in turn made people feel worse. Rumination as a response to negative events has been consistently linked to increased levels of depression.
Read more – Sad music and depression: does it help?
By reconstructing a kind of micro-happiness-culture, we showed that experiencing a negative setback in such a context is worse than if you experience that same setback in an environment that does not emphasise the value of happiness. Our work suggests Western culture has been globalising happiness, contributing to an epidemic of depression.
As our understanding of depression begins to move beyond individual-level factors to include social and cultural value systems, we need to question whether cultural values are making us happy. We are not immune to these values and our cultures are sometimes responsible for our mental health. This is not to reduce individual-level agency, but to take seriously the growing body of evidence that much of what we do is often decided outside of conscious awareness.
2 August 2017.