Thoughts on Depression — Nature or Nurture?

“When a dog bites a man, that is not news… But if a man bites a dog, that is news.” This quote, the first rule of any journalism class, is attributed to New York Sun editor John B. Bogart (1848–1921). It was somewhat of a surprise then to read a leading story in the August 6, 2020, New York Times in which former First Lady Michelle Obama says she is experiencing low-grade depression.

Being depressed during a world-wide pandemic where our lives have been upended… this is news? Wouldn’t that be the norm? A June survey conducted by the Kaiser Family Foundation found that more than 30% of adults in the U.S. are experiencing symptoms of anxiety or depression since the beginning of the pandemic.

Nature or nurture?

Is depression nature or nurture? The New York Times article quotes Dr. Timothy Sullivan, Chairman of Psychiatry and Behavioral Sciences at Staten Island University Hospital. He says, “… depression is a result of individual biological risk factors coupled with influences in the environment.”

That holds true for me. On the “nature” side, my paternal grandmother was always “anxious.” She used to “flip out” when her “judgmental” sisters-in-law from New York came to visit. (In my opinion, these ladies were a hoot! So prim and proper but with a wicked sense of humor.) In the 1980s, when Grandpa died, Grandma experienced severe depression. I remember her being admitted to Sinai Hospital’s psychiatric ward – Mt. Pleasant – for the usual 30-day stay.

Grandma was tough, however. She came from a generation where feelings were not discussed. You made your bed and you lie in it, so to speak. She probably made the staff, if you pardon the expression, “crazy” during her inpatient stay. Today’s psychotropic drugs – Zoloft, Prozac, Valium, Xanax, etc. – weren’t available. Nor could the staff easily slip her a little blue, white or whatever pill every morning with her orange juice.

Then, there’s the maternal side of my family. A few years ago, I spent time with my aunt in Arizona. As we reminisced about the family, she told a story about her oldest brother, Uncle A – the one in my world who was always cheerful, smiling and full of fun. He had a serious girlfriend in college. He was ready to propose. However, her parents said Uncle A was not good enough for their daughter, or something like that. She broke off their relationship. He came home, went into his room and stayed there for days if not weeks. He never married, either.

Uncle A was already deceased when my mom died. Her two remaining siblings, my aunt and Uncle B, did not come to Baltimore to sit shiva with us. Uncle B was honest enough to say that doing so would be too depressing for him. My aunt gave a lame excuse. I suspect had he been alive, Uncle A wouldn’t have come either.

As for the nurture piece of the puzzle, I think I may have suffered Post-Traumatic Stress Disorder (PTSD) as a child. Our family was on its way to Maine for vacation when the car hydroplaned; it spun around and slid off the highway into a ditch. The incident happened so fast; someone screamed; the driver’s door banged into a road sign. Fortunately, no one was injured. Eventually a tow truck pulled us out of the ditch, and we continued our trip. After the accident, I remember retreating into myself, unable to eat. The sight and smell of food made me nauseous. I constantly relived the accident in my head.

Anxiety and depression became a part of my life. I had stomach issues (still do at times!). I resisted learning to drive and did not until after college. Even now I prefer riding in the back seat during a road trip. Sitting in the front passenger seat is too anxiety-provoking. 

What is low-grade depression?

On her podcast Mrs. Obama said she thinks she has “low-grade depression.” According to Harvard Health Publishing, “a mood problem that’s down in the dark range, but doesn’t quite reach the level of depression, is dysthymia (dis-THIGH-me-ah). It refers to a long-term drone of low-grade depression that lasts for at least two years in adults or one year in children and teens. While not necessarily as crippling as major depression, its persistent hold can keep you from feeling good and interfere with your work, school, family and social life. Think of dysthymia as a dim gray compared to depression’s blackness.”

Dysthymia is chronic and can impact one’s life if not treated. Perhaps Mrs. Obama is just “feeling blue” and “down-in-the-dumps” as opposed to being dysthymic. Nevertheless, I commend her honesty on the subject. Remember when former First Lady Betty Ford announced she had breast cancer? Many women rushed to have the mammograms they were avoiding. Perhaps lives were saved. At the very least, some cancers were caught in their early and more treatable stages.

Thank you, Mrs. Obama, for bringing a discussion about depression out into the open.