What a miserable thing life is: you’re living in clover, only the clover isn’t good enough.
—Bertolt Brecht
When I first see someone who is alarmed by a prolonged period of low mood, I generally complete a full assessment. I find out about the person’s overall health, recent traumatic events, and life history and upbringing. I ask about each of the diagnostic criteria for the depressive disorders. A first appointment with me is something of a cross between a chat over tea and a CIA interrogation.
Toward the end of the session, I often shift gears. “William, I’d like you to imagine for a moment that we go outside and grab the next twelve people who pass by this building. We’re going to give them your life. Your sleep schedule. Your level of exercise. Your diet. Your amount of social contact. We’ll give them your job, your boss, your home, your family, your financial situation—everything. Twenty-four hours a day, we’ll have them live exactly the way you’ve been living recently. After a month we’ll come back and see how they’re doing. How do you think they’d be?”
William, a bit disoriented to discover that he’s consulting a madman, blinks a bit. Then—whether his name is William or Johanna or Kamal or Carmelita—the reply is almost always the same: “I think they’d be depressed.” Usually I agree.
Notice what I don’t do. I don’t give our abductees William’s childhood history or losses or any of the other factors that might be involved in the development of his low mood. I just give them the life he leads now. Usually that’s enough to make his present mood understandable. Sometimes I have to throw in, “And we’ll have them think the way you think.” At that point, he is all but certain to agree that the mood makes perfect sense. More often, however, giving our captives his behavior is enough.
Does this mean that none of those other causes of the low mood are relevant? Of course not. The near-drowning incident when he was eleven and the bullying he experienced all through high school are still with him. The divorce last year, his diabetes diagnosis, and the home invasion six months ago are profound influences. They will have to be dealt with. But they led him to adopt a way of living that now, alone, is sufficient to keep the fire burning. If all I do is focus on his history and ignore his current lifestyle, we will get nowhere. I will be fighting a forest fire by trying to track down the careless campers who started it—useful, perhaps, but insufficient.
If William is so displeased by his present mood, why does he not simply change his behavior? The answer lies in the interconnections between mood and impulse. As the mood darkens, the natural tendency is to withdraw and self-protect, conserving energy as we retreat into the depths of the cave to recover. William is doing what feels natural to him—so much so that it seems impossible for him to do anything else.
Causality, in this instance, travels in both directions. In order for our mood to become like William’s, we do not need the divorce, the bullying, the home invasion, or the diabetes. All we need is to adopt his lifestyle. Misery is not out of reach for even the most fortunate among us. Let’s consider ten of the most useful strategies.