Could Depression Have an Upside?

憂鬱也有益處？別信的好！

By Richard A. Friedman, M.D.

It’s popular these days to view human behavior through the lens of evolutionary biology. What survival advantages, researchers ask, may lie hidden in our actions?
從演化生物學的角度檢視人類的行為，當下正夯。研究人員要問的是，我們的行為當中究竟隱含哪些有利於生存的優勢？

Depression has come in for particular scrutiny. Some evolutionary psychologists think it conceals something positive.
憂鬱（沮喪）受到特別嚴格的檢視。部分演化心理學家認為，它隱含正面意義。

Certain studies might seem to support this perspective. Paul W. Andrews, a psychologist at Virginia Commonwealth University, reported that normal subjects get sadder while trying to solve a demanding spatial pattern recognition test, suggesting that something about sadness might improve analytical reasoning.
一些研究似可佐證這種見解。維吉尼亞聯邦大學心理學家安德魯斯說，在接受困難的立體圖案認知能力測驗時，一般的實驗對象往往會變得比較憂傷，顯示這種心理狀態或許可以提高分析推理的能力。

Joseph P. Forgas, a psychologist at the University of New South Wales in Australia, found that sad subjects were better judges of deception than happy ones. After subjects were shown a video intended to induce a happy or a sad mood, Dr. Forgas had them view deceptive or truthful interviews with people who denied committing a theft. Subjects in a sad mood were more skeptical and more accurate in detecting deceptive communication, while subjects in a positive mood were far more trusting and gullible.
澳洲新南威爾斯大學心理學家傅賈斯發現，憂傷的實驗對象比快樂的更善於察覺欺騙行為。他首先讓這兩組志願者觀看一段影片，以製造快樂或憂傷的情緒，接著讓他們收看否認有偷竊行為者接受面談時，或說真話或說謊的錄影。憂傷者比較容易懷疑，也更能準確察覺欺瞞的回答。心情愉快者則遠較前者容易相信人和受騙。

Findings like these may suggest some benefits to sadness, but lately they have been generalized to patients with full-blown depression. For example, Dr. Andrews and Dr. J. Anderson Thomson Jr., a psychiatrist at the University of Virginia, have proposed that the rumination of depressives is an adaptive strategy to solve a painful problem.
此類研究結果可能意味憂傷也有些好處，不過學術界最近把它們推論到重度憂鬱症病人的身上。例如，安德魯斯與維吉尼亞大學精神病學家湯森就認為，憂鬱症患者的反覆沉思是解決痛苦問題的調適性策略。

But the subjects in the above studies were normal controls whose moods were manipulated to be transiently sad. They do not really resemble people with clinical depression, whose condition can last months or even years.
然而上述實驗的志願者都屬於情緒受到操控，進入短暫憂傷狀態的正常控制組，有異於症狀可能持續數月甚至數年的臨床憂鬱症病患。

Indeed, as Dr. Forgas said by e-mail, “I never worked with depressives, and I do not think that the experiments we have done looking at mood effects on cognitive processes in normal populations experiencing minor, everyday mood differences can be readily generalized to depressive cognition.”
誠如傅賈斯透過電子郵件所說的：「我從未與憂鬱症患者共同工作，我們對日常情緒出現輕微差異的一般人所做的情緒影響認知實驗結果，我認為不能予以概念化，直接套用在憂鬱症患者的認知上。」

Under close scrutiny, the case for depression’s adaptive benefits has problems – big ones. For one thing, the ruminative thinking of depression is often not particularly effective in solving problems. As another patient of mine once said: “I would think the same things over and over and could never decide what to do. It’s not a creative way of thinking.”
嚴密檢視下，憂鬱的調適益處有了問題，而且問題很大。例如，憂鬱狀態下的反覆沉思通常對解決問題並不特別管用。本文作者的一名病人曾經說：「我會反覆思索同樣的事，卻總不知如何是好。這不是創造性的思考方式。」

More critically, depression can arise without any psychosocial stressor at all, which makes it hard to argue that depression is a response to a difficult situation or problem. Dr. David J. Kupfer, a psychiatrist at the University of Pittsburgh, has found that a major life stressor almost always precedes a first episode of depression, but that episodes recur with milder stressors, or even none at all. If depression conferred a problem-solving benefit, it should not become a chronic or autonomous condition.
更重要的是，憂鬱可能在社會心理壓力因素完全不存在的情況下出現，因此很難說它是對困難局面或問題的反應。匹茲堡大學精神病學家卡普福發現，憂鬱首次發作之前幾乎總有重大的生活壓力因素出現，然而其後憂鬱症卻會在碰到較小的壓力，甚至毫無壓力時復發。憂鬱若有助於解決問題，不該成為慢性或自發的情況。

According to the World Health Organization, depression is the leading cause of disability and the fourth leading contributor to the global burden of disease. Add the fact that 2 percent to 12 percent of depressed people eventually commit suicide, and the “advantages” of depression suddenly don’t look so good.
世衛組織聲稱，憂鬱症是導致失能的主因，也是全球疾病負擔的第四大構成要素。若再加上2%到12%的憂鬱症病患最終會自殺這個事實，憂鬱的「好處」頓時變得不那麼美好了。

Why, then, does the notion persist that depression confers special insights and benefits?
那麼，為何有人認為憂鬱可以帶給人特別的洞察力及好處？

I got a clue recently from one depressed patient. He was an educated and articulate young man who, after he had recovered, speculated that his newfound cheerfulness was not his authentic self, which he described as brooding and creative.
本文作者最近從一名憂鬱症患者身上得到線索。他是受過良好教育且善於表達的年輕人，康復後認為，他新出現的愉快開朗並非真正的自我。他自認比較傾向於沉思與創造。

This may explain why depression is increasingly romanticized. What is natural, the thinking goes, is best. If we are designed to suffer depression in response to life’s ills, there must be a good reason for it, and we should allow it to take its painful and natural course.
這或可解釋何以憂鬱越來越被人們浪漫化。這一派的想法是，自然的就是最好的。如果面對生命逆境即陷入憂鬱是人類的天性，個中定有道理。我們應該讓它痛苦而自然的發展。

But unlike ordinary sadness, the natural course of depression can be devastating and lethal. And while sadness is useful, clinical depression signals a failure to adapt to stress or loss, because it impairs a person’s ability to solve the very dilemmas that triggered it.
然而憂鬱不同於一般的憂傷，它的自然發展可能具有毀滅性與致命性。憂傷誠然有用，臨床憂鬱症卻意味無法適應壓力或損失，因為它會影響我們解決問題的能力，而這些問題正是憂鬱出現的原因。

Even if depression is “natural” and evolved from an emotional state that might once have given us some advantage, that doesn’t make it any more desirable than other maladies. Nature offers us cancer, infections and heart disease, which we happily avoid and do our best to treat. Depression is no different.
即使憂鬱「自然」發生，而且源於可能曾對我們有些好處的情緒狀態，也不足以使它比其他疾病更受歡迎。大自然給我們癌症、各種傳染病與心臟疾病；我們都避之猶恐不及並盡力治療。憂鬱沒什麼不同。

原文參照：
http://www.nytimes.com/2012/01/17/health/depression-defies-rush-to-find-evolutionary-upside.html

2012-02-21聯合報/G5版/UNITEDDAILYNEWS 陳世欽譯 原文參見紐時週報十一版左