Choosing Sadness: The Irony of Depression

I knew a man some years ago who suffered from serious and chronic depression. He also lived what seemed to me a melancholy life, listening to sad, sentimental music, reading dreary existential novels, and rarely venturing out of his dark and gloomy house. I cared for this man, and I was perplexed by this. I knew that he suffered from a debilitating disease, but he also didn’t seem to be taking simple steps that might lift his mood. It was almost like he was choosing sadness.

This seems like an ungenerous thought, I know, but it turns out there may be some truth to it. Hebrew University psychological scientist Maya Tamir and her colleagues have been studying how people with depression regulate their emotions, and they may have an explanation for my acquaintance’s paradoxical and forlorn lifestyle choices.

Emotional regulation is the process of changing one’s current emotions into more desirable ones. We all do it all the time. It’s well known and not all that surprising that depressed people have difficulty with emotion regulation, but Tamir believes that we have been looking at emotion dysregulation the wrong way. Specifically, we’ve been assuming that depression is linked to deficits in regulation strategies, when in fact the problem may have to do with regulation goals.

The distinction between strategies and goals is crucial. Some strategies are adaptive and others not. For example, cognitive reappraisal is a healthy strategy for most people, one that involves rethinking and changing the meaning of situations so that they generate different emotions. Situation selection is another—choosing positive stimuli like movies and music. Rumination, very common in depression, is an example of a maladaptive regulation strategy. There is some evidence that depressed people use maladaptive strategies, but Tamir thinks that focusing on the effectiveness of emotional regulation may be missing the point.

The problem may be more basic. It may instead be that depressed people are choosing the wrong emotion regulation goal to begin with. That is, depressed people may be effective enough in regulating their emotions, but they may be choosing to regulate in a direction that reinforces their negative mood. This raises the possibility that depressed people are actually more motivated to experience unpleasant emotions like sadness, as strange as this sounds.

Tamir and her colleagues tested this provocative idea is a few experiments. In one, for example, they asked depressed and healthy subjects to choose between looking at sad pictures or amusing ones (or neutral ones). So all the subjects were using the same stimuli selection strategy, but the depressed subjects still chose significantly more of the sad images—even though they clearly had the option of avoiding them. In a second similar study, subjects chose music, and again depressed subjects chose to listen to sad tunes more often than healthy controls did, even when upbeat music was available. Finally, even when depressed subjects were explicitly trained to reappraise situations in more positive ways, they chose not to use the strategy as often as healthy controls.

So across studies, as reported in a forthcoming issue of the journal Psychological Science, depressed subjects clearly chose to engage with stimuli that caused them moderate to intense sadness. The findings show that depressed individuals, compared to healthy controls, regulate their emotions in a manner that is likely to maintain sadness. But they did not choose to decrease happiness. They chose more happy images than sad images, and what’s more, they said they preferred happiness to sadness.

So why, if they prefer happiness, would they deliberately choose regulatory goals that undermine that happiness? One possibility, the scientists say, is that depressed people use emotion regulation to verify their emotional selves. In other words, sadness is more familiar to depressed people, so they are motivated to experience sadness as a way of reaffirming who they are. Depression is also closely tied to low self-esteem, and it may be that depressed people believe that they deserve to feel bad.

My depressed friend wanted relief from his misery, sometimes desperately. He struggled, yet ironically, he often acted in ways that maintained—rather than alleviated—his misery. Apparently he’s not alone in this sad choice.

Follow Wray Herbert’s reporting on psychological science in The Huffington Post and on Twitter at @wrayherbert.