Jerome Kagan: the best predictor of depression is being poor
I'm a great fan of Professor Jerome Kagan, the eminent Harvard psychologist, who has done important work on the role of the amygdala in emotional disorders like social anxiety. I admire his humane appreciation for both the sciences and the humanities, and his awareness of psychology and psychiatry's dangerous tendency to ignore the role of culture, values, language and context in human emotional experience.
Kagan, considered one of the finest psychologists ever, is clearly deeply concerned about the direction of western intellectual life, and in particular about "the dramatic ascent of the natural sciences in the years following World War 2, which intimidated the other two scholarly communities" - ie the social sciences and the humanities. He feels we in the West have become out of balance, overly fixated on a biologically materialist view of the human condition, with serious consequences for our societies.
He expresses his concerns about our culture's tendency to simplistic scientific materialism in his new book, Psychology's Ghosts, which he discussed last month on Radio Boston. He said that psychology and psychiatry focus too much on the symptoms of emotional problems, while ignoring the causes - and, in particular, ignoring the cause of poverty:
If you think about all the physical diseases, they are diagnosed not by the symptoms you tell your doctor, but by the cause. Malaria means not that you have a fever but that you have the malarial parasite. Psychiatry is the only sub-discipline in medicine where the diagnoses are only based on the symptoms. You tell your doctor you can’t sleep and you have no energy and he says that you’re depressed. You’re treated for depression on the basis of your symptoms when your depression could come on for a half a dozen different reasons and the reasons are important in how you treat the patient.
There is inadequate research being done on the life history causes. In medicine, if you have a disease, immediately several hundred or a thousand investigators start at once — take AIDS — to find out what was the cause. There is very little research going on on the role of class, on the role of life history, on the role of who you identified with, your religious identification, your ethnic identification. In other words, there’s a whole complex set of causes; they are not being studied.
The problem is that biology made extraordinary advances, both in genetics and in ways to measure the brain. Because that technology is available, people rushed over to that side and hoped that that would solve the problem, abandoning the other half. To put it briefly, biology says you’re likely to be vulnerable to this envelope of illnesses. Your environment, your setting, your class, your culture, where you live disposes and selects from that envelope the symptoms you might develop.
As I read the literature, and I have many people on my side — the best predictor today in Europe or North America of who will be depressed is not a gene and it’s not a measure of your brain; it’s whether you’re poor. And that makes sense.
If, in a country like ours with an enormous range of income, you’re poor and you’ve been poor since you were a child, which means that your medical care is less adequate, your diet’s less adequate, you’re probably fighting some low level infections and you’re poor — that’s a pretty good reason to be depressed.
That then is taken out because we’re looking for the genes. Now, in fact, there probably is 10 percent of depressed who do have a specific genetic vulnerability and then we’re missing the 80 percent who don’t have a specific genetic vulnerability — they have a very good reason for being depressed [...]
We’re hoping that we will discover the biological causes and treat the biological causes and we won’t have to worry about the societal causes and the individual lifestyle circumstances that people deal with. That’s the hope. My own view — and I’m not alone — is that is denying the problem.
He also has another go at the 'politics of happiness' for its reductionism and scientific and cultural crudeness, singling out a book called The Politics of Happiness by his old provost of Harvard, Derek Bok:
I read this excellent book by President Bok which was called "The Politics of Happiness”. He was summarizing a large body of research; right now and in the last decade hundreds of investigators have been asking people from almost every country in the world, “How satisfied are you with your life?” And they’re writing up that some societies are good and some societies are bad.
But my problem with that is that there are many reasons why a person in Ghana and a person in Los Angeles would give you the same answer. Your answer to the question “How satisfied are you with your life?” is a function of four conditions:
- Temperament: Some people have wonderful temperaments; nothing bothers them.
- Values: What values did you set up as a child that you had to meet? If you set high values, you’re not going to be happy. And if you set easy values, you’re going to be happy.
- Comparison: Who are you comparing yourself with? If you’re in Los Angeles — who are you comparing yourself with when you say, “I have a pretty good life.”
- Country: What country are you in? If you’re in Denmark, you say, “I’ve had a wonderful life!” Denmark’s the best country in the world. If the Danes don’t change anything in Denmark but now let the Danes know they’re 25th in the world (there are 24 countries better than they) suddenly every Dane will say, “I’m not very satisfied with my life.”
So we have four factors. Those combinations change across the world. So I don’t know what the statement means when someone in Ghana, Cairo, or Los Angeles, “You know, I’m pretty satisfied with my life.”
Good psychology, in other words, needs to become much more culturally aware, more aware of words and the different ways people use them. Kagan says:
Let’s take the field of personality. Right now we have terms like introvert, extrovert, shy, anxious. Notice those words are naked. They don’t say with whom you’re introverted, when you’re introverted in what settings you’re introverted. In other languages — take Japanese for example. There’s no word for “leader” in Japanese. There’s only a word for leader of a corporation, leader of a radio station, leader of a platoon. Because they understand that a person who’s a good leader of a radio station might be a lousy leader of a platoon. And the same thing for extroversion, introversion, shyness.
And that’s a problem with the English language. And the problem is that 80 percent of research on personality is done by Americans using the English language. The English language is a very bad language for talking about personality because it doesn’t tell you the context, the setting, with whom you are where this trait might be expressed.
He seems to be arguing, much as Harvard's Jerome Bruner did in Acts of Meaning, that psychology and psychiatry needs to find a proper balance with the social sciences' and the humanities' sensitivity to culture, language, ethics and economics.
In his previous book, The Three Cultures: Natural Sciences, Social Sciences and the Humanities, Kagan likewise suggested western intellectual life has become out of balance, with the natural sciences overly dominating at the cost of the humanities and social sciences. In an interview with ROROTOKO magazine, he said:
The Three Cultures compares the premises, vocabulary, sources of evidence, contributions, and limitations of the research, scholarship, and theories of natural scientists, social scientists, and humanists. The contributions of the natural sciences, which include better health, longevity, and labor-saving devices, have [over the last 100 years] persuaded the public and the media that natural scientists are entitled to a special status and that judicial, legislative, and even some personal decisions, should be based on factual evidence affirmed by the studies of these intellectuals. This view is seriously flawed.
Biologists have established beyond doubt that all male primates, including humans, are naturally sexually promiscuous. But few communities are ready to remove moral and legal sanctions on a man who impregnates a woman who is not his legal spouse. That decision rests on a moral belief – and it is not foolish though it flouts the scientific facts. [...]
Every democracy requires an opposition party to prevent one temporarily in power from becoming despotic. And every society needs a cohort of intellectuals to check the dominance of a single perspective when its ideological hand becomes too heavy. The first cohort of natural scientists, especially Kepler, Galileo, Bacon, and Newton, assumed this responsibility when Christian philosophy dominated European thought and their work catalyzed the Enlightenment. However, following three centuries of increasing secular power, natural scientists have become members of the entrenched establishment.
This new arrangement leaves writers, poets, philosophers, historians, and social scientists as the loyal opposition against a materialistic determinism that exaggerates the influence of genes and neurochemistry on human behavior and minimizes the influence of culture, values, and the historical moment on the meanings of words, the sources of uncertainty, and each person’s attempt to render their life coherent.
Well put Professor Kagan.