Depression, Anxiety, and Choice

People who suffer from depression often share a common characteristic that might not be obvious: a sense of loss. You don’t actually have to lose something to suffer from a sense of loss. To be sure, many mourn real losses, but many also mourn potential losses. We look at where we are in life and become sad at where we are not. A universe of possibilities exist and most seem better than the one we find ourselves in currently. So we mourn the loss of a thing we never had in the first place, but maybe now imagine we should possess. We mourn the potential but unpossessed and we mourn the unrealized aspiration.

In the general case, depression is a feeling of not having something once possessed or something never possessed but often desired. This latter feeling is made worse by the act of comparing one’s condition or status to that of others; in other words, the grass is seemingly always greener on the other side.
Anxiety, on the other hand, comes from being overwhelmed by choice. Faced with numerous choices, we struggle with which choice is the best (and usually this internal conflict is unnecessary). Society promotes such angst. Society promotes such comparisons. Society promotes greed and avarice and discontent. In modern life, we are seldom faced with only one option; if we are (and it is clear that there is only one option), anxiety is removed and we march ahead even if the one option is a bad one. We might not be happy about it, but we do so because there is no choice. In other words, unhappiness is not as much related to our station in life (depression and suicide was definitely at peak highs during the Great Depression), but it is more related to the feeling that we are the cause of our station in life. So with few choices we have few regrets.

But life is scarcely that simple.

Imagine going to the store. Every aisle is filled with dozens of products that are in essence all the same. You want peanut butter, but the peanut butter aisle provides literally dozens of choices in some stores. Why? Because different peanut butter companies all want your money. Each, according to them, is surely the best. Buy the wrong one and you’ll regret it. This is a metaphor for modern life.
All choices, even good ones, are soon questioned. Could I have a made a better decision? What past decisions are responsible for my current state (which by comparison to other people’s lives, seems bad)? Where did I go wrong? Soon a track record of seemingly “bad” decisions (which aren’t necessarily bad, just constantly in question given this choice-angst) leads us to a feeling of loss of our potentially better lives. What have I lost out on by not making another decision previously? How many poor decisions are the difference between where I am and where I think I ought to be?

In this way there is a connection between depression and anxiety. Modernity enhances this problem with too much choice. Advertisers use the best psychological tools available to convince us that we have made a poor decision and that we should make a different one. We are forced to constantly question every decision, thus losing confidence in our abilities to make even the most basic decisions. Even if we live an idyllic life, we often lose confidence that it is the right life. The grass is always greener on the other side, no matter how green the grass is that we are standing on.

By many measures, life today should be better than ever in modern society. We live longer, healthier lives. We have historically few people living in poverty or going to bed hungry. We have the highest standard of living, across all economic spectrums and in all countries of the world, that has ever existed. Virtually anything you want is a few clicks away. You can have delivered to your home almost everything imaginable the next day, at a lower cost than ever before. You can listen to any song or watch any movie or read almost any book ever written in mere seconds. Crime is near historic lows. You have more contact with the world and the people in it, less barriers between companionship, more civility, more access to travel, more leisure time, and greater availability of social services and safety nets than at any time in history.

Yet, rates of suicide, depression and anxiety are all rising and are at historic highs (for as long as we have good data). People are unhappier today than ever. Drug addition and abuse rates are soaring. (Suicide rates peaked at 22/100k during the Great Depression, but apart from that small outlier, rates are otherwise at historic highs and rising consistently).



Depression and anxiety are particularly prevalent among women. Our estimates of rates of depression and anxiety among women are consistently rising and are at all time highs (that’s just women who seek treatment, and, given the stigma associated with mental health disorders, it stands to reason that most women with depression don’t seek treatment). Again, this is occurring at a time when women have external factors that should make them happier than ever – the greatest equality ever enjoyed by women, more wealth, more work, etc.

So why the disconnect?

First, the very presence of choice in our every day lives creates unnecessary anxiety. Choice is the angst of modernity. Too many choices paralyze us with indecision. We think too much about the consequences of every decision, not realizing that many of the choices are false choices (like the choices of peanut butter) and most of the choices are just irrelevant or inconsequential. If you spend more than 20 minutes thinking about what car you’re going to buy, you’ve probably spent too much time. The course of your life is not dependent upon which shade of blue paint you choose or whether you have leather or not. But marketers prey on us and create false choice and scare us with the consequences of bad decisions. Women are preyed on more than men in this regard, since they make more of the financial decisions as compared to men.

We have more choices today and therefore more anxiety. A new mother wants the very best for her baby. She has the ability to spend countless hours “researching” the best options for her pregnancy and her newborn. An almost endless cadre of salesmen are at her service to create fear and pseudo-problems, and then offer a solution. Should I get an epidural or not? Should I get a breast pump or not? Should I have my baby in the hospital or not? Should I drink caffeine while I’m pregnant or not? Should I take a fish oil supplement or not? Should I jump on a trampoline or not? Should I feed my baby all organic food or not? Should I vaccinate my baby or not? What will happen if I can’t breastfeed? What if I have to have a cesarean? What if I have to get antibiotics? How do all these and thousands of other little choices affect the life of my child and her future development? Will I cause my baby to get autism? Is my baby not going to be as smart as other kids because I bought the cheap prenatal vitamins? All this at a time when maternal and neonatal outcomes are not just better, but dramatically better, than ever before.

I could go on for days. Most of these questions have obvious and easy decisions (Should I cut my hand off or not?). It was anxiety provoking just to write those questions, let alone live like that. This endless stream of meaningless questions preoccupies the minds of the modern woman, not just about childbirth but about nearly every facet of life. Television programs and web content specialize in creating drama. Most women believe that the modern world is fundamentally unsafe for children, for example; that they can never send a child outside to play for fear of kidnapping. Yet that type of violence towards children is at historic lows. But modern media specializes in presenting these types of stories almost daily because people watch them and they create a sense of the world that doesn’t actually exist.

Paralyzed by such indecision, and in fear that a (meaningless) choice will be all the difference in their lives, men and women blame perceived future failures on some prior bad decision. They soon convince themselves that they are inadequate at making good decisions, and the cycle is reinforced. Self-efficacy decreases and the paralysis and a low sense of self-worth and self-esteem takes over.

Faced with enough such failures, depression is nearly inevitable. Hallmark features of depression include helplessness, hopelessness, and guilt. Helplessness invades the minds of those who are convinced of their own inadequacies and inability to live and thrive in the modern world. Hopelessness is a learned mindset that besets a person who feels as if every step and every action is failure, i.e., they always make the wrong choice. Guilt is the result of blaming yourself for your perceived negative condition due to your own bad choices.

We are taught as children today that failure is not an option; for example, grades must be perfect – one slip up and your whole life can be ruined. This is fantastic nonsense. But it promotes the feeling that every decision is more important than ever before, and in a world with so many decisions to make and so many things to choose from, how can we ever make the right choices?

Were people happier 150 years ago? Yes. The reasons I am sure are complex but certainly this was due in large part to fewer choices. Having no choice isn’t great either, but having too many choices is overwhelming.

The second reason for the disconnect between how people feel and how people actually are today is that people are told, more than ever, that their lives are bad or that they are victims of society. Doctors do tests on people that promote anxiety through false positives (and make money in the process); the result is that everyone feels like they are dying of something. Politicians tell people that they are victims of some systemic bias or some other stacked-against-you system and that only that politician can help you (you can’t help yourself); this results in feelings of dependency, victimhood, and low self-efficacy. Insurance salesmen scare people into all the what-ifs of the world. Conmen convince people that every substance causes cancer (except theirs). The world is a scary, unjust place with saviors at every corner waiting to offer you help because you can’t help yourself.

Except it’s not a scary place. But this fear-mongering and victimhood promotion is the cause of the feelings of hopelessness and helplessness that beset modern life.

It’s liberating to know that our choices are just not that important; and even more liberating to know that usually even if we make a bad choice we can try again and do it differently the next time. This, of course, is not to say that all choices are inconsequential; but the more consequential the choice, the easier the decision. We don’t usually struggle or have anxiety over meaningful choices. Most people aren’t burdened with the decision of whether to put arsenic or sugar in their coffee; but the choice between Nutrasweet and Splenda is the subject of modern angst and decision paralysis. Where there is clarity, there is no decision. Most of us aren’t forced to decide between a $100,000 car and a $20,000 car; the decision is made for us by our paychecks. But choosing between Honda and Toyota drives us crazy.

The point is that hard questions answer themselves. Don’t sweat the small stuff, and almost everything is small stuff.

Modern society teaches us that we are nothing without goals. We plan for our retirement at age 20; we plan our careers in middle school; we are made to feel that every step is mission critical. We don’t let life happen and make the most of our circumstances; rather, we feel like we must game the system or fail. General goals are great, of course; do well in middle school and high school and college will probably follow. Do well in college and a good career hopefully will fall into place. But to teach a 12 year old that she can plan where specifically she will be in life in 20 years is a set-up for failure and the negative feelings associated therewith.

I’m not good at making goals. It’s a weakness of mine. Maybe it comes from also being afraid of the conclusion and the inevitable question, What next? What happens when goals are met but we are still unhappy? We are made to believe that if we “succeed” as defined by accomplishing certain goals, then we will be happy. We are taught that happiness is avoidance of pain and struggle and the pursuit of pleasure. But perhaps the journey is its own reward.

Perhaps happiness arises through strife and struggle. Maybe the daily victories over adversity better promote happiness and self-efficacy than does the complacency of “arrival.”

The things that really define our lives like marriage, childbirth, schools, jobs, etc. are not something that can really be planned. They are not goals that we should design plans for and count on being happy once we get there. Happiness is not a destination somewhere in the future; it’s here and now or it’s never.

These brief punctuations that transform our lives, like marriage or childbirth, graduation from school or a new job – these in fact are not transformations, but signposts on a long journey whose end in actuality is death. I don’t know where the road goes and I don’t think that I want to know. I don’t even really have a preference. Not having a preference makes one less likely to be continually disappointed.

When I look back over the journey so far, I am awestruck at the seeming randomness of certain key but often trivial events which have put me where I am today. Would I have met my wife if I had gone to a different high school? If I hadn’t gone on that field trip with her, would we have ever even had a meaningful conversation that led to a relationship? In fact, a lot of small, inconsequential decisions in our lives add up to the particular way the script has been written, but there was no particularly compelling reasons for any of those decisions to be made the way they were at the time. There was no master plan. At the time, I would have been happy with any of the many alternative paths that were presented to me and I can’t even remember why I made whatever decisions I made at the time. In retrospect, all of those meaningless and trivial decisions were more important to my life than the type of peanut butter I eat (Peter Pan) or whether my car has heated seats (it doesn’t).

So it’s not that our decisions are inconsequential; indeed, the stories of our lives remind us of how both consequential our every small decision truly is but also how marvelously unprepared we are to make any of them.` Decisions are easy and obvious in retrospect but impossible to estimate prospectively. So I learned not to worry about what appear to be major life decisions because they are really no more important than the choice of where I eat lunch today, which has the power to be one the most important and transformative events in my life, or perhaps just a tasty meal.

Don’t give into the fear-mongering that is stock and trade of those who would like to exploit you. Cancer is scary; there’s almost nothing you can do to prevent it. If you smoke, stop. Otherwise, don’t freak out about it; if it happens, you’ll deal with it and whatever the outcome is you’ll be ready. Replace the word cancer with anything else you worry about and smoking with any other obvious stupid decision you make related to that and repeat. The formula is really simple.

Less choice means less decision. Less decisions mean less anxiety. Less anxiety means less depression. Make the important and obvious decisions without thought and without regret. Flip a coin for the rest.