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Stanford Report, May 22, 2002

No more tears


People who are depressed cry no more than those who aren't, study finds

BY LISA TREI

Depression evokes powerful images of sadness and despair that are often expressed by tears. But common lore that depressed people cry more than those who are not depressed may be wrong, a new study indicates.

The findings, which show how the emotions of depressed people become blunted, could lead to more effective ways to treat the common mental illness.

Jonathan Rottenberg, a fifth-year graduate student in psychology, sat in the room where volunteers viewed an often tear-jerking movie clip. The volunteers were monitored for how much they cried and how sad they looked. Photo: L.A. Cicero

According to research led by Jonathan Rottenberg, a fifth-year graduate student in psychology, depressed men and women are no more likely to cry than non-depressed people when they watch a tear-jerking movie clip. Furthermore, according to results published this month in the Journal of Abnormal Psychology, people depressed for six months and longer are even less likely to cry than short-term sufferers.

Psychology Associate Professor James Gross, a study co-author, said the results show that a depressed person's emotions may be misaligned. "It's as though crying is no longer able to coordinate the body and mind as it does for people who are not depressed," he said. "I think that has profound significance for how we as a society conceptualize and even treat depression."

Rottenberg said the study is an early effort to better define the emotional disturbances at the core of depression. "By figuring that out, we can begin to think about how we might better fix what's broken and design treatments that are more effective than the ones we currently have," he said.

Depression afflicts one in five people during the course of a lifetime. Average bouts last six months, but the ailment can turn into a chronic illness. "Depression has devastating costs for society," Rottenberg said. "It costs people their jobs, costs people their marriages and, in all too many cases, it costs people their lives."

The fact that depression is so common may be one reason why so little empirical research on the subject exists, Gross explained.

"We think we know about it because we've all been a little bit sad or anxious," he said. "When we get a little bit sad we cry a little bit. When we get more sad we cry even more. So, intuitively, when we get really, really sad, as in depression, we cry a lot. But what do we really know? What is really going on in the brain?"

Personal intuition about depression may also discourage society from treating mental and physical health equally, Gross said. Unlike an ailment such as cardiovascular disease, people may think they already know everything about depression because they have experienced it firsthand.

"What [Rottenberg] is finding out in this paper is that a lot of what we think is wrong," Gross said. "That is critical because as the public begins to better understand that we can't rely on intuitions, they'll understand that we have to actually do science if we want to make advances in understanding psychopathology and, more broadly, understanding processes that govern everyday social interactions."

The study

The researchers studied 48 women and 23 men with major depression and 24 women and 9 men with no psychiatric problems. Volunteers sat alone in a small, comfortably furnished room and watched a one-minute film of coastal landscape scenery on a television. The neutral film was used as a baseline for the second clip, which was taken from the 1979 film The Champ, directed by Franco Zeffirelli. The three-minute scene shows a young boy learning about the death of his father; he reacts first with disbelief and then becomes increasingly inconsolable.

Researchers monitored participants for how much they cried and how sad they looked. They also measured bodily changes such as heart and breathing rates, the sweatiness of their palms and whether their bodies moved.

The results

About one-fifth of the volunteers cried during the sad film, whether or not they were depressed. Contrary to expectations, bouts of crying did not begin sooner or last longer in the depressed group. Criers who were depressed also reported feeling less sad than nondepressed criers. Both depressed and non-depressed women cried far more often than men did after watching the sad film. Only one man -- who was not depressed -- cried during The Champ.

"That's a bit of a mystery to us," Gross said. "We really think that crying ... has a powerful biological basis. But the fact that men and women [reacted] in such different ways to me suggests that these biological processes take place in a larger cultural context."

In this country, Gross said, young boys and girls do not differ in how much and how often they cry. But significant differences emerge by early adulthood. "Men are seven times less likely to cry than women in our culture," he said. "Who as a boy hasn't heard, 'Don't cry, you're such a sissy.'" Further research is needed to explore these findings in relation to depression, he added.

Volunteers who cried in the non-depressed group rated themselves as sadder while watching The Champ clip than those who did not cry. They also showed sadder facial expressions and experienced major physical changes as their heart rates increased and the palms of their hands sweated. In contrast, crying among the depressed participants had little effect on the ratings that gauged sadness, including facial grimacing and other bodily responses.

Furthermore, the study found that crying sharply declined among women who had been depressed for six months or longer. Only 7 of 28 of this group cried, compared with 10 of 19 women who had been depressed for a shorter period. "Those individuals who had been depressed the longest were the least likely to cry," the authors wrote.

Rottenberg said the chronically depressed might cry less over time because crying often occurs when someone is distressed and wants help from other people. "We know that depressed people have fairly serious disturbances in their social functioning," he said. "They lose friends over time and have problems in marital functioning. One possible interpretation is that the crying behavior is dying away because it's no longer effective in bringing help from other people."

In a related study that will be published this fall in the journal Psychophysiology, Rottenberg looked at bodily changes that occurred after crying episodes. Nondepressed people appeared to recover rapidly from the effects of crying, whereas depressed people did not. "This might mean that depressed people don't have the ability to right themselves once the crying response gets under way," he said. "Essentially, the person has become less flexible -- the person is stuck."

Ordinarily, when someone has a bad day, he or she goes to bed and wakes up feeling better, Rottenberg said. "Nothing has happened -- you just went to sleep," he said. "But something has happened inside of you that enables you to wake up in a completely different state of mind. It seems pretty clear that this does not happen [during] episodes of depression. You have people who have strung together bad days for months. The normal braking mechanism that allows someone to recover, physiologically or otherwise, is not working."

Study implications

Rottenberg and his colleagues hope their findings will help correct popular misconceptions about depression and promote more effective treatments. "I think our work is at the beginning of a wave," he said. "When we really peel back and look at what we do know about how emotions are disordered in depression, it's pretty humbling."

The study also has broader implications for understanding human behavior, Rottenberg said. "We looked at one response, in one context," he said, referring to the study. "There are many other kinds of responses to look at, such as laughing, which is another rich and important social behavior. Just as we use crying to learn a piece of the puzzle about how emotions are broken in depression, we can use other behaviors that we are starting to know more about to understand other aspects of the puzzle."

Rottenberg said he loves to study crying. "It's uniquely human," he said. "It has a very powerful impact on us socially. It marks very significant things. But at the same time it's quite mysterious. We're just beginning to learn the physiology and psychology of this behavior."

"Crying Threshold and Intensity in Major Depressive Disorder" is published this month in the Journal of Abnormal Psychology. Its co-authors are Rottenberg; Gross; Frank H. Wilhelm, senior research scholar in the Department of Psychiatry and Behavioral Sciences; graduate student Sadia Najmi; and psychology Professor Ian H. Gotlib.