Samantha Osani

Seasonal Affective Disorder from an Anthropological Perspective:

A Cross-Cultural Examination
Samantha Osani
Anthropology Capstone
Anth423
Jeffrey Snodgrass
Fall 2013

ABSTRACT
This paper examines seasonal affective disorder (SAD) through the lens of biological and
cultural anthropology, using several cultures to determine variation within the illness. Seasonal
affective disorder is a sub-category of depression in which the patient experiences oversleeping,
overeating, drastic mood changes, weight gain, carbohydrate cravings and more in response to a
change in climate, temperature, and/or amount of light. SAD has been part of the psychology
field since the 1980s, but it could have existed in human biology for much longer. Evolutionary
adaptations and genetics are taken into consideration when evaluating the origins of the illness.
Outside of biological and psychological perspectives, SAD is considered to be an evolutionary
response to cold weather, in which a person would hibernate (as other animals do) in order to
preserve energy, protect oneself from the elements and predators, and to improve chances of
reproduction and survival. Culture shapes SAD through the use of societal messages and social
expectations, and the way psychology projects its knowledge onto the public. It is also shaped by
the way each individual culture perceives mental illness. Cultural anthropology argues against
modern psychology, being in favor of evolutionary and sociocultural theories rather than
biomedical ones.

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INTRODUCTION

On a global scale, humans succumb to various forms of suffering, mental and

physical alike. Depression is a commonly acknowledged and experienced mental

affliction in the world of Western medicine, though it presents itself in a number of ways.

Seasonal Affective Disorder – henceforth abbreviated as SAD – is a subcategory of

depression, in which the patient becomes depressed during colder, darker seasons. It can

also happen during the summer, though the frequency of those cases is significantly

lower (APA DSM-IV 2000:389). Biologically, it can be related to temperature of the

environment, hours of sunlight during the day, and decreased levels of important

hormones. But our knowledge of SAD is influenced by “Western assumptions about the

mind and body” (Tsai 2002), and is therefore limited. Depression and other similar

afflictions vary across cultures, depending on whether or not a specific culture is

influenced by Western knowledge.

Ethan Watters’ book Crazy Like Us details the infiltration of Western mental

illnesses across cultures, showing that the culture of countries such as Japan and China

did not have prior concepts of these illnesses (Watters 2010). Western medicine has

neglected to acknowledge the fact that each culture defines their perception of mental

illnesses, and that this influences the diseases themselves. This book largely influenced

one hypothesis of this paper: is SAD strictly a biological phenomenon, or is it also a

product of culture? Could a component of SAD be influenced by Western psychiatry

infiltrating other cultures? Watters’ theory that we are, as a culture, “homogenizing”

mental illness is something this paper intends to question. Through the use of research, I

set out to determine whether or not SAD is influenced by culture, just as depression and

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other mental illnesses are. Are sufferers of SAD responding in an evolutionary way, or

could they also be merely influenced by social messages and cultural ideals? Would SAD

exist without psychological knowledge or cultural expectations? As Watters stated:

different cultures interpret ideas in different ways. Based on this concept, a cross-cultural

comparison of SAD should reveal the answers. Across various locales, this paper presents

SAD in three dimensions: historically, biologically, and in cultural context. The

conclusions include treatment of SAD and a re-evaluation of hypotheses. Seasonal

affective disorder affects millions of people globally, and while biological factors remain

a common thread, SAD may additionally be a construct of cultural influence.

BACKGROUND OF SEASONAL AFFECTIVE DISORDER

Norman E. Rosenthal originally characterized the term ‘seasonal affective

disorder’ in 1984. It is an affliction “characterized by recurrent depressions that occur

annually at the same time each year” (Rosenthal 1984). The twenty-nine patients featured

in this study displayed similar symptoms including “hypersomnia, overeating, and

carbohydrate craving” in response to changes related to climate and altitude. Nearly thirty

years later, this is still the general definition of SAD: symptoms of depression incurred by

lower temperatures and often, higher altitude. This study conducted by Rosenthal

concluded that artificial light was shown to improve the depression of approximately a

third of the patients; this research paved the way for further light testing on SAD patients.

The idea of winter depression has been around longer than the term itself.

Although Rosenthal conducted the light therapy study in 1984, an earlier study conducted

in 1981 followed the winter depression of eleven patients. All of who exhibited classic

SAD symptoms: fatigue, disinterest, increased hunger, decreased mobility, and

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relationship strains (Asher 1982). These studies and symptoms pose an interesting

hypothesis: if a person can succumb to these ailments simply due to colder weather and

fewer hours of exposure to sunlight per day, then has SAD existed for thousands of

years? It would make sense for one to assume that humans who have long thrived in cold,

dark climates could fall victim to winter depression, but the situation is much more than it

appears on the outside.

From a psychological perspective, there is much to be said regarding seasonal

affective disorder. The condition first appeared in the DSM-III, released in the late

eighties after Rosenthal’s research. Currently, it is categorized as a mood disorder, under

“Major Depressive Disorder – Seasonal Pattern” (APA DSM-IV 2000:389-390). There

are four diagnostic criteria in the DSM for SAD: a relationship between mood changes at

a particular time of year (i.e. fall or winter), changes from hypomania in summer to

depression in winter, remissions of SAD in at least the past two years, and SAD episodes

outnumbering other depressive or mood disorders throughout an individual’s lifetime.

Typical symptoms listed in the DSM include overeating, oversleeping, weight gain,

carbohydrate craving and irritable mood in response to the time of year. Light treatment

is referenced, but the DSM also states that the majority of SAD patients are women. This

fact encourages the theory that SAD, along with other depressive states, could potentially

be an evolutionary response.

THE BIOLOGY BEHIND SEASONAL AFFECTIVE DISORDER

There are many controversies surrounding not only depression but also the whole

of mental illness diagnostics. Biologically, seasonal affective disorder is thought to be

caused by reduced intake of light by the hypothalamus, the part of the brain that regulates

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mood, sleep, and appetite. When a person is suffering from SAD, they experience a

drastic change in all of these categories. A lack of light delivered to the eyes – and

subsequently, hypothalamus – results in decreased levels of melatonin as well as a

disruption in circadian rhythm (Sohn 2005). For animals, melatonin is the “mediating

hormone between light and seasonal behavior” (Sohn 2005), and this causes scientists to

believe the same applies to humans. Much like animals, humans adapt to their

environment, and that is where the evolutionary arguments interject.

“Our brains evolved under ‘field conditions’ of long daily sunlight exposure,

subject to rhythmic lengthening and shortening by seasons. Now, however, most of our

days are unnaturally dark and our nights are unnaturally light. We have lost our strongest

connection with the daily rhythm of nature” (Norden 1995). This quote from Michael J.

Norden’s book Beyond Prozac perfectly encapsulates the majority of theories relating

evolution to seasonal affective disorder. Our sedentary, workaholic lifestyle has only

been part of human history for roughly a century, not nearly enough time for our bodies

to evolve and adapt to stressors and cold, dark conditions.

In terms of basic human biology, dreading cold weather and long, dark nights

could be an evolutionary reflex; perhaps SAD is a survival instinct intended to protect us

from the elements and predators. As previously stated, the DSM estimates 60-90% of

SAD patients to be women. Only in the last century, approximately, have we as a species

attempted to label every commotion our bodies project outwards, mental illness and

physical ailment alike. Perhaps depression is the result of millions of years of evolution.

Many researchers studying SAD seem to think so. The symptoms of SAD include

carbohydrate craving, weight gain, oversleeping and lethargy, among others.

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Professionals have compared these symptoms to ancient seasonal lifestyle patterns and

concluded that the symptoms align with characteristics of those lifestyles. Caroline Davis

of York University proposes that SAD is a vestigial evolutionary trait designed to

conserve energy in colder seasons when resources are scarce, and also to enhance

reproductive success (Davis 2005). Withdrawing in colder climates increases

reproductive success, promotes healthier pregnancies, and gives rise to “enhanced

female-male pair-bonding”, as well as increasing the likelihood of reproductive success

in the spring when hypomania replaces hypersomnia (Eagles 2004).

This makes sense to evolutionists: if a species is to improve its chances of

survival through the winter, that species is going to consume high amounts of

carbohydrates, reduce their physical activity, and retreat to a place they can sleep for long

periods of time. Seasonal affective disorder may indeed be a leftover trait given to us by

our ancestors to protect us from the elements and ensure the continuation of our species.

The issue with this gift, however, is that it does not align with our current modern

lifestyles, and we have not been enveloped by those modern lifestyles long enough to

adapt against seasonal affective disorder.

Another problem is that of society. While our ancestors and other species

hibernate without trouble, the human race has evolved to the point of individualism. That

is to say, a human will find a problem within themselves and label it unique and worthy

of attention and treatment, instead of acknowledging the problem as part of the human

condition. Seasonal affective disorder is an excellent example; a person may find him or

herself suffering from winter blues, and seek the help of doctors and medication. This is

due to the rise of psychology in the Western world. Psychology conveys messages to the

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public based on their professional opinion, and that opinion is interpreted by society as

fact. Commercials will tell people that, if they are suffering from symptoms A-Z, they

certainly need this medication, whereas anthropological research will tell that person

those symptoms are normal to the human species and they simply need to incorporate a

light box and more physical activity into their daily routines. We are a society of instant

gratification, and if we can pop a pill to cure our problems, we will surely do so before

changing our daily routines.

In addition to evolution, location may also have a key role concerning SAD.

Much of the research seems to agree that regions of higher latitudes such as Scandinavia,

Alaska and Iceland have higher frequencies of SAD patients (Jackson-Triche 2002).

Lower altitudes also have higher rates of seasonal depression. Knowing that SAD could

potentially be a vestigial evolutionary trait to defend oneself against the difficulties of

cold weather, it is understandable that regions of higher latitude with cold, dark periods

are where many SAD patients are identified as living. The following section will compare

people of various locations and their cultures to show variation within the illness.

SEASONAL AFFECTIVE DISORDER AS DEFINED BY CULTURE

As with many other mental disorders, SAD was first defined by American

psychologists three decades ago. SAD, along with those other disorders, slowly made

their way as an export to other countries and cultures. In Crazy Like Us, Ethan Watters

describes how depression made its way over to Japan in the last few decades; Japan did

not have a concept of depression prior to Western psychiatry introducing itself to the

culture. Having depression is seen as a sign of weakness in the Japanese culture, so many

people are reluctant to say they are depressed. While the Japanese version of depression

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may not equate to our version of depression, pharmaceutical companies saw an

opportunity to profit off of the millions of people inhabiting Japan. They sent

representatives to research Japanese culture in order to determine how best to present

their anti-depressants.

The majority of Japanese people surely did not need anti-depressants, nor did they

understand what Western depression was. Unfortunately, the pharmaceutical companies

worked their black magic to make a spot for themselves in the Japanese market through

the use of their integrated spies and target-specific advertisement. The idea that Western

concepts of mental illness can drastically alter many aspects of a culture posed a serious

question for this research; apart from biological factors, could culture have something to

do with SAD?

The United States exemplifies Western medicine, therefore it would make sense

that up to ten percent of the population suffers from seasonal affective disorder. This

means that millions of people in the United States suffer from SAD every year, in

addition to the people suffering from major depressive disorder. Compared to the vastly

lower percent of populations suffering from SAD in other Western cultures including the

U.K., Canada, and Australia, the United States seems to be more susceptible to SAD than

others (Holistic 2013). What is causing this discrepancy? The answer lies in Ethan

Watters’ book Crazy Like Us. His theory that we are exporting mental illness rings true

on both sides. We formulated all types of mental illnesses before exporting them to other

cultures, thus we are exposed to them first. This gives our population a longer time to be

aware of them, in addition to being encouraged by society to seek treatment.

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Concepts of sadness in American culture vary throughout the media. Because we

are a forward-thinking culture, we assume we can find a logical solution for everything

we experience; thus the invention of modern psychiatry. As a culture, we absorb the fact

that a pill can probably ease any type of pain. We receive these messages in the media

every day, through television commercials, radio and newspaper advertisements, movies,

and so many more. Because of these messages, people tend to say “I’m depressed” more

than “I feel sad”, and to many doctors, that is deserving of a diagnosis and medication

(Theiss 2012). It is possible that many diagnoses of depression stem from people

absorbing messages conveyed to them, subconsciously, through the media. For cultures

lacking the concept of depression, they express their feelings through visible sadness and

somatization (Kleinman 1991). Now that Western ideas have begun to infiltrate other

regions, those messages may be a driving force behind SAD in other cultures as well as

our own.

In his book Depression in Japan, Junko Kitanaka provides a detailed account

regarding every aspect of depression in Japan. Although this book does not explicitly

mention seasonal affective disorder, comparisons and inferences can be made due to the

fact that SAD is a sub-category of depression. Culturally, depression (utsubyo) was

relatively unheard of until the last two decades. There exists a form of depression in

Japan that is more common than clinical depression: karoshi. Karoshi is overwork

depression, which often leads to suicide. With the introduction of modern psychiatry,

depression went from a “rare” disease to something tangible and treatable (Kitanaka

2012). Kitanaka also argues that depression in Japan is “reshaping cultural debates about

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how society should deal with individual subjects of social distress”: this relates to Ethan

Watters’ argument, that some aspects of mental illness are culture-bound.

Depression from a psychiatric standpoint is fairly new to Japan; therefore the lack of data

on SAD across the population is a reflection of that. The most recent research conducted

regarding SAD in Japan dates to 2003, and compares factors including climate, latitude,

and socio-cultural elements as influencing SAD among adults and high school students in

Japan. Of roughly ten thousand Japanese people tested, two percent met the criteria for

SAD. The study concluded that SAD was more common in high school students than in

adults, stating that socio-cultural factors were more of a driving force for them than in

adults, who seemed to respond more to latitude and climate (Imai 2003). These results

reveal something very important: Western concepts of mental illness are clearly seeping

into the minds of the younger generations and being validated, while adults report typical

symptoms in response to latitude and climate. This study is an excellent example of

cultural versus biological elements when studying seasonal affective disorder and the

influence of Western medicine.

In other colder climates such as Canada, the research varies. An indigenous Inuit

community in the Canadian Arctic was studied for SAD and it was determined that, while

twenty-five percent of them were depressed, very few of them matched the diagnostic

criteria for SAD (Haggarty). For descendants of Icelandic emigrants to Canada, the

frequency of SAD was extremely low compared to other parts of the population

(Magnusson). This research aligns with the genetic theory of multigenerational

adaptation against SAD. The prevalence of SAD in Canada is roughly two to three

percent of the total population: comparing this to the ten percent of the United States, and

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the fact that Canada is closer to the north pole (latitude hypothesis), we can assume that

culture makes up for the discrepancy (CMHA 2013).

Another curious comparison to make across cultures is that of Australia. Because

Australia lies within a temperate zone that is usually void of SAD patients, it is curious

that roughly two percent of the population suffers from it. Of all the modernized, Western

countries, Australia has the lowest rate of SAD (Murray 2004). The low percentage of

Australians suffering from SAD could be a reflection of the latitude and climate

hypothesis: if generations of Australians or indigenous folk have lived in the climate long

enough, they would not need SAD to combat the elements of winter. However, many

Australians are emigrants from Europe, unlike their aboriginal neighbors. A few hundred

years of generations could not eradicate the genetic necessity for SAD altogether, though

it may have made it easier to evolve under temperate conditions. The small percentage of

SAD patients in Australia potentially reveals how many of those European emigrant

bloodlines still have SAD engrained into their genetic makeup.

TREATMENT

The majority of SAD patients around the world do not realize that SAD is a

normal feature to the human existence, and will subsequently seek treatment. Because the

exact cause of seasonal affective disorder remains a mystery, there are various forms of

treatment available to patients. These range from the biomedical to the psychoanalytic,

and are generally specific to a theorized cause. For example, many doctors will

recommend a tropical vacation to those suffering from severe symptoms in drastically

cold, dark climates. Three treatments for seasonal affective disorder include light therapy,

medication, and psychotherapy.

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One theory on the causes of SAD states that the illness presents itself when

normal levels of daylight are unavailable. This causes the hypothalamus to malfunction,

and symptoms such as overeating or oversleeping appear. The treatment provided based

on this theory is light treatment. The benefits of light have been known since the ancient

Greeks, with solariums being popular in the early twentieth century for medical problems

ranging from psychiatric to general medical issues. By the time modern medication

became readily available in the later part of the twentieth century, however, the benefits

of light treatment were considered obsolete (Norden 1995). Now, light treatment is

making a triumphant comeback.

Beating Depression, a book for sufferers of various forms of depression, states

that seasonal depression arises when “the number of daylight hours decreases… the

pattern of release of brain chemicals has been altered” (Jackson-Triche 2002). The book

further states that light therapy consists of a patient sitting near a light box, which has

been programmed to deliver artificial light at around 2,500-10,000 lux (a measurement of

brightness). Typical sunlight outdoors averages 50,000-100,000 lux; this type of

treatment has been known to show significant improvement in patients. Whether or not it

functions as a placebo is unknown, but the results are drastic with no known side effects.

It is thought that light therapy delivers small amounts of Vitamin D to the body and

encourages both serotonin and melatonin production, both of which are limited in

availability for the human body during colder, darker periods (Norden 1995).

While light therapy is the recommended form of treatment for SAD patients, the

success rate is roughly fifty percent and tends to be combined with antidepressants. SAD

is thought to be related to decreased levels of serotonin, as stated through the

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hypothalamus theory, thus the majority of medication prescribed is usually a selective

serotonin uptake inhibitor (SSRI). Escitalopram, fluoxetine, and citalopram all have been

proven clinically to reduce the symptoms of SAD in combination with light therapy. All

medications were shown to have a higher success rate by at least twenty percent over

placebo groups in pharmaceutical patient studies (Partonen 2010).

Light therapy and medication can be helpful in treating seasonal affective

disorder. But, as with all mental disorders, psychoanalytic treatment can further assist the

use of biomedical treatment. SAD has the potential to be cognitively and behaviorally

based, and researchers have discovered the positive influence that cognitive behavioral

therapy can have on patients. CBT is a very effective method for treating many forms of

depression. It can include various components: keeping a journal, maintaining a healthy

diet and active lifestyle, having a strict bedtime routine to offset hypersomnia, and most

importantly, CBT aims to alter the thought process of the patient. According to the very

first CBT-SAD research study ever published, CBT was proven to help long-term

symptoms among patients (Rohan 2004). Additionally, CBT poses no negative side

effects in comparison to medication, an important detail that many patients consider

when faced with treatment options.

CONCLUSIONS

Seasonal affective disorder may be thousands of years older than we think. Before

the content of this paper was researched and compiled, biological theories held their place

at the top of the causes. It is evident now that SAD is the result of so many more

elements. Biology states that SAD is caused by a reduced intake of light to the

hypothalamus, causing a malfunction of normal bodily functions such as the circadian

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rhythm, appetite, mood, and hormone production. Evolutionary theories describe SAD as

a vestigial trait, programmed into our DNA to help us ensure reproduction and survival

through winter against predators and the elements. The latitude hypothesis describes the

correlation between the high frequency of SAD patients and high latitudes, i.e. locations

closer to the poles where there are shorter, darker days, and colder climates.

Culture also plays a role influencing SAD, with each culture having various

perceptions of mental illness and depression, and each culture conveying those

perceptions in the media. The United States views mental illness as a chemical imbalance

in the brain, while the Japanese view it as a sickness of the soul or heart. These cultural

differences explain why the United States has the highest frequency of SAD patients

anywhere in the world. We have been exposed to mental illness and medication for such

a long time that our society has nearly become desensitized to it; it has become normal

for us to be diagnosed and medicated. Because of this, it is more important now than ever

for research related to evolution and culture to reach the minds of the public. Seasonal

affective disorder is so much more than a chemical imbalance in the brain: it is the

process of many elements acting in unison to create a condition that is exceedingly

normal to the human race.

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