10.15.06
Down with depression
A friend of mine went through a bad patch for a few years when everything went wrong. He got sick, lost his job and his father died. He had good friends who stood by him during this troubled time. But sometimes friends aren’t enough and on one of the many visits to the GP to complain of his as-yet- undiagnosed illness, the doctor prescribed an antidepressant. Then things got really interesting.
Up until then he would be fine for a few weeks, have a few days of being down and not able to cope, and then pick himself up again. With the medication the mood swings came every 20 minutes. I’d get an angry and hostile phone call. The next call would be full of remorse and upset. I’d run round and find him completely calm and optimistic. Later he’d be relentlessly pacing, full of plans, and fidgeting. Depression I could cope with; the cure I couldn’t.
He switched drugs and things settled down, but there was a new edge to his personality that hadn’t been there before. The hostile phone calls still came; less frequently but enough to make me think twice before answering the phone when I saw his caller ID. I’d forgive the attacks, but he tired of being forgiven. I withdrew and he resented it. As far as I’m concerned, though he might tell it differently, I lost a friend not to depression but to Prozac.
Another friend of mine had everything: a great job, the perfect marriage, and no money problems. He was good-looking and popular. Despite this, he felt very lonely and sad. There was nothing specific in his life to explain this overwhelming misery. If he ever hinted that all wasn’t well, he got the “what have you got to be depressed about?” response. So he learnt to keep his misery to himself, shamed by it, and eventually killed himself.
I thought of them both last week when Patricia Casey, a psychiatrist, complained that the media, when examining topics such as depression, places an undue emphasis on unproven treatments such as counselling. “There is a general portrayal of medication as bad and talking as good — a gross oversimplification,” she said.
Casey claims depression and other psychological disorders are overdiagnosed, resulting in inappropriate treatment. Last year she said that about twice as many people as require them are being prescribed antidepressants. “By overdiagnosing and overtreating we are robbing people psychologically of their own resolution to difficulties,” she argued.
So we’re trying to cure some unhappy people who are entitled to be unhappy. Yet we can’t persuade the ones who have no apparent reason to be unhappy that it’s fine to ask for help. In the meantime, a lot of people are on personality-altering drugs for which they have no real medical need, while the truly depressed go untreated. Casey recognises that too many people are getting the drugs, but she resents public criticism of the drug itself. If she’s conflicted, how are the rest of us supposed to feel?
The problem seems to be that 220 years after the right to pursue happiness was enshrined in the American constitution, the compulsion to be happy is enshrined in our modern culture. Happiness is no longer a right, it’s a duty. A very narrowly defined list of factors is deemed to make us happy. If we can tick all the right boxes then we should be happy. If something demonstrably bad happens, the therapeutic industry rushes in to cure the “disproportionate” response.
Stable relationship? Check. Nice house? Check. Nice job? Check. Clever attractive friends who meet frequently for dinner parties and pints? Check. Healthy family? Check. Two holidays a year? Check. Congratulations, sir, here is your Happiness Certificate, good for the next five years or until something dreadful happens. Any complaints will be casually dismissed with “pull yourself together”.
And if something dreadful happens? If you get sick? Lose your job? If someone dies? Then counselling will be thrust upon you quite sharply. You’ll be allowed three months of public displays of misery (time extended for death of a child perhaps) and if you can’t get back to “normal” there is always Prozac or Valium, or whatever they are giving people these days to make them function like proper consumerist members of society.
By the way, if you intend running for public office, make sure your depression doesn’t get out. We’ve got politicians who confess to taking money, taking a drink or even a lover of the same sex. But do you know any politician who’d admit to taking an antidepressant or even undergoing relatively benign talking therapy? Strange how that one hasn’t surfaced yet.
It’s the zero-tolerance approach to depression. In a world obsessed by empowerment, we feel under enormous pressure to correct any flaws in our lives. If we can’t, we feel helpless and even more depressed.
This intolerance of depression is a relatively recent attitude. In history and literature, the well-recognised condition of “melancholia” conferred a kind of respect on the victim. Some call it the Van Gogh effect. What if Van Gogh had access to Prozac and been cured of his depression? Would it have ruined his creativity? Abraham Lincoln suffered from clinical depression all his life, and one of his biographers, Joshua Wolf Shenk, argues that his “inimitable character took great strength from the piercing insights of depression”.
I am not arguing that those who suffer from depression should not be cured. Not all depressives are tortured artists or great leaders who must suffer in order to create. People in pain need relief, and modern medicine offers them a chance of a normal life.
The problem is that psychiatry prides itself on its links to biology: simple chemical imbalances can cause mental illness and therefore a pill can cure it. Some argue depression is a disease that should be eradicated just like TB.
Psychiatry might deliver a scientific cure but has no scientific way to decide who is sick. It would help if GPs weren’t allowed to prescribe antidepressants. At least if a patient got to see a psychiatrist there might be some hope of an accurate diagnosis and appropriate treatment. But the mental health services in this country are so pathetic that patients could be waiting months to see a psychiatrist.
So this is the result: the undepressed are on prescription drugs and the really depressed are unable to raise their hands and ask for help. Now that’s depressing.
Update: The President of the Pedantry Association has already been on to observe that the “pursuit of happiness” is NOT in the constitution, it’s in the Declaration of Independence. I’m raging.
JC Skinner said,
October 15, 2006 at 7:12 pm
Your anecdotal assessment of the interaction between medicine and depressive people is, as always well-written, but I really think that you could do with doing a lot of research in the area before proposing something so preposterous as stripping GPs of prescribing rights.
Patricia Casey may feel that too many people are receiving SSRIs, and she may well be right. But as a medic herself, I have little doubt that she would concur that far too little, not too much, is done for depressive people in Ireland by the state’s arm, the health services.
The recent suicide of two brothers in Belfast, which was extensively covered in local media, and about which I blogged last week, revealed just one of the ways in which the health system regularly fails the depressed.
If you believe that depressed people are under pressure to feel happy, then I agree, but that is one of the symptoms of depression, not society.
If on the other hand you believe that assisting depressed people to deal with their condition somehow is stripping them of their individual humanity, then I hope to God that no friend of yours seeks assistance from you for depression in the future.
I don’t mean to be hard on you, but the relationship between depression and medicine is a much more complex interaction than you seem to think it is.
Darren Mac an PhrÃora said,
October 15, 2006 at 7:39 pm
I enjoyed the article. I read most of it and then I fastforwarded to the end to see was there a happy ending. You mighten’t know much about them but I think that an emphasis on complimentary thereapies e.g. Reiki is essential- valuable anyway- in discussions on treating depression.
Darren Mac an PhrÃora said,
October 15, 2006 at 10:22 pm
“Update: The President of the Pedantry Association has already been on to observe that the “pursuit of happiness” is NOT in the constitution, it’s in the Declaration of Independence. I’m raging. However, you’d think the subs would pick up on this, wouldn’t you?”
Thats a great idea!!! The pursuit of happiness should be in the consitution. Maybe your small botún was actually worth it!!! I think so!!!
Sarah said,
October 15, 2006 at 10:28 pm
JC, the area is very complicated and alas 1300 words in the ST isn’t enough to address it without seeming a bit crude in places and then the odd sentence gets scrapped in editing.
However, my fundamental point is this:
Psychiatrists say that depression is a result of a simple chemical imbalance which can be corrected by an SSRI.
However, when you go to a doctor and give the symptoms of depression, does anyone actually DO a test for this chemical imbalance? No, they don’t. Instead you give the list of depression symptoms (early waking, loss of appetite, persistent low mood – which anyone who reads self-help magazines knows about) and then you are diagnosed with depression.
My issue is that based on the experiences of people I know (and I have more than one depressed friend!) the following usually applies:
- WOMAN (almost always women) has life crisis – horrible work situation, bereavement, break up of relationship whatever. Goes to a GP and weeps. They are depressed – something very upsetting has happened to them. They get prescribed an SSRI ( I know personally 5 women that this has happened to). I think this is ridiculous. They are not clinically depressed. They are not depressed because of some chemical imbalance in their brain. They are depressed because something bad happened. I think they should be offered counselling so they can learn some coping strategies. And quite frankly I know 2 women who went having been tutored in the list of depression symptoms cos they hated their jobs and didn’t want to go and wanted a cert and they walked out with prescriptions. One took the tablets, the other didn’t. The one who took the tablets ended up really depressed and then couldn’t work for 6 months. She eventually got herself off the tablets. She shouldn’t have been on them in the first place.
This is what Patricia Casey is talking about.
- MAN – is clinically depressed. Self esteem completely shit. Hints to friends that he is unhappy. Friends laugh off OR are sympathetic for a while but after a few months get annoyed. Man will never go to doctor. Kills himself. What is the rate now? 500 a year? Apologies for gender stereotyping but the statistics back me up.
- Don’t get me started on the ones that do go to the doctor – get the SSRI and kill themselves 2 weeks later.
GP’s should not be prescribing SSRI’s to people on the basis of one 15 minute visit. These are major drugs. If as Patricia Casey says they are over prescribing then they will either have to change their habits or have the right taken away from them. This is like antibiotics except they are totally screwing with people’s lives.
Now, the issue of where does personality end and depression begin? I did say in the article that I am not advocating that people who are depressed should not be cured but I do think that we have no room these days for people who have a melancholic type personality. They may not be depressed, but they may be quiet, and wry, and insightful and look darkly but perhaps accurately on the world. Sometimes it just seems that the deep people get shunted off to a corner. (not that happy people can’t be deep). But we have no room for the eccentric I think.
And I reiterate my point about denying people their experiences. Maybe people who have been bereaved should be allowed be miserable for a few years. I REALLY object to those who are grieving being prescribed anti-depressants. Maybe there is a process they need to go through. Who is to tell them how deeply and for how long they can grieve? Why not give them sympathy and space and no pressure to conform. I heard one commentator say about Darren Clarke’s tears that he got sympathy because the wife was dead 6 weeks. If it was 3 months there would have been much less sympathy. I think they were right.
And its not just bereavement – its anything. We can’t bear to be around sad people. So we wish that they would pull themselves together and cope because it makes US feel uncomfortable. So we advise them to “get help”. I think we need help if we can’t make space for someone who wants to cry, or not speak. Its the lack of sympathy for sadness that makes the depressed person feel even more isolated and depressed. If you had one friend who would just listen, without piling in with the advice, that can make an enormous difference. Instead we are all quite convinced that if the unhappy person would simply do A, B and C then they would get better.
Finally I read something last week on someone’s blog where they said they were pleased because they were happy 51% of the time. I thought it was great! I think if someone is happy 75% of the time, they worry about the other 25% a lot. I immediately decided to stop worrying about the x% of my life that isn’t happy and felt better straight away.
JC Skinner said,
October 15, 2006 at 10:56 pm
There’s no doubt that a GP ought not have to prescribe SSRIs to a person on the basis of a short consultation. But they are in the bind that they are overworked and don’t have the time to truly explore people’s psychological symptoms because of the waiting room of people outside the surgery door.
But equally, should they refuse to offer something – and there is still a perception that a pill can cure all ills out there – and that person was to kill themselves, they will have to answer to the grieving family and themselves.
What he can’t do is refer them to psychiatric services, because they are even more overworked, as Patricia Casey could testify.
And he can’t do the chemical imbalance test because those chemicals relate to dopamine production in your brain. It’s not very easy to get at!
One poster mentioned Reiki. Well, it seems to me that the perceived benefit of ‘alternative’ medicines is this time factor. Go to a GP and get 15 minutes and a pill, or go to an alternative practitioner who will gently listen to all of your problems for an hour. Even before you get the head massage, or the snake oil, you feel better.
The problem lies with our overworked and underfunded mental health services, and the Government who keep them that way.
I think we need to distinguish between those people ‘happy to be melancholy’ and those who are in real psychological pain as the result of depression.
There is a small but growing medical school of thought that advocates considering depression as a mood rather than a disorder. They might have a point in doing so, if only by way of changing society’s perception of depression from that of a mental illness to something that is less stigmatisable.
But it seems to me that there is still a clear difference between someone hurting to the point of suicidal ideation and someone who is just naturally melancholic by nature. The first does need help, and probably of a medical nature. The latter doesn’t.
Maybe we do ignore the latter too often in our extrovert-focused, hyperbusy society. I’m not sure what we can do about that. It would probably require some sort of return to community based values that I can’t see occuring. Maybe it’s just something we should all strive as individuals to be more tolerant and understanding towards.
Billy Waters said,
October 16, 2006 at 12:05 am
I lost a friend to the cure for depression. Lost as in it is impossible to talk to them whithout reference to the cocktail of nuttiness added pharmacutically.
Now he is a totally different person and too difficult to deal with or be in contact with. The antidepressants numbed his head but did nothing apart from adding addiction to his burden.
John of Dublin said,
October 16, 2006 at 12:11 pm
Good article and your points are well made. Very useful debate to raise.
Pete said,
October 16, 2006 at 1:37 pm
The distinction between grieving and clinical depression is very important. They are completely different things, and treating with the same drugs / therapies doesn’t make sense. Grieving is a process, which does eventually end on it’s own, and usually leaves the person stronger than they were before. People grieve over all sorts of things, not just someone dying. I think the best thing to do for them is to try and make sure they don’t make any big mistakes in their life while their judgement is clouded by grief, but otherwise just let them go through the grieving process.
Ian Tims said,
October 18, 2006 at 1:46 pm
Sarah
I have to say that is one of the most refreshing pieces I have seen in a long time.
As I read, I felt myself becoming unburdened, nodding in agreement that the “happiness checklist” is not a “must-have”. I hope that many others will take that away too.
This is a keeper!
Ian
Daniel K. said,
October 18, 2006 at 5:49 pm
down with happiness, go contentment. I know it sounds flippant but finding little things that make the day a bit brighter is part of the effort.
Sarah said,
October 18, 2006 at 7:11 pm
Thank you Ian and so right Daniel. I did my thank you list today. It really works. That guy Shenk has an amazing article about Lincoln’s depression in The Atlantic (to which I have a subscription). If anyone’s interested I’m allowed email it from their website. Drop me a line and I’ll pass it on.
omaniblog said,
April 3, 2007 at 11:33 am
Sarah
I know this is late to be commenting on your excellent post and subsequent comments. My excuse is that I was suffering with severe depression at the time and haven’t read this until now. I’ve been blogging about depression since January2007 and I’m going to make some reference to your post, as soon as I have absorbed it all properly.
I would like to get the article about Lincoln’s depression, please. Thomas Keneally’s short biography “Lincoln” gives quotes from some of Lincoln’s writing and associates.
Your point about modern politicians not daring to reveal the slightest trace of depression is very well made. When Kennedy resigned as leader of the LibDems he spoke, eventually, about his alcoholism but not much about his depressions.
Thanks again.
From Bath to Cork with Baby Grace :: Abraham Lincoln, Depression & Sarah Carey’s blog :: April :: 2007 said,
April 4, 2007 at 8:41 am
[...] Keneally’s short biography “Lincoln” alerted me to this. Sarah Carey’s blog and its reference to an article in the Atlantic Review gave me a lot more information about [...]
shane fagan said,
December 5, 2007 at 9:59 pm
very interesting debate
donkykemore said,
December 12, 2007 at 1:03 am
there are as many misunderstandings and otherwise poorly understood concepts that it would be difficult to compose a constructive or even instructive critique.
Melancholia for example is not a new concept ; it may be so described so in wikipedia but there the researcher should abandon any trivializing with the subject and consult a more authoritative and informed sourse material before opining further . Patricia Casey for example would be considered a lightweight in the field.
You could address your observations more usefully by examining the hedonism of the crack culture who have brought us personal moral bankruptcy , suicide and carnage in the home – through their pursuit of the right to happiness through chemical enhancement – for which they are rewarded with acres of press coverage for the voyeuristic unwashed masses.
Perhaps the piece as written is best abandoned or prof erred to Hello magazine as a sort of agony / ecstasy yummuy mummy column
cure depression said,
October 23, 2008 at 7:18 am
Depression is a commonplace event in modern times, taking on many different forms, including physical, sexual, emotional, and verbal abuse, occurring in many different contexts.