Let’s talk about depression. 7


Recently, Giles Fraser published an interesting article about the way in which we approach the issue of mental health. Interesting – but almost entirely uncontroversial. The response was pretty much unanimous. There was no debate. Fraser was condemned for his ignorance, condemned for his callous attitude, and dismissed. His dismissal, I allege, was both unfounded and unjust. It was also symptomatic of a growing problem with the way in which we approach this topic as a whole.

 

An emerging phenomenon in well-meaning, apparently ‘progressive’ circles is that discourse around mental health has shifted away from the idea that we ought to understand causes of depression. It has shifted away from inquiring about the extent to which depression exists, and away from asking what solutions to the problem we possess. It has shifted away from asking how far we should be sceptical towards those who claim to know everything on the subject, be those the sufferers themselves or doctors and pharmaceutical companies.

 

Instead, what has been adopted is the idea that depression is some kind of disease. We man the barricades against those we feel might contribute to any stigmatisation of sufferers at all. In the name of protecting the “victims” from perceived slights, we have decided to shut down discourse altogether. Whilst I am entirely open to disagreement, my own experience in various mental health communities suggests that we seem to have reached a state where sufferers are wont to wear their “disease” as some kind of badge of honour. Pride in overcoming something awful has become pride in simply experiencing something awful. Whenever journalists like Fraser contribute something to the debate, the insistence is that he has no knowledge of mental health – doesn’t he know the science? As someone who hasn’t experienced the terrifying blackness of depression, what right does he have to write on it?

 

Well, actually, fellow sufferers: you know nothing. I know nothing. The current medical profession knows very little. It may well be the case that the voice of those who suffer has been stifled for too long, but it is worse than ignorant to suggest that you alone now hold the answers. The individual experiences of what we call mental illness are so diverse, so intensely private and personal, that to form “communities of understanding” through which external responses can be quashed is both naïve and dangerous. In a situation where we know so little about mental health, any external voice – such as Fraser’s – which might contribute to our understanding is to be welcomed. However difficult and painful it may be, the reintroduction of robust standards for discussion is indispensable if we are to progress even slightly in this field.

 

Now that my small diatribe about mental-health discussion is over, I want to move on to dissecting some of the points Fraser made in his article – points which are worth discussing, rather than being dismissed as though they were some kind of attack. Again, the perspective offered here is but one, and as subjective as any other, but stated in the interests of broadening and advancing debate.

 

The claim that drug companies have decided to fit existing chemicals into “normal” conditions is not just speculative emotional backlash. In Frasers’ case, we deal with the Christian argument against the ‘unnaturalness’ of using pills to treat the human condition. This approach is not just confined to religious groups: Harvard, for instance, has conducted many symposiums on what is termed the “medicalisation” of society, and the role of capital in driving this. The condemnation of this medicalisation has also come from the accounts of those who have been mental health professionals. Also of note in the above piece is the massive shift from doctors’ prescription of talk therapy to the prescription of anti-depressant drugs. When we place our emphasis on causes rather than symptoms of depression, this shift visibly demonstrates the NHS’ complete failure to deal with mental health issues, and its increasing reliance on what is seen as a simple, trouble-free solution.

 

The fact we have these supposedly-easy solutions is one reason why the NHS, and the rest of society as a whole, is saved from ever having to confront actual causes of despair. The demand on mental health sufferers is simply to adapt to this shift; aided through the quick prescription of SSRIs or some substitute. In fact, the prescription of pills and the claim that these “help people get back on their feet” is likely to do more to enhance the perception of blame upon the individuals involved. This medication will redeem the chemical imbalance within you, we are told, and if you still can’t adapt after that? Well, then, it is no structural problem but a real personal failing. This approach stands in lieu of open and robust discourse about causation, and it is silencing. It is repressive. When we are miserable, it doesn’t matter whether or not it is a disease. All that matters is the abject malaise and unhappiness to which we are, crushingly, subject.

 

Until our reactionary mentality is dropped, and we can progress from treating the discussion as a battle – a fight to the death between Them and Us, between those who understand and those who do not, even between what is right and what is wrong – we will be stuck in inertia. Our task is to look at the means available for the reduction of human despair. This is the only way in which progress might, finally, begin to emerge: progress not just for those who suffer with poor mental health, but progress for society as a whole.

 

A shorter version of this article is here at Nouse.

 

7 thoughts on “Let’s talk about depression.

  • Reply
    @Sectioned_

    I’d like to point you in the direction of over a dozen thoughtful responses, many of them written by experts by experience, to Giles Fraser’s piece on mental illness. They are linked on this page:

    http://sectioneduk.wordpress.com/2013/08/10/pill-shaming-giles-fraser-and-happy-pills/

    I’m sure the many people with lived experience of mental health problems and those working in the field who have tried to engage with Giles Fraser in discussion about his piece would welcome his reflection on these pieces and ones like them. They are worth looking at. So far, it seems they’re being dismissed as attacks rather than an opportunity to engage, listen and reflect.

  • Reply
    Pepperbury

    Yes, yes, but… I’m dismayed you seem to simultaneously acknowledge the social/ psychosocial/ environmental causes of despair and yet also seem to castigate the NHS for not confronting these “real causes”… poverty, abuse, bereavement etc. What in your opinion can a health service, which is there fundamentally to treat illness, actually meaningfully do to make a difference?

    I work in the NHS, in a mental health setting, and it so often feels like, at best, we give people useful tools (eg mindfulness, some CBT techniques, space to “offload”) to put up with their shit lives with less fuss, but when it comes down to actually making meaningful changes which would improve the quality of people’s lives… well then the NHS is perhaps the last organisation you could expect to be doing this.

  • Reply
    Sophie

    I disagree, it does matter if we’re miserable because of a disease. People have reacted so badly to the article because it shows the same misunderstanding that sufferers are tired of trying to explain over and over. Yes people get sad, people have bad days, but they’re often a response to, as the articles suggested, things going badly in our lives. Depression can start as a reaction to bad things, but soon it becomes the case that things can be going great, there can be absolutely no reason to be unhappy, but none of that means anything…it’s just emptiness and sadness and no amount of good things can change our mood.
    I agree that discussion shouldn’t be closed down by people excluding those who can’t possibly know more than a sufferer, and I agree that we need to better approach what being happy is (and yes, it includes having bad days), but I believe that in this case the response was justified because some of the comments were alarmingly close to the views of the “cheer up brigade”, who are far more silencing and stigmatizing than responses to the article ever could be.

  • Reply
    Angie Pedley

    I think anti-depressants are still used to keep people quiet. GPs don’t know what else to do with people who come wanting cures for their unhappiness. Even the 6-12 sessions of counselling which the NHS can give aren’t always enough to help people see their own responsibility in living.
    To constantly talk of depression specifically as an illness & a disease doesn’t help I think because many just give in & say “it’s an illness, there’s nothing I can do”. Ultimately we are each responsible for ourselves. We can try to point people in helpful directions but each must take up the challenge. I realise this is anunpoplular view & doesn’t apply to all mental health difficulties. Too many unhappy people are being diagnosed as depressed.

  • Reply
    Andrew of Feelbetter Counselling

    It seems to me that your article is cry of rage at what we are told depression is and desire for a better understanding.
    .So try this. It is based on the Human Givens approach. Please excuse the length of this – and I hope that it is of interest and I am doing these ideas justice.

    One needs to begin with an organising idea about what it is to be human. And how about this – that humans have innate emotional needs that they must get met for emotional health (around control, safety, work and meaning and relationships and community) and resources or a guidance system (in practice much of it around how we use emotions) that we use to get these needs met. And so, what we do every minute of the day (you could say) is to use our resources as best we can to get our essential emotional needs met. Further, if needs are not well met, then emotional and mental difficulties will inevitably arise? A corollary is that mental and emotional problems will be impossible for anyone who is living a life of balance where resources are working well enough such that needs are reasonably or very well met.

    And so it is clear – if resources are not working properly or the environment is hard such that needs are not well met, then this will cause emotional distress. And depression is one consequence of such stress and on my blog I have summarised it thus:

    Depression is the mental and physical exhaustion caused by the body’s need to dream more than it is capable of. And why is there the need to engage in high energy dreaming? It is the failing attempt to clear excessive levels of arousal, worrying and mental exhaustion. Depression is a self feeding vicious circle where symptoms and signs of depression multiply. To understand dreaming is the key to this way to understand depression. Thus we all dream every night as a form of essential mind maintenance to keep our emotional template healthy and able to work for us. But dreaming takes up energy and if you are worrying a lot, then you cannot dream as much as you need. And this is why the best symptom of depression is to wake up exhausted. And clearly if that is the case, then a vicious circle develops where ones capacity get ones needs met is more and more difficult, which in turn leads to more worrying and dreaming and so on.

    In my professional experience, the way many describe this is that they feel trapped in their minds, trapped in useless rumination, which is fed by terror and fear. It is as if being trapped in a burning room with no means of escape. Truly terrifying indeed and where suicide can appear the only means of escape.

    I will stop there and thanks to all those who read to the end and hope that I have expressed these ideas sufficiently clearly that you can evaluate them properly

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