Why It’s OK To Be Depressed Sometimes
The modern Western mindset has it that depression is an abnormal state. That when you're a bit down, it means you have a medical problem that requires treatment. Of course, this isn't necessarily true. While depression is clearly a major problem for many people that does require treatment of some type, do we all need to be treated every time we are down? More than this, though, if we become depressed, should we consider ourselves in some way abnormal?
What has been called the 'medicalisation' of mental health issues has long been noted by groups like the anti-psychiatrists. Indeed, Adam Curtis' new documentary provides a stark reminder of how modern mental health is driven by numbers. "Check-lists are nothing more than statistically derived descriptions of what is considered 'abnormal'"In creating the manuals relied on by many, but not all, psychiatrists (and psychologists) for diagnosis, the complexity of human thought and emotion has been reduced to a number of check-lists. These check-lists are nothing more than statistically derived descriptions of what is considered 'abnormal' - and therefore normal - human behaviour. By their very nature they make no attempt to understand the person themselves.
Mental illness may have been exaggerated
One of the major architects of this manual for diagnosing mental disorders is Dr Robert Spitzer. Dr Spitzer is interviewed in Adam Curtis' documentary. When asked what he thinks of his creation he admits, looking rather uncomfortable, that the rates of mental disorders have probably been exaggerated. The rate of exaggeration? Dr Spitzer says no one really knows, but it might be 20, 30, even 40%.
Certainly this is a worrying idea, but what worries me more is the effect it has on the way people view themselves and their personal experience. If doctors, a highly respected group in society, adopt certain yardsticks of mental health, it is only natural that these are going to affect the way we all think about our private emotional lives.
Who benefits?
Those with a Machiavellian bent might ask who the medicalisation of depression benefits. Roger Mulder, a psychiatrist in New Zealand suggests that both researchers and clinicians have something to gain from the increased prevalence of depression (Mulder, 2005). Clinicians make more work for themselves while researchers can attract more money to their research. And there's the pharmaceutical industry, but let's not start with them.
"If you continue to tell someone they have a disorder, they soon come to believe it."One group the increasing medicalisation of depression certainly doesn't benefit is those people who previously thought they were 'a little down', and are now labelled with a 'disorder'. If there's one thing that decades of research in psychology has taught us, it's that human beings are extremely susceptible to suggestion. If you continue to tell someone they have a disorder, they soon come to believe it.
Depression across cultures
Perhaps the clearest way to understand the modern Western attitude to depression is to compare it to that in other cultures. Derek Summerfield, a consultant psychiatrist at the Institute of Psychiatry, points out that Westerners tend to view emotion as internal, unintentional, biological and unrelated to cognition (Summerfield, 2006).
"At least non-Western attitudes to depression acknowledge that a situation can be changed." By contrast, a non-Western viewpoint is often characterised by a focus on situational and moral factors. The Western depression-as-disease model has the hallmarks of a condition inescapable without 'treatment'. How can you change your biology or tame emotions apparently arising unbidden from the deep? At least non-Western attitudes to depression acknowledge that a situation can be changed.
It's OK to be depressed sometimes
Ultimately we don't often hear the simple message that it's OK to be depressed sometimes. It's not pleasant, but it's part of being human. It doesn't necessarily mean professional treatment is required.
References
Summerfield, D. (2006). Depression: epidemic or pseudo-epidemic? Journal of The Royal Society of Medicine, 99(3), 161-162.
Mulder, R. (2005) An epidemic of depression or the medicalisation of unhappiness. New Zealand Family Physician, 32(3), 161-163.
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Thank you! This needs to be brought to the forefront of discussion about mental disorders. My opinion is that for the most part so-called mental illness probably is physiologically based, but that does not imply finding a magic bullet medical "cure" for it. You didn't mention insurance companies who would rather pay for a few visits and some pills rather than the often lengthy but ultimately more fruitful traditional talking therapy.
Greg, when you say most mental illness is physiologically based, do you mean its cause is physiological? If so, I would take issue with that. It's one of the main points this post is making is that a Western viewpoint over-emphasises the physiological basis of mental illness.
If not, where is it located? I don't believe in metaphysical entities.
Apologies Greg, I shouldn't have said 'physiological basis', I meant 'physiological causes'. I'm saying the physiological causes of mental illness have been over-stated.
I've been reading your blog for some time now (even referencing it sometimes in my own). You address some very interesting topics, and this one resonated with me.
We are a society that tends to slap "disorder" to lots of things. I see it as a way that this generation (meaning the boomers) has tended to want to point a finger at something as being the culprit instead of taking responsibility for our own actions and behaviors.
Plus, we are the instant gratification generation, too, and if Prozac or whatever will make our problems go way, well, why not?
And we have unrealistic expectations of "happiness," and so we think something's wrong if we're not happy 24/7.
It's not much fun to be sad sometimes, but it's part of the human condition. And then, it goes away.
Hi Kat, I'm glad it's useful for you. Good points, particularly about taking responsibility which is vital.
As someone who is experiencing a bout of depression at the moment, i wish that cognition could be employed to control the stress response as I have had to resort to bloody anti depressants again. I cannot seem to control the acute physiological reaction i get when i am trying to deal with relatively banal life events. I am not talking about feeling a bit down, I usually feel suicidal during these episodes and out of control. Now is it really possible to take responsibilty for such a depression, or are emotional responses different in nature to rational thought. David Wainwright The author of Stress The Making of a Modern Epidemic said in a recent interview that emotional responses are not something that people have opted into like an ideology, they cannot be argued out of it, the emotional life is very physiological. He does not think that we should not try to struggle against it however.
It would be very convenient for me if the Cartesian model of humanity was true, but I become incapacitated when i face adversity.
Hi anonymous, I'm sorry to hear you're suffering at the moment. Thanks for sharing your thoughts.
I know there's been quite a bit of research done on the neurotransmitters and that end of the physiological causes/effects of depression, but what puzzles me is that while it's now known that those who suffer from depression have low serotonin levels, it's still unknown whether the low levels are a cause of depression or a result of it... and, well, perhaps I haven't read enough studies on this to know for sure, but why can't it be determined? If psychological research has come so far to determine that a relationship exists, why is it that we don't know which causes which?
Apologies for going off on a rant there, but I guess my point is, if we were to know that the physiological factors were a result of depression rather than a cause, it seems to me that it would change the way people view it currently -- it'd be more of a "let me treat the symptoms" rather than a "let me cure it" approach.
The simple answer to your first question is: we don't know because the question is really hard. The problem is the causes of depression are many and varied and it's extremely difficult to disentangle causes from effects.
Certainly psychologists, psychiatrists and so on are working at both ends - both on a cure and on alleviating the symptoms.