It is difficult to say anything about depression without upsetting people, both sufferers and therapists. Millions of people do suffer unbearable emotional distress to the extent that the only way they can work out how to cope is to withdraw; to sink into a depressive episode. It is not generally a conscious or deliberate choice either although the issue of ‘choice’ is significant.
Similarly economic depression is a choice. Economies and businesses do not have emotions, but business people do and when they lose confidence they withdraw from trading and investing in their future. Ultimately there is no such thing as depression or recession. People depress their mood in order to avoid pain. Businesses recede from trading in order to avoid risk. There is only one antidote and that is for individual human beings to stop depressing their negative emotions and receding from risk and to rebuild confidence as a basis upon which to begin reversing these processes.
I believe the idea of depression as an illness is a huge con on many different levels. First of all, I do not think it is an illness, I think it is a strategy, albeit an unconscious and non-culpable strategy which traps millions. A strategy is something you do rather than an abstract thing like an illness. Why does this matter? Because the label you attach to any phenomenon has a highly significant influence over your subsequent experience and response to that phenomenon. Having an illness is more likely to induce passivity because it absolves the sufferer from responsibility. Having an illness stops people from doing something different. To ‘recover’ from ‘depression’ requires action. It’s tough because this is exactly what people (and economies) who are in the grip of depression find so difficult. But without action people can stay stuck in their dysfunctional strategies for decades. So the challenging reality is that those who are often least well-equipped to make choices find themselves in the situation of having to make a choice.
The problem with the ‘illness’ version of depression does not end here though. It gets worse. Once depression is characterised as an illness it gives the green light to pharmaceutical companies (and politicians) to start peddling ‘medicine’. And whether you are a human being or the whole global economy, the medicine so often turns out to be worse than the cure. Becoming dependent on a drug (or a government) can paralyse creativity and demolish hope.
Until the mid-1960’s the National Institute of Mental Health (the NIMH) in the US frequently cited extensive evidence that people suffering from a first bout of depression would generally recover in a relatively short time and would be unlikely to suffer a recurrence. People just seemed to work through the process and get themselves back on their feet again. Jonathan Cole of NIMH wrote “Depression is, on the whole, one of the psychiatric conditions with the best prognosis for eventual recovery, with or without treatment.”
Then the pharmaceutical industry took over and some people started making a lot of money on the basis of very little hard science
‘The overall global antidepressant market for the four indications, (Major Depressive Disorder, Obsessive Compulsive Disorder, General Anxiety Disorder and Panic Disorder) was valued at $11.9 billion in 2011, growing from $10.5 billion in 2004 and indicating a Compounded Annual Growth Rate (CAGR) of 1.7%.’ 1
Over the last 50 years there has been repeated concern that those on anti-depressant medication were more likely to suffer a relapse and that bouts of depression last longer for those who are medicated compared with those who are not.
‘Investigators at the University of Pennsylvania reported that 69% of patients withdrawn from an antidepressant relapsed within six months. There was “rapid clinical deterioration in most of the patients.” ‘ 2
The National Institute of Mental Health (NIMH) also had doubts about pharmacological approaches to depression,
In an 18-month NIMH study that compared four types of treatment (two forms of psychotherapy, an antidepressant, and placebo), the group that was initially treated with the antidepressant had the lowest stay-well rate by the end of the study.
It seems that medication can and often does make things worse; in some cases, much worse. Clearly there are also millions who, whilst they are taking their medication, feel better.
In addition to the pitfalls of medication, since 1952, when the Diagnostic and Statistical Manual of Mental Illness (DSM) was first published, definitions and categories of depression have expanded exponentially. In the latest edition, DSM V, finally published last week after years of controversy, there are now extended categories of depression to include bereavement and even ‘at risk’ categories (i.e. people who are not yet depressed but who may apparently become depressed at some time in the future).
We face the prospect of everyone on the planet ending up with some kind of diagnosis. In 2012 The World Health Organisation estimated that globally 350 million were suffering from depression. That is 5% of the global population.
Interestingly, however, in April 2013 the NIMH challenged the whole basis of the DSM arguing that their diagnoses are not based on
‘any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment. Patients with mental disorders deserve better’.3
NIMH now plans to create an alternative set of diagnostic criteria which take greater account of biological factors and advances in neuroscience.
This is revolutionary and whilst I welcome a more scientific approach I believe that NIMH are still missing a vital ingredient; the uniqueness of each and every patient. Their scientific approach is better than DSM’s ever wider ‘consensus’ based definitions which indicate a desperate need to categorise everyone and everything, to the delight of the drug companies who have a desperate need to offer a pill for everyone and everything.
I also worry that NIMH are still pursuing a version of the medical model for what I believe is more often than not an individual reaction to a widening and diverse social malaise. I often help people who are clearly not ‘ill’ but simply ‘alienated’ from society. I claim to work well with these people perhaps because I share their sense of alienation and outrage at the injustices, inequity and lack of consideration prevalent in Western culture.
I fear that the NIMH science-based approach will ultimately still fail to challenge the dominance of psychopharmacology at the expense of cognitive psychotherapies and psycho-sensory therapies.
If you want to read a comprehensive analysis of the limitations and dangers of drug therapy for mental illness there are two excellent books: ’ Anatomy of an Epidemic’ by Robert Whittaker and ‘Bad Pharma’ by Ben Goldacre.
Please remember though, you should NOT stop taking medication without first consulting your doctor. Anti-depressants alter brain function and you may need to taper off rather than stop abruptly in order to stay safe. Consult a qualified medical person.
If you have tried conventional psychotherapy, CBT and/or medication or you are simply looking for a more natural and empowering solution to depressive moods and episodes read how hypnotherapy can help to resolve depression.