With the World Health Organisation talking of increasing access to treatment to deal with the “global epidemic” in depression-related disability - predicting that it will be second only to heart disease as the most important cause of disability by 2010, British psychiatrist Paul Keedwell suggests that depression actually might serve some useful functions.
In a recent article, excerpted below, he writes that “The truth is that short-term pain can lead to longer-term gain.”
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… Although technological advances in antidepressant treatments have undoubtedly been responsible for the alleviation of much suffering, strict adherence to the medical (disease) model is preventing a more complete understanding of why we as a species are so susceptible to depression, with at least 20% of men and 25% of women experiencing the condition in their lifetimes. The disease model may also be engendering a sense of powerlessness in those with depression or ex-sufferers. What so commonly goes along with this perspective is the implication that the condition is due to some unusual constitutional weakness. The only solution, therefore, is chemical.
It is a complete nonsense to talk of depression being unusual when it is plainly common. [...] Most of us probably have a moderate susceptibility to the condition under certain stressful circumstances. Nevertheless, we see GPs overprescribing antidepressants, and the World Health Organisation talks of increasing access to “treatment” to deal with the global epidemic in depression-related disability - predicted to be second only to heart disease as the most important cause of disability by 2010. [...]
My recent review of theories and personal observations suggests that depression might serve some useful functions. [...] The truth is that short-term pain can lead to longer-term gain. A recently published follow-up study of depression in Holland - the Netherlands Mental Health Survey and Incidence Study (Nemesis) - used a sample of 165 people with a major depressive episode, and provides some preliminary scientific evidence to suggest that depression is indeed helpful in the longer term. Researchers who were looking for evidence to suggest that depression leaves people chronically disabled were surprised to discover the opposite.
The population they followed from before illness to the period after recovery showed that people seemed to cope better with life’s trials after depression than they were doing before its onset. In the group as a whole, averaged ratings of vitality, psychological health, social and leisure activities, occupational performance and general health all significantly improved upon recovery from depression, compared to functioning prior to the depression. [...]
Evolutionary theories of depression explore why the condition has apparently persisted so commonly and universally since ancient times. [...] To explain why depression has not been “bred out” through Darwinian natural selection, theories have suggested that rather than being a defect, depression could be a defence against the chronic stress that misguided people can put themselves under. It is possible that depression defends us against the tendency to deny our true needs by chasing unobtainable goals and helps to bring these needs into sharper focus. More specifically, the proposed benefits are as follows: removal from a stressful situation, introspection, problem solving, the development of a new perspective, and reintegrating this with the community upon recovery. [...]
Depression may have forced our ancestors to look again at their strengths and their limitations, their coping strategies, their direction, their priorities, their supports. Regardless of the reason for falling into depression, the journey has the potential to make us better equipped, in a general sense, for life.
If we are too busy to think and feel, to be mindful, depression might represent the first opportunity to take an honest inventory of ourselves. If the modern world prevents us from learning from depression, perhaps it is the fault of the modern world and not this ubiquitous human condition.
[emphasis mine]
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