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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March 2, 2008, 7:43 am at 7:43 am
I can’t remember who it was, but somebody pointed out that a far higher percentage of lefties than righties are on anti-depressants and in therapy for some sort of emotional problem or other. He called the state these leftard druggies live in, “artificial happiness,” which tickled me to death, and also pointed out that with the enormous levels of cognitive dissonance they have to deal with – the difference between actual reality and the virtual reality they live in – that it’s no wonder they’re brain-fucked.
So I guess these drugs are keeping them leftards by preventing them from going through the introspection/problem-solving stages. Sounds like an evil “Big Pharma” plot to me.
March 2, 2008, 8:17 am at 8:17 am
#1 Angus, we kind of got into this on another thread, where I made this comment (and others made good comments too, esp. Saltydog).
Whilst I still believe that in cases of serious, like really serious, depression, meds may well be the only answer, I think there’s a lot to be said for working your own way out of your problems on your own terms, and benefiting from the confidence and self-esteem you can get from knowing that you’re not helpless. Sort of the same issue with the Counseling Industry.
As for Lefties and mental illness, a lot of bloggers picked up on that recent piece by Dr Lyle Rossiter.
“Sounds like an evil “Big Pharma” plot to me.” LOL! Are you channeling a Lefty Conspiracy Theorist?
March 2, 2008, 4:46 pm at 4:46 pm
People – doctors included – tend not to distinguish between major and minor depression. The former probably does involve certain chemical (neurotransmitter) imbalance and is a terrible condition which can affect anyone from any walk of life, regardless of intelligence, education and success. It is sometimes found at one end of the emotional spectrum in bi-polar people; think of your standard tormented creative genius, like Angus.
Minor depression is lumped under the same umbrella to give us these misleading figures of 20-40% of the population being affected. Response to medication in this group is variable. I also suspect that general ‘unhappiness’ is labelled depression for a whole host of reasons. Let’s just say it’s easier to tell someone “you’re suffering from depression and it’s due to chemical imbalances we can correct” than to say “you’re unhappy because your mind-set, developed from early childhood, has created a set of behaviours which have detrimental consequences and are so ingrained you don’t see what’s happening and would have difficulty adjusting your behaviour even if you did.”
Anxiety, personality disorders and adjustment disorders are also labelled ‘depression’ for convenience by both doctors and patients.
The grumpy old man who complains to the bank teller, the taxi driver, the children running across his front lawn, is probably not suffering depression. The nice old guy who you used to see taking his morning walk around the neighbourhood but now stays mostly indoors, who returns your greeting politely and even smiles, is the one to keep an eye on. That’s a generalisation. Miserable old farts can get true depression as well. But you get the idea.
The problem with major depression is that sufferers do not – cannot – take that introspective look. Their thoughts are spiralling down a whirlpool of skewed perception, beginning with the negative, progressing to the irrational and in some cases ending with the outright delusional.
I also doubt that the majority of sufferers of depression function better after their episode. It might appear so, as the early stages of depression can be subtle, and/or emerging from an already troubled existence, so their ‘baseline’ function might overlap with this. And yes, about half the cases are single episodes. But for the other half, depression is a relapsing or chronic condition and they never get back to their ‘old selves’.
March 2, 2008, 5:22 pm at 5:22 pm
I, for one, believe in better living through chemistry. You can never know how horrible depression is, and what it can make you do, until you’ve experienced a full-blown episode yourself.
March 2, 2008, 6:23 pm at 6:23 pm
What an amazingly informative comment, Dminor. I learned more about depression from that comment than from all other sources combined (When professionals sling their lingo at me, most of it goes over my head).
I think I making progress: From bi-polar to the miserable old fart stage.
March 2, 2008, 8:12 pm at 8:12 pm
Doctor D, what would be a more accurate stat of people suffering from “real” depression, i.e. the kind that actually handicaps them are cannot be “cured” without drugs?
See it’s stats like those that the media and the WHO run with, plus the number of people I know who just seem to take drugs because they were “down in the dumps,” that lead me to believe that in “disease-ifying” a legitimate human emotion, we can do a lot more harm than good. People used to get “blue,” and then manage to work their way through it and come out stronger and more empowered. Now everyone who’s sad is “disabled” – it’s a weird concept.
I mean, depression as a disability being a “global epidemic…second only to heart disease”? Should we start putting Prozac in the water supply? Again, I have no doubt that there are mental illnesses which need to be treated as medical conditions and the sufferers medicated – I have a relative who falls into that category. But I think this doctor has a point when he says that “The disease model may also be engendering a sense of powerlessness in those with depression or ex-sufferers” – if you take the cases of “not-really-clinical-depression” that are nonetheless so diagnosed.
I also wonder if the over-diagnosis of “sadness” or “anxiety” as “depression” does a disservice to those who actually suffer from what I think of as “real” depression – the kind you and Rebecca speak of.
Anyway, just my ramblings on this.