Comment: Sarah Carey: Down with depression — (The Times)

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The Times

A friend of mine went through a bad patch for a few years when everything went wrong. He got sick, lost his job and his father died. He had good friends who stood by him during this troubled time. But sometimes friends aren’t enough and on one of the many visits to the GP to complain of his as-yet- undiagnosed illness, the doctor prescribed an antidepressant. Then things got really interesting.

Up until then he would be fine for a few weeks, have a few days of being down and not able to cope, and then pick himself up again. With the medication the mood swings came every 20 minutes. I’d get an angry and hostile phone call. The next call would be full of remorse and upset. I’d run round and find him completely calm and optimistic. Later he’d be relentlessly pacing, full of plans, and fidgeting. Depression I could cope with; the cure I couldn’t.

He switched drugs and things settled down, but there was a new edge to his personality that hadn’t been there before. The hostile phone calls still came; less frequently but enough to make me think twice before answering the phone when I saw his caller ID. I’d forgive the attacks, but he tired of being forgiven. I withdrew and he resented it. As far as I’m concerned, though he might tell it differently, I lost a friend not to depression but to Prozac.

Another friend of mine had everything: a great job, the perfect marriage, and no money problems. He was good-looking and popular. Despite this, he felt very lonely and sad. There was nothing specific in his life to explain this overwhelming misery. If he ever hinted that all wasn’t well, he got the “what have you got to be depressed about?” response. So he learnt to keep his misery to himself, shamed by it, and eventually killed himself.

I thought of them both last week when Patricia Casey, a psychiatrist, complained that the media, when examining topics such as depression, places an undue emphasis on unproven treatments such as counselling. “There is a general portrayal of medication as bad and talking as good ­ a gross oversimplification,” she said.

Casey claims depression and other psychological disorders are overdiagnosed, resulting in inappropriate treatment. Last year she said that about twice as many people as require them are being prescribed antidepressants. “By overdiagnosing and overtreating we are robbing people psychologically of their own resolution to difficulties,” she argued.

So we’re trying to cure some unhappy people who are entitled to be unhappy. Yet we can’t persuade the ones who have no apparent reason to be unhappy that it’s fine to ask for help. In the meantime, a lot of people are on personality-altering drugs for which they have no real medical need, while the truly depressed go untreated. Casey recognises that too many people are getting the drugs, but she resents public criticism of the drug itself. If she’s conflicted, how are the rest of us supposed to feel?

The problem seems to be that 220 years after the right to pursue happiness was enshrined in the American constitution, the compulsion to be happy is enshrined in our modern culture. Happiness is no longer a right, it’s a duty. A very narrowly defined list of factors is deemed to make us happy. If we can tick all the right boxes then we should be happy. If something demonstrably bad happens, the therapeutic industry rushes in to cure the “disproportionate” response.

Stable relationship? Check. Nice house? Check. Nice job? Check. Clever attractive friends who meet frequently for dinner parties and pints? Check. Healthy family? Check. Two holidays a year? Check. Congratulations, sir, here is your Happiness Certificate, good for the next five years or until something dreadful happens. Any complaints will be casually dismissed with “pull yourself together”.

And if something dreadful happens? If you get sick? Lose your job? If someone dies? Then counselling will be thrust upon you quite sharply. You’ll be allowed three months of public displays of misery (time extended for death of a child perhaps) and if you can’t get back to “normal” there is always Prozac or Valium, or whatever they are giving people these days to make them function like proper consumerist members of society.

By the way, if you intend running for public office, make sure your depression doesn’t get out. We’ve got politicians who confess to taking money, taking a drink or even a lover of the same sex. But do you know any politician who’d admit to taking an antidepressant or even undergoing relatively benign talking therapy? Strange how that one hasn’t surfaced yet.

It’s the zero-tolerance approach to depression. In a world obsessed by empowerment, we feel under enormous pressure to correct any flaws in our lives. If we can’t, we feel helpless and even more depressed.

This intolerance of depression is a relatively recent attitude. In history and literature, the well-recognised condition of “melancholia” conferred a kind of respect on the victim. Some call it the Van Gogh effect. What if Van Gogh had access to Prozac and been cured of his depression? Would it have ruined his creativity? Abraham Lincoln suffered from clinical depression all his life, and one of his biographers, Joshua Wolf Shenk, argues that his “inimitable character took great strength from the piercing insights of depression”.

I am not arguing that those who suffer from depression should not be cured. Not all depressives are tortured artists or great leaders who must suffer in order to create. People in pain need relief, and modern medicine offers them a chance of a normal life.

The problem is that psychiatry prides itself on its links to biology: simple chemical imbalances can cause mental illness and therefore a pill can cure it. Some argue depression is a disease that should be eradicated just like TB.

Psychiatry might deliver a scientific cure but has no scientific way to decide who is sick. It would help if GPs weren’t allowed to prescribe antidepressants. At least if a patient got to see a psychiatrist there might be some hope of an accurate diagnosis and appropriate treatment. But the mental health services in this country are so pathetic that patients could be waiting months to see a psychiatrist.

So this is the result: the undepressed are on prescription drugs and the really depressed are unable to raise their hands and ask for help. Now that’s depressing.