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March 5, 2008

Good Grief (as Opposed to Bad)

Here's an article I found really annoying and trite, despite--or rather, because of--the fact that its goal is to complicate the way we see depression. Written by some British psychiatrist, it decries "the assumption that depression is a disease," an assumption "reinforced and perpetuated by biologists, psychiatrists and pharmaceutical companies, all of whom have a vested interest - consciously or unconsciously - in the clinical perspective." He also laments the fact that "Most of the time, depression is hidden from view because of the stigma attached to it."

I've already written about what I think was one of the greatest benefits of Prozac: that it made it so much less shameful to be depressed or to seek treatment for it. So I'm a bit surprised to read a passage like this one:

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.

What? What the fuck? I mean, yeah, the disease model has its drawbacks, many of which I think this guy fails to address, but the idea that "the condition is due to some unusual constitutional weakness" was MUCH more destructive under the previous way of seeing depression, because the "constitutional weakness" was moral rather than physical. I mean, one of the main things now recommended (in, for example, the studies I mentioned last week) for mild depression is exercise, something to get blood moving and alter brain chemistry etc, etc, whereas before the main recommendation was to "just get over yourself and improve that lousy attitude, you weak-willed, weepy little snit."

I tried very hard to find a decent bio of Dr. Keedwell; I realize it's dangerous to speculate about things like age based on a tiny photo on a webpage, but Dr. Keedwell looks pretty young, and I seriously wonder if he is old enough to have had much experience with the way depression was viewed before the development of Prozac.

I am also irritated by the fact that the good doctor fails to address an issue of semantics. "Depression" IS a disease, which is not to say that grief or despair are diseases--they are not, because those are not the names of a disease. However, "depression" is a disease because "depression" is the clinical name for a condition or set of conditions that doctors treat. Doctors do not treat grief or despair; friends, family, counselors and clergypeople treat grief and despair.

In other words, all these words may be names for essentially the same ontological condition, but "depression" is the only one doctors deal with.

I'm a fact-checker--I think the impulse that makes me one is part of the same set of personality traits that made me so susceptible to depression in the first place--in other words, a refusal to take things at face value, to accept someone else's authority just because, without looking into the facts and causes as well as I can myself. So I'm also indignant that the doctor doesn't even bother to fact-check something like the year of John Stuart Mill's birth. Thus, he writes, "The precocious philosopher John Stuart Mill wrote his famous work, Utilitarianism, [as if Utilitarianism was his only famous work--what about On Liberty or The Sujbection of Women? Does this guy not know how to use commas?] in 1861 at the age of 19 and became depressed at the age of 21," which meant that the newspaper had to print this correction: "We exaggerated the precociousness of John Stuart Mill in saying he wrote his famous work Utilitarianism in 1861 at the age of 19 in the article below. He was 55 at the time."

Many years ago I came across an idea called "depressive realism," best stated, in my opinion, in an amazing article entitled "A proposal to classify happiness as a psychiatric disorder" by Richard P Bentall and published in the Journal of Medical Ethics. You can read the abstract here, but this passage sums it up pretty well:

It has been shown that happy people, in comparison with people who are miserable or depressed, are impaired when retrieving negative events from long-term memory. Happy people have also been shown to exhibit various biases of judgement that prevent them from acquiring a realistic understanding of their physical and social environment... (and) give unrealistically positive evaluations of their own achievements, believe that others share their unrealistic opinions about themselves, and show a general lack of evenhandedness when comparing themselves to others. Although the lack of these biases in depressed people has led many psychiatric researchers to focus their attention on what has come to be known as depressive realism it is the unrealism of happy people that is more noteworthy, and surely clear evidence that such people should be regarded as psychiatrically disordered.

(I really recommend this article; it's absolutely deadpan, quite informative and insightful, and still hysterically funny. Find a copy if you can.)

So there's a long history of attention to the ways in which "depression" or "melancholy states" or "grief" offer states of being superior to happiness; one of the best discussions of this matter from the 20th century is from William James's Varieties of Religious Experience, particularly the chapters on "The Religion of Healthy-Mindedness" and "The Sick Soul." Comparing "healthy-mindedness" to "morbid-mindedness," James writes

It seems to me that we are bound to say that morbid-mindedness ranges over the wider scale of experience, and that its survey is the one that overlaps. The method of averting one's attention from evil, and living simply in the light of good is splendid as long as it will work. It will work with many persons; it will work far more generally than most of us are ready to suppose; and within the sphere of its successful operation there is nothing to be said against it as a religious solution. But it breaks down impotently as soon as melancholy comes; and even though one be quite from from melancholy one's self, there is no doubt that healthy-mindedness is inadequate as a philosophical doctrine, because the evil facts which it refuses positively to account for are a genuine portion of reality; and they may after all be the best key to life's significance, and possibly the only openers of our eyes to the deepest levels of truth.

In other words, James is trying to grapple with the spiritual and intellectual meaning of suffering, a question at the heart of Buddhism, after all. But Keedwell reduces this complex issue to the glib sentence, "Depression can lead to great insights and achievements."

And OK, that sentence is a transition, not merely the summation of his thesis--he goes on to elaborate and give examples of what he means. But still, it's "depression" again. The clinical condition again. He complains about the fact that "depression" is seen so often through "the clinical perspective," but that's the only perspective he seems able to have on it. He even goes so far as to wonder "why depression has not been 'bred out' through Darwinian natural selection."

There's something incredibly wrong with that, though it will take me a while to figure out everything that's screwed up there. What leaps to mind is the idea that the question is possible ONLY if you see "depression" as clinical, avoidable state rather than one intrinsic to consciousness (because even animals get depressed). Can you imagine wondering why happiness or love or anger or contentment or poor time-management skills or plain old STUPIDITY have not been 'bred out' of us through Darwinian natural selection? As if dumb people or people who go through periods of profound sadness can't procreate.

Anyway. I could continue arguing with this thesis, and I probably will, but I think I've said enough for today.

Posted by Holly at March 5, 2008 10:46 AM

Comments

Posted by: Revena at March 7, 2008 4:07 AM

Posted by: Holly at March 9, 2008 11:17 AM

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