It was brought to my attention yesterday that this is depression awareness week, so as it is something that has featured a lot in my life personally and professionally I thought I would write about it.
Depression became a big part of my life in my mid teens, when my dad had a breakdown. It pretty much turned my world upside down, and while a lot of what i experienced was to do with worrying about what I could see happening to people I loved, I also had to deal with a lot of stuff relating to social attitudes. Not anything anyone said to me – I don’t think we ever received anything but kindness or support from people around us, who were mainly family members and their church friends – or implied, but my own issues in feeling uncomfortable about talking to anyone about what was going on, anger at what I imagined people thought based on how depression tends to be viewed. I don’t think I talked to any of my friends about it much if at all at the time. I felt like he was being swallowed up in his own sense of failure.
When I met Ian, my partner, he was being treated for depression (at the age of 19), though fortunately this has not been a long lasting issue. Since then at least four of my closest friends have gone or are going through some form or other of it, along with lots of people I know less well.
There is no one cause of depression. I think the simplest and most accurate way to explain it is as a normal human experience (rather than a psychological disturbance as such, which is how it is clinically viewed), but one which can cause a lot of suffering for those who experience it. The stats for reported depression suggests that it is one of the most common mental illnesses:
”It is estimated that 5-10% of the population at any given time is suffering from identifiable depression needing psychiatric or psychosocial intervention. The life-time risk of developing depression is 10-20% in females and slightly less in males.” (WHO, 2004)
Clearly with any sort of neurotic mental illness (a condition where people are still aware of reality) there are problems with report rates as a definite stat, because there are two issues which impact: firstly, the social stigma surrounding mental illness, and in particular the barriers to admitting an inability to cope. This may be the reason why the figure is slightly higher in women, who tend to seek medical help quicker and have less social pressure not to crack or show emotion. Additionally, there is probably a good deal of self-treatment, including relatively healthy activities such as exercising but also forays into other things such as alcoholism (or other addictions) or eating disorders.
Depression is in part biological, in that people who are experiencing depression have chemical differences in the brain. It relates in part to levels of serotonin (a neurochemical which has a knock on effect on lots of other things chemically) activity in the brain, so is in that sense an invisible physical difference between those who experience it and those who do not, and like many other invisible physical differences tends to be misunderstood as a matter of choice (just not choosing to snap out of it). It is likely that people are to some extent genetically predisposed towards depression – born with a genetic combination which does not determine that they will become depressed but maybe makes their vulnerability greater in the right set of circumstances.
Environmental stressors, including both issues in the home environment, personal relationships, work life etc, but also wider factors such as poverty and discrimination, all increase vulnerability to depression. Depression levels tend to go up at times of economic austerity (and have risen under the coalition). This may be in part down to increased personal failure and hopelessness – it has long been argued that depression is in part a behavioural response to repetitive failure and lack of control (Seligman’s learned helplessness theory) – in a time of high unemployment but may also relate to cuts to support services which could manage depression at a milder level.
Anti-psychiatrists argue that the medicalised diagnosis of depression is a form of social control: that depression is a result of a failure of our social support systems and structure to provide opportunity and care, and that by diagnosing we point the finger inside the individual in deciding the cause rather than engaging with a wider look outwards at what is going wrong in our society. They also point to the massive international capitalist interests of psychiatric drug companies which do bear some investigation, though there isn’t space to do it here.
Treatments for depression are controversial. Generally SSRIs (a drug which impacts on serotonin activity) are used these days but there is much debate over their effectiveness: they seem to be most effective for those with moderate to extreme depression, with placebos performing at the same level for mild depression and possible increased risk of suicide in teenagers and young adults. As with any psychiatric drug, there are issues surrounding control (by giving someone a drug you are taking away their involvement in their recovery, to some extent), dependency, side-effects etc. While traditionally depression has also been supported by psychotherapy with a humanistic element (person-centred counseling for example), in recent times Cognitive Behavioural Therapy (CBT), a shorter, cheaper therapy which involves a large body of work being undertaken by the client alone, is rising in popularity. Reviews of therapeutic effectiveness suggest that the most important factor in success is how skilled the therapist is rather than the therapy chosen.
As with most mental illnesses, I think it is really important that we look at the extent to which those suffering feel obliged to take responsibility. The assumption is that mental illnesses are a matter of choice, and this causes real problems in terms of what people have to go through, It puts up barriers which prevent the same level of social support that someone with a clear physical illness can get (though even that is being eroded under the current climate of suspicion over “scrounging” being deliberately stirred by the government and media). Depression may not be visible to the naked human eye, but unless it has been experienced there is no way to really judge how much it distorts judgement and decisions or what it is like living inside it. Like many other social issues, I think one of the first things we should do is look at the extent to which our education system and society teaches children an empathic imagination: the ability to see the world from another’s point of view rather than a shallow process of uninformed judgement.