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Apr 2, 2015

Rundle: 'depression confessional' culture obscures the true nature of mental illness

Mia Freedman's original confessional on her anxiety, coupled with her supporters' follow-up commentary, display a profound lack of understanding of the historical and social causes of depression and anxiety.

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Good God, when you go to war with Mia Freedman, everyone piles on. Your correspondent made a comment on la Freedman’s piece “I’m finally ready to talk about my anxiety“, and suddenly everyone was there, from la Freedman herself to her Dad to Ageistas-turned-Guardianistas, to (ha) Paul Murray, one of Sky News’ resident shock jocks. It was like a Wes Anderson movie, you keep expecting Owen Wilson to come through the door in a silly uniform.

So let’s try and get a bit more light than heat from this conversation, shall we? First off, depression and anxiety are a real thing, individually and socially. Despite being compared to Mark Latham by Freedman (of which more later), I’m emphatically not of the “pull yourself together we didn’t have this in the 1950s” school.

But there are different types of depression and anxiety. Manic depression/bipolar disorder seems a fairly separate condition. Serious or clinical depression, which leaves people unable to function, is separated off (in various different ways, by various categorisation systems) from a more common-or-garden variant. There are various types of anxiety, but one particular type appears to be related to depression — which is why it responds to SSRI (selective serotonin re-uptake inhibitor) drugs that were originally marketed as anti-depressants (whereas other types, which respond to other drugs such as Xanax and Valium, do not). “Standard depression” and anxiety appear to be on the rise in contemporary society. But are they?

The question is not easy to answer. Some types of subjective disorder/mental illness appear to occur in all societies. The condition we call “paranoid schizophrenia” appears to be constant, with a 1% occurrence in all societies — and is identified as a disorder, even in societies that believe in magic and supernatural forces (which is one thing that marks schizophrenia in a secular-scientific society). Serious clinical depression appears to have a degree of universal occurrence, too — stories of people falling “into a melancholy” lasting for years appear to be a record of this.

But what appears to be new are distinct forms of depression and anxiety spreading over an ever-wider area of social life. For a century or so, a form of anxiety — known for a number of decades as “the nervous breakdown” — has been current. More recently, it was joined, and to some extent superseded by, a persistent form of depression that leaves people functional but feeling utterly hollowed out inside — feelings of meaninglessness, obsessional negative thinking about self, disconnection, lack of pleasure, low energy, fuzzy mind, psychosomatic illness, etc. A certain type of anxiety has a similar structure of circular thinking — extreme hypochondria, panic, etc — to the obsessional negativity of depression.

Whatever the occurrence of other types of subjective disorder across cultures, this condition appears to be very specific to our culture, that of prosperous consumer-oriented, media/image-dominated mass society. Cultures based around smaller intimate societies, pre-capitalist forms of production, strong religious or traditional beliefs, may have all sorts of problems, but they don’t have these ones, by and large. From within the sociological/social-psychological discipline that suggests a root cause — meaningful life in such societies is founded on shared meaning, a lesser role for individuality and choice, and a common belief system. That puts a ground beneath people’s feet. Sadness, even misery, occurs, but they do not become that vague, cloudy but tormenting, depression/anxiety that many modern people recognise.

“The argument that mental depression could create a persistent physical depression pre-existed the rise of the market for SSRIs, but it was effectively cemented in place by their success.”

Further to this theory of the psychology of depression/anxiety is a theory of physical changes created by it. This is the “cortisol hypothesis” — the argument that the long-term occurrence of such feelings elevates levels of the fight-or-flight hormone cortisol, which is eventually depressive in itself, and also lowers the levels of the brain chemical serotonin. Playing a role in many functions, serotonin has a role in regulating mood, chiefly by allowing us to gain pleasure from the presence of trusted others (the “loved-up” effect of MDMA/ecstasy, which creates a serotonin flood, may be, in effect, causing one to identify strangers as loved others). The suggestion would be that persistent depression gets people “stuck” in a physical-mental rut, from which it is difficult to get out of by an act of will or self-determination alone.

Chemical anti-depressants have been known since the 1950s, but they were fairly crude in their effect. In the 1970s, fluoxetine was discovered, the first SSRI. Serotonin fills the “synaptic gap” in the brain — the space between synapses, the brain’s many billions of connection points. The cortisol hypothesis suggests that in depressives, it is reabsorbed too quickly by the “receptors” (like little drains) budded on the synapse. SSRIs have a chemical structure similar to serotonin, but they are not absorbed by the receptors — so they “plug” some of them, and serotonin stays in the gap longer. This appears to produce an immediate lift in many users of SSRIs, but the main effect appears to occur three to five weeks later, when a sustained lift out of depression often (but not always) occurs.

From the time Prozac, produced by Eli Lilly, came on the market, every other Big Pharma company started to bud off variants. Zoloft and Paxil were the two major ones, and Lexapro, the variant Freedman was spruiking, one of the minor leaguers. Such drugs are all minor molecular variants of each other, and they have a 17-year branded patent (after which they can be sold generically by anyone). However, the corporations producing these drugs can extend the patents if they can argue that they treat other conditions — thus Lexapro had its patent life extended as an anti-anxiety drug, and Zoloft was applied as a treatment for “social phobia”, a pretty amorphous condition that the manufacturers argued was a hard medical condition. In one particularly audacious move, Zoloft’s manufacturer tried to have “shyness” defined as a medicable condition.

SSRIs took off in a way that no drug ever had to date. By the 1990s, they were the most -prescribed drugs, earning Big Pharma billions, hitting prescription levels of 10-15% of the population. They were in use for about five years before people began to notice that they were changing the culture, our idea of selfhood — and the actual materiality of the selfhood of people taking them. The argument that mental depression could create a persistent physical depression pre-existed the rise of the market for SSRIs, but it was effectively cemented in place by their success, their vast marketing campaigns, and the capacity of Big Pharma to fund research that tracked in certain directions.

But as SSRIs spread and governments cut back funding for more expensive talking-therapy approaches, the mental-to-physical theory of depression and anxiety began to fall away , and a simpler de facto model took over — depression and anxiety were treated as purely physical/neurological functions, to be directly adjusted by drugs. GPs had preferred to refer troubled patients to psychotherapists, to apply a mix of talking and drug therapy; increasingly GPs themselves began to prescribe the drugs with very little follow-up. They had initially been presented as taking three weeks to work, but it was clear to many that an immediate effect was occurring in many people. GPs want to alleviate suffering, large numbers of depressed people came through their doors, the drugs seemed to work, and GPs tend to be practical types, not prone to cross-cultural analysis. Though other people tried to emphasise the complex nature of depression as a social/psychological occurrence, the de facto physical theory started to win out.

The approach was also attractive to many sufferers too. Depression has many factors, and some of its particular occurrence may have individual factors — dysfunctional childhoods, bad adolescences, physical/sexual/emotional abuse, personality traits useful in some societies (e.g. mildness, gentleness, introversion) that make life difficult in an individualist, market-based society. Committing to therapy offered a longer, more difficult path, one that involved admitting a lack of success in negotiating parts of life, and confronting things that the depression or anxiety might have been an unconscious strategy to avoid. Not only do SSRIs offer an immediate lift, they also offer the idea that one is afflicted with a random physical condition. It not only absolves the sufferer from a more difficult struggle, it gives one the status of the ill, a degree of special dispensation.

“The physical theory of depression ignores the stark fact that many societies that do not have our characteristics simply do not have the levels of depression and anxiety we are experiencing.”

But this ever-widening acceptance of the physical approach to depression occurred at the same time as some contrary indications. While it was clear that SSRIs altered the chemical processes of the brain, several studies suggested that there was no difference between SSRIs and a placebo in alleviating depression and anxiety. This in turn has thrown doubt on the serotonin/cortisol hypothesis. This isn’t unusual in this area; for more than half a century, lithium has been used to treat bipolar disorder, yet there is still no authoritative theory of how it works. The placebo effect disturbed many practitioners, which they dealt with by ignoring it (no profession is more practiced in psychological defences than psychological professional practice). There was no real theory applied, but the simplest one would be from anthropology — the pill is a gift, a material exchange of reciprocal connection between doctor and patient. Effectively, it’s an invitation to magical thinking that relieves the patient of the burden of their own afflictions, and thus allows their energy to flow outwards to the world again. “Pick up thy bed and walk” — Jesus, by using a touch of the hand, was one of the first documented short-term psychotherapy providers.

SSRIs have been so lucrative for their patent-holders that they have gone to extraordinary lengths to maintain the market. This has meant playing down some of the serious side effects. Earlier anti-depressants had had general side effects — they left users feeling sluggish and fuzzy. SSRIs had particular side effects — they left most users without side effects, but caused a very dire one in a small number (1-2%) of users, which was a sudden and overpowering surge of suicidal feelings. The simple enough theory of that was that depression had the effect of depriving very troubled people of will (and was thus to a degree protective). Recharged by an increase of energy and purpose, but with none of their psychological issues dealt with, the combination supercharged the drive to self-destruction. There has also been an argument that SSRIs promote homicidal behaviour, for related reasons, and Big Pharma fought court cases all through the ’90s to try and head that off at the pass.

Proportionally, these were relatively rare occurrences — though given the numbers of people taking these drugs, the raw figures of suicidality are quite high — but in the 2000s another issue began to emerge, that of habituation and neurological damage from long-term use. SSRIs had been marketed on the claim that they wouldn’t have an effect on people who didn’t have depleted serotonin, wouldn’t diminish in effect over time, and wouldn’t cause receptor damage. But none of this had been tested prior to FDA approval and only emerged after the drugs had been in use for a decade or more. The dangers are obvious — prolonged use could reduce the effectiveness to zero, damage the mood “hardware” and leave sufferers in a worse state than they began in, and with resistance to the drug in question.

That SSRIs are beneficial, life-saving in some instances, and an effective treatment for deep-seated and resistant depression and anxiety seems well-established (though some would disagree). But the level of prescription that goes with the “physical” theory of depression/anxiety is vastly in excess. No one really advanced the simplistic physical theory of depression, bald and unvarnished; it has simply grown up around practice — and then it started to steer the practice and exclude alternatives. But the physical theory of depression ignores the stark fact that many societies that do not have our characteristics simply do not have the levels of depression and anxiety we are experiencing, especially the levels of it in adolescence and childhood.

When we approach it from the other end, the social end, we can say something different about depression and anxiety — that we have a depressogenic society, creating depressed people who would not otherwise be so, and creating a vast amount of unnecessary suffering. But what is it about our society that is creating this depressive excess? As I noted, the clear division is between societies “grounded” by abiding others, shared purpose and work, mutual obligation in close networks and a relatively concrete belief system. Modernity, of any character, is the factor most likely to increase these conditions — scattering villages into cities, replacing traditional culture with mass culture, allowing people to become isolated and disconnected — but that only goes part of the way. After the “great transformation” when we went from “communities” to abstract societies, both the working  and middle class re-assembled community in the form of neighbourhoods, associations, congregations, etc.

But, in the 1960s, those worlds were subject to a fresh break-up. A consumer economy, class mobility, liberal social revolutions and a new centrality for mass media put the individual at the centre of social life — with the increased risks of collapse that individualism creates. In the ’80s and ’90s a further break-up of social networks occurred with the extension of the market into all areas of social life and the absolute dominance of a culture based on a vast stream of images. Beneath this all, a master process ran — working life ceased to be about production for a local community, for each other, and became commodity production, work to produce something with no particular meaning attached to it, to sell on the market.

The result is a society that is supercharged, dynamic, often exciting, and liberating. But it is also competitive, setting people against each other, hyper-individualistic, repeatedly dissolves grounding meanings — where you grew up, how you lived, etc — and all of it driving many people to work very hard with no meaningful purpose. When the going is good, it’s great, when it’s not, you can fall for a long way. It is also afflicted with what one might call the “precursor” of depression and anxiety, narcissism — a see-saw of manic (and defensive) overvaluation of self and a sense of crushing insignificance amid the global image gallery.

That way of life can create outbreaks of depression and anxiety everywhere, but it tends to hit two groups hardest. The first is the powerless — those with little control over their lives, victims of under-resourced education, abusive backgrounds, working-class worlds from which work has been removed, rural areas in serious decline (where community has become attenuated) and the like. Depression and anxiety in these cases are what Martin Seligman called  “learned helplessness” — when no choice you could reasonably make could make a difference, you collapse into a vicious circle of defeated and depressive mood.

The other group that seems to be afflicted by depression and anxiety are at the other end of things — culture and media producers. Levels of depression and anxiety appear to be very high amongst this group, judging by the number of articles written about it in media for affluent consumers. There are many particular reasons for this. Culture/media producers work in a world of images, disconnected texts and relentless production of content with no great meaning. It’s like working in a hall of mirrors. Unless you understand that you’re in a hall of mirrors, you are bound to be disoriented. Then there is the particular form of the work. Whatever the many advantages of such work over factory labour, the latter doesn’t ask for your continued passionate engagement; many people in culture and media circles find themselves sucked dry by the continued demand for ideas, opinions, performance, etc. Increasingly this demands a mobilisation of self, drawing on personal experience and attitude to create material for sale. Within an overarching purpose for doing it — political, for example– many people will simply find themselves out of gas. That is particularly so in our era. The great era of liberal media is over, when large organisations were willing to put capital in the service of truth and inquiry. With honourable exceptions, media are now content mills, and media and culture can feel, for many people, a ghastly parody of what they went into it for.So, many people have a desire to believe that their depression or anxiety is nothing other than a physical illness, and a whole medical system is willing to agree with them. But there is also an interest the system itself has in maintaining such a false and simplistic belief. To really address these issues. we’d have to start thinking about social and cultural change — rebuilding a way of life in which there is more possibility for people to live in meaningful interconnection, less set against each other in an isolating manner, and less dominated by commodities, and images. Those who have an interest — even an unconscious one — in the current world continuing are those who have an interest in selling meaning back to a general populace one piece at a time. Such interests cannot but shape their worldview.

In the wake of last week’s article, the critic fielded a number of criticisms, all of them easily dealt with. A persistent one was that “I was not a doctor”, so couldn’t speak. Well, first of all I wasn’t advocating a course of action. Freedman was, pushing a line pretty strongly pro-SSRI, and implicitly suggesting indefinite use. I merely pointed out the side effects. Freedman’s doctor either didn’t point these out, professionally remiss, or Freedman didn’t pass them on, and she was remiss. More broadly, however, the idea that only doctors, or those channelling them, can speak on the topic is to pre-decide the issue as a medical one, and depression/anxiety as a physical disease, which is pretty circular. The most extreme form of that was the argument that to suggest that people with such conditions, think about whether factors in their life might be contributing — like living in the vortex of media-entrepreneurial mania — was to be “patronising”. This seems about the most bizarre application of the medical “physical” model of depression/anxiety around; that you should entirely abandon any sort of reflection on how you live, and simply jack into your brain with a chemical. This is the denial of autonomy and self-determination at its most confused.

Secondly, was the suggestion that a personal article should be above criticism, especially a “brave”, confessional one. But, of course, it wasn’t just a personal article — it was evangelising for a certain type of drug, so to claim immunity would be perverse. And how brave is it to publish another mental illness memoir, really? Nor is contacting the author for more information a feasible option. If you’re going to advocate a debatable course of action based on your own experience, it becomes a public object, to be debated with robustness.

Depression and anxiety have become major topics in the contemporary world because they’ve become major challenges in many people’s lives, either directly or through people they’re close to. But the depression/anxiety memoir, etc, has also become something else — a heroic narrative, something that lifts the reader out of the mundane and tells of overcoming the odds. Frontier narratives for a built-out world, inward ho! They make people feel alive in a deadened world, which is why they are endlessly repeated. Without pushing back against this on a collective level, it will only get worse. It will be worse for your kids, and it will occur in a context not of expanding opportunity and prosperity, but of the narrowing of such. The crisis will come, best prepare for it.

Australia has become a world centre for this. Whether we have more depression and anxiety than elsewhere is hard to quantify, but we sure love to talk about it. We’ve gone from true blue to Beyondblue in a couple of generations. One reason why that might be, is that our culture was so thin in the first place. With old value systems like imperial mission or cultural nationalism gone, we’re just a big suburb on the coast, swamped by the new anti-culture, anti-social media, etc. Depression confessional has become the centre of our cultural life. Politicians, footballers, writers, etc — it never stops. There was a point to it early on, but now it is part of a cultural predicament. And also of diminishing returns, as the discussion never moves forward to what it needs to do, which is to talk about this issue as a social and historical phenomenon. Ultimately, to make the decision to ring-fence a part of your own behaviour as pathological is to make a separation between self and world that can’t help but put your whole subjectivity “in brackets” as it were. For some it may be necessary; for all it should be a last resort. Better to try and avoid the trap altogether than to hack your leg off to get out of it.

Books from which this article was drawn and further reading for those interested:

  • Rick Ingram (Ed) Contemporary psychological approaches to depression: Theory, research, and treatment;
  • Peter Kramer, Listening to Prozac and Against Depression;
  • Peter Breggin, Toxic Psychiatry;
  • Joanna Moncrieff, The Myth of the Chemical Cure; 
  • Martin Seligman, Helplessness: On Depression, Development and Death;
  • John Cornwall, The Power To Harm;
  • Erich Fromm, The Sane Society and On Being Human; 
  • Susan Pinker, The Village Effect; 
  • Christopher Lasch, The Culture of Narcissism;
  • Pierre Bourdieu, The Weight of the World: Social Suffering in Contemporary Society; and
  • The depression-anxiety film club! Three films by Adam Curtis: The Century of the Self; The Trap; Watched Over By The Grace of Loving Machines.

Over to you, Mia.

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30 thoughts on “Rundle: ‘depression confessional’ culture obscures the true nature of mental illness

  1. Daniel Retward

    A good account.

    In my limited experience of those on anti-depressants, one of the side effects is loss of emotional intimacy with family and friends.

    It would be interesting to see if depression is more contagious when being treated by anti-depressants.

    For myself, there is much to be said for gardening, bush walking and pets for normalising the human psyche.

  2. lethell

    I did think your original article was a bit harsh but this more thoughtful expansion of it is well worth reading.
    Strange irony: Jeff Kennett as spokesperson for Beyond Blue yet as a politician a paradigmatic exemplar of the sort of neoliberalism whose explicit aim is the destruction of a sense of obligation to the community in favour of the hyper-individualistic economic concept of value that is a leading cause of depression.
    (Like Fraser, in his post-political life agitating against the very conditions he helped to create.)

  3. KennyB

    Similar, my reactions to SSRIs were similar to many others during the 90s and early 200s, eventually a case of “don’t care”, and quite numb distanciation from “things” and people also perhaps because any path or goals seemed to have been removed.

    To say nothing of sexual disfunction cause by SSRIs – not getting it up, then not being able to come. I think this is much more serious than many allow for it. In the short term the drugs were moderately useful, but only ever for short terms. I was and remain concerned about the situational side of one’s life and what sort of circumstances and behaviours and perceptions I needed to solve “issues” or remove triggers for gloom. I decided to do over a year of relatively “soft” semi-Freudian psychiatry (because I particularly wanted this form of therapy, and I knew a practice who did it.) I found these interactions were far more useful as ongoing therapy.

    I would not wish to use SSRIs again, frankly. But they can work for some, although the longer term use issues aren’t being addressed properly.

    As for Freedman, I couldn’t care less what she did and how she felt. I have no time for “single solution” proponents to anything whether fad diets or Voodoo homeopathy or mental health. I thought Guy was being far too gentle with Ms Freedman.

  4. parrick

    The cure for this ill is not to sit still,
    Or descend in the SSRI mire;
    But to take a large hoe and a shovel also,
    And dig till you gently perspire;

    And then you will find that the sun and the wind,
    And the Djinn of the Garden too,
    Have lifted the hump —
    The horrible hump —
    The hump that is black and blue!

    With apologies to Rudyard Kipling

  5. Colin James

    It’s always a tad confronting to read almost anything written by Guy Rundle because he makes me realise how shallow and opinion led is much of my cogitations on matters social, political, economic and otherwise. I had long surmised that Australia did not have a depression epidemic just an unhappiness one. Being unhappy implies some responsibility. Pathologising unhappiness to depression removes accountability and medicalises the state. And that’s where my thinking stopped. Guy takes us into the layers of substrata and historical contexts that navigate the transition from true blue to Beyond blue with his usual dexterity. Bastard.

  6. burnmuthaburn

    it’s all about failure (perceived or real).

    trust me; i am a failure…………

    if only i could know if my failure was perceived or real…….

    (i’m not shitting you……. this is deadly serious)

  7. puddleduck

    Thanks Guy for a thoughtful and thought-provoking article.

    While not (yet) in a worse state than I was before I was prescribed the first of three different types of SSRIs, I am worried about the habituation and neurological damage that may result from now 15 years on these things, not to mention the health effects of the additional 25kg I’m carrying as a result.

  8. puddleduck

    PS I can recommend Andrew Solomon’s “Anatomy of Depression”.

  9. David Barrow

    When Guy Rundle writes:

    “This in turn has thrown doubt on the serotonin/cortisol hypothesis. This isn’t unusual in this area; for more than half a century, lithium has been used to treat bipolar disorder, yet there is still no authoritative theory of how it works. The placebo effect disturbed many practitioners, which they dealt with by ignoring it (no profession is more practiced in psychological defences than psychological professional practice).”

    Does he mean lithium has a placebo effect? Or the wider “serotonin/cortisol hypothesis”?

    Lithium was not a placebo effect for me (I’m sure).

    October 2014, in a defamation trial against Andrew Bolt (of the NewsCorp stable), I publicly disclosed for the first time that that I have a bipolar condition well-managed with medication since 2007.

    One ‘benefit’ (sort of) from having an illness that was raging untreated for so long is that I have some lengthy comparative time periods with and without medication.

    Here’s my timeline:

    1989: age 19 onset of bipolar symptoms: disruption to relationships, career and finances due to manic and depressive moods. This raged for the next 18 years.

    2005: age 36 first bipolar medical diagnosis after attending psychiatric sessions for 6 months. Diagnosis confirmed through second opinion of world leading psychiatrist Prof Isaac Schweitzer.

    29 March 2007: after 2 years of resistance I finally started taking Lithium. Very positive results stabilising moods which enabled me to work the regular hours of a job again. Since then have taken Lithium daily for 8 years and added Lamotrigine in Dec 2007 to give more protection against depression. It should be noted that these bipolar medications can have serious harmful side-effects; although I have not suffered any that I am aware of or have shown up in regular blood tests.

    Summary: 19 years with no symptoms; then 18 years bipolar raged without medication; then 8 years on bipolar meds and have achieved mood stability.

    I would recommend people with disruptive moods seek out an opinion, or a couple of them, from a healthcare professional, and also consider medication. For me it has been a miracle and perhaps it will work wonders for you as well.

    For all the insight and empathy-awareness that came from the 18 years between 1989 and 2007 of whiteknuckled, untreated rapid-cycling bipolar chaos, I would have preferred that someone encouraged me to explore medical help earlier. In my case, it would have saved me much needless suffering.

    David Barrow

  10. Catherine Scott

    A few facts. Antidepressants are snake oil and snake oil at that with sometimes deadly side effects. Apart from all the other stuff that can go wrong they are implicated in suicides and homocides. And no better than placebo
    http://www.scientificamerican.com/article/antidepressants-do-they-work-or-dont-they/

    Mental distress of all types increases as inequality increases.

    In countries like Japan where both positive and negative emotions are accepted as normal and not things that should be controlled but just observed and let pass reactive anxiety and depression occur much less frequently.

  11. Lubo Gregor

    Best thing I read in long time. Especially the part about a meaningful life in societies founded on shared meaning, a lesser role for individuality and choice, and a common belief system. Can we get back to those? Will we have to start colonising the space to create them again? Will our current culture have to completely collapse and be rebuild into such societies in a natural way?

    And another thing, I had no idea who Mia Freedman was until Guy’s last article (I’m consciously ignorant of the popular culture), I wonder how many girls and women became depressed under the influence of magazines like Cosmopolitan, Cleo and Marie Claire and the endless ads in them?

  12. Frederica

    This reads better than the last article Guy. I am actually on the same drug and I’ve been on quite a few over the last 15 years but I don’t think it was a good idea for Mia to spruik a particular brand of anti-depressant. I must comment however that one of the strangest things people think about these drugs is that it turns you into some sort of happy zombie who just doesn’t care. I’ve never experienced that myself (for example I still think Kennett is a d&%ckhead and refuse to donate to beyond blue). They aren’t like benzo’s (Xanax etc) either. Benzo’s can be bloody addictive and I remember feeling pretty stoned for the short period I did take them.
    Mia’s article is pretty much right for her audience who I’m afraid to say get right into the Hero narrative and love to wallow in a good cancer survival story.
    Mostly the Hero narrative is only applied for those who give themselves coffee enemas and ‘prove the doctors wrong’ so it’s nice to see it applied to just following evidence based medicine. It’s sorely needed by her readers some of whom are seriously hooked on media like Mercola.com. Hopefully if the meds work well she might stop spruiking all the other cr*p like drinking apple cider (I mean, why would you do that?)
    I’m also not sure about your ‘culture and media producers’ and anxiety correlation, that could just be a ‘basketballers and height’ correlation rather than causation.

  13. Nin - ti

    You seem to be making a puritanical judgement here, “these people have not worked hard for their cure, therefore don’t deserve to be cured”, in your preference for talk therapy over medication. Your whole article evinces a distaste for fast cures. In fact, talk therapy doesn’t work all that well for depression. Cognitive behavioural therapy does work and I suppose might be seen as the “moral high road” but it requires a degree of will and commitment often impossible for someone suffering from depression.
    I can’t agree with the argument that more simple societies didn’t have high rates of depression. Much like the evolution of colour description in language and the evidence that if there is no word for a colour, people don’t see it, there is no point in complaining of something when there is no treatment. Historical comparisons in this regard are hopelessly biassed. I agree that depression and the obsession with happiness are the preoccupations of an affluent society. It’s not something you consider when you are struggling for survival.
    You sound like a character from “Atlas Shrugged” telling someone that what they need is to do an honest day’s work. Have you been reading too much Ayn Rand recently?

  14. old greybeard

    I am married to a clinical psychologist and one who eventually overcooked herself and became a serious depressive. The SSRI road has been badly laid. For some it works, but the “real” trial figures were doctored and in fact the SSRI benefits were not much above placebo. The side effects can be very nasty, apart from the sexual function (been there) they can produce very vivid dreams, so much so that you can’t be sure it was a dream and it invades your waking life. This drove my father to attempt suicide and he nearly succeeded, despite being in hospital. People in the media who spruik specific drugs need a right bollocking. They have little depth of knowledge and a conflict of interest. I would not take dear Mama Mia’s word anyway, as I find her a lightweight dill, but she was irresponsible at best.
    Big Pharma spends a lot of money on promotions and research on “first world problems”. The serious work, new antibiotics etc is done by the public purse. The Eli Lillys of the world do not want cures, they want long term medication use by rich people who will pay to avoid any discomfort. I KNOW how serious depression is, but it has become a host for a large range of parasites.

  15. Ian Holder

    Thank you Guy. With one exception, the psychiatrists I have seen for anxiety, depression and now mild bipolar have been open and honest about the the unknown nature of how this all works; I am on lithium now and my current psych said he and the profession don’t know why but it can help and has helped me. I am thankful for such honesty. The exception drugged me up until I lost all emotion telling me that was better than feeling sad!
    Agree with the sense of alienation being a big factor for me… Do not feel I fit in in this world with its materialistic nature and emphasis on what you do as work rather than who you are.

  16. AR

    Over 5000 words to paraphrase R D Laing? A appropriate response to a mad society?
    I’m with Parrick.

  17. Norman Hanscombe

    There’s little doubt, Guy, that over-simplistic approaches such as saying we soldiered on in the 1950s miss important points. On the other hand, too many commentators are ready to ignore the fact that changing societal attitudes do seem responsible for much of the increase in anxiety depression cases.
    I’d suggest a non-emotively tainted analogy [which illustrates what can happen with changed environmental circumstance is to be found in the world of budgerigar breeding. The wild budgerigar is almost always green, but its DNA contains an amazing number of variants. Early on the blue budgerigars appeared in aviaries, and s soon selective breeding had established a new show-bird variety. Others followed, and by the 1950s the Annual Contest contained varieties not originally part of aviarists’ wildest dreams.
    Aviarists had used selective breeding to encourage the passing on of attributes which had always been in the species’ DNA, but didn’t survive in the outside world. Modern Western society can be seen as having played [for totally different reasons of course] a not dissimilar role in how we’ve enabled evolution to change course via our interventions which ensured those with genetic flaws were able to survive and reproduce.
    Added to this were our policies telling us we needed to deal with anxiety and depression in ways which passed the ‘blame’ on to circumstances beyond our possible management. Is it any wonder anxiety and depression became growth industries? These suggestions will, of course, give rise to less than friendly responses; but people needn’t hold back for fear of causing me to become depressed. I decided in childhood that it wasn’t a very effective reaction to stress, and although I’ve changed my stand on numerous issues, I’ve never seen any reason since to change my position on that.
    I trust, Guy, that at 12.09 p.m. budgerigars isn’t a topic which requires lengthy ‘moderation’?

  18. Rodger Davies

    I have found that i need

  19. Liz

    Your last line basically summed up the article, and my views on the subject:

    “For some it may be necessary; for all it should be a last resort. Better to try and avoid the trap altogether than to hack your leg off to get out of it.”

    The comments below the original article by Freedman bothered me – it was as if people were quickly jumping on the pill popping bandwagon and urging others to join them, with a lone objector or two being roundly criticised.

    I guess when you’re on something and have no immediate prospect of ever getting off it, you would feel pretty defensive about it, and want to justify it whenever possible.

    Life is problematic and many of us have periods of sadness and inability to function. Unless one has schizophrenia or a severe mental illness, I will never be convinced that mind-altering medication, for the forseeable future, is the answer.

  20. Justin Harris

    Whilst as individuals we have differing forms of mental illness, 1 area not looked at thoroughly is chronic fatigue syndrome which is more common in most of our mental illnesses than you would believe.
    Once our adrenal glands suffer which can be from mental stress mainly but also diet (i.e) caffine which damages the adrenal glands, in doing so the lack of cortisol production manifests itself in many mental conditions.

    Many of the drugs are not only useless but can deepen the impact on the adrenal system and here is a very interesting doco that shows how big pharma spun their way into this industry.

    https://www.youtube.com/watch?v=uFkivsEy3CI

    Having used most of these drugs I can honestly say they were little to no help whatsoever and even caused thyroid cancer to which I lost my thyroid. The fillers in some of these drugs contain bromine amongst other things and displaces iodine in the thyroid. This will cause massive damage psychologically so the 1st thing I recommend to anyone is get hold of potassium iodide and take some every day as nearly all people are lacking in Australia as the iodine level in the soils here are very poor. The Japanese traditionally have always had among the highest lifespans “pre fukushima” as their diet consists of lots of seaweed which is rich in iodine. There is a correlation between the lack of iodine and mental health which big pharma won’t let on about, in fact “Abraham Lincoln” is on record quoting if you wanted to destroy a society take away their iodine. Much was known about this in his time but sadly this has been lost in history. You don’t even see it on supermarket shelves anymore having to order it which is real sad. They even took iodine out of bread where it was a good improver and antiseptic and “again” replaced it with bromine. Does this give you a clue to where this is going?
    This is not a magic bullet or cure all but can have significant effects in most people. Look at the simple things first before you even go near these drugs, doctors are even prescribing anti-psychotics to people with “Lymes Disease” so beware.

  21. Draco Houston

    This all rings true to me, grundle. I’ve been on sadpills for years and they don’t do anything anymore. I won’t go over the details because that would be a Depressional.

    There may well be various kinds of mental illness that can be treated by medical methods but mine is not one of them. I can’t be the only one.

  22. Humphrey Bower

    Thanks Guy for a thoughtful and discriminating piece. My psychiatrist father always said that in his experience there were people,who suffered from manic-depression (which he regarded as a full-blown psychotic illness, probably biochemical in aetiology) and people who were ‘rationally’ depressed because they had something to be sad about. This would I think include the social anomie you describe as a by-product of modernity. Freud however also spoke of something he called ‘neurotic misery’, which he claimed psychoanalysis could cure to extent that it could be replaced by ”the normal unhappiness that is the common lot of humanity’. I suspect anxiety can be similarly differentiated between neurotic phobias on the one hand and ‘rational’ anxiety in face of modernity or indeed existence on the other. Kierkegaard dignified the latter with a spiritual significance (which Heidegger later ontologiized); the Great Dane also elevated despair to a spiritual ‘sickness unto death’. None of which is to diminish the suffering of those afflicted by any of these variations on the theme of being human; nor to dispute anyone’s right to alleviate that suffering however they can: medication, analysis, cognitive behavioural therapy, meditation, religion, philosophy, the endorphins released by physical exercise, or any combination of the above (physical exercise has worked wonders for me, with occasional resort to an analyst with whom I have a reliable sense of rapport). Ultimately however the closest we can get to a cure is (as you imply) at least the idea of a good life and a better society. Best, Humph

  23. Liamj

    Good work GR, credit for backing in your criticism with cogent argument.
    Its no accident that the social determinants arguments don’t lead to progressive change, or that Bloody Jeff is head salesman for beyondblue. Jane Fonda was the prototype for a model now mass mediated around the world: the solution to the subversion & failure of social reform was & is to pathologise discontent and internalise responsibility for social problems – “its not them, its you”. Big Pharma and its many varieties of soma are just serving a function required by the suicide cult we call civilisation.

  24. Jack Robertson

    Great, great article. Thanks for the precision, care and research, in typically fast turnaround.

  25. Bozwell

    A very well researched and wide ranging article Guy.
    Very impressive, and well up to your standard.
    As a retired Psychiatric Nurse, your comments and referenced opinions accord closely to my observations.
    It is less expensive to prescribe than to engage in dialogue and bolster up social support.
    Too much for me to comment on,but the fragmentation and alienation of our society,the self- interest of Big Pharma,and abandonment of the mentally ill by our Governments are all factors.
    In addition the growth of narcissism over the past couple of decades leads to the ‘hollowing out’
    of the psyche.
    Where can we look for real meaning these days?

    BTW your social analysis,as always is spot on.

  26. Alex

    Guy, this is a great article, which I am yet to finish. It’s already made me late for work, and I’m only half-way through it! Cheers, Alex.

  27. Dubious Virtue

    @Catherine Scott

    Great point! Japan manages things like depression much better than the west. One way they do this is everyone knows their place. Some people are better than others and the social hierarchy reflects this. People don’t get as depressed about things they cannot control as that’s their place in life, to be lower than someone else… and they’re happy because of it.

    There are also ways to make sure past mistakes don’t come flooding back to remind one of the failures in life. For example when say a student is found to have committed fraud in a scientific paper the supervisor commits suicide.

    Suicide is quite accepted in Japanese society. Rather than try such “snake oil” as pharmaceuticals, or CBT for years and be a burden to those around you just jump in front of a train.

    So bow down and accept your place in society or if that doesn’t work just off yourself. That sounds like a much better solution… thanks Catherine.

  28. Peter.Grudzinskas@pharmaxis.com.au

    Guy Rundle states in his discussion of drug treatment of depression (Crikey 2/4/15) that “several studies suggested that there was no difference between SSRIs and a placebo in alleviating depression and anxiety.”
    WTF? The JAMA article (freely available on the web: not sure why the secondary reference in “GreenMedInfo” was used) states its conclusion clearly and concisely:
    “Conclusions The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial.”
    This is NOT the same as “no difference to placebo”, it attempts to link the response to treatment with these agents with the severity of presenting symptoms. Guy, you are usually a thoughtful yet entertaining writer whose contributions to Crikey are a highlight of the publication: what is going on here? Who are you really angry with?

  29. Stephanie Aguirre

    There is a great idea by anthropologist Knauft which argues that globalisation and modernisation actually increases cultural distinctness and community because cultures engage with ‘modern forces’ in a specific cultural style. Knauft puts it better. Depression, like autism spectrum disorders and other illnesses are recognised and diagnosed now because they are understood I don’t think it is fair to say ‘in the past there was a lot less people suffered from diseases which they couldn’t diagnose at the time’. There is of course a hierarchy of needs – if I spend all day hunting/gathering and very little leisure time you don’t sit around thinking about how meaningless existence is. I have no qualms about the author’s lack of medical degree but would be more concerned about his knowledge of history, sociology and anthropology. Interesting debate.

  30. Robert LeChef

    More whining and slavish thinking. Victim thinking is always the blaming of personal mediocrity on others or on exter. “Oh, poor me, I’m depressed.” You’re depressed because you’re mediocre, cowardly, and weak. Arrogant too, most likely. You are the walking dead, the rabble. You sow what you reap. Depression is a sign of poor character and no superficial or mendacious rationalizing will ever change that. Talk of receptors is merely confusing cause with effect. They are utterly irrelevant and the pseudoscience that has formed around the biology is grotesque. In short, your’e depressed because you suck. Have the humility to and courage to confront that truth. The world ought never to succumb and bow to the weak, the cowardly, the degenerate.

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