The War on Depression: where is the enemy weak?
These pages are mainly about Depression. The starting point is to understand how Depression comes about and the finishing point is dealing with it better.
As an individual psychiatrist it may not be possible to make much of an impact on the wider problem of Depression, which affects so many millions of people.
But there are many fronts to fight on, outside the hospital.
There are a few themes to these pieces. One is to do with how toxic modern life has become. One is to do with how the mind works and in particular how people make choices. And a third one is to explain how health systems such as the NHS operate for (or sometimes against) people with mental health problems.
However we regard Depression, as an illness, as wear and tear, as a reaction to loss or as a social barometer, there is always another perspective to take.
Rather than ask the question, ‘why do some people get depressed?’ we might just as well ask why everyone isn’t depressed all the time.
Lets get the bad news out of the way right now: people get older. Generally when they get older they get more ill, and (don’t say it, please) eventually die.
In some ways that fact, the D word, is a potential party – pooper, even when we are young and have a fabulous future to look forward to.
Worse than that, even younger people can get ill, and they certainly can be subjected to terrible events (such as school).
Its been said that all political careers end in failure. Partly that’s because of the scoring system in politics, which tends to be ‘sudden death’, either by way of an election, or by way of sudden death.
But the same is not true of most sportsmen and women, who are somehow able to retire at the right time. In boxing, that’s while the brain is still working. For the rest of us, its a matter of recognising changes and adjusting to them .
If we adjust too much too quickly we are hypochondriacs and wimps. If we adjust too late we are foolhardy and in denial.
Life is very complicated and dangerous and a lot of us don’t make it, either in terms of quality or quantity of life. Some of us spend a lot of time ‘off the road,’ on the hard shoulder of life, but that doesn’t make us burned out ruins.
In seeing Depression as a wear and tear or stress related illness, we are not really explaining it very much. I prefer to see it as a natural phenomenon that is also an enemy, like rust. Or, at times, Gravity. Black ice. Wind. Electricity. Biscuits. Etc
All necessary but dangerous when out of control.
Depression happens when the system that controls mood is defective. The system has failed to calibrate correctly, or feed back on itself, or stay at a level. Most of what we do in treating Depression, one way or another, is to try and get the control system working better.
Often that’s a matter of seeing the situation differently: reflecting, reframing, resetting, recalibrating. (4 Rs. Much better than 3.)
The way we see Depression, in its widest contexts, affects very much how we deal with it. Depression is a very isolating experience, both in terms of reduced social contact, and reduced range and quality of thinking.
But if Depression was inevitable, or even an overwhelming likelihood, why is it that many people never get depressed, whatever happens? Do they have a very sophisticated chemical control mechanism? Or do they reflect upon the world in a different way? Or do they have some protective factor, like a guardian angel?
After this length of time, over 50 years of antidepressant and drug therapy, it doesn’t look as though we have a breakthrough solution, at least by way of a tablet. It would be nice to think a magic bullet would get discovered, much as saltwater killed the Triffids in one of the Day of the Triffids films, or the Common Cold killed the Martians in War of the Worlds.
While we wait to find the enemy’s weak spot, we continue to fight on all fronts. Depression’s Achilles Heal is in fact the thing that makes it strong, its incoherence as a diagnostic concept.
Could Depression fall apart under the weight of its own complexity, like the coalition government?
More to follow.