Depression is complex. There isn’t a single cause and there isn’t a single miracle cure. If you believe that you just need to take a pill, without changing the way you conduct your life, you will discover the limitations in relying on medication.
Yesterday, T. M. Luhrmann asked whether people around the world are more depressed these days or whether we are just more aware of depression.
She reported from India:
I’VE been in and out of India for years, but on a recent visit to Chennai, in the state of Tamil Nadu, it seemed that suicide and depression had become part of the social conversation in a way that was once taboo.
Rangaswamy Thara, a psychiatrist and director of the Schizophrenia Research Foundation there, described this shift: “Someone fails his exams, so he commits suicide. He is rebuked by his father, so he commits suicide.” At the same time, there seem to be many more people in Chennai seeking help for emotional and psychiatric problems than there were 10 years ago, Dr. Thara said.
Statistics tell a sobering story:
The World Health Organization reports that suicide rates have increased 60 percent over the past 50 years, most strikingly in the developing world, and that by 2020 depression will be the second most prevalent medical condition in the world.
To what can we attribute this increase in depression? Luhrmann listed several possible causes.
First, we feel compelled to pathologize everyday experience. That is, we are so enthralled with science that we see moral dilemmas as biochemical flaws. The fact that there is no science of ethics has not deterred those who want to increase the dominion of science.
Some of these figures might simply reflect more willingness to label an experience as a symptom. For example, until recently, most Japanese understood intense fatigue as sacrifice for one’s work and suicide as an act of reasoned will. In her book “Depression in Japan,” the anthropologist Junko Kitanaka writes that partly as a result of aggressive pharmaceutical marketing, many Japanese began to think of their fatigue and suicidal thoughts as symptoms created by a disease. The number of diagnoses of depression in that country more than doubled between 1999 and 2008.
Second, Luhrmann noted that more and more people are living in cities. Rapid urbanization produces anomie, a feeling of not belonging to community, of being rootless and of not knowing the rules of social interaction:
Yet there is reason to believe that mental illness is indeed increasing around the world, if only because urbanization is increasing. By 2010, for the first time in history, more than half the world’s population lived in cities. Cities are places of possibility: They are, as E. B. White said of New York, “the visible symbol of aspiration and faith, the white plume saying that the way is up.” But cities also break traditions and fracture families, and they breed psychiatric illness. In a city you are more likely to be depressed, to fall ill with schizophrenia, and to use alcohol and drugs. Poverty and rapid urbanization sharpen these effects.
And then there’s social media. Our awareness of how everyone else lives might make us feel diminished. You might feel confident for being the king of the hill, only to discover that, compared with someone who lives somewhere else, you are really the king of an anthill.
In Luhrmann’s words:
We know that social position affects both when you die and how sick you get: The higher your social position, the healthier you are. It turns out that your sense of relative social rank — where you draw a line on an abstract ladder to show where you are with respect to others — predicts many health outcomes, including depression, sometimes even more powerfully than your objective socioeconomic status.
We place ourselves in a vast social order in which most of us are ants. It may truly be a depressing reflection.
I would only add one point to Luhrmann’s excellent analysis. When the media is filled with constant discussions of depression, it does not merely help people to diagnose themselves; it helps produce more depression. It tells people what symptoms they should adopt if they want to be taken seriously today’s medicine men… i.e., today’s mental health professionals.
We owe this argument to Ethan Watters and his fine book, Crazy Like Us. To the best of my knowledge, Watters was the first to predict that the media would help propagate American mental illnesses around the world.