Life After Depression

It’s a strange question. You would have thought that psycho professionals would have been all over it. Apparently, they are not. At least, that’s what Benedict Carey reports in the New York Times.

The burning question is: what does a cure for depression look like. If you have the flu, cure means not having the flu. If you have heart disease, cure means not having heart disease. In medicine, cure seems to mean the elimination of symptoms and the return to biological normality. If your muscles are weakened by disuse, cure involves therapy that restores them to normal functioning.

Now, when you suffer from a mental illness like depression, what does cure look like? Carey reports the latest research:

Treatment trials typically last six to eight weeks, and they focus on reducing negative symptoms, such as feelings of worthlessness, fatigue and thoughts of suicide. What happens in the subsequent months and years — and which positive developments occur, and for whom — is largely unknown.

Researchers tend to glom on to the idea of flourishing, failing to notice that the word is a mere variant on the word flowering. Their idea suggests that treatment will turn you into a potted plant or a towering redwood tree. More precisely, it will turn you into vegetation.

To be more serious about this issue, psychiatrists mean that those who are cured of depression have achieved work/life balance, general all-roundness and have learned how to enjoy vacations. Unfortunately, in the case of depression cure involves subjective measures, like how people feel. True enough, an individual who has been cured of an infection will feel better, but the better feeling does not, in itself, constitute cure.

Carey explains:

In a forthcoming analysis, to be published in Clinical Psychological Science, the same team of psychologists make a rough estimate of the number of post-depression “flourishers,” using data from a periodic national survey called the Midlife Development in the United States. The survey includes more than 6,000 people between the ages of 25 and 75 and more than 500 who met criteria for depression. About half of the people who had received a diagnosis recovered afterward, meaning they had been symptom free for at least a year, the researchers found. One in five of those — 10 percent of the total — were thriving a decade later. The research team based that judgment on an assessment that includes measures of how people feel, how well their relationships are going, and their work.

Obviously, Carey notes, the 10% number is not very encouraging. It does not suggest that we have beaten depression. To put it in context, he adds this observation:

The best comparison is the portion of people who were rated as thriving who never had depression: 20 percent.

Thriving is apparently a sometime less flowery synonym for flourishing. Still, being cured of depression does not necessarily mean that you are thriving. It might mean that you are functional, that you are doing your job, fulfilling your responsibilities to other people, enjoying what there is to enjoy, being able to focus on the tasks at hand and so on.

One notes that since depression involves an inability to feel pleasure-- called anhedonia-- someone who had been cured will obviously be able to feel pleasure. Since depression often involves a loss of appetite, both alimentary and libidinal, a cure will naturally involve the return of those desires. Since depression involves a loss of pride, its cure would naturally involve feeling pride, in oneself, in one’s community and in one’s nation. Finally, cure might even include achievement and accomplishment … not to mention the ever elusive happiness.

You would think that someone who was cured of depression would be happy, but such seems not to be the case. We would do better to look at the issue in terms of character. Someone who has been cured of depression can not only function in the world, but can function as an individual with good character. In the past, before psychiatry extended its tentacles into the issue of depression, it was considered a character flaw. Thomas Aquinas connected depression with the sin of sloth.

And one must also add that there are several different forms of depression-- and thus, just as one treatment does not fit all of them, so too may different type produce different outcomes.