Sunday, June 17, 2012

Unhappy or Depressed

No one’s unhappy anymore. Everyone is depressed.

It’s one thing to cheer the arrival of each new class of psychiatric medication. For many people they have provided significant benefits.

Powerful and effective new medications have always posed a temptation. Psychiatrists love their medications so much that they want to share them. As the old saying goes, when you only have a hammer, everything looks like a nail.

Psychiatrists believe that they are morally obligated to direct people into treatment. To do so they have tried to make people more vigilant and more savvy in identifying pathological emotions. You know, the kinds that make you feel bad.

Unfortunately, this has led them to pathologize human experience and to lay down directives for how we conduct our lives.

Theodore Dalrymple explains how psychiatry has influenced the culture:

The word “unhappy” has been virtually abolished from the English language. For every person who says “I’m unhappy” there must now be a thousand who say “I’m depressed.” The change in semantics is important: the person who says he is unhappy knows that there is something wrong with his life that he should try to alter if he can; whereas the person who says “I’m depressed” is ill, and it is therefore the responsibility of someone else — the doctor — to make him better.

Psychiatry has a perfectly mechanistic view of human behavior. It has therefore eliminated moral agency.

Bad moods and ill feelings are no longer running commentaries on everyday life. They are no longer spurs to actions. They are no longer signposts pointing out where we should improve our lives. They no longer grant us responsibility for our lives.

Even normal emotions will count as psychiatric symptoms, if not, diseases. If we learn that we are powerless to change them we know that we must repair to our friendly psychiatrist and receive a blessed prescription.

It’s useful to recall that a leading cognitive psychologist, Martin Seligman has defined depression as “learned helplessness.” He used the phrase as the title of his best-selling book.

If your emotions are merely pathological phenomena, roughly akin to a bacterial infection, isn’t psychiatry trying to teach you to feel helpless when faced with bad moods, bad attitudes and emotional pain?

If this is true, then psychiatry has inadvertently gotten into the business of producing an attitude of helplessness, and thus,  depression.

Dalrymple explains that the same applies to grief and mourning. If you lose a loved one, psychiatry will grant you two weeks of mourning. After two weeks, if you have not yet moved on, you must medicate your grief.

If you are in mourning, psychiatry is inducing you to feel anxious lest your grief not disappear in a timely fashion. Those near and dear to you will be encouraged to time your grief cycle.

And yet, it is obvious that you will grieve longer and harder for someone who was near and dear than you will for a superficial acquaintance.

When psychiatry limits normal grief to two weeks it is failing to make this elementary distinction.

Dalrymple draws the logical conclusion: warm, close, durable relationships must now be declared a risk factor for depression.

If psychiatry were to be consistent, it should recommend that people develop more short-term, superficial relationships. When you lose someone who is unimportant you will be able to keep your grief within the two week limit.

In his words:

One may legitimately wonder what kind of human relationships the APA  [American Psychiatric Association] expects people to have: certainly not very deep ones. Indeed, the APA probably would count having deep and lasting relationships as pathological, as a risk factor for “depression” later on when the objects of these morbid relationships die. Better to keep everything on an even, superficial level; then there will be no cause for grief. Sorry: depression.

There is nothing wrong with having a certain number of superficial relationships in one’s life. Not everyone can be your BFF.

Yet, if your relationships are all superficial you will feel disconnected from other human beings. Feeling disconnected is a major cause of depression.

So much so that mental health professionals agree that the most powerful therapeutic factor in talk therapy is the ability to forge a human connection.

Funnily enough, if modern psychiatrists see patients for a short period of time and merely write prescriptions, they are, almost by definition, refusing to connect with their patients.

What are people learning from these kinds of psychiatric consultations? Are they learning that they and their problems are of no real interest and that nothing can be done beyond taking an upper or a downer and numbing yourself to your emotions?

Psychiatry seems to be saying that you do not need to solve your problems. You need but medicate your moods.

When faced with criticism for defining the proper mourning period to be two weeks, the APA responded by adding a footnote to its diagnostic statistical manual. In an astonishing example of spin, it will now state that when you are in mourning for more than two weeks you should not necessarily be seen as suffering from a “major depression.”

Say what?

To explicate the idea, you can still consider it a depression. You can still medicate it. You just need to moderate the dosage. 


Anonymous said...


Thank you for this very interesting post. When I was a student in university I remember being very impressed with Viktor Frankl and his concept of "logotherapy". The idea being that we must strive to find a purpose and meaning in life. Rather than medicalizing normal human emotions and feelings, finding these purposes and meanings would place them all in a proper and healthier context.

It was all given great weight in the light of Frankl's experience surviving the horrors of Aushwitz. I remember him quoting Nietzsche's dictum that "if you have found a why to live you can bear with any how."

What are your thoughts on Frankl? Is he even discussed today in the profession? His approach (at least to this laymen) seems like it is more pro-active, optimistic and fruitful than the rather dreary situation you describe in your post.

Best wishes

Sam L. said...

After my wife died, a sister-in-law sent me an Ellen Goodman column on grief. As best I recollect, she said something like this: we grieve at our own pace, in our own way, for as long as it takes us, individually.

When my wife's sister's husband died, I wrote her to say that it hurts greatly, it hurts long, and it doesn't get better. It does, however, get less bad, and someday you will realize you weren't hurting yesterday. But then it's "the old war wound" which will ache and twinge unexpectedly, but with decreasing frequency, and maybe strength.

My last one was a year ago.

Anonymous said...

Making normal emotions a pathology is a great diservice to us. Screw the APA. Unfortunately, depression is a very real thing, as you know. I was dogged and consumed by the "Black Dog" when I was younger. It runs in the family, the Black Dog does. With appropriate medication, I re-found my will and exercised it (and Exorcised it). Taking up arms against a sea of troubles, I prevailed. I built a good life and defeated the urge to self-slaughter while accomplishing many good things. There is, as you know, a place for the medications. Thanks, Zoloft, I made it. Now I stand unassisted. It is a crutch, but crutches are occasionally indicated for an injury.


Anonymous said...

Sam L. I don't know you, but I'm sorry for the death of your wife. There is nothing anyone can say. To seize on the topic of the post, to shield ourselves from grief by not forming deep relationships is a greater loss than the grief we are trying to prevent!
Tennyson speaks for me here: "'Tis better to have loved and lost than never to have loved at all."