Sunday, August 5, 2018

Worshipping Depression

Among those who have written most eloquently about depression William Styron stands out. The author of the memoir Darkness at Noon inspired many people to tell their stories of depression.

Three decades ago Styron became a spokesman for the depressed, arguing that it was not a moral failure but a “biochemical meltdown.” When he admitted himself to a psychiatric hospital he said that he was suffering “a gray drizzle of unrelenting horror.”

As opposed to most memoirists, Styron was a great writer. His story might have been the same or different from those of other depressed patients, but he was a vastly better writer.

This creates its own problems, call them unintentional side-effects. Once you romanticize a mental illness, you are likely to produce more of it. And if you make it seem that the condition is untreatable, like a malediction, you are going to discourage people from seeking treatment. If you declare that it is merely a brain condition, you are going to disincentivize talk therapy, especially the kind that has proved most effective in treating depression: cognitive treatment.

We ought seriously to overcome the absurd notion that more public exposure of a mental illness is going to help cure the problem. In most cases, it will aggravate the problem.

For the record, I do not know the nature of Styron’s depression. And there are different kinds of depression. I do not know how he was treated, though I do know, from Pagan Kennedy’s New York Times article, that he never took an SSRI. One finds this rather strange. Though one notes that there are other medical treatments for depression, from electroshock to the class of medications that includes Anafranil and Tofranil… and also the MAO inhibitors… whatever that is.

Kennedy says nothing about the different treatment modalities, and nothing about cognitive therapy.

On one side she explains that Styron’s book was required reading for psychiatry residents, because it taught them to listen to their patients. On the other side, once psychiatrist decided that depression was a brain disease they stopped listening to their patients… because the only thing that mattered was finding the right medication.

Kennedy points out, saliently, that when Prozac became available to the public many people believed that it would cure depression forever. Dr. Peter Kramer wrote a bestseller called Listening to Prozac that did not merely claim that Prozac would cure your depression. Kramer declared that Prozac would make you into someone else.

At the least, Prozac did break the hold that psychoanalysis had on the mental health profession. More than a few patients had been lying on the couch for decades, feeling mildly depressed. Or feeling severely depressed. When they took Prozac they quickly discovered that depression could be overcome, only not through psychoanalysis.

Of course, Prozac was oversold. Most psychiatric medications suffer the same fate. And, after a time, Prozac seems not to be as effective or as much a panacea. This does not mean that it does not work for some patients. This does mean that we should always be somewhat skeptical when we hear Pied Pipers promising miracle cures.

For her part Kennedy notes that Prozac has failed to stem the rising tide of suicides:

During the exuberance of the 1990s, it seemed possible that drugs would one day wipe out depression, making suicide a rare occurrence. But that turned out to be an illusion. In fact, the American suicide rate has continued to climb since the beginning of the 21st century.

Like a good little progressive Kennedy blames the suicides on the NRA and climate change. It is obviously nonsense, but she deserves her say:

We don’t know why this is happening, though we do have a few clues. Easy access to guns is probably contributing to the epidemic: Studies show that when people are able to reach for a firearm, a momentary urge to self-destruct is more likely to turn fatal. Oddly enough, climate change may also be to blame: A new study shows that rising temperatures can make people more prone to suicide.

Could it be that some forms of depression are not biochemical meltdowns? Could it be that social dislocations, social anomie, and the toxic nature of today’s American culture has contributed to it? And could it be that romanticizing depression makes the problem more intractable?

After all, an Israeli social worker, by name of Moshe Farchi has developed a treatment program for soldiers suffering from post traumatic stress. The basis for his program is simple enough: when some is suffering from depressive stress, he tells himself that there is nothing he can do to overcome it. The way to deal with the problem is not to say that it’s all biochemistry, and thus that all actions are futile, but to create a program of effective actions that can demonstrate the error in the initial proposition. Farchi's program has proved to be very effective.

Or else, perhaps we have more depression because we believe that the true problem, as Kennedy notes, is to find a new way to talk about it. Someone or other, now that the psychiatric world has discovered that talk therapy is useless when trying to fight depression, some people are trying to drag it back from the dustbin of history:

With suicidal depression so widespread, we find ourselves needing new ways to talk about it, name its depredations and help families cope with it. Mr. Styron’s mission was to invent this new language of survival, but he did so at high cost to his own mental health.

We sympathize with Styron. But, we should be careful about imagining that more, better writing about depression will have really benefit those who are suffering from depression.

As it happened, Kennedy entitled her article "The Great God of Depression." It's an unfortunate title, but it may well reflect precisely the effect of Styron's writing. If we end up worshipping Depression as a god, we disempower ourselves and end up joining a cult to adore this god. 

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