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And why our approach to depression may be misguided.

As many as one in four Americans will at some time in their lives suffer from a mental illness called “Major Depressive Disorder”. Despite the growing concerns about their effectiveness, sales of antidepressant drugs continue to grow, and, in England, have more than doubled since 2008. Clearly, the approach to depression that we as a society are taking is not working. But why?

The concept of depression as a mental illness may be helpful for the more severe cases treated by hospital psychiatrists, but probably not for the majority of cases, which, by and large, are mild and short-lived, and readily interpreted in terms of life circumstances, human nature, or the human condition. Indeed, for many people, the concept of depression as a mental illness is likely to be positively harmful. How?

By pushing us towards doctors and drugs, the belief that we are suffering from a mental illness or chemical imbalance in the brain can prevent us from identifying and addressing the important real-life problems or psychological issues that are at the root of our distress, and that are, quite literally, crying out for our attention. To treat this cry out of the depths as a simple biological problem is effectively to ignore and suppress it, while ever more people join the legions of the depressed.

Depression as a signal

Crushing though it may be, depression, or the depressive position, can present a precious opportunity to come to terms with deep-seated life problems.

Just as physical pain evolved to signal injury and prevent further injury, so depression may have evolved to remove us from distressing, damaging, or futile situations, situations that do not serve us well as human beings. The time and space and solitude afforded by depression can enable us to reassess our needs, reframe our perspectives, and round up the resolve to break with established patterns. In other words, the depressive position may stand as a signal from our unconscious to our conscious that something is seriously wrong and needs working through and changing, or, at the very least, processing and understanding.

In the normal run of things, we may become so immersed in our daily life that we no longer have the opportunity or perspective to think and feel about our self. The adoption of the depressive position invites or compels us to shed our defences, stand back at a distance, re-assess our needs and priorities, and formulate a modest but realistic plan for fulfilling them.

At a deeper level, the adoption of the depressive position can enable us to develop a clearer understanding and appreciation of our self, our life, and life in general. From an existential standpoint, the adoption of the depressive position obliges us to become aware of our mortality and freedom, and challenges us to exercise the latter within the framework of the former. By meeting this ultimate challenge, we are able to break out of the mould that has been imposed upon us, discover who we truly are, and begin to give deep meaning to our lives.

Light at the end of the tunnel

Looking at it like this, it can be no surprise that many of the most creative and insightful people in history suffered from depression, or a state that might today be diagnosed as depression.

The roll of names includes the politicians Winston Churchill and Abraham Lincoln; the poets Charles Baudelaire, Elizabeth Bishop, Hart Crane, Emily Dickinson, Sylvia Plath, and RM Rilke; the thinkers Michel Foucault, William James, JS Mill, Friedrich Nietzsche, and Arthur Schopenhauer; and the writers JK Rowling, Agatha Christie, Charles Dickens, William Faulkner, Graham Greene, Leo Tolstoy, and Evelyn Waugh, among many, many others.

To quote Marcel Proust, who himself suffered from depression, “Happiness is good for the body, but it is grief which develops the strengths of the mind.”

Neel Burton is author of The Meaning of Madness and Growing from Depression.

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Is Psychiatry the New ‘Opium of the People’?

Picture credits: Atlantic Books/James Davies/Neel Burton

Dr James Davis is a medical anthropologist and trained psychotherapist who is perhaps best known for his book of 2013: Cracked: Why Psychiatry Is Doing More Harm Than Good.

Cracked is a forensic examination of our increasing reliance on psychiatry and psychiatric drugs, in which Davis essentially argues that psychiatry ‘in the name of helping others, has actually been helping itself’.

His latest book, Sedated (March 2021), is broader in scope, looking at the social and political underpinnings that facilitated and enabled this state of affairs.

Since the early 1970s, the number of mental disorders listed in the DSM, the American classification of mental disorders, has risen from 106 to 370. Antidepressant prescribing in the U.K. surged from 25 million prescriptions per year in 2002 to nearly 75 million in 2020. The coronavirus pandemic has only accelerated the trend—while more benign and empowering psychological treatments are ever harder to access.

In Sedated, Davis puts it to us that psychiatric interventions, including superficial psychological interventions principally aimed at returning people to productivity, merely create the illusion of care while leaving the structural causes of distress intact. More than that, by shifting the blame or responsibility onto the sufferer, they serve to obscure these structural causes and, thereby, to preserve and entrench the neoliberal status quo.

The interventions favoured by the government, including even the psychological interventions, are those that involve internal rather than external change, because internal change promises to increase economic productivity and so cost-effectiveness, which is the preferred criterion for endorsing one treatment over another. If we are suffering, we are simply to stiffen ourselves to the social problems created by successive policies aimed solely at the bottom line.

Karl Marx famously said that ‘religion is the opium of the people’. The social institutions responsible for understanding and managing suffering are critical to the preservation of vested interests. With the waning of religion in the West, priests may have been supplanted by psychiatrists. The idea that a pill can make us happy ought to be inherently suspicious but fits perfectly with our materialistic and mechanistic worldview.

Thus, according to the prevailing narrative, suffering is rooted in individual rather than social or existential causes, while well-being is whatever best serves the economic imperative. Behaviours that disrupt economic activity are labelled as mental disorder, and this mental disorder presents yet another money-making opportunity.

If so many of us are ill, if a quarter of us are taking a psychiatric drug, this is because our suffering, having been stripped of its deeper purpose and meaning, is no longer being heeded. It is no longer being interpreted as a vital call to change, or to protest against harmful or inhibiting conditions. 

On the contrary, once we identify as mentally ill, we become disempowered in the belief that the problem lies solely with us, or, more precisely, with misfiring chemicals in our brains. While we are at the clinic, we are not at the barricades.

And while we work to grow the economy, we are not working to grow ourselves.

This is very big picture stuff from James Davies, who weaves our worst fears into a coherent, compelling, and damning narrative.

Neel Burton is author of The Meaning of Madness.

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Orson Welles tells reporters that no one connected with the broadcast had any idea that it would cause panic. (October 31, 1938). Source: Acme News Photos/Wikicommons (public domain)

On October 30, 1938, Orson Welles broadcast an episode of the radio drama Mercury Theatre on the Air. This episode, entitled The War of the Worlds and based on a novel by HG Wells, suggested to listeners that a Martian invasion was taking place. In the charged atmosphere of the days leading up to World War II, many people missed or ignored the opening credits and mistook the radio drama for a news broadcast. Panic ensued and people began to flee, with some even reporting flashes of light and a smell of poison gas. This panic, a form of mass hysteria, is one of the many forms that anxiety can take.

Mass hysteria can befall us at almost any time. In 1989, 150 children took part in a summer programme at a youth centre in Florida. Each day at noon, the children gathered in the dining hall to be served pre-packed lunches. One day, a girl complained that her sandwich did not taste right. She felt nauseated, went to the toilet, and returned saying that she had vomited. Almost immediately, other children began experiencing symptoms such as nausea, abdominal cramps, and tingling in the hands and feet. With that, the supervisor announced that the food may be poisoned and that the children should stop eating. Within 40 minutes, 63 children were sick and more than 25 had vomited.

The children were promptly dispatched to one of three hospitals, but every test performed on them was negative. Meal samples were analyzed but no bacteria or poisons could be found. Food processing and storage standards had been scrupulously maintained and no illness had been reported from any of the other 68 sites at which the pre-packed lunches had been served.

However, there had been in the group an atmosphere of tension, created by the release two days earlier of a newspaper article reporting on management and financial problems at the youth centre. The children had no doubt picked up on the staff’s anxiety, and this had made them particularly suggestible to the first girl’s complaints. Once the figure of authority had announced that the food may be poisoned, the situation simply spiralled out of control. 

Mass hysteria is relatively uncommon, but it does provide an alarming insight into the human mind and the ease with which it might be influenced and even manipulated. It also points to our propensity to somatize, that is, to convert anxiety and distress into more concrete physical symptoms. Somatization, which can be thought of as an ego defence, is an unconscious process, and people who somatize are, almost by definition, unaware of the psychological origins of their physical symptoms.

As I discuss in The Meaning of Madness, psychological stressors can lead to physical symptoms not only by somatization, which is a psychic process, but also by physical processes involving the nervous, endocrine, and immune systems. For example, one study found that the first 24 hours of bereavement are associated with a staggering 21-fold increased risk of heart attack. Since Robert Ader’s early experiments in the 1970s, the field of psychoneuroimmunology has blossomed, uncovering a large body of evidence that has gradually led to the mainstream recognition of the adverse effects of psychological stressors on health, recovery, and ageing, and, inversely, of the protective effects of positive emotions such as happiness, belonging, and a sense of purpose or meaning.

Here, again, modern science has barely caught up with the wisdom of the Ancients, who were well aware of the close relationship between psychological and physical well-being. In Plato’s Charmides, Socrates tells the young Charmides, who has been suffering from headaches, about a charm for headaches that he learnt from one of the mystical physicians to the King of Thrace. However, this great physician cautioned that it is best to cure the soul before curing the body, since health and happiness ultimately depend on the state of the soul: 

He said all things, both good and bad, in the body and in the whole man, originated in the soul and spread from there… One ought, then, to treat the soul first and foremost, if the head and the rest of the body were to be be well. He said the soul was treated with certain charms, my dear Charmides, and that these charms were beautiful words. As a result of such words self-control came into being in souls. When it came into being and was present in them, it was then easy to secure health both for the head and for the rest of the body. 

Mental health is not just mental health. It is also physical health.