With so much media attention, you’d seriously think depression awareness raising charities would want to answer this very simple question. As the purported biological disease model of depression has now become almost an act of faith, debate now seems to revolve mainly around the relative merits of different forms of treatment. Whether it’s medication or intensive psychotherapy, any talk of treatment implies a medical condition comparable with cancer, Alzheimers or broken limbs.
Affluenza
By now it should be clear that higher material living standards do not necessarily lead to healthier or more balanced emotions. We possess more powerful, versatile and efficient electronic gadgets, more cars and can afford more holidays abroad than ever before. Yet this material abundance does not translate into greater happiness. The infamous Germanwings copilot, Andreas Lubitz, had a wealthy family who could afford to pay for expensive flying lessons. By any accounts he enjoyed a privileged jetsetting lifestyle and, if reports are correct, was not averse to performance-boosting and mood-altering medication. Countless multimillionaire celebrities have publicised their depressive episodes. Indeed depression seems largely a concern in opulent consumer cultures and the very concept of melancholy is practically unknown to pre-agrarian societies such as the Amazonian Pirarã people.
Human Emotions
Human emotions are certainly complex, but why would we have evolved to have clearly distressing and dysfunctional mood swings that make it hard for us to address any of the more immediate problems in our life? If your house is on fire along with all your worldly possessions, what should you do? Contemplate the market value of your endangered possessions? Spend the next 60 minutes negotiating with your home insurance company? Laze around watching Youtube videos about how to rebuild your life after a catastrophe? Actually none of the above, the most rational course of action would be to quickly find the safest way out of the building and if possible help anyone else at home to join you. If you fail to act fast in such situations, you may very well die and be forever unable to help anyone else dear to you. Ironically the kind of emotions people experience in the face of death differ markedly from the self-centred feelings of inferiority and introspection that prevail in melancholy. When faced with a life-threatening crisis, all considerations about your relative social standing, your body image, your love life or lack thereof or your financial woes fade into insignificance. If you are penniless, homeless and starving, the relative merits of the latest and greatest gadgets or the number of social media friends you may have, are of little concern, but you will be probably be very glad to have a square meal and a roof over your head.
Most of all people strive for two things in life: A sense of purpose and affection, i.e. we need to have clear idea of what we aim to achieve in life and to feel wanted or rather emotionally rewarded for our efforts. In the simple pre-agrarian societies that prevailed in most of humanity’s two hundred thousand year odd history, our sense of purpose was the survival of ourselves and our immediate community while our sense of love came from the close bonds we had with our community. As long as we did our bit to help in the collective struggle for survival, we would be rewarded with love and affection. As many died young from diseases and injuries that can now be easily treated, the mere fact of survival gave us cause for optimism and gratitude to mother nature and our community. Diverse cultures throughout the world value health more than material possessions.
The lottery of life has always been tough. It is clearly unfair that some of us are blessed with better, stronger or more appealing physiques than others and are thus better equipped to attract the best mating partners. However, humanity would never have evolved to its current level of technological excellence if we had not been able to harness different skill-sets. Carrying heavy building materials undoubtedly requires much muscle-power, but several thousand years ago someone took a break from the tiring task of lugging stones and logs around to devise a new more efficient technique for transporting heaving goods. At first heavy slabs of stones were rolled on logs and later logs were cut into wheels on rudimentary carts. We still needed muscle-power to load and unload carts, but mechanical engineers and craftsmen had enabled us to carry more with less effort. Even primitive societies began to value brains as well as brawn, wisdom and experience as well as youthful energy. That explains why many primitive societies cherish their elders, although they may no longer be able to help hands-on with hunting, building and food preparation, their experience and wisdom is invaluable especially in small close-knit communities.
As societies became more and more complex with greater levels of specialisation, trade and competition, more people failed to lead productive lives as their potential skills had been outsourced or devalued by techno-economic progress. Greater opportunities for some always mean fewer opportunities for others. Current socio-economic trends clearly favour flexible and highly mobile labour markets with a rapid turnaround in human resources and skill-sets. These far-reaching changes affect every aspect of our lives from job security to intimate relationships. In our brave new world, the only certainty is perpetual uncertainty, which in turn makes more and more of us dependent on remote organisations just to stay afloat.
Drugs and Psychiatry
While I do not rule out that some genuine neurological conditions may make some of us more susceptible to melancholic thoughts, the primary cause of depression in modern society is a sense of helplessness, i.e. an inability to help oneself overcome a temporary setback, exacerbated by the breakdown of traditional extended family and community networks. Any purported treatment plan that fails to identify the root causes of so much emotional distress is doomed to failure as in any other cases of misdiagnosis. If you have a broken leg, pain killers may help you temporarily cope with unpleasant sensations, but may have long-term side-effects if taken for prolonged periods of time without addressing the root causes of your suffering. Likewise, no rational dentist would treat tooth decay with ibuprofen alone. In an ideal world we would avoid breaking limbs or exposing our teeth to decay, both of which depend on external or environmental factors. However, at least caries and bone fractures are easily identifiable medical conditions. Depression, on the other hand, is a state of mind induced in an incredibly complex organ with an estimated 100 billion neurons.
The over-prescription of anti-depressants is merely a symptom of a more fundamental problem, a shift away from the psycho-social model of emotional distress to a strictly biological model of mental health patients. The former model recognises biological differences that may make some of us more susceptible to mood swings (not least of which is gender), but rather than concentrating on natural phenomena we cannot easily change, it focuses on how the rest of society can help these people become more productive citizens able to help themselves and feel wanted by helping others. The latter approach, currently in vogue, treats individuals as psychiatric subjects and psycho-social stimuli as mere external triggers of underlying conditions. This turns the depressed into victim groups who require more treatment, and thus greater dependence on others, both of which are very likely to exacerbate their sense of helplessness and under-achievement. If a condition is considered a life-long illness caused by an underlying neurological syndrome, then there is much stronger case for lifelong medication.
Many claim that anti-depressants helped them out of the depths of misery or that they would be unable to function without them. Both claims dodge the more important issues of causation. First if you are on psychoactive medication, you cannot easily just go cold turkey without suffering severe withdrawal symptoms, because your brain has already adjusted to your regular chemical stimuli. Second, there is much stronger case for mild anti-depressants for short-term use if the underlying psycho-social causes are addressed, but in these cases we cannot easily identify whether Selective Serotonin Uptake Inhibitors such as Prozac are more effective than placebos or natural remedies such as St John’s Wort. The evidence would suggest outcomes are much better for those with better emotional support from friends and family and more rewarding careers who only need temporary treatment. Unfortunately that leaves millions of marginalised individuals who struggle to realise their self-worth through meaningful work (sense of purpose) or relationships (sense of belonging).