VI. The Clinic: The Problem(s) with the Disease Model of Depression (or STOP MEDICALIZING HUMAN DISTRESS)
As I sort through the media coverage of the suicide deaths of Kate Spade and Anthony Bourdain, I find myself angered and baffled by the reduction of complex human distress to "mental illness" or the "disease of depression." My argument isn't with the term "depression," but rather how depression is taken up and the shoddy science that falsely claims depression as a biological "disease."
Let me be clear--clinical depression is absolutely a real and difficult human condition, but when we attach the word "disease" to it we are explicitly putting it in the category of medical diseases such as cancer and diabetes. This is what the very words "disease" and "illness" denote--medical conditions that affect the physical systems of the body and that can readily be identified with objective lab tests. As pharmaceutical companies' agendas ($$$) have become more important than the human beings they claim to treat, we have seen an almost complete reduction of human distress to some type of "chemical imbalance" or "mental illness." It following that, when something can be shown to be biological in origin, it can be treated with a medication. This campaign by the powers that be to medicalize human suffering has been so successful. that it is unquestioningly accepted as fact that depression, anxiety, etc are biological mental illnesses. The problem with this is that the research doesn't hold up. It never has, yet it is presented as if it is a proven scientific TRUTH. The truth, however, is that we've been sold falsehoods that have made us psychologically worse and big pharma a lot wealthier. (To read the science on this, check out Robert Whitaker's work.) Increasingly, anti-depressants are found to be less than efficacious, sometimes with serious side effects that often cause more harm than good (see the recent New York Times article on what is increasingly being discovered about long-term anti-depressant usage). In a medical/disease model of mental illness, no serious respect is paid to an often cruel world and our very real responses to it.
Now, before you start screaming about all of the studies that show biological components of depression, stop and ask yourself why it is such a threatening statement to hear that depression cannot be claimed as something solely biological. Sure, there's a biological component, but any action, feeling, or experience we have has a biological coordinate; something happens in the body, but this is not the same as a biological anomaly or breakdown causing depression or being the root of the issue. The assumptions implicit in the disease model of depression are that 1) it is easily treated with a pill and 2) that it is isolated to the individual experiencing it. Ergo, it falls on the sufferer to simply "get treated" to correct the problem, and the very real societal problems that might lend to feeling depressed are completely be ignored. (It's the person's issues, not society's!) And this is where the real damage occurs -- people who are already suffering tremendously now believe they are subject to their biological "fate" of depression. They take the pills, and when the pills don't work, they start taking more pills (often anti-psychotics meant to supplement the anti-depressants). Sometimes, this treatment works, and for those people, I am very happy. However, it is more often the case that these meds fail (again, see Whitaker's work for a comprehensive view and extremely thorough exploration of the science), and people are left feeling there is nothing that can be done. Victims of biology.
Except that there is something that can be done. When we stop buying into the lie of depression as a medical disease, we can start to really identify how the social conditions we currently live in can be depressing in themselves. Mass hatred, increased gun violence, social injustices and inequities, lack of community, lack of general kindness, working too much at jobs we often hate, economic problems, overpopulation, the fear of climate catastrophe, superficial relationships and on and on. The world isn't an extraordinarily pleasant place right now, and to not identify THAT as a serious component of depression is narrow-sighted and harmful. Society increasingly lacks value for many people, and when combined with the complexities of biology, general temperament, social support, etc, it can culminate in a belief that perhaps leaving this world is a better answer. Depression is complex and a malady of the human and social conditions. Suicide rates have dramatically increased since the late 1990s in every age group from 10-74. Are we all just increasingly biologically sick with depression? That makes no sense. If it is all biology, how come we haven't improved with ever-proliferating new drugs? How come we are feeling worse? How come suicide numbers aren't going down? People are unhappy in their lives and relationships and cannot locate a way to meaningfully engage in constructive social critique because we are so focused on our own individual "pathology"-- our own private neurosis--as if that somehow exists outside of and independent of the social world. The fact is, society itself has become neurotic, and when we blame individual biology, we leave no room to talk about the CHANGE needed in our life conditions. The cultural malaise goes unaddressed.
So, yes. I feel angry reading through the stories of Bourdain and Spade because the quick explanation falls to "mental illness" and eschews serious conversation about the state of a world that seemingly feels easier to leave than to inhabit. We are suffering as a people, and being told that it is simply our biology is a lie that enacts violence on all of us, particularly those suffering under the weight of depression. It constricts us from talking about the profound sadness that is part of our human experience and is corrosive to our ability to relate to one another and form social bonds. We need compassion, communication, reconnection, and social movements that work toward bringing us together again AS PEOPLE rather than isolating us as individual brain chemistries gone awry. We are not objects. (You often hear this objectification of self in the statement, "I have depression" rather than "I feel depressed.") We are feeling creatures suffering in what can often feel like a terribly cold world. Our collective depression needs to be seriously listened to as an indicator of the ways we are living lives not conducive to joy, so that we can work toward creation of a society that supports and enlivens us rather than one that feels crushing. We need to remember that depression is a condition of our mind, body, and spirit, and that we do have the ability to effect change upon an unjust world. To do so requires us to give up on the illusory hope that a pill can save us all and to acknowledge the very real ways people are suffering in what has increasingly become a pathological society.