Is Depression an illness or the inevitable consequence of a broken society?

The trouble with depression is that it doesn’t quite fit into the categories set out by the grey faceless bureaucracy that governs us.

Depression is a “mental illness”. But (in most cases) it isn’t a “real”, “severe” mental illness that requires psychiatric supervision and specialist mental health services. Most people with depression experience stigma and discrimination but (in most cases) depression is not a disability.  People with depression are labelled “vulnerable adults” even though (in most cases) they are no more vulnerable than any reasonably healthy adult.

Of course, depression can be a severe and sometimes life-threatening condition, but all too often its symptoms are taken to be its cause. For example, the proponents of medication argue that, “depression is caused by low levels of neurotransmitters such as Serotonin and/or Noradrenaline”. How these chemicals came to be out of balance goes unasked. The new psychology industry claims that, “depression is caused by negative thoughts and beliefs”. The fact that most people who have had depression do not have such negative thoughts and beliefs when they are well goes unquestioned.  Even the proponents of good diet and regular exercise often mistake the decline in diet and activity that result from a descent into depression as the causes of depression itself.

Socio-biologists tell a different story. They note that, for example, caged bears develop depression in response to their poor living conditions, and that they exhibit a “learned helplessness” that causes the depression to persist long after their living conditions are improved. Similarly, monkeys prematurely separated from their mothers not only become depressed, but adopt similar posture and facial expressions to those seen in depressed humans.

Anthropologists also find depression in every human culture and society. They confirm that depression most often results from either being “trapped” in stressful situations or from major loss/bereavement.

Bureaucrats, unfortunately, like to categorise us all into discrete classes.  Psychiatry, for example, cannot countenance the idea that a person could have two mental illnesses, because each illness has been discretely located within the symptom-diagnostic grids that are the Diagnostic and Statistical Manual or the International Classification of Diseases. So strong is this need to pigeonhole people, that when the coexistence of depression and anxiety became too prominent to ignore, rather than conceding that people might have two illness at once, they invented an entirely new illness – Mixed Anxiety and Depression!

Elsewhere, NHS managers assume that there is one group of people that have, for example, cancer, another that have heart disease, another diabetes, another MS, arthritis, depression, liver disease, etc, etc.  In the real world, of course, people who develop major health problems or disabilities also become depressed, just as people with arthritis can also have heart disease.

Among journalists there is a tendency to look for single causes to accompany single illnesses. Lung cancer is seen to result from smoking, heart disease from insufficient exercise, strokes from eating too much fatty food (notice that these popularised causes also serve to blame the victim).

In the real world, there is good health and there is bad health. The place where you live (Kensington & Chelsea v Merthyr Tydfil) is a far greater determinant of health and life expectancy than abstinence, good diet and regular exercise. In this real world, alcohol and drug abuse, smoking, lack of exercise, poor mental health and obesity are bound up among the 25% of us living in the most deprived socio-economic conditions. These are most often the areas with the worst housing, the highest rates of crime and antisocial behaviour, and the worst educational achievement.

Depression is as much a manifestation (which then becomes an ongoing cause) of these wider socio-economic problems as it is an individual “illness”. However, it suits the bureaucrats to treat it as an illness rather than open up that old chestnut of socio-economic renewal. Far easier to throw Prozac at people in what the Independent recently described as 'an experiment in the mass medication of socio-economic problems' than to embark on a serious long-term attempt to remove the causes of ill health in some of our most deprived communities.

The end result is that the victims of social economic failure are not only blamed for their predicament, but are exploited too.  At its peak, the pharmaceutical industry made annual profits of more than $17.5bn from worldwide sales of antidepressants.  However, in practice, far from curing depression, we have seen people using the drugs for ever longer periods.  More recently, the marketing practices of the pharmaceutical industry have been adopted by the multi-million pound psychology industry to promote the myth that you can defeat depression by thoughts alone - and as with Prozac 25 years ago, the politicians have bought into another one-size-fits-all therapy (CBT) rather than address the far more complex socio-economic causes of depression.

In most primitive cultures, when someone became depressed, people recognised that society needed fixing. Often, those who experienced depression would be allowed time out to re-orientate their lives following the stresses that caused their depression. In the modern world, we have “medicalised” the process in order to deny the urgent need to fix our society. The only way you can legitimately take time out in our culture (assuming you are not one of the wealthy few) is to persuade a doctor to diagnose you with an illness. So, in the end, many millions of people who have depression have to accept the “mental illness” label (with all the attendant stigma and discrimination that this involves) just to get the space needed to take stock and get their lives back on track.

None of this is to suggest that personal resilience and access to a wide range of treatments are not important.  Rather, it is to recognise that there is only so much that an individual can do to mitigate a condition that most often stems from situations and factors beyond his or her control.  If all we are doing is teaching people to think a bit more positively about their job prospects in the middle of a recession (or worse medicating them into feeling happier), but doing nothing to improve the economy and to create new jobs, then we should not be surprised to discover that more than 50% of those we "successfully treat" become depressed again within 2 years!

Tackling depression cannot be an either/or approach. We have to create the socio-economic conditions to foster good mental health. To paraphrase a once popular political leader, we must be tough on depression and tough on the causes of depression!