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A London-based psychologist has put his head above the parapet and warned that the coronavirus (Covid-19) pandemic could cause a surge in unnecessary mental health diagnoses and drug prescriptions. But his statement poses far bigger questions about depression, and whether it’s ‘all in our heads’ – or if society’s obsession with mental wellbeing is actually something more worrying.
‘Pathologising human responses’
Dr John Read is a professor of clinical psychology at the University of East London. He gave an interview to My London about mental health during the coronavirus lockdown. But there was one part in particular that stood out for me. And it was Read’s dissection of what feelings associated with depression are actually ‘normal’.
I think being scared at the moment is normal, people grieving is normal, to be worrying about things is normal.
It’s dangerous to pathologise [treat as psychologically abnormal] understandable human responses. These are social problems not mental health problems, but what we fear is we are going to see an increase in prescribed medication – such as in the US where there’s been a 30 per cent increase – that is a worry.
We don’t want to have people in five years struggling to get off medications.
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Many of us currently feeling isolated may do well to heed Read’s words. Because antidepressants, specifically, are not always what they seem.
Antidepressants: grounded in fact or fiction?
Whether antidepressants have grounding in medical fact is often debated. As New Scientist noted, their design is based on the out-dated theory that chemical imbalances in the brain cause depression. Correct these imbalances, and people will feel better, allegedly. Although this isn’t entirely accurate. But that’s not to say they don’t work, though. They can often be life-saving. I’m testament to the fact that for some people, they really help. You can read my story about addiction and mental health here.
In my own case, a 45mg dose of mirtazapine last thing at night allows me to navigate life without it all becoming too much. I feel in control (most of the time), productive, and more importantly worthwhile. The chaos in my head that was ruining my life has dissipated somewhat. I see the purpose of getting up every day, whatever that day may throw at me.
But there’s an elephant in the room. There’s a reason the number of antidepressant prescriptions doubled in the last decade. And it’s corporate capitalism.
Our understanding of why people are depressed, and therefore why antidepressants work, is all too often unwittingly grounded in the faults of mainstream medicine and our health systems. As Dean Burnett wrote in the Guardian:
Perhaps reliance on antidepressants is due to incredible pressures of time, money and workload on medical professionals, and alternative treatments require many hours of one-on-one interaction with trained experts, rather than swallowing a few capsules a week?
Successive UK governments in the previous decade took wrecking balls to mental health services. As has been widely accepted, the notion of austerity is one of political and social ideology. Banker bail-outs, shrinking the state, increasing corporations’ profit margins and propping up the stock markets all played their part in the slashing of public spending.
So, many doctors know support services like therapy are already at breaking point. Therefore, if the choice was between giving a patient a pill which would help, or not helping at all and seeing that patient spiral out of control, they’ll plump for the former. But the diagnosing of depression and prescribing of pills also revolves around our social and economic systems. Again, namely corporate capitalism. A study from Norway, for example, found the highest use of antidepressants was among the poorest socioeconomic groups (the poorest people). Other research often backs this up. And severe depression can be completely different: life changing and disabling.
Yet this still doesn’t explain why depressive symptoms more broadly can affect anyone, regardless of their socioeconomic background. But some psychologists’ theories on addiction could apply here.
Catherine G Lucas is the author of the book Alcohol Recovery: The Mindful Way. I previously interviewed her about her work. She believes that understanding alcoholism isn’t always as simple as mainstream psychology makes out. She told me:
Whether it’s wounding, trauma, a sense of spiritual emptiness and longing, or being highly sensitive, there’s always something underlying the drinking. The challenge, of course, is that sometimes the cause of that pain is unconscious. And the drinking creates such drama and chaos in our lives that we can think the alcohol is the problem.
But Lucas also thinks corporate capitalism plays its part. She says in her book:
Why, as a society, are we pursuing a level of consumerism that is destroying our planet, our source of food and life, stripping the earth of her natural resources faster than she can possibly replenish herself?
These notions of alcoholism, and addiction more broadly, being responses to the horrors of society also feature in psychologist Dr Gabor Maté’s work.
In his book In the Realm of Hungry Ghosts: Close Encounters with Addiction, Maté describes his experiences with treating addicts. But he also sets out his thoughts on the causes of addiction more broadly. One striking section gives an idea of just why people abuse substances:
A sense of deficient emptiness pervades our entire culture. The drug addict is more painfully conscious of this void than most people and has limited means of escaping it. The rest of us find other ways of suppressing our fear of emptiness or of distracting ourselves from it. When we have nothing to occupy our minds, bad memories, troubling anxieties, unease or the nagging mental stupor we call boredom can arise. At all costs, drug addicts want to escape spending ‘alone time’ with their minds. To a lesser degree, behavioural addictions are also responses to this terror of the void.
So, while alcoholism and drug addiction are often worse the lower a person’s socioeconomic status is, they can affect anyone – regardless of financial, material, and social wealth. Could this principle of societal horror causing addiction be applied to depression? I think so.
We think we are the all-encompassing species. Smarter, more developed, and able to play God at our own will. But in reality, our systems of society over thousands of years have held us back; made us arrogant; given us a misguided sense of intellectual superiority to every other creature and ultimately entrenched the notion that some people are more important, smarter, and better than others. For around 5,000 years we’ve had a problem as a species. We have lived in hierarchies for most of that time. A few people at the top have control over what the rest of us do.
And, if we’re honest with ourselves, we know this has never really worked.
Because if it had, why have there generally always been poor people at the bottom? Why have there commonly been some human lives that are worth more than others? Throughout our history, the majority of us have willingly accepted a minority telling us what to do. When has it benefited us? And why, in 2020, is society no more truly equal than it was thousands of years ago? Even with all our academic, scientific, and technological advances?
Today, we may be led to believe that just because we own a car, rent a house, and buy the same shopping each week that we’re ‘more equal’ to Richard Branson than Egyptian slaves were to their pharaoh. Looks can be deceptive. Because it’s all relative. Many of us may not be physical slaves – but only the so-called ‘1%’ truly have freedom in 21st-century society.
You only have to look at the not-so thin end of this wedge, where we have leaders like Donald Trump and Boris Johnson, to see where humans have gone horribly wrong. Sadly, the majority of us (the ‘99%’) have been unwitting passengers in this evolutionary car crash. And it’s here where the roots of depression may well lie.
The “dark mirror”
As psychologist Gabor Maté wrote, in the darkest places of human society:
We see the dirty underside of our economic and social culture, the reverse of the image we would like to cherish of a humane, prosperous and egalitarian society. We see our failure to honour family and community life or to protect children; we see our refusal to grant justice to Aboriginal people and we see our vindictiveness toward those who have already suffered more than most of us can imagine, Rather than lifting our eyes to the dark mirror held in front of us, we shut them to avoid the unsavoury image we see reflected there.
In the age of 24/7 news, social media, and extremes of inequality, no one can escape these horrors. You’re either living them or viewing them from the outside, in. But you can’t really avoid them. And like it or not, most people on some level know that society shouldn’t be like this.
Most people in the developed world would have seen the image of little Alan Kurdi’s dead body, washed up on Turkey’s shores in 2015 when he and his family were trying to escape the civil war in Syria. Many people will have been horrified. Some will do something about it, like becoming campaigners. But most would have glanced at this “dark mirror”, shut their eyes, and distracted themselves from the abject horror that his wasted life represented. Here’s where depression comes in.
Somewhere in the deepest recesses of their minds, Alan will have stayed with them. They may distract themselves with work, alcohol, drugs, shopping, television, family matters, or celebrity gossip. These people may consciously think that ‘it’s not my fault that little boy drowned’. They may perceive it as being a world away from their lives. But the human brain is complex, and we’re not a genetically selfish or uncaring species. We’ve been conditioned to be that way by hierarchies, where all of us are encouraged to ‘aspire’ for this, ‘strive’ towards that, under the illusion that one day we too may have power, wealth, and luxury. Of course, we never get any of it. But it keeps us working, keeps society’s cogs turning, and keeps the wealth flowing to those at the top.
Living the horror
At some point, this horror coupled with our own distractions from it has to come out somewhere. And I think in many cases it comes out in depression. Because people are consciously or subconsciously aware of how wrong everything is.
Some, like the single mother working two gig economy jobs to feed her kids, are living the horror. But she may not be totally aware of it: ‘it’s just how it is – that’s life for me’, she may tell herself. Yet she may have been given a depression diagnosis because of her ‘inability to cope with her circumstances’. Blame the mother, of course.
Meanwhile, the fairly rich hedgefund manager, working 24/7 to create wealth for himself and his family, may never give a thought to the single, gig economy mother. But he probably will have seen Alan Kurdi. He’ll think he’s depressed because of the pressures of his work: a Harley Street psychiatrist would probably agree.
Then there’s the chronically ill, disabled woman, in a constant state of lockdown as she can’t leave her own home. She may well have been told by a doctor ‘Of course you’re depressed! You’re chronically ill!’. She probably thinks of the single mother, but is unlikely to compare herself to the hedge fund manager.
Are antidepressants the answer?
So, all three of these people may be on antidepressants. Whether it’s due to the stress of being a single mum, the pressures of being a hedge fund manager, or the trauma of living with chronic illness. On the surface, these will be the causes of all these peoples’ depression. And they’ll believe that they are. But ultimately, the roots of their feelings are probably all the same. Deep down, they know the system is horrific, because when you check it, it doesn’t work for any of them. They’re all stuck, in their own way, fighting some part of it. But putting these people on antidepressants is not necessarily the answer. And for people concerned about their mental wellbeing during coronavirus lockdown, they may not be the answer, either. What may be needed is looking deeper into why we have depressive thoughts and feelings in the first place.
Part two will explore how corporate capitalism has replaced religion, how this is misguided and ultimately creates mental health crises. It will also explore how we should respond to this.
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