WillSpirit!

Once again, a discussion with Larry Drain of Hopeworks Community provides fuel for a blog post. The conversation centered on a BBC article about a World Health Organization report that predicts a global epidemic of depression. Part of the conversation hashed over the tired ‘medications or not?’ debate. However, what became more and more clear to me as I organized my thoughts, was that if depression is increasing in incidence, the important question may not be ‘what to do?’, but rather, ‘why is this happening?’

To me, the answers are obvious. First, there is probably an element of better awareness of depression on the part of clinicians and the general population. The article acknowledges this, but also suggests that the incidence of depression is actually increasing, not just increasingly recognized. So if people are getting more depressed, what is making them that way? It seems inescapable that the conditions people suffer cause the depression we see. We live in a world where resources are obscenely concentrated in the hands of very few, while the masses struggle to meet daily needs. Or don’t meet them. Our environment, the natural world that is our mother and our heart, is being eaten away by industrial exploitation and waste. Families no longer stay together. And modern communities consist of strangers that move in and out every few years, rather than villagers who have known each other for lifetimes and generations. Joblessness is rampant. Healthcare is often unavailable or of low quality. People seldom get the respect they desire. These are depressing conditions.

When I trained at our local Suicide Hot Line, the point got driven home that people become suicidal most often because of loss. Bereavement, lay offs, divorce, major illness, financial catastrophe. Those who pose the greatest threat of suicide cite these sorts of calamities as what make them want to die. They don’t say “gee, for no reason I just feel like life sucks and I want to kill myself.”

Not everyone who faces terrible setbacks, or a horribly draining environment, gets depressed and/or suicidal. Many weather such losses and depredation satisfactorily. It helps if they have a strong social network. Religious faith makes a difference. Having been raised in a more-or-less healthy family, with adequate affection and validation, must be a benefit in helping one survive. In addition, people vary in their biogenetic vulnerability toward depression. As I wrote in my little debate with Larry:

The concept behind antidepressants is that they treat disordered brain chemistry. But the makeup of a person’s brain does not cause depression. Rather, it increases the susceptibility. A pane of glass will break sooner than a sheet of plywood if hit by a brick, but it is still the impact that causes the breakage, not the composition of the glass. Yes, you can reinforce a window with wire mesh (just as you can ‘stabilize’ a person’s moods with drugs), but it might be better to reduce the conditions that lead to riots and people throwing bricks in the street.

The gist of the WHO report seems to be that we have this looming public health crises, this terrible disease epidemic, and we need to devote more funds toward treating it. The article quotes a Dr. Saxen: “We have figures to show that poorer countries have actually more depression compared to richer countries and even poor people in rich countries have a high incidence of depression compared to the richer people in the same countries,” and then goes on to point out that even though depressed mood disorders show up more in poor countries, those impoverished nations devote little funding toward mental health. If I had been writing the article, I might have looked for an expert who had something to say about why there is more despondency where there is more poverty. Even though the answer seems obvious, it still should be addressed.

People get depressed for a reason. If people have no choice but to live their lives in shanty-town squalor, with sewage in the streets and disease at every turn, they will tend to be unhappy, a.k.a., ‘depressed’. To overlook the causes of that unhappiness, and suggest that the problem is one of lack of treatment, does us all a disservice. Or maybe it’s actually a favor. That way we don’t need to accept any responsibility for the misery of others. They are just ‘mentally ill’, poor things. Maybe we can help them out with some pills.

It is the classic situation of ‘blame the victim’. Label as ‘ill’ those who, for whatever reason, are unable to hold up emotionally under the crushing wheel of hopeless situations.

I am not saying we don’t need mental health treatment. Far from it. Depression is a real condition. It can be lethal, and even when it is not, it drains the texture and joy out of life. I know this all-too-well firsthand. But I highly doubt I would have had so much depression in my life if (among other things) I had not lost my mother at age six, been abused by my stepmother, and grown up with an alcoholic father. Losing my career as a surgeon did not help, either. People get depressed for a reason.

People get depressed for a reason. We who are sensitive to depression are the proverbial ‘canaries in a coal mine’. We are the ones who will be the first to collapse in a toxic society. But others will follow. As oppression, exploitation, and environmental degradation increase, should we just build more factories to churn out more pills? Is the best response to simply resign ourselves to this much misery without indicting anyone for causing it? Perhaps it would be better to first acknowledge that what we are facing is not a mysterious ‘epidemic’ of a biological illness, but rather an all-too-predictable human response to a poisonous world.