WHO KNOWS what pushes us over the edge? A middle aged woman I once interviewed said the depression that stole her life was a mix of childhood and genes. Parents who did not show her warmth or cuddle her set the scene, but it was not until she lost her job that she entered a tunnel from which there was no escape or glimmer of light. “I get so angry when I’m told to `get a life’,” she told me in words so halting they suggested the small steps of a terrified child.
The woman, who lived alone in one bedroom walk-up apartment, is one of more than 800,000 Australians thought to be suffering depression. The number is doubling every 20 years, making it, we are told, an epidemic’ costing some $5billion a year. This is a big shift from the 1950’s when the maker of the first antidepressant, Ciba-Geigy, delayed production because they did not believe there were not enough depressed people in the world. Now, one in five of us is said to be afflicted. Depression is the leading cause of disability in the world.
But what is it? The most common explanation, usually from medicos, who write up to 10 million antidepressant prescriptions a year, is a ‘chemical imbalance.’ I prefer writer, William Styron’s term: “Darkness visible.” It captures the feeling the woman had of being inside a dark tunnel. It also evokes the lostness that comes with not being able to love, which is how I think about depression. “Depression is the flaw in love. To be creatures who love, we must be creatures who can despair at what we lose, and depression is the mechanism of that despair.”
The words are from ‘The Noonday Demon’, the best book I have read on depression. It is by a writer, not a doctor, or a therapist. Andrew Solomon is also a sufferer, and talks about pain in the way that writers do, that is, as something to be understood, not avoided. You can learn from suffering, but it means doing what Joseph Conrad did to create ‘The Heart of Darkness’.
Day after day Conrad sat with an empty sheet of paper waiting for the book to come. He knew, or thought he knew, what he wanted to say, but could not find the sentences without enduring an emptiness that plunged him into the abyss. It was a loss – castration if you like – and while that has never been popular, it is now thought unnatural enough to require medical intervention.
Was Conrad clinically depressed? Probably: Many creative people have been. But, like the poet, Les Murray, he used his “best Sunday punch” to put the condition “under the burning glass of poetic analysis”, and to good effect. This is less likely to happen now because of what William Styron calls the “breezily optimistic assertion that nearly all depressive states will be stabilized or reversed if only the suitable antidepressant can be found (and in the US, close to 30 million people, or 10 per cent of the population, have found, and use, SSRI’s).” This state of affairs did not just happen. It was engineered, as I saw several years back when Jeff Kennett, dispensing show bags of mugs, mouse mats and T-shirts, launched the national depression initiative, ‘Beyond Blue’. Jeff did not mince words: extolling the curative power of antidepressants, he made it clear that the bluebird of happiness was just a swallow away.
There was no mention of family break-up, poverty or sexual abuse – the losses that can trigger depression – just a single-minded goal to get the depressed to admit they had a ‘mental illness’ and consult a GP, who would write a script. It was, Jeff said, going to be as easy as treating the common cold. Depression treatment and testing would be marketed like the testing and treatment of breast cancer in women. Which was fine, except, as University of New South Wales professor of psychiatry Dr Gavin Andrews, told the launch, “there’s no lab test for it (most depressive disorders)”. This is not the case with breast cancer, which can be detected via mammogram or biopsy: So why, I wondered, the hard-sell on certainty and depression as a disease?
Associate Professor Michael Sawyer from Adelaide University’s department of psychiatry, may have let the cat out of the bag when he said that his decision to omit the word “illness” from his study of mental health in children represented a potential risk. “The fear was that it (his study) would become harder to sell to folk like you (media),” he said. So, what we had as a national response to depression was a media-friendly marketing ploy, where amid talk of “take-home messages” and “core business”, depression was dumbed-down to a sound-bite.
It would no longer be what it was for Chekhov, the pain of existing. It would be an organic disease, even though there is no conclusive evidence to support this. Jeff wanted the media to do some “good” for society, by which he meant, join the biological bandwagon. Personally, I preferred Bob Dylan’s never ending tour: ‘Tangled Up in Blue’, while messy, seemed more likely to provide a way out than blaming your brain.
Since that launch depression has become even more of an industry. But despite the resulting fetish for unhappy souls, we are no closer to nailing the Black Dog.
The most reliable predictor of outcome is still the relationship with the therapist, which is another way of talking about transference, which is a kind of love. This is not what Les Murray calls the “sick love” for symptoms, but a space to think about why and how we defeat ourselves. Murray managed it by dredging the hard bits up from “the smoldering ash pit of memory.” Giving himself permission to be ill was a pre-condition to getting better. He even learnt from Dr Hannibal Lecter in ‘The Silence of the Lambs’ who made it clear to him “that for self-examination to work, you must tell the exact truth, suppressing nothing.” This is closer to Freud’s free association than anything that occurred at the Beyond Blue launch.
Which is a great shame, but hardly surprising, given the biomedical myth-making that has taken over psychiatry. As T. M. Luhrmann makes clear in her book, ‘In Two Minds: The Growing Disorder in American Psychiatry’, psychiatrists now regard mental disorders as “heart attacks in the brain”, and no more expect you to explain such an event than if you had a heart attack in the heart. This takes the dignity and truth out of treatment, which is what allowed Les Murray to recover, and what the woman trapped in the tunnel had been denied.
