Lesson 1 - The Depression Industry
This class presents a non-traditional view of the genesis and treatment of the thing commonly called depression. Just in case what you are experiencing has biological roots requiring medical attention or psychological roots requiring psychotherapeutic attention, you are advised to seek traditional treatment opinions from medical and psychotherapeutic providers in addition to using the methods outlined in this class.
THE DEPRESSION INDUSTRY
Our starting point in this class is not the usual starting point in a discussion of depression. Usually depression is characterized as an illness or as a biological, psychological, social, or spiritual disorder. We will start at a different place by asserting that the thing called “depression” is human sadness in one or more of three areas: sadness about the self, sadness about one’s circumstances, and sadness about life itself.
In this class we will examine “depression” from this standpoint and you will learn how to apply the principles and practices of existential cognitive-behavior therapy (ECBT) so that you can provide yourself with relief in these three areas. Using ECBT as a self-therapy, you can become less sad—which is exactly the same as saying that you can become less depressed.
Before we address these three varieties of sadness I want to present you with the rationale for looking at “depression” as human sadness and not as an illness or a disorder. We will spend our first three lessons making some sense of this territory—only cursory sense, because I want us to move on to the helping part of the class. But this introductory discussion will be its own kind of help, because it is good to have made explicit what you’ve probably long suspected, that our epidemic of “depression” might just have something to do with the money being made from treating it.
It is no longer possible to feel sad and blue without someone wanting to call that “depression.” For the longest time human beings made the sensible distinction between feeling sad for reasons (say, because they were jobless and homeless) and feeling sad for “no reason,” a state traditionally called melancholia. With the rise of four powerful industries, the pharmaceutical industry, the psychotherapy industry, the social work industry, and the pastoral industry, it is has become increasingly difficult for people to consider that sadness might be a very normal reaction to unpleasant facts and circumstances. Cultural forces have transformed a great deal of normal sadness into the “mental illness” of depression.
In fact “sadness” and “depression” have become virtual synonyms. Nowadays if you feel sad you are supposed to get help from a pill, a therapist, a social worker, or a pastoral counselor—even if you’re sad because you’re having trouble paying the bills, your career is not taking off, your relationship is on the sour side, and life did not turn out how you hoped it would. That is, even if your sadness is rooted in your circumstances and your unhappiness with life, social forces maneuver you into the world of the medical model, where psychiatrists dispense pills and psychotherapists diagnose you. It is very hard for the average person, who suffers and feels pain because she is a human being and not because she has a mental illness, to see through this maneuvering.
Many writers have tried to speak to this issue but their voices can’t be heard very well over the incessant din accompanying the latest “miracle” antidepressant. Their books have titles like The Loss of Sadness (Horwitz and Wakefield), Creating Mental Illness (Horwitz) and The Medicalization of Society (Conrad) and their arguments are compelling. But lined up against them are countless books selling the idea that all unpleasant human situations are “treatable disorders” demanding the attention of trained professionals. This is very hard on the average person, who quite often has an intuitive sense that he or she is not being served by the medical industry but who doesn’t know where else to turn.
In this class I want to try to spell out what is going on here and help you get a better sense of what depression is and what it isn’t. I am guessing that you get sad some amount of the time and that you would like to know what to do about those bouts of the blues. If they are “really” depression, they ought to be handled certain ways. If they aren’t “really” depression but rather are sadness, they ought to be handled other ways. By the end of the class I hope that you’ll have become practiced at not morphing every bit of sadness into a depression in need of treatment. The more you can refrain from leaping to naming what ails you “depression,” the better your chances of finding homespun solutions to your painful problems.
Here is a headline right at the beginning. According to the biological depression model, you are the problem: something in you is not working correctly. According to the psychological depression model, you are the problem: maybe it’s your learned helplessness, your unresolved conflicts with your parents, your low self-esteem, or something. According to the social depression model, you are the problem: maybe you’ve become too isolated, maybe you haven’t provided yourself with enough social support, etc. According to the spiritual depression model, you are still the problem: you haven’t made the right spiritual connections, given yourself over to God, tapped into your spiritual nature, and so on. These four models identify you as the problem. Life is never the problem. How odd! How odd to think that our sadness might not sometimes be related to our life circumstances or to the facts of existence.
When you’re sad you certainly do have a problem, since sadness does not feel good. But that is not the same thing as you being the problem. In our discussion you will learn what ought to be obvious were it not for the powerful social pressures to make you the problem. You will learn that life itself can present problems that you are obliged to handle if you are to feel better. Life circumstances can cause our sadness: the problem is not always a serotonin re-up deficiency or a losing battle between our id and our superego. Sometimes the problem may be that we staked a lot on our profession and we’ve discovered that we don’t much like it; or that our mate is making faces because we aren’t bringing in enough money; or that our parents and our children need so much attention that we have no time left for ourselves. Sometimes situations like these cause us grief.
We will try to get clear on these matters during this class. Below you will find some excerpts from the literature, two exercises to get you thinking, and your first action step. When your second lesson arrives we will continue our investigation.
FROM THE LITERATURE
From The Medicalization of Society by Peter Conrad
“‘Medicalization’ describes a process by which nonmedical problems become defined and treated as medical problems, usually in terms of illness and disorder. Some analysts have suggested that the growth of medical jurisdiction is ‘one of the most potent transformations of the last half of the twentieth century in the West.’”
The Medicalization of Society, p. 4
From The Loss of Sadness by Allan Horwitz and Jerome Wakefield
“We argue that the recent explosion of putative depressive disorder, in fact, does not stem primarily from the real rise in this condition. Instead, it is largely a product of conflating the two conceptually distinct categories of normal sadness and depressive disorder and thus classifying many instances of normal sadness as mental disorders. The current ‘epidemic,’ although the result of many social factors, has been made possible by a changed psychiatric definition of depressive disorder that often allows the classification of sadness as disease, even when it is not.”
The Loss of Sadness, p. 6
From Mad in America by Robert Whitaker
“A dark truth became visible in American medicine in the 1990s. Bias by design and the spinning of results—hallmarks of fraudulent science—had moved front and center in the testing of commercial drugs … When the New England Journal of Medicine tried to identify an academic psychiatrist who could write an honest review of antidepressant drugs, it found ‘very few who did not have financial ties to drug companies.’ One author of an article on antidepressant drugs had taken money on so many occasions … that to disclose all of them ‘would have taken up more space than the article.’”
Mad in America, p. 265
From Creating Mental Illness by Allan Horwitz
“Many of the conditions encompassed by the diagnoses in the DSM [the diagnostic manual used by psychiatrists, psychologists, and psychotherapists to diagnose ‘mental illnesses’ like depression] are neither mental disorders nor discrete disease entities; instead they reflect expectable reactions to stressful conditions, culturally patterned forms of deviant behavior, and general unhappiness and dissatisfaction.”
Creating Mental Illness, p. 15
I’m challenging you to understand the word “depression” better than most people understand that word. To this end, I would like you to answer the following questions. As we proceed through the lessons, you’ll see why I asked you these questions. Start a notebook or a file for your answers. Please do not research your answers: simply think about the questions and answer them from your own experience and your own understanding.
1. What is the difference between a “symptom” and a “cause” (as in the phrase, this is a symptom of depression and this is a cause of depression)?
2. What do you think the phrase “biological depression” is trying to convey?
3. What do you think the phrase “psychological depression” is trying to convey?
4. What do you see as the difference between “sadness” and “depression”?
It is easy enough to say that there is a difference between “sadness” and “depression.” But what is the actual difference? Try answering the following questions:
1. Is the essential difference between “sadness” and “depression” that depression is more “severe” than sadness? What does “severe” mean in this context?
2. Is the essential difference between “sadness” and “depression” that sadness comes and goes but that depression “lasts”? How long does this state have to last before sadness becomes depression? And if time were the only distinguishing feature, wouldn’t long-lasting sadness more properly be called “sadness that lasts” than something else?
3. Is the essential difference between “sadness” and “depression” that, while they may look exactly the same as to symptoms, sadness and depression differ as to cause? If so, how would an expert know which thing he is looking at if the symptoms looked exactly the same?
4. Would it make sense to you if you heard someone say, “His father kept yelling at him and that’s why he got tuberculosis”? What about, “His father kept yelling at him and that’s why he’s chronically depressed.” If the latter makes sense to you and the former doesn’t, what is the underlying difference between “tuberculosis” and “depression” in the psychological model?
ACTION STEP #1
When you feel sad, something is going on. That “something” saps your energy, reduces your experience of pleasure, disrupts your normal rhythms, and paints the world gray. Whatever that “something” is, you must take responsibility for doing something positive and purposeful to improve the situation. If you do nothing, you are “buying the blues.” If you do something positive and purposeful you are refusing to collude with yourself in supporting your sadness. Take some positive and purposeful action today to beat the blues!