Feeling sad about depression?

Or, the end of the anti-depressant era

Whether or not you are or have been depressed (whatever that may mean exactly), you may have felt sadness about depression, yours or someone else’s, or, indeed, that of many people around you (even of the society in general), the contemporary, local or global, epoch or era of depression perhaps. Media consumers are now being asked to feel sad about depression in a more specific way, namely, to regret (and, by implication, to bemoan and to struggle against) the abandonment of depression, and other mental disorders (in the psychiatric technical sense) by Bigpharma, which means the abandonment of anti-depressant and anti-psychotic drugs. Sounds like some people want more money. A quick look at the media coverage of this ‘event’ sheds some reasons to doubt that giving our current experts in power more money will make anyone happy except them.

Call it like it is. But what is it?

Calling things by their name, their proper or appropriate name, may be a good idea, if only we could figure out what is proper. May sadness or melancholy be better words for describing ranges of human emotion and behavior than technical phrases like ‘depressive episode indicating a mental disorder’? For whom? When? Where? If you’ve gone through it – wondering, that is, whether or not what you are feeling or suffering ‘should be named’ an illness or mental disorder – you know how such questions press on you and raise an endless stream of further questions.

Words may cling to us. That’s one reason for the nastiness of stigmatizing words concerning mental illness. The power of words goes beyond shaping opinions, or rather, by shaping opinions, words may also shape reality, especially if we are talking about mental reality. (Sadness, melancholy, depression, bipolar disorder, mania, euphoria, happiness, ecstasy: just words. All linked to drugs in myriad ways.) Mental illness words are exceedingly clingy, sticky, hard to fling-off or pare away, like burrs (think of language as a walk through a wood full of burrs and other grabby things).

Cut the idea that new better drugs must be the way to go.

Try cutting away some clingy ideas. Cut the idea that new better drugs must be the way to go. At the same time as Bigpharma is withdrawing, Generalpublic is being prepared to give additional support to Bigpharma to reverse this tragic turn of events. Presumably Bigpharma’s withdrawal is a bad thing: the CBC headline places the implication before us squarely by referring to the ‘huge unmet need for better drugs’  and letting us think for ourselves of the valiant therapeutic pharmacological revolution of recent decades which is now being lost to history. Better to listen here to someone in power, namely Dr. Thomas Insel, head of the U.S. National Institutes of Mental Health, as quoted in the CBC article:

“Antipsychotics and antidepressants have been some of the most profitable agents for companies over the last two decades. But that doesn’t mean they’re effective. What it means is that they sell and they can be marketed.”

Think about that. But is it not because we thought that the last few decades had seen improvements in treatment of psychosis and depression by drugs that we wish to continue such innovations? Or what?

Digging deeper

Here a little digging into the meaning of events can help. The CBC piece, like most but not all of the media coverage, leaves out some important facts. The CBC cites the fact that the era or epoch we are talking about is roughly the last fifty years. Fifty years is significant for the reason the CBC gives, namely, the fabrication of new chemical compounds following WWII, but also for a related reason the CBC does not mention (in that piece), namely the patent expiry dates of such drugs. Part of the reason profits are no longer attractive enough for Bigpharma is the patents are expiring and so there is competition from generic manufacturers. Another part of the explanation for profit decline are the lawsuits, primarily in the U.S., linking anti-depressants with increased risk of suicide and killing – including mass killing – several of which suits have heard from the expert testimony of David Healy, ex-secretary of the U.K. Pharmacological Association and author of The Anti-Depressant Era. Could people also be refusing, more and more, the idea of a drug fix for each and every mental disorder (whether or not this is good for them), partly for the abundant reasons for scepticism regarding psychiatric-pharmacology (barely touched upon here)?

David Healy has a Canadian connection too: he applied for a professorship at the University of Toronto (my alma mater, to disclose any conflict), and was offered the job, only for the offer to be retracted after a backroom complaint from Bigpharma (Healy sued and won). The Anti-Depressant Era, and the simpler Let Them Eat Prozac, document the manufacture of beliefs and the construction of realities (the two are inseparable in human life) concerning depression. Related work on how professional individuals and institutions construct (through the use of words but also through force, economic and otherwise) eras or epochs of belief and social reality – belief and social reality concerning illness and mental disorder specifically – include Ivan Illich and Michel Foucault. None of the above questions the trauma of individuals suffering depression or other mental illnesses, but it does question the accuracy and methodology of the diagnostic categories and the corresponding therapeutic models.

The drug fix ideology is perfect for those with no time…to spend with others, especially people suffering mental trauma.

Contemporary psychiatry is a mess and there have been few moments in its short history when that was not true. Today’s disillusionment with the DSM (Diagnostic and Statistical Manual of Mental Disorders, the American Psychiatric Association’s bible) and, perhaps, the NIMH’s director’s timely reminder not to confuse profits with therapy, point to a contemporary occasion of opportunity – to think depression and other ‘mental disorders’ in non-reductive ways, addressing the social and moral dimensions directly, as the psychology and psychiatry of a hundred years ago was more willing to do (in William James and Karl Jaspers, for example). Going back here is going forward, if only you have the time. The drug fix ideology is perfect for those with no time; to be clear, those with no time to spend on themselves, and no time they wish to spend with others, especially people suffering mental trauma. But that’s the extreme possessive individualism of our late capitalist virtual consumerist dystopias.

So, if you are still feeling sad about depression, chill. There’s no exact answer, but do something: do something other than hope for a drug. From an even older source, Robert Burton’s seventeenth century The Anatomy of Melancholy, a ginormous book with a classical education built into it, from a sufferer who sums up the whole damn complicated ‘thing’ in a simple phrase: ‘BE NOT SOLITARY, BE NOT IDLE.’

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