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A World Without Depression
Alex Steffen, 17 May 05

In the next ten years, many neurologists say, we will understand the brain as never before, gaining not only insight, but an increasing ability to treat brain dysfunction and mental illness. These breakthroughs offer incredible, worldchanging potential for transformation, in ways we're just beginning to grasp.

Take depression. Large numbers of people -- perhaps as many as one in ten -- will experience at least one major episode of depression in their lifetimes, and the effects of that depression on those indviduals can be horrible: terrible health costs, substance abuse, suicide.

The societal effects can be even more severe. Poverty and depression are highly correlated, and, as Andrew Solomon writes, the evidence suggests that in the developed world many poor people aren't depressed because they're poor, they're poor because they suffer from chronic depression.

The problem appears to be even worse in the developing world. Studies suggest that many of the world's poorest people suffer depression. As many as 400 million people in the developing world suffer from depression or other mental illnesses, and the vast majority of them do not have access to the best current treatments.

And "best current treatment" is a moving target: we're developing better and better drugs, certainly, but also coming to understand the other things people with mental illnesses like depression can do to help battle their diseases. In fact, as Peter Kramer writes in Against Depression,we may be nearing a point where we can routinely successfully treat depression. We may be on the brink of banishing depression -- perhaps even, if we're smart, banishing it from every corner of the planet.

Of course, some people romanticize depression and worry that we'll somehow lose something essential to our natures if depression is vanquished. I'd encourage those folks to read Kramer's essay, There's Nothing Deep About Depression. For myself, as someone who's seen depression utterly destroy the lives of several people I love, I'd be happy to see untreated depression made as obsolete as smallpox.

Imagine a planet where all people's health needs were met -- not just a planet where all children were immunized against preventable diseases, and not just a planet where everyone had clean water and enough to eat, but a planet where the hundreds of millions of people who are unable to lift themselves out of dire situations because they're crushed under mood disorders and mental illness suddenly had those burdens lifted. This is not a pipe dream. As the Millennium Development Goals show, planetary transformation of social conditions could be triggered for comparatively tiny amounts of money.

What might be possible in such a world? In a world of people released from the dragging effects of needless and seriously counter-productive mental and physical illnesses, what might we be able to accomplish? What, in short, would a world without depression look like?

(photo credit: Nicole DeVito)

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What, in short, would a world without depression look like?

Well, there would be no Van Gogh, for starters.

Posted by: Joseph Willemssen on 17 May 05

Nice touch with all the banner ads for Zoloft plastered around that article by Dr. Kramer.

Posted by: Joseph Willemssen on 17 May 05

Actually, the studies are pretty conclusive that creative people with depression are more creative when they're not debilitated by their depression. Read Against Depression.

Posted by: Alex Steffen on 17 May 05

Actually, the studies are pretty conclusive that creative people with depression are more creative when they're not debilitated by their depression.

I don't doubt that, but I do doubt whether the creativity would be expressed in the same way without depression as a precursor.

Posted by: Joseph Willemssen on 17 May 05

This is a grossly sanguine take on the question. And it depresses the hell out of me that it made it's way onto Please take these sorts of reports with a huge grain of salt. Studies also indicate that depressives have a MUCH more accurate view of reality.

I don't know who said it of psychiatry/psychology something like "the job of the therapist is to adjust a person to an unjust world..."

Thanks but I'll stay 'unadjusted' thank you.

I'm going to go happily crawl back under my rock now.

Posted by: EAM on 17 May 05

The whole idea of dismissing the emotional states in other cultures seems to me arrogant in the extreme. I have no more reason to buy into the pseudo-science's conclusions re which feelings are "clinical" and which are "valid" than to buy into the saving power of the various "saving faiths" being so eagerly peddled these days. I wonder if we should start a war in order to facilitate "banishing it from every corner of the planet," just in case the insurgents resist?

Posted by: DaveW on 17 May 05

Wow, I hardly know where to start.

I'd love to see links for the studies suggesting that people in the grips of depression have a clearer grip on reality. Everything I've ever read on the subject, and my own experience dealing with severely depressed people, suggests the exact opposite: that depressed people are subject to unrealistic thinking, limited emotional response and monochromatic outlooks, not to mention substance abuse and suicidal thoughts.

And DaveW: where exactly do you see me dismissing other cultures? And what the hell does depression, which is primarily neurochemical, have to do with cultural mores, any more than schizophrenia or alzheimers? Finally, your last sentence is just silly.

Posted by: alex Steffen on 17 May 05

This is a common problem, when discussing depression, this lack of differentiation between clinical depression and moodiness or 'creative difference.' But it is a fallacy.

Clinical depression, as Alex says, is a serious medical condition, with serious consequences. Depressed people are indeed not creative, they are only destructive; they are not 'different from the norm', they are painfully similar to one another; and I must agree that they do not see the world more accurately, but are blinded by their condition.

To see drugs as an attempt to homogenize minds is a valid (and well-trod) concern, but need it be so shrill? Unless we engineer everyone to think the same (which I submit is impossible), we will have difference - and that is enough to give rise to creativity, insight, wisdom, everything, in short, that art thrives on.
Finally, curing clinical depression has no effect on pain; the pain of loss, of love, of grief, of difference... Van Gogh, Virginia Woolf - their madness may have influenced their art, but it did not cause it. It was relief from madness that allowed that.

Posted by: justus on 17 May 05

It was relief from madness that allowed that.

Right. But without the madness, where would be the relief?

I thought Huxley covered this topic pretty well already.

Posted by: Joseph Willemssen on 17 May 05

Yes, like I said, well-trod.

I believe his main character hung himself.

Posted by: justus on 17 May 05

Does it make sense to say that the causes of clinical depression are culturally sensitive? Or for that matter any other neurological disease? Or not?

Posted by: Zaid on 17 May 05

My understanding is that there are certain culturally-specific variations in the way these diseases manifest themselves, and very definitely wide ranges in responses to the diseases in different cultures, but that the chemical/physical underpinnings of depression and other mental illnesses are pretty constant among human beings in general.

But maybe somebody reading has more specific information?

Posted by: alex Steffen on 17 May 05

It's possible that Vincent van Gogh would have lived to age 63 like his father, instead of dying at age 37.

Posted by: Dave on 17 May 05

Wow... I'm shocked this made it to WorldChanging as well.

I'm close to many people who have been on antidepressants at one time or another. I would be shocked if any of them agreed with what Alex has written here.

I remember a woman I was dating going on SSRI's. She was a musician, and it eliminated all her creative juice and motivation. She lost her sense of purpose in life, even though she wasn't as unhappy. So she stopped. The experience helped her gain a lot of perspective on herself, but she never went back to antidepressants.

Someone else I'm close to seemed to stop caring about things that weren't going so well. It wasn't that they ceased controling him, it's that they ceased bothering him at all. This was big stuff in his life, like with his long term girlfriend.

Generally I think SSRIs, and other potential chemical interventions in emotional patterns, are valuable tools, but are far from magic bullets. Just because we see a chemical imbalance does not mean that this imbalance is the cause of what we see in others or experience in ourselves. And chemical intervention may simply push underlying issues down to have them pop up in another form, like cancer. What ever happened to spiritual and emotional growth as a path toward healing?

To be honest, when I look at depression levels and antidepressant use in our society (and worldwide!), I think of our economic systems. How much opportunity do most of us have to develop and express ourselves as full humans? What kinds of social relationships and lives did people have before the industrial age?

Looking at the developing world you see the same thing. The rural poor with access to land may struggle, but it's no surprise that the urban poor, disconnected from community, history, and their own labor, are depressed.

And we want to treat this with drugs!?

Posted by: hank on 17 May 05

I'm surprised about another statement. I'm mildly familiar with the literature on depression, and very familiar with the literature on poverty. I'm not familiar with any article that posits that depression causes poverty rather than the other way around. Particularly in nations with significant wealth disparities.

Posted by: Lester Spence on 17 May 05

Depression absolutely causes poverty- if for no other reason than the poor are malnourished. Hundreds of millions of these people are simply too hungry to be anything other than depressed. Lack of adequate B vitamins, especially B1, B6, B12 and folic acid are proven to cause depression. Lack of adequate magnesium and other minerals can cause depression. Lack of omega 3 fatty acids has also been shown to cause depression.

So, if we want to give the poor in the developing world some pills, lets give them vitamins, minerals, and arctic fish oil.

But their situation demands more than that, more than even the best of big pharma solutions. (By the way, you'll notice that the back of the bottle of SSRIs always says, "Take With Food".) Because the problem is bigger than that:

Malnutrition during childhood causes their brains not develop properly. Can’t fix that with Big Pharma. Combine that with the grinding reality they face day after day. The single outstanding characteristic of clinical depression shared by the world’s poor is hopelessness.

These people don’t need Effexor. They need hope. They need proper food, access to jobs or land, education, health care, family planning… Of course depression contributes to poverty. And poverty contributes to depression. Another nasty feedback loop. But don’t give them antidepressants. Give them jobs.

Development experts have known what to do about this for decades, even if they argue bitterly over how to implement it. We could try the old fashioned way, by a Global Coalition of the Willing, spending no more than we spend per year on the Iraq War, and in a few years we might get actually get somewhere. The problem with development schemes is that they have never really been tried on that scale.

But we won’t try it because there is no political will to try it. Instead we will talk about sending them pills.

That’s depressing.

Posted by: wprescott on 17 May 05

Alex: I forget the reference but do recall a paper claiming that depressed people tended to have a more accurate self-perception than happy people, who had a somewhat less realistic picture of reality. Whether or not more research followed it up I don't know. Whoever is citing it above seems to be exaggerating, at least to my recall.

In general, I think Western medicine's eagerness to medicate 'mental illnesses' stems from a profound misunderstanding about humanity - check the DSM, their bottom line is whether or not a person can function in society - but I remember a piece of chalk graffitti once seen, "what is it to be well-adjusted to a profoundly sick world?" And isn't worldchanging at least tacitly acknowledging something is far from right with the world, and that change is necessary? And part of that change comes in how we see ourselves: in relation to our planet, and in terms of what we need to make us happy, since it isn't found in rampant consumerism.

Hmmm. This could easily become a big wide ranging ranty essay, and it's already conflating topics, so I'm going to stop now and go to the beach :)

Posted by: billy on 17 May 05

Lots to respond to! Thanks for all the comments.

wprescott: perhaps you missed the parts where I wrote

"best current treatment" is a moving target: we're developing better and better drugs, certainly, but also coming to understand the other things people with mental illnesses like depression can do to help battle their diseases.


Imagine a planet where all people's health needs were met -- not just a planet where all children were immunized against preventable diseases, and not just a planet where everyone had clean water and enough to eat, but a planet where the hundreds of millions of people who are unable to lift themselves out of dire situations because they're crushed under mood disorders and mental illness suddenly had those burdens lifted. This is not a pipe dream. As the Millennium Development Goals show, planetary transformation of social conditions could be triggered for comparatively tiny amounts of money.

Nobody here is arguing for just "sending them pills." Quite the opposite You're putting words in my mouth. I'm quite clearly advocating for expanding mental health treatment capacity of all kinds in the developing world as part of an overall strategy of sustainable development and the eradication of poverty.

Hank: I don't even mention SSRIs, much less say they're a silver bullet.

Lester: Besides Solomon's book, there was a NYT article three or four years ago on a study showing the depression->poverty link. Further, a quick Google search turned up this as the first hit:

Does depression worsen poverty?
There is a reason to support this possibility with evidence for two major mechanisms. First, the evidence that mental disorders lead to disability which has been described earlier. For example, studies of primary health care users in India showed that subjects with depression spent more than twice the number of days in the previous month in bed or were unable to do their daily activities as compared to others (2). Second, there is evidence that persons with depression receive more health care, especially in primary health care. Most people with depression consult for physical symptoms and in many health systems, both in developing and developed countries, this can lead to numerous costly consultations, investigations and polyphar-macy (7;16).

while that doesn't say depression->poverty, it does indicate two mechanisms through which people would be impoverished. Given the great reduction in ability to function that seriously depressed people experience, I don't see why one would find the link difficult to accept.

Obviously there's chicken and egg here -- many poor people live under tremendous stress and in tragic conditions, and obviously that makes people depressed. Obviously, too, many people who go through untreated mental illnesses have catastrophic failures of fortune.

Joe: I know what you're saying, but I think there's plenty of madness for artists to draw on in the world and the human condition, without internalizing their own. I find your argument similar to the argument that drinking creates great writers -- many great writers were drunks, but many have said themselves that writing hurt, not helped, their work.

Besides, you don't have to be nuts to feel. Justus puts it well when he says "curing clinical depression has no effect on pain; the pain of loss, of love, of grief, of difference... "


Posted by: alex Steffen on 17 May 05

Alex, I'm not claiming that depression leads to great art, but you asked what a world without depression would look like, and we know for a fact that certain geniuses would have never gone down the paths they went in their lives without severe mental trauma along the way.

And this then extends and influences us all.

I can't imagine, for example, what my life would be like without the influence of William James, yet he would probably have been just some forgettable physician if he had never had battles with depression and other mental troubles.

The idea of the "sick soul", "spiritual rebirth", and such are all part of a process of becoming more human for lots and lots of people. Does this mean that we all need to go into major depression to eventually be well? No, but there are some fundamental aspects of the human condition which are profoundly troubling -- like mortality, suffering, and the existence of evil -- and we are better people for somehow finding a means of coming to peace with those things in some way, and some sort of pharmaceutical "cure", genetic manipulation, etc, isn't really going to be of much help in doing that.

You're also going on fairly shaky ground by even trying to define depression or believing that there is something wrong or unnatural about it. I think it's more of a qualitative judgment that has to do with depth of depression, persistence over time, and length. Until we have a much firmer grasp on the relationship between mind, spirit, and body, we're launching into the dark by thinking we can "solve" something that we don't clearly understand.

If you ever get a chance, take a look at McDermott's anthology of James' writings. The first section deals with his struggle with depression and how it it was essential in its influence on the great person he became.

Posted by: Joseph Willemssen on 17 May 05

Not to beat a dead horse (I would never!)...

I appreciate, I truly do, the connection between madness and genius; no one who has read Key Redfield Jameson's autobiography and Touched By Fire can fail to see it ever again.

BUT. But, I have a very dear friend whose brother was depressed - truly depressed - and guess what? he found him hanging in his apartment. Can you imagine? He doesn't care about William James, does he? Now I do, very much, and I value the influence of darkness on our collective appreciation of light. But there is still a difference between the blues, no matter how bad, and true, annihilating depression.
The former is useful, though painful. The latter I hope is wiped, like polio, from our lives. To all future geniuses this may thwart, I'm sorry.

Posted by: Justus on 17 May 05

To all future geniuses this may thwart, I'm sorry.

There's "Brave New World" in a nutshell - let's medicate us all and we'll never have to suffer the difficulties of being human. If we all end up mediocre, so be it.


So we need to forgo genius in our world because people hang themselves?

Posted by: Joseph Willemssen on 17 May 05

Sorry, Justus - that was a little snippy of me. Sorry for sounding rude.

Posted by: Joseph Willemssen on 17 May 05

I read Peter Kramer's article and was quite put off - he stays entirely on the individual level, and argues only against the "heroic melancholy" straw man, ignoring deeper questions about causality.

A valuable analogy is to pain. Pain is a signal, and the same is true of depression, on the social and individual scale - there is real stuff that is not working that leads into the depression. Addressing the depression itself for a given individual is like only prescribing painkillers to someone without addressing whatever's leading to the pain. It may feel better, but if the upstream problems aren't addressed, things will just get worse (unfortunately, not necessarily in obvious ways). As has been mentioned there can be feedback loops - e.g. pain leading to muscle tightening that sustains a problem - so symptom treatments such as painkillers and anti-depressants can indirectly aid in addressing initial/root causes. But they can't be sufficient by themselves.

From Alex' last comment it sounds like there's more agreement on this page than there is in the larger debate regarding this complexity of causality, and addressing depression holistically.

As long as we're on the subject of symptomatic depression treatments, here's an interesting new treatment , and this Kuro5hin article has been making the rounds -

Posted by: John Abbe on 18 May 05

ONE: Depression in poor countries is often due to disease: Malnutrition, vitamin deficiency, chronic malaria, chronic back pain or arthritis, etc.
TWO: Often biochemical aspects of depression result in somatization, i.e. body pain. When we worked with Cambodian refugees and boat people, few were "depressed"...but many had medical complaints that improved with anti depressant medications...
Three: Much of the existentialist angst we seen in the USA is not found in poorer countries. They don't have time to worry. This is one reason I dropped out of psychiatry residency: Too many patients depressed and crying about problems I thought were minor...
Four: Suicides do happen in poor countries-- but often due to outside circumstances, such as farmers in India or women in China. In India, death leads to a possibly better next life. In China, women often have no other ways to protest a bad marriage.
But those with religion often find meaning in suffering, (e.g. Buddists of Cambodia or Filippino Catholics) and do not kill themselves...and of
course Christianity and Islam frown on suicide...

Posted by: Nancy Reyes on 18 May 05

We should first try to give a definition of what we mean by "health", before even trying to find ways how to get rid of so-called mental illness.

For psychodynamic theories, being sick means being in good shape!!! In fact, try to think the other way round, when you're overwhelmed by physical strains, emotions, family shit or work slavery, the best way to respond to it is by getting sick, wherever you are. At least you're showing some limits, you're alive, you're saying it's too much! If you keep being stuffed by outside shit, you end up compensating one way or another. Get high, drink scotch, eat junk food, meditate, fight, play video games, get sick for a while, watch TV... Whatever, do what what you feel, it's the best medication ever! Avoid brave new world by any means!

Don't judge anyone, don't even think people are poor because they're depressed. "You're poor, because you're sick", is it what they mean? Another way to say that poverty is an individual issue, related to everyone's own actions, independently from the socioeconomical, family and genetic context. They seem to say that if you're poor, it's your fault! Bullshit, poverty is a complex phenomenon. It can mainly be explained through political economics, not only neuropsychology or cognitve theories!!! We should first try to ask ourselves the reasons why people get sick... What about you? Do you get sick for no reason? Why so many people get cancers in so-called developed countries?

Shall we start digging out the consequences of our societal hectic pace and sick environment?

Posted by: Yves Grassioulet on 18 May 05

For people who want their depression treated, or who are clear and present dangers to themselves, better treatments for depression are obviously great.

I've never been clinically diagnosed, by I get depressed, and I think I know the full spectrum. Sometimes it's been a fruitful manure for inspiration to grow in. Sometimes it's just a quagmire holding me back. I sometimes have trouble telling them apart, but I'm learning.

I think most of the critiques of Alex's perspective can be understood from his last paragraph:

In a world of people released from the dragging effects of needless and seriously counter-productive mental and physical illnesses, what might we be able to accomplish?

This I concur with. The phrase "needless and seriously counter-productive" is the essential caveat. It admits that there's no monolithic thing called "depression" or "mental illness" that just needs to be wiped out, much as toxicity in nature is a relative term. In the right doses, toxins do good.

What, in short, would a world without depression look like?

And there you'd lost me. This implicitly equates "depression" with the aforementioned "needless and seriously counter-productive mental ... illnesses". All nuance is lost, and the debate degenerates into Van Gogh vs. my dead brother.

And some people have made an even more crucial point of connecting the issue to society. We aren't islands (surely an underlying principle of WorldChanging?). The big danger with focussing on treating individuals' depression is that the root causes are largely ignored. I think some mental illness can be narrowed down to individual physiology, but I think this is dwarfed by the illnesses absorbed from the dysfunctional social web we're embedded in.

Alex, it's a shame it took a few comments to lead you from your post's "many poor people aren't depressed because they're poor, they're poor because they suffer from chronic depression", to admitting that "there's chicken and egg here". The chicken/egg is society/individual, and we really have to tackle that dynamic. Neurochemical tech may be a valuable tool in doing this, but I think people are totally justified in shuddering when it's foregrounded like this.

Posted by: Gyrus on 18 May 05

The depth of this exchange really cheered me up! What a thoughtful bunch of people - I'm feeling blessed to know ye.

Posted by: EAM on 18 May 05

We are all familiar of cases in which middle income families ended up becoming poor through illness. In these cases depression CAN cause poverty.

But the type of poverty under discussion--the poverty that exists in many spaces in rural and urban America, the poverty that exists in many spaces in the rest of the world--is EXACERBATED, but not CAUSED by poverty. There are significant structural deficits that cause poverty to be almost literally handed down over time. So the depression-->poverty argument only fits a tiny handful of the cases we would presumably be discussing if we were to study the relationship in earnest.

It's extremely important we get the causal flows right. You treat depression in the neighborhood I grew up in outside of Detroit, and you ease suffering a great deal. But in as much as these people are unable to get jobs anywhere other than McDonalds, their poverty is definitely not the cause of illness. More like their poverty makes them more depressed.

Posted by: Lester Spence on 18 May 05

don't apologise, I am sympathetic to your view, and my comment was a little flip.

However, you and a few others writing here are still conflating clinical depression, which is rooted in individual neurochemistry (and can be aggravated, but not caused by purely social phenomenon, like poverty) and human suffering, which is rooted in being alive.

Depression is not 'the difficulties of being human.' It is from an acute appreciation of those difficulties that great artists and thinkers derive their greatness.

Posted by: justus on 18 May 05

"Depression is not 'the difficulties of being human.' It is from an acute appreciation of those difficulties that great artists and thinkers derive their greatness."

But that 'acute appreciation' is probalby what perciptates the chemical cascade evident in the nuerochemistry of many depressives. I come from a long line of sensitive acute depressives myself - and did try the SSRIs - but felt completely flattened. I'll reserve it for emergencies - but I get pressure to be on it all the time -- a life in that flat space would drive me to suicide quicker than anything I can think of. I benefited GREATLY however from yoga and NLP techniques, meditation, exercise and diet - and found great benefit also - lasting benefit from time spent with an adept therapist. Thoughts drive neurochemistry as much as the reverse is true. But good therapy is not a profit center for big pharma or HMOs now is it?

Posted by: EAM on 18 May 05

Asking whether depression causes poverty, or whether poverty causes depression, is like asking what event begins the water cycle. It's a *cycle*. Meaningful help includes treating illness, including mental illness. It also means every other practical measure to help people lead more wholesome lives - such as the cheap, simple water filter featured in another recent post here.

No doubt improving diagnosis is as important as improving treatment. It seems essential that those making the diagnosis be from, or at least very familiar with, the cultural milieu of those to be evaluated. Merely drugging people, to numb them, is like putting air freshener in an outhouse. But Alex isn't talking about that - he's talking about the hope that medical advances could help many, many people overcome mental illness. The SEVA Foundation works to treat preventable blindness in poor countries. This seems like the same idea, and it's hard to see how that's a bad thing.

Posted by: David Foley on 18 May 05

Depressingly, I can't see any support for the suggestion that we're nearing a world without depression. Alex you seem to have skewed Peter Kramer's stance when you say "we may be nearing a point where we can routinely successfully treat depression" (followed by "we may be on the brink of banishing depression").

Kramer appears more focused on the question of whether, assuming we could, people really do want to completely banish (serious) depression. In fact, Kramer says "in reality, the possibility of eradicating depression is not at hand" in

This article is interesting reading, extracts:

Does that mean that we want to eradicate it as we have eradicated smallpox, so that no human being need ever suffer depression again? I made it clear that mere sadness was not at issue. Take major depression, however you define it. Are you content to be rid of that condition?

Always, the response was hedged: aren't we meant to be depressed? Are we talking about changing human nature?
But the benefits of major depression, taken as a single disease, have been hard to demonstrate. If anything, traits eroded by depression -- like energy and mental flexibility -- show up in contemporary studies of creativity.
To be depressed is to occupy the role of rebel and social critic. Depression, in our culture, is what tuberculosis was 100 years ago: illness that signifies refinement.

Posted by: Janelle on 18 May 05

Janelle - really interesting comments --e xcept that I don't 'choose ' my condition to signify anything.

"Take major depression, however you define it. Are you content to be rid of that condition?"

Well the danger is in how you define it. It's a spectrum disease -- as Rilke said " I'm afraid that if my devil's leave me my angels will take flight as well."

I don't romanticise the worst bouts of -yes- clinical depression I've had -- but they are inseprable from the full spectrum of my emotional range.

Again - elmininate the unjust circumstances that surround the question - and come back. A well fed, upper middle class person and a poor person who is starving in sub saharan Africa are suffering for very different reasons. I don't need food, and I'm not at all convinced I need drugs. I would be much less depressed however if I had hope for a just world... If I were that person in Africa not watching my children die of starvation would go a long way towards picking up my spirits -- Don't we have to choose between priorities?... Doesn't food and justice come before a HUGE boon for big pharma - that is NO guarantee of the 'problem' being solved? There ARE proven strategies to eliminate poverty and the suffering it entails -- however it does involve a shift in priorities and more importantly wealth. Housing, food, family planning, education, infrastructure, protection from environmental degratdation, tools for subsistence, healthcare (or are you proposing we divert attention from malaria, cholera and TB TO depression?) .....these are the elements that poor people need.

Posted by: EAM on 18 May 05

What alarms me about this is how First Worldly is this solution. Buy this suite of medicines from our companies and you will be well. It seems to me another chance to create dependencies in more impoverished people to the Big Money companies of the US and other First World countries.

Banning DDT was thought to be the panacea; it has led to huge increases in malaria deaths. Unleashing the atom was thought to be an ideal step forward. How can we maintain the hubris that a pill can fix the broken minds of 400M people. The side effects, the unintended consequences will be huge.

Nothing here to be sanguine about at all.


Posted by: Mark on 18 May 05

Not sure I made it clear enought that the 4 bottom para's in my post above were directly copied quotes from Kramer's article.

Its an interesting window into society that Kramer found people in treatment for persistent depression that hadn't responded to other treatment attempts, who actually expressed reservations about completely ridding of their depression (I wonder if that was an inseparable product of the fact that when asked, they all knew there actually was no perfect cure therefore they were suspicious of what a hypothetical successful cure would actually entail).

EAM you raise some points that I nearly made myself: ie I gathered Kramer's research & hence his comments apply only to the first world so shouldn't be extrapolated further. Depression within developed countries is a different kettle of fish to people in LDC's suffering from poverty and lack of opportunities to improve the quality of their lives (although within rich countries there can also be people stuck in dire situations, plus people suffering from lack of meaning in the face of worldwide problems). Doing all that we can to improve physical conditions, health, education & equality of opportunities for the poorest people should definitely be priority above all.

Posted by: Janelle on 18 May 05

I wouldn't be surprised if depression were linked partly to...


I bet you that someone will sell some pills to the third world for that too. That is, if Monsanto doesn't get there first...

Posted by: Taran on 19 May 05

Sounds like we just need to start pumping out Soma to everyone -

Posted by: Chris Bunk on 19 May 05

Again, nothing in my post suggests that societal factors aren't an issue in mental illnesses -- I'm making a different point, which is that mental illness is a factor in many societal problems.

Therefore, if we improve mental health care availability, societal problems will be alieviated.

That's the point here, folks.

It's also neither rocket science nor cloaked totalitarianism.

I think the obsession in these comments with idea that mental health care is a plot on the part of corporations reflects the obsessions of the commenters far more than either reality or the focus of the post.

So please, enough with the soma references. They weren't clever the first time, much less the tenth.

Posted by: alex Steffen on 19 May 05

Alex, it's entirely possible that some of the comments here are diverging from the intended pitch of your post. But it's surely a strength of this site that posts open the way for more general, searching discussions.

And, although Huxley/soma references have a danger of becoming stock responses, I'm heartened that within such an implicitly tech-friendly bunch of people, there is still stalwart, critical and direct suspicion about the intersection of potentially beneficial technology and the unaccountable machinations of big business.

The exploitative motives of profit-seeking are, I feel, probably a bigger enemy to the potential benefits of technology than any knee-jerk Luddism. As long as we're clear of your own views, I say let the cynicism about corporations bloom.

Posted by: Gyrus on 20 May 05

I'm am sorry Alex you misunderstand me. I am not against 'mental health care' - I am against solutions that are not nessesarily solutions. Mental health care entails a great deal more than a pill though.

I also take exception to your implication that being suspicioius of big pharma implies any sort of 'obsession' - that's adhominum at its worst my friend. I am suspicious of big pharma because I know a bit about it. Just one small example in order to keep popular medications at a premium after a patent runs out pharmaceutical companies will slightly adjust the mix of the drug - not in any way that effects it's medical effect, but so that they can re-brand it and keep it at a premium. That medications are branded and marketed just like any other commodity should give one pause.

"Therefore, if we improve mental health care availability, societal problems will be alieviated."

Here we almost agree, though two things instead of alieviated I would say ameleorated (if i could spell it!) and I would ask you to define 'mental health care' as what it is - and that is way beyond giving people pills.

Posted by: EAM on 20 May 05

Hi everybody. It is somewhat reassuring to see the topic being treated here in some considerable depth, yet I cannot rid myself of the impression that it is still a very theoretical discussion.
I am far from critisizing folks for the different appearance their disease might take, but most of the posts from people with diagnosed depression sound to me like this is a more episodical version of the disease.
Yet, there is no 'true' depression any more than there is a 'true' concept of life and the world. But I can speak from my own personal experience, and I still cannot say I am completely out of it, that chronical depression is a very long and tedious journey out of the darkness that has taken me more than 2 years so far, and who knows how long it has taken me to nourish the condition on the other hand. Yet I rejected from the beginning treating the whole thing medically, since you would get rid of the symptoms, but not the reasons for the disease.
Sometimes it is really hard and the emptiness and desperation that I felt and that some times still lingers around, is nothing inspiring or even mildly artistic.
Before the onset of the severe depression I have always considered myself to be a mildly melancholic person and also would have called myself realistic and pragmatic, but simply not being able to get up the energy to get out of the house for hours on end although you feel that you want to, or other things that you would like to do but at the same time try to avoid, has not much to do with creativity.
I wrote and played music, prose and poetry, computer programs and started filming, all of which helped me through weaker episodes of melancholy and, since a lot of those activities was actually in a certain dialecticism towards and with the condition, where one was the way out of the other but couldn't have existed without the other at the same time, I sort of started to think of it as a means of inspiration. Not any more. Two years of staring down a black abbyss has done wonders to cure me from that (mis)concept(ion).

What I like to think of as being instrumental in getting me to crawl back out of that black pit is a certain tendency towards self-analysis, trying to pick the elements that could have caused aspects of the condition to develop. This is a puzzle, most of the parts that, maybe after a year or so are almost frighteningly obvious, are completely obscured at first; blind alleys opened up almost every time once I thought I had made some kind of progress. The frustration about this was almost as difficult to overcome as the condition itself.
A second element that has allowed me somewhat to bundle and concentrate my efforts, although I still cannot clearly say where and whether it has helped me, was, as mentioned by others before, meditation, for me in the form of Vipassana and, although considered to be somewhat the younger brother of Vipassana, Anapanna meditation.
I have no religious leanings at all and was very positively surprised that, although most of the teachers of this technique seem to be buddhists, there was no indoctrination during the retreats, or at last none that were made a part of the technique itself.

Yet, as I have mentioned, I am still considering myself not to be completely out of it, although the hopelessness, the restlessness without direction, the fear without object and constant thoughts of suicide are mostly gone or can be turned into something more fruitful when they pop up. I reckon this will be with me for as long as I live, but I think I have also managed to learn a lot about myself and the workings of the mind in general (I am also a neurobiologist) through this condition.
But if anything (I feel like I have babbled a lot...), what I would like to point out is, that there might be no clear and complete solutions to this problem and appearances are very individual. And, since you need shadow to have light and health is only the obvious absence of the debilitating effects of a disease (whatever can be conceived as 'absence' or what state it is you are being debilitated from), it is hard to differentiate what is just dialectic and what is truly harmful.

I am still learning, so I have no solutions, maybe a couple of suggestions or ideas if I manage to catch them. But that in a part is why I make music or write or think!

Posted by: yogibimbi on 20 May 05

My problem isn't with big pharma coming in to save the day. It's with the central argument that you note--deal with mental health illness and you deal with social problems, POVERTY specifically. The research isn't convincing, the theory simply isn't logical. Poverty is transmitted across generations. If your parents are poor, most likely YOU will be poor. In as much as children are born poor, but are NOT born depressed, it makes MUCH more sense to argue that dealing with the causes of poverty heals depression than the other way around. Of course this is not to say that dealing with depression amongst all populations isn't beneficial. I would much rather be poor and NOT suffer from chronic depression, than be poor and suffer from it.

Posted by: Lester Spence on 21 May 05

Good point -we're not born racist either - conditions in the world we arrive in often make that outcome hard to avoid. That may seem like a strange tangent -- but it's not at all.

Posted by: EAM on 23 May 05

well i was born in a relatively wealthy family, sent to expensive boarding schools, primed to join the upper middle chattering classes.
due to little -to-zero parental affection and a very dysfunctional family i was kicked out of all the schools, faced my first psychiatrist at 13, ran away at 14, was sent to juvenile hall, dropped out, slept in squats, attempted suicide twice, then hitched around n. africa 6 months, india another 6, meandered over to america in search of the whole earth catalog and good blues, arrived in hawaii, spent 16 years navel-gazing, learning guitar and surfing until i relearned how to let go of time, studied massage and natural healing, yoga and meditation, had three kids penniless, wandered back to europe, inherited some money, restored a cottage, reclaimed a farm, bought a donkey and some musical instruments, taught myself digital recording, and am happier than i ever thought i could have become.

i still have lunatic mood swings, and sometimes brood at the edge of an anger so deep and terrifying i have to be alone in case it erupts with a friend too close by.

personally i feel social justice is the key to lifting a cloud of potential depression off the whole of humanity.

we all have personal karma (personal destiny), and we all have collective karma (family and cultural baggage). they are two halves of the whole, and each one leverages the other.

i am personally quite solar and optimistic, but my threshold to flip into dr. hyde is fragile, and i can only work towards social justice from the standpoint of relatively serene equanimity that my disciplines and practices allow me to enjoy.

my first reaction to getting out of the 'first' world at 18 was surprise at how many people smiled and were nice to each other.

it blew my mind to think that you didn't always have to 'earn' affection, and that serenity had been flushed from our lexicon of social ideals with modernity, and with it much of our humanity.

our supermarkets had military rows of tasteless vegetables and fruit, an odour of disinfectant, and had automatic doors.

their markets were full of colours, scents, fresh produce and the earthy warm redolence of humanity.

after the consumerist nightmare of america, and the awareness of exploitation and injustice in asia, s. america, and africa, europe seems a tenuous middle ground, so far from perfect, but lacking the crude, painful exaggeratedness of everywhere else.

a fortress-bubble sadly yes, but one with relative moderation as one of its pragmatic qualites, as well as some historical, temporal and geographical luck.

i know only one person who choses to take meds for depression.
they make her artificial, shrill and bubbly; i don't think she realises.

it's probably better on the inside than chronic melancholia, for what it's worth...

i can't imagine the red cross wandering around the detritus of the tsunami offering 'happy' pills, serotonin uptake inhibitors and the like...

the tsunami was evidently tragic, and caught the headlines; the everyday banality of 20-30,000 children dying of preventable diseases daily is harder to catch in a soundbite or image. the depression of any sentient, thinking human is rational in the wake of tragedy, what's harder to understand, let alone medicate, is the spiritual anomie of growing up in a predatory, moronically obtuse, masochistic first-world society, rich in tools, resources and ideas, but crippled by greed and concupiscence and controlled by insatiable hungry-ghost megalomaniacs, who delight in inflicting their brutally ignorant agendas on those of us who would like to live in uncomplicated peace with our neighbours without some mongol horde come over the hill and rape our women, enslave our children, militarise our young men, rip out our trees, salt our fields, burn our barns and give us just fox news as our orwellian tunnel reality...

my girlfriend is a medical student, and she says the side effects of these mood elevators are not pretty, long-term liver damage for one.

perhaps they are the modern equivalent of alcohol, i can't say.

a hit of brandy would be a correct therapy for cold or shock, yet opening a liquor store in a disaster zone would seem in doubtful taste...

quite fraught with conflict, this issue!

great thread, thanks to all for listening and contributing.

Posted by: Michael Dunkley on 24 May 05



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