'An aphorism, properly stamped and molded, has not been "deciphered" when it has simply been read; rather one has then to begin its interpretation, for which is required an art of interpretation.' -- Nietzsche, 'On the Genealogy of Morals'
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'An aphorism, properly stamped and molded, has not been "deciphered" when it has simply been read; rather one has then to begin its interpretation, for which is required an art of interpretation.' -- Nietzsche, 'On the Genealogy of Morals'
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The Worried Well#2
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November 8, 2005
Depression and mental illness have become a big public health problem. In this article in The Guardian, which was reprinted from London Review of Books in 2002, Mikkel Borch-Jacobsen says that:
Fortunately, however, we're told on all sides that depression is no longer a fate. Antidepressant drugs have been around since the mid-1950s, and the new generation - the selective serotonin re-uptake inhibitors (or SSRIs) - work wonders. Under the influence of Prozac, Zoloft or Paxil, people for whom existence had been an unbearable burden suddenly find renewed pleasure in life, without having to suffer the unpleasant side-effects of the older generation of antidepressants, the tricyclics and the MAOIs (monoamine oxidase inhibitors). Admittedly, SSRIs sometimes lead to diminished libido and even, among men, to impotence, but that is surely a small price to pay for a restored capacity for happiness. 20 million people worldwide are now thought to be taking Prozac, and we are hearing reports of a new era of 'cosmetic psychopharmacology', in which drugs will be used to treat not only clinical depression, but daily mood swings and existential angst. So farewell Kierkegaard and Heidegger.
Mikkel Borch-Jacobsen says that there is a problem with this therapeutic optimism. If it is indeed true that antidepressants cure depression, how is it that the illness is spreading ever more widely? The incongruous fact is that depression was never so prevalent as it has been since the introduction of antidepressants. It has always been with us, though it went by other names and sometimes assumed different shapes, depending on the era. MIkkel says:
If more and more people are depressed, might it not be because we live in a society that is more and more depressing? Left-leaning commentators often argue that the pharmaceutical industry has over-medicalised a real social misery, created by the stress of modern life, the loss of identity markers, the isolation of the individual, unemployment and so on.... The problem with this sociological explanation is that it explains nothing. Even supposing that society is more inhuman than in the past, when socialised medicine and unemployment benefits didn't yet exist, why would this give rise to depression rather than anxiety, fatigue, 'nervous breakdown' or just plain anger?
And yet it has to do with the subjectivity of individualism in a competitive market society.
I have just come across this text. I'm not sure that I agree with the proposed alternative to the drug base cure (ie. taking drugs for depression ) that Gail Bell advocates. Bell says:
For an alternative to drugs, Gail goes back to the 1600s and quotes from Robert Burton's The anatomy of melancholia. Eat well and get enough sleep, says Robert, wear clean clothes and comb your hair; seek the company of others and get out in the sunshine. Cognitive behavioural therapy is another more modern technique which teaches us to recognise negative thought patterns and to retrain our brains into a positive outlook
The 'worried well'. I'm not sure that I like the term. It sounds like a term of disdain--a way of dismissing or downplaying depression, despite the current acceptance of different kinds of depression.The distress of depressives is in every way real; but this reality is not hard-wired in their genes or neurotransmitters.
Mikkel Borch-Jacobsen says that:
Just as Freudian neuroses were the pathology of a subject defined by prohibition and internal conflict, so contemporary depression is "the reverse of the sovereign individual, of the man who believes himself to be the author of his own life". In that sense, depression is not directly provoked or caused by contemporary society. Rather, Ehrenberg suggests, it is the negative 'counterpart' to the subjectivity created and so highly valued in this society.
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It's interesting that a parallel discourse has arisen - or at least a practice, if not an entire discourse - against the antidepressive that hasn't occurred in such an obvious way with regard to say cancer. The argument could well be made that more people in the 20th century have cancer, and more and more are getting it, as quick as we develop new ays of detection and treatment - mind you, "alternative medicine" has its own rites and riots against that, but it's never been as mainstreamed, unless you count Tuesday night on the Auntie.
As one who is on medication (efexxor and lithium) and has been for almost 9 years, I come from a particular viewpoint, so assumptions exist therein. For isntance the pills have never been a cure-all, they are, most of the time, a safety net that makes up for a chemical deficiency that is most likely genetic and was exarcerbated by self medication during some very important, socially formative years. Mind you, a Sydney psych once diagnosed me as a nihilst for a Centrelink form... I was pleased to be so pathologised. BUt returning to the point, the pills have been presented to me, in 80% of medical stff I've seen, as only one part of the treattment, and equally if not more important is delaing with the malaise that exacerbates the conditions. So I say yes, much of the "epidemic" is symptomatic of "patients" operating in a system where a cure must be found for continual feelings of profound disappointment - a consumer system is only able to provide a consumerist answer, especially when the patient is using government money to pay the provider a market reduced amount.
I was lucky - five months in a private clinic was paid for my privvate health - but there are many who aren't, who get shipped in and out of public psych wards in 3 days... for some, including schizophrenics and bipolars (apologies for the essentialising of the illness), the medications may function, for some time, as a respite, but the system will continue to fail them.
Ideally a multi-pronged approach of cognitive therapy, life skills, social building activities, community/family awareness programs, not to mention addressing the thousands of underlying issues for contemporary people with problems, growing up and as adults, would go some way. Instead we have John Howard handing Jeff Kennett Beyond Blue, and Jeff telling regional meetins that we should all admite John because he exercises every day.
As to looking to the past - melancholia has a long association with morality and its corruptions, and I suspect the Protestant Work Ethic arrises from a time of great labor and economic change, of suffering and misery alike. And we ought not to forget that many of the symptoms of depression were associated with the diease of masturbation just over a century ago. Peter Lewis Allen's The Wages of Sin is eloquent on both "lovesickness" (a type of depression requiring, according to many, therapeutic intercourse for symptom relief) and the perils of self-pleasuring (best displayed here by the French - http://monicajackson.com/images/blah/danger.jpg)
I'm not advocating an embrace of the medical industrial complex - it's brutality and its commitment to shareholders is almost self-evident - but I'm wary, from experience and from a theoretical position, of ascribing a one-way power mechanism - it's complicated, as complicated as the "individuals" and the results produced, and if it helps, the makers of Efexxor XR have stopped putting in their product booklets in orders where, due to large doses, the patient gets three or four boxes per script - I think the sad dolphin and the jumping happy dolphin, at the start and end of the booklet respectively, wore thin.
(apologies for the attorcious typing - severely undercaffinated)