Love and Mercy

There may not be a word used as frequently in our day that’s so lacking in a precise definition as the word Depression. Literally, to depress is to press down, which we still recognize when a doctor uses a tongue depresser to see the back of our throat. But since the latter part of the 19th century the word has been used to describe a state of our psyche, and more recently, the word itself has perhaps become victim to its own original sense by having its meaning “pressed down.” Rather than clarifying – repeated use of the word depression has given the idea a quality of vagueness. Perhaps it is the vagueness that allows the psychiatric community to take liberties in the diagnostics and treatment of what we now call depression.

But it seems to me that when we are depressed we cannot quite say what it is we are. Are we sad, tired, weary, hopeless, lonely, or have we lost our sense of meaning and purpose, becoming disillusioned? Maybe we don’t feel much of anything at all and so, we’re just not ourselves. But is every uncomfortable psychic state experienced an illness in need of a cure? In America it seems so.

So, you may ask, what’s wrong with that, isn’t there science aplenty to prove that our moods are just a by-product of brain functioning? And in taking drugs to regulate that functioning – if we do in fact feel better we must have had a chemical imbalance right? …and therefore an illness? Well not if double blind tests show that every method used to treat depression, including a placebo, show at best a 50% rate of alleviating symptoms in the short term (4-6 weeks).  But there’s lots of commercial interest in manufacturing depression as an illness when your business is selling cures.

The DSM-IV clinical definition does not attempt to explain how or why one would come to be depressed and doesn’t care. Their definitions of pathology attempt to convince us that we have a disease, something gone wrong in the physical state of our brain and body. Like most organizations with a vested commercial interest, there is a reason for the APA’s framing of conditions. They have a deep, long standing relationship with organizations that are benefitting from marketing depression. It’s not so much that depression or its symptoms do not exist, but that we don’t have definitive answers as to how our mental states relate to things like diet, habit, or other environmental influences.

There has never been a time when we humans did not seek to alter our moods through some form of substance or chemicals. But until recently there has never been an organized attempt to define a symptom as a disease. We do so now because the pharmaceutical companies have spent the last 60 years investing time and resources to develop their chemical cures that they can sell. Our ability to trust and believe in medication should be questioned, especially when the cure is occasionally much worse than the so-called disease. With revolving door relationships between the FDA and the drug manufacturers, the definition of illness and the drugs marketed to cure them have gained legitimacy and acceptance in the culture and that should be suspect.

According to the experts, for one to be diagnosed with a Major Depression:

“Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning. Some of the symptoms: (1) depressed mood or (2) loss of interest or pleasure. (3) Feelings of worthlessness (4) Poor concentration (5) Thoughts of death.” These might as well be symptoms of stress or chronic pain or illness, but in this case they are symptoms of a so-called illness. With criteria as unscientific and commonplace as this, diagnosing a depression and prescribing drugs for a cure have led to an epidemic in mental illness in the United States. Again, 2 weeks constitutes chronic?

How about Major Happiness? If it’s true that lowered serotonin levels cause depressed states wouldn’t it also be true that heightened levels cause too much happiness? Of course you’ve never heard of this because the idea that serotonin levels are responsible for depression are speculative. And besides, who would want to cure themselves of happiness – even if it were a disease?

In many cases the psychotropic drugs prescribed for mood disorders do help people, by their own assessment. Who can argue with that and who would want to deny anyone their right to be medicated? But who decides what is best for us in a culture that relies on expertise with commercial interests judging the value and safety of both the definition of illness and the drugs used to treat them?

This is where we fail the most in a culture that is increasingly experiencing the breakdown in the quality of our relationships. No wonder we’re depressed. We should be, if not for the current state of the culture and the world at large, then at least for the mysterious, vulnerable predicament that humans have found themselves in since the dawn of existence that we moderns seem sometimes to have forgotten.

Depression, as a descriptive, is only useful for those interested in defining a marketable illness, and those willing to embrace an identity of themselves as pathologically in need of a label to understand themselves. If you take the word away, what other language would you use to define what is going on?  What do we mean when we say we are depressed?

I, for one, have always struggled with words and concepts used to define me because not only is it not helpful, but definitions attempt to keep us from the natural motion of living and because all attempts at embracing an identity tempt us into believing we are static beings, when we are clearly not. Life is hard, we often live in conflict shifting between competing ideas, we struggle daily to meet our basic needs, to give and receive love, and to make peace with ourselves and others. And in our modern world, where the level of comfort has reached unprecedented standards, we have heightened our expectations for perpetual happiness against a background of an often unacknowledged increased vulnerability. We have so much more to lose as much has been given.

For myself, having lived with a life long struggle with life itself, I had to examine my need for an over reaching sense of satisfaction and remember daily to forgive, both myself and others for failing to be all I envision us to be. Being human means being separate, limited, vulnerable, and making our way in a finite existence that includes sickness, pain and death. That is life’s premise, and although challenging, the greatest task may be to simply make our peace with that and do the best we can to be who we are and listen for what is calling us.

The one great thing about being an individual is the freedom we each have to define for ourselves a purpose and meaning that touches us (and hopefully others) enough to sustain us in the day to day. Never sell yourself short on what calls to you. Instead of pursuing happiness, perhaps we should embrace what, where and who we are now.

Some thoughts from James Hillman on depression:

“Today this depression has lost the confines it had in earlier psychiatry. It’s in youth, children, and the term is used very broadly. But it is so important to get back to what experience that person (depression sufferer) is in.”
“In practice, for people to say I am depressed is insufficient, it won’t do. I want to know what, where, how, what are the physical correlates, what do you eat, what happens when you are in that chair and when you get up out of the chair. I want to know an enormous amount about your body.”

Thanks Brian, Love and mercy to you and your friends tonight.