In his recent article Giles Fraser allows a valid underlying point to be undermined by his profound lack of understanding of depression. It would be malevolent to want him to address this lack of understanding, as it would necessitate him actually suffering from depression to really grasp the peculiarities of the disease, but it serves as an exemplary illustration of many commonly held misconceptions. Indeed, never has the adage “ignorance is bliss” been more apt.
His fundamental viewpoint that the rush to medicate sets a dangerous tone and in some cases can be counter-productive is one that I have some sympathy for, but the manner in which he has phrased his argument speaks volumes about the disconnect between an outsider’s perspective on depression and the reality for the person living with it.
Within the article he takes the view that unhappiness can be a rational response to misery-inducing situations, which is undoubtedly true – there are endless scenarios in which a melancholic mood is natural and to be expected – the loss of a loved one, the break-up of a marriage, even the nagging fear that you are not liked nor respected by your peers. However, these have no relevance to depression; it does not conform to Behaviourist notions of stimulus-response in which exogenous factors play a determinant role and, with enough time, can be put to one side and forgotten about.
Depression is an entirely different beast – one which circumvents rationality altogether and cares not for who you are nor the situation you are in. You could be famous, successful, have the perfect family or the world at your feet, and yet if your brain happens to be so inclined then all of these things are little more than minor distractions to the all-encompassing narrative of your life, which is a rather repetitive and one-dimensional story of inadequacy and self-loathing.
For this is the hallmark of depression; not feeling low, or feeling down – which as Giles points out can be perfectly rational responses – but an unrelenting self-hatred that wilfully inflicts emotional damage on a daily basis.
Imagine if you can your worst enemy – the person you hate most in the world, a person you find intolerable and insufferable, a person whose very existence is enough to make you curse humanity for giving life to this awful being. Imagine that they are allowed to follow you around 24 hours a day – and not only that, they are able to enter your thoughts directly, so that try as you might it is impossible to ignore them. Now imagine that somehow they have managed to tap into your subconscious and accessed all of your darkest fears, your most vulnerable weaknesses, your most stubborn insecurities – imagine they are able to review every humiliating event in your life, or reproduce every embarrassing incident in high definition, tap into every train of thought that involves self-doubt and magnify this beyond recognition. Imagine what it is like to be bullied inside your own head by somebody who knows exactly how to hurt you, and delights in continually doing so. There is no escape, there is no refuge, there is only the pain of being endlessly bombarded by shame, guilt and disgust – because that awful human being that you believe doesn’t deserve the gift of life, is you.
It is often said that depression is a selfish illness – which is not strictly true. It does not make you selfish – what it can do is make you self-obsessed, or possibly self-absorbed. Given the chance, many depressives can actually be wonderfully empathetic, as they can relate to the pain of others and welcome the opportunity to escape from themselves for a while. But, as sure as night follows day, it is not long before they are on their own again – and with solitude comes introspection. The author Matt Haig has made some beautifully succinct summaries of what is like to be depressed on Twitter, such as:
Depression isn’t a murder in an Agatha Christie novel. It often doesn’t have a cause or a motive any more than cancer does. It just IS.
Those who think depressives are self-absorbed, set your leg on fire and see how self-absorbed you are in the next ten minutes. Pain = self.
Which are far more eloquent than I will ever manage. It is not that depressives do not care about anybody else, far from it, but they cannot escape the overwhelming noise coming from within their heads that is constantly barracking their every move and thought. Depressives are the literal opposite of narcissists, and even though the label egocentric might be slightly more accurate – even this fails to recognise the curious dichotomy between the intensity of negative feelings towards one’s self and the lack of self-worth, whilst simultaneously placing yourself at the centre of everything and everyone.
The paranoia that often accompanies depression is little more than a projection of feelings onto others; depressives are unable to see past their own bias and so it follows logically that if they are the wretched scum they believe themselves to be, then surely everyone else must be of a similar opinion? Even when friends and family, anxious to reassure, surround a depressive with love and comfort and praise, it rings hollow in their ears and appears superficial and false; how could they possibly mean such pleasantries when the subject is so clearly undeserving? In this sense they are egocentric, because they are unable to recognise or accept the opinions of others as being any way true representations of reality. People that speak of the kindness, charm or wit you display “don’t know the real me” or are just themselves being generous and kind and have not yet woken up to the reality of what a terrible human being you truly are.
All too often the paranoia can create a self-fulfilling prophecy. Depressives can frequently be hyper-sensitive and incredibly attuned to very minor aspects of other people’s paralanguage, and given their natural inclination to believe the worst about themselves, something that could be completely unrelated – such as the person being tired, having a bad day at work, or feeling distracted because they have issues in their own life – can be misinterpreted, over-analysed and then packaged as evidence of rejection. For anyone that has spent a lot of time around a depressive, they will know that it can be hard work, it can result in constantly walking on eggshells and wondering if something innocuous you said is now being turned into a stick to beat themselves with. For many people, trying to understand or reason why is too great an obstacle, and so by projecting these feelings onto others, the depressive ultimately manages to make it all come true – eventually the people around them really are trying to get away, they do feel awkward and uncomfortable and they are making excuses not to be subjected to such intense emotional brooding.
The egocentrism of depression manifests itself in believing that everyone else hates you as much as you hate yourself, in believing that everyone else is as aware of your every utterance and has analysed it as much as you to reveal every faux pax. It is the inability to escape from a constant internal dialogue in which the narrator delights in pointing out your every flaw, or gleefully celebrating every awkward moment, every humiliating incident. In truth it is no wonder that depressives become self-conscious and self-absorbed – if you were constantly bombarded with negative commentary on everything you did then no doubt you would have a similar response.
Hopefully at this stage Giles, you are recognising that appeals to rationality are a lost cause – for let us be frank: depression is a mental illness. One that may not always present itself in such an extreme fashion as say psychosis or schizophrenia, but a mental illness nonetheless. Rationality has almost no place in a discussion about depression.
Having said that, one might argue that depression is a rational response to a stimulus, in that if you had a friend or acquaintance that was as savagely vitriolic and mean-spirited about you as you are about yourself, then hating that person would be a perfectly rational response. If this were the case, you would undoubtedly exclude that person from your life and vow never to have anything to do with them again. Sadly for all the depressives out there the bully will not be banished and until the relationship can be reconciled the torment will carry on. Self-loathing may make logical sense given a depressive’s propensity to be truly horrible to themselves, but that abstract knowledge does not make it any easier to deal with.
It is at this stage that I would like to agree with Giles, for I believe that the immediate response to this should not be to medicate. To me it smacks of an unwillingness to properly engage with the person’s needs and deal with the situation they are in. That’s not to say that drugs do not have their place – undoubtedly they do, and in many cases I’m sure that depression is the result of a chemical imbalance within the person’s brain that can be addressed through the wonders of modern medicine. However, I think that these should be prescribed after a little more consideration and an attempt to deal with the problem in a less invasive manner. For me the first course of action should always be some form of counselling, whether of the common-or-garden variety or something like cognitive behaviour therapy that tries to address negative thought patterns and encourage the depressive to break out of the cycle of self-loathing. I do not blame GPs, they do not have the time (nor possibly the expertise) to be able to diagnose and understand a person’s condition, so they do what they know best which is offer an immediate solution that might help. Frequently that immediate solution is pharmaceutical.
I personally have only had one experience with anti-depressants, and it was not a good one. At the age of eighteen, feeling helpless and lost, I went to my GP and asked them what could be done. Despite my natural aversion to resolving the situation using drugs, at the time I felt so powerless to exert any control over my emotions that I was willing to try just about anything. I was prescribed Seroxat, a drug later found to cause increased rates of suicide. Whilst it did not make me feel suicidal as such, it stripped me of all emotions and left me an apathetic husk – for instance whilst I would not have stepped in front of a bus, if I was crossing the road and a bus was coming, I probably wouldn’t have bothered to get out of the way. I realise that’s a rather confusing way of explaining it, but it was a rather confusing time. The moniker ‘happy-pills’ is not an accurate description, as (in my experience) they do not make you happy – what they do is make you numb. They are like an emotional anaesthetic that dull the pain and allow you to function at a basic level; you can make it out of bed, you can brush your teeth, you can go to work – you can pretend to be ‘normal’.
For this is one of the most prevalent misconceptions about depression; that the person is somehow just being self-indulgent and all they need to do is “pull themselves together” and get up and go. These people live a privileged existence to believe it is as easy as that, for pulling yourself together after you’ve spent a lifetime pulling yourself apart is easier said than done. If you don’t believe this, drop a cup on the floor and see how easy it is to smash, then collect all the pieces and see how long it takes to put them back together. One incident, one trigger is enough to send a depressive into a negative cycle, but in my personal experience there has never been a single incident that suddenly made me think “you know what, I feel good about myself now”. It is probably that my brain is wired to have a predilection for negativity; for instance I often have – apropos of nothing – recollection of random memories from throughout my lifetime in which I’ve said or done something embarrassing that causes deep feelings of shame. I never suddenly remember that funny thing I said that made everyone laugh, or the intelligent thing that made everyone think – I remember the awful thing I said that makes me cringe. The idea that it’s just a matter of being a bit more stoical and soldiering on merely indicates the lack of understanding. Depression not only robs you of any zest for life, it can also literally rob you of the energy you need to survive on an everyday basis. Getting out of bed, washing, eating can all become insurmountable tasks that you just aren’t capable of. I once went eight days without eating and I didn’t even notice, because depression is all-consuming and subjugates everything else in your life, it is not a foolish thing you can just put to one side and forget about; it is everything, it is relentless, it is forever.
This is one of the curious idiosyncrasies of depression, the sufferer believes that this is their fate and ever will be. Unlike other illnesses, having depression does not seem like a temporary inconvenience that makes you feel awful but you know you will recover from, it feels permanent. From the depths of despair it often seems as though there is no way out and that this is your lot till the day that you die. Of course, this is not true, there are means and ways of escaping and I agree that drugs should not be the sole recourse, but in many cases drugs do have their part to play and are the best option. Undoubtedly prescribing strong pharmaceuticals to deal with a natural reaction to life events is using a sledgehammer to crack a nut, but to dismiss depression as simply feeling sad is to miss the point entirely.
Ultimately each case must be taken on its individual merit and each person must be treated as an individual, with an appropriate course of action taken that suits their needs and condition. The rush to label negative emotions as depression does smack of quackery and runs the risk of a quasi-medical classification, but to extrapolate that to the extent that Giles has and assume that depression is – in essence – a made up condition or an exaggeration is hazardous in the extreme. Though there have been cases of drugs causing strong reactions to the extent of promoting suicide, the notion that they should be done away with altogether runs the risk of kicking the crutch from underneath countless sufferers who rely on these drugs to get them through the day. Whilst in principle it is sound to question the ubiquity of prescribing drugs as the only solution, to truly find better solutions we need to start with understanding what depression really is, and in that respect the people we should be speaking to are the experts – the sufferers – not casual commenters who cannot comprehend even the basic traits nor distinguish between feeling sad and feeling depressed.
Whilst the drugs may be viewed as a way of “shutting people up” ( a view I disagree with, as I feel their purpose is more to quieten the internal voice of doubt and self-hatred), I believe a more damaging way of silencing these people is to strip them of their voice and discredit their condition by seeing it as little more than a response to a shit job or home life. The idea that drugs are prescribed because society is unwilling to accept deviations from the norm belittles the suffering and angst of millions of people, and reveals a woeful ignorance about the debilitating effect depression has on people’s lives.