Forgive him father, for he knows not what he does

by thedirtyho

In Brave New World, Aldous Huxley portrays a chillingly dystopian vision of a future in which control of the masses is exercised, not in some totalitarian fashion as per George Orwell’s 1984 or Yevgeny Zamayatin’s We, but in the insidious application of psychoactive drugs. People are kept in a Somatose state and conditioned to view unhappiness and malcontent moods as a form of social deviancy that must be eradicated, not through brutality and coercion, but rather through ostracising those unwilling to conform to apathetic acceptance.

In both his recent article and appearance on The Moral Maze, Giles Fraser seems to identify our descent into this dystopian hell, citing the “fascism of the smiley face” associated with the ‘happiness industry’. He rails against the medicalisation of human emotions that are understandable and rational responses to life events, highlighting the need to embrace unhappiness as part of the human condition, without which life would be colourless and dull. Our rush to treat every drop in mood as a medical condition denies us the right to feel sad, or give voice to the pain inside when coping with the cruel circumstances life brings. In the picture he paints, those feeling sad and unhappy are outcasts until willing to succumb to the chemical control mechanism promoted by Big Pharma.

Taken at face value, there is a lot of validity in what he says, and though there has been much reaction to the piece, little of the vitriol is directed at this basic principle. Any sensible person would agree that prescribing strong psychoactive medicine to somebody not in need is a hugely irresponsible and dangerous thing to do, and whilst I have little evidence to support arguments either for or against the notion that we are over-medicating people that are not in need, in principle the possibility (maybe even the likelihood) that it is happening is one that nobody can deny.

However, this is not the issue at stake. The article and radio appearance, however well-intentioned, appeared to illustrate an underlying misconception of what depression truly is, despite several protestations of innocence. The reoccurring theme has been that society demands that we are happy and that everyone is continually bombarded with unrealistic expectations of a picture-perfect life, which if we are not fortunate enough to possess we must replicate through rampant pill-popping. The right to unhappiness is being driven underground by an aspirational culture that believes everyone should be happy, smiling and compliant; just as celebrities on magazine covers have their bodies airbrushed to perfection, our minds are to be touched up and artificially fixed. Just as women are told they should break free from patriarchal and oppressive representations of flawless skin and fatless figures, in his mind Giles believes that people who are sad should throw off the shackles of societal expectation and celebrate the full spectrum of human feeling. Van Gogh, Beethoven and Keats embraced their emotions to bring us insight into what it is to be human. Without the opportunity to feel sad, we cannot appreciate what it means to be happy. Without darkness, there can be no light.

Whilst Giles and his defenders are keen to point out that there is no one sentence in which he equates unhappiness with depression, perhaps for some the more salient point is that he singularly fails to draw a distinction between them also. At no point is there a disclaimer to say sadness and depression are discrete entities, and in both the article and Moral Maze discussion he gives no indication of recognising any difference between them. For those accusing the offended masses of falsely ascribing errant interpretations and reading between the lines, the obvious suggestion is to turn Giles’s challenge on its head and ask them to show where he distinguishes between unhappiness as a natural reaction to life events and depression which can be entirely unrelated to circumstance.

The more that this is pointed out, the more entrenched his position becomes. His timeline is littered with links to pieces about the danger of anti-depressants or in praise and defence of what he has said. However, just as those taking umbrage are accused of missing the point, it appears he and his acolytes are spectacularly guilty of the same. Nobody has denied the inherent dangers associated with these drugs. Indeed all drugs, no matter how innocuous, come with warnings of all manner of side-effects and contra-indications. Powerful psychoactive drugs capable of altering the brain’s biochemistry are something that no-one would take lightly, indeed for many the act of taking them is one of desperation. But at the risk of penning the title for Lance Armstrong’s new book – It’s Not About The Drugs.

Undoubtedly this is where Giles’s focus lies, and in truth he raises important points that are worthy of discussion – but not at the detriment of the other discussion taking place, which he seems determined to dismiss out of hand. The idea that we are too quick to rush into the arms of pharmaceutical solutions and the idea that there are myriad misconceptions about depression are not antagonistic, they are not mutually exclusive, and we do ourselves a disservice to treat them as such.

Many feel that Giles inadvertently revealed a common lack of comprehension regarding depression and that this warrants more than pithy justifications, but as yet these are far from forthcoming. His retort “Twitter at its worst is the hermeneutics of the mob. Interpretation becomes copying via RT. Mimesis and bullying. All very Girardian” has a mildly petulant tone, and brings to mind Jeremiah 9:23 “Let not the wise man glory in his wisdom.”

An unwillingness to engage with those he has offended, coupled with a determination to lay the blame at their feet for (as he sees it) falsely interpreting him, has hints of that deadly sin, Pride. To characterise those he purports to be defending as bullies engaging in a mob mentality verges on hypocrisy, having previously portrayed anti-depressants as a way of denying the disaffected a voice which he himself is now unwilling to hear.

There is however, some good that can come from this, a light at the end of the tunnel. The ongoing outcry is detracting from the message that Giles intended to convey, and causing growing concern amongst those who feel marginalised and misrepresented. There are no gains to be had from perpetuating the impasse, which interferes with both sides’ story. The solution is relatively simple – the discussion can be re-purposed to include each aspect, in which we are free to explore the dangers of drugs being too easily distributed as well as examining how and why society has come to view depression as something it’s not.

One explanation could be the advent of the 3rd incarnation of the Diagnostic and Statistical Manual of Mental Disorders (DSM III), published in 1980, that influenced the WHO’s ICD-10 classification of mental disorders, in which the differences between reactive and endogenous depression were set aside. Rather than taking a holistic view that included psychosocial aspects of depression, it was now to be defined purely by symptoms, and there was a widespread shift from classifying conditions as depression rather than anxiety. Now in the UK when depression is diagnosed, the severity is assessed by means of the Patient Health Questionnaire, a self-administered tick-box exercise that formed part of the PRIME-MD diagnostic tool developed in the 90s. Following on from the ICD-10 reclassificarion came the rise in prescribing anti-depressants (though this may well be a case of correlation rather than causation, as this was around the same time SSRIs became widely available), which is analysed in detail by many in the medical profession, conveniently collated and summarised in this paper by AnneMarie Cunningham. This paper neatly illustrates the possibility of taking a nuanced view of the situation that incorporates both sides of the discussion, and it highlights the potentially dangerous impact of restricting how we see depression as simply symptoms to be treated. For ultimately, is it not better to attempt to address the root cause, rather than – as Giles rightly says – reverse engineer a solution?

For here, maybe, lies the crux of the matter. For some people the drugs do work. For some they don’t. There is no one-size-fits-all solution, and pills certainly do not represent some form of cure-all panacea. Equally, for some that may be in the depths of depression, talking therapies might be overwhelmingly intimidating when even the most simple conversational interactions are out of their reach. However, Giles does not seem to recognise or offer any solution beyond accepting these feelings and make-do-and-mend. He is not proposing that for those suffering from depression there are alternatives, he is suggesting that these are simply natural emotions and that suffering is, and always will be, a part of the human condition. An attempt to tackle this is to deny what we are, it is reflective of the narrow and superficial expectations society imposes upon us to be ‘compulsorily happy’.

It is these proclamations that have caused such response and reaction. The widespread inference has been that those seeking help are capitulating to society’s demands and that instead they should be celebrating the gift of life in all its diverse glory. There is no recognition that for people suffering from depression, life is the sort of gift they’d rather return, but are expected to accept it with the grace and gratitude befitting something wonderful. Many religions view those opting for suicide as sinners who will be condemned to hell – but they do not realise that to reach that point, those suffering are already there.

There is an easy solution to this awkward situation – repentance. Whether the original intention was to convey this message or not, nevertheless this has been many peoples’ reading of it, so rather than blame them for their lack of understanding, accept responsibility for an inability to clearly communicate the real message. It would be the easiest thing in the world to say something along the lines of:

“I’m sorry if people interpreted it that way, for that was not my intention. For some people depression is a debilitating disease that consumes their entire essence, leaving them unable to function on even a basic level, which can be completely unrelated to what is happening in their lives. In these instances, nobody should be made to suffer such enduring agony, and it is only right that we explore every avenue when trying to address these problems. I accept that for each person there is an individual solution, but the point I was trying to make is that we increasingly run the risk of seeing drugs as the be-all-and-end-all. I would have thought more carefully about what I was saying if I thought that people felt I was belittling their condition or trying to diminish their experience and for that I can only apologise. Sometimes serendipity can present us with opportunities to grow and learn; for me this episode has highlighted how easy it is to misconstrue and misrepresent what people say and feel, and I am hopeful that we can move the discussion forward to include all points of view”

It really would be that easy Giles. A brief statement acknowledging why people are upset and accepting some culpability for causing such widespread offence. Admission of error is not a humiliation, it is humility. This is an imploration to – even if you do not believe you are at fault – turn the other cheek. For whilst you are absolutely right to make the point that drugs cannot, and never will be, the sole answer – it is crucially important to recognise that for many, the notion that people even remotely understand what they’re going through is often the first step on the road to redemption.