I noticed today that Depression Awareness Week is coming, according the website of the charity Depression Alliance. This year it’s going to be the week of 11th-18th April — oh — well, I suppose I’m in no position to complain that they don’t update their website very often.
Like many sources of information and self-help about mental illness, Depression Alliance have a fuzzy definition of what mental illness is, and that’s much more serious.
The banner at the top of the site proclaims:
1 in 5 people in the UK suffer from Depression..
“You’re not alone!”
That’s what Depression Alliance is all about. Their success as an organization depends on as many people as possible being classed as depressed. To catch as many people as possible in their net, they choose to define depression in terms of fifteen common symptoms:
As a general rule, if you have experienced four or more of these symptoms, for most of the day nearly every day, for over two weeks, then you should seek help.
- Tiredness and loss of energy
- Persistent sadness
- Loss of self-confidence and self-esteem
- Difficulty concentrating
[…and eleven others…]
At the top of the page there’s a bit about normal moods:
Feeling sad or fed up is a normal reaction to experiences that are upsetting, stressful or difficult; those feelings will usually pass.
This way of defining depression catches many people in the net who are not mentally ill. It looks like they have distinguished between normal low mood and illness, but they haven’t.
This is important if you are one of the people caught in the depression net, because you might not be as ill as Depression Alliance would like to think you are.
The OFF switch
Going back to first principles, depression is a mental state that stops you doing anything much. It’s an OFF switch in your mind. It has evolved to be triggered when something serious happens that you can’t control. It’s as if some inner wisdom is saying to you, “Give it a while. Don’t get involved. Wait for the dust to settle.”
Of course, it doesn’t feel like inner wisdom. It feels horrible. Another part of your mind is saying to you, “Don’t stay this way.”
But depression is a good ability to have. It’s an automatic reaction that protects you from harm in situations where you have no control. Depression can go wrong, however, and it can go wrong in several different ways. Only one of those ways is illness. This is what Depression Alliance are not telling you — only a fraction of the people caught in their depression net are actually ill.
The rest of the people caught in their net are having that automatic reaction to something, or they did have that normal reactive depression once and something has prolonged it unnaturally.
1. Dust takes time to settle
The most common story goes like this. Something bad happens in your life. You have no control over it. Your inner wisdom says, “Give it a while. Don’t get involved. Wait for the dust to settle.” You become depressed and do nothing for a while, maybe a few months. The dust settles. You move on.
That’s a normal process of adjustment to things that can happen to anyone. The death of someone important to you, surviving a car accident, being made redundant, even the birth of a child — any of these things and many more like them can cause normal reactive depression for several months.
But the Depression Alliance net will try to close on you after just two weeks. If you fall for the scam, you might be tricked into prolonging your depression for much longer than necessary, perhaps for years.
So if some major identifiable change happened in your life in the last several months, and it was beyond your control, and you are still affected by it emotionally, any symptoms of depression that you might have are probably not a sign of mental illness. They are probably a sign that your mind is working normally, protecting you while the dust settles.
It is certainly not harmful to treat specific symptoms of this kind of depression, provided the treatment is short-term. For example, if your sleep is disturbed you might take medication to help, or if you have thoughts of suicide you might talk to a counsellor. But don’t lose sight of the fact that your depression is a normal reaction that will gradually clear.
If you rush to take the usual self-help advice, however — thinking happy thoughts, exercising more, eating fresh fruit, joining a club, or suppressing your feelings with medication — you run the risk of interfering with the normal reaction you are having, and prolonging it.
2. Dust that doesn’t settle
Another common story goes like this. You find yourself in a bad situation that you have no control over. Your inner wisdom says, “Give it a while. Don’t get involved. Wait for the dust to settle.” But the dust never settles.
Now you’re stuck.
Even this is not an illness. The problem is not you. The problem is still external. After a while another switch in your mind should normally say, “Stuff this inner wisdom, I’m off out of here”, and you should be off out of there. But some situations trap you so you can’t leave.
For example, the trap might be interpersonal, a double bind where someone puts you in an impossible position by deliberately hurting you while at the same time making you feel guilt by pretending you hurt them. Or the trap might be a conflict of interest — your boss is abusive but you need to keep the job to keep your sons at Eton. There are many kinds of trap.
All the usual self-help advice is about avoiding the problem — think happy thoughts, exercise more, eat fresh fruit, join a club. If you focus on following this kind of advice, the external problem will persist and so will your depression.
Also, by telling you that you’re ill when you’re not, all the usual self-help advice reinforces your lack of control over the external situation that’s really causing the problem. Reinforcing your lack of control presses your mental OFF switch harder. You become more depressed.
In these situations, the usual self-help advice turns normal depression into a long term disability that mimics real illness. You might even start to develop serious symptoms like doing harm to yourself, feeling that you are not real, or hearing voices.
Even if you develop more symptoms, this is still not an illness. There’s still nothing wrong with your mind. If you can get out of the external situation that’s causing the problem, the symptoms will simply go away.
Most people caught in this kind of scenario can remember a time before they were depressed, perhaps many years ago. They can remember that something bad happened back then, and they can remember making a decision not to engage, almost like signing a pledge of powerlessness.
The solution is simply to tear up that pledge. Leave. Accept the external consequences of taking power back, and then the inner consequences of your powerlessness will disappear.
Another common story goes like this. You feel down and you tell your doctor. Your doctor says to try some pills. They make you worse. Your doctor says to try different pills. They make you worse too. Your doctor says to try some other pills. This goes on for a while, and finally you find some pills that seem to stabilize things. You’re not getting worse any more.
But you’re not getting better either.
Research seems to show that antidepressant medication is not as good as the drug manufacturers would like everyone to believe. Worse than that, it seems that it tends to prolong depression. It’s not yet clear exactly why this is, because most of the research is funded by drug manufacturers who don’t want to think too much about this aspect of their products. There’s a summary of some of the findings here: Antidepressants/Depression
In the 1990s and early 200s, an Italian psychiatrist, Giovanna Fava, repeatedly wrote papers on how it appeared that antidepressants increased the likelihood that a person suffering a depressive episode would become chronically ill. At least a few other prominent experts in the field agreed that psychiatry needed to investigate this problem.
Anyway, the upshot is that if you take psychiatric medication long term (more than a few months) and you’re not having any other treatment, the medication might “stabilize” you in a state of illness, keeping you inside that Depression Alliance net.
This could also be true even if your current diagnosis is not depression. If your diagnosis was originally depression, and the depression was left untreated (or treated only with medication, which amounts to the same thing), then your untreated depression may have led to further symptoms, and those further symptoms might have shifted your diagnosis.
So, no matter how ill you’re being told you are, if you can retrace your steps back to a time when you were diagnosed with depression and medicated for depression, it might be that unmedicating and treating the original depression would get you out of the whole mess.
When things are bad it’s hard to refuse medication, but medication without a treatment plan for getting you well can turn very nasty. (Medication in the short term, as part of a treatment plan, often works wonders.)
A little less common these days, I hope (perhaps foolishly), is the story that goes like this. You feel down and you go to a therapist (or a counsellor, it makes no difference). You find you can really relate to the therapist. But there’s something about the therapist or the therapy sessions you can’t work out, and that becomes the focus of the sessions, not solving the problem of why you feel down, but solving some other problem that has only arisen because of the therapy itself. So you still feel down, but you also feel you can’t stop having therapy.
This kind of phoney therapy can go on for years — decades, in some cases. I described some aspects of it in more detail in Hot Babes:
Coercive counsellors…create phoney relationships where the emotion and the attachment are manufactured by the counsellor’s deliberately weird behaviour. Clients in those relationships are victims of wierdos.
In the NHS version of this scam, therapy is limited to a certain number of sessions with each therapist. There is never any treatment plan. You use up your quota of sessions, go on a waiting list for a while, get “support” of various kinds for a while, have some more therapy, and so on, potentially forever.
Like the usual self-help advice, therapy without a treatment plan becomes a way to avoid the problem that is causing your depression. It reinforces your lack of control, presses your mental OFF switch harder, and makes you become more depressed. As you become more depressed, you can develop further symptoms, which change your diagnosis, making you believe you are even more ill, reinforcing your lack of control, and so on in a vicious circle.
The solution to this one is very simple, which is not to say it is easy — if you don’t have a treatment plan that you can believe in after the first few sessions of therapy, walk out and refuse to see that therapist again. Sadly, it can be very difficult to do that if you’re depressed, and even more difficult if your therapist cleverly turns it into a guilt trip.
5. Actual illness
Finally, amongst all those people caught in the Depression Alliance net, some really are ill. A psychotherapist’s definition of an illness like depression is that it’s a mood disorder. A mood is persistent and there is no apparent reason for it, nothing maintaining it — it’s “all in the mind”.
This is different from the Depression Alliance definition, because it recognizes that all kinds of moods, inclucing depression, are normal. It’s only when a mood persists for no apparent reason that it can be considered to be a mental illness.
When you have successful therapy for a mood disorder, it begins with a strong feeling of trust in your therapist. From there you develop a treatment plan that you have confidence in, that will discover the cause of your disorder and involve steps to fix it. The plan might include temporary medication to help with symptoms in the short term, making life easier for you while you carry out the rest of the plan.
Discovering the cause of a mood disorder starts by eliminating all possible external causes and maintaining factors, like events that were beyond your control, interpersonal and practical traps in your life, inappropriate medication, and previous failed attempts at therapy. After those have been eliminated, the patterns of thinking that cause your illness can be identified.
The treatment plan for a mood disorder is a plan to address specific, identified patterns of thinking that are individual to you, and that make no sense. The goal is to replace them with patterns of thinking that do make sense. A treatment plan does not change your mood or your other symptoms. It changes the patterns of thinking that cause your mood and other symptoms.
An odd thing about successful treatment for depression is that after treatment you can still become depressed! The treatment addresses your illness, but when bad things happen to you, you are still able to protect yourself by becoming depressed in the normal reactive way just like anyone else.
Before you include yourself in Depression Alliance’s “1 in 5” consider whether you deserve to be caught in that net, and how you will get out of it if you are caught. External factors cause much depression. It’s normal, it can last for months, and it protects you when bad things happen that are beyond your control.
If you start to think you are ill when you are not, the treatment might make you worse off. You might be able to help yourself by thinking through the external factors in your life before your depression started, and the factors maintaining your depression now.
It might be best to trust your inner wisdom. It might be time to say, “Stuff this inner wisdom, I’m off out of here.” It might be time to walk away from your dependency on a drug or a therapist. Or it might be time to get a treatment plan that’s not just one-size-fits-all advice about ways to avoid the problem.