A Different Kind of Antidepression

In the early days of the 21st century, a South African psychiatrist named Derek Summerfeld went to Cambodia, at a time when antidepressants were first being introduced there. He began to explain the concept to the doctors he met. They listened patiently and then told him they didn’t need these new antidepressants, because they already had antidepressants that work. He assumed they were talking about some kind of herbal remedy.

He asked them to explain, and they told him about a rice farmer they knew whose left leg was blown off by a landmine. He was fitted with a new limb, but he felt constantly anxious about the future, and was filled with despair. The doctors sat with him, and talked through his troubles. They realised that even with his new artificial limb, his old job—working in the rice paddies—was leaving him constantly stressed and in physical pain, and that was making him want to just stop living. So they had an idea. They believed that if he became a dairy farmer, he could live differently. So they bought him a cow. In the months and years that followed, his life changed. His depression—which had been profound—went away. “You see, doctor,” they told him, the cow was an “antidepressant”.

To them, finding an antidepressant didn’t mean finding a way to change your brain chemistry. It meant finding a way to solve the problem that was causing the depression in the first place. We can do the same. Some of these solutions are things we can do as individuals, in our private lives. Some require bigger social shifts, which we can only achieve together, as citizens. But all of them require us to change our understanding of what depression and anxiety really are.

This is radical, but it is not, I discovered, a maverick position. In its official statement for World Health Day in 2017, the United Nations reviewed the best evidence and concluded that “the dominant biomedical narrative of depression” is based on “biased and selective use of research outcomes” that “must be abandoned”. We need to move from “focusing on ‘chemical imbalances”, they said, to focusing more on “power imbalances”.

— Johann Hari, in an edited extract from his book, Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions, courtesy of the Guardian.

(Please note that this is not intended to disparage or cast doubt on other treatments such as therapies or medications; rather it is meant to present an alternative, if not complementary, approach to helping those who struggle with depression in all its forms and degrees. Given that this malady affects diverse people for diverse reasons, it is sensible to consider every possible approach or treatment paradigm to address it.)

On Depression, Suicide, and Being a Good Person

The psychologist Rollo May once noted that “depression is the inability to construct a future”. Whatever the scientific merits of that observation, I believe it offers a reasonable explanation for how someone could do something that most of us would find impossible: consciously ending their own lives, often regardless of their seemingly positive circumstances. If one is unable to see any point to their lives, or to conceive of any future beyond the painful past and present that is all they know, then what other choice to they have, as far as they can see?

Obviously, depression and suicidal ideation are fundamentally personal matters that affect each individual differently, so I am reluctant to generalize about how it feels, where it stems from, and so on. Please take this as the uneducated stream of consciousness of one person and nothing more.

All I can say is that as a sufferer of depression and anxiety (both thankfully far milder than most), as well as someone familiar with the subject through loved ones and personal research, I have learned one valuable thing: no expression of love or validation is too small. Every little bit counts. No matter how futile it may seem, at the very least we must try.

I have heard too many stories of people being brought back from the brink of suicide and despair by the spontaneous phone call of a loved one, or the random act of kindness from a stranger. Humans inherently seek out validation and meaning in their lives; as a social and sentient species, we require both love and a sense of purpose. Simply being acknowledged by another human being, or being given something to work towards — a charitable cause, the making of art, the caring of others — is enough to enrich our lives and keep us going.

There is little I can say that is not already known: that suicide is irreversible, that depression and mental illness are nothing to be ashamed of and suffer alone with, that the people around you care and want you to stay. The unfortunate reality is that no matter how much we remind ourselves of these things, or how much we try to be there for others, the tragedy of the human condition continues. Many of us will be or feel powerless to help ourselves or others. In response to tragedy, we will reflect, act accordingly in the short term, but then move on until the next grim reminder.

Of course, this is not to discourage people from seeking help or offering it — doing good is still valuable and necessary regardless of whether bad things continue to happen. Over the years, I have learned from both personal experience and the accounts of others, that no matter what your mental status — depressed, suicidal, satisfied, etc — doing good for others feels deeply uplifting and self-actualizing. After all, we need to start somewhere, and in such a cruel world, no act of goodness is too small. It will always matter to someone, perhaps enough to save their lives. What have we got to lose in the process?

Ultimately, my point is that we must remain vigilant in our goodness and conscientiousness, to be kind and loving to as many of our fellow humans as possible. As the Scottish author Ian Maclaren rightly advised, “Be kind, for everyone you meet is fighting a hard battle”. In doing so, we can better our chances at enriching, if not saving, both others’ lives and our own. Even if it does not work out — if people continue to suffer, act self-destructively, or remain unmoved to act morally — at the very least we can say that we did very sincere best, and will continue to do so as long as human suffering on both an individual and societal level remains.

If you have read up to this point, thank you, and remember that I am always here for you, whether you’re an acquaintance or my very closest loved one. Your value as a person is all the same. Try me, you’ve got nothing to lose and no judgement to contend with. I know I can seem distant and unavailable, but believe me, I can and will make the time. It is hardly an inconvenience. On the contrary, it would be my honor. Be well my readers.

Robin Williams and the Tragedy of the Comedian

The recent death of  iconic actor and comedian Robin Williams has understandably lead to much shock and sadness, especially in light of the fact that he had committed suicide. Needless to say, there are no shortage of eulogies and reflections related to his legacy, accomplishments, and characters — what one would expect when such a titanic and beloved personality departs so suddenly — as well as discussions centered on his lifetime struggle with addiction and depression (which was nonetheless masked or mitigated in the public eye by his consistent lightheartedness and energy).

While I can go at length about this matter myself, or share a trove of excellent pieces covering everything there is to know and appreciate about Williams, I will stick to one that I found especially informative and relevant.

Over at Cracked, David Wong wrote an engaging piece that explored why it is that so many energetic, humorous, and seemingly well-adjusted people — celebrity or otherwise — end up as unlikely victims of suicide. I recommend you read the whole article, as it does a good job of mixing in thoughtful musings with the magazine’s characteristic wit and humor (which in this instance I found appropriately more tactful than usual). The crux of it is this:

Every time [a funny person makes] a joke around you, they’re doing it because they instinctively and reflexively think that’s what they need to do to make you like them. They’re afraid that the moment the laughter stops, all that’s left is that gross, awkward kid everyone hated on the playground.

I can attest to these both by observation and experience. I am very insecure about my personality and personal merits, which is one reason I indulge in sharing knowledge or being a clown, both online and off — it makes me feel valuable and desired, even though I also subsequently feel terrified of the “real” me being discovered and subsequently disliked.

Thankfully, my own struggles with self-loathing and the subsequent depression have never been bad enough to lead to addiction or self-destructive behavior. In fact, as I have gotten older, I have graciously been made to feel very accepted by many people despite my flaws, which has helped me passed my personal hangups, slowly but surely.

Speaking more broadly, one big point to glean from the article — and from the many similar observations of suicide victims appearing well on the surface — is that most people suffer in silence. Even those of us without depression or a serious mental illness feel the need to mask our hardships, internalize our negative feelings, and opt not to be a “burden” to those around us.

For many people, the alternative coping mechanism is to act out, to find worth and validation as someone entertaining and fun. One finds a purpose in brightening others’ days so that they do not suffer the same way you do. Imparting laughter and happiness is a way to gain social acceptance while also feeling like you’re doing some good in the world, which is always a nice feeling no matter what your mental state.

It is thus little wonder that so many troubled people gravitate to behaving or embracing seemingly contradictory behavior. It gives meaning and uplights their moods and others’. It is also a way to lighten the pain and burden of depression by making it more bearable, or even funny. What else is there to do with so much intractable sadness and hopelessness — aside from escaping into mind-altering substances, or ending your mind altogether.

Obviously, not all happy and humorous people harbor deep-seated and often fatal pain. Rather, it is that not all sad and pained people seem to clearly be that way. Symptoms of depression manifest in many different ways, as do the ways that people deal with them, so generalizations should be made with caution. But clearly, there is a pattern of suicides being unexpected and unlikely.

The observation that sufferers of depression are often those who we least expect is somewhat of a cliche, but clearly it is something that needs reminding. Too often we remain shocked and surprised when someone like Williams commits suicide, but maybe that reflects the strong sociocultural pressure to keep one’s sadness buried as much as possible. Maybe it testifies to how strong the stigma of depression, suicide, and addiction are, such that people would rather put on a mask and trudge through it at their own risk, rather than let it become exposed or admitting to a problem.

Of course, these are all just visceral musings and generalizations, not any sort of sociocultural prescription. Tragedies like this naturally elicit a lot of self-reflection and soul-searching, perhaps because there is something fundamentally relatable with how people choose to cope with their struggles, whether through humor, lashing out, or addiction.

My thoughts on all this are incomplete. Expect more later my friends. Until then, feel free to share your own ideas as usual.

 

 

 

Link

The following excerpt is from a post on Brute Reason discussing the problems with using psychiatric terms in a colloquial and metaphorical sense.

These words are used so casually that our conception of their meaning gradually shifts without our even noticing it. It’s like a boy-who-cried-wolf type of situation in that regard. If nine different friends joke to you about how they’re ‘sooooo OCD’ because they like all their books organized just so on their shelf (a situation familiar to just about every bibliophile, honestly), then the tenth friend who comes to you and tells you that they have OCD is probably going to evoke that mental image, rather than one of someone who actually can’t stop obsessing over particular little things and carrying out rituals that interfere with that person’s normal functioning, perhaps to the point of triggering comorbid disorders like depression. This may be a person who washes their hands until they are raw and hurting, someone who has to flick the light switch on and off seven times every time they leave a room, or someone who has recurring, uncontrollable thoughts about hurting someone they love even though they have no actual desire to do that.Well, that sounds a little different than insisting that your books be categorized by subject and then alphabetized by author, no?Likewise, if your friends are constantly telling you they’re ‘depressed’ because their team lost or because they got a bad grade, only to return to their normal, cheerful selves within a few hours, the next person who tells you that they are “depressed” might elicit a reaction of, ‘Come on, get over it! You’ll feel better if you go out with us.’

And so the meanings of words change.

We must either change the way these words are used, or at the very least recognize the nuance in their meaning — not everyone who says they have anxiety or depression actually does, in the clinical sense; moreover, those who do make a serious claim to such conditions should be given the benefit of the doubt, and not assumed to be displaying mere personality quirks or the like.
Thoughts?

Olivia Prenpaze

I recently saw one of the saddest and most impactful videos in some time: a young woman named Olivia Prenpaze made a courageous confession about a very difficult secret: multiple suicide attempts due to a myriad of personal and psychological problems, ranging from bullying and depression, to psychosis and anorexia. She also tried to reassure others that they can fight through their own demons and that they must never bully or harm another person.

Unfortunately, she ended up taking her own life not long after the video was posted a couple of months ago.

It pains me to imagine that such a brave and wonderful person is forever gone from this world. I would have liked to have known her, and maybe to have at least tried to help her. I wish so badly that I could save people like this. It saddens me that there are millions of people like her who die and suffer every year, even as I write this, for reasons beyond their control – reasons they did not deserve.

She didn’t ask to be born with a cruel range of mental illnesses that took their toll on her wellbeing. She was a victim of random chance, of a mind whose innate suffering was made worse by the negligence and outright cruelty of the society around her. I can’t imagine being born into a life where I must struggle against my own mind on a daily basis, to say nothing of external forces.

It was a testament to her strength that she pulled through for as long as she did, all the while maintaining an impenetrable façade of happiness. Even the most beautiful and happy people can be suffering immensely underneath.

If anyone reading this ever needs help, I’m here. I don’t care who you are or what the problem is, don’t hesitate to message me. I’ll do everything I can to help you. I wish I could make all this tragedy stop, but I’ll be satisfied if I can save at least one life. That’s as precious as they come.

Anglo-Saxon Culture and Depression

Even though they’re not the countries with the world’s highest suicide rate (that dubious distinction goes to a number of mostly East Asian and ex-communist countries) it seems that the US, Canada, and the UK have a much more developed culture of depression, in which the subject is considerably more public and ubiquitous in society, to the point of developing it’s own sub-culture and social apparatus.

Based on my own experience, most of the  websites and organizations that are formed around depression and mental illness originate in these countries, as do most of their members and clients. Depression also seems to be a far more prevalent topic,  frequently referenced in popular culture, literature, cinema, and media. Commercials advertising various treatments are common, and an entire “medical industrial complex” has formed in the face of growing diagnoses of clinical depression and it’s ilk.

Indeed, the psychiatric and psychological community is arguably more developed in Anglo-Saxon nations than anywhere else in the world.  Nowadays, both fields are perceived to be dominated by Americans in particular; the DSM – a handbook classifying various mental disorders – is published by the American Psychiatric Association, and is increasingly used across the world instead of international variants.

Of course, I must acknowledge that much of this is based on anecdotal evidence, namely my years serving as a moderator or active member of various websites for the mental illness community. It was mid-away through my “citizen psychiatry” that I began to ponder about this possible Anglo-Saxon connection.

There is also the issue of a causal dilemma. It’s possible that depression is simply more noticed in these countries because we’re more open to confronting it, and have more advance research and medical methodology to diagnose it. Widespread interest and treatment of mental illnesses often follows a country’s entrance into industrialization: a society overcomes the “old” evils of poverty or infectious disease, only for these to be superseded with “modern” ailments like obesity and psychological maladies.

I would like feedback on this, given my limited time to expand on this topic as much as I’d like. Is there something inherent in Anglo-Saxon culture and society that precludes higher incidences of depression? Is it the perverse influence of the highly developed medical and psychiatric community, which many people seem to regard cynically? Is it something else entirely, or maybe nothing at all?