Tuesday, 24 April 2012

Let's Talk About the Dark, Part 2: Eric Maisel, R.D. Laing, Ben Goldacre and Adam Curtis

Warning!  This post is ridiculously long!  Be prepared to sit for a bit…

Last post I wrote you a mini history of why I think I get sad, and what it feels like for me.  This is so you know that I’m not speaking of these things with no damn idea what I’m talking about.  On the other hand, what I told you of is simply and only, my personal experience.  No two people’s experiences of anything will ever be exactly the same.  Before I begin to tell you about the first part (actually, it’s only the first 3 chapters and the introduction) of Eric Maisel’s useful new book, Rethinking Depression[1], I want to make one thing crystal clear to anyone reading.  It’s this:

Everybody’s feelings are different, though similar.  One person may struggle with a feeling s/he calls depression their whole lives and say little about it to anyone; another may seek help by talking or medicine, and often.  Some people feel chronic sadness or depression is a deeply private thing; others feel the stigma of it should be fought and we should talk about it openly, a lot.  Some people are greatly benefited by drugs prescribed them for their feelings and their management; some people have had awful reactions to these medicines; some people will not touch them out of principle.  Same goes for talking therapies, or any kind of help.

Never think, for one second, reading this (or anything I write, I’ve told you this before), that anyone’s own experiences of this life are invalid.  Personally, I have been sad on and off my whole life, and several times very badly.  Personally, I have tried 6 different types of anti-depressants and had awful side effects from each one, and zero help from them.  So I won’t be trying anymore, I shouldn’t think, and I will worry for you if you do or are, in case you have the same problems I did with the meds.  Personally, I have tried several therapists and 2 psychiatrists.  All the therapists I tried had hobby horses of their own disciplines, and all were a disaster for me.  One psychiatrist was worse than useless, and one was a lovely man, who tried me on cognitive behavioural therapy – which didn’t do much for me; I don’t think it’s the saviour of our minds other people think it is.  I don’t like or trust most doctors, due to my own mental health experiences with them, and to watching them ill-treat Troubadour when we were married, and he had been seriously ill.  But these are My Experiences Alone.  I will be talking out of them, of course.  I will reference them.  But I do not mean to invalidate anyone else’s.  If you take meds and it works for you – good.  If you have a great counsellor or therapist etc, and it works for you: good.  Good for you.  We are not all the same; we are similar.  Got it? 

Evangelism is never going to work for me.  Sharing information and experiences and trying different tactics at different times for different things, IS.  What works for me may not for you.  And vice versa.

For this reason, I have a slight problem with the tone and assumption of the first bit of Eric Maisel’s book.  He writes very conversationally, as he always does, very persuasively – he is a great writer, a great polemicist, and I have admired some 20 so far of his 35 or so book output on creativity, living creative lives, and staving off sadness and meaning loss in our lives by organising our thoughts and philosophic leanings more cleanly and clearly. 

Eric Maisel sets out a thesis in the first part of the book that really, there is no such thing as ‘depression’ as we know it now.  What there is – and he goes to great lengths to not underplay it[2] – is a deep and persistent, chronic human sadness, that we can all feel.  It can come at any time, for a reason we can see, or for no apparent reason at all.  Furthermore, it has been hijacked by the pharmacological industry, for their profit.  He says that we have ‘unwanted’ emotions sometimes, that we have been taught to label as ‘abnormal’.  He says: ‘Unwanted does not equal abnormal’ (p.9). 

He argues the chicken and egg scenario of biological brain differences in those feeling chronically sad: are their brains showing differences in chemical actions and areas working more or less BECAUSE they became sad and it changed the working of their brains?  Or because their brains were like that anyway, because they have a proper biological disorder and this MADE them sad?[3] 

He argues the medical industry would like us to believe the latter, when he thinks the former is more likely.  The same goes for the effects of various anti-depressants.  Do they work because chemicals have an effect (you drink; you’ll get drunk), which means you may think you must have had depression because this pill FIXED it?[4]  Or is it simply that your feelings were altered by chemicals, your symptoms masked – while the causes of your malady were left completely unaddressed, and therefore, likely to make a quick return once the pills are stopped?  He is angry at the way the medical industry as a whole seems relatively uninterested in finding the causes for this modern epidemic of depression (an idea we’ll return to), and trying instead to validate their own authority arbiting status by merely inventing labels for maladies, syndromes, disorders, and then offering us drugs for them (all of Chapter 1).  Drugs that he says may or may not do anything for you (pp.31-35). 

He worries that we are as a culture laying down for all this, adopting the language given to us by the medical and pharmacological industry (I regularly refer to my late father as both ‘OCD’ and ‘obviously clinically depressed, just never diagnosed’, for example).  The fact that it can be mightily comforting to have a name for the thing that ails us, is not lost on him. 
The fundamental linguistic game played by the mental health industry, is to characterize anything that remotely needs remediating or changing a disorder.  That hundreds of millions of people agree to play this game only proves the power of naming. (p.39)
But he suggests that by buying into the labels of medicine, wholesale, and taking all their drugs and their expensive talking therapies, we are giving up what personal responsibility and control we could have for trying to feel better ourselves.  He argues that by remembering that this modern thing we call ‘depression’ is in fact a 20th century label and construction; by remembering that throughout history, people were seen as ‘melancholic’ of temperament (a philosophical word rather than a purely medical label)[5], some more so than others, and that we can find ways of living our lives differently and training our minds and thought processes better, so that life is less easily able to lose its meaning and sink into a pit of greyness – we would be better off.

He isn’t by any means, a lone voice in the wilderness saying that our Western society is too quick to yell mental illness, and ‘pathologize the experiences of everyday life’ (p.9).  He backs up his points with several scientific studies (all supporting his points, of course), and quite a few good books, some of which I have read[6].  I need to make clear that a lot of this story takes place in America, and is about the American pharmacological industry for a large part, which functions a bit differently to ours.  Though the idea of comforting labels is all over both our societies.

I had greatly furrowed brow while reading all this.  I agree that our society is very quick to jump on bandwagons; and that we all seem to love a Label, for ourselves or others – as Bill Maher recently said, I need to label you, as if I don’t, I don’t know whether to ignore all your opinions immediately or not (I paraphrase, as we have annoyingly deleted that download of his Real Time – if anyone can give me the correct quote, please do, its within the last month).  Its scary to consistently be feeling things that go against society’s grain of needing us to be team oriented, happy happy happy all the time, and mostly extrovert in behaviour.  It’s scary to feel unable to talk about this for fear of being criticised as wimpy/ malingering/ unable to look after your children/ unable to hold down your job, or the nicest one of all: ‘mental’, ‘crazy’.  So its no surprise that some of us have chugged down our diagnoses of depression with a relief or gusto that may seem odd to others.  If it’s got a Proper Medical Name, then its REAL…and because more people are speaking out about it, its starting to lose its stigma – because so many of us seem to have it, or have had it, or will have it at some point.  There then lays out before us an array of ‘help’: support groups, drugs, psychiatrists.  This can be very comforting.  And it can work, for some people. (I'll come back to this in the 3rd and last post of this series.)

But I do agree that it goes too far.  It’s very tempting to say things like, if you grieve too long after a death, you have gone from mourning to depression.  How long is too long?  It’s obviously different for us all.  You can’t bring it all down to numbers, and lists of symptoms.  That’s over-generalizing, and creates its own problems. 

This was dealt with in depth by the UK documentary film maker, Adam Curtis, in the first episode of his short series The Trap: What Happened to our Dreams of Freedom? broadcast here in 2007.  (If you want to go see that bit, it’s on YouTube here, and it starts about 36 minutes in, with R.D.Laing looking very thoughtful and pinched, listen from there – I warn you, its dense, lots to take in.)  The section I am mentioning is part of a wider critique of political control in Western and specifically UK society, so I am quote mining, in a way; it’s a small part of what he was saying, but an important part. 

Eric Maisel’s book focuses the early sections on how depression is not a real thing at all, but a construct, made by doctors, and an incredible find for the psycho-pharmaceutical industry.  He doesn’t give any background as to why this may have happened, or how.  This is where Adam Curtis comes in, and the section of his documentary I just mentioned.  So before you jump up and down and yell: ‘But I AM sick!’ do have a think about how the label of depression arose, and what it does in our society.  The background information is, in fact, vital to thinking about it all.

What Adam Curtis proposed was this (for those of you who have no time to watch a 10 min clip, or don’t want to) - any phrases in speech-marks indicate direct quotes from Curtis's narration; indented paragraphs are longer quotes:  

Celebrity Scots psychiatrist RD Laing goes to America, mid 1960s.  He is against the medical elite, as always propounding mental illness as a purely biological thing, taking no account of intellectual and social factors.  He viewed psychiatry as a ‘fake science’ used for political control of people. Labels of madness or sanity have no actual reality, they are just convenient labels to lock up people ‘who want to break free’ politically – who differ from the norms.  One of the many young US psychiatrists who came to Laing to learn was called Rosenhan, and he devised a truly breathtaking experiment to see if psychiatrists could tell the difference between madness and sanity.  You need to watch the documentary clip for this bit alone, or read this link that describes the experiment: it’s truly shocking.  Basically, they really couldn’t.  Healthy people were judged sick, sick people judged healthy.  It emphasised the immense dangers of psychiatric labelling.  It was an important experiment and sent shockwaves through the American psychiatric establishment at the time (1973).  (Maisel sites some similar though less dramatic experiments, pp.27-30.)

The psychiatric establishment fought back though, with a new system of diagnosis that relied on the scientific, clear and clean beacon of numbers.  ‘All human judgement removed’.  The new system was based on ‘measurable surface behaviour of human beings’.  Curtis has Paul McHugh, then psychiatrist in chief of Johns Hopkins Hospital explain quite clearly that psychiatry has no clue what causes any of the conditions – ADD, ADHD, OCD, BPD, PPSD, GAD etc, but could just tell you ‘what they look like’ based on surface behaviour that could be observed and recorded.  Characteristics of all these Disorders, including depression, were listed very specifically, and questionnaires devised asking people if they thought they had these characteristics (NB: human judgement straight back in there, doh!).  The choices were ‘yes’ or ‘no’, so that anyone could conduct an interview with a symptom checklist, and the results could be fed into a computer, that would then diagnose a person as having this or that disorder, or none.  If they were normal or abnormal. Curtis has Dr Robert Spitzer, creator of the new diagnostic system in 1979, confirm this was how it was supposed to work: ‘no clinical judgement required’.

This is the bit we will start to be familiar with, over here in the UK.  In the late 70’s, to test the checklists, interviewers were sent all over the USA to question randomly selected people with them.  The point is made that till then, psychiatrists had only seen people who felt they needed help, who felt ill.  'No one had asked regular people how they felt'.  Do you need me to tell you that the results were apparently terrifying?  That more than 50% of Americans suffered from some type of mental disorder, 17% of them had a depressive incident at some point.  This is where the idea of a ‘hidden epidemic’ of depression comes from, in our society.  More surveys were done, more random people: very similar results were returned.

Many many people found ‘the checklists were a liberation: their private suffering was finally being recognised’.  But here come the unforeseen consequences:
Millions of people began to use the checklists to monitor and diagnose themselves; to identify what was aberrant or abnormal in their behaviour and feelings.  By definition this also set up a powerful model for them, of what were the normal behaviour and feelings to which they should aspire.  Psychiatrists began to find more and more people coming to them, demanding to made normal.
Paul McHugh makes the point that previously people did not wish to seem ‘psychiatrically injured’ but that now they had a new ideal of NORMAL they wanted to be made to fit the model.  Curtis concludes this section with saying:
The disorders and checklists were becoming a powerful and objective guide to what were the correct and appropriate feelings in an age of individualism and emotion.  This was a very different system of order: no longer were people told how to behave by an elite.  Instead, they now used the checklists to monitor their feelings and police their own behaviour.  They were reassured that these new categories were scientific and could be checked by the power of numbers.

Now, you may think it weird I have devoted so much time to Adam Curtis in a review of a book by someone else, but I ask you – if an author declares depression doesn’t actually exist, is a construct, and serves other ends for those who created that label, not really much for us…would you have liked a bit of background to such an immense claim?  I had already seen this documentary, read a fair bit of Laing and knew about the anti-psychiatry movement (of which Laing did not like to think he was associated, by the way), so I could see where Eric Maisel was coming from.  The other point of course is that RD Laing is very important for modern existentialists – he saw mental illness as part of lived experience, cultural and societal, not just a biological phenomenon and that it must be treated as an intellectual, societal, cultural phenomenon; and Eric Maisel is an existentialist, so tends to take the same view.

I think the problem I had with the first part of this book was that whilst this modern thing, ‘depression’ is almost certainly a creation of the mental health industry and its adjuncts, and that restating how we feel when we feel awful as simply part of lived experience, and then trying to live differently and more mindfully, with a set of good existential tools on how to do so…will not work for everyone.  Maisel makes it clear that existentialism is a tough philosophy, hard and rigorous (bit like I find Zen Buddhism – too hard for me by far)…BUT.

Let me put it like this.  I read Sally Brampton’s Shoot the Damn Dog (2009) a while back.  (As a result of it I became quite vocal for a while about ‘my depression’ in an attempt to remove stigma, at least from around myself.)  Its one of the most harrowing books I’ve ever read.  That woman had a hell going on inside her for a long time.  I did think, reading it, that all the meds she had given to her did not seem to be helping at all, and she freely says they gave her awful awful side effects.  Eventually she came out of it all, years later (also unimpressed with cognitive behavioural therapy, as I am).  I also note that Marion Keyes, beloved chick lit Irish author is only just now feeling better from a depression that she described on her website in absolutely heartrending flat clear terms.  Both these women, and these are but 2 examples, were on the floor with whatever ailed them.  And their lives were fine before sudden felling by depression, or whatever we want to call it.  Marian Keyes had had some depressions like mine before, but nothing like what befell her the last 2 or so years.

I don’t think either of these women could have been helped, at their worst states of mind, by existentialism, or by being told that depression doesn’t exist and they felt ‘chronic human sadness’…Semantics would not have helped them, at this point, I think.  Do you see?

Many of us feel quite shitty, quite a lot of the time.  And there are degrees of it, different for each person.  Whilst I think many of us are far too quick to embrace the idea of being mentally ill (for whatever reason), I think there are states people get into where you genuinely cannot, for sometimes a feck of a long while, think your way out of it, or do things that will make you feel more in control and thus feel better about life and yourself.  Some people really do disappear into an abyss for a while.  Whatever we want to call that, depression, a melancholic episode…it’s REAL.  People die there sometimes.

The dangers of the first part of Eric Maisel’s otherwise very useful book is to blithely state that depression is just a word.  A bad word in service of the psycho-pharmacological industry.  It may well be, as I have tried to show you with a bit of background. 

But it is very dangerous indeed to lump all the ways people feel when they feel sad together and if someone in the absolute pits of sadness came across this book, and tried to read from the start, when they are at that point where you aren’t capable of proper action or thought, I don’t think it would help – it would make you feel worse, because you would feel guilty and powerless to feel any better, despite seeing the logic in some of what he says. I don’t personally think meds are the answer either.  But that’s just me, ok?  I don’t know what the answer is.  I think the fact may be that its different for each person.

I too think the pharmacological industry is not an altruistic one by any damn means, and I would totally concur with (UK medical doctor) Ben Goldacre, author of Bad Science, in this assessment of ‘medicalisation[7]’:
[which is] the expansion of the biomedical remit into domains where it may not be helpful or necessary…In its most aggressive form, this process has been characterised as “disease-mongering”.  It can be seen throughout the world of quack cures – and being alive to it can be like having the scales removed from your eyes – but in big pharma the story goes like this: the low-hanging fruit of medical research has all been harvested, and the industry is rapidly running out of novel molecular entities.  They registered fifty a year in the 1990s, but now its down to twenty a year, and a lot of those are just copies.  They are in trouble.

Because they cannot find new treatments for the diseases we already have, the pill companies instead invent new diseases for the treatments they already have.  Recent favourites include Social Anxiety Disorder (a new use for SSRI drugs[8]), Female Sexual Dysfunction (a new use for Viagra in women)…and so on: problems, in a real sense, but perhaps not necessarily the stuff of pills, and perhaps not best conceived of in reductionist biomedical terms.  In fact, reframing intelligence, loss of libido, shyness and tiredness as medical pill problems could be considered crass, exploitative and frankly disempowering. (p.153, my italics)

Which brings us back to Eric Maisel, who would also utterly agree with that, I’m sure.

 Despite the fact I am in two minds about dismissing the word ‘depression’ for everyone, I have actually found dismissing it for myself quite useful.  In my last major fit of being in the pit, I frantically googled about the web looking for things to help me think.  I’m a pagan by inclination, so I googled pagans and depression (wondering why my own notions were helping me so little), and found this blog article.  It’s noteworthy because of one line, for me.  It said that pagans are often quite left-leaning, politically, and lefties have a lot to be depressed about in the way our society is going.  Or this one, about free-thinking people being more often classified as mentally ill (harking back to RD Laing’s point of psychiatry as something to label and lock up those who disagree with societal norms).  That really made me think.   

Why was I so quick to embrace the idea of being depressed as thing that was happening to me, against which I was powerless (in a way)…making it seem like an alien, or chemical invader.  In fact: there’s loads going on all around me, that explain perfectly well why I am worried, anxious, and downright upset, a lot of the time.  Watch the news!  Live with someone like Stanley who watches the news a lot!  Have an upbringing like the one I described last post. You’ll then be a bit vulnerable to paranoid feelings, insecurity and phases of feeling worthless.  Trust issues.  It’s understandable, not a mystery.   Be someone who seems to think a lot, to over think, analyse a lot.  To have been alone often, so sees things from the outsider perspective, often.  To get into bad mental habits as a result of all ones experiences, is not a surprise.  And it would affect and take each of us differently, depending on what our personal experiences were.  Obviously. 

So whilst I’m not going to be one to take the label or idea of depression away from anyone who is finding it helpful in learning how to feel better, and live differently; unless I am in the real pits, I do take it away from myself.  I’m me and I get damn sad, damn often.  But I like to try and deal with it with my own brain, which is why I do like the rest of Eric Maisel’s book, the meaty bit, the solutions.  Which we’ll get to next post, the last one of the series. 

It won’t work for everyone, it won’t always work for me, and its only part of an answer.  But it is part.  I think it can help.  Some of us could do worse than try some of his ideas.

[1] Maisel, Eric, Rethinking Depression, California: New World Library, 2012.
[2] Rethinking Depression, all of pages 49-52, give a long list of reasons why we get unhappy.
[3] RD – p.16, p.20
[4] RD – p.34, p.41.
[5] RD, p.10.
[6] The ones I have read and can recommend as interesting to the topic are: Charles Barber’s Comfortably Numb: How Psychiatry is Medicating a Nation (2008), Richard Bentall’s Doctoring the Mind: Is Our Current Treatment of Mental Illness Any Good? (2009), Daniel Carlat’s Unhinged: The Trouble with Psychiatry – A Doctors Revelatins about a Profession in Crisis (2010), Peter Conrad’s The Medicalization of Society: On the Transformation of Human Conditions into Treatable Disorders (2007), Allan Horwitz and Jerome Wakefield’s (also featured in Adam Curtis’s documentary The Trap) The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depression Disorder (2007) and lastly, Joanna Moncrieff’s The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment (2009).  There are many more he lists that look very interesting, but these are the ones I can vouch for as MOST interesting.
[7] Goldacre, Ben, Bad Science, London: Fourth Estate, 2008
[8] An antidepressant, Prozac is of the SSRI family.

1 comment:

  1. I have to admit that I don't like the 'label' of depression eg as an illness either. This is mainly because its too easy for GPs to hand out the 'happy pills' these days. They should have a checklist to diagnose longer-term depression maybe. I also think because its subjective(sorry this is contraversial) some ple abuse it either for attention or to get time off work. 'Stress is the new backache' as they say.

    Everyone suffers from acute depression sometimes, sometimes for an obvious reason and sometimes for a less obvious one. However I think chronic or longer-term depression deserves a different category (or label I suppose). Bereavement is always going to be long-term depression and people expect you to have completely recovered after a year but I believe for most this is unlikely to be achievable. At least, however, in this case there is 1 obvious cause. Other 'chronically depressed' people don't understand the cause(s) and there's is harder to treat.

    I suppose I'd distinguish long, from short-term depression, as when you can't see a way out or light-at-the-end-of-the-tunnel. When I've felt down for a few days it has scared me, thinking 'what if this feeling doesn't go away?' but then I find something positive in life and am able to move on. When people get in a spiral of seeing the worst in everything the only way out of this is to force yourself (with help from someone else) to do things - to generate a sense of everyday achievement. I think its the little things in life that really do make us happy on a day-to-day basis afterall.