In this age of fads, the subject of depression is something of a paradox in that it seems to be a perennial fad. Unlike Kony 2012, Tamagotchis, Rickrolling, and the Atkins Diet, depression appears doomed to repeat a cycle of interest and indifference in the minds of the public. The script goes as follows:
A clinically depressed celebrity commits suicide, the issue trends on social media for a day or two, and then a fresh batch of hashtags and headlines capture our attention. Rinse and repeat, with the occasional variation on this theme.
For most people, the importance of mental health isn’t sufficiently intuitive. The seriousness of conditions like depression requires constant reinforcement via the media exposure afforded by ailing celebrities. In contrast, no one need be reminded that physical health is important, and rarely is it necessary to convince others that one’s physical issues are legitimate—skiving off work aside. People don’t tend to suggest pulling yourself up by your bootstraps when what ails you can readily be identified in the lab.
Mental health is more subjective in nature. Diagnosis tends to rely heavily on self-report. If an individual visits his GP and claims to have cancer, his opinion is irrelevant in light of biopsies and blood tests. If he instead claims to suffer from depression, subjective experience is all we have to go on. For some people this is the first barrier to understanding depression, but the most significant obstacle is the perception that mental and physical health are distinct.
We are intuitively mind-body dualists, so it’s no surprise that this is the prevailing view. Even when one understands that the mind reduces to physical processes, moment-to-moment experience tends to leave the opposite impression. This fact is largely responsible for the maddening notion that depression is a disease of the will, as though its victims can overcome the condition through force of character or the application of reason. The truth is that depression is no more amenable to will or logic than any physical disorder you’d care to mention. On the contrary, losing one’s grasp on reason is almost inevitable when one’s surrounding context is a bottomless pit. In comparison to acute depression, a nihilistic worldview can appear flush with meaning and purpose.
My only firsthand experience of the condition resulted from an ill-advised attempt to quit opiates cold turkey after a decade of heavy daily use. Until that point, I only understood the condition in an abstract sense. Even as I routinely lent my ear to ailing friends, I could sympathise but never empathise. I have long been a fan of Richard Dawkins’ poetic description of our extraordinarily fortunate existence:
“We are going to die, and that makes us the lucky ones. Most people are never going to die because they are never going to be born. The potential people who could have been here in my place but who will in fact never see the light of day outnumber the sand grains of Arabia. Certainly those unborn ghosts include greater poets than Keats, scientists greater than Newton. We know this because the set of possible people allowed by our DNA so massively exceeds the set of actual people. In the teeth of these stupefying odds it is you and I, in our ordinariness, that are here.We privileged few, who won the lottery of birth against all odds, how dare we whine at our inevitable return to that prior state from which the vast majority have never stirred?”
-Unweaving the Rainbow: Science, Delusion and the Appetite for Wonder
In light of my mental state at the time, reading the above passage felt like listening to someone dictate excerpts from The Secret while they watched me get waterboarded. To say the experience rendered me fetal would be an insult to fetuses, who are doubtless more productive than I was during this period. The impulse to commit suicide was never something I could relate to. I love life. I don’t fear being dead, but I do fear not being alive—there’s a meaningful distinction somewhere in there. Suicide never crossed my mind, but the experience allowed me to understand the impulse. Putting that little narrative detour aside, a more recent example from my life has greater relevance here. It highlights how irrational our perception of depression tends to be, even for individuals coping with the condition.
I have spent the better part of a year convincing someone close to me that medication might be the best option to treat her anxiety and depression. It’s clear that talk therapy isn’t going to cut it in her case—certainly not by itself. She has resisted thus far and generally offers two arguments against experimenting with medication.
- She feels her anxiety is what makes her special. It’s what motivates her to work so much harder than everyone around her. She is concerned that medication will blunt her anxiety and erase the only element of her personality she values: her work ethic.
- Medication will only artificially alter her mood. Therefore, whatever relief it provides will in some sense be an illusion.
We’ve debated the first point many times, but I’m more interested in the latter. It’s a variation of the appeal to nature fallacy: natural is good, unnatural is bad. One rarely hears this argument in relation to physical maladies. To take another example from my own life, I was diagnosed with psoriatic arthritis over a decade ago. For me, declining to take medication would be to choose a life of crippling pain. So as you might expect, my commitment to remaining natural is on a par with that of the average bodybuilder. Immunosuppressants have succeeded in alleviating my joint pain to a significant degree, improving my quality of life beyond measure. Why should depression be treated differently? Mitigating mental suffering should feel every bit as intuitive as treating arthritis, or any other condition that diminishes one’s quality of life.
Taking my friend’s argument to its logical conclusion, all mental states would have to be considered an illusion. Everything we do is purposed towards elevating conscious experience, after all. We constantly tinker with brain chemistry, even if we aren’t conscious of that fact. The use of anti-depressants is just a more explicit, and medically necessary, alternative to the kinds of behaviours we engage in every day.
In fairness to my friend, if confronted with the same objections she would doubtless say exactly what I have repeatedly said to her. However, depression isn’t a rational illness. It is prohibitively emotional and intuitive. To sufferers, subjective experience can be more compelling than the most bulletproof logic. To the neurochemically sound, understanding of the condition is at best abstract and at worst non-existent. The faulty intuition that physical and mental health are separable is at the root of the issue, and depression will continue to be perceived as relatively trivial so long as that intuition goes unchallenged.