Depression is not the same as "being sad", Giles Fraser

Casual “let’s not pathologise sadness” musings don't contribute much to the debate about medication for depression.

I’m writing this post to dispel a few myths about depression and the use of medication. I should mention, however, that I’m none of the following: psychiatrist, psychologist, pharmacist, biologist, philosopher, renowned expert in happiness and the inner workings of every human soul. That said, neither is Giles Fraser, the Guardian’s Loose Canon, but he hasn’t let that stop him. Besides, unlike Fraser, I’m in a permanent fog of drug-induced pseudo-contentment, hence I’m even less likely to demonstrate any degree of restraint.

In a piece entitled "Taking pills for unhappiness reinforces the idea that being sad is not human", Fraser rehashes many common stereotypes about depression, mental illness and SSRIs. To be fair, he doesn’t do it quite as nastily as some people. He’s no Julie Burchill, for instance (sorry, Giles!). Nonetheless, making tired, half-baked claims in a seemingly well-meant manner can be even more damaging than just being an out-and-out bully.

I’ve taken Prozac, on and off, for 18 years. Mostly it’s been on. I’m not sure whether I should say it’s “for depression” as I’m conscious this can get people’s backs up, as though I’m positioning myself as one above those who merely get a bit fed up. Ooh, look at me, I’m depressed and that means I’m special! is what no one who suffers from depression actually says, but other people hear it all the same, since the alternative — that depression is something which none of us quite understand — is too annoying for words.

So let’s not bother with a diagnosis. I take Prozac not for fun, but because my life functions better with it. I don’t know the precise cause and effect. To be honest, I don’t think it should be my job to mount a detailed scientific defence of the drug when the main reasons for which it is attacked seem to come more from the arts side. People don’t like Prozac and similar drugs not because they are harmful — it is for those taking them to weigh up pros and cons — but because the whole SSRI narrative just isn’t aesthetically pleasing enough for the critics’ exacting standards.

Fraser argues that diagnosing depression “is already to classify a particular kind of experience as something quasi-medical, thus leading one to think in terms of medical treatment”:

Sometimes I am just sad. Sometimes pissed off. Sometimes smothered in darkness. But we often lump all these experiences together simply because pharmaceutical companies have developed a certain sort of treatment. And, once you have a hammer in your hand, it is convenient to see every problem in terms of its being a nail. We have found the solution, now let’s make the problem fit the solution we have available. It’s a form of reverse engineering.

So depression is over-diagnosed simply because anti-depressants exist. There is no question as to whether legions of merely “pissed off” people would seriously go along with this (repeat prescriptions are not cheap), nor any question as to whether Prozac and the like have any effect whatsoever on “pissed off-ness” (believe me, they don’t – on the contrary, once you’re taken out of your own bubble, it’s amazing the number of things which will now piss you off). But no matter; Fraser has a neat story he wants to present, and it doesn’t involve depression being messy, or people having overlapping and/or contradictory motives for supporting the use of drugs to treat it.

I might take Prozac because it helps me. But wait! It also helps The Man, aka Big Pharma, therefore it must be dodgy!

Thus we are encouraged to think of our problems in terms of the lucrative solutions to problems we didn’t know we had. In this way, the pharmaceutical companies are responsible for the very conditions they propose to alleviate.

Thus many people like me are depressed merely because they want us to think that. Without the existence of drugs we’d just be anything from mildly perturbed to suicidal, the solution to which would be … Well, I’m not exactly sure (but — and I’m guessing here — perhaps not just St John’s Wort and a daily bike ride, thank you very much).

The most worrying thing about Fraser’s thesis, however, is not merely that he positions the motives of pharmaceutical companies as the driving force in a much more complex narrative, but that he thereby makes sufferers of depression complicit in their own suffering and the suffering of others:

Forget the fact that some people are miserable because they are struggling on zero-hours contracts, or have lost their partner or have been watching the news too much – if we translate misery into some sort of chemical imbalance then someone can make big money out of it. But unhappiness is often a perfectly proper response to the state of the world. If you have a shit job or a shit home life, being unhappy is hardly inappropriate. At best, many of the drugs we are popping only deal with the symptoms of all this, not the causes. At worst, they pathologise deviations for normalcy, thus helping to police the established values of consumer capitalism, and reinforcing the very unhappiness that they purport to cure.

This is a tidy way of putting things, and one that seems to speak for the little man. But it doesn’t represent the truth. Drugs do not deal with the symptoms of unhappiness. SSRIs do not simply allow people to drift along in a delusional haze, believing all is well in the world while they themselves and everyone around them is trodden into the dust. For some people, medication is what enables you to no longer turn in on yourself. Unhappiness is indeed often a perfectly proper response to the state of the world, but it needs to be directed and understood before change is possible. If you are too numb to feel pain or anger, you won’t even recognise your shit job or your shit home life. I don’t know the precise relationship between mental illness and external social influences — isn’t this still hotly debated? — but I do know that for social change to include those who need it most, you need these people to feel strong. Some of them might, right now, need to take medication for that to happen. That might make idealists feel uncomfortable but there it is.

I don’t wish to cheerlead for drugs to treat all mental illnesses. Many drugs — those used for schizophrenia, for instance — have hugely damaging side-effects, and I wonder whether the sacrifice is always worth it (and whether it’s a sacrifice we’re forcing on others, without allowing them to choose their own destiny). I don’t, however, think the casual “let’s not pathologise sadness” musings in which Fraser indulges contribute much to this debate. At best, they’re frustrating. At worst, they make people who take anti-depressants feel accused of being too weak to deal with reality. In truth, I think Fraser is the one unable to deal with a reality that’s far more flawed and poorly understood than he would like.

This piece originally appeared at Glosswatch, under the title "Sweeping it under the carpet: depression, Prozac and Giles Fraser"

A rainy day. Photo: Getty

Glosswitch is a feminist mother of three who works in publishing.

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I hate musicals. Apart from Guys and Dolls, South Pacific, Follies – oh, wait

Every second is designed to be pleasing, so that by the end my face aches from all the smiling.

I always thought I hated musicals. Showy, flamboyant, and minutely choreographed, they seemed to be the antithesis of the minimalist indie scene I grew up in, where a ramshackle DIY ethos prevailed, where it wasn’t cool to be too professional, too slick, too stagey. My immersion in that world coincided with the heady days of Andrew Lloyd Webber’s triumphs in the West End – Evita in 1978, Cats in 1981 – neither of which I saw, being full of scorn for such shows.

From then on I convinced myself that musicals were not for me, conveniently forgetting my childhood love of West Side Story (for which I’d bought the piano music, bashing out “I Feel Pretty” over and over again in the privacy of the dining room, on the small upright that was wedged in behind the door).

I was also conveniently forgetting Meet Me In St Louis and A Star is Born, as well as An American in Paris, which I’d been to see with a boy I was actually in a band with – he somehow finding it possible to combine a love of The Clash with a love of Gene Kelly. And I was pretending that Saturday Night Fever wasn’t really a musical, and neither was Cabaret – because that would mean my two favourite films of all time were musicals, and I didn’t like musicals.

Maybe what I meant was stage musicals? Yes, that was probably it. They were awful. I mean, not Funny Girl obviously. When people ask “If you could go back in time, what gig would you most like to have attended?” two of my answers are: “Judy Garland at Carnegie Hall, and Barbra Streisand in the original 1964 Broadway production of Funny Girl.” I would, of course, also make an exception for Guys and Dolls, and South Pacific, and My Fair Lady, and… oh God, what was I talking about? I’d always loved musicals, I just stopped remembering.

Then one of our teens took me to see Les Misérables. She’d become obsessed with it, loving the show so much she then went and read the Victor Hugo book – and loving that so much, she then re-read it in the original French. I know! Never tell me today’s young people are lazy and lacking in commitment. So I went with her to see the long-running stage version with my sceptical face on, one eyebrow fully arched, and by the time of Éponine’s death and “A Little Fall of Rain” I had practically wept both raised eyebrows off my face. Call me converted. Call me reminded.

I was late to Sondheim because of those years of prejudice, and I’ve been trying to catch up ever since, keeping my eyes open for London productions. Assassins at the Menier Chocolate Factory was stunning, and Imelda Staunton in Gypsy (yes, I know he only wrote the lyrics) was a revelation. Here she is again tonight in Follies at the National Theatre, the show that is in part a homage to the era of the Ziegfeld Follies, that period between the wars that some think of as the Golden Age of Musicals.

Although, as Sondheim writes in his extraordinary book, Finishing The Hat, (which contains his lyrics plus his comments on them and on everything else): “There are others who think of the Golden Age of Musicals as the 1950s, but then every generation thinks the Golden Age was the previous one.” How I would have loved to have seen those shows in the 1970s, when they were new and startling.

They still are, of course, and this production of Follies is a delight from start to finish. A masterclass in lyrics – Sondheim’s skill in writing for older women is unmatched – it is also sumptuously beautiful, full of emotion and sardonic wit, switching between the two in the blink of an eye, in a way that appears effortless.

And I realise that what I love about musicals is their utter commitment to the audience’s pleasure. Every second is designed to be pleasing, so that by the end my face aches from all the smiling, and my mascara has somehow become smudged from having something in my eye, and I have already booked tickets to go again. So sue me.

Tracey Thorn is a musician and writer, best known as one half of Everything but the Girl. She writes the fortnightly “Off the Record” column for the New Statesman. Her latest book is Naked at the Albert Hall.

This article first appeared in the 21 September 2017 issue of the New Statesman, The revenge of the left