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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How the sports industry inspired us to become less active

Sport’s obsession with being “inspirational” doesn't help public-health interventions – it hinders them.

A year before the Hillsborough tragedy of 1989, the nadir of English football’s fortunes, the original New Times debate mapped precisely the forces that would transform this venerable but declining working-class game into the global commercial spectacular that is the Premier League. The new communications technologies and their global reach would be shaped by private rather than public interests (privately owned clubs, not the Football Association) and by the market, not the state (Sky rather than the BBC).

That debate also recognised the relentless individualistic consumerism that has driven the continuing success of sport in Britain: we now have record levels of gym membership, buy more sports goods than before, and watch more sport on ever more devices. If newspapers and internet chat rooms are anything to go by, we read more and talk more about sport than we used to. The New Year honours lists suggest we accord it ever more social weight.

What the New Times thinkers failed to note, however, was that we would be consuming most of this sport sitting down and with distinctly bigger waistlines. In the years since the London 2012 Olympics, Britain – already perilously sedentary – has been exercising even less. In the late 1950s the average weight was 65 kilograms (10.2 stone) for men and 55 kilograms (8.7 stone) for women. Today those figures are 84 kilograms (13.2 stone) and 70 kilograms (11 stone), respectively, with nearly a quarter of adults classed as obese.

It has become clear that a central legacy of the deindustrialisation of the 1980s was an increasingly sedentary life, made worse by the collapse of public transport, the relentless motorisation of everyday life and the difficulty of cycling as a mode of transport. This was compounded by the entrenchment of the snacking and fast-food industries, which helped shift the nation’s already poor eating habits in the direction of sugar. The fortunes of the McDonald’s chain can stand proxy for the process. It took ten years, from 1974 to 1984, for the company to reach 100 outlets in the UK; over the next two decades it increased its presence twelvefold.

Under successive governments, school playing fields, public commons, parks and municipal leisure facilities, already dilapi­dated and many of them of Edwardian vintage, were either sold off or abandoned. Our own era has added to this litany; digital screens continue to multiply and unsupervised play has collapsed following concerns about children’s safety.

All this at a time when our elite athletes are prospering. Yes, England may not have won the football World Cup, but its rugby union team is the Six Nations champion. Its cricketers have won the Ashes. The Premier League is hailed as the world’s best and richest. Team GB has had an ever-increasing haul of Olympic laurels, and has showcased and celebrated women’s and disability sports as never before. How, in an era of such “inspirational” sporting success, can we in fact be exercising less?

We need to start from the idea that sport, even the Premier League, is just the rule-bound, competitive end of a much wider spectrum of physical culture and ways of playing. Sport has its special place in this culture – fun runs, Zumba classes and personal training sessions do not offer athletic brilliance, narrative complexity or collective ecstasy – but the world-views of commercial and elite sport should not be given special importance. Indeed, there is good reason, in their present form, to disregard them altogether.

In the world of elite sport, decision-making is meant to be “performance based”, so it is remarkable how immune it is to arguments that more star athletes do not translate into a healthier population. Perhaps it is true that future Olympians will be inspired by role models during their youth. For most children, however, the mundane reality is that parents, peers, schooling, wealth and access to infrastructure are the primary determinants of participation. One reason why levels of exercise have fallen is that household budgets don’t stretch to dance classes, swimming lessons and the like.

Where there is a clear and established path out of poverty through professional sport – football in most parts of the world, baseball in the Dominican Republic, athletics in Jamaica – the commercial spectacular continues to feed the grass roots with hope, if not resources. And given the make-up of its labour force, the English Premier League seems to be doing most of its best work outside of the country.

Sport’s obsession with being “inspirational” is a hindrance to public-health interventions, not a help. We need to be cajoling, entreating, even tricking people into activity. While some will want to go to the “next level” or “just do it ”, others might be quite happy to wander around their own level, or “just about do it”. We need to ask people to dance and invite them to play. It is clear enough from comparable countries such as Finland and Denmark that the precondition for an active and healthy nation is getting more people moving about by walking, cycling and, where conditions allow, skateboarding, skiing and skating. For a fraction of the cost of the HS2 rail link and, I suspect, with much greater social and economic benefits, we could make a significant start on this.

Our priorities need to shift in other ways, too. Children should continue to be an important concern, but the sports industry’s fetishisation of youth must be countered by an equal concern with getting the disabled and the elderly to be more active. Indeed, there may be bigger health gains to be made here for each pound spent. Given current trends, informal running, swimming and gym use will account overwhelmingly for our calorie-burning. But are we building and maintaining the infrastructure that makes this type of exercise possible, and offering prices that make it affordable?

It is worth returning to two initiatives of the last Labour government – the Playbuilder scheme and school sport partnerships – which were either scrapped or diluted by the coalition government in 2010. The first created a small central fund to support the creation of new playgrounds; the second established grass-roots networks that stitched together educational and sporting institutions of all kinds. Both could be revived, devolved and expanded significantly.

But why stop at playgrounds? Why just schools and sports? Add urban running zones, cycle networks and a new generation of lidos. Sports clubs and facilities should be plugged in to the health and social-care systems, and a new generation of innovative, grass-roots sports NGOs should be brought into the network.

None of this is to suggest that we should stop trying to shape and regulate the commercial sporting spectacular, or the governance of sport, or that we should even drastically reduce the funding for elite Olympians. This last costs considerably less than the annual wage bill of a smaller Premier League club. There is an important agenda of opening up, democratising and diversifying sports governance, as well as addressing sport’s intersecting crises of corruption, doping and crass commercialism.

However, what needs to end is this: the risible notion that globalised, commercial sporting spectaculars are models for running our institutions, or the route to an active and healthier society.

David Goldblatt is the author of “The Ball Is Round: a Global History of Football” and “The Game of Our Lives” (both Penguin)

This article first appeared in the 16 February 2017 issue of the New Statesman, The New Times