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"

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

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Is anyone prepared to solve the NHS funding crisis?

As long as the political taboo on raising taxes endures, the service will be in financial peril. 

It has long been clear that the NHS is in financial ill-health. But today's figures, conveniently delayed until after the Conservative conference, are still stunningly bad. The service ran a deficit of £930m between April and June (greater than the £820m recorded for the whole of the 2014/15 financial year) and is on course for a shortfall of at least £2bn this year - its worst position for a generation. 

Though often described as having been shielded from austerity, owing to its ring-fenced budget, the NHS is enduring the toughest spending settlement in its history. Since 1950, health spending has grown at an average annual rate of 4 per cent, but over the last parliament it rose by just 0.5 per cent. An ageing population, rising treatment costs and the social care crisis all mean that the NHS has to run merely to stand still. The Tories have pledged to provide £10bn more for the service but this still leaves £20bn of efficiency savings required. 

Speculation is now turning to whether George Osborne will provide an emergency injection of funds in the Autumn Statement on 25 November. But the long-term question is whether anyone is prepared to offer a sustainable solution to the crisis. Health experts argue that only a rise in general taxation (income tax, VAT, national insurance), patient charges or a hypothecated "health tax" will secure the future of a universal, high-quality service. But the political taboo against increasing taxes on all but the richest means no politician has ventured into this territory. Shadow health secretary Heidi Alexander has today called for the government to "find money urgently to get through the coming winter months". But the bigger question is whether, under Jeremy Corbyn, Labour is prepared to go beyond sticking-plaster solutions. 

George Eaton is political editor of the New Statesman.