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.

Alison McGovern
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Forget universal basic income - this is how we can include voters in economic growth

The links between economic growth of the country and that of the people, families and towns have broken. The state can fix them again. 

Economic policy is always boring, until it’s too late.

Pensions. How they are funded, who they cover, what happens if they fail. Boring. Until it was too late.

Mortgages. Who has them, who needs one, who should have one. Boring. Until it was too late.

Finance. Capital markets, their products, their structure, their risk profile. Boring. Until it was too late.

You see the point I’m making. It’s easy to look away from numbers. The data doesn’t necessarily tell us an obvious story. And then one day, a catalyst sparks an unforeseen, if, with hindsight, predictable event, and we all wonder why we didn’t see it coming.

Something similar happened with the Brexit vote. Of course, it was a perfect political storm: an overconfident Prime Minister calls a referendum that he only needs to have to pay off his right flank, safe in the knowledge that the mainstream voters and the leadership of the Labour party will carry him through. Except he forgets that there is someone more despised than even his right flank - him. 

But beneath all of that, the Brexit vote revealed a divided country. Between those who felt that Britain as it was before the referendum offered them a decent enough – if imperfect - future, and those who felt it offered them nothing of the sort. 

Could we have seen it coming? Perhaps we could. Take two graphs.

Real wages are still, today, on average below what they were in 2008, nearly a decade ago. At the point of the referendum, average wages were yet to return to the level they hit eight years earlier. The difference between real and nominal wages is inflation. People have watched prices steadily drift up while their wages have remained stubbornly flat. Not an overnight shock, but a long drawn out crisis all the same.

Vast numbers of pensioners (over 60 per cent of them) voted to leave the European Union, and pensioners incomes have not seen the same fall as incomes for the working age population (in fact they rose by 19 per cent in real terms in the last 10 years). But it is important not to overinterpret the data with hindsight. After all, there are nearly 32m British people of working age. That surely should have been enough to carry the vote, had far too many people had so little reason to back the status quo.

In the years running up to the crucial Brexit vote, the economy was, by and large, moving ahead. But in the case of the most crucial, most noticeable, economic transfer - a person’s wages - the economy was not moving ahead at all. In fact between the crash and the 2015 general election, wages largely only fell, and since then, pay has struggled to make up ground, against a picture of an otherwise ‘growing’ economy.

Worst of all - nearly 4m households in measurable (and therefore known) poverty include someone at work. Of the 17m Brexit voters, some were wealthy retired voters who always hated Brussels. But how many more simply had too little to lose, and couldn’t stand David Cameron?

The problem with all this though, and the reason we didn’t see it coming, is that no one’s life is a graph. I mean, we are all data points. But no one feels like a data point. And people are notoriously bad at providing logical, graph-like, mathematical reasons for their political judgements. "My individual wages have failed to keep pace with growth in the economy at large," said no person on no doorstep, ever. Unhappiness with what is on offer manifests itself in lots of different ways but it isn’t likely to be an analysis of the macro-economy.

We all know of course that people are much more likely to connect with politics (and politicians) emotionally. That is how we make our choices. But our emotions are informed by the facts of our life and are responses to the facts we see. So, whilst the graphs above cannot tell us all we need to know about why Remain lost, they do tell us about some facts likely to impact on the choices we make.

The challenge is to work out how we can change the trends shown on the graph, and how this in turn will affect those who lost out over the past decade. What can be done to repair the link between economic growth and economic growth for all?

This challenge is to create "inclusive growth". Or as I think of it, making sure there is a hard chain which links growth in the economy overall to the growth of wages and incomes of the many. When the country rises, so must all within it.

The hard links in the chain are what should have kept our country together. They are the rules that should have meant that the British economy doing better meant individuals, families, towns, cities all doing better too. You can see from the graphs above that the rules worked between 1997 and about 2005. Our country grew, and we all grew in capacity with it. But then the model stopped working. And 11 years later people were asked to vote for the status quo, even though the status quo was clearly failing the many.

We will never be able to see the trends until it is too late. We need rules that shape our markets, including the labour market, to achieve an outcome that people can see and feel in their pockets. Analysis of the past is only any good if it can help shape the future. 

It’s not enough to say that somehow our economy is rigged against people, as if this was one great fiddle. Rather, we should remember that policy choices have consequences. 

Now some people suggest that the correct response to falling wages, and precarious work, is some sort of universal benefit, or citizens’ income. But recent Fabian Society research demonstrated that the vast majority of people – about 80 per cent - feel positive about their work even despite the story told here about wages. So even if it were practical for government to raise taxes in order to transfer something in the region of the state pension to every person in our country, it hardly seems like it would be popular. 

If people, in general terms, actually like their work, the problem is then making sure they get paid enough and get promotions. It means recognising what the past decade has taught us: that the growth of the economy must mean economic growth for all within the economy, or else there will be consequences.

So, the question remains: what are the hard links in the chain between the economic growth of the country as a whole, and economic growth of the people, families and towns within it?

Unfortunately, this is where the boring stuff still matters. You can get paid more if you have better prospects. That means a buoyant labour market, and the skills to participate in it.

Now the government say that they are addressing the challenges in our economy by investing in infrastructure, through an industrial strategy. And along with buzzy new ideas like universal basic income (where citizens are guaranteed a certain income), everyone in politics loves announcing campaigns for new railway lines (me included). Trains are big, fast, expensive and showy. But travelling to work by train tends to be the preserve of those who already have a high-skilled job and are commuting some distance. We should worry a little more about those who get the bus to work.

Then take those who work in low-pay sectors like care, retail, hospitality, or construction. Each sector has its own challenges, but one thing that unites of all these sectors is the likelihood of people working in them to be working below their potential skill level. Hopefully our new metro mayors will be able to provide better education opportunities for those at or near the minimum wage. But what about in those areas without mayors? Do they fall even further behind? Skills transfers matter much more for future growth than a massive financial transfer like universal basic income.

And in case anyone should think that I have forgotten, with less than 15 per cent of people in the private sector represented by a trade union, it is little wonder that workers have insufficient power to command better wages. Our labour market leaves too many people on their own, without the strength of collective bargaining to get them a good deal.

Universal basic income fails for another crucial reason. It would fail for the same reason that tax credits were economically effective but open to political challenge. For most people, the part of government, of the state, that they wish to defend are the things they can see, they can touch, emotionally engage with. The hospital their child was born in, that cared for a sick parent, the school they went to, the park they played in with their grandchild. They prefer to earn their wages, and do a job they enjoy. Transfer payments from the state are always harder to defend, as the history books attest. 

So for me, truly inclusive growth means making the most of the institutions we already have – colleges of further education for example – and building new ones like universal quality childcare. Many members of our workforce are prevented from returning to work after the birth of a child, simply because of the cost of childcare. Universal free childcare would allow many more women to go back to work or have the time to gain more skills, should they want to. Moreover, good quality childcare would benefit all of our children by narrowing the attainment gap. These hard links in the chain - the links that ensure that growth in Britain involves economic growth of all of those people and places within it - are, in fact, the institutions of the state. 

These are the platforms Labour governments have built for ordinary people to stand on. But these are the very institutions under attack from current government policy. If we’re going to rebuild the chain, then the government must change tack. We need to develop new ideas and solutions and the all-party parliamentary group on inclusive growth can be a place to bring people together across the party divide. Theresa May has spoken about an economy that works for all. Now’s the time to protect the institutions that can deliver that economy and inclusive growth, before it is too late.

The APPG on Inclusive Growth's 'State of the Debate' event with the OECD, World Economic Forum, RSA and IPPR is on Tuesday 21st February at 6.30pm at Parliament. See www.inclusivegrowth.co.uk for full details.

Alison McGovern is Labour MP for Wirral South.