An Australian psychiatrist, writing in the British Medical Journal, has said something many of us think but are nervous about expressing out loud, writes John Waters.
Prof Gordon Parker believes that the concept of "depression" has got out of hand. Doctors are diagnosing as depressed people who are merely "unhappy". A low threshold for diagnosing clinical depression risks treating normal emotional states as "illness", he argued. Prof Parker was challenged in the same edition of the publication by a fellow Australian, Prof Hickie, who said that diagnosis and treatment of depression had led to a reduction in suicides.
One of the ridiculous aspects of our media society is that, when two such distinguished experts disagree on a subject with potential implications for everyone, most of us have to stand silently by. To make any kind of statement on such matters requires some form of "expertise" which must be flagged in advance of any intervention by the waving of credentials.
But it must be obvious to most 10-year-olds that Prof Parker is talking sense and Prof Hickie talking through his hat. The number of prescriptions issued for anti-depressants is growing in the UK at the rate of about 6 per cent per annum, while suicide rates have remained static at a high level for at least a decade. The same is undoubtedly true of this country.
Virtually every newspaper report about suicide nowadays cites depression as a major cause, implying that those who take their own lives do so because they suffer from some perhaps unrecognised clinical condition.
Some years ago, the leading Irish psychiatrist and then chairman of Aware, Dr Patrick McKeon, spoke about the nature of what is called depression. "Human beings, to live with themselves," he said, "actually have a natural infusion of positive perspectives on things, and that enables us to keep going in life. When that's taken away, that's actually called depression . . . if anyone is really involved in life they are going to get depressed at some stage or other in their life. To anybody who says they don't get depressed . . . I say, are you really that switched off."
Life can be tough. Bad things happen. We feel let down, sad. Sometimes we feel sad for no apparent reason. St Thomas Aquinas defined sadness as "the desire for an absent good". In a society that persistently seeks to deny a higher meaning, it is not surprising that more people feel more and more sad, but we dispose of the evidence of our vacuity by defining them as "depressed".
There may be a moral dimension also, which again I require to cite an expert in order to outline. In The Frivolity of Evil,one of the superb essays in his collection, Our Culture? What's Left of It,Theodore Dalrymple addressed the matter of what our societies term depression, which he argues has eliminated "the word and even the concept of unhappiness from modern life". Dr Dalrymple worked for 14 years as a psychiatrist in British prisons and mental institutions, retiring in 2004.
"Of the thousands of patients I have seen," he wrote, "only two or three have ever claimed to be unhappy: all the rest have said they were depressed." This semantic shift is deeply significant, for it implies that dissatisfaction with life is itself pathological, a medical condition, which it is the responsibility of the doctor to alleviate by medical means. Everyone has a right to health; depression is unhealthy; therefore everyone has a right to be happy (the opposite of being depressed). This idea in turn implies that one's state of mind, or one's mood, is or should be independent of the way one lives one's life, a belief that must deprive human existence of all meaning, radically disconnecting reward from conduct.
He wrote about one patient, a woman who had lived a life of, to any objective assessment, outright misery. Having been raped as a child by her mother's boyfriend "with the mother's full knowledge", she had herself chosen as lovers a succession of highly violent men, who had left her with three children. As a psychiatrist, he met many such women, who had chosen men "who had their evil written all over them, sometimes quite literally in the form of tattoos saying F*** Off or Mad Dog".
Such horrors, according to Dalrymple, are the inevitable consequence of a culture of ideas in which the notion of personal responsibility has been eliminated. An "unholy alliance" between left-wing liberals and right-wing free-marketeers has made "a long march though the minds of the young", elevating non-judgmentalism to the highest value and dispensing with ideas of personal responsibility in favour of total "freedom to choose". When the individual chooses badly and encounters unhappiness, we decide she has become ill. Dalrymple's only cause for optimism "has been the fact that my patients, with a few exceptions, can be brought to see the truth of what I say: they are not depressed; they are unhappy and they are unhappy because they have chosen to live in a way that they ought not to live, and in which it is impossible to be happy".