Stay off the drugs kids

Growing up in Europe where psycho-analysis is far more influential than psychology, I didn’t come across many people advocating medication for most bouts of depression or anxiety.

In Australia though, it strikes me that medicating depression is increasingly common. This concerns me. I am particularly concerned by the tendency to medicate someone at the first sign of depression, and the increasingly widespread pop-psychology belief that depression is caused by chemical imbalances in the brain (note that I am specifically referring to the pop-psych theory and not the actual psych theory, which is much more nuanced).

Chemical imbalances are often a symptom of psychological distress, not the cause. Medicating someone may return them to something more approximate to ‘normal’ functioning, but in many cases the underlying environmental or ‘spiritual’ cause of the neurosis remains. In such cases the individual will remain unhealthy no matter how long they stay on the medication. If the medication is then removed, the individual will slip back into depression.  Medicating depression in such cases is thus akin to medicating someone with the flu and a poor immune system with paracetamol. The severity of the symptoms will decrease but they will still have a virus. Moreover, the depression may lead them to behave as though they are cured when in fact the illness remains.

In many cases of depression, especially where teenagers are concerned, the depression is the body’s way of telling you that something is wrong. If you medicate away those signs, you can no longer tell whether something is still wrong or not. The symptoms of depression must be allowed to remain until the patient has worked through the psychological causes (as opposed to the chemical causes) of the distress, otherwise they may arrive at an incomplete resolution of their neurosis.

Obviously there are qualifiers to this. In cases where a sufferer is exceedingly non-functional or engaging in self harm, medication must be administered. But this is to return the patient to a degree of functionality where they can engage with the psychological source of their distress. Medication must be controlled so that it merely tames the symptoms rather than covering them up outright.  

The theory of chemical imbalances and quick medication is causing a great deal of distress to people who undergo what you might call an ‘existential crisis’, which may take some months or years to resolve, but which if resolved systematically, rationally and without drugs, will produce lasting ‘spiritual’ growth. When medicated, such crises remain unresolved and can send people off the rails further down the track.

For example, I have an acquaintance who has been struggling to work through the conflict between her strongly held feminist beliefs and her desire to mother a brood. When this conflict first started to capture the attention of her unconscious she was rapidly medicated but a psychologist who made little attempt to actually engage with the issues that might be causing the distress. As a result, this particular acquaintance of mine has struggled with depression for half a decade amidst a life that is really going quite amicably: she has graduated with strong grades, met a partner with whom she has forged a strong bond, and stood on her feet as an adult. I can’t help but think that if she wasn’t being medicated all the way through she might have been less capable of juggling all these competing demands, but she would also have a nuanced and refined understanding of her feelings towards marriage to a man and the war on men. I wonder what is more important: sound mental health and a conception of one’s identity and purpose, or staying on the socially prescribed timeline of career and personal development.

Another case concerns a girl I know in Sydney who was a top honours student but has gone off the rails a bit during her PhD. After a split with a long-time boyfriend to whom she was subconsciously betrothed she descended into a minor bout of depression. Unfortunately, she was medicated at this point and has continued to have background feelings of insecurity and aimlessness. If she had simply been left to explore the raw, negative emotional space and work through it rationally, she may have overcome the existential crisis that her break-up precipitated in a matter of months and now be back on the affirmation trail.

It strikes me that modern psychology often assumes that whatever we were doing before we got depression constitutes our ‘normalcy’, and that curing someone of mental illness simply involves returning them to a state in which they can continue with those practices. But surely it is obvious that something about those practices led to the depressive episode. Whatever that was must be cured, not simply the chemical imbalance that it precipitated.

I don’t deny that in some cases there really is just a chemical error (manic depression, for example), but I imagine that these cases present themselves at an early age. Late onset mental illness must, in the majority of cases, relate to existential factors.

If we deny the role of existential factors we often take the responsibility for overcoming depression out of the hands of the person affected. I once remarked to a friend of mine that a mutual friend had been on medication for several years and was still depressed despite the fact that, to my eyes at least, the existential causes of the depression were quite obvious. He replied that it was a chemical imbalance so what could she do about it.

Surely this is a ridiculous attitude. We are not slaves to our chemicals. History is littered with examples of people who have experienced depression and worked through the issues in question. At one point there was not a chemical imbalance, now there is one. What caused the change? Identify it, work on it, resolve it.

Perhaps part of the problem is that people tend to see psychologists who are educated in what constitutes ‘normal’ behaviour, rather than counsellors or psychiatrists who are more interested in talking and personal growth. Psycho-analysis grew out of a combination of the medical and philosophic-religious tradition. It is concerned with existential health as much as it is with psychopaths and other behavioural deviants. This is particularly true of the psychoanalysis of Frankel, Jung and Fromm, though not so much of Freud. Unfortunately, Freud is much more popular and well-known in Anglo society. Psychology has a different origin and remains focussed on behaviour rather than the agent undertaking the behaviour.

I should acknowledge that I am neither a psychologist nor a psycho-analyst, though I have read somewhat extensively in the latter. Perhaps this disqualifies me from commenting.  I do find this argument somewhat compelling, which is why I have refrained from writing this piece for several years. In the end I decided that my 4 and half years with depression qualify me to write a brief opinion piece on the matter. I do not say this as some kind of emotionally aggressive counter to any arguments against my position here. I always welcome sensible criticism. I merely thought it important to point out where I am coming from, mostly to demonstrate that I am not insensitively lambasting depressed individuals for not taking more control over their lives.

Inevitably, most sensitive teenagers will go through a period of depression. It is almost a part of growing up. In some cases the issues involved will be more or less complicated. As a society I think it healthy for us to support people and give them all the time they need to work through these periods of mental unrest. I don’t think that medicating them so they can ‘get on with it’ constitutes support. I think it is akin to sweeping things under the rug. It is also a reflection of the Anglo world’s aversion to the serious, dark and sad parts of reality. We would rather ignore and cover up the signs of negativity than actually root out the causes of that negativity. On the rare occasions when we do speak about the darkness, went tend to make depression into a fad item. Recently, especially since ‘Skins’ became popular with the kids, it has been ‘in vogue’ to be depressed; as though your life was meaningless unless you had a reason to feel suicidal.

As a final curious note on this issue, I want to mention an article I read about a man with an unusually high and ‘deviant’ sexual appetite who was medicated with Prozac. In interview years later, he noted that the Prozac made him very ‘normal’. He became more productive at work and was promoted. His friends found him easier to get along with. He was better able to control his sexual urges. But he also stressed that he didn’t consider any of his sexual urges unhealthy in the first place (and nor did society: they were not at all criminal) and had only agreed to see a psychologist on his wife’s insistence. He noted that while he was more ‘normal’ he felt less himself throughout his time under medication and more unwell. Eventually he came off the drug, left his wife, moved town and started afresh. He said he has never regretted the decision. Perhaps ‘normal’ behaviour should not be our goal when treating people with depression but rather, a strong sense of self-esteem and self-directedness.

Victor Frankel’s school of psycho-analysis—logo-therapy—begins from the premise that all neurosis is the manifestation of disconnect between the value structure the patient has built up through which to gauge their self-worth, and the reality of their life. If you medicate someone so they can behave in conformity to their original value structure that may be an effective cure. But Frankel points out that it is often far more effective to investigate whether the value structure was healthy and/or compatible with the patient in the first place.