There exists a disease that has the potential to affect each and every one of us. The incidence of this disease has increased ten-fold during the last century, and it is rising unabated. It can come in varying degrees of intensity, and it can be deadly in 15 percent of cases. It seems to strike women more often than men. There are various types of treatments that can provide relief, but there is no cure. It can strike the average person, but it has also been known to strike the wealthy, the famous - even world leaders have been afflicted. According to the World Health Organization, it is the 4th leading cause of disease burden in the world. By 2030, it will probably become the second leading cause of disease burden. This is a silent and insidious epidemic, the likes of which has no precedence in human history; chances are that you know somebody who has been affected. The disease is clinical depression.
Clinical depression is very different from the sadness one experiences from time to time. To illustrate an extreme case, I have provided the following passage from the June 1998 edition of Scientific American; it's a quote from the memoir of American novelist William Styron:
"He [a psychiatrist] asked me if I was suicidal, and I reluctantly told him yes. I did not particularize--since there seemed no need to--did not tell him that in truth many of the artifacts of my house had become potential devices for my own destruction: the attic rafters (and an outside maple or two) a means to hang myself, the garage a place to inhale carbon monoxide, the bathtub a vessel to receive the flow from my opened arteries. The kitchen knives in their drawers had but one purpose for me. Death by heart attack seemed particularly inviting, absolving me as it would of active responsibility, and I had toyed with the idea of self-induced pneumonia--a long frigid, shirt-sleeved hike through the rainy woods. Nor had I overlooked an ostensible accident, a la Randall Jarrell, by walking in front of a truck on the highway nearby.... Such hideous fantasies, which cause well people to shudder, are to the deeply depressed mind what lascivious daydreams are to persons of robust sexuality."
If you are a depressed person, the world seems grey and remote. You feel that you are powerless. There is no point in washing or looking after your appearance, and no point in even getting out of bed in the morning. You take no pleasure in anything in life; sex, a pay rise, a party or a fine meal give you no joy. You feel imprisoned in a dark colourless inner world, and the exuberance and brightness of youth seems light years away.
Australia's Beyond Blue website lists the following behaviours associated with depression:
* moodiness that is out of character
* increased irritability and frustration
* finding it hard to take minor personal criticisms
* spending less time with friends and family
* loss of interest in food, sex, exercise or other pleasurable activities
* being awake throughout the night
* increased alcohol and drug use
* staying home from work or school
* increased physical health complaints like fatigue or pain
* being reckless or taking unnecessary risks (e.g. driving fast or dangerously)
* slowing down of thoughts and actions.
What's the cause of this disorder? Ask a group of average people this question, and there's a good chance that you'll hear the words "chemical imbalance in the brain" mentioned on more than one occasion. Some might even throw in the word "genetic". There has been a lot scientific research into depression. Brain imaging has shown that depressed people have underactivity in the side-section of the frontal cortex (the part of the brain concerned with generating actions) while the middle part (the part which generates conscious emotion) is overactive. This means that the depressed person is without drive or will to do anything, yet is fixated on their emotional state. Great! We have just used sophisticated brain imaging technology to help us to state the bleeding obvious. What else do we know?
The June 1998 edition of Scientific American talks about a disorder in the hypothalamic-pituitary-adrenal (HPA) axis - the system that manages the body's response to stress:
"When a threat to physical or psychological well-being is detected, the hypothalamus amplifies production of corticotropin-releasing factor (CRF), which induces the pituitary to secrete ACTH. ACTH then instructs the adrenal gland atop each kidney to release cortisol. Together all the changes prepare the body to fight or flee and cause it to shut down activities that would distract from self-protection. For instance, cortisol enhances the delivery of fuel to muscles. At the same time, CRF depresses the appetite for food and sex and heightens alertness. Chronic activation of the HPA axis, however, may lay the ground for illness and, it appears, for depression."
This can explain why persistent anxiety, stress and despair can lead to depression. SSRIs (Selective Serotonin Reuptake Inhibitors) are sometimes prescribed to people with depression, and they return CRF levels to normal.
There are other theories, and there is also the suggestion of a genetic cause - although no gene has yet been identified.
Brain imaging and other scientific research can give us a good picture of what is going on in a depressed person's brain, and it can lead to more effective treatments. But how do we explain the growing rate of people suffering from depression? Here's an interesting statistic from U.S psychologist Professor Martin Seligman: For a person born around World War 1, the lifetime prevalence of severe depression is 1%. For a person born around World War 2, the lifetime prevalence is 5%. However, if you were born in the 1960s or later, the lifetime prevalence of severe depression appears (so far) to be 10-15%. But wait, there's more: 2 generations ago, if you became depressed, your first bout was likely to be at around 35 years of age. Today, the mean age for the first instance of depression is 14.
Yes, a depressed person may have "chemical imbalances in the brain" and the disorder can be triggered by emotional trauma, and, yes, some people are genetically more susceptible to depression than others, but these figures cannot be explained by neurobiology or genetics. And I don't believe that they can be explained by factors such as air-pollution and nutrition; although it is suggested that diets low in B-complex vitamins and omega-3 fatty acids may contribute to the problem, I don't believe this is a major factor. My opinion is that modern society is the main contributor: a society that threatens to isolate and marginalise the individual.
In 1970, Philip Slater wrote in "The Pursuit of Loneliness" that Americans "seek a private house, a private means of transportation, a private garden, a private laundry, self-service stores, and do-it-yourself skills of every kind. An enormous technology seems to have set itself the task of making it unnecessary for one human being ever to ask anything of another in the course of going about his daily business" Slater goes on to say that even within families there is a feeling that "each member should have a separate room, and even a separate telephone, television, and car when economically possible. We seek more and more privacy and feel more and more alienated and lonely when we get it."
Today, many of us (myself included) can say that we do not know many of our neighbours. We occasionally hear of elderly people who die alone in their homes, with their bodies lying undiscovered for months or even years. When a person goes on a shooting rampage, reporters interview the neighbours and ask what the killer was like. The answer is typically something like, "He was a very quiet person ... he pretty much kept to himself." Dear reader, I say that many of us are more alone than we might like to be. Even within the family, TV, DVDs, radio and Internet take up the majority of our evening hours, leaving less time for social and emotional talking; our children become like strangers in our homes.
Outside of work and home/family life, many people have nothing else. In the U.S sitcom "Cheers", the theme song says, " ... sometimes you want to go, where everybody knows your name, and they're always glad you came ... ". Traditionally, all great civilizations had their informal gathering places: the piazzas of Italy, the pubs of Britain, the beer gardens of Germany etc. - places where people would gather, gossip, and talk freely. These days, just as the cinema and theatre have been usurped by TV and DVDs, people prefer to spend an evening at home to a night at the pub. There is also a lack of places for children to hang out in the suburbs. Meeting and chatting to real people has become more difficult; even on public transport: it is difficult to strike up a conversation with a fellow train-traveller when she is listening to her iPod or has her nose buried in a newspaper or is texting on her mobile phone.
In such a society where communications are reduced, it becomes easier for people to lose (or miss out on) the feelings of acceptance, the acknowledegements of their own worth.
Consumerism also has a lot to answer for. Today, we are working harder than ever: we have to pay for our children's private educations, plasma TVs, home renovations, gadgets, the latest cars, designer clothes, jewellery, beauty products, investment properties etc. and we are influenced by a media which sells us an illusion of ourselves in order to make profits. We are urged to borrow money to fund our expensive lifestyles; we are encouraged to mortgage our homes to buy investment properties with the goal of early retirement, but we find that as our income increases, so too does our spending. Somehow, the ugly word "debt" has been replaced by the respectable word "credit". In the old days, there was a certain stigma attached to debt; today, getting credit seems to be a mark of success. I recently received a letter from my bank with the good news that, as a valued customer, I am invited to apply for a "preferred loan" at a reduced interest rate. It came with the seductive sentence, "Now you don't have to wait for the things you want". The amount of debt owed by Australians is at a record high, but we can handle it because we are working harder than ever. However it leaves little time and energy to cultivate other interests and friendships.
Depression is an extreme mental state which comes from a sense of defeat maybe due to failure or loneliness or misfortune. When an emotion like despair becomes persistent - as can occur when a person is lacking a support-base, for example - it leads to the pathological state we know as clinical depression. It is a normal human reaction to adverse conditions. I believe that the reduction in human interaction is the real cause of the depression epidemic. It seems that we humans are not suited to the selfish society that we have created.
Big corporations are worried about the epidemic of depression because it affects an employee's efficiency and performance and, as a consequence, the company's bottom-line is adversely affected. But there are treatments - drugs that can alleviate some of the symptoms, but may give some undesirable side-effects - so that the economic machine can continue to function efficiently. However, the best cure is to avoid the disease in the first place. Reduce your chances of depression by spending less time at work and "getting out there" and being more social. Do volunteer work; if you like reading, join or start a book club; if you are religious, become more active in church activities; do a language course, or any kind of course; do ballroom dancing. The opportunities are limited only by your imagination. Blessed is the person who is satisfied with the simple things in life.
Thoughts about science, human nature and other stuff.
