The internet has been abuzz over the last few days over something called Project Semicolon: A nonprofit movement that aims to help those struggling with depression. And it is not just Project Semicolon which helps us deal with our woes and sorrows, one simply needs to type ‘depression’ on the Google search bar to know all that’s developing on that front. An impromptu search currently churns up headlines like these for the author: ‘study finds link with prolonged depression and brain shrinkage’; ‘eight things you don’t need to say to someone who’s battling depression’ and ‘a comedian who turned to the stage to find relief from depression’. For someone who suddenly stumbles on the ‘depression’ scene, it would seem as though Earth’s most intelligent species is battling a depression epidemic.
According to a 2012 WHO report, depression is a global crisis, the world, has become a sad place. The report has some ‘anxious’ revelations to make:
♦ Almost a million lives are lost yearly due to suicide, which translates to 3,000 suicide deaths every day.
♦ One in ten people suffers from major depression and almost one out of five has suffered from this disorder during their lifetime.
♦ Unipolar depressive disorders have been ranked as the third leading cause of the global burden of disease in 2004 and will move into the first place by 2030.
And so on and so forth. The statistics speak of a ubiquity of this term we know as depression. Is it what philosophers call the human condition? An essential part of human existence? Clearly, there is more to it, there has to be. But, how do we differentiate between depression— that grim medical condition—and sorrow, gloom, grief and melancholy? People are bound to experience losses in their life. Relationships fall apart; people lose their jobs and millions experience economic hardships.
The concept of stress is more pronounced in the modern world than ever before. Rapid change of environment, displacement, technological advancements and the society’s growing expectations from an individual, all trigger a feeling of lack of control over one’s surroundings and life. But when do these everyday issues sum up to create an ailment called depression? And is depression really an illness or is discontent now being treated as a diagnosable condition?
The first of these concerns is aptly summarised by practicing psychologist Ranjana Kar: “It is truly difficult to determine and define depression in a rigid manner. Especially when all of us encounter rough-patches almost all the time in our lives and are often prone to depressive thoughts. How much of it is an illness and how much of it part of the normal?”
The most common method of diagnosing depression in patients is by conducting tests such as those prescribed under the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV); the Minnesota Multiphasic Personality Inventory (MMPI), and the International Classification of Diseases (ICD-10) among others. Almost all of these focus on the standard depressive symptoms of loss of interest, fatigue, drowsiness and sense of guilt and involve gruelling Q&A sessions.
Here are some randomly picked questions and pick and choose options which figure in the above mentioned tests:
♦ I have a good appetite (MMPI)
♦ I wake up fresh & rested most mornings MMPI)
♦ I am easily awakened by noise (MMPI)
♦ I work under a great deal of tension (MMPI)
♦ I wish I could be as happy as others seem to be (MMPI)
♦ In the last month, has there been a period of time when you were feeling depressed or down most of the day nearly every day? (DSM-IV)
♦ Do you have trouble thinking or concentrating? (DSM-IV)
But do these questions necessarily have to be linked to a depressive mental state which gives enough evidence to brand an individual as one experiencing a medical condition that needs treatment or medication? To understand this, sociologists Allan Horwitz and Jerome Wakefield focus their attention on professional diagnosis of depression in their book The Loss of Sadness and talk about the sudden change in the diagnosis process which came about in the 1980s with tests like DSM-III and DSM-IV, adding more symptoms to what was initially diagnosable as depression: symptoms of grief lasting a disproportionately long time so as to become dangerously dysfunctional to the patient and his or her world as to indicate pathology.
Now to this ever-evolving benchmark of what depression is and isn’t, add the complete lack of evidence to support its existing medical treatment. This is what a 2011 report on depression from the National Institute of Mental Health (NIHM), US, had to say about what causes depression: “Most likely, depression is caused by a combination of genetic, biological, environmental, and psychological factors. Depressive illnesses are disorders of the brain. Long-standing theories about depression suggest that important neurotransmitters—chemicals that brain cells use to communicate—are out of balance in depression. But it has been difficult to prove this.” Yet, it was with tremendous consistency that the report claimed that depression ‘is a common but serious illness’ and ‘most of those who experience depression need treatment to get better’.
The NIHM report is not an exception. Such a dilemma has been part of almost all talks about depression. In fact, depression is probably one of those rare ailments in the history of humanity which is not supported by strong theoretical evidence to prove that it is a disease that can be cured chemically. Almost all tests conducted by nonpharmaceutical companies have shown a negligible difference between the effects of treatment through placebos and antidepressants.