Depression is meant to signal something is in need of remedy.
By PATRICK CHISHOLM
CHRISTIAN SCIENCE MONITOR
If Prozac had been around when Michael Jordan was in high school, would he still have become a basketball star?
As a sophomore, Jordan was crestfallen after failing to make his high-school basketball team. Determined to shake off his anguish, he worked diligently to improve his game. The rest is history, but who knows if history would have taken a different course had Prozac or some other antidepressant (assuming they really work as advertised) made Jordan content to accept that he did not make the team?
Mental pain exists for the same reason physical pain exists: to signal that something is wrong and needs remedying.
Writing in the Journal of Affective Disorders, behavioral biologists Paul W. Watson and Paul W. Andrews suggest that depression plays two positive roles: (1) focusing limited cognitive resources on planning ways out of complex social problems, and (2) motivating family, friends and others to assist the affected person in solving the problem. The capacity for depression would not have evolved unless it conferred net benefits, argue the authors.
They posit that "anti-depressant medications risk handicapping the client's ability to navigate and control their social environment; this could, in the long run, hinder the depressive from making key improvements in quality of life." Their hypothesis "suggests that drugs should not be given unless the causative social problems also are being addressed, and that drugs not be allowed to emasculate the ruminative and motivational functions of a potentially adaptive depression."
This could explain the paradox that antidepressants, especially among teenagers, actually may sometimes result in suicide.
OK, admittedly, telling people to lay off the Prozac is easy for me to say since I've never been diagnosed with clinical depression. Were that to change, perhaps I would acquiesce to the stuff. But would I be doing myself good?
Conventional medical belief says that depression is a disease, deriving from a chemical imbalance in the brain. Paul E. Herr, author of "Managing the Tribe," echoes the claim of Watson and Andrews: "The most damning evidence against the chemical-imbalance theory is disarmingly simple -- the fact that we can feel depressed in the first place means depression must have a purpose."
Tom Cruise has a point. Recently the actor famously told "Today" show host Matt Lauer that drugs are not the answer to treating depression.
Lending credence to Cruise's assertion is a three-decade-long study by the World Health Organization, which found that recovery rates of people with schizophrenia are typically far better in poorer countries than in richer ones such as the United States. "The astounding result calls into question one of the central tenets of modern psychiatry: that a 'brain disease' such as schizophrenia is best treated by hospitals, drugs and biomedical interventions," stated a recent Washington Post article. The researchers concluded that the stronger family ties in poorer countries must have a profound impact on recovery. And anti-psychotic drugs that treat outward symptoms may actually exacerbate social withdrawal, it was pointed out.
When is it OK?
So, are there times when medication should be used to treat depression?
To answer this question it is useful to look to the field of evolutionary psychology. Our minds and bodies were designed for hunter-gatherer societies, since that's where we evolved. While depression may yield benefits in hunter-gatherer societies, the vast complexities and complications of modern society may prevent those benefits from ever occurring.
"Managing the Tribe" author Herr argues that depression and elation are the powerful emotional incentives that were crucial for successful hunting, warfare and communal living back when humans lived in small tribal groups of roughly 50 members. There was one homogeneous culture. The priorities of the group, he writes, were known, understood, and respected by all. "Depression could be easily avoided by achieving proficiency in one, or more, of the tribe's main survival skills. Ignoring the tribe's priorities would result in a corrective response from the culture-enabling system -- shame and depression."
But modern society is a mishmash of many subcultures (work cultures, family cultures, teen cultures, pop cultures, religious cultures, etc.) that did not exist in primitive societies. A person is a member of many such subcultures, but their priorities often conflict with one another. The result, opines Herr, is a hodgepodge of contradictory achievement goals. "This situation can lead to chronic, disabling depression in which the depressed person has no idea why he/she is being punished. In this case, there is no referent for corrective action."
The challenge for psychiatrists is to figure out when depression can be alleviated through behavioral changes.
But from what I gather, physicians don't spend much time on that. By doling out pills for normal human blues, they may be removing a key motivator for personal betterment.