Depression: A Medical or Existential Condition?
Not so long ago GPs, in particular and, with some justification, were criticised for failing to notice that some of their patients presenting with physical symptoms were actually suffering from what came to be diagnosed as ‘clinical depression’. In Sick and Tired: Healing the Illnesses Doctors Cannot Cure (Phoenix 2006), Dr Nick Read for instance, effectively demonstrated that severely emotionally confused states were often a cause of real, not just imagined, physical symptoms.
Now, apparently, the wind has changed direction and many practicians are diagnosing clinical depression instead of giving the attention they might to what may be the symptoms of real disease. My own recent experience serves as an example. Painful symptoms led to a diagnosis for which there was clear evidence from MRI of a physical lesion. Rashly, I mentioned to my GP and the appropriate consultant that the symptoms and were making me abnormally depressed. Both of them supposed that my depressed state was a factor aggravating the symptoms, whereas I had no doubt – having reason to believe I know myself well – that a primary cause of my emotional state was the physical condition!
Modern society might be better served, I suggest, if we were to acknowledge that a depressed mood, however mild or severe, is essentially not a medical but an existential condition. Unnecessary confusion seems to have arisen because some of its ‘symptoms’ can often be relieved by psychotropic drugs, including alcohol and so on, thus providing an opportunity for patients’ natural powers of recuperation to ‘kick in’. Unfortunately, as many contributors to the Critical Psychiatry Website have made clear, such drugs, however effective in alleviating symptoms, mask the real causes of the depressed state — with the result that those causes remain hidden.
Pace those who maintain a belief in endogenous depression, all depression is caused by something, however difficult establishing the causes may prove — made worse by the fact that only the patients can discover the causes, however much and whatever the quality of help they may receive. Severe existential depression and not just what we may call ‘fedupness’ is essentially a healthy reaction to finding oneself a citizen in a morbid society.
It was in the 11th century CE that Hai Gaon stated, ‘What we are suffering from is life; and the only cure is death.’ What a pity the Department of Health and the other ‘Defeat Depression’ enthusiasts have yet to realise that!