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Surviving America's
Depression Epidemic

by Bruce E. Levine, PhD

How Do We Find Morale, Energy, and Community in a World Gone Crazy?

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Americans live in the age of industrialized medicine, and everyone--inside and outside of health care--is now in the same boat. Doctors are financially pressured to be speedy mechanics, and patients often receive assembly-line treatment, which can be a painful reminder of their assembly-line lives. While most Americans manage to go to work and pay their bills, more than a few struggle just to get out of bed, and growing numbers feel fragile, hollow, hopeless, and defeated.
In 1998, Martin Seligman, then president of the American Psychological Association, spoke to the National Press Club about an American depression epidemic: "[W]e discovered two astonishing things about the rate of depression across the century. The first was there is now between 10 and 20 times as much of it as there was 50 years ago. And the second is that it has become a young person's problem. When I first started working in depression 30 years ago . . . the average age of which the first onset of depression occurred was 29.5. Essentially middle-aged housewives' disorder. Now the average age is between 14 and 15."

Despite the unparalleled material wealth of the United States, we Americans--especially our young--are increasingly unhappy. What is happening in our society and culture? How is it that the more we have come to rely on mental health professionals, the higher the rates of depression? And are we in need of a different approach to overcoming despair?

During the course of our lives, it is the unusual person who does not have at least one period of deep despair. The majority of depressed people do not choose professional treatment but many do. Standard mental health treatments routinely ignore the depressing effects of an extreme consumer culture, and for people who feel alienated from such a culture, it is my experience that conventional treatments can actually increase their sense of alienation and contribute to their despair.

I am in my third decade of working with people who have not been helped by standard psychiatric treatments. I have found that while the majority of such "treatment resisters" do not identify with any political party, most share these political views: they are deeply pained by a society that focuses on increasing consumption rather than celebrating life; they believe that powerful corporations rather than individuals and communities dictate public policy; they suspect that many of those authorities and institutions--including those in mental health--that inform Americans have been corrupted and hijacked by corporations whose singular goal is increased profit; and they consider it common sense that an alternative approach that threatens the societal status quo will be ignored or derided by those who financially profit from the status quo.

I recall one such treatment resister, a middle-aged man who was dragged into family counseling by his wife because of their daughter's self-destructive behaviors. On his own, he had valiantly struggled to overcome rage and despair that he attributed to job stress caused, he said, "by a new CEO whose only loyalty is to stock share value." He made clear that he disliked manipulative managers and know-nothing mental health professionals as well as the term depression. He said, "I know what helplessness and hopelessness are, and I know what shutting down my pain is, but the diagnosis of depression is some damn shrink psychobabble." He explained that the word depression didn't do justice to his experience and only irritated him. In contrast, when I used the word hurting, it touched him deeply.

I have found that the words people use to describe their conditions lead them down certain paths. The term depression so pervades our culture that I cannot escape its use. However, when I am in emotional pain and without the energy to act constructively, I consider myself demoralized rather than depressed. Depression reminds me that I am depressing my pain and my being--this I need no reminder of. Demoralized reminds me that I am lacking morale, and morale is exactly the word I need to be reminded of when I am down in the dumps. It heightens my awareness to that which is energizing and inspiring. Morale is the emotional experience of cheerfulness, confidence, and zeal in the face of hardship. Without morale, difficult tasks seem impossible to accomplish; with morale, those same tasks can feel challenging and fun. When I think about morale, I am reminded that an individual can inspire a community, a community can energize an individual, and we can all remoralize one another.
Many people I have known who are diagnosed with depression are more gentle than the world around them. It saddens me when unhappy people who have become so despondent that they consider suicide view themselves as weak or sick. If death feels more attractive than life, it means nothing more than the fact that one's present pain feels unbearable.
There is no more scary topic for mental health professionals than suicide. In the United States, if you are considering suicide, you are not alone. In 2000 it was estimated that every year, 750,000 people make a suicide attempt. That's over 2,000 every day! The U.S. Surgeon General, focusing on mental health in 1999, reported that suicide was the eighth leading cause of death and the third leading cause of death for teenagers and that the rate of teen male suicide had tripled since the 1960s. While many Americans are reluctant to criticize our way of life, it is clear that Happy Meals are not quite doing the trick.
I have talked to many extremely demoralized adults and teenagers who have been diagnosed with depression. When we humans are seriously depressed, no matter what our age, we routinely become self-absorbed. While depressed adults can pretend to care about another's presence, depressed adolescents are usually more genuine, and their self-absorption is often straightforward. Adolescents' blank faces and one-word replies make clear the futility of my probing. When I stop torturing them with questions, they usually stop torturing me with nothingness.
In reflecting on the empirical research on depression, on my work with depressed people, on the memoirs and essays of people who have experienced depression, and on my own personal experience with demoralization, immobilization, and despair, it is difficult to deny the power of faith and belief--what scientists term "expectations" and the "placebo effect." In a 2004 study on the influence of patient expectations on the effectiveness of an experimental antidepressant, it was found that among depressed patients who expected that medication would be very effective, 90 percent had a positive response; while among those expecting medication to be somewhat effective, only 33 percent had a positive response. No depressed people were included in this study who expected the experimental drug to be ineffective, but such nonbelievers rarely tell me about having a positive response with antidepressants.
It has been my experience that to the extent that one has faith in the efficacy of any treatment or approach, one's likelihood--at least temporarily--of overcoming depression increases. By contrast, an absence of faith in anything is associated with chronic depression. People can choose to have faith in religion, philosophy, art, dietary supplements, or exercise. I have seen many different belief systems work to reduce despair. However, I do not advocate that you believe in anything for the sake of belief. What we believe in matters a great deal. The beliefs we choose determine in no small way what kind of people we are, what kind of friends we have, and what kind of effect we have on society.
The faith encouraged by consumer culture is a faith in money, technology, and consumer products, and it is a faith that often has significant adverse side effects, including addiction and withdrawal. Americans who don't share the faith of such a culture will likely feel alienated from society, and alienation--from either one's humanity or one's surroundings--is painful and can be a source of depression.
In the United States, mental health treatment is increasingly shaped by two powerful industries: giant pharmaceutical companies, often collectively referred to as Big Pharma, and insurance companies (and their managed-care bureaucracies). It is in the best interest of Big Pharma if people are prescribed drugs, and it is in the best interest of insurance companies if treatment is extremely brief. In addition to encouraging doctors to prescribe drugs, insurance companies also pressure psychotherapists to focus narrowly on what is easiest to do in a few sessions. Commonly, this means teaching "rational thinking" and "social skills." Ironically, these simplistic techniques require little in the way of a therapeutic relationship and can be learned through a book. Prior to the current era, psychotherapists were free to choose among many options. For example, one therapy--now threatened with extinction in the time-pressured world of managed care--consists of helping depressed people find meaning in their lives. Once, it was routinely accepted that meaninglessness was an important source of depression, but today, managed-care time restraints have resulted in denying and ignoring this reality.
Historically, the mental health profession has been a joke of sorts when it comes to morale boosting. Specifically, I recall the old joke: "How many psychiatrists does it take to change a light bulb? Only one, but the light bulb must want to change." Even before the time pressures of the managed-care era, many mental health professionals were quick to abdicate responsibility for patient immobilization. Today, most of them spend little time being frustrated. They simply write a prescription or refer to a drug prescriber. The new joke--not quite as funny--is, "How many psychiatrists does it take to change a light bulb? Only one, but the light bulb must be medication compliant." If you are immobilized and behaving self-destructively, I don't assume that you are irresponsible or in need of medication. One strong possibility is that you are not around anyone--even if you are seeing a mental health professional--who has the capacity to energize you.
What about the craft of healing? Mental health professionals increasingly view themselves more as technicians who provide medications and skills rather than healers who care about wholeness. Despite that, relationships still do occur in psychotherapy, and occasionally, sometimes even accidentally, so does healing. However, in our timepressured era, even more prevalent than simplistic therapy is a procedure called medication management. A typical "med management" session consists of checking symptoms and updating prescriptions, and recipients tell me that they are usually in and out with a new prescription in ten or fifteen minutes. They also tell me that it's common for med managements to be scheduled every two or three months, and that during these appointments, the doctor often needs to peek at their files to remember their names. In such assembly-line treatment, there is virtually no chance of a relationship forming, and gone is even the accidental possibility of healing through another's humanity.
In the training of mental health professionals, the revitalizing component of reviving community is all too often neglected. There is no greater antidepressant than focusing beyond one's private sphere to a societal concern. Whatever the scale, mental health professionals need to encourage community building of some kind. People who engage in life-affirming change have a greater chance to connect with like-minded others, and they are rewarded with greater vitality.
My conclusion is that standard psychiatric treatments for depression are, for many people, unsustainable. The latest research shows that antidepressants often work no better than placebos or no treatment at all, can cause short-term and long-term adverse effects that may be as or more problematic than the original problem, can result in drug tolerance (an increasing need for higher dosage), and can promote dependency on pharmaceutical and insurance corporations. Moreover, antidepressants and other mental health industry treatments divert all of us from examining the unsustainable aspects of society that create the social conditions for depression.

Excerpted with permission from Surviving America's Depression Epidemic by Bruce Levine, published by Chelsea Green. Available in stores or visit www.chelseagreen.com


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Related Info:
Ed Bauman, PhD on combating depression with diet & lifestyle
Are You Depressed or Just Human?
Daniel Goleman, Ph.D., on emotions and your health
Cognitive Therapy
Being the Change We Seek
Marci Shimoff on being happy from the inside out
Creating a Life of Material and Spiritual Abundance
Learning Universal Responsibility

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