Darkness Visible: The Depression of George Scialabba

by Corey Robin on November 13, 2014

Many of you will know George Scialabba simply as “geo,” one of our most thoughtful, incisive, and funny commenters at Crooked Timber. You may not know, however, that George has a day job. Two, actually. One is as the manager of a building at Harvard. The other is as one of our most brilliant contemporary essayists and critics. I discovered George’s essays about a decade and a half ago, and I’ve been hooked ever since.

One other fact about George you may not know: he has been suffering from acute depression for nearly a half-century.

In The Baffler today, he has a memoir of sorts about that depression. It’s really a record of the memos, emails, reports from the various doctors, therapists, psychiatrists he has seen over the years. While I’ve read some of the memoirs/reports of depression—William Styron’s and Andrew Solomon’s—George’s collection of documents is oddly more harrowing and desperate than those memoirs. Because you see just how baffled and helpless the doctors and helping professions often are as well. Every few years, they have to reinvent the wheel, it seems, and start from scratch.

What also marks George’s piece is his attention to the political economy of mental illness and its treatment. His conclusion, I fear, will be overlooked:


Let me bring this melancholy chronicle up to date. The last record printed here is dated July 2012. Things remained bad through August and September. In early October I began a three-month medical leave of absence, with pay; I had taken a similar leave in 2005, when the depression was at its worst. Harvard has a generous provision for medical leave, perhaps because of the presence of a strong union, the Harvard Union of Clerical and Technical Workers (HUCTW). Once again, the medical leave made possible a course of electroconvulsive therapy, this one only about half as long as before.


What would have happened if I had not received those medical leaves is something I’d rather not think about. At the least, a psychological ordeal would have eventuated in a financial calamity. The combination of an enlightened employer and a strong union is one that ever fewer Americans enjoy. Universal financial security is probably the single best countermeasure to the depression epidemic. It would certainly be more effective and more humane—and even, perhaps, cheaper—than providing antidepressants and ECT.



Anyway, you should read it. Here also is a piece in the Boston Globe about it. And an interview with George, too.

{ 97 comments }

1

MPAVictoria 11.13.14 at 9:52 pm

“What would have happened if I had not received those medical leaves is something I’d rather not think about.”

This strikes me close to home. My spouse has been off work because of serious depression and anxiety for over 4 months. We are lucky that I make almost enough money to pay our bills and that we were able to save a bit of money during better times. However, mental health treatment is expensive and my benefit package in that area incredibly meager. So I spend a lot of time worrying about money and praying that our elderly pets remain healthy.

My life has been EXTREMELY difficult during this time. I have literally spent afternoons sobbing at my desk. And my spouse is, obviously, having an even more difficult time. Yet (and this is terrifying) we are relatively lucky. I have no idea how we would cope if I didn’t have a well paying job. It scares me to even think about it.

2

The Temporary Name 11.13.14 at 9:58 pm

Thanks to geo for his continuing existence.

3

Hob 11.13.14 at 10:05 pm

This is really excellent and I’ll be reading and absorbing it for some time.

I have a tiny, tangential response to one thing in the interview, maybe not worth sharing but just something I happen to know: the word “denies” in medical records (as in “patient denies suicidal ideation”) is just a term of art, a common shorthand for “the patient told me that the patient does not have”, rather than a value judgment.

4

MPAVictoria 11.13.14 at 10:37 pm

“Thanks to geo for his continuing existence.”

This as well. Very moving piece.

5

hix 11.13.14 at 11:22 pm

I agree wholeheartedly. I think ive consumed lots of medical and adminstrative resources in the last month without much positive result. All that could have been avoided if there were such a thing as an enlighted employer or unions for students. And the reason it has not been even worse is that i got a decent level of financial security. It must be so relieving to be able to talk about depression out in the public thanks to an union that ensures there are no negative job consequences.

6

MPAVictoria 11.14.14 at 12:05 am

“It must be so relieving to be able to talk about depression out in the public thanks to an union that ensures there are no negative job consequences.”

And some people here question why we post under pseudonyms….

7

Main Street Muse 11.14.14 at 12:31 am

“Plus, given the longevity of this particular demon, it seems important to try to squeeze some insight from the mass of words and array of prescription drugs applied against its havoc. “

This is a beautifully painful piece to read. Thanks Corey for linking to it. Depression is an illness as destructive as cancer, but the stigma (and lack of insurance coverage) makes it harder to treat. Kudos to George Scialabba for shedding light on his search for insight into this havoc.

MPAVictoria, I’m sorry you are dealing with such an illness in your family. It is very hard.

8

mattski 11.14.14 at 12:47 am

Bless you, geo, from a fellow depressive.

9

phenomenal cat 11.14.14 at 2:00 am

I’d like to read the links, but as I’ve just crawled out of my own void in the last year I’m afraid I’ll find them too harrowing.

Anyway, props to Geo for sharing your plight; that’s a hard thing to do. And don’t give up. I know it ain’t much, but sometimes its all we got.

10

MPAVictoria 11.14.14 at 2:21 am

Thanks MSM. I am just trying to keep moving until I can see some daylight.

11

Rich Puchalsky 11.14.14 at 5:22 am

Good wishes from me, geo, and MPAVictoria. My son is going through problems with depression, and my spouse and I are having to negotiate the medical system on his behalf.

12

Meredith 11.14.14 at 5:58 am

Rich, geo, MPAVictoria, you are not alone. Stay with it, with those you love, including yourselves. Do not forget yourselves.

13

ZM 11.14.14 at 9:10 am

Thanks Corey Robin for linking to this article. Glad to hear you are well Geo.

I think universities have improved support services for students since Geo was doing his graduate course, at least this is the case in Australian universities. Although the problem remains of how to juggle study and illness etc.

Also in Australia we have universal healthcare, and mental health is counted as part of this (although our current government wants to create a $7 co-payment and other changes, but are being stymied by the Senate). We also have a pharmaceutical benefit scheme which discounts the price of medicine quite considerably especially for concession card holders, so a medication that might cost hundred of dollars would cost the patient about $6.

A recent large change to public mental health treatment in Australia was the decision to prioritise young people. So a number of centres were set up for people under 25. This has plusses and minuses and has raised some controversy, but the idea in theory is that it will decrease the impact of mental illness over the course of the person’s life.

14

Maria 11.14.14 at 11:03 am

Sending you love, MPA. For all that virtual wishes help… But you are very loved in these parts.

And to Rich, and hix, and especially geo.

15

Maria 11.14.14 at 11:04 am

And mattski. Gods, there are so many of us.

16

Val 11.14.14 at 12:36 pm

I’m a researcher in public health, which actually makes it difficult for me to say anything, because mental health isn’t my field. But as a general thing I’d like to say this – we live in societies that have made it easy for us to be sedentary, to eat junk food, and to spend a lot of time on our own, and those things aren’t good for us on the whole – mentally or physically. I guess being alone can ennoble people in some circumstances, but for most of us, too much isolation just isn’t good for us.

Geo knows, by the sound of it, and I think many people are aware, that there is a lot of doubt about pharmaceutical approaches. I am suspicious of them, but it’s hard though because most of us haven’t experienced the depths of pain that geo – and some others here – are talking about.

In another way it sounds as if geo is someone who is nice, intelligent, sensible – and finds it hard to live in a pretty fucked up society. Maybe because he put a lot of hope in god, and that didn’t work for him – too intelligent I guess – it left him feeling a lot of despair. I guess geo might read this, so I won’t say any more in case of clumsiness, but I wish geo and everyone here well.

17

Val 11.14.14 at 12:46 pm

What I mean I guess, about geo and the others who have written here – I have read contributions from you and admired them – it’s not you that’s the problem, even though you feel the pain. I hope that knowing people care does help.

18

Widmerpool 11.14.14 at 2:25 pm

Val @16: “we live in societies that have made it easy for us to be sedentary, to eat junk food … and those things aren’t good for us on the whole”

True (I leave aside whether solitude is actually possible for most of us these days), but please be careful about turning these observations into advice. Vegan world-class athletes get depressed. Depressives tire of hearing that workouts and Whole Foods are the answers.

19

rea 11.14.14 at 2:49 pm

I’m no mental health scientist, but I’ve got 50 years of experience with depression. It seems to me that better diet and exercise can help a bit, but aren’t cures. The drugs help some, but for me at least it’s never as simple as “take drugs, stop being depressed.” It doesn’t seem to be as simple as a chemical imbalance–there seems to be a correlation for me between depression and bad things happening. And love helps a lot/em> but even that isn’t a complete cure.

20

MPAVictoria 11.14.14 at 3:46 pm

Thank you to everyone for the well wishes. They are very much appreciated.

@rea

“It seems to me that better diet and exercise can help a bit, but aren’t cures.”

Agreed. One of the few things I can do to help my partner is participate in the psychologist recommended daily physical activity with them. And it does help a bit. However, depression makes you, or at least makes my spouse, want to curl up in bed and never get out. So it has become my daily task to slowly and gently nudge the spouse out the door for our daily walk/yoga/trip to the gym if feeling particularly ambitious. This can take hours and sometimes I fail at getting them out of the house at all. :-(

“The drugs help some, but for me at least it’s never as simple as “take drugs, stop being depressed.”
This seems to be my spouse’s experience. They improved things a bit but didn’t solve the problem. We are still trying different meds though and I keep hoping one will be more effective.

“there seems to be a correlation for me between depression and bad things happening”
So true. Yet you really can’t stop bad things from happening. And when you are depressed your ability to cope is severely degraded. Things that would be minor annoyances or inconveniences other times seem much larger and more serious.

Anyway, good luck rea. I hope you feel better soon.

21

bill benzon 11.14.14 at 4:26 pm

FWIW, Nature currently has a special issue on depression and access is free:

http://www.nature.com/news/depression-1.16305?WT.mc_id=EMI_NATURE_1411_NSDEPRESSION_PORTFOLIO

22

mattski 11.14.14 at 4:40 pm

Val, Widmerpool, rea,

I want to write more about this when I have time, maybe tonight, but right now: I agree there probably is no ‘cure.’ There are things that help like exercise & good eating habits. Also, contact with people–that might be a big one. For me, I had positive results from pharma in the mid-90’s, but only for a short period of time. Since then drugs don’t seem to do anything for me. I do think it’s interesting that I sometimes pine for ‘tribal’ society, where we are seldom alone and our identities are bound up with a larger group. But that very pining is suffering…

This is for geo, and everyone of course!

23

rea 11.14.14 at 5:26 pm

good luck rea. I hope you feel better soon.

I really appreciate this, but I should add [knocking on wood] that that I’m not in a particularly bad place right now.

24

Shirley0401 11.14.14 at 5:30 pm

I’ve had some personal experience with depression, so I’ll add my $0.02 in reference to the quote below. (At long last, there’s a post on CT I’m at least somewhat qualified to comment upon, and here I am wishing I wasn’t.)
OP: “What also marks George’s piece is his attention to the political economy of mental illness and its treatment. His conclusion, I fear, will be overlooked.”
While I’m fortunate to have had only one major depressive episode (my Psych-D called it something along the lines of “trauma specific”), I suffer most of the time from diagnostically-significant level of anhedonia, and this is something I’ve always been disheartened to see adressed so infrequently. It’s as though acknowledging the impact environmental factors has on mental health is somehow incompatible with taking the medical aspects seriously. (When, of course, it’s often a case of both.)
When I spent a few months in a pretty deep hole a half-decade ago, this became starkly clear to me. If I hadn’t had a humane and relatively generous benefits package from my job, I probably wouldn’t have felt justified in seeking the treatment that ultimately made the difference for me. That’s the thing about depression — everything is compounded by feelings of shame/worthlessness in having so little control over one’s emotions, which can so easily lead to a lack of action. Which I have a hard time doesn’t sometimes lead pretty directly to even worse outcomes. Up to and including suicide. I have little doubt if I’d been working a job that provided no support, I would have felt obligated to “stick it out.” It wasn’t until I finally got intensive treatment, and started to come out the other side, that I realized how sick I’d been, and how one more piece of bad luck could probably have pushed me over the edge.
The related but separate issue of the role the larger environment plays is one I’ll leave up to people who can address it with more information and clarity than I can provide, but I 100% am in agreement with Val (@16): “In another way it sounds as if geo is someone who is nice, intelligent, sensible – and finds it hard to live in a pretty fucked up society.”
While I don’t discount the role biology plays, it’s clear from what I’ve read (and experienced) that environmental factors play a huge role in whether, if, and when a genetic predisposition translates into diagnostically significant symtoms. The fact that we *do* live in a fucked up society can’t count for nothing. So much of my own depression had so much to do with feeling disconnected and acutely aware of the fuckedupness of society. The term “hopelessness” pops up in the DSM and on the Beck Inventory. While I don’t doubt depression can lead one to feel hopeless about things that wouldn’t otherwise be of great concern, there’s also, pretty objectively, a lot going on to make one feel hopeless about an awful lot.

25

guest 11.14.14 at 6:30 pm

Isn’t there often a direct connection to homelessness?

26

Widmerpool 11.14.14 at 8:08 pm

Shirley0401, On those notes, I share Mr. Scialabba’s aversion to Feeling Good and CBT books of that ilk.

27

Val 11.14.14 at 8:51 pm

@Widmerpool
I don’t mean to suggest that that better diet and exercise are the answers. As you say, I think they can help. What I’m struggling to say – and it’s difficult as someone who doesn’t have specialist expertise, and whose own experience of depression is not of severe depression – is that social causes, or social determinants (I’m also trying not to use jargon but I think that’s a useful phrase) are really important. Individuals who suffer probably have genetic or biological vulnerability – though even that can’t be divorced from social determinants because we’re always social beings – but I think the major problem is social not individual.

The trouble is it doesn’t necessarily help people much when people like me start talking about social determinants, because society won’t change overnight. But at a simple level, being aware that we do live in a society where some people make a lot of money out of selling junk food, or playing on people’s insecurities and vulnerabilities, might at least make it easier to resist. A young person in a project I was involved in once said that junk food advertising isn’t just selling you food, it’s selling you a lifestyle in which everyone looks “hot” and is having a great time. Selling false answers. Our world is full of that. I’m not sure if CBT is entirely false, though. I think individual therapies can probably help but can only be part of the solution.

As far as my work and study in public health is concerned, I think there’s ample evidence that inequity – social unfairness – contributes a great deal to ill health, both physical and mental, so what I’m trying to do is to work for a fairer as well as more sustainable society, where people care about each other as well as the planet, and I keep trying to do that even though I sometimes get discouraged and also sometimes make mistakes in talking with people. I’m not a clinician and I don’t mean to offer advice in that sense, but so much of our health system is oriented towards the individual, when it’s more often society that’s the cause (putting it simplistically I know), that I feel I have to say something.

28

Val 11.14.14 at 8:58 pm

Also I’d like to commend what Shirley0401 said.

29

The Temporary Name 11.14.14 at 10:53 pm

Depressives tire of hearing that workouts and Whole Foods are the answers.

Depressives tire of hearing that anything’s the answer. None are complete, and the labour of charting a better path seems impossible. Some are lucky enough to have friends, relatives, workmates, and societal institutions to help them along, if not out of it. When people don’t, it’s very depressing.

Image stolen from the second part of an oft-linked comic here: http://hyperboleandahalf.blogspot.com/2011/10/adventures-in-depression.html

30

The Temporary Name 11.14.14 at 10:56 pm

And yet, I should commend the positive advice offered from everyone, all of which I think is true to a degree, and I offer sympathy to anyone who’d benefit from such a thing.

31

Origami Isopod 11.15.14 at 3:05 am

to spend a lot of time on our own, and those things aren’t good for us on the whole – mentally or physically. I guess being alone can ennoble people in some circumstances, but for most of us, too much isolation just isn’t good for us.

Please don’t assume everybody has the same social needs as you. The idea of living in a “tribal” community where everybody is up in each other’s business gives me the hives.

32

Val 11.15.14 at 6:09 am

@31
I am not talking about my own social needs, I am talking as someone who is not an expert in this area, but is doing a PhD in public health and knows quite a lot about the social determinants of health.

33

bad Jim 11.15.14 at 6:44 am

What a harrowing account! So many different doctors, so many different prescriptions, so little long-term carry-through — it’s as though no one knows what to do. Worse, for many, is that even inadequate help isn’t necessarily available.

Sometimes people find something that works, but it’s clearly not as simple as taking a pill to correct your brain chemistry, or at least not for everyone. Psychotherapy helps sometimes, but it’s expensive. Scialabba seems to have gone for long periods without anyone taking care of him. Perhaps that’s just the way it goes, but it doesn’t seem optimal.

ECT helps, but why? Amnesia appears to be the worst side effect, but here’s a crazy idea: perhaps that’s what makes it work. Some studies of SSRI’s on mice suggest that they may affect hippocampus neuron growth, but follow-up interviews have been inconclusive. We tend to discuss depression as a single thing with a possible cure, and that’s probably not a tenable approach, just as a stomach ache could be anything from indigestion to appendicitis.

My deepest sympathies for everyone who suffers from depression or cares for someone else who does. I used to take care of someone with Reagan’s Disease, which was a degenerative process she mostly didn’t seem to mind, and she finally died. Depression, in contrast, is ongoing misery with no certain prospect of relief.

34

bad Jim 11.15.14 at 7:48 am

Apropos of nothing: I’m a long-time fan of rea, whose comments I’ve treasured since I first encountered them. I’ve since, elsewhere, seen entire paragraphs, but for the first part of what seems like forever we were only tantalized by brief inimitable jabs of wit. A master.

35

Shatterface 11.15.14 at 12:53 pm

Please don’t assume everybody has the same social needs as you. The idea of living in a “tribal” community where everybody is up in each other’s business gives me the hives.

Quite. I suffer from depression but I also have Aspergers. I don’t have the same social needs as other people.

Frankly, most people just give me a headache.

36

Origami Isopod 11.15.14 at 1:23 pm

Val, #32: Spare me from “professionals” who assert that they know my own needs better than I do. I mean, it’s not like professionals have ever been wrong, right?

Shatterface, #35: I am not 100% sure I am on the spectrum, but it is likely. My mental health increased greatly once I was able to afford to live alone. And one of the things I like best about being an adult is that, outside of certain work-related obligations, I am no longer subject to whims of the self-appointed “social directors” of the world.

37

Val 11.15.14 at 1:40 pm

@36
I’m not asserting that I know your needs better than you do. I’m talking about what has been found in population research. I’ll try to link some articles for anyone interested later.

38

Lee A. Arnold 11.15.14 at 2:37 pm

Christ I love you George.

Psychedelic therapy can reportedly help a lot. This is not the old style of hippie tripping. Proper sessions are conducted in supportive environments, reclined and wearing eyeshades for the length of the experience, with headphones piping in good quality symphonic music of certain styles, and without lyrics. Trustworthy, experienced sitters for the entire duration are a requirement. It is still mostly illegal however, so you have to find a university that is doing the research.

Two new clinical studies using functional magnetic resonance imaging provide evidence as to why this works.

A remarkable study (Carhart-Harris et al, 2012, link below) showed the surprising result that psilocybin temporarily reduces cerebral blood flow to controlling hub regions, deactivating the connectivity with other regions. This is particularly true for the medial prefrontal cortex (mPFC), the known seat of ego and rationality, whose activity and connectivity is known to be elevated in people suffering from depression, and is normalized after effective treatment.

Reducing the connectivity of the controlling hub regions does not mean complete chaos, however. In a dazzling second study just released (Petri et al. 2014, don’t miss the illustrations) topological analysis of scanning shows the emergence of enhanced brain networks at the same time.

It is hard to escape the conclusion that, to put in terms of old language, the rational ego may grow to block some other forms of brain connectivity which are really worth having, and it becomes a horrible and self-reinforcing hell because your ego necessarily appears to you to be all that you are, and a mere stroll in the park on a nice day may not suffice to help you get around it.

But there is a lot of new hope; and it seems likely that this new avenue of research will prove very helpful to many people in the very near future. Some idea of the breadth and depth of the research, and the number of people becoming involved in this with positive results, may be gauged by looking at the MAPS videos on YouTube.

Carhart-Harris et al. (2012)
http://www.pnas.org/content/109/6/2138.full.pdf

Petri et al. (2014)
http://rsif.royalsocietypublishing.org/content/11/101/20140873.full.pdf

39

Anon for Now 11.15.14 at 3:22 pm

@Rea(19) ” It doesn’t seem to be as simple as a chemical imbalance–there seems to be a correlation for me between depression and bad things happening. And love helps a lot/em> but even that isn’t a complete cure.” – Yes. I’ve experienced both. Years ago, a chemical imbalance exacerbated by stress, that medication did a lot to help (and that I was fortunate enough to be able to ween myself off of the medication following the advise of my doctors). I’ve also experienced grief and depression from bad things happening that couldn’t be touched by antidepressants. Those require an entirely different set of coping mechanisms, including exercise, cleaning up my lifestyle, surrounding myself with friends, (and the conservative use of anti-anxiety meds to get past the worst of it).

Interesting, too, that choosing to discuss the more personal aspects of depression still feels so full of stigma that this is the first post on CT for which I’ve chosen a fully anonymous handle. But so it is.

40

mattski 11.15.14 at 4:26 pm

34

Me too.

41

john in california 11.15.14 at 6:44 pm

I don’t want to provoke anything but I would ask those who find the general opinions or specific experiences expressed by many on this subject to be objectionable, to ask themselves why they think they are being directed as personal advice to them? Why the attitude? You don’t actually know the commenters, they aren’t in your face, aren’t trying to make you do anything. Why not just a neutral comment to the effect that ” That stuff doesn’t work for me.” ? Or even better, what does . ?

42

Rich Puchalsky 11.15.14 at 7:18 pm

“Why the attitude? You don’t actually know the commenters, they aren’t in your face, aren’t trying to make you do anything.”

I haven’t been annoyed at any of the advice comments (OK, I’ve been slightly, mildly, annoyed) but advice can be a burden. Someone commented on one of the other threads to J Thomas that there were drug-free, high success treatments for Aspergers (really?), and I have my doubts, but can I really choose to ignore anything that might help my high-functioning autistic son? He’s already fully in touch with all the resources that his school district, psychiatrist, and therapist can bring to bear, but who knows, maybe some random person posting on the Internet will know something they don’t. (I don’t mean that sarcastically — it seems quite possible that CT might attract people who are world class experts on this kind of thing.). And so now I have something else to do, if I decide to bother, when one of the reasons I’m commenting more on CT is because I need some kind of mental break between caregiving and work.

Likewise the people who post about diet and exercise. I can sort of guarantee that anyone dealing with depression in an industrialized country has already heard about diet and exercise. I shrug it off as well meaning, but most often if “diet and exercise” was going to work as advice, it would have already been tried and succeeded, so most often I take it to mean “Did you really try?”

43

Val 11.15.14 at 9:05 pm

@42
Rich and others – the main point of my comments was about social factors – inequality, isolation, profiteering and so on. I think they are important points, but I think people maybe get frustrated because they want more immediate answers, which I can understand. I’m happy to leave it at saying that I wish everyone here the best.

44

mattski 11.15.14 at 9:16 pm

geo, I wonder if you’ve walked in labyrinths and if so whether it did anything for you?

45

geo 11.15.14 at 9:57 pm

Labyrinths?

46

mattski 11.15.14 at 10:45 pm

Yes!

Used for thousands of years to promote mindful, meditative relaxation.

47

mattski 11.15.14 at 11:09 pm

48

novakant 11.16.14 at 1:15 am

Because you see just how baffled and helpless the doctors and helping professions often are as well. Every few years, they have to reinvent the wheel, it seems, and start from scratch.

So many different doctors, so many different prescriptions, so little long-term carry-through — it’s as though no one knows what to do.

This is unfortunately the norm for chronic depression, even with the best medical care. It’s quite rare that someone tells you: “I have been taking x and doing z for 30 years now and I’m fine.” (Also, the most popular antidepressants, SSRIs and SNRIs, cannot be a long term solution for many because they have a high rate of causing sexual dysfunction.)

If you look at the forums e.g. here, you’ll see what I mean (good sites btw).

http://www.crazymeds.us/CrazyTalk/index.php?
http://www.socialanxietysupport.com/forum/

49

Tony Lynch 11.16.14 at 2:45 am

I am not, nor have I ever (yet) suffered from depression of the kind so many here have suffered. One thing helpful for me would be to know it better. I am upset, sad and bewildered by the world very often, but I get angry, bitter, cynical, etc. When you are depressed do these reactive feelings drop away, or is it that they all turn inwards, on oneself? I hope this isn’t seen as a disrespectful question.

50

bad Jim 11.16.14 at 5:32 am

Something we call depression is a normal response to common life experiences, like the loss of a parent.

My father died at my age, quite a while ago, and I can still recall some of the abnormality I experienced at the time, an inability to enjoy things – anhedonia – which I could nearly taste. At the same time there was a great deal of stress; we were trying to sell his company, and some of us decided to leave and start our own company, betting everything we owned. Perhaps the worst part of this was leaving the people we’d been working with for years, moving from a familial environment to three macho guys.

Even so, it was pretty mild, an annoying eyelid twitch, a certain grayness. At the same time it was enormously stimulating. On top of that, my dad had been dying for a while. Although he was unhappy to leave the party early, it was in some sense a relief.

My mother died about a year ago, and it doesn’t feel the quite the same. She haunts my dreams in a way my father never did, and I’m still stuck in a pattern that developed during my years of caring for her, so to an outside observer, like my sister the therapist, I might appear depressed. I do sleep a lot; I’m addicted to dreams. It’s also very much a relief; I’m no longer tethered to someone dying of a degenerative disease, the ethics of euthanasia are no longer salient.

So something we call depression is somewhat normal, and perhaps some depressed people are merely stuck in a miserable situation. Some people have a hard time growing up. I took considerable care of a nephew whose mother died at an early age, paying for school, even housing him. Over and over he would give up and shut down halfway through the semester. Sometimes he’d get medication for anxiety, but education didn’t work for him. He did, somehow, manage to snag a pretty terrific girlfriend. Eventually I told him (probably reinforcing what she’d said) that he needed to prove to himself that he could keep something together for at least six months. So he got a job, and found that he could, and there was a big, raucous wedding in September.

None of which has anything to do with anyone else, probably. I guess I’m a little more resilient than my nephew, but then, life didn’t throw up the same challenges to me at an early age. And there could be issues with brain wiring or gut bacteria or whatever. It’s good to have pets, not just because they’re fun to stroke, but also because they need to be stroked and fed and walked. Therapy may work not just because of its content but also because of the regular contact it provides, and the opportunity for intervention when someone’s going off the rails.

51

Ronan(rf) 11.16.14 at 6:56 am

“None of which has anything to do with anyone else, probably. I guess I’m a little more resilient than my nephew, but then, life didn’t throw up the same challenges to me at an early age. “

I would say it mightn’t necessarily be relevant to the question of clinical depression, but people deal with things differently. I lost a brother when he was 15, and I was 20. Retrospectively, it seems, a lot of my life has been surrounded by young deaths. I remember my brothers friends deaths in their teens, two close friends who died in their late twenties, and numerous (many) other deaths built in to the specific backlash (ie condition, I guess) from my brothers death. But none of these later ones are my personal loss (my friends, perhaps,but it’s not the same)It does seem an unusual set of occurences when compared to my peers, though I think (plausibly) I might have built a system of mortality around my brothers death, where i remember everything bad and skew the death rate out of proportion.
Though related to your comment, I do feel myself weakening a little as I get older (and more deaths approach; aunts, uncles, at some stage (hopefully not soon) parents). Each does take a little off..
But when talking to my mother, and she talks to me (as she does), about her various burdens (more in banter than in sorrow) and I say, ‘well I’ve had the same,what’s the problem’, she replies ‘well I’m older than you!’ and she’s right.
(my point is, she carried all those burdens; the funerals I only went too she arranged. She sat with the dying, sympathised extensively with the bereaved, ran things when no one else would ..once you start taking on the responsibility it wears you down. The death is one thing, the build up another, the picking up the pieces ..)

52

bad Jim 11.16.14 at 9:02 am

I too used to be able to shirk those responsibilities, dropping my mother off at funerals after she was unable to drive herself. Now I have to confront old people all by myself.

Probably not at all the same thing, though. Maybe the same sort of behavior, as observed by an outsider, but the key difference is that grief abates, not as rapidly as one might like, but after twelve months and a day the ghost will rise to speak, and say, leave me alone!

For the sufferers it doesn’t abate, and for all we know it feels much different. Maybe not; the human repertoire is limited; visceral discomfort runs the range from over-eating to cancer. However, the pain people report far exceeds anything I’ve encountered, to the point that suicide is arguably a rational solution. (As bad as that sounds, an elderly friend of mine has strenuously advanced that point to me. She has a schizophrenic daughter and is acutely aware of the limits of the sort of care we can provide. She’s a Unitarian, though, so death holds no terror for her.)

The thing I like about ECT is that it’s what I do to recalcitrant electronics*: hit the reset button, or cycle power. Who care about how it works? SSRI’s or SNRI’s are problematic, because they have systemic effects (people get fat) and people don’t always like them, and because we don’t know how, why, or when they work, although they often do. We used to just give people barbiturates or benzodiazepines to make them feel better, and there are things to be said for drinking heavily, but we still seem to be a long way from being able to offer reliable relief.

* A good friend of mine was offended when I simply thumped the top of a computer to make it work. I certainly wouldn’t recommend it for malfunctioning humans.

53

Ben 11.16.14 at 10:25 am

As someone who still, after years in the trenches, has difficulty “coming out” to friends and family about being depressed, I’d like to thank George for being so publicly forthright about his struggles, which help reverse the stigma and mystery surrounding depression.

It’s not a small thing, breaking the omertà your mind tries to enforce.

(Thanks for the essays, too.)

Tony Lynch:

For me, those traits about the broader world (inequality, unfairness, the hypocritical rigged chaos of most every large institution) become the only characteristics I focus on when I can think beyond my immediate existence.

News stories are examples of them; family members’ plans are inadequate b/c they don’t account for them; friends are naive for not recognizing them; and so it goes.

It’s often noted that depressed people score higher on tests of awareness of the world around them than others . Who can say whether that’s losing the ability to lie to oneself, or to focus on anything else.

54

gianni 11.16.14 at 10:51 am

If one were to want to read some of this ‘geo’ fellow’s best work, where might one start? any recommendations?

55

hix 11.16.14 at 12:45 pm

Perceived unfairness is definitly something that drags me down quite often. I`ve had my fair share of big stuff going on. Relativly young death after longish suffering in the imidiate family and things like that. But those came by large after i already was clinically depressive. Some people that know im clinically depressive think those things caused the depression and that i was healthy before – and they accept that as a legitimate reason to be clincially depressive, even when they dont understand what it it means. They even keep thinking its that way after i told them its not the case. If they had not happend i might not be depressive anymore by now, or not. Who knows. In those cases, the “just accept it” “learn to deal with frustrations” “just get through it” suggested by therapists is easier to do. It doesnt nag the same way. Somtimes even little unfairness in contrast is often harder to deal with. The cases where you get told “oh come on its not so bad”, “yeah sure you could sue against it and youd definitly win, but there will be retaliation thats much worse than the current unfairness and you cant do anthing against that then”. Those are in a way much harder to just accept.

56

mattski 11.16.14 at 1:07 pm

I think a lot about the interconnectedness of politics, spirituality and psychology. Part of what it means to be left-leaning is concern for the group rather than merely the individual. But there comes a point at which the tendency of our minds to gravitate towards injustice–something in the world isn’t right!–becomes excessive, self-defeating, gratuitous. It becomes an excuse for inaction…

Bad Jim said some people have a hard time growing up. That’s true, uncomfortably, for me. I feel sometimes like a pie with a slice missing: in most respects fully grown and competent, but in a few specific areas not very well developed.

57

hix 11.16.14 at 2:36 pm

Also, in my case im pretty sure almost everything mentioned above explicitly or implicity has played a more or less big role at times causing/weakening/strengthening the extend of depression. And all the standard counter measures also tend to help up to a point. The thing with advice i think is that almost everyone that had to deal with depression for a longer period has received advice that got the balance totally wrong, or in some cases, even advice that was plain stupid. Add the depression typical sensitivy and everything that looks like advice can be received rather bad.

58

Anon for Now 11.16.14 at 3:44 pm

@Tony (49): “I am not, nor have I ever (yet) suffered from depression of the kind so many here have suffered. One thing helpful for me would be to know it better.” – It’s not an easy question because depression manifests itself in so many different ways across people, and even for a person at different times. In my case, the way in which I responded (badly) to some stressful situations led me to seek help. I was frankly surprised when I was told by my doctor that almost every pattern I exhibited indicated strong depression. The other surprise was the effect of medication for me: it didn’t clear away the clouds and turn dissatisfaction into naive happiness. But it did cause me to remember what it felt like to be ME. I hadn’t realized that I’d lost any real sense of myself until I had it back. My friends noticed it, too. I revealed to very few people that I was taking anti-depressants (not even my husband for several weeks after starting treatment), but many noted the positive changes without having a clue as to the source.

It’s tricky, too, because there are so many options and it is hit-or-miss finding what medication and dosage works for any given person. A friend has struggled mightily trying to find the right mixture that works for her (and given her depression is loathe to ‘bother’ the doctor when something isn’t working for her).

59

Ze Kraggash 11.16.14 at 4:10 pm

I’m surprised: I had the impression that modern pharmaceuticals really are very close to a panacea. I’m also surprised that electroshock is still a medical treatment.

60

Dick Muliken 11.16.14 at 6:45 pm

Dreadful to be flippant, I suppose, but i think George should meet -and then marry- Daphne Merkin.

61

geo 11.16.14 at 7:04 pm

No offense taken, Dick. Could you arrange an introduction?

62

William Berry 11.16.14 at 7:39 pm

@gianni:

Just googling “George Scialabba” gives a decent portal to start with.

Bio links, as well as links to interviews, pieces in “The Nation”, “The Baffler”, etc.

63

mattski 11.17.14 at 3:29 am

geo,

Have you written much about Catholicism?

64

JW Mason 11.17.14 at 3:30 am

Gianni-

You could pick up his Book, “What Are Intellectuals Good For?”

65

geo 11.17.14 at 4:06 am

mattski@63: A few times, but only once personally, in an essay called “An Honest Believer” in The Modern Predicament. Here it is, from my website: http://www.georgescialabba.net/mtgs/1987/10/c-s-lewis-beloved-tormentor/print/.

66

mattski 11.17.14 at 5:26 am

Thank you, geo.

67

Andrew F. 11.17.14 at 5:47 am

geo, you know me only as a pseudonymous commenter with whom you often disagree. My words therefore may not mean much.

First, I want to compliment you on your courage in releasing those notes. I found it deeply moving. Thank you for that.

Second, I read your record as one of remarkable resilience, however it all might have felt at the time, and one of great achievements, attained even while battling, relentlessly, against an illness the very nature of which is to weaken our will to fight.

What puzzles me is that how often a man with so much courage, strength, distinction, and insight, disagrees with me. ;) Perhaps your doctors have missed a facet of this problem geo.

I did note that one of your doctors noted you were dismissive of Aaron Beck’s books. I am no expert, but I wonder whether your opinion of Beck has changed, and the degree to which your feelings about Beck and cognitive behavioral therapy coincided.

A few random thoughts, sparked by a phrase here and there in the comment thread and post (mostly the threat). Read further at your peril.

I’ve never found much utility in books like Darkness Visisble. Too much, as I recall, emoting via the well laid words of his sentences. But I read it when I was very young, and perhaps that judgment is more one on me.

Afterwards, looking back, I realized the difference. Styron was writing to evoke sympathy in his readers, to show the readers “what it is like” (inevitable “sort of” disclaimer). Psychologists, though, wrote more in vocabularies of precision and control. These latter are the most useful.

Geo, whatever you’re doing that is working, that’s wonderful.

For the others, while I am not an expert, my understanding is that, for most cases of moderate to severe depression, certain forms of therapy, particularly cognitive/behavioral, when combined with psycopharmaceuticals, have had the best outcomes. Regular exercise, healthy diet, and social interaction would only add to those outcomes.

Again Geo, thank you for sharing so much, so bravely, with everyone.

68

ZM 11.17.14 at 6:26 am

geo,

“A few times, but only once personally, in an essay called “An Honest Believer” in The Modern Predicament.”

That was an interesting article. I only have read C.S. Lewis’ Narnia books.

I wonder if you ever met the Australian Greg Dening while you were studying at Harvard? He would have been doing his Phd there about the same time as you were studying. He was still a Jesuit priest at the time, although he was to leave the priesthood in the 70s.

He briefly writes about the loneliness he experience in his years at Harvard, helped only by the presence of a couple of Australian friends, in one of his essays. I will copy it in case it might be of interest to you.

“Dewberry Street, Boston, was its fashionable ‘Brahmin’ self when I saw it for the first time in September 1964. But the Jesuit residence on it was dark and unwelcoming. The Boston ‘Irish’ Jesuits there queried why I should be coming to atheistic Harvard when there was a perfectly good Jesuit university in town.

I answered them with the story that the ‘Brahmin’ family among all ‘Brahmins’, the Saltonstalls, had given me a scholarship which they had established in memory of a son most in the Pacific war. I clearly rose up the social ladder in the Jesuits’ estimation when I said I had been invited to the Senator’s residence at Gloucester.

I had been a Jesuit for sixteen years and a priest for eighteen months. I had come to Harvard to read anthropology. ….

That first year at Harvard was the loneliest year of my life. Harvard was a cold and distant place. Doug Oliver [Professor of Anthropology] was in Tahiti. I had to learn a half dozen new languages, not just one — linguistics, geology, genetics, and cultural, social and physical anthropology. Fresh out of four years of theology in which I had discovered the intellectual foundations for the changes in the Church being created by Vatican Council II, I found the official Boston Church stultifyingly ignorant of what the changes meant.

Two friends from Melbourne broke the loneliness. Rowan and Mary Ireland had been undergraduates with me at the University of Melbourne. Together we had experienced those heady days of Catholic liberation at Melbourne in the 1950s, when the poet, Vincent Buckley, and others were bringing back from Europe, years before its time in Australia, the spirit of an open Church. Rowan, Mary and I clung to one another in Harvard’s Cambridge. They were newly married and student poor. Rowan’s spirit was being tested as strongly in sociology in the William James Building at Harvard, as was mine in anthropology in the Peabody Museum.

On occasions, we learned the comfort of a shared eucharist on virtually their only piece of furniture, a kitchen table. We knew, but coped with, the awkwardness of such self-revelatory liturgy. The Vietnam was was still on. We made our protests and could not understand from afar why Australia should display its indifference, to us its amorality, as it did.”

69

mattski 11.17.14 at 4:07 pm

geo,

I read your 1987 piece with interest. I wonder what your relationship to the whole superstructure of Catholicism is today? I know that’s a complicated, maybe impossible question. But I’m very curious about the evolution of your thoughts.

I guess I want to ask whether you ever found anything of interest in eastern religion?

Aside: I second Andrew F.’s comments, and want to give appreciation to Andrew F for contributing here even though he often attracts a lot of flak. May I ask Andrew if he is from a Catholic background?

70

Rich Puchalsky 11.17.14 at 4:28 pm

“A few times, but only once personally, in an essay called “An Honest Believer” in The Modern Predicament. “

I’d be happy to divert the thread off to Chesterton (Sunday in _The Man Who Was Thursday_ is one of the best portrayals of God: awe-inspiring, sinister, and manipulative) and C.S. Lewis (the “children’s books” are where he expressed his thought more coherently and openly than his adult books, which I’ve also read all of), but shouldn’t.

It may be easier growing up Jewish in America than growing up Catholic. Remember the Antichrist is a living Jewish male business? That kind of thing sets you straight on society’s values from early on, and as a result you don’t feel like you have to defend all that nonsense.

71

geo 11.17.14 at 6:15 pm

Andrew: I very much appreciate your kind words and freely forgive you for disagreeing with me about other, less weighty matters. About cognitive behavioral therapy: I still have mixed feelings. On the one hand, reframing the way you think about things does help a lot. It’s beginning to dawn on more and more people that cognition and emotion are not radically distinct, but we still only have the remotest glimpse of the implications of that fact. On the other hand: the CBT therapists I’ve started with have been mechanical to the point of robotic about assigning homework, requiring one to fill out ruled charts showing your daily performance, etc. It’s useful for many people, I’m sure, but it drove me up the wall. It wouldn’t have taken that much imagination or sense of humor to help me re-cognize my behavior, but perhaps those therapists had skipped the course on imagination and humor.

I found great comfort in Darkness Visible, Kate Millett’s The Loony Bin Trip, Andrew Solomon’s The Noonday Demon, and the searing passages from Wittgenstein’s letters and diaries quoted in Ray Monk’s biography. I don’t know why; I suppose misery loves company, especially distinguished company.

ZM: I didn’t know Greg Dening, though the name rings a faint bell. Harvard probably was a colder place in the 1950s, especially for graduate students. Things are somewhat better now, though not, perhaps, for the best of reasons. Elite education is now more expensive and more competitive. So students and their parents think of themselves as customers and demand support services like counseling, advising, community centers. Also, student suicides have left the university scrambling to protect itself from criticism that it’s not helping enough. Of course, the idea that elite universities might recognize that the socioeconomic reasons higher education has become appallingly expensive and competitive — reasons brilliantly explained in William Deresiewicz’s Excellent Sheep — and take a stand in opposition to dominant social/political trends is unthinkable. The people running elite universities are political sheep (and commercial wolves).

mattski: As I get older and more resigned to spending eternity burning in hell, I feel less fiercely resentful of Catholicism and more curious about whether something can be salvaged from traditional religion that will help us escape the cultural nihilism that radical skepticism and competitive individualism may (but need not) result in. The writings of Christopher Lasch (especially The True and Only Heaven), Wendell Berry, Flannery O’Connor, and Walker Percy are where I look for religious truth. As for Eastern religion, I’m just starting to become interested, by way of the increasing evidence that meditation is excellent psychic exercise. But for the main part of my life — mid-20s to mid-60s — and still, to some extent, politics of the Morris/Ruskin/Callenbach visionary utopian sort was my religion.

Rich: I’d love to follow you into a long digression on Lewis and Chesterton. Maybe Crooked Timber could ask Francis Spufford, who’s recently published a fascinating, Chesterton/Lewis-like piece of apologetics called Unapologetic: Why In Spite of Everything Christianity Still Makes Surprising Emotional Sense, to guest host a thread on the subject.

72

Rich Puchalsky 11.17.14 at 8:27 pm

“Maybe Crooked Timber could ask Francis Spufford, who’s recently published a fascinating, Chesterton/Lewis-like piece of apologetics called Unapologetic: Why In Spite of Everything Christianity Still Makes Surprising Emotional Sense, to guest host a thread on the subject.”

Every now and then I start to compose a comment on something, then realize that I’ve written whatever I’m going to write better as a poem than I could otherwise. Here it is.

(I haven’t read the Spufford book: it sounds interesting, but potentially in a train-wreck kind of way.)

73

Anderson 11.17.14 at 8:51 pm

“Christianity still makes surprising emotional sense” – that sounds like a good 6-word precis of the Critique of Practical Reason.

74

The Temporary Name 11.17.14 at 9:27 pm

On the other hand: the CBT therapists I’ve started with have been mechanical to the point of robotic about assigning homework, requiring one to fill out ruled charts showing your daily performance, etc. It’s useful for many people, I’m sure, but it drove me up the wall.

It sounds that way to me, but FWIW there are all kinds of health-charting applications that live on phones these days, and some friends find them easy and useful. I hate the thought of them and have not investigated, but they’re out there.

Anecdotally a friend of mine was utterly devastated when CBT-predicted outcomes were untrue: a really ridiculous and unfortunate set of coincidences which her therapist assured her had to be magical thinking (and set out rules and processes for identifying such things) were in fact true. Yes, bad therapist, but zealots of all sorts are not to be trusted and you can find them in CBT as much as anything else.

75

dbk 11.17.14 at 9:58 pm

Thanks many to all contributors to this thread, and above all to geo for initiating it.

As a fellow-traveler through depression both endogenous and exogenous for most of my life, I have little to add, at least at present. Scientific (neuro-biological) understanding of this illness, its ultimate causes, and its treatment remains limited, ambiguous, ever-changing … that geo has been able to write so much in spite of it all is a great testament to the human spirit.

And at the tail-end of the thread to find other devotees of Chesterton (Father Brown: the best), and Flannery O’Connor … is there anything finer than “Everything that Rises Must Converge”?

Thank you, geo.

76

Teachable Mo' 11.17.14 at 10:38 pm

re: 71 and Cognitive Behavior Therapy

Chronic depressive with several acute episodes here. CBT helped me a great deal. Much more than the chemicals that I was given. My therapist was earnest, honest, and humorless, and I wouldn’t have had it any other way.

The techniques of CBT weren’t difficult to master, and their ordinariness has helped immensely over the years. In self-analysis, cutting back on irony, exaggeration, and “imaginative” imagery may sound dulling, but it isn’t. You’re always yourself.

Obviously, if people have tried it and it didn’t work for them, then one hopes that something else will. But if you’re new to treating depression, don’t just skip CBT based on hearsay. It took a few months for me to get over the acute phase I was in and a few months after that to convince me to return to CBT when I was in need. But that’s been +40 years ago now.

77

The Temporary Name 11.17.14 at 10:44 pm

IIRC CBT is one of the few talking-cure thingamajigs with evidence of efficacy behind it. Happy to be corrected.

78

novakant 11.17.14 at 11:57 pm

How can you determine and compare the efficacy of therapies? – double-blind studies are impossible. I think the only thing we can say is: talking to someone helps and “whatever works for you”.

79

The Temporary Name 11.18.14 at 12:20 am

How can you determine and compare the efficacy of therapies?

Lots of people think they can do that.

Take me with a big grain of salt, but for a long time the scandal of psychology was apparently that people going through psychological treatments did about as well as people who waited it out. CBT was apparently a rare exception that sped up the process.

Again, corrections welcome.

80

Rich Puchalsky 11.18.14 at 2:30 am

“And at the tail-end of the thread to find other devotees of Chesterton (Father Brown: the best)”

Chesterton did help to influence me to become an anarchist. Who wouldn’t want to be a super cool Chesterton villain, complete with a underground network that apparently exists so that we can make each other dishes of lobster mayonnaise? I remember one Father Brown mystery where the anarchist basically stands in one place, thinking about a poem and saying nothing, and this requires an entire deductive chain of thought from Father Brown about why he’s standing there saying nothing and did not in fact kill or harm anyone. And hey, I stand in one place thinking about a poem and saying nothing quite often! If that’s all it takes to be a challenge to right thinkers everywhere, including the not hurting anyone part, then who could resist? Later on anarchist Occupy activists took this insight of Chesterton’s into account when they devised the (quite effective, surprisingly) tactic of sitting around in a public park.

81

novakant 11.18.14 at 9:53 am

#79

Look, there’s decent Wikipedia entry on psychotherapy containing a wealth of links. It should be obvious, though, that measuring and then comparing efficacy is inherently problematic, as scientific principles cannot be applied because of the dynamic nature of therapy and there is even disagree about the desired outcomes. And that is assuming people are actually interested in the well-being of those suffering rather than trying to push their ideological agenda or policy goals.

82

Andrew F. 11.18.14 at 11:58 am

geo @71: On the other hand: the CBT therapists I’ve started with have been mechanical to the point of robotic about assigning homework, requiring one to fill out ruled charts showing your daily performance, etc. It’s useful for many people, I’m sure, but it drove me up the wall.

I vaguely recall a book by Judith Beck on the subject that is good. It’s written more for students and practitioners than for patients, so while there’s an absence of many charts and such there is plenty of description of the theory. Might be an interesting read for you, though I’m sure we all have reading lists at this point that are monuments to overreaching ambition.

83

Teachable Mo' 11.18.14 at 3:16 pm

re:81

I don’t know about ideological agenda, but my therapist’s goal was to keep me out of the ground. After that, my life and what I made of it was up to me. Clinical Depression’s chemical foundation makes it an easier (sometimes, in a way) problem to solve. As opposed to neurosis or psychosis or something else. The therapist is more like an army nurse a mile from the line of battle. The goal is to patch the patients up sufficiently to get them back to the action. In our sessions, we didn’t deal in dreams or childhood. There wasn’t a single “Hmmmm. Interesting.” from my therapist. The theory of CBT as I understand it is that thinking has physical consequences. Iterative thoughts will have incredibly similar consequences. And if those consequences involve the chemicals which depress the brain and one’s emotions, well, it’s possible that other thoughts will have other consequences and produce other chemicals. It’s entirely possible that Clinical Depression is as varied as, say, peptic ulcers and CBT is only effective for some strains of depression. It could entirely be a placebo. But, knock wood, I’m still here as are many others. CBT isn’t as all-consuming as the 12 Step Method. You don’t get dependent upon it as some do with pharmaceuticals. It doesn’t pretend to be a “cure”. It helps you to get a handle on things and move on.

84

novakant 11.18.14 at 7:19 pm

nb. I am not arguing against CBT at all and I agree that it can be very useful. What I find dangerous is the current trend to view it as a cheap, one size fits all solution and to simultaneously denigrate other approaches. As I said I am critical of efficacy statistics but even if we want to go along with them CBT has a success rate of 50% – i.e. it only helps every other patient.

85

mattski 11.18.14 at 7:59 pm

Thanks, geo.

It is so difficult to put oneself in another’s shoes sometimes. So very difficult for me to understand the mindset of a person such as yourself who grew up immersed in Catholic teaching and culture. I had one very close Catholic friend growing up, but his experience of Catholicism was of course very different from yours in that he was living in a much more diverse community.

I’m unfamiliar with Christopher Lasch’s work. But in my late teens I really enjoyed a couple of Percy’s novels (my father tipped me to Percy with the proviso, “he’s like Vonnegut, only better” and I was inclined to agree!) Wendell Berry played a big role for me in my 20’s, helping send me on a sojourn into organic farming that in many ways didn’t turn out that well, although on balance I don’t regret it. And what I remember of Flannery O’Connor, which is from high school, is that virtually everything ended in a conflagration of one sort or another! She is rightfully or wrongfully associated in my mind with Mel Gibson, another Catholic with a problematic fixation on violence. (!?)

What I find so reassuring about eastern forms of religion is the credible basis in empiricism. Buddhism has been described as a ‘science of mind’ and fairly so I think. The Eckart Tolle interview I posted above is a pretty good exposition of plain old generic spirituality, and Tolle often references the words of Jesus as well as the Buddha, doing a creditable job of pointing out that they were for all practical purposes talking about the same thing.

Buddhist scripture tends to have a repetitive quality that reminds me of some kinds of electronic music, or Philip Glass. Which can be a calming influence, enabling the absorption of a subtle, but reality-based teaching. Here’s one of my favorites, a short discourse on the Uncreated.

86

The Temporary Name 11.18.14 at 8:18 pm

It should be obvious, though, that measuring and then comparing efficacy is inherently problematic, as scientific principles cannot be applied because of the dynamic nature of therapy and there is even disagree about the desired outcomes.

I think it here depends on what you think can be science, which a recent thread had a lot of. I agree, it’s problematic, and I suppose the best answer is to trust metastudies over single studies given that small lots must skew wildly here and there…but to keep attempting small studies.

I am not arguing against CBT at all and I agree that it can be very useful. What I find dangerous is the current trend to view it as a cheap, one size fits all solution and to simultaneously denigrate other approaches. As I said I am critical of efficacy statistics but even if we want to go along with them CBT has a success rate of 50% – i.e. it only helps every other patient.

Yes, I agree, and I think most people on the thread do: works for some, not for all, other things might be better. What better advice could there be to a depressive than TRUST NOTHING? (Just black humour, I think we’re pretty much in accord.)

87

Val 11.19.14 at 12:26 am

Below is the description of a seminar (this Friday) that I am not actually able to go to (and given that it is in Melbourne, I doubt many others here would either!) but it sounds as this Professor’s work would be of great interest to many on this thread:

“Professor Peter Kinderman (University of Liverpool) Life beyond the disease model: A psychological vision of mental health and well-being (Chair Prof Jane Fisher)

The American Psychiatric Association’s recent revision of DSM-5, has received widespread criticism. This has identified serious inadequacies in the specific proposed revisions, and has also highlighted the fundamental scientific, philosophical, practical and humanitarian weaknesses in the diagnostic approach to psychological well-being, underpinning the traditional psychiatric approach. This debate provides the opportunity to propose a more scientific grounded and clinically useful system. We need to change from a ‘disease model’ to a ‘psychosocial model’. This keynote address will set out a robust, coherent and realistic psychological alternative. Our mental health and well-being depend on the things happen to us, how we make sense of those events and how we respond to them. We must stop diagnosing non-existent illnesses and instead develop a more appropriate system for describing and defining people’s emotional problems. Services should be based on the premise that the origins of distress are largely social. That means that services should replace ‘diagnoses’ with straightforward descriptions of problems, should radically reduce their reliance on medication, using it pragmatically rather than presenting it as ‘treatment’, and instead tailor help to each person’s unique and complex needs. This would see a shift from an ethos of coercion to an ethos of care, from professional hegemony to genuinely multi-disciplinary team-working, from medical interventions to psychosocial alternatives and a greater focus on the social prerequisites for genuine mental health and well-being.

Peter Kinderman is professor of Clinical Psychology and Head of the Institute of Psychology, Health and Society at the University of Liverpool. His research interests are in psychological processes underpinning well-being and mental health, and in particular psychotic phenomena such as delusions and hallucinations. He has published widely on the role of psychological factors as mediators between biological, social and circumstantial factors in mental health and well-being. He is also interested in the application of such psychological science to public policy. He was twice elected Chair of the British Psychological Society Division of Clinical Psychology; from 2004 to 2005, and again from 2010-2011. In that role, he worked with the UK Department of Health, the BBC, the Health Professions Council, the European Union Fundamental Rights Agency and the UK Office for National Statistics, amongst others. He has recently launched a free, online, open-access course exploring our understanding of mental health and well-being and published ‘A Prescription for Psychiatry’, which presents his vision for the future of mental health services. You can follow him on Twitter as @peterkinderman.”

88

Teachable Mo' 11.19.14 at 2:31 am

re: 84

“CBT has a success rate of 50% – i.e. it only helps every other patient.”

That “only” is an example of the kind of thinking that CBT would flag. (At least according to the training I remember.) If 50% of the people who come for help do get help, that’s good. That’s a lot of people getting help.

89

geo 11.19.14 at 2:32 am

Thanks for the Kinderman reference, Val. Two excellent books by Gary Greenberg that take a similar position: Manufacturing Depression: The Secret History of a Modern Disease and The Book of Woe: The DSM and the Unmaking of Psychiatry.

90

bad Jim 11.19.14 at 7:01 am

I’ve read that psychiatrists are happy to prescribe drugs and reluctant to prescribe therapy, so I’m inclined to think it uncharitable to characterize CBT as a “cheap” solution if most patients aren’t even offered that.

50% is nothing to sneeze at; it’s more like “Holy Shit! Something works!”

91

The Temporary Name 11.19.14 at 8:46 am

I’d bet a lot of people aren’t offered CBT because they can’t pay for it. The drugs are cheaper (if you’re in a position to afford those).

92

Jim Buck 11.19.14 at 9:10 am

In the UK, CBT is currently being used as Cut Benefits Therapy; government endorsement is driving the research base; and IAPT (Increasing Access to Psychological Therapies) and ATOS (or whatever has replaced it) are being used to promote Stoicism in the absence of Socialism. That “50% success rate” allows the other 50% to be stigmatised as malingerers: ‘If it worked for her, it should work for you; you just don’t want to do the work.” “Can’t pay your heating bill? House cold? Look at it this way instead: “It ain’t half hot’.

93

Val 11.19.14 at 11:03 am

@ 89
Thanks geo for those references. The bit I particularly liked in Prof Kinderman’s intro is “the origins of distress are largely social”.

That’s what I’ve been trying to suggest, including in some of my earlier comments above, which haven’t been well understood. It’s nice to hear it said so succinctly from a recognised expert.

94

ZM 11.19.14 at 1:04 pm

“The bit I particularly liked in Prof Kinderman’s intro is “the origins of distress are largely social”.”

I have mixed feelings to this because it is sort of a mix of the external/social and the internal. There are negative external events that are causes or origins, but people’s internal responses to things go along particularly personal ways. So some external event that does not have a terrible effect on one person can be a greater or different source of pain and unhappiness or worse to another person.

Usually I prefer to emphasise agency, but agency is constrained by natural things like the weather and environment, or by social things like other people/groups. The dispiriting other thread where apparently ensuring both parties consent is too onerous a task, is sort of an example where you could identify an external cause of suffering, and then try to fix it socially through education and regulation. But if you find external causes so negative they are making you ill, this illness is probably going to affect your ability to work out a good method about how to change the external causes and so you might just make things worse and more confusing.

For instance I can find climate change very distressing at times. But when I am most distressed I am so affected that it impedes me doing assignments where I have to find sustainable solutions. You can try to not think about things that cause great distress, or try to avoid being in situations that similarly cause distress, but then you avoid various things you might otherwise like to do, or need to do , and this is then another negative.

And, while from a public health and social reform perspective it makes sense to look at external causes so you might change them, from a therapeutic perspective the therapist is unlikely going to be able to exert a great influence that changes external factors, and so a focus on internal responses to external things probably makes more sense in the therapist-patient relationship. Even if this has the downside of overlooking external things.

Probably then it comes down to decisions to concentrate on intrinsic physical or discursive causes or you might have spiritual as well depending. Since I like to read old books — diet and exercise and social company and environment (especially air) are all given attention as cures in The Anatomy of Melancholy. There are many sorts of causes for melancholy given, some just Sorrow and Fear but also The Miseries of Scholars and Scoffs, Calumnies &c. It is an interesting book but laid out and page numbered in a very odd way that makes it hard to navigate.

95

Rich Puchalsky 11.19.14 at 1:39 pm

There really isn’t anything as perishable (in the sense of losing value rapidly with time) as a theory about mental illness / distress by an expert. I remember a book I read in my Intro to Psychology course in the early 1980s by an expert who thought that schizophrenia was caused by family miscommunication. Even books about how the prevailing consensus is wrong can be right as far as that goes, while their positive ideas about what is right are themselves not correct.

Here all the general things that I think that people in contact with the mental health system tend to discover:

1. There really is no satisfactory science being done anywhere in the field. What you basically have are competing folk remedies and little bits of sciency treatments which, if they work, no one really understands why.

2. It really seems pretty clear (to me, anyways) that, like cancer, this is probably a large number of different conditions given an overall label. People talk about “a cure for cancer” is if there’s going to be a singular one, but there’s probably not going to be because it’s probably hundreds of different disease syndromes.

3. Despite this there is no shortage of experts coming up with large-scale universalizing theories. “The origins of distress are largely social” is one of them. It’s probably unfalsifiable, and profoundly unhelpful either at an individual or social level, unless the people giving treatment have the power to change society, and the science-backed knowledge to know that they’re really changing it in the right direction.

4. There are obvious reasons why drug therapy is more and more popular in some countries that have to do with Big Pharma and its increasing control over the financial process of paying for treatment. It’s fine to criticize this, but the criticism can be done without either saying that drugs don’t actually work (they may work for some things) or having any idea of what would work better.

5. Despite all of these problems, no one suffering from severe depression can ignore all of the proffered theories, because something has to be done. When something has to be done, and the “somethings” generally don’t work, then people have to try one thing after another until they find something that works for them or they get better by themselves or they don’t. geo’s history really looks pretty typical to me.

96

novakant 11.19.14 at 7:12 pm

Quarreling about CBT etc. I totally forgot to thank geo for his brave attempt to de-stigmatize depression, so: thanks, man!

97

Shirley0401 11.19.14 at 8:38 pm

Ze Kraggash @ 59 “I had the impression that modern pharmaceuticals really are very close to a panacea.”
I think the verdict is far from in on that, and depending on what they’re measuring, it will still depend very much on what you consider an acceptable outcome.
I’ve taken meds. They’ve worked, in the sense that my symptoms were mitigated. The issue for me (and others, though not all others, with whom I’ve spoken), in very simplistic terms, is whether it’s better to be shallow and happy or thoughtful and sad. (Which is not to say it’s impossible for someone to be thoughtful and happy, just that it’s a combination that might be particularly difficult for some of us.)
When I was downing 50 mg of Paxil every day, I had a blast. I also: took more risks, hurt some people that were/are close to me, didn’t remotely challenge myself (intellectually or spiritually) in any way, and ran up significant debt. I still had the same theoretical values, I just focused on my own enjoyment/satisfaction more than I usually do. If I wanted to get snarky, I could suggest perhaps I acted like a much more “American” version of the American I’ve always been. Acquisitive, short-sighted, selfish. &c.
I don’t currently take meds, and I haven’t for a few years, even though the Paxil certainly helped with many of the symptoms (anhedonia, irregular/restless sleep, appetite). While my mood improved, people remarked that I seemed to have more energy, and I was able to be “in the moment” more, I also found myself less interested in things that didn’t immediately involve/concern me at that moment. I guess the effectiveness of the drugs depends on what one is shooting for.
Oh, and I completely agree with everyone else who agrees that “the origins of distress” are indeed quite often “largely social.” And while treating individual symptoms for individual people (which I support 100%) doesn’t preclude also looking at ways we could try to address the social factors that make modern life so likely to make people depressed, it seems like the approach we’ve overwhelmingly decided to take, as a society, is to focus almost exclusively on the individual. Which is a shame, considering that we might be capable of doing a far better job of coming at it from both ends…

Comments on this entry are closed.