2.27.2010

Housekeeping

Here's a link to an interesting New York Times article called "Depression's Upside." It's not in favor of depression or anything, but I like that the article considers the possibility that depression is a natural fact rather than simply haunting and inexplicable terror that swoops down and strikes the unfortunate. Or, well, read the article. Here's one interesting excerpt:
The persistence of this affliction — and the fact that it seemed to be heritable — posed a serious challenge to Darwin’s new evolutionary theory. If depression was a disorder, then evolution had made a tragic mistake, allowing an illness that impedes reproduction — it leads people to stop having sex and consider suicide — to spread throughout the population. For some unknown reason, the modern human mind is tilted toward sadness and, as we’ve now come to think, needs drugs to rescue itself.

The alternative, of course, is that depression has a secret purpose and our medical interventions are making a bad situation even worse. Like a fever that helps the immune system fight off infection — increased body temperature sends white blood cells into overdrive — depression might be an unpleasant yet adaptive response to affliction. Maybe Darwin was right. We suffer — we suffer terribly — but we don’t suffer in vain.
And then later:
Consider a 2005 paper led by Steven Hollon, a psychologist at Vanderbilt University: he found that people on antidepressants had a 76 percent chance of relapse within a year when the drugs were discontinued. In contrast, patients given a form of cognitive talk therapy had a relapse rate of 31 percent. And Hollon’s data aren’t unusual: several studies found that patients treated with medication were approximately twice as likely to relapse as patients treated with cognitive behavior therapy. “The high relapse rate suggests that the drugs aren’t really solving anything,” Thomson says. “In fact, they seem to be interfering with the solution, so that patients are discouraged from dealing with their problems. We end up having to keep people on the drugs forever. It was as if these people have a bodily infection, and modern psychiatry is just treating their fever.”
ALSO: Here's the conclusion to yesterday's Sufi "teaching story," for the curious:
The other two were furious:

"And why didn't you call us before making such a personal decision?"

"How could I? You were both so far away, finding masters and having such holy visions! Yesterday we discussed the importance of putting into practice that which we learn on a spiritual plane. In my case, God acted quickly, and had me awake dying of hunger!"

10 comments:

Insignificant Wrangler said...

The depression article is an interesting read. I am tempted to incorporate it into some kind of critique of the electronic amplification of ideology--increasingly vibrant symbolic orderings--that further divorce us from a "natural" reality. But I'll try and resist that temptation and go play Call of Duty 4.

But, before then, I'll say that I like that story. The sophist wins.

Casey said...

I was just thinking about you Santos. Didn't you totally love _The Matrix_? Explain how you can like that movie, as a sophist, when the whole point of the movie was that it is possible to get out into the "real?" And what's "the real" but the Truth?

Monica said...

Yeah, very interesting--thanks for this. I think the issue, once again, goes back to balance. There are certainly people who need to be "rescued" by prescription medication--people who are really, truly chronically depressed. But it seems like we are now inclined to believe that if we aren't happy 99% of the time, then we must be depressed, and therefore need something to fix the depression. Whatever happened to grieving? I actually do my best writing when I'm on the cusp of experiencing depression--it's like there's a space there that allows me to experience, for a brief time, a different perspective of my life and the world, etc. Oh, and the Jewish idea of sitting shiva--where one literally is forced to grieve and mourn for seven days--makes for an interesting addition to this discussion as well. I think there's something useful in allowing ourselves the opportunity to just be sad and not feel pressured to be happy.

Then again, I can be a rather dark person, and so I appreciate my states of depression when they come.

Casey said...

Mon,

Sounds like you're well balanced to me. Grieving ought not to be associated very strongly with depression... I think the DSM IV said if you grieve for more than two months, you're depressed--but my guess is that most psychiatrists would be flexible there.

But it sounds like you know when you're depressed, and what it feels like. It's never been so clear for me. I think I have been depressed at times, but I never know it during the depression. And so I'm interested in the problems of labels, here... if we call it depression, we will have certain expectations. If we call it "a dark night of the soul," we might develop other (possibly better) expectations.

But I'm not confident here. Just thinking aloud.

Wishydig said...

i agree with all of the criticism of the "we need to be happy" culture. and i fully agree with the view of dark moods as possibly productive moods.

"DSM IV said if you grieve for more than two months, you're depressed"

that's melding a depressive episode and a depressive disorder. but it's not an important point because a disorder is really just a specified diagnosis that can be defined by the occurrence of just one episode -- in which case it's a "single episode" disorder. more importantly:

it's not just that you grieve for more than two months. let's back up.

feeling depressed is not enough to get a diagnosis: neither disorder nor episode. several things are necessary. the requisite number of symptoms from a determined set, some specific features/effects, the absence of certain issues/explanations.

so if someone is grieving, the therapist will ask how long ago it was, and if the person is feeling guilty or worthless. if they're thinking about death or suicide (other than a general 'fear' of death), how often they feel this way. how much of the day. general functioning. weight gain? loss? insomnia?

if someone has lost a loved one, some of these are to be expected. especially early on. if the grieving is not letting up, or if it's getting in the way of other functioning, then that's something a psychiatrist is trained to help with. (not just with drugs.) if the bereaved has been suffering for only a week, if they’re flattened by it or thinking of killing themselves and they don’t have support from friends, family, or other community, psychiatrists are trained to help. even if the grieving “makes sense.”

some of what you've said, casey, about pursuing, embracing and understanding 'depression', and monica, the fact that you might actually function a little better during a downswing, is moving past the definition of depression as an episode/disorder that makes that exceedingly difficult if nearly impossible. as i said above, i don't disagree with the importance of embracing darkness, but monica’s right: darkness does not equal depression.

i haven't looked at hollon's work, but a few thoughts: to flatly compare drug with cognitive therapy will include many cases in which the psychiatrist used drugs as a replacement or shortcut and didn't do the necessary cognitive therapy that should, in my opinion, always be part of the therapy.

and cognitive/talk is a rather imprecise way of describing the alternative to drug therapy. so i don't know if hollon is talking about behavioral too, or systems, or group, or analysis.

not only that, but what was the diagnosis of the people who were treated with pharmaceuticals and those who were not? if a depressive disorder was a 'single episode' disorder, was cognitive more likely the first step? and were drugs typically used when the disorder was already diagnosed as 'recurrent'? this is kinda like saying that cancer that was treated with just chemo was less likely to recur than cancer that was treated with chemo and radiation. it's not because radiation isn't as 'good' as chemo, but the cancer that's treated that aggressively is already more likely to recur.

terminology: we get on a dysphemism treadmill when we start questioning the label. the minute we decide to call it a "dark night of the soul" we put an expiration date on that as the better term. (tho i don't think it would be an improvement even at first.) it's the general impression we have of people who act "that way" or who ask for help with "that problem" that sullies the terminology.

i won't say much about the "depression as growth stimulus" idea, because i think it's overly romantic. i'd need to hear more about how you think that would actually work and how one should proceed.

Casey said...

I don't disagree strongly with any of that except the part about terminology. It's not that we can relabel it and thereby wipe away people's associations. We can't just call "depression" "happiness," obviously. But clinical depression remains after treatment in something like 60% of sufferers, so it has developed a connotation of unredeemability (word?!). Calling it "dark night of the soul" or even "a demon possession" simply identifies it as no-less-a-low than depression, but with a chance of snapping out of it.

Wishydig: there used to be a debate in theology about how you get saved--one side saying "gradually," the other saying, "instantaneously." It's my impression that psychiatrists are all gradualists; does that seem like a fair analysis to you?

pure_sophist_monster said...

I would only this: http://www.theonion.com/content/radio_news/study_depression_hits_losers

Casey said...

ha!

Wishydig said...

"clinical depression remains after treatment in something like 60% of sufferers, so it has developed a connotation of unredeemability."

whatever it's called, if described/defined the way psychiatrists currently do, it will have a similar recurrence rate. and besides, this is overlooking the difference between single episode disorder and recurrent disorder. and there's no discussion here of depression as a comorbid disorder and how comorbidity rates vary depending on which disorders are presenting.

i think what's happening here is that therapy is describing something different from what some "religions" would describe. a therapist is going to look at the behavior and the indications of the problem and observe (not decide) that in a certain number of the treated, a number of those indicators will either return or remain even if just to a lesser degree.

the 'salvation' approach is freer to say that the person is immediately saved or rid of the "sin" or "possession" or is simply no longer "lost" because that's not what's being measured. in some religious views, it doesn't matter that the person is likely to present the same symptoms. they're saved. and a little hiccup is to be expected. but they accepted the blood of christ! that's all they ever needed to do!

that's some religious views. obviously, with your last question you recognize that not all religious views are the same.

tho i will agree that therapy tends towards the gradual view, i still have to object to the connection of treatment to salvation. salvation can be (tho isn't always) defined without regard to the behavior of the individual.

a therapist doesn't have that same freedom. unless dsm wants to put in there a diagnosis that says "patient has achieved type-z curing by assuring the therapist of an honest desire to get better. therapist has granted this diagnosis because it seems the patient was really being honest about this desire."

Casey said...

Ok