Why are we increasingly turning to chemicals - prescribed drugs - to deal with emotional lows, asks Fiona O'Doherty
For many of us the time after Christmas can generate a strange slump into what we might call post-Christmas blues. It might just be the effect of exhaustion, or even the stress of too much close contact with "loved ones", but others might be experiencing a more serious and less transitory low mood.
In Britain, a society of 55 million people, there were 31 million prescriptions for anti-depressants, including some repeat prescriptions for the same individuals, in 2006 alone. Could Ireland be so far behind? Before we reach for the chemical solutions to our problems, should we be asking some questions about what is greater - the problem or the solutions offered?
If the rate of prescriptions in the UK has risen to such a level, does that indicate that this is an appropriate response to an escalating problem, or could the treatments be exacerbating the problems they are supposed to cure?
While severe depression can be like an illness, requiring proper treatment including medication and other remedies, the recipients of 31 million prescriptions of antidepressants in the UK in 2006 must have included many millions of people suffering from a negative emotional state that it makes no sense to describe as "illness".
In these cases, the label "depression" is an inappropriate medicalisation for normal human emotions.
The fact that these 31 million prescriptions may in some cases dull such negative emotions is not evidence of the existence of so much "illness", no more than the fact that alcohol can produce positive feelings is evidence that happiness is a disorder. Both emotional states, however, can be measured by chemical changes in the brain.
We are increasingly turning to chemical solutions to provide our emotional highs - for instance via alcohol or cocaine - but it seems that we increasingly also expect a chemical solution to our emotional lows through anti-depressants such as Prozac.
This does not mean that someone who is already taking anti-depressants should stop taking them - no more than it implies that the person who enjoys a drink at a party should stop doing so.
Depression - or at least the mental states for which many of these millions of prescriptions are made - is in my experience better described as the emotional reaction to a failure of expectation.
Expectations, when they are unrealistic, are not mitigated by wealth, material goods or intelligence and so "depression" can occur in anyone whose life expectations are not met.
But suppose it is the case that our society is generating those unrealistic expectations and then describing failure by individuals to meet them as a pathology or problem in the individual? We then provide drugs and/or therapy for the problem, call for increased services for these individuals, and perpetuate the message that "the problem is in you" and has nothing to do with "us", thus absolving society of any responsibility for the underlying problem.
Is the medicalisation of emotional states then really profit dressed up as compassion?
Research trials for drugs always have tightly defined criteria for the patients on whom the drugs are tested. But the later mass prescriptions to large sections of society whose condition and characteristics would never have fitted the criteria necessary to be included in the trial mean the definition of "depressed" is becoming wider.
The effectiveness of the treatment becomes less but the profits of the pharmaceutical companies soar, arguing continuously that "we are only treating the tip of the iceberg".
But the industry that is "depression" and its treatment is not confined to pharmaceuticals. My own profession provides "talking therapies" - for I am a clinical psychologist - and is therefore vulnerable to the same charge of laying responsibility for depression on the individual rather than on the expectations that we generate as a society.
The burgeoning of the counselling industry serves a similar, if less profitable, function to that of anti-depressants. Do talking therapies and medication, by focusing on the individual as the unit of treatment, perpetuate the problem and focus on the wrong issues? The individuals concerned are made to feel there is something wrong with them as people, while we as a society can feel good by demanding more resources to provide help for sick individuals, while at the same time ignoring our own contribution to the problem through our societal attitudes.
One example of this is society's attitude to heavy and binge drinking - one of the major predictors of suicide. Suicide prevention programmes that attempt to identify "at risk" young men may be ineffective against a context where society lauds heavy drinking through the language of "a few scoops" and "getting hammered", or selling alcohol at giveaway prices in supermarkets.
We have created a society that expects immediate gratification of all our needs, along with the idea that to every life problem there is a solution - if only sufficient "services" were available. If such solutions - treatments - are not provided, then we tend to assume there is someone to blame. One thing we do not do is question what role we as individuals making up society play in the escalation of problems loosely diagnosed as "depression" through increased expectations of success, be they of the national football team, points in the Leaving Certificate or financial gain.
We often set unrealistic targets for individual achievement - be they academic, personal, occupational or financial. When an individual does not, or cannot, reach all these targets, we are increasingly diagnosing their consequent negative emotions as an illness.
As a society we are to a considerable extent emotionally immature, expecting immediate gratification of highs - obtained often through drugs such as alcohol or cocaine - with little tolerance for negative emotions that are increasingly medicalised. We are increasingly fostering values where only measurable achievement is of merit.
The focus of success, as well as failure, has become the self, the individual, rather than the group or community. Unmeasurable achievements in areas such as the local community, the arts or altruism do not attract the same plaudits.
Is it going too far to say that it may be unethical to treat many millions of these individual recipients of anti-depressants or of counselling for depression, if at the same time we ignore the need for change in society and fail to see the link between the two? To use an analogy, it is like trying to treat a public water pollution crisis by providing filters for each individual house rather than concentrating treatments and resources on the source of the pollution. Whereas both approaches will protect the individual or household once the problem already exists, it is clear that to focus only on individual households would be ineffective and lead to an increase in the problem in the long term. This of course is good news if profit or professional ambition is the motive.
So what is the alternative? As a society we need to focus on a programme for our "emotional education" that creates values beyond the achievement of single individuals. Emotional education would involve learning to rediscover and appreciate aspirations and rewards for achievements that extend beyond the individual self. The current cult of celebrity, the obsession of the mass media, does the very opposite.
At a social policy level this would involve solutions that go to the heart of the problem in society and reduce the focus on the individual. To reduce rates of negative mood we should aim for our education as a society, and for policy decisions aimed at developing values and expectations based on common rather than individual goals.
We must stop blaming the individual and diagnosing them as ill for simply not reaching unattainable targets generated by our societal values and attitudes exemplified by the corrosive dominance of the cult of celebrity.
Fiona O'Doherty is a clinical psychologist, practising in Ireland and Britain