Could Depression Be A Healthy Response to a Dysfunctional World?

More and more people are taking anti-depressants these days and more and more doctors are treating us for serious mental disorder.  I’m beginning to wonder if all these people really have a brain disease or is depression and other “mental illnesses,” really a healthy response to living in a dysfunctional world.

We know people become depressed following a divorce or the death of a loved one. When we suffer a loss, we may become sad. We may cry or mope around with little energy. The things that once gave us joy seem uninteresting. We may sleep too much or not be able to sleep at all. We overeat or may have no appetite for food.

Most of us don’t take medications to deal with this kind of depression. We recognize it as a healthy reaction to a traumatic life experience. We don’t try to make the feelings go away. We let ourselves grieve and eventually we come back and regain the joy we once had. We may have to learn new skills or develop new relationships after the loss of a loved one, but we don’t see ourselves as sick or mentally ill.

I remember when I was in medical school many years ago. I had just graduated from college at U.C. Santa Barbara and had gotten a four year, full-tuition fellowship at U.C. San Francisco Medical School. I was excited to be embarking on a career in medicine where I could help people. But during the time I was in medical school I became increasingly anxious and depressed. I wasn’t prepared for the long hours, lack of sleep, demanding, often bullying, staff.

I thought there must be something the matter with me that I couldn’t handle the demands of what was reported to be one of the best medical schools in the world. I eventually dropped out and for years I felt like a failure for not being able to do what it takes to become a doctor. It never occurred to me at the time that become anxious and depressed might have been a healthy response to a dysfunctional learning environment of medical school.

I never realized how pervasive the problem was or how it impacted the lives of the medical profession and all those who see a doctor for help until I learned about the work of Dr. Pamela Wible. In her powerfully moving book, Physician Suicide Letters, Dr. Wible, herself a family physician, exposes the pervasive and largely hidden medical culture of bullying, hazing, and abuse that is a regular part of medical school training throughout the U.S. and around the world.

The result is that more and more medical professionals are breaking down under the weight of a dysfunctional system. “Each year more than one million Americans lose their doctors to suicide,” says Dr. Wible, “and nobody ever tells the patients the truth. Nobody talks about our doctors jumping from hospital rooftops, overdosing in call rooms, hanging themselves in hospital chapels. It’s medicine’s dirty secret—and it’s covered up by our hospitals, clinics, and medical schools.”

Dr. Wible begins her book with these words:

“Despite it all, I remain an optimist. Medical school knocked me to my knees. I haven’t been the same since. Even though I still have a sparkle in my eyes and joy in my heart, a piece of me is missing. I can never get it back. I’ve tried. My innocence is gone.”

She goes on to describe her first year in medical school. “In my school, there seemed to be no end to the filthy jokes that demeaned female patients and classmates. In lectures, my instructors actually made fun of vegetarians for eating ‘health food.’ When I protested the dog labs, where first-year students had to kill dogs, the dean diagnosed me with ‘Bambi Syndrome.’ I was belittled because I cared—about animals, about people, about my own health, and about this planet we call home.”

I thought surely things must have changed since I went to medical school or since Dr. Wible graduated, but that is not the case.  In a report Dr. Wible wrote on September 4, 2017, she found that 75% of medical students are on antidepressants or stimulants or both. One of her colleagues, Dr. Jaya V. Nair says, “How broken is the system that doctors have to be pushed into illness in order to be trained to do their job?”

One of the doctors who responded to Dr. Wible said, “I’ve been on an antidepressant since being premed—18 years now. Little did I know it would be impossible to wean myself off and that my entire class was using Adderall.” Another doctor responded, “True but most take them in secret as there are negative consequences and stigma that come with getting your mental health addressed.”

Dr. Wible notes that physicians must answer mental health questions, right next to questions on felonies and DUIs, in order to secure a medical license, hospital privileges, and participate with insurance plans. They are forced to disclose their “confidential” medical history. “You have to defend yourself—again and again for your entire career. You’re treated like a criminal for taking meds to cope with the torment of medical training and practice.”

One long time doctor told her, “I’ve been in practice 20 years and have been on antidepressants for all of that time,” says Jason. “I drive 300 miles to seek care and always pay in cash. I am forced to lie on my state relicensing every year. There is no way in hell I would ever disclose this to the medical board—they are not our friends.”

“What if we stop the mental health witch hunt on our doctors?” asks Dr. Wible.  “Why not replace threats and punishment with safe confidential care? What if we address the root of the problem—the great sickness in medical education—rather than shifting blame to 75% of medical students for not having enough serotonin or dopamine or norepinephrine in their brains?”

What  Dr. Wible is pointing out in our dysfunctional medical education system is a microcosm of what is going on in the larger world. We are living on a finite planet, with finite resources, yet we act like we can continue growing indefinitely. Our population increases every minute of every day and we don’t have enough clean air, clean water, and land to grow food for everyone. We continue to use fossil fuels and increase the global temperatures and then are surprised when we keep having killer storms. Does it make sense to see people who are responding to these challenges, either consciously or unconsciously, by becoming depressed, as “mentally ill?”

Perhaps it’s time to recognize that a lot of us are becoming depressed because we are living in a dysfunctional society, not because we are mentally ill. Maybe we’re living in a manic-depressive world and we should treat more of the social problems we face, rather than focusing on individuals. We might do better to address these larger social issues directly, rather than trying to medicate the population. Your comments are very much appreciated.

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Comments

  1. You pose an interesting question about the cause of depression, relating it to the dysfunction in our world. It’s a brilliant idea! When people experience a loss and experinece “situational depression” there is often a negative inner dialog going on and as the grieving process winds down, that dialoge usually stops. What if the pervasive depression is a grieving process, a stress response, that has never ended? What if there is a constant, negative inner dialog going on about the state of the world and our individual lives that my not be turning out the way we wanted them to? All of this would cause the “chemical imbalance” in the brain that drugs attempt to correct, sometimes with little success. Allopathic medicine does not consider that the cause of the imbalance is due to a mind/body connection that is not working properly. It’s just a “mechanical problem”, if you will, that needs drugs and a label to fix. It’s really time to correct the systems that are contributing to our mental states and above all, establish safer practices in medical training especially in hospitals. The long hours that the interns have to keep with out reasonable rest is, in my opinion, a safety hazard.

  2. “If you’re not depressed, you’re not paying attention to what’s happening.”
    Dr. Gabor Mate is the clearest voice for this point of view. He shows how most human ills are caused by environmental factors (processed foods, economic hardship, pollution, toxic chemicals in our environment, racial prejudice, etc.) cause the human body to go into a state of constant stress, with ill heath the result. Then he recounts the many ways we try to cope: materialism andconsumption, entertaining ousel es to death, fighting each other or the system, collapse into depression, religiosity, etc.

    The information accelleration is now faster than the human nervous system was designed to handle. No wonder we are so fucked up, and fucked as a species.

  3. Bill Bright says:

    Jed

    When one suffers a depressive event that is beyond sadness they likely are unable to make decisions about their own care. So many people have no idea what major depression is, and everyone thinks they know. Likely it is not even a mental illness but is an actual physical disease that impacts one’s mood along with so many other physical systems in the body. There is research now that indicates it is an inflamitory disease, the science is not settled and we shall see. I know that depression impacts every aspect of a person’s being and medicine can be a literal life saver. A part of the shaming occurs when so many assume they understand what depression actually does to a person, like cancer one could never know what a cancer diagnosis does the a person without having lived it; the same is true for depression.

  4. In all of the years I have been following your MenAlive thread, Jed, I truly believe that this last article, on depression is your best – and probably on one of the most serious, and common, although totally appropriate responses to the planet we live on and are desecrating.
    Being a depression sufferer myself – for decades now, I have often, whilst talking to mental health professionals, alluded to what I have termed as ” Environmental Depression” when referring to a primary driver for my mental state. Being a practising Earth Scientist and naturalist, I am acutely aware of the processes and systems which regulate so much of our earth’s viability as a life support system for humans – AND the hideousness wrought thereon by all of us – as humans.
    As far as I am concerned, and despite common comments to the effect that my worrying/depression won’t change the system one bit, I believe that a deep depression is the only sane and appropriate response to the daily horror we are exposed to – and the effects thereof on system Earth. It doesn’t help me to live a happy life though and I find it extremely difficult to attempt to adopt the attitude that, as nothing can be changed, one may as well stop worrying/caring/aching…..and just accept, be happy, and move on.!
    Do you have another option you could recommend?
    Thanks, as always, for giving us, as fellow men, an outlet, and a forum in which to express ourselves.
    PS your last article about cheap sex and modern men also hit home very hard…..you;re definitely onto something there too!
    Regards
    Sven

  5. Jed, i’m glad you addressed this issue. I think your points are valid, and I would add that it’s likely a spectrum event. I think the background noise of dysfucntional system puts undo stress on all of us that contributes, either primarily or less to mental illness. We can;t finally separate ourselves from the matrix of society.

    With this said, when a person suffers from depression, they might know just what precipitated it. They may not. As you likely know, there are many factors that can trigger a major depression: nutritional, hereditary, epigenetic, stress, loss, etc. We could add to the mix global collapse. Like stress or genetic predispositions, one is particularly privy to global dysfunction might list it as primary. Or, as a background contributor if they were in a relationship which triggered depression.

    I am particularly conscious of climate change crisis and I have wondered if it contributed to my depression last year. Alas, I don’t think it did, at least not primarily.

    Good stuff, thanks, Jack

  6. I feel this deeply and see it in many of my friends. It’s hard to feel happy when you know the planet is dying, when you are watching your friends also struggle with depression about our planet and its future. More of my friends “don’t want to to bring kids into this world” than do. And our government’s lack of concern is particularly depressing.

  7. Friends,
    Thanks for the feedback and comments indicating you resonate with the article and the issues I raise. As Lion notes there are other good writers focused on these issues, including Dr. Gabor Mate who I admire a great deal.

  8. Dianne L. Ochiltree says:

    Yes! Depression (like physical pain) is an indication of a problem that needs attention. It’s a symptom not the problem itself. It makes sense to heal the underlying problem instead of focusing only on treating the symptom.

    • Dianne,
      Thanks for the comments. The fact that there are underlying social causes of depression does not mean that individuals shouldn’t be treated. It just means that treating individuals is not enough to keep the problem from impacting more and more people. There’s an old story about a guy pulling drowning people out of a river. He pulls one out and no sooner does he get them to shore before there’s another one calling for help. Finally, he calls for help himself, asks a friend to pull out the next person who is drowning while he tells him, “I’m going upstream to find out who keeps pushing people into the river.”

  9. Larry Potts says:

    I disagree. My depression was caused by conflict aversion and my inability to cope with what was going on in my life for a number of years. I was never taught the skills to ask honest questions or give honest opinions because growing up, we avoided conflict/truth. My avoidance led to numbness and eventually decisions that were damaging to my marriage and family. I was surprised/shocked when I was diagnosed with severe depression, but when I started to finally be honest with my therapist and took my medication as prescribed, I was able to heal. The world did not cause my depression, I did by being an “avoider”.

    • Larry, Thanks for your response. As someone who has suffered from depression myself, I agree that there are certainly definitely personal, interpersonal, and biochemical aspects to depression which should not be discounted, avoided, or denied. I suspect that depression as a complex set of issues that operates at many levels in our lives. Sharing our own experiences can help us better understand the causes and the treatments.

  10. I believe that depression is the inevitable result of living in a world that feels unbearable to many people. I have been thinking this for years, and I am so grateful to you for writing this article.

    • Diana, Thanks. We all reflect the trauma going on around us in our personal lives. We need to heal ourselves in order to heal the larger problems in the world and we need to heal the larger problems in the world in order to heal ourselves.

    • Very well put Diana, and it certainly is my experience too, particularly with respect to the horrific damage humans are wreaking on this planet in terms of the environment (OUR environment).
      As an earth scientist, and a practising marine geoscientist, I am acutely aware of, and believe I understand a lot about the background to the issues we are experiencing. This, coupled with humanity’s apparent inability, or selfishness to constructively change our way of life, is very depressing – especially when one realises that one is, oneself, partly to blame, and similarly, maybe selfish enough to avoid make changes, on a personal level.