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.