Tag Archives: depression

IS DEPRESSION REALLY AN ILLNESS?

There appears to be an outbreak of depression. Is it a sickness … or something else?

Kick It Out's Raise Your Game conference 2014

Q: So depression is back in focus again. Clarke Carlisle (pictured above), the former footballer and ex-chairman of the Professional Players’ Association, has said he tried to kill himself by throwing himself under a lorry last December. He said he’d been suffering from depression. And Coronation Street has been featuring a story about Steve McDonald (played by Simon Gregson, pictured below) trying to get to grips with his depression. Corrie is, as usual, tackling a serious social issue and Steve’s condition seems authentic. So my first question: Who is immune to depression and will never experience the severe despondency and dejection that typically come after some kind of disappointment but seem to stick around too long and become a general feeling of hopelessness and inadequacy?

A: No one. It’s a quick answer to a long question, but it’s the truth. It doesn’t matter how successful you may be, you can still suffer depression. Reminders that life is worth living and that others are far worse off make little impression: reasoned arguments carry no weight when balanced against a complex of irrational anxieties with multiple origins. In fact, many of the most conspicuously accomplished, intelligent, imaginative and all-round successful people have suffered from this sort of condition. Brooke Shields, Elton John, J.K. Rowling, Morrissey, Sheryl Crowe are among the legion of contemporaries. Historically, artists and dignitaries and, such as Ernest Hemingway (1899-1961), Tennessee Williams (1911-83), Paul Gaugin (1848-1903), Vincent Van Gogh (1853-90) and Winston Churchill (1874-1965) experienced moods that weren’t at the time called depression but had many of the characteristics. As you know, one of my guilty pleasures is Sherlock Holmes and he was a depressive. In A Study in Scarlet Conan Doyle describes the first meeting of Holmes and Dr. Watson in 1881. The great detective explains: “I get in the dumps at times, and don’t open my mouth for days on end. You must not think I am sulky when I do that. Just let me alone.” So it seems Holmes suffered from depression; he just called it “the dumps.”

simon gregson

Q: So what exactly is depression?

A: The Word Health Organization (WHO) describes depression as “a common mental disorder” i.e. an actual condition rather than just a set of symptoms. WHO characterizes the condition “with depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration … At its worst, depression can lead to suicide, a tragic fatality associated with the loss of about 850 000 lives every year… the leading cause of disability… affecting about 121 million people worldwide. People with depression may experience a lack of interest and pleasure in daily activities, according to the American Psychological Association (APA). And MedicineNet.com notes that these may include “activities that were once interesting or enjoyable, including sex.” The despondency and dejection typically felt over a period of time are often accompanied by weight loss or gain, insomnia or excessive sleeping, lack of energy, inability to concentrate, feelings of worthlessness or excessive guilt and recurrent thoughts of death or suicide. The experiences of persistent sadness, hopelessness, worthlessness and guilt are also possible. Particularly pernicious is the unusual fatigue that is often accompanied by low energy levels; disturbed sleep patterns and a difficulty in concentrating, remembering, or making decisions. There can also be physical symptoms, such as headaches, digestive disorders, and routines pains that do not respond to treatment. Alcohol or drug abuse may be signs of depression; Carlisle confessed that he had an alcohol dependency. The two major types of depression have been distinguished as Dysthymia, a persistent, mild depression lasting for at least two years with symptoms never disappearing for longer than two months and milder cyclothymia.

Q: It’s unlike you to accept medical definitions. What are your own thoughts?

A:  The word depression wasn’t part of the medical vocabulary before 1987. That was the year in which the Eli Lilly pharmaceutical company introduced the drug fluoxetine onto the market. Its brand name was Prozac. Up till then people went to their doctors with “anxiety” or “nerves” and were usually prescribed tranquillisers such as Valium (the trademark for diazepam, muscle-relaxant drug.) Originally developed for high blood pressure, then as an anti-obesity agent, fluoxetine was tested on patients with severe mental disorders in which thought and emotions were so impaired that communication was extremely difficult if not impossible. The condition of most these psychotic patients remained unchanged and deteriorated in some cases. Then the fluoxetine was tried on five individuals with milder conditions and it seemed to cheer them up. More testing began in earnest. Today, about 54 million people around the world habitually take Prozac, which is just one of several prescription drugs known collectively as antidepressants. Between 1991 – i.e. four years after the introduction of Prozac – and 2001, depression in the USA more than doubled. It seemed more than a coincidence. According to the World Health Organization (WHO), depression is set to become second only to heart disease as the world’s leading disability by 2020.

Q: So, if I understand you correctly, you’re saying we invented the drug first, then created a medical condition that it was capable of treating.

A: Depression might not have begun in the early 1990s, but its official recognition as a sickness that could be clinically diagnosed and treated with medication marked the start of depression as we know it.

Q: That sounds a somewhat cynical appraisal. Is it?

A: I don’t think so. Most medical conditions are defined by their treatment. Clearly, there are a theoretically countless number of sicknesses; the ones we have identified as treatable we have named. For example, I was watching BBC2’s Wolf Hall and was interested to learn the central character Thomas Cromwell’s wife and daughters died suddenly and without obvious symptoms. Apparently, they died with what was called sweating sickness, which appeared around the end of the fifteenth century; it disappeared in 1551. But we still don’t have a name for the disease, which was, in practice, untreatable. Our understanding of illness depends on how the medical profession defines it. Now, it has defined depression as an illness and prescribes treatment accordingly.

Q: So it is an illness, right? I mean, people are always saying we should approach it as we would a broken leg or influenza or any other kind of malady. That way, we remove the stigma associated with mental illness. That’s a good thing, surely.

A: Yes, if it promotes a more open approach to the subject, then, obviously, it must be a good thing. Many people who have suffered from depression have been encouraged to talk freely about their condition and seek ways of shrugging it. I just think we should recognize that depression is not actually like a broken leg or cancer. Its causes are often difficult to discern: depression has multiple origins in the life experiences of the people concerned. I know some people will offer the simplistic view that depression is just a neurochemical imbalance that can be fixed with drugs. It can be managed by drugs, perhaps. But the sources of depression are complex and, often, unknowable. So, on balance, I don’t object to the comparison with physical complaints. But I think we should see physical conditions as metaphors, that is, to highlight similarities. Depression is not a physical sickness.

 

 

 

 

 

Depression in sport

IAN THORPE IS THE LATEST SPORTS STAR TO SUFFER

Ian Thorpe ‘in rehab for depression’, says managerThe five-times Olympic swimming champion, Ian Thorpe, has been admitted to rehab after suffering from depression, local media said on Monday.

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The recent news about Ian Thorpe  would have been stunning ten years ago. Today, we are used to hearing about former Olympic champions, football greats, rugby legends and stars from many other sports who quickly fall from grace once their competitive career ends. Depression is prevalent among athletes across the whole spectrum of sports. Why? After all, these are people who have achieved more than most of us and enjoy the adulation of sports fans. Perhaps the very factors that drove their success also contribute towards their depression. One of the chapters of my book Making Sense of Sports examines the specific causes of depression in sport. I include it here: Sinking Under Pressure

Jonathan Trott’s stress-related illness

Jonathan Trott - England

The news that cricketer Jonathan Trott is returning from England’s tour of Australia, suffering from what’s been described as a “stress-related illness,” reminds us of how depression can unexpectedly descend on the most unlikely people. In recent years, athletes from across the whole spectrum of sports, have seemed particularly prone to depression. Perhaps there is something peculiar about the intense, competitive environments in which they operate. The 32-year-old Trott endured a torrid time during the first test in Brisbane as he was twice dismissed cheaply by Mitchell Johnson. He was also the victim of insults from David Warner, who accused England of being “scared” of fast bowling and Trott of being “weak”.  A few months ago, Ellis Cashmore wrote a blog on depression. Here we repeat that blog.

Is depression really an illness?

It sounds a ridiculous question today. Ten years ago, we would have discussed it. Twenty years ago, we would have been suspicious. And thirty years ago, we wouldn’t have heard of the word depression, at least not in the way we use it today to describe a prolonged feeling of despondency and hopelessness. The way we conceptualize depression is largely a result of medicine.

About 54 million people around the world habitually take Prozac, which is just one of several prescription drugs known collectively as antidepressants. Between 1991 – i.e. four years after the introduction of Prozac – and 2001, depression in the USA more than doubled. It seemed more than a coincidence. Before 1986, people were nervous, glum, moody or felt continually down in the dumps. Depression didn’t begin in the early 1990s, but its official recognition as a sickness that could be clinically diagnosed and treated with medication marked the start its medicalization. This refers to the treatment of something – potentially anything – as a medical problem, even if there is little justification. That little justification is: we can treat it. If we have the ability to address any behaviour pattern or unwelcome emotional state with a medical intervention, it becomes a medical condition. Problem gambling and sex addiction, for example, are accepted as medical conditions. Treating them as such precludes any analysis of the underlying cultural conditions that give rise to complex patterns of behaviour that become, in some senses, unwelcome.

So when I hear the likes of Clarke Carlisle, the ex-pro footballer, chairman of the PFA, and Staffordshire University alumnus – and with whom I align myself in his campaigns against racism in sport – talking about depression in football, I have mixed feelings. On the one hand I appreciate that labelling mental states that interfere with normal functioning as illnesses helps remove the stigma once attached to mood disorders. If you manage the symptoms with therapy and drugs, then it serves to de-stigmatize it. On the other hand, it masks the origins or sources of the condition and painlessly negates its social dimensions. Symptoms are treated; causes are identified as within the individual, not his or her surroundings. Medicalization is a dominant force: today, more people are diagnosed with mental disorders than at any time in history. Are we getting sicker, or less “normal”? Or are we just inventing new kinds of mental disorder? The “bible” of psychiatric disorder is a US manual, The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, which is used worldwide as a basis for diagnosis, research and medical education. The 2013 edition contains diagnoses of conditions such as mixed anxiety depression, psychosis risk syndrome and temper dysregulation disorder, as well as the more familiar binge eating. Accepting depression as a sickness means subscribing to what’s called a disease model.

Three particularly influential critiques of the disease model emerged in the 1960s and 1970s. They were those of Thomas S. Szasz (1920- ), R.D.Laing (1927-89) and Thomas J. Scheff (1929- ). In his The Myth of Mental Illness (1974), Szasz critiqued both the concept of mental disorder as a disease, or even illness, and the psychiatric profession that perpetrated it. In a different, though complementary way, Laing (1965) located the causes of behaviours that are seen as symptoms of mental disorders in the family, where he saw destructive conflicts disguised as “love” and “care.”

Scheff’s Being Mentally Ill (1966) proposed that mental disorders are the product of social responses to certain kinds of deviant behaviour. Being normal means conforming to an expected standard. Normalcy is a convention: a customary set of protocols and guidelines as to how we should think and act. Deviations are labelled and those who get stuck with a label find themselves unable to shrug them.

In all these and many related arguments, the complexities and diversity of character and content of what is popularly recognized as mental illness meant that it could not be reduced to the status of a disease or straightforward illness. Mental disorder is experienced in the mind, but the implied arena is larger: private conditions are indexed to social processes.

The terms that come under the rubric of mental disorder are, from this perspective, convenient labels. Once someone gets labelled as suffering from a mental disorder and in need of treatment, whether pharmaceutical or psychiatric (or both) the stigma sticks. This makes it difficult for them to be anything but someone who suffers or who has once suffered from a mental disorder and, in this sense, isn’t totally no

While it may serve the purposes of sport to liken, equate or make mental disorders synonymous with physical illness, we should guard against seeing this as the only way to understand mental disorders. According to many scholars, disordered people are often coping with exceptional social predicaments and their symptoms are more reflections of what goes on outside them than inside them.

Depression and associated mental disorders, even those of the most serious nature, have diverse origins and divergent paths of development. Mental disorders should always be understood in context and conceptualizing them as diseases does not necessarily advance this understanding. Even if it does embolden footballers and other athletes to talk about their problems in public.