Tag Archives: Coronation Street

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.

 

 

 

 

 

Corrie and the right-to-die, part three

THE END OF A GRIM BUT BRILLIANT STORY

The contentious subject of euthanasia has never before been addressed, at least not like this: uncluttered by piousness and unblemished by homily. Coronation Street has abstracted from the ethical debate about the right-to-die a dramatic exposition of the emotions it elicits and the human consequences it involves. On Monday night, viewers will weep as the terminally ill Hayley Cropper, played by Julie Hesmondalgh (below), takes her own life. It will be the culmination of perhaps the most challenging and certainly the most provocative storyline in the history of the soap and, for that matter, any soap.

Hayley Cropper from Coronation Street

Readers of this blog will know I have twice written appreciative pieces on this story, which has been handled with delicacy and imagination by the scriptwriters. Hesmondalgh and her stage husband David Neilson, who plays Roy Cropper, have delivered virtuoso performances, taking viewers on a forbidding journey from Hayley’s initial prognosis through an uncomfortable debate and finally to Monday night’s finale. The entire story has rang with truth even against the background of comic turns and improbable chains of events elsewhere in the show. The tragically deteriorating Hayley’s death is all the more powerful because we believe it. So much so that the Samaritans fear it could affect “vulnerable viewers.”  The Samaritans are undoubtedly well-intentioned, but when they warn, “There is a risk of copycat suicides,” they are inadvertently being alarmist. There is no such risk. Coronation Street viewers are sentient enough to realize they are engaging with a drama, not seeking counsel from Dr. Jack Kevorkian, who assisted in many patient suicides. Other groups, such as Care Not Killing have complained the story should have focused on the quality care available to terminally ill patients. My own view is that the writers have done their due diligence and presented a storyline that has covered several angles without losing any of the humanity involved. This is not to say it won’t influence people: it most assuredly will, but in a way that promotes reflection and deliberation. No one will watch Monday’s two episodes and remain unchanged. Art should change us. I have covered the various sides of the debate previously and won’t repeat them; suffice it to say that, in my view, Corrie has steered refreshingly clear of moral signposts and simply allowed viewers to become guiltless intruders on a highly personal discourse between two people who love each other but recognize the inevitability of one’s death. We have been able to glimpse the terrible vision and, on Monday, some of us will need to watch through parted fingers as Hayley leaves us.

I will be discussing this story with Liz Green on her morning show on BBC Radio Leeds next Monday.

 

 

Corrie and the right-to-die

DRAMA HANDLES EUTHANASIA WITH SUBTLETY

Coronation Street’s reputation as Britain’s premier soap is based on its preparedness to take on divisive social issues and avoid crass simplifications. It is currently featuring euthanasia. In the itv drama, Hayley Cropper, the transsexual character played by Julie Hesmondalgh, has just been diagnosed with inoperable pancreatic cancer, with six months’ life expectancy. Last week she told her husband Roy, the singular, thoughtful café owner played by David Neilson, that she intends to take control of what’s left of her life and die when and in circumstances of her own choosing. She sees the alternative as a nightmarish descent into morphine-induced purgatory where visions of her past life as a man will return. Her usually sympathetic husband surprises her with his response. At first, he assures her that she will change her mind, then resigns himself to the prospect of being complicit in her termination. He accuses her of being selfish by depriving him of every last available second he cherishes with her. Reminding her of the palliative care she will receive, he tries to convince her that she won’t necessarily suffer from the confusion than sometimes results from pain relief. “I’d rather forego the goodbye if it meant you weren’t suffering,” he tells her. With no resolution, Hayley collapses and is entered into hospital with an infection. As usual, Corrie’s writers have handled a sensitive moral dilemma with care, never reducing the issue to pat answers. The viewer completely understands Hayley’s concerns about losing control as the cancer debilitates her, while feeling the impact of her decision on her loving husband, who himself attempted suicide in the past.

http://www.youtube.com/watch?v=CdpwJBCz9BI

The drama makes the debate complicated, tangled and wracked with competing emotions. Euthanasia elicits all manner of emotion. At one level, it seems an individual has every right to end his or her life however they wish, particularly if the alternative is prolonged suffering of some kind. Loved ones are forcibly reminded of the preciousness of life and the possible catastrophic impact on their own lives. Palliative care, we are often assured, has come on in leaps and bounds in recent years and the kind of torment Hayley anticipates is unlikely to happen. All the same, should a person be forced to accept care against his or her will?  Should they be compelled to live with medication until the disease reaches its inevitable conclusion? Or should they be allowed to decide for themselves? Under English law, all adults have the right to refuse medical treatment, as long as they have sufficient capacity (the ability to use and understand information to make a decision).

Other countries have different rules. Active euthanasia is currently only legal in Belgium, Holland and Luxembourg, for example. New Zealand’s recently withdrawn End-of-Life Choice Bill would have allowed adult residents to access medical assistance in hastening their death if they met certain criteria. Patients and their families must have a clear understanding of all of their options through carefully guided conversations with their medical practitioners.  By making euthanasia legal, the law would have allowed family members to discuss options and support each other, rather than have clandestine conversations and face legal prosecution if they follow a loved one’s requests. So the pro-euthanasia or “right-to-choose” argument is not for totally unrestricted choice in one’s own suicide and its guiding morality is that, while dying is not a good thing, it’s often preferable to suffering and the loss of dignity diseases sometimes entail. Those who oppose assisted dying are usually guided by a moral compass that comes from their faith. No one, they argue, has the right to “play God” and there is something profoundly irreligious about an arrangement that permits exactly this. Most religions regards the preservation of human life as one of the supreme moral values, though there is no complete unanimity in, for example, Buddhism, Sikhism and some areas of Christianity. Corrie will, again, set an agenda for a debate about a subject that will continue to arouse great emotions. It is to the show’s credit that it can integrate issues of great complexity into its narrative.

@elliscashmore