How did we become a generation of mentally ill people?

“An analysis of why depression is on the rise.”

Mental health has been somewhat of a touchy topic .We don’t like to talk about it much. And when we do, we don’t talk about it very well — it shows in the terms we use to describe the mentally ill (crazy, psycho, retarded for instance) and the caricatured stereotypes portrayed in the media.

However, in the recent past, there has been a growing presence of a particular kind of mental illness in popular culture — depression. Several celebrities have come out in the open about their experiences with Major Depressive Disorder (MDD or depression). It looks like we can now have a public discussion regarding the once-taboo-topic without its victims feeling humiliated.

With this trend, some genuinely disturbing statistics have come to light. The World Health Organisation (WHO) estimates that worldwide depression is the leading cause of disability for people in midlife and for women of all ages. Depression is diagnosed in about 40% of patients who see a psychiatrist. This percentage has doubled just in the last 20 years .Consumption of antidepressants has soared since 1990. By 2000, antidepressants were the best-selling prescription drugs of any type! Yet, studies suggest that there are vast numbers of untreated depressed people. In the past, depression was a major psychiatric illness that was not very common. But according to current estimates, one in every ten people is likely to have had depression at some point in their life.

The sharp increase in the number of cases of MDD is ironic in some sense. Statistically speaking, we are now in the best, most peaceful time in our species’ existence. If you didn’t know who you were to be born as, I’d argue this is the best time to be born — thanks to the global decline in violence and discrimination, great advancement in science, technology and medicine, better education opportunities, lower mortality and poverty rates. How then, did we get ourselves into this bizarre epidemic of mental disorder?

Turns out, it may not be an epidemic at all. The sudden rise in the rate of MDD can be explained by a change in its diagnosis by the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-III) in 1980. These changes were made in an effort to make the criteria for depression (and other mental disorders) uniform and easily quantifiable. In the past, only symptoms that were “excessive” and “inexplicable” were considered to be signs of depressive disorder. This made the diagnosis somewhat subjective. Now however, someone who has three to five symptoms out of a list of nine, that include — depressed mood, loss of interest in usual activities, insomnia, fatigue, lessened appetite, an inability to concentrate and similar symptoms — for as brief a period as two weeks is considered to have MDD (Major Depressive Disorder). The problem is, everyone is likely to have gone through some degree of these symptoms while combating normal sadness. The current diagnostic guidelines conflates clinical depression with severe, but healthy sadness.

Mental Health advocates like such large projected patient figures because now it starts to look like this is a public health concern of massive proportions. This helps in reducing social stigma and diverting more resources to the problem. Pharmaceutical companies have obvious advantages from peddling drugs to healthy people with intense sorrow, misdiagnosed as mental health patients. And individuals may find comfort in the idea that the problems they face are because of an illness that would go away by taking some pills. The consequences of over and un-necessary medication is worrisome. The risks and side-effects of medication on healthy individuals has not been appropriately studied or assessed.

Even though some anti-depressant medications may help alleviate normal sadness, the misdiagnosis of personal sorrow as mental illness has damaging effects, particularly for younger people. Hardships is what trains our mind to form defence mechanisms and develop mental fortitude — it pushes one to identify and change the environmental factors that cause distress. Sadness is not something we need to run away from by popping pills. It is a healthy emotional response to something important going wrong in an individual’s life. And the natural come-back is to think hard, and systematically try to figure out how one might do something to change it. There is nothing wrong with wanting to feel better and if it involves taking medication, so be it. But it is unnecessary and dangerous to box up and label these natural emotions as mental disorder.

I cannot stress enough on the importance of being kind and sensitive to people combating severe sadness or clinical depression. Anything we do or say, is probably going to have a greater impact than we assume. It is irresponsible to belittle their problems. Having said that, trying to help a person who is suffering from natural, intense sadness, but has been misdiagnosed as a patient of MDD, is tricky. The internet is full of rubbish articles listing out things you should never say to a person struggling with depression (See for instance, http://www.lifehack.org/articles/communication/12-things-you-should-never-say-person-struggling-with-depression.html). Going by these lists, there is virtually nothing you can say to a mis-labelled patient apart from platitudes like — “What can I do for you” and “I am here for you”. Any conversation regarding making changes or taking actions to help cope with the distress is considered insensitive. It seems impossible to have an honest conversation and bring a perspective differing from the so-called patient’s, to the table.

In conclusion, it is of utmost importance to have a more nuanced diagnosis of MDD, even at the cost of some inconsistencies. The DSM-4 in 1994 took a step in the right direction and included some minimum ‘clinically significant’ thresholds in diagnostic criteria. More academic discussions need to happen around reducing the rate of false positives in diagnosis of mental disorder. We must ensure that the clinically depressed patients and those suffering from severe sadness, get safe and effective treatment, most appropriate to their respective conditions.