The Justice of the Mind
We all know about depression. It’s scary, to be quite honest. It will sneak up on you and put you on your knees begging for mercy from its bitter torture. The positive thing, however, is that we have numerous ways of getting you better and back into your normal life. As Elizabeth Spelman, author of the book Repair: The Impulse to Restore in a Fragile World, stated in her book, there are two main ways to repair a human being, either retributive or restorative. The retributive way of being repaired is through antidepressant medications while the restorative form of repair is a kind of therapy referred to as cognitive-behavioral treatment. These two methods can bring a man wishing for his deathbed back into society and his normal life, but to understand just how effectively these two methods can work, one must understand their purpose, both in a literal and reparative sense, and what the end result can potentially be.
Spelman’s thoughts on metaphorical retributive and restorative repair were introduced through the justice system, saying how “repair is at the very heart of justice” (Spelman 51), but maybe a depressive episode is a situation in which there is a victim and a perpetrator, the sufferer and the depression itself, respectively. This new metaphor of repair can show that the repair being done to the mind of a depressed individual is essentially the effect of antidepressants being retributive justice, just quickly shutting away the problem and cognitive-behavioral therapy being restorative, working with every part of the mind, which is an internal community itself, to push away the depression and come to terms with its current reality so that you can return to yours.
Depression — the word reeks of dread and suffering. A thing that we all would like to avoid. But “the true story of H. reparans throws into sharp relief how we humans have responded to the fact of being creatures who are inherently limited by the resources at our disposal, who are subject to the ever present possibility of failures and decay” (Spelman 138), so what do we do when depression’s cold, heavy grip catches up to our running? Well, first we would have to know what it is to even think that have it.
Depression is defined as “one of the most common psychiatric disorders and…the most costly. Depression is also a highly recurrent disorder with an increasingly younger age of onset for the initial episode” (Gotlib & Hammen 1), causing it to be an increasingly large problem in our youth. Signs have been seen even as early as in middle school and the age of initial onset is getting lower and lower; therefore, a “cure” is becoming more and more vital to protect our youth from this evil. While suffering from depression, one cannot feel emotional or social situations as those who are not suffering, partially causing the amount of money from work lost in the United States from those suffering with depression “exceeds $33 billion” (Gotlib & Hammen 31) as of 1996, so if adjusted for inflation and the larger number of people suffering with depression that number skyrockets even higher. But perhaps the most daunting part of depression is its persistence. Studies have said that “over 75% of depressed patients have more than one depressive episode” (Gotlib & Hammen 1), meaning that people are haunted by an over looming shadow of decay more than once in their lives more often than not. But who are the people that have demons living within their head? What do they do so differently that leaves them open to this torment?
Meet Jerry, he can tell us all about depression. Jerry has worked the same desk job for fifteen years, been married for ten, and had kids for five, but recently he hasn’t been feeling the same as he had been before, no longer wanting to climb to the top of his business or be as attentive to his family as he once was. Jerry begins to feel “constantly sad or burdened, or [he loses] interest in all activities, even those [he] previously enjoyed. This holds true nearly all day, on most days, and lasts at least two weeks” (Harvard Special Help Report). He used to be excited for his children’s ball games but now he thinks of it as a chore, he would rather bring his food to his room than eat with his family, and throughout the day Jerry will just sit and stare at a blank computer screen sitting at his paper-filled desk with no clear pattern of thought or emotion. Jerry is experiencing what is called a major depressive episode, which is a highly dangerous place for Jerry to live. His mind becomes a battlefield between repair and disrepair, slowly determining if he will ever recover from this illness or not.
Jerry, aware of the signs of depression, is finally forced to visit the doctor to address and suggest treatment for his symptoms. When the doctors figure out that Jerry is suffering from depression, they have many options as to where they could move from there. Doctors each have the attitude that “the resiliency of the human spirit shines even more brightly in its having held firm against the horrible forces brought to bear upon it” (Spelman 114); therefore, they will run through each of their options to see what would best suit their patient, but in most situations, they would suggest one of two options: cognitive-behavioral treatment or antidepressants. Each of these show promise in many of the studies that they have been a part of, showing varied but generally positive results in their subjects, but what can be done for Jerry specifically?
They can decide that Jerry should undergo cognitive-behavioral treatment and reverse the malicious effects that depression has had and been able to grow through within his mind. It’s a risky choice because “the forces of evil…cannot do irreparable harm. But sometimes they can” (Spelman 123), meaning that from the very start of this treatment, they could’ve already lost because his mind just wasn’t strong enough to recover from itself. Cognitive-behavioral therapy, otherwise known as CBT is commonly used for anxiety disorders in adults (Hofmann and Smits) and is sometimes considered as “some of the most effective psychosocial treatments for depression” (Gotlib & Hammen 383), allowing adults with depression to be able to be repaired and brought back into society. The therapy itself works by changing the patient’s point of view and attitude toward different situations over a course of about a year by providing cognitive ques into their thought processes and effectively cutting off depressive thoughts. When thinking of Spelman’s reparative/restorative argument, CBT shows more of the signs of being a medium of restorative repair. Rather than off-putting the effects of depression on Jerry, psychologists will go pick directly at his brain in attempt to heal it and banish depression permanently. Rather than a quick prescription and a check-up appointment from a psychiatrist, Jerry is going to be sat down on the stereotypical couch as he talks about his feelings until he feels all better. While that was an oversimplified explanation, Jerry can really recover from this problem if he utilizes CBT correctly. It’s not just a chemical change inside of his head, his mind is trained to fight off the dark thoughts brewing inside of his head and he can truly be considered repaired after the therapy is over. As good of a medium for restorative repair that this is, how good could the harbinger for retributive repair fair on Jerry instead of CBT?
The form of treatment most similar to retributive repair would be antidepressants. These drugs do not care for Jerry and whether he gets better or not, despite their wide usage. Between 2005 and 2008, the number of users of antidepressants rose almost 400% for patients 12 and over, pinning the number now to about one in every ten American adults using antidepressants regularly (Wehrwein). All that they will accomplish is the hopeful possibility of a chemical reaction within his head that will stop the bad thoughts from being prominent. As much as we should like to dub antidepressants as a quick option for a doctor who doesn’t have the time for anything further, the results of them are too stunningly positive to do so. Research by doctors has provided us with the information that “patients receiving tricyclic antidepressants showed a 60 to 70 percent improvement or response rate” (Potter and Paul), a great number considering the aggressive and persistent nature of this illness. Furthermore, there are dozens of options for antidepressants that someone like Jerry can choose from.
Jerry and his doctor will discuss this option of repair by discussing his symptoms, the side-effects he would be most okay with experiencing, how well it works for people like him, whether he’s on other medications, and other conditions that he may be suffering from, all topped with the cherry of what price he would like to pay (Staff, By Mayo Clinic). The most questionable part of this process of repair, however, is the effects. The pills that he is now prescribed could be absolute duds that fail to react at all. He could give up right there at the failure of the milligram tablets that he had been hoping would make him feel better again considering his fragile state-of-mind or, in a more likely event, the doctor would give Jerry another long-term prescription which would work or be replaced again, and eventually Jerry would be cured, at least from that depressive episode.
Jerry has been through a horrible process that no humans would like to be a part of. His emotional attachment had been stripped from him and returned once more, which is far more than many patients can say about the disease. Spelman touched upon the ideas of disrepair in her book, saying that sometimes “the rubble is just there, not razable, not redeemable, not pretty” (Spelman 118). With depression, the possibility is all too real that the patient won’t get better. There’s the chance that no matter the method of repair, whether retributive or restorative, he or she just won’t have the drive left within him or her to fight off his or her illness, that they are in utter disrepair, but Jerry was fortunate enough to come out the other end with his life and his mind both intact. The feeling of emptiness is very difficult to handle, as it brings you out of your own comfort zone for an extended period of time, and now he must adjust back to his original life. The fact that he may be experiencing treatment for a very long time generally means that the transition of lifestyles is facilitated through a slow immersion into reality. Jerry is healed of his depression, repaired and ready to deal with his daily tasks that he had once found mundane. With the help of doctors, he was able to use Spelman’s ideas or either retributive or reparative repair and he was brought back to the light from a pitch-dark spot within his life.
Elizabeth Spelman’s book effectively changes the way you think about repair, whether it be related to depression or any other project of repair. For this situation, Spelman provides the examples of retributive and restorative repair, but she provided a plethora of others for different situations throughout her book. “But not everything that breaks can be fixed. The skills we repairing animals have to learn include the self-reflexive one of coming to grips with the limits of those skills and figuring out what to do in the face of the irreparable” (Spelman 102) she said, which is the problem for depression today. While retributive repair boasts a 60%-70% success rate and restorative being effective in its own rights, there are still people that will end the day uncured and haunted by depression.
While Jerry is only a figment of my research, depression is still a very real problem. Not every person can be cured in the simple way that we want, real people experience problems that hinder their process, sometimes before it even begins, others right at the end of their road to recovery. The metaphorical methods of reparative and restorative repair that are currently present in our world for depression simply just aren’t enough and must be more effective for the sake of our neighbors and peers. Spelman indicated that restorative justice was more effective than retributive justice, so considering their evenness in repair of the depressed mind, maybe there’s another form of repair that we haven’t discovered yet that will potentially end depression once and for all. Not everything can be repaired, but in terms of depression, we cannot accept irreparability.
Gotlib, Ian H., and Constance L. Hammen. Handbook of Depression. New York:
Guilford, 2009. Print.
Harvard Special Help Report. “Understanding Depression.” Health and Wellness
Resource Center. Gale Cengage Learning, 18 Mar. 2006. Web. 24 Oct. 2016.
Hofmann, Stefan G., and Jasper A. J. Smits. “Cognitive-Behavioral Therapy for Adult Anxiety Disorders: A Meta-Analysis of Randomized Placebo- Controlled Trials.” The Journal of Clinical Psychiatry. U.S. National Library of Medicine, 2008. Web. 07 Nov. 2016.
Potter, William Z., M.D., Ph.D., and Steven M. Paul, M.D. “Publications.” Do Antidepressants Really Work? N.p., 09 Feb. 2012. Web. 14 Nov. 2016.
Spelman, Elizabeth V. Repair: The Impulse to Restore in a Fragile World. Boston: Beacon, 2002. Print.
Staff, By Mayo Clinic. “Depression (major Depressive Disorder).” Antidepressants: Selecting One That’s Right for You. N.p., n.d. Web. 31 Oct. 2016.
Wehrwein, Peter. “Astounding Increase in Antidepressant Use by Americans Harvard Health Blog.” Harvard Health Blog RSS. N.p., 20 Oct. 2011. Web. 14 Nov. 2016.