Elsewhere on this site, I have argued that depression is not an illness, but rather is an adaptive mechanism that encourages us to make changes in our habits or our circumstances.
I have written about what I call the seven natural anti-depressants: good nutrition; fresh air; sunshine (in moderation); physical activity; purposeful activity; good relationships; and adequate and regular sleep.
But the question has often been posed: Why does this adaptive mechanism apparently not work in some cases? Why is it that for some people the unpleasant feeling fails to act as a spur to make changes, and instead the person sinks further into despondency and inactivity?
My general response to this argument is that in general, we do what we’ve been trained to do. I’m using the word “trained” here in a very wide sense to include not only the habits instilled by our parents and other significant adults, but also the habits that were “taught” to us by our experiences.
I thought it might be helpful to illustrate this by sketching the progress of a person who came to me several years ago for help with depression. To protect the person’s privacy, her name and various details have been changed.
Jean was 34 years old, married, mother of three children, and manager of a popular and successful restaurant. She had been feeling increasingly despondent for a few years, and finally, on a friend’s recommendation, went to see a psychiatrist in another town. He talked to her for thirty minutes and prescribed an anti-depressant (Paxil). Her next appointment was in two weeks. She told the psychiatrist that she wasn’t feeling much better. He said give it time. Two weeks later she was back in the office and told the psychiatrist that she was so down that she could see little point in going on. He arranged for her to be involuntarily committed to a private mental hospital.
She stayed at the mental hospital for four weeks. Her Paxil dose was increased and additionally, she was given an anti-anxiety drug. She received art therapy, which consisted of sitting in a room with other residents painting pictures, and music therapy, which involved listening to music. Every day she had group therapy. This consisted of sitting in a group with eight or ten other residents and “just talking.”
At no time during the four weeks did anyone ask her why she was depressed.
On discharge, the hospital referred her to me because I worked at the community mental health center in her home town.
I scheduled two hours for Jean’s first visit, and we talked. Or more correctly, I encouraged her to talk, and I listened. Here’s her story.
Jean was raised in a small mid-west town, the eldest of four siblings, in what she called a “conventional” family. Her mother was a stay-at-home Mom, and her father worked as a manager at a feed store. They weren’t wealthy, but with the frugality that was common for the time, they weren’t poor either.
In the home, her father was the boss to whom her mother deferred routinely. Her mother was devoted to her husband and her children, and worked tirelessly pretty much all day.
Jean said that her childhood had the normal ups and downs, but that there were no great traumas or horrific incidents. As the eldest daughter, she helped her mother a great deal with childcare of the younger siblings and with household chores generally.
At school she did well, finishing with a GPA of 3.5. She had considered college, but decided against it. She took a job waiting tables at a restaurant, and at age 20, married her high school sweetheart, George. He worked as a mechanic.
About two years later, George got an offer of a better mechanic job at a town about 100 miles away. They talked it over and decided to go. Jean had no difficulty finding a job as a waitress. They settled into their new surroundings fairly well, but Jean missed her family (especially her mother), and although she got along OK with people, she discovered that she was not too skillful in the area of making new friends. (Up till then she had lived in her home town and her friends were ready-made, so to speak.)
They rented a home but within a year were able to make a down-payment on a home of their own. The mortgage was high but with both of them working, they could manage.
Two years later Jean was promoted to assistant manager at the restaurant, and adapted to the new responsibilities without difficulty.
By this time life had settled into a routine. George worked as a mechanic, and when he came home, he pretty much considered that his day’s work was done. Two or three evenings a week he would go out to the bar to “unwind” with his friends. He would mow the yard and a few other outdoor chores, but all the cooking, laundry, cleaning, etc., fell to Jean. She accepted this as her womanly lot, and never complained – or even thought of complaining.
A year after buying their house their first child was born, followed by two more at two-yearly intervals. Jean adored the babies, and felt terribly torn at having to leave them with sitters and daycare when she went to work.
Then she was promoted to manager at the restaurant, and sometimes, if there were problems, she had to work late.
Meanwhile the children were growing, and their needs were becoming more complex. Jean found that she was routinely getting up at five a.m. and seldom getting to bed before midnight. Sometimes she would be doing laundry at one a.m. She was drinking enormous quantities of coffee.
On her thirtieth birthday Jean realized the she was very unhappy. This made her feel guilty. After all, she had a good husband, three beautiful, healthy children, a great job, and a nice home. What more could she rightfully expect? She resolved to stop feeling sorry for herself (as she put it) and try harder. She limped along like this for another four years. During this time her two older children started getting into trouble at school, and her husband started “looking at” one of the secretaries at his place of work. With regards to the latter, Jean decided that she had been neglecting her appearance, and resolved to pay more attention to make-up, dress, etc., and to work harder at retaining George’s affection.
By this time, for Jean, the meaning of life was simple: try to keep it together; try to get through the day.
She had one close friend, Betty. They got together for a chat about once a week, and during one of these sessions Jean started to sob disconsolately. Betty, who had herself consulted a psychiatrist a few years earlier, recommended that Jean do the same. And so to the pills, the mental hospital – and my office.
It didn’t take any great intelligence or insights to see why Jean was depressed. What’s staggering about her case, however, is that neither the psychiatrist nor the hospital staff bothered to ask her why she was feeling down. The reason for this is that as far as they were concerned, they already knew the reason. She had a brain illness, and she needed to take pills “just like a diabetic has to take insulin.” (Yes, they did actually say this!)
At the end of the first session, I told Jean that given the load she was carrying, it was not surprising that she was feeling down; rather, the surprising thing was that she was managing to cope at all. She told me that she didn’t feel that the pills were doing her any good, but that she was afraid to stop taking them for fear that “they” would send her back to the mental hospital. She explained that that had not been a positive experience, and that she didn’t belong there.
I suggested that she come back to see me weekly for a few weeks, and I made sure that she had our phone number in case she needed help outside office hours. When she left the office, she seemed lighter than she had seemed initially, and she stated that it had been helpful just talking about things. I suggested that she bring her husband to the next session if he was willing.
Next week she showed up on time with George. I asked George for his perspective, and he said that he had known things weren’t great for about the last year. He had had no idea what was wrong, but now that he knew Jean had a brain disease (and the pills to treat it), everything would be OK.
Somebody – I’ve forgotten who – once said that therapy is the art of presenting the facts to a person in a way that they can accept. So I spent the next hour trying to let George hear the message that I had received loud and clear from Jean the week before. It was clear, however, that Jean was reluctant to be particularly confrontive in this regard, and I was careful to respect her lead. Towards the end of the session, however, I did point out that Jean was in effect working the equivalent of about 100+ hours per week.
George had been raised in a conventional household also. Dad went out to work. Mother was a stay-at-home Mom. He felt that if his mother could do it, his wife should also be able. I pointed out that his wife’s situation was not quite the same, in that she had a full-time job managing the restaurant. To which George expressed the view that this wasn’t real work because all that managers do is sit around and tell other people what to do. Jean listened to all this quietly and respectfully.
Next week Jean came in alone. She asked me what I thought she should do. I said that I couldn’t make her decisions for her, but that in my view it was clear that something had to change. I explained that we all need some activities in our life that we enjoy and/or give us a sense of success. I expressed the view that her life had become so grueling that even activities that otherwise might have been pleasant and rewarding were no longer so. Jean agreed with this.
We spent the next few sessions exploring options – looking for ways in which Jean could reduce her workload and find more joy and meaning in her life. Each week she would update me on what she had managed to achieve. She began to feel better. She started to smile, and her general demeanor seemed brighter and more positive.
On week eight she came in and told me that she had told George that she wasn’t going to do any more laundry – that from now on this was his job. “Wow,” I said. “How did he take it?” “He didn’t like it at first, but then he agreed.”
And so it went. On week ten she told me that she had been tapering the pills and wasn’t going to get any more. On week twelve I expressed the belief that she probably didn’t need to come in any more. She agreed. She phoned me several months later and told me that she was still doing fine.
And Jean is by no means an isolated case. Up till about 1950 or so, most mothers were stay-at-home Moms. Then, for various reasons, this started to change. Women entered the work force in large numbers and began to develop careers to an unprecedented degree. All of which is fine, but it took several decades for our cultural ethos to adjust to this huge demographic shift. Throughout my career I have worked with scores, perhaps hundreds, of women who, like Jean, were working a full job in the workplace and a second full-time job at home. I don’t know anyone who wouldn’t find that depressing and debilitating.
But the mental health system seldom even bothers to ask the critical question: “What’s got you down?” In my experience, most people can provide clear, cogent answers to this question, and with a little encouragement can come up with remedies.
Nothing succeeds like success. When a person realizes that he/she has solved one problem, they are empowered to tackle others. Pills on the other hand, with their implied message of helplessness, disempower people and encourage excessive dependency.
Jean was not ill. She was just over-worked and under-appreciated. Her circumstances had changed drastically, and the skills, attitudes, and habits she had developed in her formative years were no longer sufficient to bring her a sense of joy, fulfillment, or success.
There are millions of women like Jean in America. Many of them have been systematically deceived, disempowered, and drugged by psychiatrists.