Mental_Illness2

There Is No Depression Cure-All, So Stop Talking Like There Is One

We've got a terrible tendency to whip out the prescription pad to play doctor because we’ve stumbled upon our own successful recipe for mental health

Everyone should try my patented cure for feeling sad: pop music. I listen to pop songs when I get down. All I need to do is find the perfectly upbeat three-minute fix that feels like summer on a Saturday afternoon, and I get an instant mood boost. Pop music has helped me through years of various low moments for as long as I can remember — breakups and deaths, bad news and bad days. As a result, I’ve never needed antidepressants or anti-anxiety meds of any kind. Instead of taking medication, you too should try my pop music solution for depression, because it works so well for me!

… You see how bananas that argument is, right?

Of course, this is not really how people or depression work. Listening to music is something I do that makes me feel good, but it’s not good advice for anyone but me. If pop music were all it took to cure the world’s ills, we wouldn’t want to dive out of the car window when the Lyft driver puts the Chainsmokers on.

This simple understanding — what works for me may not work for you, or anyone — doesn’t stop us from whipping out the prescription pad to play doctor because we’ve stumbled upon our very own successful recipe for solid mental health. Recently, Chance the Rapper’s manager, Pat Corcoran, came under fire for doing just that:

In response to Corcoran’s tweet, lots of people came forward to demonstrate what should be obvious:

Sure, there’s nothing all that wrong with any of the things on his list. Those are all things that would add up to a generalized healthy approach to life so far as we know it in 2018. It’s not dangerous to suggest that anyone who struggles to feel well could take thorough stock of everything they’re doing and see if, just like tweaking diet or quitting smoking, you can fiddle with the knobs of an individual life and see if there’s anything that tips the scales toward greater well-being.

But what is dangerous is the idea that all those things must be tried first because they worked for someone else, because medication is always some last resort that should be avoided at all costs by everyone no matter what, and that, by implication, needing meds is the worst of all outcomes, a kind of failure of the better, more natural approach. It’s also irritating because it implies that people with lifelong depression haven’t tried anything else before, until you came along and pointed it out.

All that sounds a lot like what used to be the stigma around talk therapy. For most of my life, therapy was considered an utter failure by a person who should be private enough, stoic enough and have their shit together enough to handle their own issues. Anyone who couldn’t was a legit nutjob.

What’s more, many creatives believe they can’t possibly continue to make Good Art if they zombify themselves with meds.

Such beliefs have sent a lot of people to an early grave because of stress, suicide or drug abuse.

So in effect, by pleading with people to try everything else but meds, we’ve just switched out the stigma of therapy with pills, and decided meds are the stuff of weak people who don’t have the stamina to really address their issues. I don’t believe Corcoran’s advice was malicious at all, but it still reinforces the stigma that therapy and meds are the last stop on the crazy train.

What is also particularly insidious about pushing the drug of lifestyle over a real drug is that it’s classist. When certain people (celebrities, wealthy folk, billionaire entrepreneurs, Kanye West) advise the masses on more natural, hopped-up-on-my-own-personal-discipline strategies for dealing with mental health issues, they ignore the incredible amount of leisure, knowledge and resources one must have to deploy such regimens.

It reinforces a dangerous idea that the new leisure class is being beyond medication; the new leisure class is being able to play guinea pig with your own health — because you always have multiple safety nets, including traditional medicine, beneath you. Never mind that if that were actually true, no celebrity or rich person would ever be depressed.

It’s also hypocritical. We use all sorts of drugs all the time to microdose and ameliorate depression, and because everyone does it and it requires no prescription, those are supposed to be okay:

It’s also denial:

Of course, we’ve all caught the organic, pesticide-free, clean-living bug and most of us would prefer to not be reliant on any particular substance to feel okay. But that’s not reality for most people. Anyone who’s dared admit to feeling down has likely been served up an onslaught of natural, one-stop cures for anxiety and depression, all implying that the organic fix is in reach if you want it bad enough. Just a sampling of things that will zap the blues: Diet. Mindfulness. Working out. Helping others. Talk therapy. Even just waiting it out. If any one of those things worked for someone somewhere, then presumably doing all of them means you’re bound to hit the jackpot, right?

No. For some people, medication is simply the only thing that works. No one is defending Big Pharma, because a pill is not the cure-all it’s been pitched by pharmaceutical companies to be either. But in the most comprehensive analysis we have of all the research on antidepressants — that’s accounting for bias — what we do know is that overall, they’re modestly effective. But they are particularly effective for people with acute major depression, especially when taken alongside the first two months of therapy.

Even still, that doesn’t mean it’s either one or the other. Depression is complicated, and even when the drugs work, it doesn’t mean the drugs cure forever or for everyone. Here’s Harvard explaining what we actually know about how depression works:

It’s often said that depression results from a chemical imbalance, but that figure of speech doesn’t capture how complex the disease is. Research suggests that depression doesn’t spring from simply having too much or too little of certain brain chemicals. Rather, there are many possible causes of depression, including faulty mood regulation by the brain, genetic vulnerability, stressful life events, medications and medical problems. It’s believed that several of these forces interact to bring on depression.

To be sure, chemicals are involved in this process, but it is not a simple matter of one chemical being too low and another too high. Rather, many chemicals are involved, working both inside and outside nerve cells. There are millions, even billions, of chemical reactions that make up the dynamic system that is responsible for your mood, perceptions, and how you experience life.

With this level of complexity, you can see how two people might have similar symptoms of depression, but the problem on the inside, and therefore what treatments will work best, may be entirely different.

In other words, Chance’s manager is right! And so is everyone who said the only thing worked for them was therapy and meds! And so are the people who said they did running and therapy and meds and going vegan! The only true takeaway here: There is no cure-all for anyone. Everyone’s issues and treatment are highly individual. That is okay. You can run, and he can take Zoloft, and she can get more Vitamin D, and I can listen to a bunch of songs, and someone can do all that while standing on their head playing the xylophone.

That doesn’t mean we can’t tell the story of what helped us, so long as we never imply it’s what will help anyone else. That appears to be what Corcoran really meant — he just needed a little help to see it.