Sweeping it under the carpet: Depression, Prozac and Giles Fraser

I’m writing this post to dispel a few myths about depression and the use of medication. I should mention, however, that I’m none of the following: psychiatrist, psychologist, pharmacist, biologist, philosopher, renowned expert in happiness and the inner workings of every human soul. That said, neither is Giles Fraser, the Guardian’s Loose Canon, but he hasn’t let that stop him. Besides, unlike Fraser, I’m in a permanent fog of drug-induced pseudo-contentment, hence I’m even less likely to demonstrate any degree of restraint.

In a piece entitled Taking pills for unhappiness reinforces the idea that being sad is not human, Fraser rehashes many common stereotypes about depression, mental illness and SSRIs. To be fair, he doesn’t do it quite as nastily as some people. He’s no Julie Burchill, for instance (sorry, Giles!). Nonetheless, making tired, half-baked claims in a seemingly well-meant manner can be even more damaging than just being an out-and-out bully.

I’ve taken Prozac, on and off, for 18 years. Mostly it’s been on. I’m not sure whether I should say it’s “for depression” as I’m conscious this can get people’s backs up, as though I’m positioning myself as one above those who merely get a bit fed up. Ooh, look at me, I’m depressed and that means I’m special! is what no one who suffers from depression actually says, but other people hear it all the same, since the alternative — that depression is something which none of us quite understand — is too annoying for words.

So let’s not bother with a diagnosis. I take Prozac not for fun, but because my life functions better with it. I don’t know the precise cause and effect. To be honest, I don’t think it should be my job to mount a detailed scientific defence of the drug when the main reasons for which it is attacked seem to come more from the arts side. People don’t like Prozac and similar drugs not because they are harmful — it is for those taking them to weigh up pros and cons — but because the whole SSRI narrative just isn’t aesthetically pleasing enough for the critics’ exacting standards.

Fraser argues that diagnosing depression “is already to classify a particular kind of experience as something quasi-medical, thus leading one to think in terms of medical treatment”:

Sometimes I am just sad. Sometimes pissed off. Sometimes smothered in darkness. But we often lump all these experiences together simply because pharmaceutical companies have developed a certain sort of treatment. And, once you have a hammer in your hand, it is convenient to see every problem in terms of its being a nail. We have found the solution, now let’s make the problem fit the solution we have available. It’s a form of reverse engineering.

So depression is over-diagnosed simply because anti-depressants exist. There is no question as to whether legions of merely “pissed off” people would seriously go along with this (repeat prescriptions are not cheap), nor any question as to whether Prozac and the like have any effect whatsoever on “pissed off-ness” (believe me, they don’t – on the contrary, once you’re taken out of your own bubble, it’s amazing the number of things which will now piss you off). But no matter; Fraser has a neat story he wants to present, and it doesn’t involve depression being messy, or people having overlapping and/or contradictory motives for supporting the use of drugs to treat it.

I might take Prozac because it helps me. But wait! It also helps The Man, aka Big Pharma, therefore it must be dodgy!

Thus we are encouraged to think of our problems in terms of the lucrative solutions to problems we didn’t know we had. In this way, the pharmaceutical companies are responsible for the very conditions they propose to alleviate.

Thus many people like me are depressed merely because they want us to think that. Without the existence of drugs we’d just be anything from mildly perturbed to suicidal, the solution to which would be … Well, I’m not exactly sure (but — and I’m guessing here — perhaps not just St John’s Wort and a daily bike ride, thank you very much).

The most worrying thing about Fraser’s thesis, however, is not merely that he positions the motives of pharmaceutical companies as the driving force in a much more complex narrative, but that he thereby makes sufferers of depression complicit in their own suffering and the suffering of others:

Forget the fact that some people are miserable because they are struggling on zero-hours contracts, or have lost their partner or have been watching the news too much – if we translate misery into some sort of chemical imbalance then someone can make big money out of it. But unhappiness is often a perfectly proper response to the state of the world. If you have a shit job or a shit home life, being unhappy is hardly inappropriate. At best, many of the drugs we are popping only deal with the symptoms of all this, not the causes. At worst, they pathologise deviations for normalcy, thus helping to police the established values of consumer capitalism, and reinforcing the very unhappiness that they purport to cure.

This is a tidy way of putting things, and one that seems to speak for the little man. But it doesn’t represent the truth. Drugs do not deal with the symptoms of unhappiness. SSRIs do not simply allow people to drift along in a delusional haze, believing all is well in the world while they themselves and everyone around them is trodden into the dust. For some people, medication is what enables you to no longer turn in on yourself. Unhappiness is indeed often a perfectly proper response to the state of the world, but it needs to be directed and understood before change is possible. If you are too numb to feel pain or anger, you won’t even recognise your shit job or your shit home life. I don’t know the precise relationship between mental illness and external social influences — isn’t this still hotly debated? — but I do know that for social change to include those who need it most, you need these people to feel strong. Some of them might, right now, need to take medication for that to happen. That might make idealists feel uncomfortable but there it is.

I don’t wish to cheerlead for drugs to treat all mental illnesses. Many drugs — those used for schizophrenia, for instance — have hugely damaging side-effects, and I wonder whether the sacrifice is always worth it (and whether it’s a sacrifice we’re forcing on others, without allowing them to choose their own destiny). I don’t, however, think the casual “let’s not pathologise sadness” musings in which Fraser indulges contribute much to this debate. At best, they’re frustrating. At worst, they make people who take anti-depressants feel accused of being too weak to deal with reality. In truth, I think Fraser is the one unable to deal with a reality that’s far more flawed and poorly understood than he would like.

13 thoughts on “Sweeping it under the carpet: Depression, Prozac and Giles Fraser

  1. All I would say about this as a GP who has experienced depression on a reasonably regular basis is that I wouldn’t wish it on my worst enemy . I think I suss out the ‘sad’ people by those who claim to not tolerate the side effects . If you have depression you would eat dog poo if it made you feel better and a bit of nausea most definitely wouldn’t be a hindrance .P.S. this is not proven in clinical trials , just my observation

    1. So people who “claim” not to tolerate the side effects aren’t “legitimately” depressed? That is … saddeningly invalidating.

  2. I think the whole conversation on this issue is missing a crucial element on the (un)availability of other kinds of treatment like the more expensive talking therapy option. Saying depression is a ‘proper’ illness doesn’t have to mean saying it must be treated with medicinal chemicals and by the same token, saying unhappiness is often entirely reasonable even when its symptoms get pathological doesn’t have to mean rejecting treatment of those symptoms with medicinal chemicals (I’m avoiding saying just ‘medicine’ to make it clear I’m talking about the prescription drug variety). My line on this is ‘the long term cure might be the overthrow of patriarchy but if I get depressed again I still need destigmatization, medicinal chemicals if I so choose and freely available talking therapy in the here and now’. Prozac can put a pillow between you and rock bottom and give you the energy/ focus/ whatever you need to be able to come up with coping strategies for your probably reasonable grounds for depression, but most people still don’t have the resources from there to do it on their own. I know I needed and was lucky to get therapy that enables me to ward off depression now when there’s no-one to pay for it any more. I couldn’t have spotted patterns and figured certain things out by myself, you know? I can understand the urge in survivors of mental health afflictions to give these afflictions the language of the medical establishment and the ‘status’ of other illnesses. But it should be enough to say that the *effects* of mental health afflictions are as painful, disabling and harmful as any illness in order for sufferers to be treated with compassion. The ‘reasonable grounds’ thesis, meanwhile, is valuable in that currently too many sufferers aren’t considered capable of making their own decisions about what kind of care and treatment we need. And besides, there are plenty of illnesses whose status as ‘real illness’ (i.e. physical illness) isn’t questioned, even though the causes are environmental. But regardless, no one should be left to deal with a traumatic experience like depression on their own with *just* a packet of pills, or even a packet of pills and a well meaning but badly informed network of family and friends.

    Sorry, this has become very rambly, but I often feel there’s an undressed divide between ‘pro-pillers’ and ‘anti-pillers’ in the discussion around this issue. I also realise I can only really speak to the experience of depression (and anxiety) whereas schizophrenia and eating disorders etc may be very different.

    But yeah: don’t leave out the talking therapy option and it’s not a ‘with pills or against pills’ situation was all I wanted to say.

  3. I know people with schizophrenia, and they HAVE to be on medication, regardless of side effects. They have to. Or they can’t function. Full stop.

    Zoe, I’ve quit antidepressants because of intolerable side effects, and that does not mean that I’m faking my depression. Please stop making generalities like this.

    1. I’m not saying that people with schizophrenia (or other mental health issues) shouldn’t take medication. What I’m saying is that there’s no need to say mental illness is an entirely chemical affair which must be treated entirely chemically therefore. There is, as with most things, a third way between the chemical approach and the social approach. Actually there are probably as many was of approaching mental health as there are sufferers of mental health afflictions. I can understand why survivors get defensive when people out right rule that the chemical approach is bad: it is a survival issue for us, right? But you don’t have to throw everything else under the bus to defend the usefulness of Prozac (which Glosswitch isn’t doing, I’m aware). Lots of its defenders do end up denying or down playing the influence of environment, though, which is a dead end to anyone interested in social justice, and I never hear *anyone* talking about the importance and inaccessibility of talking therapies, which is a huge medical and social issue which neither side in the ‘pro-pills’ ‘anti-pills’ debate seems to be addressing.

      1. You’re saying that people with schizophrenia shouldn’t take medication. Social justice will cure them, and if not, they can always try talk therapy. Because talking will get rid of those hallucinations and delusions.
        Right.

        1. Um , no I’m not saying that. I’m saying you don’t have to choose between medication, talking therapy and social justice, you should be able to have all three (if you so choose). Find me a sentence where I say people with schizophrenia or any other mental health problem shouldn’t take medication.

  4. I have Borderline Personality Disorder. I feel emotions 10 times what “normal” people feel. Dialectical Behaviour Therapy is the best treatment for BPD. Medication is usually needed at first to enable us sufferers to be well enough to even begin treatment. 10% of BPD sufferers commit suicide. Dr. Marsha Linehan, creator of DBT and a sufferer herself said “People with BPD are like people with third-degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement.”

    Please check out my website for more information on Borderline Personality Disorder: http://makebpdstigmafree.wordpress.com/

  5. — “I don’t know the precise cause and effect.”

    Neither does anyone else. Nobody actually knows what depression is, or why SSRIs work. It’s just one of those funky medical things (nobody know exactly how or why paracetamol works, either).

    Just another tranche of ambiguity to add to the already-messy picture, and all the more reasons for self satisfied laymen to butt the hell out of other people’s medical decisions.

  6. I just made an analogy of taking meds to my dad who thinks I should be off meds ASAP. (I have BPD and I take lexapro). Having bpd is kind of like having a flat tire. Taking meds is like the jack to bring the car up. And going to therapy is the actual changing of the tire. You need the meds to boost you up (literally) so you can effectively change.

  7. i know my feelings, my thoughts, my physical abilities, and my mental abilities are better while taking my prozac…i have defiantly fought the effects of my life while not taking it regularly…..i have thrown the towel in at 44….i shall fight it no more. i like who i am, and others around me agree, i function, process, and behave much better on my prozac. no more shame of my medicine game:)

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