Treating Depression Is Not Medicalizing Sadness

One of the criticisms I often see leveled at therapy and medication is that it’s turning basic human emotion into an illness. There was a huge outcry of this when the DSM V took out the grief clause from the diagnosis of depression (previously one could not be diagnosed with depression 6 months after a major loss), people often throw this at ADD, and in this otherwise lovely article about chronic depression, one psychiatrist refers to diagnoses like dysthymia as follows: “The ‘thymias’ which the DSMs discover – cyclothymia, dysthymia – are helpful for private practitioners in the States. They provide another disorder to be diagnosed, treated and billed for.” The author follows this up with “We’ve reached a point where if you are not actively experiencing ‘happiness’ then you feel you are ill. And if your friends and family think you aren’t happy enough or making them happy enough, they advise a trip to the doctor. “

Now don’t get me wrong, I do think there are many ways that our society fetishizes happiness. Many people find ways to run away from any negative emotions, and those who do act down or angry or sad are generally encouraged to do whatever they can to change that. Those of us with fairly pessimistic temperaments are accused of self-sabotage, of choosing a bad attitude, of being debbie downers. No one really much wants to be around us and we are informed in no uncertain terms of that fact.

But where I do want to differ from these criticisms is that they seem to equate the treatment of depression, even low level depression, with our society’s inability to handle negative emotions. These are two very different things. There’s an odd perception from those who haven’t actually experienced therapy that it’s about getting rid of all the bad feelings and that the end goal is to create someone who is happy clappy skippy doo. At the very least, people who go to therapy are supposed to come out “well adjusted” which for some reason is often associated with a Stepfordish oddness or calmness. We imagine Chris Traeger bouncing around like a hyperactive puppy when we think of those who have overcome depression.

parks and recreation animated GIF (not me)

In reality, this is exactly the opposite of the experience that I have had with therapy, and I suspect that many other people have had to delve into some extremely unpleasant emotions as a result of therapy. One of the main elements of therapy for me has been learning that negative emotions are necessary, provide information, and can be tolerated. I have learned tools to be able to feel bad and not immediately spring to fix whatever is wrong (which oftentimes is nothing).  My therapists have repeatedly told me that they want to find the appropriate place for all of the elements that make me up, including such winners as ennui, existential angst, and an overactive sense of guilt.

Here’s the clear and defining line between depression and normal, healthy sadness: depression affects your ability to function in your life. Whether that’s because it’s major depressive disorder and you have reached a point where you can’t shower in the mornings or whether that’s because it’s pervasive depressive disorder and you’ve felt low level emptiness your entire life and you just can’t handle it anymore, what makes something a problem is when it starts to interfere with someone’s life in a negative way. Now this isn’t as clear and defining of a line as we would like, but there it is and most individuals would be able to tell you if they feel like their emotions are getting in the way of their life.

Treating depression, whether with medication or with therapy, is about allowing an individual to function again. A functional human being feels painful feelings sometimes. One of the most obvious examples of the ways in which treatment of depression is actually antithetical to happiness obsessions is in mindfulness practices, particularly DBT. These ask an individual to simply notice their feelings without judgment, letting them happen without trying to change them.

One of the many reasons that people often end up in therapy or on medication is because they have been too afraid to honestly look at their negative emotions, feel them, and let them go. Of course there are some therapists and clinics that may go too far and end up treating any negative emotions as problematic, but overall the profession’s aim is to help people who are struggling.

The other piece of the puzzle is medication, which many people view as a “quick fix” for those who refuse to deal with their problems and just want to be happy all the time. Now I haven’t been on every medication ever so I can’t speak to all experiences, but that really is not how medication works most of the time. I have never had medication actually lift my mood, it simply has held back some of the negative so that I have space to work towards positive for myself. It allows me to go about my daily life in a relatively normal manner so that I can find ways to be effective long term. Again, it’s about keeping depression from drastically impacting my life.

Perhaps the reason that so many people point towards the prevalence of therapy and medication in our society as evidence that we refuse to be happy is because of a basic misunderstanding of what those treatments do. If someone’s emotions are keeping them from achieving their goals in life, from having relationships, from effectively doing their jobs, then the aim of treating those emotions is to help that person live their life. That doesn’t require happiness, but it does require the ability to cope with negative emotions.

I do think that it’s important to address our societal phobia of sadness, grief, and pain. But the way to do that is not to throw the mentally ill under the bus by implying they are running from their negative emotions when they seek out treatment. A diagnosis of depression does not say “this person is too sad”. It says “this person can’t function the way they would like to because their emotions are consistently out of control”. There is a world of difference between those two statements.

Ok, maybe I’m a little bit Chris Traeger.

The Moral Value of Truth

This is part 2 of a 3 part series addressing why I get extremely pissed off at certain commenters/tropes in the skeptical community. Part 1 can be found here.

A common trope in the skeptical community is that we have a moral imperative towards truth: there is a value in truth that trumps all other values, and the pursuit of truth is the most important thing we can do. Many of us believe that this is what separates us from religious communities, or what will make us happier, more effective human beings. Others of us might believe that this is the definition of “skeptic”: the ruthless pursuit of truth. I believe that this moral imperative towards truth is harmful and unnecessary.

To explain: truth is an instrumental, not an innate value. Whether something is true or not does not tell us whether it is useful or will make us happy or anything else. Perhaps some people might argue that truth in and of itself is a value, because they pursue it for its own sake (I am often among these people because I value curiosity and learning), but for the most part, we view happiness, contentedness, equality, fairness, and other quality of life things as innate values. These are what we strive for. Why? Because we know that they make our own life better, and in order to be consistent, we must understand that they make other people’s lives better as well. Now we could get into a very nuanced debate here about values, the objectivity of values, and the point of values, but I think that most of us will agree that we should strive to improve the quality of as many human lives as possible. I’m going to be working from that assumption for the rest of this post, and I’m really not interested in a debate about where morals come from.

Truth often can contribute to our happiness. It is hard to be happy if we are basing our happiness on a lie or on delusion, because those things can fall apart and leave us incredibly unhappy. However this does not mean that we need to ruthlessly pursue truth. It means that in the important aspects of our lives, we should try to base our values and actions on truth. Truth can also make us incredibly unhappy, as can the search for truth. I know many people, myself included, who are almost haunted by the need for certainty and truth, and who are truly disturbed by the lack of purpose in our lives. If I look at all the facts, that is the most true conclusion that I find: that there is no purpose in my life. This has led to some serious emotional and mental problems for me. The idea that it’s more important for me to be close to that truth and hold that truth than it is for me to deal with my depression or recover from my eating disorder is ridiculous to me. Whether I have a certain purpose or not doesn’t truly affect how I should act and the efficacy of my actions in the here and now. It is pursuing truth too far, to the point where it becomes removed from my life and simply becomes an intellectual exercise that is causing me misery. So for now, I choose to ignore that truth and focus on different truths.

Truth is certainly a part of morality and a part of happiness. Being true with other people has to do with trust, which is an important part of relationships. Not ignoring or deluding yourself about something that affects your life, or something that could change your behavior is extremely important because it keeps your happiness grounded in the way things actually are: a much more stable happiness than it would be otherwise. But desperately pushing for truth, and acting as though truth is more important than human well-being is harmful. We do not have a moral imperative to seek out every kind of truth, every piece of truth. It’s impossible for any human being to find the whole truth, and we always need to recognize the subjective perspective from which we are pursuing truth. When we forget those things in our pursuit of truth, we end up letting curiosity or a need to know drive us past any recognizable point of usefulness. Yes, knowledge for knowledge’s sake can be useful and beautiful and exciting, but if it stops being those things, we have absolutely no reason to continue pursuing it. We are allowed to be content in not knowing, or in not caring about something. If an individual doesn’t care whether there’s a god or not, and proceeds to live their life in a kind and fulfilled way, why should we care if they are not actively trying to find out? We shouldn’t. There is no reason they should need to. The pursuit of truth serves us. We are not slaves to a quest for truth. We are constrained by the facts of situations, and those are the times when it does become imperative for us to pursue truth. My mental health and emotional well being are more important to me than the objective “truth” of a situation. Does this make me a wishful thinker? Maybe. I don’t really care. Because being right isn’t all important to me.