Views & Reviews Soundings

Not sick, just low

BMJ 2007; 334 doi: (Published 24 May 2007) Cite this as: BMJ 2007;334:1116
  1. Des Spence, general practitioner, Glasgow
  1. destwo{at}

    Every time I open the bathroom cabinet the unopened packet of St John's wort stares out at me. Why don't I throw it out? Why did I decide not to take this herbal antidepressant? Was it the feeling of weakness that someone like me, a control freak, could get so low? I am willing to admit to a sustained period of unhappiness that by any biased and highly leading depression questionnaire would have me rated as “clinically” depressed. I am not alone: in the United Kingdom last year some 31 million prescriptions for antidepressants were written, a 6% increase on the previous year. Why didn't I seek such treatment?

    With all our wealth, comfort, and “me time” these days, why do so many of us find ourselves in the darkest corner of this gilded cage? It is easy to point the finger of blame at the thoughtless GPs, the naive psychiatrists, the greedy drug companies, and the media, which long ago substituted sensationalism for journalism. But this is all too simple, for there is a broader theme at work—the culture of individualism. We have a society that is strong on rights but short on responsibility. And the result? An atomised society in free fall in the chasm between expectation and reality. Our vast media factories pollute the airways with messages that happiness is an absolute entitlement and comes at no personal cost. We are experiencing a global emotional climate change, with extreme storms of behaviour—and this changed climate is melting the icecaps of stoicism and acceptance.

    Medicine needs to move away from intervening in mood issues, for we are destabilising the situation further. Esteem is born from overcoming adversity, so when life's problems become an illness, and when coping is seen as denial, what hope is there for our sense of self worth? Depressive pain has a psychological purpose in the same way that physical pain has physiological purpose. Low mood is as normal and as important to our sense of wellbeing as happiness is. This is not to dismiss depression but merely to free it from the totalitarianism of medicine and reflect the heat of these emotions back into broader society. Family and friends—the people who know the context of our lives—are the natural emotional sump. Sharing pain brings us closer, and when the world turns and seasons change we can take our turn to listen and support. Exercise, walks in the country, and other such “organic” treatment seem a natural solution to many people, but most of all, healing comes with time.

    With 31 million prescriptions and a 6% annual growth, medicine should admit that its offer to “cure” depression was naive and wrong. Drug treatment should be reserved for the very few, not the many. Over the years I have taken many a hard look in that bathroom cabinet mirror—the time for the medical profession to look at its own reflection is long overdue.

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