Britain is depressed. Especially its
women. Recently the Irish author Marian Keyes announced on her
website that she is suffering from such “crippling depression” that
she was unable to sleep, write, eat, read or talk.
Depending on which study you
believe, a woman aged 25 in 1980 was between three and ten times more
likely to have suffered depression than her grandmother. The increase
has continued in the past 30 years, particularly among girls from
affluent homes.
The proportion of such girls
suffering at the age of 15 almost doubled between 1987 and 2006 (up
from 24 per cent to 43 per cent). Scientists are now confident that
these increases are real, not because of our greater willingness to
engage in psychobabble. Overall, 23 per cent of us suffered from a
mental illness of some kind in the past 12 months.
The proportion rockets among the young:
32 per cent of 16-24 year olds, dropping steadily as we get older, to
11 per cent of over-75s.
With the short, dark days of January
especially hard for those with depression — many psychologists claim
today that with freezing temperatures, debts from the Christmas
break, and gloom about returning to work, add up to the most
depressing day of the year — what has gone wrong and, even more
importantly, what can you do if you are suffering?
Some people blame their genes. For
decades we have treated as common knowledge the existence of a
depression gene. But one of the most interesting developments of last
year was a growing conviction among scientists that genes play little
or no role in depression.
The Human Genome Project, which
mapped all our DNA, has not reliably identified a single example of a
gene for any mental illness.
In the face of this, the leading
gene researchers have been forced into a dramatic retraction of their
previous claims. They now accept that we are never going to find
individual genes for individual mental illnesses, including extreme
ones, such as schizophrenia. The about-turn comes after several false
dawns, the best example being what was thought to be a critical gene
variant for depression. A 2003 study reported in Science magazine
found that people with it were more likely to become depressed if
they were maltreated as children: it created a vulnerability.
However, a report published last
year has almost disproved this. It examined 14,250 people whose DNA
had been mapped in 14 different studies. Those with the variant were
not at greater risk of depression nor were they more likely to be
depressed when the variant was combined with childhood maltreatment.
Although it is just possible that other studies will reinstate the
variant as playing a part, other evidence suggests that it plays none
at all.
For instance, in developed nations,
women and people on a low income are twice as likely to be depressed
as men and the wealthy. Yet they are not more likely to have the
variant. Worldwide, depression is least common in the Far East, yet a
study of 29 nations found the variant to be most frequent there.
The implications are huge: to
paraphrase Bill Clinton, it’s the environment, stupid! There is
buckets of evidence that two factors are crucial: the quality of care
you receive in your early years and the kind of society in which you
live.
If the care during your first year
was unresponsive, you are at much greater risk. Likewise as a
toddler: you get used to being let down and expecting the worst. In
later childhood, overcontrolling mothers who hover over their child’s
every action with hypercritical eyes put the child at risk of
perfectionist, depressive self-criticism. Equally, physical or sexual
abuse greatly increases the risk, the younger the maltreatment, the
greater the harm.
Early maltreatment changes the
content and size of our brains. On average, a woman who was sexually
abused has 5 per cent less of the hippocampal region of the brain,
crucial for regulation of emotions. Being made fearful or lonely by
early care jacks up secretion of cortisol, the “fight or flight”
hormone. It creates a jumpy, insecure, self-doubting person.
Only the most fanatical of genetic
fundamentalists now dispute that parental care is a key cause of
depression. However, it is not all your mum and dad’s fault.
In 2004, the World Health
Organisation published the results of a survey of the amount of
mental illness in 14 nations. Unlike the easily dismissed surveys of
happiness so beloved by economists, this evidence is based on
in-depth interviews by trained professionals — it is as good as it
gets. It proved that people living in English-speaking nations are
twice as likely to suffer a mental illness as those in mainland
Western Europe. For example, by far the most mentally ill nation was
America, with 26 per cent of its population having a depressive
episode in the past 12 months. The average for the continental
Europeans was 11.5 per cent (based on nationally representative
samples in Germany, France, Italy, Belgium, Spain and the
Netherlands).
Taken together with the evidence
that we are much more mentally ill than our grandparents, this
strongly suggests that the kind of society in which you live plays a
big part in whether you suffer. Why is our society more toxic, and
why has it become more so since 1950?
In my book Britain on the Couch, I
identify two major toxins that spread between 1950 and 1980. The
first was an epidemic of “social comparison”, of “keeping up with the
Joneses”. After 1950, material and social aspirations rocketed and we
became a nation of wannabes. In particular, women and people from
poor homes were encouraged to reach for the sky. Whether in the
classroom or the workplace, all of us were pressurised to believe
that we could achieve more and do better. So high did our aspirations
become that even the ostensible winners began to feel like losers.
Egged on by the new medium of television, we obsessively and
enviously compared our lot with that of others, constantly feeling we
were being deprived of what was “rightfully” ours.
The other great disaster was the
rise in the divorce rate, reflecting a period in history when the
battle of the sexes has never been worse. This gender rancour also
reflected our bloated individualism and confused aspirations. Men
were supposed to love their partner for who she was, not what she
looked like; women to love men not their bank balances. There was a
formidable rage from women dumped for younger models and from men
traded for more dominant, successful peers.
The problem was especially acute
among women, so that two thirds of divorces were initiated by them.
In the 1960s, 40 per cent of women were prepared to marry a man they
did not love, as long as he had other desirable qualities (such as a
sense of humour and wealth). The proportion had dropped to 15 per
cent by the late 1980s. This was, of course, the period in which the
divorce rate mushroomed. At exactly the moment when more marriages
were ending than ever, women were placing a higher premium on love.
No wonder there were so many broken hearts. The epidemic of “keeping
up with the Joneses” combined with the outbreak of unparalleled
gender rancour continued after 1980. Then another virus swept the
English-speaking world, explaining why we are twice as mentally ill
as our continental cousins: affluenza — placing too high a value on
money, possessions, appearances and fame — became endemic. Those
values make you much more susceptible to depression.
By now you are probably thinking: “I
can’t change our society and I don’t want to move to Denmark. Sitting
here depressed in 2010, what can I as an individual do about my
misery?” Thankfully, there’s a great deal.
It’s very good news that genes are
almost certainly not the cause, as your distress is not an inevitable
destiny. People who do not believe their problem is genetic are much
more likely to recover.
The main treatment options are pills
and therapy. Unless you are desperate, forget pills. In most cases,
even if they do have an effect it is a “placebo” — people given chalk
pills, but told they are antidepressants, are almost as likely to
claim to feel better as people given the real thing. And pills have
nasty side-effects, such as loss of libido.
The best talking cure is the one
invented by Freud, psychodynamic psychotherapy. It has moved on a
long way and it has been proven to work better than its main
competitor, Cognitive Behavioural Therapy (CBT).
The strongest evidence for its
superiority was published last year. Initially, eight to 20 sessions
of short-term CBT reduced depression and anxiety, more so than having
psychoanalytic therapy two to three times a week. However, after
three years, those receiving long-term psychoanalytic treatment were
dramatically better off — less likely to be depressed and four times
more likely to have recovered from anxiety. A recent survey of 23
other studies had similar findings.
It is vital that you engage in
systematic scrutiny of how parental care in the early years affected
you (take the “find a therapist” option at
www.psychoanalytic-council.org). Since hardcore CBT explicitly
rejects discussing early care, it will never be of enduring, profound
value to distressed people. However, psychoanalysis is expensive and
time consuming. Two less intensive therapies are also proven to
help. Cognitive Analytic Therapy, uses the best of CBT and
psychoanalysis to investigate how your childhood is affecting you, in
16 sessions (www.acat.me.uk).
The second therapy, the Hoffman Process, entails eight days in a
residential setting (www.hoffmaninstitute.co.uk).
It is a remarkable shortcut to understanding what went wrong in your
childhood as well as a highly imaginative way of cheering you up.
Indeed, that was the option taken by Sheila, a depressed television
producer. With additional help from a psycho- dynamic therapist, she
sees things very differently today. “I suffered chromatically black
moods. No longer. I can see how my childhood prepared me to be a
miserable Bridget Jones, made worse by the values of a sick society.
Touch wood, I now have sustained sanity.”
Oliver James is the author of
Britain on the Couch — How Keeping Up With The Joneses has Depressed
Us Since 1950, Vermilion, £8.99. For more information, visit:
www.Oliver-James-Books.com |
