Treatment: The Depression Policy

Photo Credit – JesterArts – Stockxpert

One of my wake-up moments arrived decades ago when I read a New York Review of Books essay on a government practice known as “channeling.” This was during the Vietnam draft era, and the term referred to the decisions that young men were forced to make about their lives because of the prospect of compulsory military service. There was plenty of stress to go around as I and every guy I knew tried to figure this one out. You could defer service if you went to college, then on to grad school (until they took that option away) or divinity school (a number of surprising conversions there) or became a conscientious objector or even leave the country. And there were many who wanted to serve, to let the draft take them or get a jump on the system and enlist – and they had the prospect of hot combat before them. The draft was always there to keep the pressure on.

The point of the article was that the draft had been designed to do more than just fill up slots in the army. Its unrelenting pressure and your personal stress were instruments of national policy to “channel” the better-off kids into college and graduate education or into training as military officers, while the working-class kids, with fewer options, would become the rank and file of the armed forces. That way, everybody would conform to the prevailing ideas of how society ought to work. That knowledge radicalized me on the spot. Government was getting its hands inside my mind and my deepest feelings! The hell with that, I thought, we’ve got to change this rotten system!

As it turned out, I was at that same time having my first adventures with psychotherapy. What I didn’t know until recently, however, was that psychiatrists of that period had their own policy about the treatment of depression that was to have even more long-lasting effects on my inner life than the temporary problem of dealing with military service.

Peter Kramer describes what used to be the prevailing mode of responding to depression by the psychiatric community in an essay you can download from Amazon for $.49. Tools of the Trade is a good introduction to changing ideas about the nature and treatment of this illness. What brought me up short was his discussion of the school of thought which saw depression as a useful stimulus pushing a patient to probe deeply into the traumas of the past. Those traumas, it was thought, were the real problems and causes of everything that followed. Depression was seen more as a side-effect that was better left untreated, except during emergencies, because the self-doubt it induced would help pry out the repressed secrets of the unconscious and also reveal the behavioral patterns of the past that were poisoning the present.

So here was another policy of manipulation that used my inner anguish as a means to achieving what was thought to be a greater good. Of course, this worked best if I could remain ignorant of what was being done. At that time, I didn’t have the knowledge or tools to challenge any psychiatrist. For one thing, I had symptoms that scared the hell out of me, and I lacked a name to give them. I didn’t know anything about depression. I just thought I was a bad person who also had some strange neurosis. Then too, I had read Freud (The Interpretation of Dreams has to be one the most interesting books about the mind ever written) and accepted the idea that getting better somehow had to do with understanding the murky psychic past. In reality, though, what drove me to seek this help were things like:
*- bouts of incapacitating panic
*-a frequent social anxiety so intense that I could hardly bear to mingle with new people in even the smallest group settings
*- a despair about myself that pushed me to heavy drinking and suicidal thoughts
*- a “normal” state in which I couldn’t feel much of anything and never showed spontaneous emotional reactions of any depth to anyone.

Of course, I did not suspect that these things might be linked. Nor did I identify them so neatly to the psychiatrists. I just knew I was in a wretched state, and I was looking for answers. What I usually talked about were stories of traumatic love affairs or parental encounters that made me miserable or some other external event. With the help of a number of breakthrough dreams, I came to see, as the therapists wanted me to, that I was still burdened with the unconscious repetition of behaviors learned while growing up in an often violent household. That would make me a prize therapy pupil except for the bothersome fact that I never got any relief from those nasty symptoms: the panic and anxiety, the despair and inner sense of shame, the inability to feel much or respond to people and day-to-day events, and the rest of it, were unrelenting during this entire time.

True to form as Kramer describes it, none of these psychiatrists offered any treatment specifically directed at the depression, except in one case where I was clearly going to start smacking my head against the nearest wall if I didn’t get some medication for a short time. In fact, only one of them even mentioned the word or referred to the other symptoms I described as part of any particular condition.

Kramer is outraged by this approach to treatment, especially in light of today’s understanding that depression is a progressive illness that needs to be dealt with as early as possible. If neglected, it tends to become a self-perpetuating force that causes long-term damage to several of the body’s major systems. It seems simple enough. If you’re a doctor, treat the illness! Part of the urgency of his message, of course, is his awareness that this school of thought is by no means gone. At least today, there are many more choices for treatment than anyone dreamed of 30 years ago.

If I have a condition like depression (whether or not I want to call it a disease) I want all the knowledge I can get about what it is and all the options for responding. Then I want to work out a strategy to deal with it directly with the help of whatever sort of therapist or guide I may choose. What I don’t want is a medical profession making those choices for me and then not telling me what they’re up to. When depression hits people for the first time, they don’t know what’s going on. If they get to the point of recognizing they need help, it has to be help directed to the problem they come in the door with.

It may seem that we’ve all gotten beyond those dark old days, but I doubt it. Many mental health providers today are working on a theory of depression that is being disproved by the progress of research. The amine neurotransmitters are not the whole story, and the antidepressants based on that model don’t work for many, like me, with major depression that has had decades to do its damage.

The only honest approach to treatment I can conceive is to be open about the current state of incomplete knowledge, inform the depressed person looking for help about the potential consequences of the condition and work out an approach that relies of active partnership of patient and provider instead of secret formulas or passive reliance on medication alone.

What has your experience been like in putting together a treatment partnership?