Question As someone who is clinically depressed, I have often wondered: philosophically speaking, is trying to treat depression wrong? People are depressed for a reason, possibly because life's pretty damned depressing once you get down to it. It seems to me that in plenty of cases, depression is a logical reaction to this planet, a rather depressing thought in and of itself. Despite the wars and the plagues and the genocides and the poverty and the seemingly countless other reasons for one to be depressed, people treat depression like a disease when it seems more like a perfectly acceptable reaction to the human condition. Treating depression like this appears to me as a rather unsubtle way of trying to trick people into believing everything is going to be okay when reality seems to contradict this. Any thoughts?

Accepted:
November 17, 2009

Comments

Thank you for your question. I think you're right to wonder whether treating depression is always justified. After all, sometimes being upset about something is an appropriate reaction. For instance, we wouldn't feel the need to "treat" someone's grief over the death of a loved one. On the other hand, while a certain amount of grief over such a situation seems justified and appropriate, one might also suggest that it is possible to take that grief too far. If I had a friend who was grieving intensely and for a very long time over the loss of a loved one, I might start to think of ways I might try to help. Similarly, while one can be entirely justified in being depressed over the state of the world, I am not sure that being clinically depressed is the *only* appropriate reaction to the world's state. This is for a number of reasons. First of all, there are a number of things to be absolutely thrilled about: a beautiful sunrise, the smell a pine forest, being able to fully trust another person, a favorite work of art, are all examples. Secondly, one appropriate response to the depressing things about the world is to try to do something that, if only in a small way, might change them. For instance, it's depressing how much poverty and hunger there are in my community. My response is to work at the local food bank, in an effort to make a small difference. I don't claim that it's the *only* appropriate response, but I would suggest that it's *one* appropriate response. Note also that I'd have a lot of trouble helping out with local hunger if I were clinically depressed.

Please let me stress that I don't for a moment think that clinical depression is something you can simply decide to overcome. Overcoming it would surely take a long time and a lot of effort. But I would suggest that depression of the sort you're experiencing is only one appropriate response to the state of the world. There are others to be considered also. One can take these options seriously without falling for a simplistic picture in which any depression is something that needs to be "cured," or in which, as you put it, "everything is going to be okay." I seriously doubt that everything ever will be okay, but that doesn't make me want to stop fighting the fight.

Depression used to be classified in two forms: endogenous ("originating from within") and reactive. There was an obvious point to this way of classifying things, but a different way has been suggested recently. The newer way is to distinguish between cases in which depression, the medical condition, is present, with its bodily neurophysiological causes, and cases in which only symptoms of depression are present, and which lack the underlying neurophysiological cause. The symptoms might however be produced by some environmental cause, a depressing incident, a personal loss or a major setback in life, without the marked and persisting change in the biochemistry of the brain which is believed to underly the medical condition. The significant difference between the two kinds of condition seems to be that changes in the environment typically don’t touch the medical condition. That may even be a defining characteristic of the condition, as well the usual things doctors look for, such as failure of concentration, changes in eating habits, sleep disturbances, and so on. (Grief, perhaps, can be severe enough to be a borderline case, or develop into real depression.)

Whether to treat with medication should be based on this distinction, or one like it. When the condition is serious enough to block the happy and satisfying life that we could otherwise reasonably expect, then we should perhaps be thinking about treating it with medication. If we see a friend or family member going through the darkness and dangers of severe depression, we will want to do what we can, and we all have an obligation to help, especially if we are medical professionals.

There is by the way also some interesting empirical evidence that people suffering from depression are actually more accurate in their judgments of situations with possible negative outcomes than people without the condition. From this point of view it might look as though the depression is the result of the more accurate perception! On the other hand, depression causes inaccurate and falsely negative mis-readings of facial expressions.

The world situation is disturbing. But if someone has real depression, can’t work, can’t sleep properly, can’t form ideas or concentrate, then this may have to do with an organic problem. What is being removed by medication is this very clear and noticeable condition, with all its miseries. It would be a trick and a tricky philosophical proposition if treatment just removed the perceptions and judgments of the world situation. But they may not actually be the cause of the distress, though it can seem as though they are. The situation is rather that proper medication may be able to prevent irrelevant and unnecessary distress, and even to make it possible to act on the view one has of the world situation.