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Malady or
Malaise?
Deciphering the Roots of Widespread Adolescent
Depression in America
By Sean
Daneshgar
“The great owners, striking
at the immediate thing…not knowing these things are results, not
causes. Results, not causes; results, not causes. The causes lie
deep and simply—the causes are a hunger in a stomach, multiplied a
million times; a hunger in a single soul, hunger for joy and some
security, multiplied a million times; muscles and mind aching to
grow, to work, to create, multiplied a million times. The last clear
definite function of man---muscles aching to work, minds aching to
create beyond the single need—this is
man"
John Steinbeck in The Grapes of
Wrath1
At eight o’clock in the morning, as the first bell rings, the
typical American high school campus may seem a peaceful, functional,
and generally happy place. Students go to class, prepared to take
notes, generally calm, except perhaps when pleading to borrow a
pencil from a friend, or interrupting the teacher to ask a question
about the most recent lecture. Upon first glance, the typical
American high school may seem like a colorized and more modernized
version of a picturesque school filmed in black and white back in
the 1950’s. That’s why it surprises so many adults when they hear
that the suicide rate among adolescents has tripled since 1950
(Bernstein 601)2, that one out of every twelve
adolescents has suffered significant depression by the age of
eighteen (Bostic 60)3, or that the symptoms of depression
are now evident in as early as the toddler years (Tyre “Finding”
54)4. It may be in the privacy of their own rooms, late
at night, when teenagers put down the cheerful mask, or in the
bathroom, where some teenagers may be found cutting themselves on
the wrist to release some of the social pressure on them, that this
unbearable coat of negativity is shed off. Or, for most adolescents,
the case may be that feelings of unhappiness have become such a
banal part of life that no special attention is given to them—that
they simply persist like a dark, unavoidable shadow. Regardless,
depression has become the hallmark of the rising generation, and
parents and professionals alike are having trouble understanding
why.
Most parents have latched on to a tradition of biological
reductionism, or over-simplification, in order to reason through
this seemingly inexplicable misfortune of their children (Scull
72)5. Since the days of the ancient Greek physician,
Hippocrates, mental illness has been interpreted as a problem that
stems exclusively and originally from the human body. His humoral
theory, which “held that physical and mental disorders stemmed from
an oversupply of one of the four bodily fluids–blood, phlegm, yellow
bile and black bile” (Worsnop 10)6—“depression was
attributed to an excess of the black bile, the ‘cold and dry’ humor”
(Worsnop 10)7—lasted until the seventeenth century, when
it was replaced by new scientific, and equally reductionist,
findings. In light of the rich commercial market such a unanimous
perception provides, modern day pharmaceutical companies have
capitalized on this time-tested, but inaccurate conception of mental
health, in order to administer psychiatric drugs on a massive scale.
Pharmaceutical companies in total make four hundred billion dollars
a year in profit, Americans contributing to half of that figure
(Angell 53)9. By 2001, the U.S. sales on antidepressants
per year already had reached 11.4 billion dollars, but have
continued to grow to 13.4 billion dollars in 2004 (“Commonly”
2)10. In 1998, children ages two through eighteen
received 1.9 million prescriptions for antidepressants, which
represented an eighty-six percent increase in four years. Based on
IMS Health statistics, those figures have also continued to grow
steadily (Koch 5)11. If antidepressants were doing the
job, then suicide and depression rates would not be escalating. But
if the source of the problem is not biological, then what is
it?
By three o’clock it becomes clear that the daily life of the
average American teenager is imbalanced—the once friendly
countenances of these adolescents have turned into stressful
grimaces, the look in their eyes, once hopeful, lack hope, the march
down the stairs of school has become tired, to say the least. The
relentless pressure from parents and other adults is the cause of
the widespread unhappiness among adolescents. Children are trained,
from infancy, to achieve academically, and then in the afternoon
either artistically or athletically, in order to become good
candidates for college, which is perceived as a ticket to lifelong
happiness. This perception translates into every aspect of the
average high school student’s life, which becomes dominated by
school, and less defined by friendship or activities natural to
teenagers. Herein lies the direct link between adolescents’
lifestyles and depression—stress, anxiety, and also paucities of
self-esteem that arise from an inability to achieve at what parents
have determined a sufficient level. Furthermore, instead of finding
outlets in those things most human—nature, physical activity, or
art—which are often also the most inaccessible, teenagers turn to
television, over or under-eating, or other self-destructive
behaviors. In a 2003 study by CNS, it was found that one third of
the nation’s high school students are getting less than one hour of
physical activity a week. Instead, over a third of these students
are too exhausted to exert energy, watching more than three hours of
television—per school day. And correspondingly, more than twelve
percent of our nation’s adolescents are substantially overweight
(“Youth” 1-3)12. Perhaps this is the rising generation’s
form of rebellion—apathy. Or, perhaps, astounding facts like the one
that some colleges are now accepting as few as nine percent of
applicants are causing them to resign, on the couch, with a bag of
potato chips, or at a party, with a bottle of alcohol—binge drinking
(and other desperate forms of drug abuse) among adolescents has
reached record numbers in the last decade (Marano 62)12b.
One thing is certain; teenagers today are not discovering the
personal activities, or interest in the ethical issues, that are the
true medium to meaning and full living. Instead, anything of meaning
has become commercialized by the college process and by an
increasingly profit-based society.
It is clear that for those adolescents whose unhappiness
stems from the cultural malaise outlined above, antidepressants are
not the cure. These adolescents are “feeling depressed,” as opposed
to suffering from clinical depression that merits psychiatric
treatment—they are “unhappy,” but not yet “mentally ill.” In fact,
antidepressants only should serve the purpose of alleviating the
depressive symptoms of people of all ages who have severe mental
illness, (although these drugs have not been adequately screened and
tailored for non-adults). Beyond the inherent dangers and
side-effects of the medications for depression, especially for
adolescents and other younger children who take them, there are
long-term dangers of the overuse of psychiatric drugs. The
“quick-fix” mentality parents have adopted, which tells them that
drugs will provide productive children who can achieve enough to
ensure happiness, has the unintended effect of extending the adult
world’s ignorance about the underground social problems of today’s
adolescents that are only reflected in remote, high strung
statistics. If parents continue to perceive depression as
biological, and antidepressants as the cure, then adolescent
depression will persist, escalate, and amplify. Because moderate
adolescent depression is caused by factors of the cultural malaise,
parents and professionals should not be treating their unhappy
children with anti-depressants.
While the teenage years
once were a time of freedom and self-actualization, discomfort and
pessimism have practically become part of the definition of
adolescence, afflicting more than just a subset of teenagers. A
“substantial proportion of young people is suffering from strong
feelings of unhappiness and despair” (Robertson 126)13.
While the scope of unhappiness among adolescents is immeasurable,
the astounding amount of diagnoses of severe depression among
children indicates the worsening of the cultural malaise. Over
seventy percent of adolescents tested in a recent study displayed
some degree of depression (Robertson 126)14. Already the
third leading cause of death among adolescents, suicide is now the
fourth leading cause of death among children of ages ten through
fourteen—the incidence of depression is increasing faster among
children than any other age group (Marano 66)15. Some
have applied anthropological principles to argue that the increased
incidence of depression can be explained solely genetically, stating
that the availability of antidepressants has caused an increase in
the percentage of the population that is genetically predisposed to
depression (because those parents who were previously afraid to
reproduce due to the nonexistence of antidepressants are now willing
to do so) (Koch 5)16. However, the substantial increase
in suicide rates cannot be explained away genetically—while
increased genetic reproduction may play a role, it is surely
minimal. In fact, science has posited that all moderate cases of
adolescent depression are environmentally caused (Robertson 126).
Many medical professionals tend to extend the perception that social
factors have not played a role in the increased incidence of
depression by attributing it to better identification of the
symptoms of depression, based on a new biological and a new
behavioral model for identifying depression (Koch 7)17.
While it is true that more depression is being diagnosed than ever
before, the symptoms of depression hold more widespread currency
than ever before as well. The facts that severe cases of depression
are on the rise, as the suicide rate demonstrates, but that more
subtle, prolonged forms of depression seem to be rising among the
general teenage population, may seem to provide a contraction. But
the fact is that cases of moderate depression are not being handled
appropriately, and therefore escalating to severe depression
(Bernstein 605)18. So what are the causes of moderate
depression, and how should they be
treated?
The primary source of
widespread unhappiness in America is the overly status and end-point
driven nature of American society. Beyond friendship, ethics, social
involvement, and balanced living, the value of individualism defines
the American outlook on life. “Parents perceive the world as a
terribly competitive place”, observes David Anderegg, a child
psychologist in Lenox, Massachusetts, “And many of them project that
onto their children when they’re the ones who live and work in a
competitive environment. They then imagine that their children must
be swimming in a big shark tank, too” (Marano 70)19. As
the nation is founded upon the principles of commercialism and now
seeks to maintain the status of “superpower,” adults have adopted
this mentality in order to survive and flourish, and seek to train
their children in this mentality, in order for them to be able to
handle society as well. Ironically, the direct social causes of
depression, such as the misguided attempts to instill self-esteem in
children, parental hovering, pressure to achieve, physical
inactivity, and consumerism all stem from the overly competitive
social fabric of America.
The traditional causes of
depression have involved parental neglecting of children, family
instability, or shortcomings in interpersonal relationships
(Robertson 128)20. However, Penn psychologist Martin
Seligman explains that in recent years, parents’ bestowing of
“unearned self-esteem” on their children is causing depression (Koch
16)21. Parents provide their children with a positive
environment and remove all road bumps or challenges. Insulated by
this external environment, children fail to develop socially. But
parents’ failure to allow their children to grow extends beyond
attempts to instill a sense of self-esteem. Parents are quick to
essentially live life for their children—to make their children’s
decisions, to do their children’s homework, to define their
children’s goals. In Time Out or Burn Out for the Next
Generation, the Dean of Admissions and Financial Aid of Harvard
University, William Fitzsimmons, writes, “the problem can often be
well-meaning but misguided parents who try to mold their children
into an image of success they value; and their children, being
moldable as they are, often get on board and go along with the
program before they have any capacity to make such a choice for
themselves” (Fitzsimmons 7)22. The failure to develop
socially and autonomously has been shown scientifically to implicate
depression. The prefrontal cortex (PFC), which is the executive
branch of the brain, holds the ability to plan and also
self-regulates hormones against depression. Insufficient social
learning, or failing to develop social skills, can cause the PFC to
allow for depression. The PFC is “deeply implicated in depression, a
disorder increasingly seen as caused or maintained by unregulated
thought patterns–lack of intellectual rigor” (Marano
66)23. Harvard psychologist Jerome Kagan has even shown
that overparenting can cause children to become prone to depression
as early as in pregnancy. “About 20 percent of babies
are born with a high strung temperament. They can be spotted even in
the womb; they have fast heartbeats. Their nervous systems are
innately programmed to be overexcitable in response to stimulation,
constantly sending out false alarms about what is dangerous…For
them, overparenting can program the nervous system to create
lifelong vulnerability to anxiety and depression” (Marano
66)24. And those who do not learn to deal with social
situations as children end up unable to compromise or maintain
relationships as adults, failed or lost relationships being a common
cause of depression (Marano 66)25. An inability to deal
with social situations or controlling one’s life, a phenomenon
called learned
helplessness, is also implicated in depression and caused by
parental hovering (Bernstein 605)26. Furthermore, a child
who only knows the positive world that his parents have provided him
will inevitably experience a clash with the real world, which he
will experience as a trauma, another factor of depression (Robertson
127)27. In order to develop immunity against failure
later in life, and to appreciate success, an adolescent must “find a
way to deal with life’s day-to-day stresses…[and] develop resilience
and coping strategies” (Marano
68)28.
Although enabling their
children to avoid the challenges of growing up, adults in the lives
of adolescents no longer provide a source of comfort or mentorship
in general, but rather serve as mediums to the college craze. The
competitive nature of the American workplace has trickled down to
American colleges, which is where anxiety and depression are most
concentrated. (Suicide is the second leading cause of death among
college students (Bernstein 601)29.) Parents become so
sucked into the college craze that they put relentless pressure on
their children to achieve, in order to make their children better
candidates for the top colleges. Yet pressure, stress, and anxiety
are the primary cause of depression. Also, children who are
constantly pressured to achieve inevitably develop a self-image of
insufficiency. When children constantly see their parents doing
their work, or inversely fail to achieve the grades and status that
their parents expect of them, they become depressed (Robertson
126)31 Interestingly, “while a negative view of self was
strongly related to adolescent depression [in a recent study,]
negative perceptions of the world were not” (Robertson
127)32 a phenomenon called negative attributional
style. Children increasingly see themselves as insufficient, and
are not able to understand that the toxic system they belong to is
the problem. They would not develop self-esteem issues if they knew
that the relentless pressure from parents is to be blamed. “Parents
need to abandon the idea of perfection and give up some of the
invasive control they’ve maintained over their children…And
recognize that parents themselves have created many of the stresses
and anxieties children are suffering from, without giving them tools
to manage them” (Marano 70,
103)33.
The overemphasis on
achievement causes many adolescents to forego essential activities
for teenagers. “It is common to encounter even the most successful
students, who have won all the ‘prizes,’ stepping back and wondering
if it was all worth it…Often they say they missed their youth
entirely, never living in the present, always pursuing some
ill-defined future goal” (Fitzsimmons 3)34. Teenagers are
not only missing out on the fun the teenage years once symbolized,
but also lacking sleep and physical health. “The school day
continues well into the night with structured study time and drills”
(Fitzsimmons 1)35. Children are no longer “pulling
all-nighters” to spend time with friends, but rather to finish
school projects or study for upcoming exams or standardized tests.
Parents’ attempts to ensure their children happiness would be better
served if they realized the importance of living in the now and of
balance. What is more important for a child to learn than a lesson
in history or math is to live life to the fullest every day, and to
develop healthy habits. In fact, the “measures that promote healthy
adolescent growth also are helpful for depression. Moderate aerobic
exercise relieved depressive symptoms in almost half of young adults
in one recent study” (Bostic 60)36. One supplementary
reason physical activity in the form of athletics is important is
that through sports cognitive ability is developed, and the PFC
which regulates against depression functions well (Marano
64)37. Instead, parents are allowing their children to
lose physical health over the quest to achieve. The issue of obesity
among Americans is not unrelated to depression. “Overweight people
tend to feel more lethargic. Obese individuals participate less
often in many enjoyable physical activities” (Cafaro
141)38. Children are partly so depressed because they
spend their days behind the desk, on the computer, or in the
classroom, as opposed to in nature. Even athletics take place in
depressingly urban areas. Intemperance about the necessity of
physical activity and nature in daily life is causing many children
to grow up depressed. Their “full human flourishing depends on a
varied and stimulating environment, including accessible wild areas
that preserve the native flora and fauna” (Cafaro 138)39.
But instead, they are experiencing what environmental ethicist
Phillip Cafaro calls “ecosystem sickness,” which “leads to
intellectual and spiritual losses.” The ecosystem “may no longer be
productive of happy and healthy human beings” (Cafaro
142)40.
The pursuit of wealth and
power has always been a part of the American psyche, but now the
pursuit of academic status is causing adolescents to feel the
pressure of American society as well. Teenagers now have less
concern for ethical, political, or social issues (for which
education is deemed important), which has been displaced by the
quest for status, whether academic or financial. To get into college
is now the accomplishment, rather than to use a college education in
order to contribute to society. However, “material wealth is not a
ticket to happiness,” as cliché goes. In fact, “moral shortcuts to
happiness in fact tend to
place us on winding roads toward unhappiness” (Cafaro
137)41. Adolescents are largely putting the pursuit of
material possessions or status above ethical or moral concerns,
which is causing them to be depressed. Cafaro explains, “When the
acquisition of material possessions leads us to ignore higher
pursuits, or when society’s overconsumption undermines natures’
health and integrity, our own lives suffer” (Cafaro
138)42. His assertion is backed by scientific findings;
“Studies have shown that people with more materialistic outlooks on
life tend to have poor interpersonal relationships” (Cafaro
149)43. In particular, “late adolescents with a strong
materialistic value orientation report lower self-actualization and
vitality, as well as more depression and anxiety” (Cafaro
149)44. The materialistic outlook and the pressure to
achieve perpetuate stress, as “the gap between what people have and
what they want is more pronounced in the material realm…It leads to
a race to get and spend that leaves many people feeling hurried and
harassed” (Cafaro 149)45. The most fulfilling experiences
in life are those that hold social or ethical meaning, and today’s
teenagers are less and less inclined to pursue happiness through
activity. They “neglect fulfilling, socially useful work for the
trappings of status or success” (Cafaro 150)46.
Adolescents are not discovering the ethical or artistic passions
that would make them feel alive and productive. They are unaware
that real satisfaction comes from the “the pleasures of love and
friendship, aesthetic appreciation and the pursuit of knowledge”
(Cafaro 143)47.
Americans have reached a
point in which the pursuit of material wealth or social status is so
banal that it seems normal. Depression, materialism’s counterpart,
has likewise become a fact of life for most Americans. Instead of
recognizing and combating the ethical problems that are the social
triggers of depression, families have continued on the competitive
path, as the financial and social pressures on them seem too
daunting to address. As Virginia Portmann says, “American parents
today [continue to] expect their children to be perfect–the
smartest, fastest, most charming people in the universe. And if they
can’t get the children to prove it on their own, they’ll turn to
doctors to make their kids into the people that parents want to
believe their kids are” (Marano 64)48. The American
public is more ready to call itself “mentally ill” and to take a
“magic pill” than realize that it can reverse its symptoms of
depression by changing its lifestyle.
“The modern mentality, in
which each sphere of knowledge is treated as unrelated to the
others, in medical terms separates the psychic form from the organic
and then, supposedly in the name of progress, divides the human
organism up into a multiplicity of
areas.”
Francois
Laplantine49
Doctors are quick to
believe that drugs can provide a cure for depression because
pharmaceutical companies have influenced them to believe, through
biased research, advertising, and subsidizing, that depression is
basically and originally biological. Pharmaceutical companies claim
to conduct research that aims to make scientific progress in
understanding depression and treating it, but their claim is far
from the truth. Only fourteen percent of profits have been used for
“research and development” since 1990 for these companies, and due
to the lack of public pressure, this ratio has not changed (Angell
55)50. Of the little research that is done, most of it is
aimed at making profitable variations on old drugs, while the rest
is aimed at proving that the already existent drugs are useful.
“This is about as valid as the research funded for years by the
tobacco companies that concluded ‘scientifically’ that cigarettes
were neither addicting nor harmful” (Glasser 19)51. More
money is geared toward “persistence and compliance,” or pursuing and
retaining clients and dispensers, than toward research. Furthermore,
“marketing and administration,” or advertising, amounts to a
disproportionate thirty-six percent of all sales. Clearly,
pharmaceutical companies are a business before a health agency.
These companies make it more “lucrative for mental-health-care
services to prescribe an antidepressant than to provide
psychotherapy” (Worsnop 6-7)52. As the epitome of the
consumer society that has disregarded ethical but also human
concerns because of greed and the prioritization of profit (Cafaro
148)53, the pharmaceutical industry has furthered a
perception of depression as biological and of drugs as the best form
of treatment.
Why is the American public
so quick to accept the data presented to them by the pharmaceutical
industries? Primarily, Americans are not getting the unbiased
information about depression and the health costs of antidepressants
due to the dominance of pharmaceutical companies in the medical
world. “The public has no awareness that the price of this pill is
to blind you to the [lesson that you] can pursue happiness and
mental health on your own. [That there] is a further price you risk
when you take strong brain drugs; many of them harm the brain and
cause real mental illness” (Glasser 24)54. Having seen
that the drugs have been successful for specific forms of depression
in clinical trials, parents assume that the drugs must work for all
types of depression, including their children’s (Szalavitz
52)55. Also, because psychiatric drugs are more
accessible and cheaper than psychotherapy, more people choose
antidepressants as the primary form of treatment (Szalavitz
52)56. However, beyond the fact that their own doctors
are openly endorsing these products, American parents are also to be
blamed. They are constantly looking for the “quick fix,” for the
easy way or cure. Whether by ignoring the faults of their children
and the challenges of growing up, or by looking for happiness in a
pill, the American public portrays an insatiable propensity to avoid
pain. Far from facing the burdensome task of counteracting the
cultural malaise that afflicts their families, parents use the
biological explanation of depression as a scapegoat for their
idleness.
The medicines parents
acquire for their moderately depressed children are ineffective.
Counseled by the advice of their conventional doctors, they consider
the advice of psychiatrists like William Glasser, who explains that
for moderate forms of depression, the appropriate route of treatment
is changes in thinking habits or lifestyle, as unconventional, and
therefore undependable. However, along with many psychiatrists,
Glasser has shown that the children who are struck by stress do not
initially have clinical depression that requires medication, but
rather feel depressed. Glasser, who is world-renowned, provides a
conceptual tool to understand the difference between mental health
and mental illness. He suggests that mental health is just like
physical health; on the physical health spectrum, there is healthy, unhealthy, or sick. The challenge for
someone who is physically unhealthy is to exercise and
diet in order to move to the healthy end of the spectrum.
He proposes that the mental health spectrum operates the same way,
with a spectrum of healthy, unhealthy, or mentally ill, and that a
majority of cases of depression are not quite severe enough to be
considered mental
illness, but rather solvable through conscious efforts to
improve mental health
(Glasser 14)57. Yet sticking to the data that all forms
of depression can be solved neurochemically, American parents choose
to give their children psychiatric drugs, unlike in most other
cultures (Bernstein 578)58. One explanation for the
genuinely perceived effectiveness of these drugs on moderately
depressed patients may be the placebo effect; “the newness and the
chicness of the medication give it a placebo aura that helps it take
effect” (Luhrmann 208)59. However, research shows that
“SSRIs…may be no more effective for depression than placebos”
(Glasser 2)60. In fact, only one third of patients given
treated pharmacologically for depression show significant
improvement. One third of depressed patients do not respond at all
(Luhrmann 208)61.
Antidepressants were first
developed to counteract severe chemical abnormalities in the brain,
by “boosting their activity” (“Depression Medications”
1)62. Tricyclic antidepressants, the first class of
antidepressants discovered, work by reducing the levels of
neurotransmitters norepinephrine and serotonin, therefore giving the
receiving neurons more stimulation (“Depression Medications”
2)63. However, due to the widespread side effects of this
class of drugs, Selective Serotonin Reuptake Inhibitors (SSRIs),
which solely work by reducing the level of serotonin, were more
recently created as a safer alternative. Still, according to the
NIMH, these drugs are only recommended for patients with severe
symptoms of depression who are at risk for self-inflicted harm or
suicide (“Depression Research” 4)64, or who have lost the
ability to function mentally (“Depression Medications”
1)65. For them, antidepressants are a godsend. (This is
not to say that for severe patients, who display clear biological
abnormalities, pharmacological treatment on its own is enough.
Research has shown that a particular gene variation that causes
people with severe depression to produce extremely low levels of
serotonin also makes these people resistant to antidepressants like
Prozac or Zoloft, which are SSRIs that act on serotonin” (Miller
34)66. They are predisposed to reject antidepressants,
but also likely to have severe past trauma or negative thinking
habits that require psychotherapy (Worsnop 6)67.)
However, for moderate cases of depression that stem from constant
social stressors, which would be better termed unhappiness, science also
shows that drugs are wholly ineffective. Two years ago researchers
found that people “were more likely to become depressed in response
to stress [this applies to moderate depression] if they have a
particular variant of a gene that influences the movement of
serotonin across nerve-cell membranes. Subsequent studies have
linked the same gene to alcohol abuse, anxiety disorders and
resistance to antidepressants. It turns out that the amygdale, the
part of the brain that reacts to threat, is more reactive [overly
reactive] in people with this gene” (Miller 35)68. But
beyond basic resistance to antidepressants, what makes moderate
cases of depression particularly unworthy of antidepressants is the
fact that people with moderate depression do not have a clear and
identifiable pathway to depression that can be targeted with
specific antidepressants. The “psychiatric profession has [claimed}
that mental illnesses are specific, identifiably different diseases,
each allegedly amenable to treatment with a particular class of
drugs or magic bullets” (Scull 72)69. However, the
allegedly growing selectivity of antidepressants does not positively
affect moderate cases of depression, which in the first place may
not have a distinct biological abnormality.
The ineffectiveness of
these medicines in curing depression does not mean that there is not
a biological component to depression. Genetics does play a role in
all types of depression by making one predisposed to depression,
Whether or not a person develops depression depends on the amount of
stress that the person experiences (Bernstein 606). A certain subset
of the human population with a genetic predisposition to depression
will develop depressive symptoms when confronted with the pressures
and stressors of society, such as the parental ones on adolescents.
There “is ample evidence that animals—rats and monkeys, for
example—that are forced into a subordinate status within their
social systems adapt their brain chemistry accordingly, becoming
“depressed” in humanlike ways. Their behavior is anxious and
withdrawn; the level of serotonin (the neurotransmitter boosted by
some antidepressants) declines in their brains” (Ehrenreich
211)71. The problem is that businessmen have interpreted
recent findings on the interaction of genes and social experience to
assert that depression has a solely biological basis. The medical
profession uses the evidence that genetics plays a role in
depression and that “life experiences create chemical abnormalities”
(Worsnop 21)72 in the brain to insist that psychiatric
treatment targeting these brain chemistry abnormalities will not
only alleviate the symptoms of depression, but also combat the
underlying causes (Glasser 17)73. This assertion is
misleading because a) often there is no brain chemistry abnormality,
and b) the brain chemistry abnormality is not an underlying cause of
depression. William Glasser explains that a change in brain chemistry
does not necessarily represent an abnormality that merits
psychiatric treatment. “Since your brain chemistry must change
continually as your behavior changes, you can’t have the same brain
chemistry when you are happy as you have when you are fearful,
angry, or depressed. But because it changes does not make it
abnormal” (Glasser 17)74. But psychiatrists and
pediatricians, based in part on the research that pharmacological
companies are providing them, assume that any depressive system
coincides with an internal neurochemical imbalance. “The fact that
[the doctor] hasn’t a shred of valid evidence to support his claim
doesn’t bother him. His common sense tells him it is impossible for
you to have symptoms [of depression] and still have a physically and
chemically normal brain” (Glasser 17)75. Even the claim
that those who develop legitimate brain chemistry abnormalities can
be cured with psychiatric treatment is unchecked. A brain chemistry
abnormality is more responsibly considered a result, as opposed to a cause. While psychiatric
treatment is useful for alleviating the severe behavioral symptoms
of depression, targeting the brain chemistry abnormality
pharmacologically by no means cures or undoes the underlying
problem. Although negative thinking habits are commonly conceived as
a result of depression,
research proves that a “negative attributional style [blaming
oneself for the flaws of the society one belongs to] is, in fact, a
risk factor for depression, not just a result of being depressed”
(Bernstein 605)76.
Some psychiatrists argue
that it is often difficult to know which patients have severe
biological abnormalities in the brain and which are suffering from a
more socially treatable form of depression, and for this reason
drugs are the safest bet (Bostic 60)77. However, the fact
that the symptoms of depression are indistinguishable is by no means
an excuse to assign antidepressants, even if “most medical decisions
must be made with incomplete information,” which is a mantra
commonly chanted by physicians and psychiatrists. In fact, the lack
of knowledge about the brain and the totality of ways in which drugs
are interacting with the human body is evidence against the use of
these drugs due to health costs, which are often unaccounted for.
Psychiatrists commonly argue that they prescribe these medications
cautiously and appropriately, and that not using the drugs would be
a nonsensical argument. But the psychiatric profession is largely
unregulated; psychiatrists commonly have their own style of
diagnoses and treatment based on a combination of personal
experience and inferences based on depressive symptoms (Luhrmann
207)78. In fact, now even family physicians, who are
uneducated in the use of psychiatry, are making psychiatric
diagnoses, which are often the least effective (Luhrmann
206)79. The misdiagnoses are particularly prevalent for
children. Pediatricians who are not knowledgeable enough to
prescribe psychiatric drugs commonly do so and are recruited by drug
companies. “In a UNC survey, 72% of pediatricians…said they
prescribed antidepressants for children, but only 16% felt
comfortable with the practice, and only 8 % said they had been
trained to treat childhood depression” (Koch 8)80. These
“general practitioners can miss side effects that psychiatrists are
trained to spot” (Koch 8)81, or inversely misdiagnose
symptoms. Recent findings now suggest that “common antidepressants
may foster suicidal thoughts and actions in some kids” (Bostic
60)81b. This may be explained by the fact that their
doctors are prescribing drugs irresponsibly. It has been shown in
clinical trials that normal people given SSRIs become
suicidal—suicide rates are two and a half times higher in subjects
given SSRIs than in those given placebos (Szalavitz
52)82. Instead of recognizing the social stressors of
their teenage patients’ lives, the unhappiness, doctors may be
assigning medicines that directly promote suicide.
Even informed diagnoses
have unavoidable health costs. Most ominously, pills can mask
psychological problems that worsen over time when not addressed
through changes in thinking habits or lifestyle. In a 1986 study,
Prien and Kupfer found that although “pharmacological interventions
reduce the expression of symptoms, they appear to do little to
reduce the subsequent risk” (Hollon 251)83. In the same
study, it was found that patients who are discontinued from their
medications prematurely are two to three times more likely to have
the symptoms return. In other words, they found that patients
“treated with cognitive therapy have a reduced risk for subsequent
relapse relative to patients brought to remission pharmacologically”
(Hollon 251)84. Drugs do little to address the underlying
causes of depression, which may cause the feelings of depression to
exacerbate into severe depressive disorders. There are also apparent
side-effects that are harmful to any patients using antidepressants.
The drugs can “produce painful withdrawal symptoms.” And “some
patients are given these medications without appropriate warnings”
(Szalavitz 55)85. What seems like the patient’s lack of
regard for his own health may actually be attributed to the fact
that these drugs are “neither as safe nor as effective as we are led
to believe” (Critser 1)86 by the pharmaceutical
companies. These companies make little effort to improve their
drugs, a testament to their weak concern for the health costs of the
drugs; “only about half of pharma’s products launched since 1990
represent clinically significant improvements over older, cheaper
products” (Critser 1)87. In fact, of the seventy-eight
new drugs brought to the market in 2002, only seven “were classified
by the FDA as improvements over older drugs,” and none of those
seven came from a major US drug company (Angell 56)88.
The only major improvement on older antidepressants in recent times
has been the production of SSRIs, which, despite having “fewer side
effects than the older drugs” (“Depression Research”
3)89, have a weaker response rate in children than in
adults (“Depression Research”
7)90.
The health costs and
ineffectiveness of antidepressants are greatest for children and
adolescents. The increase in cases of depression among adolescents
and the lowering age of its victims has caused the “use of
psychoactive medications among children [to triple] in the last
decade” (Tyre “Finding” 54)91. But as the drugs were
initially created for adults, they have been untested for children
and are regarded as unhelpful by about a third of parents (Tyre
“Finding” 54)92. What is ominous about the
incompatibility between children and these drugs are the health
costs. “Because the drugs have not been extensively tested for
children, no clear age or dosage guidelines exist” (Koch
8)93. This problem is exacerbated by the fact that
teenagers are constantly growing and have a differing physiology and
metabolism from adults (Tyre “An Rx” 74)94. The cost of
the ambiguity regarding dosages for “young patients” can be
“agitation, sedation, cognitive dulling, abnormal liver and kidney
function, and an impaired immune system” (Tyre “Finding”
56)95. Particularly frightening is that the adolescent
brain is still growing, and the effects of these powerful
medications on brain development have not been assessed. “No one
knows…what the long-term effects are of manipulating serotonin, a
brain chemical that affects mood” (Koch 37-38)96. Instead
of seeking to better understand the child or adult brain,
pharmaceutical companies have geared their minimal research towards
making lucrative variations on old drugs. Consequently, “we have
made remarkably little progress in understanding depression” (Scull
72)97, let alone adolescent depression. In fact, the
pharmaceutical companies have only just begun to include children in
their screening of drugs because there is now a profit to be made in
doing so (Tyre “An Rx”
75)98.
Proponents of the use of antidepressants point out that
psychotherapy also has risks. “Yale psychologist Susan Nole-Hoeksema
argues that moderate depression can be exacerbated by focusing
obsessively on the ‘causes and consequences’ of personal problems”
(Szalavitz 53). Furthermore, there are some reported cases of the
personal relationship between the therapist and patient interfering
with the professional procedure (Szalavitz 53)99.
However, these are not criticisms that can be applied to
psychotherapy as a procedure, which has been refined and tested over
years of its practical application and success. Rather, these are
criticisms of particular doctors who fell short of providing
adequate psychotherapy. The health costs of psychiatric treatment
far outweigh those of psychotherapy, which are virtually nonexistent
when psychotherapy is handled properly. A common presumption is that
psychotherapy has the same viability as drugs, and therefore
antidepressants should be used as the primary treatment because they
are easy and more accessible (Luhrmann 209)101. However,
psychotherapy is the most “useful initial treatment” (“Depression
Research” 4)102 for adolescents depressed by the cultural
malaise, because psychotherapy “can help teens figure out what makes
them feel helpless or self-critical and develop strategies to put
things right” (Bostic 60)103. Psychotherapy can teach
adolescents that they are not at fault for their stress, and provide
adolescents with the ethical and creative outlets that will immerse
them in a world of positives, as opposed to negatives—a task that
proper parenting can accomplish
commensurately.
Therapists and parents
alike have the unique opportunity to help their children find what
makes them come fully alive. Instead of pressuring their children to
achieve some ill-defined and preconceived image of success, parents
must allow their children to experiment and self-discover, as the
only road to real success is “to become more fully oneself, to
succeed in the field and on the terms that one oneself defines”
(Fitzsimmons 7)104. Once they do, adolescents will
inevitably be drawn to socially meaningful and amenable roles and
interests, as happiness lies in morality. “Nothing makes us more
fully human than the ability to articulate and live up to our
ethical values” (Cafaro 151)105. It is no different for
the rising generation; “when adolescents latch on to an activity
they value that also helps others, their mood improves and so does
their sense of self. Imaging studies confirm that altruistic
behavior lights up the brain’s reward areas” (Bostic
60)106. Motivation, discipline, and morality, inevitably
follow passion. What adolescents need are time, lifestyle habits,
encouragement (but not too much), and good values—the ingredients of
a mentally healthy
environment—to discover those passions. “Just as physical health can
be taught to millions of people who are out of shape, but not
physically ill, mental health can be taught to [the millions of
adolescents] who are unhappy but not mentally ill” (Glasser
4-5)107.
The reason that parents and doctors are unable to see the
basic problems that must be addressed is that they are not viewing
depression and adolescence in their totality. As the founder of
homeopathy, Hahnenmann, wrote, “only the totality of symptoms can
reveal the image of the illness” (Aubin 76)108. Yet
Americans today “often see an either-or choice between these two
ways of looking at mental illness, the one rooted in medication with
discourse about brains and neurotransmitters, the other rooted in
medication with a discourse about self-awareness. This is a mistaken
perception” (Luhrmann 212)109. The American public is
increasingly confused by the dichotomy of the mental health world,
finding itself compelled to choose between biologically and
psychologically reductionist treatments. And often, the public
chooses the alternative with the most compelling and advertised, or
simply the most understandable, argument in its favor. “The real
story of twentieth-century psychiatry is how complex mental illness
is…and how, in the face of this complexity, people cling to coherent
explanations like poor swimmers to a raft” (Luhrmann
212)110. But the truth is that the issue of depression
among children is far simpler than the public is led to believe.
Both views of depression “can be right simultaneously because all
experience must ultimately be coded by processes in the brain”
(Szalavitz 52)111. Negative thought patterns and brain
abnormalities both stem from the cultural malaise adolescents are
subjected to. The problem lies in the competitive identity of the
nation, which trickles down onto parents, and children—in the race
to create perfect children, who will become perfect candidates for
college, and then prestigious professions—in gluttonous consumerism
and in the denial of those teenage things which are most natural,
like thinking, sleeping, eating, playing, befriending, loving, and
living. Before we go searching for cures in the manmade, we must
evaluate our lives and our use (or overuse) of the tools for
successful living that are natural to us. It is important for
children to embrace responsibility and the realities of practical
living. But not to an extreme. Only once parents give their children
the freedom to hook off from the false world of competition—and to
begin to find the positive things that make them feel alive—will
America’s children begin to march to the steady beat of their own
drum, as opposed to the languished march of the entire rising
generation.
“Don’t ask yourself what
the world needs;
Ask yourself what makes you
come alive.
And then go do
that.
Because what the world
needs is
People who have come
alive.”
Harold
Whitman112
Works Cited
“Commonly
Requested Therapeutic Class and Product Information” IMS
Health 2006. 23 February 2006
<http://www.imshealth.com/ims>
“Depression Medications”
CBC 9 August
2004. 23 February 2006
<http://www.cbc.ca/news/background/drugs/depression.html>
“Depression Research at the
National Institute of Mental Health.” NIMH 1999. 23 February
2006 <http://nimh.nih.gov>
“Youth Online:
Comprehensive Results” CNS 1 December 2004. 23 February 2006
<http://apps.nccd.cdc.gov/yrbss/index.asp>
Angell, Marcia. “The Truth
About the Drug Companies.” New York Review. (2004):
52-28.
Aubin, Michel, and Philippe
Picard. Homeopathy: A different way of treating common
ailments. Bash; Ashgrove, 1983.
Bernstein, Douglas A., et
al. Psychology. Boston: Houghton Mifflin,
2006.
Bostic, Jeff Q, and Michael
Craig Millar. “When Should You Worry?” Newsweek. 25 Apr 2005:
60.
Cafaro, Phlip J. “Gluttony,
Arrogance, Greed, And Apathy: An Exploration of Environmental Vice.”
IAEP 2005. 1 Mar 2006.
<http://www.environmentalphilosophy.org/Cafaro.pdf>
Critser, Greg. “Take your
pills, ignore your belly.” Los Angeles
Times. 20 Nov 2005:
M1+.
Ehrenreich, Barbara.
Nickel and Dimed: On (Not) Getting By In America. New York:
Henry Holt, 2001.
Fitzsimmons, William,
Marlyn McGrath Lewis and Charles Ducey. “Time Out or Burn Out for
the Next Generation.” Cambridge. Harvard University,
2004.
Glasser, William.
Warning: Psychiatry can be Hazardous to Your Mental Health.
New York: HarperCollins, 2003.
Hollon, Steven D.
“Cognitive Models of Depression from a Psychobiological
Perspective.” Psychological Inquiry. 3.3 (1992): 125-138,
Jstor. Brentwood School Lib, Los Angeles. 30 Nov 2005.
<http://jstor.org/>
Koch, Kathy. “Childhood
Depression.: 9. 26. 16 Jul 1999. Brentwood School Lib, Los Angeles.
CQ Researcher. CQ Press. 12 Dec 2005.
<http://library2.cqpress.com>
Luhrmann, T.M. Of 2
Minds: The Growing Disorder in American Psychiatry. New York:
Alfred A. Knopf, 2000.
Marano, Hara Estroff. “A
Nation of Wimps.” Psychology Today. Nov/Dec 2004: 58-70.
103.
Miller, Michael Craig.
“Managing Every Shade of Blue.” Newsweek. Summer
2005.
Robertson, John F, and
Ronald L. Simons. “Family Factors, Self-Esteem, and Adolescent
Depression.” Journal of Marriage and the Family. 51 (1989)
125-138, Jstor. Brentwood School Lib, Los Angeles. 30 Nov 2005.
<http://jstor.org/>
Scholzman, Steven. “The New
Pharmacopoeia.” Newsweek. 25 Apr 2005:
56.
Scull, Andrew. “Letter to
the Editor.” New York Review. (2005):
52.
Steinbeck, John. The
Grapes of Wrath. New York: Penguin,
1939.
Szalavitz, Maia. “In
Defense of Happy Pills.” Reason. 37.5 (2005):
48-55.
Tyre, Peg. “An Rx for
Kids–With Warnings.” Newsweek. Summer 2005:
74-75.
Tyre, Peg. “Finding What
Works.” Newsweek. 25 Apr 2005:
54-56.
Whitman, Harold. “Author
Index.” QuotationReference. 2006. 2 Mar 2006.
Worsnop, Richard L.
“Depression.” 2.37. 9 Oct 1992. Brentwood School Lib, Los Angeles.
CQ Researcher. CQ Press. 12 Dec 2005.
<http://library2.cqpress.com>
Works
Consulted
“Commonly
Requested Therapeutic Class and Product Information” IMS
Health 2006. 23 February 2006
<http://www.imshealth.com/ims>
“Depression Medications”
CBC 9 August
2004. 23 February 2006
<http://www.cbc.ca/news/background/drugs/depression.html>
“Depression Research at the
National Institute of Mental Health.” NIMH 1999. 23 February
2006 <http://nimh.nih.gov>
“Youth Online:
Comprehensive Results” CNS 1 December 2004. 23 February 2006
<http://apps.nccd.cdc.gov/yrbss/index.asp>
Angell, Marcia. “The Truth
About the Drug Companies.” New York Review. (2004):
52-28.
Aubin, Michel, and Philippe
Picard. Homeopathy: A different way of treating common
ailments. Bash; Ashgrove, 1983.
Bernstein, Douglas A., et
al. Psychology. Boston: Houghton Mifflin,
2006.
Bostic, Jeff Q, and Michael
Craig Millar. “When Should You Worry?” Newsweek. 25 Apr 2005:
60.
Cafaro, Phlip J. “Gluttony,
Arrogance, Greed, And Apathy: An Exploration of Environmental Vice.”
IAEP 2005. 1 Mar 2006.
<http://www.environmentalphilosophy.org/Cafaro.pdf>
Collins, Paul. “The
Vanishing Boy: If Prozac could keep us from losing our son, it was
worth a try.” Lives. 30 Oct 2005.
Critser, Greg. “Take your
pills, ignore your belly.” Los Angeles
Times. 20 Nov 2005:
M1+.
Ehrenreich, Barbara.
Nickel and Dimed: On (Not) Getting By In America. New York:
Henry Holt, 2001.
Fitzsimmons, William,
Marlyn McGrath Lewis and Charles Ducey. “Time Out or Burn Out for
the Next Generation.” Cambridge. Harvard University,
2004.
Glasser, William.
Warning: Psychiatry can be Hazardous to Your Mental Health.
New York: HarperCollins, 2003.
Hollon, Steven D.
“Cognitive Models of Depression from a Psychobiological
Perspective.” Psychological Inquiry. 3.3 (1992): 125-138,
Jstor. Brentwood School Lib, Los Angeles. 30 Nov 2005.
<http://jstor.org/>
Koch, Kathy. “Childhood
Depression.: 9. 26. 16 Jul 1999. Brentwood School Lib, Los Angeles.
CQ Researcher. CQ Press. 12 Dec 2005.
<http://library2.cqpress.com>
Luhrmann, T.M. Of 2
Minds: The Growing Disorder in American Psychiatry. New York:
Alfred A. Knopf, 2000.
Marano, Hara Estroff. “A
Nation of Wimps.” Psychology Today. Nov/Dec 2004: 58-70.
103.
Miller, Michael Craig.
“Managing Every Shade of Blue.” Newsweek. Summer
2005.
Ridley, Matt. “What Makes
You Who You Are.” Time. 2 Oct. 2003:
55-63.
Robertson, John F, and
Ronald L. Simons. “Family Factors, Self-Esteem, and Adolescent
Depression.” Journal of Marriage and the Family. 51 (1989)
125-138, Jstor. Brentwood School Lib, Los Angeles. 30 Nov 2005.
<http://jstor.org/>
Scholzman, Steven. “The New
Pharmacopoeia.” Newsweek. 25 Apr 2005:
56.
Scull, Andrew. “Letter to
the Editor.” New York Review. (2005):
52.
Steinbeck, John. The
Grapes of Wrath. New York: Penguin,
1939.
Szalavitz, Maia. “In
Defense of Happy Pills.” Reason. 37.5 (2005):
48-55.
Tyre, Peg. “An Rx for
Kids–With Warnings.” Newsweek. Summer 2005:
74-75.
Tyre, Peg. “Finding What
Works.” Newsweek. 25 Apr 2005:
54-56.
Whitman, Harold. “Author
Index.” QuotationReference. 2006. 2 Mar 2006.
Worsnop, Richard L.
“Depression.” 2.37. 9 Oct 1992. Brentwood School Lib, Los Angeles.
CQ Researcher. CQ Press. 12 Dec 2005.
<http://library2.cqpress.com> |
