Manufacturing Depression by Gary Greenberg

Is depression truly a disease? What is the basis for that diagnosis? How accurate is a diagnosis of depression? How do we define what "normal mental health" is, so that we can decide what depression is? Do people get depressed, or just sad?

These are very controversial questions, and psychotherapist Gary Greenberg doesn't hold back as he researches the answers. He even chronicles his own journey through depression and the efficacy (or not) of a variety of treatments.

I found the questions compelling, and his story and research very convincing. However, it needs to be mentioned that his experiences are in the US healthcare system; and that there is much more freedom to advertise anti-depressants in the States.

Some of the highlights of Greenberg's analysis:

"¢ The message that depression results from a chemical imbalance in our brain, and is a serious medical condition that can be treated, has saturated our popular culture. It is now virtually unquestionable (except by Greenberg).

"¢ Has depression been manufactured, not as an illness but as an idea? Do we believe we have a right to be happy? Do we think that all suffering, emotional as well as physical, is wrong and should be relieved?

"¢ How can depression be called a disease when the only diagnosis is descriptive; there is no medical test to confirm diagnosis, unlike an infection?

"¢ Greenberg concludes that it is possible that the descriptive tests used to diagnose depression could possibly lead to a diagnosis that the whole world is insane: "an enormous market opportunity for an industry that would aim its magic bullets at insanity."

"¢ One of the problems in getting approval for depression-relieving drugs was a requirement by the Federal Drugs Authority in the US for proof that it was effective with a particular disease. This meant that depression had to be named as a specific illness.

"¢ Depression drugs actually perform poorly in trials, and do not just block serotonin, causing many different forms of discomfort.

"¢ In 2003-4 a group of researchers tested the diagnostic methods of 152 family GPs. The GPs knew they were going to be tested, but not when. The team used actors to simulate two forms of depressive disorder; and they also had two scripts: one where they asked for a drug by name, and the second where they just asked about any anti-depressant. They also had the option of not asking for drugs at all. The results were embarrassing. 31% of the times they didn't ask for drugs, they were prescribed drugs anyway; 53% asking for a specific drug received a script for it; and 76% of those occasions when they asked for "a medicine" were prescribed an anti-depressant. Greenberg points out that when a patient asks for drugs it is not a symptom of depression or any other disease except substance abuse disorder!

Greenberg contends that no matter how good your actors are, or how well you know the symptoms, you cannot fake diabetes. There is a test which a doctor must do, and receive a positive result for, before insulin is prescribed.

He also points out that the rush to prescribe and take drugs insulates us from the roller-coaster of life: the highs and lows, the joys and sadness, the awareness of our own mortality, our weakness and inadequacy, our passions and desires… And medication means we can get on with the busyness of life.

While reading this book I went to visit a friend of mine who had been hospitalised earlier this year suffering from stress. He explained to me that his doctor had diagnosed him with an anxiety disorder and prescribed anti-depressants. They had improved his lifestyle immeasurably. He saw life in colours again, he was able to experience joy, he had become much easier for his family to be with, and he was more effective at work.

It made me realise that whatever the truth of Greenberg's claims, they relate to rapid diagnosis, over-prescription, and negligence on the part of doctors in following through with care. For many, these drugs truly have made life able to be enjoyed again, prevented heart attacks and suicides, and saved marriages.

In his final chapter titled "The Magnificence of Normal" Greenberg ends his journey through depression research with the following comments:

Call your sorrow a disease or don't. Take drugs or don't. See a therapist or don't. but whatever you do, when life drives you to your knees, which it is bound to do, which maybe it is meant to do, don't settle for being sick in the brain. Remember that's just a story. You can tell your own story about your discontents, and my guess is that it will be a better one than the doctors have manufactured.

This is a provocative book, but it is important that this topic is explored, especially as the World Health Organisation predicts that in the next decade depression will be the single biggest health burden on the world.

Greenberg would agree that for individuals feeling overwhelmed, or travelling through deep troughs of sustained unhappiness, the first step is to see a GP; and to ensure that any suggested treatment treats the possible causes as well as symptoms.