Documentation On the Social Problem of Unnaturally Rampant Depression

“According to National Institutes of Mental Health figures, 20,000,000 people or approximately 15% of the U.S. adult population suffers from a serious depressive disorder in any given year.”—John H. Greist, MD and Thomas H. Greist, MD, Antidepressant Treatment—the Essentials

 

 

 

“If you are going through a divorce, that’s a private trouble.  When half of the marriages in America are failing, that’s a public issue.”—David Karp, Speaking of Sadness: Depression, Disconnection, and the Meanings of Illness

Without this rousing faith, too many losers would have too many excuses, and even legitimate excuses have a price.

 

 

 

 

 

Also, see Major Depression & Dysthymic Disorder, Annotated Bibliography, and my own webpage The corrections that victim correction tries to make piecemeal would, if made in their sum total, seem very offensive, with quotes which give ghastly statistics on our rates of depression, etc., from ads and guides which talk about 20,000,000 depressions each year in the USA as if they’re among the biological diseases that are parts of the natural order, so we’ll just have to get control over this through medication, thought reform, etc.  Yet the magnitude of this social problem, can’t just be brushed aside!

To say that as doctors treat the million of Americans who suffer a serious depressive disorder in any given year, they should know this rate since it would help the doctors treat each individual as if their depressions simply are their problems, completely ignores the fact that this involves an unnaturally high rate of helplessness, happening to millions of people, year in and year out.  Depression is the only dread disease of which many of the causes seem sacrosanct.  “Everyone knows” that what’s at fault, is inside the millions of victims.  We’re to have the same faith in this failsafe sort of self-responsibility, that we’d have in any other cultural norms, as if it’s a universal truth that will work forever.  “God, grant me serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference,” doesn’t necessarily mean, “Accepting hardship as a pathway to peace; Taking as Jesus did this sinful world as it is not as I would have it,” but is necessarily that unconditional, all-or-nothing, and

 

 

From the website of the British charity, Defeat Depression:

Editorials

RISKS FOR DEPRESSION


Everyone knows that everyday unhappiness can be brought about by stressful experiences. But there is also substantial evidence that such adversity may at times result in clinically significant anxiety and depression. In this editorial we summarize the evidence for this link in relation to depression. Although much of what we describe comes from research with women, the general principles appear to apply to both sexes.

Women have been studied largely because of a consistent finding that they are 2-3 times more likely than men to experience depression in their lifetime Interestingly, this excess emerges at puberty and largely disappears after the menopause. It has been suggested that this may reflect biological differences, particularly involving the sex hormones, but puberty is not a discrete event and major psychological and social changes occur at the same time, clouding the simple biological interpretation. For example, the prevalence is greatest at the time in a woman’s life where she is most involved in caring for pre-school children and it may be this, rather than age itself, that accounts for the age-related trend among women.

In addition to female sex, national surveys have consistently identified a number of demographic factors linked to depression. For example, higher rates among financially and educationally disadvantaged populations, living in the inner city and being separated or divorced. Married men appear to do better than single men without children and vice versa for women. Lone mothers are especially vulnerable. But interesting as these observations are, they do not really explain what it is about the social environment that is ‘toxic’ or why only some of the people with these broad characteristics should become depressed.

The first and most obvious explanation is that clinical depression might be precipitated by particularly severe stressful experiences. There is considerable evidence to support this notion. Both discrete life events above a certain severity of unpleasantness, and ongoing difficulties of a similar severity have been shown to be more common in the year before onset. Further studies have refined these early observations and shown that depression is more likely following particular classes of experience — those involving disruption, losses and experiences of humiliation or entrapment. It has also been shown that some of these types of experience (e.g. children becoming involved in crime or drug dealing) are particularly common in inner-cities and may partially explain the greater prevalence of depression in these settings. It appears that differences in rates of these experiences between urban and rural settings around the world closely mirrors differences in the rate of disorder in these same settings. These findings provide a sobering comment for those who only turn to genetics to explain international differences in the prevalence of disorder.

It is clear however, that while adversity may be a necessary condition for the precipitation of depression, it is seldom a wholly sufficient cause. Many people who experience the most appalling adversity do not develop depression and this suggests that there must be other factors operating that make some people more vulnerable to adversity than others. A strong candidate for such an effect is social support, long seen as providing an important buffering effect against the impact of unpleasant experience. It has emerged that women both express a greater need for emotional support than men and find it less often from their marital partners. Reflections on the mechanism by which emotional support from the environment could have an impact on an individual’s mood state has also led to investigations of the links between such support and more psychological features of people vulnerable to depression - such as their ongoing levels of self-esteem, their way of appraising their stressful experiences, and with more or less negative automatic thoughts than normal and their other coping skills; such as problem-solving and looking on the bright side of life or rumination and feeling out of place and alientated. The links go in both directions: emotional support with confiding can improve someone’s coping skills and self-esteem, but if coping and self-esteem are too low initially a person may not risk confiding in anyone and will therefore remain without support.

The origins of this spiral of poor self-worth and absence of support in some people go back to earlier childhood experience (though it is clear that they can arise in adulthood as well). For example, the childhood experience of chronic neglect or abuse from a parent or parent-surrogate has repeatedly been shown to increase the risk of depression later in life. It appears that such experiences not only produces a lasting impact on self-esteem and coping but can also lay the individual open to a greater exposure to stress in adulthood. For example, there are well established links between neglect/abuse in childhood and teenage pregnancy and between both of these factors and a poor quality marriage that in turn throws off the humiliation and entrapment events that precipitate later depression.

Social factors that are linked to remission and recovery are largely a mirror-image of those implicated in onset. So, for example, recovery is more likely to occur following life events that bring fresh hope or which reduce chronic difficulties. Similarly, the presence of ongoing emotional support contributes to remission. These observations lead on naturally to a consideration of psychosocial interventions based on this causal model. There have now been a number of studies, most of which have built upon the notion of the provision of support. This may be provided through regular meetings with a group of individuals with similar issues to solve (e.g. groups of new mothers at risk of postnatal depression have proved relatively successful) or may involve meetings on a one-to-one basis only, which perhaps give greater scope for the development of the kind of intimate trust required for emotional support to be effective. This second type of intervention is the essence of volunteer befriending. Some organizations combine group and one to-one principles. Some studies have combined support groups with befriending ensuring that the volunteer befrienders attend the groups along with the depressed individuals but respecting the confidentiality of their one-to-one discussions together. Other interventions have sought to involve spouses in the groups, sometimes with and sometimes without their depressed partners attending. Some extremely persuasive evaluations of these interventions have been reported though the scale of the effort so far has been slight when compared to the investment in pharmacological therapy.



AUTHORS:

Tlrril Harris
Senior Research Fellow in the Socio-Medical Research Group, Academic Psychiatry St Thomas’ Hospital, King’s College, London, UK. She is also a psychoanalytic psychotherapist in part-time private practice.

Thomas Craig
Professor of Community Psychiatry at Guy’s, King’s and St Thomas’ School of Medicine, London, UK. His research and clinical interests concern the impact of social circumstances on the onset and course of psychiatric disorders and on the development of innovative community psychiatric interventions to address these needs.

From a Harvard webpage:

Children from working-class families twice as likely to be depressed adults
Researcher says social inequalities and depression have roots in early life

Children from low socioeconomic backgrounds have an elevated risk of depression throughout their lifetimes, even if they become more professionally successful than their parents. That’s the conclusion of a study conducted by Harvard School of Public Health researcher Stephen Gilman and colleagues. The study also suggests that girls raised in working-class households are more likely to develop depression as adults than boys in similar households. Gilman points out that the majority of participants in the study did not develop depression, indicating that childhood factors are only part of the story of major depression. However, “the identification of risks for depression early in life reinforces the importance of childhood experiences for adult health and may be one avenue towards the reduction of social inequalities in psychiatric disorders,” Gilman says.

 

The following are the statistics from the Myths webpage of The National Mental Health Awareness Campaign:

KIDS WILL BE KIDS

Myth: Teenagers don’t suffer from “real” mental illnesses — they are just moody.
Fact: One in five teens has some type of mental health problem in a given year.

— American Psychological Association

Myth: Talk about suicide is an idle threat that need not be taken seriously.
Fact: Suicide is the third leading cause of death among teens and adolescents.

— Surgeon General’s Report on Mental Health


 


JUST SNAP OUT OF IT

Myth:
We’re good people. Mental illness doesn’t happen to my family.
Fact: One in four families is affected by a mental health problem.

— National Alliance for the Mentally Ill

Myth: Eating disorders only affect celebrities and models.
Fact: Each year eating disorders and binge eating affect 24 million Americans.

— National Institute of Mental Health

 


IT’S JUST THE BLUES

Myth: Children are too young to get depressed, it must be something else.
Fact: More than two million children suffer from depression in the United States and more than half of them go untreated.

— US Center for Mental Health Services

Myth:
It’s not depression, you’re just going through a phase.
Fact: Nineteen million adults in the United States suffer from some form of depression every year.
— National Institute of Mental Health

Myth:
Senior citizens don’t get depressed, it’s just an expected part of aging.
Fact: Five million older Americans suffer from clinical depression and account for 20% of all suicides.

— Surgeon General’s Report on Mental Health

 


THEY’RE JUST WEAK


Myth: People who abuse drugs aren’t sick they are just weak.
Fact: Over 66% of young people with a substance use disorder have a co-occurring mental health problem which complicates treatment.

— Surgeon General’s Report on Mental Health

Myth: Troubled youth just need more discipline.
Fact: Almost 20% of youths in juvenile justice facilities have a serious emotional disturbance and most have a diagnosable mental disorder.

— US Department of Justice

 


WE JUST CAN’T AFFORD IT

Myth: Insurance doesn’t need to cover mental health, it’s not a big problem.
Fact: Fifty-four million Americans are affected by mental illness each year, regardless of ethnicity, sex or socioeconomic class.

— Surgeon General’s Report on Mental Health

Myth: Doctors are too busy treating physical problems to deal with mental health.
Fact: Up to one-half of all visits to primary care physicians are due to conditions that are caused or exacerbated by mental illness.

— Collaborative Family Healthcare Coalition

Myth: Mental illness is a personal problem not a business concern.
Fact: Depression is the leading cause of disability in the United States over back problems, heart disease and liver failure.

— World Health Organization
 

From Undoing Depression by Richard O’Connor, Ph.D., the chapter Active Treatment of Depression.  Note that “how our society conceives of it now, how we respond to it, how we try to treat it,” is that we accept what causes so much of it, but try to fix it.  Rampant depression seems to call for Jerry Lewis and Ronald McDonald.  Yet how we treat other common diseases, such as heart disease and cancer, is through hygiene to try to prevent them.  Some of this involves rather restrictive laws, such as the Delaney Amendment banning carcinogenic food additives.  Yet the only hygiene that we can have in preventing depression, is to avoid depressiongenic people and situations, when we can.  When we can’t, then all are to figure that that’s just life’s inherent unfairness, which all must accept.  Just look at self-help for women in trouble, and you’ll see that even if their husbands are treating them outrageously, then that seems to be just something that the women would have to avoid, no matter what this costs them.  The risk factors for heart disease, on the other hand, tend to be easy to avoid:

The result is that depression is at the same time a disease and a social problem, an understandable reaction to stress and a self-destructive state. In this initial chapter I am going to focus on depression as a social problem: how our society conceives of it now, how we respond to it, how we try to treat it. As we then move on to discuss direct treatment, the rest of the book will speak to the other aspects of depression.

THE CRISIS IN CARE FOR DEPRESSION

Depression is second only to heart disease in its health impact worldwide. This surprising news comes not from any mental health advocacy group, but from the World Bank and World Health Organization (Murray & Lopez, 1996), which measured the lost years of healthy life due to disease. In the United States in 1990, the cost of treatment of depression, increased mortality, and loss of productivity was estimated at $44 billion a year, higher than any disease but heart disease, greater than the effect of cancer, of AIDS, of lung disease, MS, or any other single disease entity (Greenberg, Stiglin, Finkelstein, & Berndt, 1993). Nationally, there are approximately 30,000 suicides annually, as compared to 20,000 homicides (American Association of Suicidology, 1997). One person in five will suffer an episode of major depression during his or her lifetime, and one person in five is suffering from some form of depression at any given moment (Agency for Health Care Policy and Research [AHCPR], 1993). Health economists equate the disability caused by major depression with that of blindness or paraplegia (Murray & Lopez, 1996). And the impact will only get worse: For each group born since 1900, the age of onset of depression has gotten younger, and the lifetime risk has increased. If current trends continue, the average age of onset for children born in the year 2000 will be 20 years old (Thase, 1999).

If all this is true, if depression is indeed our second biggest public health problem, if it affects 20 percent of the population, costs us so much, and is only getting worse, you may be asking yourself, Where’s the big national foundation leading the battle against depression? Where’s Jerry Lewis and Ronald McDonald?

Regarding the poverty that many of the women who stolidly liberate themselves from problem husbands, must live with, the following is from the Johns Hopkins, Bloomberg School of Public Health.  This study certainly doesn’t have the public health approach as William Ryan described in Blaming the Victim.  He wrote that treating the individual deviance of the special unusual groups of persons who have the problems, is the opposite of the public health approach: “This has been the dominant style in American social welfare and health activities, then: to treat what we call social problems, such as poverty, disease, and mental illness, in terms of the individual deviance of the special, unusual groups of persons who had those problems. There has also been a competing style, however... [Public health practitioners] set out to prevent disease, not in individuals, but in the total population, through improved sanitation, inoculation against communicable disease, and the policing of housing conditions.”)

Ann Jones’ satirically summarized the victim-blaming of battered wives, as, “Without the wife-beater’s wife there would be no wife beating.”  The self-help zeitgeist says that no matter how little resources each of these women has, if only they all did whatever it took to escape, and somehow recognize and avoid such men in the future, that would eliminate the problem, and women should want to see this problem eliminated through women’s self-reliance and self-empowerment.

July 11, 2001

DEPRESSION COMMON IN SINGLE MOTHERS RECEIVING WELFARE

Scientist explores what contributes to depression and how it may prevent women from gaining employment and leaving welfare

Single mothers of young children receiving welfare are more likely to suffer from depressive symptoms that may indicate clinical depression, yet few receive mental health treatment, according to research conducted at the Johns Hopkins Bloomberg School of Public Health. The study looks at the factors in these women’s lives that contribute to depressive symptoms, and examines whether these symptoms may prevent the women from gaining employment and becoming independent from welfare. The results appear in a special edition of Women and Health devoted to welfare issues.

“One challenge facing state welfare agencies is to identify barriers to employment. One such barrier — depression — is high among low-income single mothers,” says Mary Jo Coiro, PhD, assistant scientist in the department of health policy and management at the Johns Hopkins Bloomberg School of Public Health. “Results of this study indicate that while women with higher levels of depression were at an increased risk for welfare dependency, their depression was not associated with the likelihood of their working or attending school or training programs.”

Data for the study were extracted from a national evaluation of welfare-to-work strategies. All of the welfare recipients enrolled in the national evaluation were assigned to either programs designed to promote employment or to a control group. Because Dr. Coiro’s study was not designed to compare the programs, only those participants in the control group were included in the sample. These women remained eligible for financial aid, and could seek out education, training, or employment on their own, but were not required to participate in any welfare-to work activities. All women were African American single mothers with at least one child aged 3 to 4 at enrollment time.

Sociodemographic information about each woman was obtained from a questionnaire at the beginning of the evaluation. Details included mother’s age, race, education, employment status and history, history of welfare receipt, and number and ages of children. Participants were then interviewed three months later, to assess social support and life stress, and again two years later to gauge the success of moving from welfare to employment.

Forty percent of the women reported symptom levels that would likely indicate a diagnosis of clinical depression, yet very few had received any mental health services. Significantly higher levels of depressive symptoms were found in woman who grew up in households receiving financial aid, who were on welfare for more than five years, who perceived less social support to be available to them, and who reported more stress in their lives.

The study then addressed whether the depressive symptoms influenced participation in educational and training activities, employment, and success in leaving welfare within the two-year period. While symptoms of depression did not affect the likelihood of attending educational or training activities, women with more depressive symptoms were less likely to leave welfare over the two-year period. “Therefore, to get the most out of educational or training activities, and gain successful employment enabling the transition off of welfare, it may be more effective to treat those with depressive symptoms prior to beginning a program,” suggests Dr. Coiro.

Surprisingly, mothers reporting higher levels of stress were more likely to become employed and to go off welfare. According to Dr. Coiro, this could be because the desperation of their situation necessitated finding employment, or perhaps the mothers were already actively seeking employment at the beginning of the evaluation, which could heighten their levels of stress.

“These findings support the need for further research and point to the importance of identifying and treating symptoms of depression in low-income mothers,” concludes Dr. Coiro, “for the benefit of the women and their children, and in working towards the larger goal of achieving successful employment and independency from welfare.”

Funding for this study was provided by the National Institute of Child Health and Human Development Family and Child Well-being Research Network, with support to the author from the Society for a Science of Clinical Psychology Dissertation Research Award.

Public Affairs Media Contacts:
Tim Parsons @ 410.955.6878 or paffairs@jhsph.edu

From the September/October issue of Psychotherapy Networker magazine, the Networker News column by Wray Herbert, near the front of the magazine, an obituary of George Albee, “The Passing of a Visionary”:

As much as anyone, he fueled the spirit of innovation and activism that characterized the mental health field in the ’60s and ’70s. To his death, he championed a singular idea—primary prevention of psychological disorders—that stands in stark contrast to the direction the field has taken during the past 25 years....

He had a respected place at the table during the Carter Commission’s deliberations, but the work and recommendations of that commission died an ignominious death with Ronald Reagan’s victory in 1980.  The new social mantra was: marketplace forces are the solution, a philosophical shift that was compatible with the newly declared Decade of the Brain.  This meant the government no longer needed to be involved in social programs, because neuroscience and the increasingly dominant psychopharmacological industry were going to fix people’s anguish at a cellular level....

The notion of prevention still got some lip service, but it was just that.  It doesn’t even get lip service today. While the report of President Bush’s New Freedom Commission, his own mental health commission, released in July of 2003, documented a treatment system “fragmented and in disarray, lead [ing] to unnecessary and costly disability, homelessness, school failure, and incarceration,” its entire focus is those who are already ill.  The report doesn’t even mention primary prevention....

In the wake of the commission’s report, 16 national mental health groups pulled together to form the Campaign for Mental Health Reform, to implement the commission’s recommendations.  These groups include the usual suspects: the National Mental Health Association, the American Psychological Association, the National Alliance for the Mentally Ill, and others.  Two years after the report’s release, the Campaign for Mental Health Reform noted “little progress in realizing the Commission’s goals or implementing its recommendations.”  Indeed, in that two-year time frame, the reform campaign documents such developments as:

As grim as these outcomes are, all this evidence of the system’s failure has to do with treating disease.  Gone is any language of community empowerment.

From a Reuter’s story of January 1, 2007, “Physical abuse leads to adult depression, study finds”:

Physically abused children have a 59 percent increased risk of lifetime major depression compared with similar children who were not abused, said the study in this month’s issue of the Archives of General Psychiatry.

Earlier studies had linked childhood abuse with serious depression but researchers said this study is the first to show that depression is a consequence of the abuse.

 

 

 

 

                                                                      

 

 

 

 

   

 

 

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