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Depression: Fear and prejudice by Barbara A. Miriello, MFT In contemporary culture, the dark labor of depression is shunned. In an environment possessed with more, bigger, brighter and faster, darkness is even more reviled. As the Peanuts character, Lucy, proclaims, "I don't want ups and downs! I want ups and ups!" Prescriptions for anti- depressant medications are too often proffered for the mild discomforts of over-indulged lives. Without the honoring of darkness, balance and whole- ness will always elude. It is often the same pain of personal trauma, which can distort and hamper us, that opens us to deeper awarenesses in the first place. It is the best among us -- artists, saints, leaders and healers, who mine the depths of depression's treachery, and resurface with the treasures that enrich us and show us the way into the future. But, from the medical vantage point, it is commonly assumed now that a diagnosis of depression automatically results in a prescription for anti-depressants. The fact that safe medication exists does not negate the need for thought and careful choice in how to proceed with treatment. In fact, with the exception of medical contra-indications for the use of anti-depressants, such as with pregnancy or negative interactions with other needed medications, the possibility of not using these medicines is not considered. Psychiatrists are pressured by insurance cost/benefit analyses, to give drugs and return health care recipients to the workplace within the short allotment of treatment time. The advent of easily tolerated, safe, low side-effect anti-depressant medication has opened new discussion about depression and suffering. This is an essential dialogue that must continue in order to thrash out the consequences and contradictions generated by these medicines. The breakthrough has had an enormous public impact. Although the first wave of consumer interest in this topic has passed, the dialogue has just begun. The recent work integrating psychology, meditation, and spirituality has been rich. However, most of the available literature about prayer and meditation does not address depression. And, little of the literature about depression considers both spirituality and medication. Further, the public, and many medical and psychology professionals as well, still have very little understanding of the endorphin system and the basic biochemistry of depression. While there is blithe over-use of anti-depressants, there is also a contrasting, but just as unfounded, opposition to them.. Many fear that they are addictive. They believe that anti-depressants are "uppers," that they "make you high" and "let you avoid your problems." Most see them as artificial stimulants to overcome sluggishness, indulgent self-preoccupation, or laziness. They are seen as an escape, a crutch, and an admission of weakness. Many fear they will numb away their ability to feel. The fact that anti-depressant medications, which treat the endorphin system, are entirely different than central nervous-system stimulants is largely unknown. There is not a negative judgment placed on taking blood pressure medication or insulin because the disorders, which necessitate these medications, affect part of the person and they are not considered as being within the control of the individual. But depression, unlike other disorders, affects what we know to be our very self. Because depression has so many complex components of mind, body and spirit, anti-depressants are harder to comprehend and accept. Although depression can be entirely an inherited illness, taking medication for it is still viewed as moral weakness. Sadly, a woman recently disclosed to me that her mother had committed suicide a few years ago after years of fighting depression. I asked whether she had used anti-depressants. The woman replied, "No. She didn't believe in them." Medication is not a matter of belief. Moreover, depression itself frightens us. It is shrouded in secrecy, shame and guilt. The stigma of depression continues to dominate public opinion, and public disclosure of depression can limit or end careers. Admitting to depression usually means one is considered unfit for positions of great responsibility. Further, the stigma is also internalized by the sufferer, both adding shame, self-recrimination and blame to the burden they carry, as well as creating resistance to admitting its presence and seeking help. Despite all we now know, many still commit suicide rather than admit to being depressed. Fear and prejudice remain the majority response to depression, and widespread education will be needed for a long time to come to alter this popular bias. Just as proper education has lifted earlier biases against leprosy, deafness, epilepsy, multiple sclerosis, and narcolepsy, we will one day look back at this prejudice with regret. In the case of depression, the numbers liberated by the healing of this stigma will be many times greater. Barbara A. Miriello, MFT Center for Inner Work 5100 Marlborough Drive San Diego, California, USA 92116 619-584-1725 Office 619-979-6390 Page 619-582-2697 Facsimile |
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