Yesterday the Shorpy historical photo blog had a very interesting picture of a 1924 “Mental Hygiene” exhibition. Below is a small copy. To view it in huge format (so you can read everything on the wall) see the original photo at Shorpy.
The fascinating thing about this photo is it shows an early stage of what I like to call “illnification”: the gradual process of how, over the last 150 years, everyday mental problems became more and more formally classified and treated as illness. This includes depression.
Of course depression has always interested doctors – in fact, since the earliest times. In the 1st century AD, the prominent Greek physician Rufus of Ephesus already studied depression; he thought it was caused by “black bile”. Do you want to know what in his view was the best remedy? Sex! He said that having sexual intercourse settles and calms the passions, and thus would counteract depression. Apparently, he did not yet recognize that severe depression can make it difficult to have satisfying sex.
Interestingly, Rufus also thought that depression had something to do with intellectual genius (a notion that was later revived by 18th-century Romanticists). Now maybe that’s a comfort to some of us! A commented edition of Rufus’ 2000-years-old treatise can still be ordered from Google Books, Amazon, or directly from the publisher here.
But I digress. The real process of “illnifying” depression began much later, in the second half of the 19th century. It has accelerated significantly since about 1900. Gradually, pharmacists, psychiatrists and hospitals discovered that there was big business in treating common mental health problems – including depression.
The 1924 Shorpy photo illustrates this in a striking way. It shows advertisements of four psychiatric clinics offering a first examination for free (or 50 cents). Sheets inform the public how to recognize the symptoms of mental problems: “Nervous Mannerisms are Mental Danger Signals – SEE THE DOCTOR”. They list danger signals in children: “Inactivity, Morbidness, Unsociability, Fits of ‘Blues’, Excitability, Extreme Timidity ARE UNCHILDLIKE BEHAVIOR – Should Be Attended To”.
Prominently on the 1924 exhibition wall is this quote:
“We see a time – When the strange child, the worried mother, the confused and depressed workman will appeal to the hospitals for relief – as they now run to them for diabetes, appendicitis, or typhoid fever”.
Here you have it: illnification, 1924-style. Largely, the time they saw coming, has indeed come.
Partly thanks to the commercial motives behind this illnification process, today we have professional attention, medication, therapies and insights that didn’t exist 100 years ago. When something is seriously wrong psychically, today we are indeed more inclined to “appeal to the hospitals for relief”. By itself, surely this is not a bad thing.
But often it looks like this process is still going on, continuously pushing further the boundaries between what are fairly common mood or behavior problems at one side, and what is labeled “illness” or “disorder” on the other side. A prime example is of course ADHD in children: diagnosed with “Attention Deficit Hyperactivity Disorder” today, forty years ago most of the same children would have been simply called “unruly”. Instead of giving them pills, parents would just have waited for them to grow up a little.
The same kind of border-shifting illnification is still going on with mild forms of depression, too. People who forty years ago might have labeled themselves simply as “sad” or “somber”, may today tend more to seek professional help or medication because they now view themselves as suffering from Depression Disorder.
The question that arises here is, haven’t we pushed the borders far enough by now? Aren’t we beginning to overdo it?
Basically, the problem here seems to be that we’ve gotten used to setting our goals a little too high. We all want (hope, maybe even expect) to be perfect. From that perspective, there must be something wrong with everyone who’s not perfect – they ought to be helped and cured. But consequently, because no one is really perfect, because no one of us is happy all the time, we might end up classifying nearly everyone as suffering from some kind of illness or disorder.
This would be pointless and in a few cases (where this classification might have the effect of a self-fulfilling prophecy) it might even be counterproductive. So the question remains: where and how do we draw the border line between common mood problems and depression?
The approach of those 1924 mental health people may have been better than ours. They did not yet strive for perfection. The message on their exhibition was focused on recognizing indications of something abnormal in mood or behavior. Back then, the boundary between just being distressed or suffering from depression still was defined by a simple common-sense notion of what was fairly normal on the one hand, and what was definitely not normal on the other hand.
Maybe that’s where we should draw the border line between illness and non-illness again. And, resisting commercial impulses, stop further illnification.
There may be a personal lesson in this: nobody can be all right all the time. Many of us can hardly expect to go through life without incidental episodes of depression. In many cases, this is not abnormal. It’s just a fact of life. If we won’t run immediately to the doctor for every slight bout of headache, then why should we run immediately to the psychiatrist for every slight bout of depression?
• tip: If you wonder if something is really wrong with you, first ask yourself: isn’t it fairly normal what I am going through?
If what happens to you will also happen frequently to other people around you, then maybe the answer is: yes. Maybe in that case you’re not seriously ill, but just reacting in a natural way.
Of course I do not mean to suggest here that you shouldn’t look for professional help when you really need it.
So this time, instead of a funny or contemplative post, here is a long list of antidepressants and just about all their known potential side effects. If out of need or curiosity you want to skim through it, then please do read my Introduction first. This is important.
And this list is certainly not meant to suggest you should just quit using any kind of medication, without first consulting the doctor or psychiatrist who prescribed them. You know as well as I do, that such an impulsive step might be outright dangerous. I’ve always warned here against such irresponsible gambles.
Love and sexuality (the latter being a precious dimension of the first) are tricky subjects to tackle here. So let me make clear beforehand that I do not mean to provoke any kind of moral or religious debate. I hope no one will find me disrespectful or prejudiced. On the other hand, you cannot expect me to hide my own points of view.
It was all a bit like in this 1847 picture – one of the first photos ever made of a married couple. This picture was clearly meant to register, represent, and thus confirm a relationship. Today it still allows us to see those two people who one day 165 years ago, maybe a bit uneasy and nervous, together entered that newfangled photographer’s studio.
When I was a schoolboy getting close to puberty, I had not yet the slightest clue about what sexual love actually implied. But I did know fairly much of the Scriptures. If like me you grew up in an environment where all true wisdom came from daily-read religious writings, then perhaps you know those poetic lines from the apocryphal* Book of Solomon where a bride calls her beloved a tappuach: that one sweetly fragrant, shading Apple Tree that stands out to her among all the barren thorny trees of the forest.
A century ago the pioneering psychiatrist Sigmund Freud already reflected on how occurrences of deep depression might be related to our need for love. He did not know yet about all the neurological causes and dimensions of depression. But he did acknowledge (and by today’s standards even did stress too much) that depression may be triggered or worsened by unfulfilled longing for love and sex.
But if you ask me, it is Freud’s second “symbolic loss” scenario – never getting the love that somewhere deep down in your mind you are wanting and expecting and waiting for – that is far more dangerous and excruciating. This ongoing kind of deprivation can slowly and almost furtively keep eating your heart away, continually eroding your self-respect and with it your ability to love others, leading to a more permanent state of loneliness, resentment and often severe depression. Not to mention the fact that in a few men, continuous love-deprivation can also lead to sexually aggressive derailment: in essence, the violence of a rapist may stem not just from uncontrolled lust but rather from deeply resented never-ending loneliness.
Case 1: isolation. This is a fairly simple problem because it has relatively little to do with yourself: your situation does just not give you enough opportunity to get in touch with proper love candidates. This can happen when for example you are living in a very remote isolated place, or when you have a very demanding job that literally takes all your time.
Case 2: lack of awareness. You do know you feel unhappy and maybe depressed, but you are not fully aware of your own need for love. This may sound a little unlikely, but I really think there are people among us who know very well that they are in some kind of deep trouble emotionally, and who suffer from it, and who gradually sink ever further away into depression, without realizing (or daring to acknowledge) that the problem might partly be solved by finding someone to love.
Case 3: restriction. You live in a very conservative environment where strict and rigid rules (usually religious rules) severely limit any daily-life contact with potential love candidates. Your need to find, feel, express and get love might call for breaking or bending some of those rules. But in the eyes of the others, this might make you unacceptably frivolous or even a sinner. For example, this can easily be the case if you belong to some strictly Evangelical, Hasidic or Muslim community.
Case 4: paralyzing yourself. This one may sometimes (but not always) be related to the previous one. Your own firmest beliefs, feelings, norms or convictions make it impossible for you to openly seek or invite others to love you. You just know that for some uneasy reason, you would feel horribly guilty (or maybe ashamed, or disappointed in yourself) if you did so. Somehow, you are unable to come to terms with your own cravings.
Case 5: misunderstanding the nature of love. You keep striving not for a really complete loving relation, but for some not-anchored aspects of love that you might wrongly identify with love as a whole.
Case 7: insincerity. You are simply not honest and open enough about yourself when you encounter possible love candidates. Or, to put it in a different way, you are just trying too hard. You lose all spontaneity because you are toiling all the time to make sure you won’t say something stupid or wrong, make a mistake or a clumsy gesture. You keep trying to be what you hope other people will find most charming, or funny, or sexy, or smart. That nonstop performance requires quite an effort. Especially if like most of us, you are by nature not always that charming, funny, sexy, or smart.
Case 8: self-deprecation. Here we finally get to the one that is most often tormenting people who suffer from serious depression. You feel not just inadequate, but totally worthless. You are in fact sure that you do not deserve to be loved by anyone, that you have nothing of value left to offer to others, and that no one will ever come down to really love you.
May 21, 1949 –
