The loss of Robin Williams has been a grim gain for depression as renewed interest ignites on the disease
We used to talk much about the ‘Big C’. Vast amounts of charitable action and billions of pounds and dollars have been thrown at the issue, and at research for treatment. On the other hand, the ‘Big D’ – Depression – has remained a taboo topic in public debate and is the Cinderella of medical matters. It suffers from under-diagnosis, misdiagnosis, misunderstanding, confusion, shame and even contempt. It is usually accompanied by a shrug of annoyance and ’encouragement’ to ’pull yourself together,’ even though it is a disease.
This Victorian approach to the problem only compounds the disastrous effects of depression on our society. The stereotypical depiction of someone with depression is of a listless mother (single for preference) with long, lank, lustreless hair; an expressionless face, dependent on a cocktail of “our” hard-earned, tax-paid-for drugs and welfare benefits. This is an egregious, unfair and shocking situation. I would suggest that it is up there with racism and bigotry, and therefore socially stigmatising. So it turns out our loss of Robin Williams is a grim gain for depression as the media turns its attention to the problem.
The Guardian ran a report on depression by their health editor, Sarah Bosely, in which she points out: ‘Less than a third of people with common mental health problems get any treatment at all – a situation the nation would not tolerate at all if they had cancer.’ She cites Simon Wessely, president of the Royal College of Psychiatrists, who remarks: ‘people are still routinely waiting for – well, we don’t really know, but certainly 18 weeks, possibly up to two years – for their treatment that is routine in some parts of the country.’ ‘Imagine,’ he told her, ‘the reaction if I gave a talk that began: “so, we have a problem in cancer service at the moment. Only 30% of people with cancer are getting any treatment, so 70% of them don’t get any treatment at all and it’s not even recognised.” You would be appalled and you would be screaming from the rooftops.’ Quite.
While England’s NHS Chief Executive, Simon Stevens, sympathised with Wessley’s horror at these statistics, he informed him that the issue would involve a ‘much longer dialogue with the public.’ His comment scantly conceals the real problem: the government’s insistence on austerity as £12 billion additional cut-backs are due to come on stream. While the chancellor has no choice but to match pound-for-pound money raised in the voluntary sector for cancer because it is such an obvious, multiple cause of death, the government and, to a certain extent, society remain indifferent to or intolerant to the problem of depression.
Depression, however, is largely a hidden condition with a less obvious connection to death. It is on a spectrum ranging from occasionally ’feeling blue’, recurring instances of what Churchill described as his ’Black Dog days’, up to a clinical condition needing life-long chemical solutions. In extreme cases, depression can lead to schizophrenia and, exceptionally, suicide. From symptoms occasioned by bullying through circumstantial set-backs, anxiety, panic attacks and beyond, the causes are various and often multiple.
Of those burdened with depression, 90% of sufferers remain untreated inside the NHS target of 18 weeks, while many remain undiagnosed or misdiagnosed as doctors are divided about depression and uncertain about the variety of symptoms presented, as well as the appropriate prognosis. Ms Bosely writes: ‘A larger proportion of people with psychosis, who have severe mental illness such as schizophrenia, are on treatment but even that figure is still only 65% according to Wessely, who added: “For most mental disorders it is still the exception not the rule to be recognised, detected and treated.”’
Wessley further argues that ‘the concern over pills for depression, anxiety and attention deficit hyperactivity disorder (ADHD) could be misplaced’. He suggests that much of the criticism assumes that GPs are putting more people on pills because of an absence of talking therapies. However, the number of therapists being trained to provide Cognitive Behavioural Therapy (CBT) has substantially risen thanks to a government programme called Improving Access to Psychological Therapies (IAPT). ‘If you say they [pills] are more effective,’ he concludes, ‘I don’t really think that’s true. I think they are cheaper and easier. CBT is certainly more popular with some, but others don’t like it. The truth is most people don’t get either.’ My advice on CBT is this: don’t be shy, polite or ashamed. As the old BT ad used to say: ‘It’s good to talk!’
Unfortunately, to governments, disease is unprofitable and has a negative effect on the bottom line. So we cannot expect any more help from the Austerity State. Disease exposes our frailty. It challenges our infallibility and expectations of immortality. The government can always find the cash to bankroll rebels in Syria or resistance in Iraq. It can finance arming the entire military industrial complex that is Israel and its brutal Israeli Defence Force (IDF). State-sponsored murder has always been a profitable business; medical care, however, is too costly and time-consuming.
The Victorians abandoned sufferers of depression and dementia in asylums. It is high time we provided them with asylum – literally, “shelter” – and the care, comfort, humane medical or psychological assistance we can. Above all, it is our acceptance, understanding, love and compassion that are what we really have to offer – and offer it we must.
Image from: http://www.huffingtonpost.com/jonathan-rottenberg/seeing-depression-in-the-wrong-light_b_4945290.html