Posts tagged depression
Posts tagged depression
Mental illness is our most pressing health problem
By Martin Wolf
Given the considerable economic costs to society, treatment would pay for itself
Depression and anxiety cause more misery than physical illness, poverty or unemployment. They also impose huge economic costs. Yet they are amenable to effective and relatively cheap treatments. In the UK, however, fewer than a third of adult sufferers are treated, compared with 90 per cent of those with diabetes. Only a quarter of children with these mental illnesses receive effective treatment. This undertreatment is unjust and hugely inefficient. It is largely due to continued prejudice and a lack of awareness of the existence of effective treatments. This terrible failure must end now.
This, in sum, is the argument of a compelling new book, Thrive: The Power of Evidence-Based Psychological Therapies, by Professor Richard Layard of the London School of Economics and Professor David Clark of Oxford. The former is a well-known economist. The latter is a psychologist and one of the world’s leading experts on cognitive behavioural therapies. While I am able to assess the economic arguments, I cannot judge the claims made for CBT. But, the authors note, the National Institute for Health and Care Excellence, which is responsible for assessing the effectiveness of treatments for the National Health Service, recommends its use. That makes the undersupply of these services remarkable, if not shocking.
In Britain one in six adults suffers from depression or crippling anxiety disorders. The same is true in the US and continental Europe. These conditions can be disabling. Indeed, their impact on a person’s ability to function in society is on average 50 per cent more disabling than that of angina, asthma, arthritis or diabetes. For sufferers, mental illness is the “enemy within” – an assault on the self more agonising than most physical ailments. Moreover, according to the World Health Organisation, mental illnesses account for 38 per cent of all ill health in high-income countries. Heart disease, stroke, cancer, lung disease and diabetes together account for only 22 per cent in these countries. Yet, perhaps because of the stigma of mental illnesses, health systems and employers largely ignore the severity of these effects.
Above all, mental ill health is today overwhelmingly the most important form of sickness affecting children and adults of working age. As the impact of infectious diseases has largely vanished, physical illness predominantly affects the elderly. This means that the economic consequences of mental illness are vastly greater than those of physical illness, not to mention the life-long damage done by mental illness in childhood. An extraordinarily high proportion of those in prison, for example, suffer from mental illness. About 90 per cent of those who kill themselves also suffer from mental illness. Suicide is a silent plague: “As many people in the world die from suicide as from homicide and warfare combined.” In 2000, 815,000 people killed themselves.
Moreover, the authors stress, mental illness makes it far more difficult to treat physical illnesses. People with mental illnesses find it hard to stick to their treatment plans. In addition, the consequences of mental illness contribute significantly to physical maladies.
In all, the case for treating mental illness at least as energetically as physical illness is overwhelming. The question, though, is whether that is possible. The book argues that today drugs and, even more, CBT have been proved in rigorous clinical trials to be effective. This is a matter of a properly scientific approach to development and testing treatments.
Mental ill health is today overwhelmingly the most important form of sickness affecting children and adults of working age
“For some conditions,” argue the authors – citing depression, anxiety disorders, post-traumatic stress disorder, and bulimia – “we have treatments that lead to sustained recovery in half or more people, with many others seeing worthwhile improvements.” This is not perfect. But it is immensely better than nothing. Moreover, such treatments can also be effective in treating children as young as eight. The most encouraging aspect of all is that, it turns out, we are the captains of our souls. It is possible, it seems, to help people in agony regain lost control.
Given the economic costs to society, including those caused by unemployment, disability, poor performance at work and imprisonment, the costs of treatment would pay for themselves. The cost of therapy is also not high: about the same as six months’ treatment of diabetes routinely supplied by health systems today. Yet the commitment of most high-income countries to provide universal healthcare is grossly violated in the case of mental illnesses for no good reason and at vast economic, social and personal cost. This, argue the authors persuasively, is a scandal.
Most of us know people afflicted by mental illness. All know its devastating consequences. Indeed, the authors argue that the failure to tackle mental illness is one of the reasons unhappiness is so prevalent in societies that are so rich by historical standards. If the claims made for these treatments are correct, our failure to provide them is not just a crime but a blunder. We must not let outworn prejudice stop us from taking needed action.
Author’s description: Here are the stories of two people, Rósa and Hrannar, who were in the Icelandic mental health system. Both found alternative ways of finding health, getting out of psychiatry, and getting and staying off psychiatric medication. I filmed them on a beach an hour from the capital, Reykjavik, while I was visiting Iceland — on the Solstice, June 21, a day in which it stays light out for 24 hours a day. What better day to make a film of hope!
Author’s website: http://www.wildtruth.net
Six and a half years ago U.K. film student Rebecca Brown began a selfie-a-day project documenting her life. Brown who is now 21, started the project in 2007 when she was 14 years old.
She’s now compiled the roughly 2100 pictures into a video on her Youtube channel. The video documents her battle with depression, anxiety, and an impulse control disorder, a form of OCD, known as trichotillomania. Trichotillomania is a unique disorder that causes a person to pull out their own hair when anxious.
Brown says that the project is ongoing and she plans to continue it as long as she can.
“Beauty is more than what we see with the eyes. People are more than their conditions. I am more than my hair and skin. This only shows my exterior, I hope that people will check out my videos to see more of the girl inside,” said Brown in the comments section of the video.
[I]f I return to office life, I for one will be open about having experienced depression. The more open we are, the more we can find ways to help those who suffer to help themselves. We will be able to introduce work practices that will help reduce anxiety and depression happening in the first place.
When I returned to work after suffering my first depressive episode, I shared very little of what had happened with colleagues. At the time, I was a reporter in The Times newsroom in London. My husband was a junior banker at Goldman Sachs who had just stood as a Conservative candidate in the 1997 election that saw Tony Blair returned with a landslide victory.
I was swayed by stigma: I found it difficult to tell my colleagues that I had been depressed. Partly this was because I myself found it hard to accept that I had suffered from mental ill health, even though I had been sufficiently unwell to go to a psychiatric hospital.
I had very little to be obviously depressed about. We were young, blessed with good jobs and two small children. I did not consider myself unhappy, though I was an anxious person struggling to balance our two professional careers and two small children. But I was also ambitious and I did not think admitting to depression would help my career prospects.
It was only seven years later, when I suffered a second breakdown even worse than the first, that I began to be more open about it. You might say that by then I had less to lose: I had left The Times a few years earlier and become a freelance journalist. But I still found it hard to admit to this illness.
My own forthrightness second time around allowed others with similar professional lives to reveal the anxiety they routinely experienced – while exhorting me not to tell others. One former colleague admitted to having such high levels of anxiety that he would routinely vomit ahead of attending the newsroom conference. But he never breathed a word.
An underlying predisposition to depression may be exacerbated by the stress and relentless hard work it can take to be supposedly successful. Britons work the longest hours in Europe, with the equivalent of 40 days of unpaid overtime a year, according to the National Health Service. The recession, short-term contracts and the sheer pace of the 24/7 digital world have all added to pressure in the professional workplace and made it a fertile breeding ground for depression.
In my case, my own over-sensitive nature combined with an attempt to be a career girl, a mother and a supportive wife, had twice led to a debilitating sense of being overwhelmed and illness.
Why then is the stigma around suffering from anxiety and depression still so prevalent? The most common reaction to my memoir about my battle with depression has been “you’re very brave” in an ironic, “not a good idea” manner.
Part of the answer I think is that while depression is an illness, with at times harrowing physical symptoms, the truth is more nuanced. Our behaviour can affect our mood. When I suffered from depression, there were times when I could have roused myself if I had really tried. What ended up working for me included therapy; relaxation and breathing exercises; and poetry, which helps me stop worrying by forcing me into the moment.
The link between behaviour and mood also explains why workplace colleagues may be less sympathetic than if someone was suffering from diabetes or cancer, for example. When they believe you could pull yourself together, in some cases they may be right.
Yet in other cases of clinical depression, such an attitude is laughable. I was unable even to get from my bedroom to the bathroom. Saying you feel depressed can cover a spectrum from someone feeling gloomy to utterly suicidal.
I think the second explanation for the continuing stigma is that depression is frightening. The sense that we are mad, that we have lost our minds, or our brains have gone wrong in some sense, is so terrifying that many sufferers would rather keep quiet.
Yet if I return to office life, I for one will be open about having experienced depression. The more open we are, the more we can find ways to help those who suffer to help themselves. We will be able to introduce work practices that will help reduce anxiety and depression happening in the first place. And ultimately, we will become less frightened of an illness that one in five will experience at some point in their lives.
The writer is the author of ‘Black Rainbow: how words healed me – my journey through depression’. Michael Skapinker is away
Author of the book Animal Madness, TED Fellow Laurel Braitman shares 5 ways in which animals and humans suffer from similar mental illnesses. Anthropomorphism run amok? You decide.
A golden retriever chases his tail every morning for hours on end. In the evening he compulsively licks his paws till they’re bare and oozy. When he’s given Prozac, he calms down and stops injuring himself … After the death of her mate, a scarlet macaw plucks out every last one of her feathers and doesn’t stop until she’s befriended by a cockatoo … A tabby cat who grew listless and stopped eating after his favorite human went off to college is cheered by the arrival of the family’s new pet rabbit, whom he likes to follow around the house.
Is the dog obsessive-compulsive? The parrot struggling with trichotillomania? The cat, once depressed, now recovered?
Making sense of animal emotional states and behavior, especially when they are doing things that seem abnormal, has always involved a certain amount of projection. The diagnoses that many of these animals receive reflect shifting ideas about human mental health, since people use the concepts, language and diagnostic tools they are comfortable with to puzzle out what may be wrong with the animals around them.
This isn’t to say that the creatures aren’t suffering, but the labels we give to their suffering reflect not only our beliefs about animals’ capacity for emotional expression, but also our own, most popular, ideas about mental illness and recovery. Where, for example, earlier generations saw madness, homesickness and heartbreak in themselves and other animals, veterinarians and physicians now diagnose anxiety, impulse control and obsessive-compulsive disorders in humans, dogs, gorillas, whales and many animals in between.
Looking at instances of purported animal madness is like holding up a mirror to the history of mental illness in people. It’s not always flattering — but it’s always interesting. Here are five classic examples of animal insanity, as diagnosed by arguably the craziest creatures of all, humans:
Well into the 20th century, brokenheartedness was considered a potentially lethal medical problem that affected both humans and other animals alike, from jilted lovers who were thought to have died of shock after being left at the altar to loyal dogs that died immediately after their masters. In 1937, a German shepherd named Teddy stopped eating when his horse companion died; he stayed in the horse’s stall for three days until he died himself. These cases still pop up from time to time. In 2010, two elderly male otters that had been inseparable for 15 years died within an hour of each other at a New Zealand zoo. Only one had been ill; their keepers believed that the second otter died of a broken heart. In March 2011 another heartbreak story pinged around the web. A British soldier, Lance Corporal Tasker, was killed in a firefight in Helmand, Afghanistan. His dog, Theo, a Springer spaniel mix trained to sniff out explosives, watched the whole thing. Theo wasn’t injured in the firefight, but hours after Tasker died, she suffered a fatal seizure, brought on, according to witnesses, by stress and grief over the loss of her companion.
It wasn’t until Louis Pasteur successfully inoculated the first person against rabies in 1885 that people began to understand the disease as a matter of contagion. Before Pasteur, rabies symptoms were often seen as a form of insanity that could be passed between people and other animals. How and why animals could catch madness was a confusing business. Creatures could go mad from a lifetime of abuse, such as Smiles, the Central Park rhinoceros, who reportedly did so in 1903. Maddened horses, as they were known, could simply take off running, still attached to their carriages or dragging their riders behind, often with fatal consequences. Mad monkeys bit small children at the circus, and dogs could sometimes go mad with loneliness. Looking back, it’s likely that more than a few of these animals were not actually rabid. Instead, madness was a catch-all term for lots of different kinds of emotional suffering and other forms of insanity.
Obsessive-compulsive disorders are now relatively common diagnoses in humans and other animals. Many of these behaviors are actually healthy animal activities gone awry. People, mice and dogs, for example, can develop hand- or paw-washing habits that are so extreme as to keep them from playing, eating their meals, going on walks or sleeping. Parrots can develop feather-plucking compulsions that leave them bald as roasting chickens; rodents, cats, humans and other primates can compulsively pluck their hair to the point of baldness, a disorder known as trichotillomania. Other OCD spectrum behaviors, like rituals, can also be seen in nonhumans, as for instance this dog that spins every time he sees a car.
Some animals, like some people, develop extremely specific fears of particular things in their environment, such as escalators, the beeps of an electronic alarm clock, shadows, even toaster ovens. One of the most common phobias, at least in dogs, iscrippling fear of thunderstorms, but cats can develop fears too, like this one whose owners believe is scared of measuring spoons. Horses can develop fears of plastic bags or umbrellas, among many other things. Thankfully, both people and other animals can learn to overcome their phobias, often with a mixture of behavior therapy and training, time, and psychopharmaceutical drugs such as Valium or Xanax.
Traumatic stress disorders have been documented in a variety of animal species — from great ape veterans of pharmaceutical testing and elephants rescued from brutal circus training to canine veterans of armed conflict. How similar is PTSD in different animal species? It’s hard to know, but there are many shared symptoms, from changes in temperament and mood, difficulty sleeping and more sensitive startle responses to possible flashbacks of traumatizing events. In his book Second Nature,the ethologist Jonathan Balcombe shares an account of PTSD at the Fauna Sanctuary in Quebec, Canada, a refuge for chimps who’d been used in research. One afternoon, keepers loaded a shipment of materials onto a metal trolley they pushed past the enclosure of two chimps, Tom and Pablo. As soon as the chimps caught sight of it they let out frightened shrieks and became inconsolable. The staff later realized that the same brand of trolley, or one that looked like it, had been used to transport unconscious chimps to the surgery room at a research facility where Tom and Pablo had lived, and been experimented upon, two years earlier.
Laurel Braitman’s book, Animal Madness: How Anxious Dogs, Compulsive Parrots and Elephants in Recovery Help Us Understand Ourselves, is out now.