"Despite medical advances in the last 20 years that have greatly improved our ability to help those who suffer from depression, we lack an effective system for administering care. Only a very small percentage of depressives who seek help receive appropriate treatment for their condition. Research often stalls short of being translated into useful medicine. Depressives continue to be stigmatized, which makes their lives even more difficult and lonely. Finally, many sufferers are left to spiral, unsupported, into despair because their insurance companies refuse to pay for treatment.I'm all for a network of depression centers; I think that's a great idea, although I'm not sure I agree with Solomon that depression continues to be stigmatized. If anything, I think it's become a household word, right up there with certain male performance problems that also used to be discussed -- if at all -- in hushed whispers behind closed doors. Depression as malady-du-jour, though, may have the effect of trivializing the illness, always a risk in a pharma-crazy society anyway. Depressed? Pop a pill! Nothing to it!
"These problems are similar to those cancer patients once faced, and the best way to address them might be similar as well. We need a network of depression centers, much like the cancer centers established in the 1970s."
Cancer's in no immmediate danger of being dismissed this way. I don't mean for a second to deny the devastation of the disease; I've lost friends to it, and my mother's survived both breast cancer and lung cancer. But because there's no quick fix for cancer, or even the perception of one, there aren't cheery little pop-a-pill-and-you'll-feel-better ad campaigns.
Instead, cancer's produced a rhetoric of heroism. Cancer patients are invariably described as "brave," even when they don't want to be. When my mother was being treated for breast cancer, this drove her nuts. "I'm not brave! I'm doing what I have to do. It's not like I have any choice!" Even so, cancer survivors like Lance Armstrong achieve iconic status. Military metaphors abound: cancer treatment's always "a battle," and patients either "win the battle" or "succumb after a long, brave battle."
And then there are all those blasted ribbons. Is anybody else heartily sick of perky colored lapel ribbons for every cause under the sun? Has anybody else completely given up trying to keep all the colors straight? Gary and I went grocery shopping recently, and I picked up a box of coffee filters adorned with a pink breast-cancer ribbon. Coffee filters fight breast cancer? What the hay? This brand filters carcinogens out of your coffee?
The first ribbons I remember seeing were yellow ones, probably during the Iran hostage crisis; according to Wikipedia, the yellow ribbon has a long history -- dating back to 1917 -- in military and political conflicts. Given that history, I don't think the connection to cancer ribbons (even though ribbons now signal all kinds of other things, too) is an accident. Cancer patients are, in a sense, prisoners of war, held hostage by an enemy force. It's easy to see cancer this way because it's an invasive illness, often with clearly visible battle lines drawn on x-rays and CT scans. Cancer cells are "other," hostile mutations bent on overrunning the body's defenses.
As I've said here before -- in a discussion with Will Shetterly that I can't locate at the moment -- I have trouble with battle metaphors for illness. I prefer the metaphor of the journey, with illness as a foreign country which, for all its perils and pains, may also be a place to learn new skills and meet new friends. Sometimes we get to return from that journey and come back home, at least for a while; sometimes the foreign country is the end of our travels. But since everyone's travels in this world will end one day anyway, I don't think it's helpful to imply that people who've gone on to their final destination have lost a battle, or are losers in any other sense. I've heard too many people who were ill vow to "keep fighting" even when they were exhausted and clearly needed rest instead. I suspect that in at least some cases, military imagery encourages patients to push past their limits, instead of honoring their own needs.
Battle metaphors, though, are undeniably sexy. They thrill us; they get our adrenaline going. And that means that, in some twisted way, cancer's sexy, or has been made sexy for the sake of raising money and awareness.
Depression's not sexy. It's common as dirt and every bit as dull. Depression's boring, both for the patient and for everyone else in the vicinity. For one thing, there aren't visible battle lines. Depression isn't an invasion by foreign or mutated cells. If anybody's come up with a sexy metaphor for neurotransmitter imbalances, I haven't heard it yet. There are, of course, famous literary metaphors: Styron's Darkness Visible, Churchill's "black dog." I'm quite fond of the latter; I've tried to domesticate my dog, to train it to heel. When my depression starts howling, I tell myself, "Okay, time to walk the dog," with "walk" as a shorthand for self-care. That's not very sexy, though: nobody's going to start wearing chartreuse pooper-scoopers on their lapels. The very dailiness of depression, and of other long-term chronic illnesses, mitigates against dramatic metaphors.
My "dull as dirt" simile above suggests another metaphor, an agricultural one: depression as the field in which our pain germinates and bears the fruit of compassion. This metaphor is both daily and seasonal, and works well to describe the condition. But it's not very sexy, either.
We don't have depression heroes. We don't have depression icons. There actually is a green ribbon for childhood depression (of course there is), but I had to do a Google search to learn about it. What we have instead is a pop-a-pill mentality that reduces depression -- and male performance problems, and lots of other things -- to the status of a headache.
I'm not sure there are any simple solutions to this situation. As I've said, I don't like battle metaphors, and the metaphors I do like aren't likely to raise anyone's adrenaline levels. But I do have a request: if you know someone who needs to walk the dog every day, offer to come along for companionship and support, even or especially if it's raining out. You may learn things about the neighborhood you never knew, and when you get back, you'll be newly and deeply grateful for that cosy armchair and the roof over your head.