Depressed? Don’t blame your genes. Report from the Times Newspaper.
Britain is depressed. Especially its women.
Oliver James. Times Newspaper
Recently the Irish author Marian Keyes announced on her website that she is suffering from such “crippling depression” that she was unable to sleep, write, eat, read or talk.
Depending on which study you believe, a woman aged 25 in 1980 was between three and ten times more likely to have suffered depression than her grandmother. The increase has continued in the past 30 years, particularly among girls from affluent homes.
The proportion of such girls suffering at the age of 15 almost doubled between 1987 and 2006 (up from 24 per cent to 43 per cent). Scientists are now confident that these increases are real, not because of our greater willingness to engage in psychobabble. Overall, 23 per cent of us suffered from a mental illness of some kind in the past 12 months. The proportion rockets among the young: 32 per cent of 16-24 year olds, dropping steadily as we get older, to 11 per cent of over-75s.
With the short, dark days of January especially hard for those with depression — many psychologists claim today that with freezing temperatures, debts from the Christmas break, and gloom about returning to work, add up to the most depressing day of the year — what has gone wrong and, even more importantly, what can you do if you are suffering? Related Links Am I depressed? Henry Rollins on depression, stand-up and his risky life What are the best treatments for depression?
Some people blame their genes. For decades we have treated as common knowledge the existence of a depression gene. But one of the most interesting developments of last year was a growing conviction among scientists that genes play little or no role in depression.
The Human Genome Project, which mapped all our DNA, has not reliably identified a single example of a gene for any mental illness.
In the face of this, the leading gene researchers have been forced into a dramatic retraction of their previous claims. They now accept that we are never going to find individual genes for individual mental illnesses, including extreme ones, such as schizophrenia. The about-turn comes after several false dawns, the best example being what was thought to be a critical gene variant for depression. A 2003 study reported in Science magazine found that people with it were more likely to become depressed if they were maltreated as children: it created a vulnerability.
However, a report published last year has almost disproved this. It examined 14,250 people whose DNA had been mapped in 14 different studies. Those with the variant were not at greater risk of depression nor were they more likely to be depressed when the variant was combined with childhood maltreatment. Although it is just possible that other studies will reinstate the variant as playing a part, other evidence suggests that it plays none at all.
For instance, in developed nations, women and people on a low income are twice as likely to be depressed as men and the wealthy. Yet they are not more likely to have the variant. Worldwide, depression is least common in the Far East, yet a study of 29 nations found the variant to be most frequent there.
The implications are huge: to paraphrase Bill Clinton, it’s the environment, stupid! There is buckets of evidence that two factors are crucial: the quality of care you receive in your early years and the kind of society in which you live.
If the care during your first year was unresponsive, you are at much greater risk. Likewise as a toddler: you get used to being let down and expecting the worst. In later childhood, overcontrolling mothers who hover over their child’s every action with hypercritical eyes put the child at risk of perfectionist, depressive self-criticism. Equally, physical or sexual abuse greatly increases the risk, the younger the maltreatment, the greater the harm.
Early maltreatment changes the content and size of our brains. On average, a woman who was sexually abused has 5 per cent less of the hippocampal region of the brain, crucial for regulation of emotions. Being made fearful or lonely by early care jacks up secretion of cortisol, the “fight or flight” hormone. It creates a jumpy, insecure, self-doubting person.
Only the most fanatical of genetic fundamentalists now dispute that parental care is a key cause of depression.
However, it is not all your mum and dad’s fault.
In 2004, the World Health Organisation published the results of a survey of the amount of mental illness in 14 nations. Unlike the easily dismissed surveys of happiness so beloved by economists, this evidence is based on in-depth interviews by trained professionals — it is as good as it gets. It proved that people living in English-speaking nations are twice as likely to suffer a mental illness as those in mainland Western Europe. For example, by far the most mentally ill nation was America, with 26 per cent of its population having a depressive episode in the past 12 months. The average for the continental Europeans was 11.5 per cent (based on nationally representative samples in Germany, France, Italy, Belgium, Spain and the Netherlands).
Taken together with the evidence that we are much more mentally ill than our grandparents, this strongly suggests that the kind of society in which you live plays a big part in whether you suffer. Why is our society more toxic, and why has it become more so since 1950?
In my book Britain on the Couch, I identify two major toxins that spread between 1950 and 1980. The first was an epidemic of “social comparison”, of “keeping up with the Joneses”. After 1950, material and social aspirations rocketed and we became a nation of wannabes. In particular, women and people from poor homes were encouraged to reach for the sky. Whether in the classroom or the workplace, all of us were pressurised to believe that we could achieve more and do better. So high did our aspirations become that even the ostensible winners began to feel like losers. Egged on by the new medium of television, we obsessively and enviously compared our lot with that of others, constantly feeling we were being deprived of what was “rightfully” ours.
The other great disaster was the rise in the divorce rate, reflecting a period in history when the battle of the sexes has never been worse. This gender rancour also reflected our bloated individualism and confused aspirations. Men were supposed to love their partner for who she was, not what she looked like; women to love men not their bank balances. There was a formidable rage from women dumped for younger models and from men traded for more dominant, successful peers.
The problem was especially acute among women, so that two thirds of divorces were initiated by them. In the 1960s, 40 per cent of women were prepared to marry a man they did not love, as long as he had other desirable qualities (such as a sense of humour and wealth). The proportion had dropped to 15 per cent by the late 1980s. This was, of course, the period in which the divorce rate mushroomed. At exactly the moment when more marriages were ending than ever, women were placing a higher premium on love. No wonder there were so many broken hearts. The epidemic of “keeping up with the Joneses” combined with the outbreak of unparalleled gender rancour continued after 1980. Then another virus swept the English-speaking world, explaining why we are twice as mentally ill as our continental cousins: affluenza — placing too high a value on money, possessions, appearances and fame — became endemic. Those values make you much more susceptible to depression.
By now you are probably thinking: “I can’t change our society and I don’t want to move to Denmark. Sitting here depressed in 2010, what can I as an individual do about my misery?” Thankfully, there’s a great deal.
It’s very good news that genes are almost certainly not the cause, as your distress is not an inevitable destiny. People who do not believe their problem is genetic are much more likely to recover.
The main treatment options are pills and therapy. Unless you are desperate, forget pills. In most cases, even if they do have an effect it is a “placebo” — people given chalk pills, but told they are antidepressants, are almost as likely to claim to feel better as people given the real thing. And pills have nasty side-effects, such as loss of libido.
The best talking cure is the one invented by Freud, psychodynamic psychotherapy. It has moved on a long way and it has been proven to work better than its main competitor, Cognitive Behavioural Therapy (CBT).
The strongest evidence for its superiority was published last year. Initially, eight to 20 sessions of short-term CBT reduced depression and anxiety, more so than having psychoanalytic therapy two to three times a week. However, after three years, those receiving long-term psychoanalytic treatment were dramatically better off — less likely to be depressed and four times more likely to have recovered from anxiety. A recent survey of 23 other studies had similar findings.
It is vital that you engage in systematic scrutiny of how parental care in the early years affected you (take the “find a therapist” option at psychoanalytic-council.org). Since hardcore CBT explicitly rejects discussing early care, it will never be of enduring, profound value to distressed people. However, psychoanalysis is expensive and time consuming.
Two less intensive therapies are also proven to help. Cognitive Analytic Therapy, uses the best of CBT and psychoanalysis to investigate how your childhood is affecting you, in 16 sessions (acat.me.uk). The second therapy, the Hoffman Process, entails eight days in a residential setting (hoffmaninstitute.co.uk). It is a remarkable shortcut to understanding what went wrong in your childhood as well as a highly imaginative way of cheering you up.
Indeed, that was the option taken by Sheila, a depressed television producer. With additional help from a psycho- dynamic therapist, she sees things very differently today. “I suffered chromatically black moods. No longer. I can see how my childhood prepared me to be a miserable Bridget Jones, made worse by the values of a sick society. Touch wood, I now have sustained sanity.”
Oliver James is the author of Britain on the Couch — How Keeping Up With The Joneses has Depressed Us Since 1950, Vermilion, £8.99.
For more information, visit: www.Oliver-James-Books.com