Plastic surgery for the soul

There are many things in my practice which I prefer to leave to experts, and it isn’t just brain surgery. Psychological and behavioral issues are complex enough to need not one but many specialties in medicine: psychology, psychiatry, behavioral and developmental pediatrics, neuropsychology — and, being a general pediatrician, I try stick to what I know.

Which does not help when a family comes in with a wrinkled prescription for antidepressants written by a psychiatrist and asks me if they should take it or not. So I need to have an opinion whether I feel up to it or not.

But if I have to have an opinion on antidepressants I have to have an opinion on depression, right? Well, here it is.

Mathematician and songwriter Tom Lehrer once mentioned, in a throwaway remark, a friend of his who went to medical school to specialize in “diseases of the rich”. Not to put a fine point on it, but diseases of the rich is what we treat every day — diseases of our rich culture, from obesity to drug abuse, from asthma to skin cancer, all linked, directly or not, to the surfeit of plenty and the leisure in which to consume it.

And what is depression, I ask rhetorically, but a disease of the rich? Described by Shakespeare in Prince Hamlet and King Lear, by the Russian classics in the various members of the landed gentry (Oblomov and Onegin come to mind, among others), and by Marcel Proust in himself; described in minute detail by Sigmund Freud in the Viennese upperclass society — what about the poor?

The poor, until recently, when exhibiting the classic depressive symptoms — were called lazy, shiftless and stupid.

So much for disease of the rich…

The truth is, in the rich and powerful, depression is a disease.

In the poor and the oppressed, depression is what makes their condition tolerable.

Considering that we were born in the first century in which the thought appeared that, maybe, no one need be poor OR oppressed, depression fulfilled a necessary role for the first hundred thousand years of human history.

Depression is what allowed the weaker members of the tribe to leave unchallenged the tribal leader’s authority in the hunter-gatherer age, so they would survive the fights to the death among the alpha tribesmen.

Depression is what allowed slaves, serfs, factory workers, foot soldiers get through their years of servitude, one foot in front of the other, one day at a time, in the ages when, as Thomas Hobbes put it, lives were “nasty, brutish and short”.

And in our own days, depression is what makes our children accept being bullied.

And the more they get bullied, the more depressed they get.

And the more depressed they get, the more they get bullied.

And then you give them antidepressants. Without taking away the bullies, the snickerers, the casters of sidelong glances and the utterers of suppressed chuckles.

It is no surprise to me what happens as a result:
It is a surprise that it does not happen more often.

So far I sound a bit like some of the fringier celebrities, right?
Actually, I am no more against antidepressants than I am against cereals. Remember the cereal commercials?

They usually showed a dish with fruit, milk and cereal in it, with the words “delicious part of this nutritious breakfast?” — neglecting to mention that, by itself, cereal contains nothing but carbohydrates?

Antidepressants are like that: safe and effective as part of a global change in outlook on life; but when used alone, they cannot, by themselves, change one’s life in a positive direction. Without pride in one’s achievements, without bond with one’s family, without a dash of ambition, a dollop of love, without something to make tomorrow a day to enjoy rather than endure, the magic pills are nothing but botched plastic surgery of the soul.


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