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Three Rhetorics of Depression

Ruth-Batke-Abstract-art-Emotions-Depression A while back, I went to a wedding in Texas. I distinctly remember flying into Dallas, as there was a terrific thunderstorm and from above the clouds I could see the lightning strikes as dazzling patches exploding in the darkness, like some science fiction artillery was bombarding the ground. Yet that is not what I remember most vividly about that trip. The night before the ceremony, I was staying in a motel with various guests for the wedding who had come over from the UK. One of the them must have been in a confessional mood, as he told me all about how he had recently been debilitated for several months with crippling depression. He suggested to me that there needed to be a change in the way people see depression; that it should be taken to be more like a cold, something anyone can get that passes.

I could see he needed support at that time, so I bit my tongue. But what I wanted to say was: “How dare you, who have just had one short bout of depression, come to me who have spent my whole life wrestling with it and suggest that we should be downplaying depression and making it out to be something small and trivial like a cold? You’re just a damn tourist in my homeland and have no respect for what it’s like to live with something like this. Your whole reason for making it out to be ‘like a cold’ is because you recognize there’s a stigma attached to ‘mental illness’ and you want permission to have briefly experienced what those of us who live with it must endure without you having to bear that stigmata.” I let it slide. But I never forgot that conversation.

What presumably motivated him to make his argument was an attempt to push back against the prevalent but never-voiced default rhetoric of depression, indeed, of any kind of variation from the perceived norms of mental function: ‘they’re not right.’ This is the rhetoric that makes depressives, schizophrenics, manic depressives and so forth outsiders, because they aren’t normal, they’re not ‘like us’ (whoever ‘us’ might be). This is the rhetoric that makes admitting to depressive tendencies a career-ending event for some people, that leads others to end their lives, and that can never really be eliminated because it is never really espoused. It is a fear of shadows and the unknown, thriving on ignorance and the erroneous perception that normality is both possible and desirable.

Against this default rhetoric, the wedding guest’s view (which he also connected with some remarks by Prince Charles) was to downplay depression as something less serious. But this ‘like catching a cold’ rhetoric is not really an improvement. Because depression is only anything like a cold for those people whose brush with it is a passing affair. I don’t want to belittle those experiences – depression, as anyone who has gone through it knows, is a serious business. But it’s precisely because it is a serious business that a rhetoric that downplays its seriousness can’t really be an improvement on the mob mentality of the ‘not right’ rhetoric. What deeply offended me about this perspective is that at its heart it is trying to make it okay to suffer depression by splitting off incidents of depression from ‘mental illness’ in general. But this means that it is equally a rhetoric of exclusion: it allows some to escape the claim of ‘not right’, but it still condemns the rest of us to banishment.

There is a third rhetoric of depression that is in common circulation, that of the medical establishment. According to this, depression (or major depressive disorder, or clinical depression) is a mental disorder caused by irregular behaviours of the neurotransmitters serotonin, norepinephrine, and dopamine, sometimes described informally as a ‘chemical imbalance’. It is treated through the application of anti-depressant drugs of various kinds, perhaps with additional counselling or cognitive behavioural therapy. In effect, this ‘mental illness’ rhetoric of depression views those suffering from it as faulty and in need of fixing. What I find striking about this perspective is that it insists in seeing depressive people as broken, just as the other two rhetorics do. Whether it’s because they’re ‘not right’, it’s just ‘like a cold’, or it’s ‘mental illness’, the three rhetorics of depression are united in ensuring that depression, and ‘mental illness’ in general, are set up as something that is not normal. Depressive people are broken people.

But these rhetorics are all misleading. Because depression, despite its unpleasantness, despite its severity, despite its radical effects on people’s lives is normal. It’s completely normal. As normal as falling in love with your high school sweetheart and marrying them, and actually less rare (eight times more common in the United States), whatever the movies may suggest! The problem is, we are still operating with the Eighteenth century mythos of Nature, one that tends to equate ‘natural’ with normalcy, and presupposes that there are natural norms against which everything else is measured. Deviations from the natural are thus judged as wrong in some way. This is the origin of the hermeneutics of ‘sickness’, which we are not obliged to accept for all that we have saturated ourselves with this mythology.

A hermeneutic is a principle of interpretation, and applying this term to medicine is heresy. But I have always fancied myself a heretic, especially in situations where resistance is rare. I am not, however, entirely alone in this matter, and first heard it suggested by the philosopher Charles Taylor, who was drawing on radical ideas by the renegade Catholic priest, Ivan Illich. Illich saw clearly the transformation in our mythology of health and dying in the last few centuries, and set out serious problems with our contemporary perspectives in Medical Nemesis, a book that became required reading for many studying to become medical practitioners. Alas, it does not appear to have in any way halted the trends that it argued against.

The general criticism I am advancing here has nothing to do with the efficacy of contemporary medical techniques, because it is not about treatment at all: it is about diagnosis. The medical establishment’s mission is to find a box to place everyone into. If you go to your doctor with any kind of complaint whatsoever, you will either be assigned an appropriate box for your sickness, or you will be referred to a specialist who can find an even more exacting box for you. But you will be found a box, or you will be condemned to infinite tests to attempt to establish that box. And the number of boxes available has steadily increased, without any question about the merits of categorising people in this way. As a simple empirical observation, our ever-improving medical knowledge has utterly failed to halt depression: it has increased in incidence throughout the last century, and is ten times more prevalent than it was seventy years ago.

There are good reasons to question medicalisation in general, particularly when the commercial practices of pharmaceutical companies are taken into account, but in the case of ‘mental illness’, it should be even clearer that something has gone horribly wrong. People in the autism spectrum or those with Down’s syndrome have unique ways of being in the world, but we are in no way obligated to view these phenomena as sickness, which is always a negative judgement. Recall that as recently as 1974, homosexuality was classified as a ‘mental illness’, and is still claimed as such in some places according to the mythos of Nature that perceives ‘normal’ as some idealised state of being that it is therefore wrong to deviate from. Declassifying homosexuality was a first step, but it cannot end there.

What truly bears a claim to ‘normal’ for life is diversity, variation, and change – the concept of ‘species’ that suggests that every kind of organism can be perfectly standardized is no longer plausible, and has not been for quite a while. We are at the fringes of completely overturning the old mythos of Nature and normalcy, but it cannot be done without substantial revisions to the hermeneutics of ‘sickness’. But here, our deference to doctors and medical science is a barrier in part because, as Mary Midgley observed, they have inherited the powers that used to be ascribed to priests. There is a non-religion of medical power that generates the psychological effects of blasphemy far more reliably than traditional religions these days. Woe betide anyone who challenges the authority of doctors to classify us into categories of sickness!

Yet there is resistance. It comes with the term ‘neurodiversity’ that grew out of adopting the phrase ‘neurotypical’ as a contrast case by autistic people. Similarly, it comes under the banner of ‘mental diversity’, a term I broadly prefer since the prefix ‘neuro-’ is clearly intended to draw against the authority of the sciences and this issue is not a matter of measurement or experiment, but one of ethics and understanding. These alternative rhetorics (and the movements behind them) make it easier for me to talk about depression, although even now I do so with feints and allusions and without much in the way of detail. This is still uncomfortable territory for me, and for reasons that have much more to do with the third rhetoric than the first: those who argue against medical orthodoxy are seldom welcome. Yet the standard explanation of depression that treats it as akin to a mechanical fault cannot suffice as a general explanation since it utterly fails to account for our depression epidemic. We urgently need fresh perspectives.

In my life, experiences of so-called ‘mental illness’ have made me stronger, nourished my creativity, and led me to life-long friendships. It helped that I vowed to reject suicide as an option at an early age because I could see all too clearly how devastating it would be to others. It may also have helped that I rejected pharmaceutical interventions in favour of methods that mostly built my virtues rather than my dependencies. I flatter myself that I have taken control of depression, for all that I still occasionally stumble. But I recognize that what has worked for me will not necessarily work for others. For some, pharmaceuticals have helped them establish a life worth living. For others, drugs have simply incapacitated them for a while. There is no adequate pattern here that is beyond questioning, and no-one – not even depressives themselves, and least of all doctors! – can claim ownership of depression and force everyone into just one box.

This is perhaps the greatest problem with depression: although the experiences we mark with this term have common traits, they do not share common circumstances. They reflect different biologies, different psychologies, different environments, different ways of living and thinking and being. The statistical methods of the sciences are not suited to understanding such variety; they thrive on picking out the common patterns. But boxes built to one size cannot fit all situations, any more than averaging our measurements will produce a garment everyone can wear. The essence of mental diversity is that we are all different, and we cannot be subsumed into generic models of sickness and treatment. Medicine provides us valuable options, but so too does religion, non-religion, and every other source of practices and community. We each have to find our own path. And this is true, regardless of how ‘normal’ we might think ourselves.

The opening image is And I Can Feel Your Pain, by Ruth Batke, which I found here, where it had been on sale. As ever, no copyright infringement is intended and I will take the image down if asked.

Failing to Say Farewell

Terry Prachett It’s been a week since Terry Pratchett passed, and I have still failed to write about it. The news upset me more than I would have anticipated, given that I have not even seen Terry since 1999. I have a closer relationship to Rhianna, his daughter: we’ve made games together, and meet up for a chat whenever we get the chance. The extent of my engagement with Terry was merely that I worked at a company making games in his Discworld universe.

But then, Terry was the first editor I worked with, and also the best of them all. I not only learned a tremendous amount from him, but in many respects he was the foundation of my career as a game designer and writer – if it had not been for the critical success of Discworld Noir, I could not have founded International Hobo. Erasing Terry from my life would be destroying all that I am and leaving only the wispy aspirations and tedious angst of the person I was before I started work at Perfect Entertainment.

Yet, I have failed to write my farewell. At heart, my problem is that I feel like a fake drawing on my repertoire of Pratchett anecdotes to wax lyrical about a man I was privileged to work with but could never actually know. I feel as if writing about these experiences would be the act of someone desperate to garner fame from proximity – it would solidify my position as an H-list celebrity while exposing my insignificance; the shadow, glibly praising itself for its proximity to the flame. I feel certain I will write about my experiences with Terry at some point, but I cannot do it now without feeling worse than I already do.

I will say goodbye to Terry some day, but it seems I cannot do it today. Yet I can already thank him, as I did in the last letter I wrote to him, for having such an extraordinarily positive effect on my life. And I will miss him, even though he was never really there. This, I suppose, is the effect that any great writer has through their work.

The Politeness of Tutorials

Over on ihobo today, my reply to two missives from Jed Pressgrove and Chris Billows examining the role of the tutorial in videogames in terms of different motivating ideals of politeness. Here’s an extract:

The challenge in creating an adequate tutorial is the complete absence of knowledge we possess of the actual people who will be learning to play our game. Pitch the level of detail too low, and there will be players confused by what is expected of them. Provide too much detail and those players who are skilled in figuring things out will be irritated... What is particularly bemusing about creating tutorials is that if you watch a player learn to play a game from over their shoulder, you might not need to say more than a sentence or two in order to put them on the right track. But this is because we have the intelligence to interpret the problems a player encounters and provide appropriate guidance: there is no adequate way to transfer this skill to a computer!

You can read the entirety of The Politeness of Tutorials over on

A Foundation in Nonsense

Cat in the Hat Where was the starting point for my philosophy? Recently, Charles Cameron juxtaposed one of my remarks with one from the philosopher Cornelius Castoriades:

Philosophers almost always start by saying: “I want to see what being is, what reality is. Now, here is a table; what does this table show to me as characteristic of a real being?” No philosopher ever started by saying: “I want to see what being is, what reality is. Now, here is my memory of my dream of last night; what does this show me as characteristic of a real being?” No philosopher ever starts by saying “Let the Requiem of Mozart be a paradigm of being”, and seeing in the physical world a deficient mode of being, instead of looking at things the other way around, instead of seeing in the imaginary, i.e., human mode of existence, a deficient or secondary mode of being.

I cannot claim to have started by placing an artwork like Mozart’s requiem as a ‘paradigm of being’, but I certainly did not begin philosophy by asking about being and reality. The stepping point for my philosophy was nonsense, and specifically the defence of nonsense – perhaps even, as the Discordians affirm, ‘nonsense as salvation’. The origins of this can be seen in my account of Moore’s Paradox and the Belief in False Things (2009): being told, in outright denial, that I did not believe things that I knew were false set me on a certain path. The most recent step on that path was to reformulate knowledge in order to view it as a practice.

How can nonsense possibly provide an adequate foundation for anything? Consider that to gain an authentic understanding of something we must be willing to fully experience it. If we start with conceptions of truth, nonsense is simply the vast array of things we must discard as irrelevant (often, without any serious examination of what we are dismissing). Most people live in precisely this fashion; other ways of being in the world are nonsense by default, and can be ignored or derided. But if we start from nonsense – from a close study of nonsense – we discover how suspicious truth appears when it is taken as a miraculous starting point. Truth is a worthy destination, but we cannot simply expect that it was there fully formed at the point of departure. Beginning at nonsense, on the other hand, allows us to gain a proper appreciation for truth – and indeed, for nonsense itself.

The Castoriades quote also resonated with me by stressing the importance of imagination – which has been the consistent theme in this stage of my philosophy (what I’m tempted to term ‘my immature philosophy’, although I might not live long enough to make fine wine from my own grapes). In this regard, I would like to add another connection to this chain in the form of the British philosopher Alfred North Whitehead, who in a lecture series from 1925 spoke of the relationship between the ‘realm of possibility’ and actuality:

It is the realm of alternative suggestions, whose foothold in actuality transcends each actual occasion. The real relevance of untrue propositions for each actual occasion is disclosed by art, romance, and by criticism in reference to ideals. It is the foundation of the metaphysical position which I am maintaining that the understanding of actuality requires a reference to ideality.

This philosophy – where understanding actuality actively requires thoughtful consideration of possibility – seems to face towards where Castoriades is gesturing when he talks of seeing in the physical world “a deficient mode of being”. Here, I join with these other voices in believing in the unbounded value of striving towards ideals, even if so doing is a kind of nonsense.

For Charles.

Sharing is Overbearing

I’ve removed the sharing buttons in the footer of each post: Typepad was contacting each social network every time a page was served, which makes the site run far slower than is necessary. I don’t think anyone was using these buttons, but let me know if you did find them useful.

Ideapod as a Social Intelligence Network

IdeapodNot six months after writing about social intelligence networks, and one has launched. Entitled Ideapod, it fulfils many of the aims I outlined last year. They’ve invited me to join, and since I asked for something like this it would be churlish not to participate!

It is operating at roughly the scale I designated ‘Thoughts’ (100 words – a minute to read), with their actual constraint being 1,000 characters. I am a supporter of constraints of this kind, having seen how Twitter refines bons mots, jokes, and taglines with its 140 character limit. The key to Ideapod’s set up is the ability to ‘relate’ one idea to another idea – which is why I think this qualifies as a SIN. It will be interesting to see how this works out in practice.

Because I am still more comfortable with an essay or letter as a form of discourse, being on Ideapod shouldn’t to detract from the blogs – it will just allow me to synthesise ideas formed here and in my books into shorter statements to be ‘related’ in their database. But it’s interesting to see the SIN idea tested out in an actual programmed system.