A guy walks into a gym... No, this isn't a joke, it's the beginning of an analogy. Bear with me.
Anyway, a guy, let's call him Kevin, walks into a gym. He does a workout that is the most crazy, intense thing the gym instructors have ever seen. He hits all the weights machines, all the free weights, and does an hour on each of the cardio machines; the treadmill, the elliptical, the stationary bike, the stepper, you name it. By the end of the session, he is wasted, and leaves the gym barely able to walk.
No one sees Kevin at the gym for two months. When he finally walks back in, he's still limping. He says to one of the instructors, 'I think I overdid it last time.'
What response would you expect from the gym instructor? Let's make this a multiple choice game! Does the instructor reply with:
A: 'Kevin, for you, working out is clearly dangerous. You almost killed yourself last time, so you should avoid working out at all costs.'
Or B: 'Kevin, you really overdid it. Too much exercise can be as bad as no exercise. Talk to us, and we'll show you how to exercise safely, and keep fit and healthy.'
Okay, it's a bit of a silly and extreme story, but deliberately so. I'm going to use this scenario as a reducto absurdum to shine a light on a particularly silly attitude to depression I encountered recently.
The instance of a depressive illness in question was a serious bout of depression that had been triggered by excessive stress. The person under discussion, Kevin let's say, had a long history of depression, but had been successfully managing the condition for a number of years.
Unfortunately, he was then subjected to a long and drawn out sequence of stressful events that eventually triggered a serious depressive episode.
Before I go any further, let's just have a reality check. The NHS cites stress as a common cause of depression. The 'causes of depression' section of the NHS website details how people often describe a 'downward spiral of events' that leads to depression. On other occasions, it can be a single, significant stressful event that triggers depression, such as a bereavement. I want to make this point very clear: Stress can, and does, trigger depression. It's not always the case, of course. Everyone experiences stress of differing intensity throughout their lives, but not everyone suffers a depressive illness. But for those prone to depressive illness, stress is often a trigger.
I will, I promise, get back the gym thing. For now, though, let's talk a little more about stress. The NHS website gives a pretty definitive explanation of what stress is:
But also, look at what the NHS says about managing stress:
Now we can draw some safe conclusions: Everyone experiences pressure and stress in their lives. Too much pressure leads to stress that a person may not be able to cope with, and this in turn can lead to a depressive illness.
So now consider the following question. If Kevin has a history of depressive illness, and is aware that stress can be a trigger, should he...
A: Avoid all stress at all costs?
Or B: Learn and use recognised techniques to manage stress, in order to avoid or minimise depressive illness?
Now you will begin to see where the silly gym analogy comes in, and hopefully see why a silly analogy was needed.
In the conversation I had today, my interlocutor insisted that Kevin, who had suffered the stress-triggered depressive illness, should change the way he lives to avoid some of those circumstances that can cause stress.
But for Kevin, it wasn't one particular circumstance that caused stress and triggered a depressive episode. It was a combination of circumstances. Kevin is completely able to handle his given circumstances in normal conditions. what happened to him was an unusual and unexpected series of stressful events, which combined with the normal day to day stresses we all experience, to create a cumulative effect. This triggered a breaking point that led to a depressive episode.
With this in mind, is there any value in telling Kevin to avoid some of the circumstances that caused stress? Think about it. It stands to reason that the unusual and unexpected events will not be happening all the time, and by their nature will not be avoidable (they're unusual and unexpected, after all). As for the normal day to day stresses, if he was handling them fine before, why should he avoid them now? And is it even possible to avoid normal day to day stresses and pressures? What would you do to achieve this? Avoid work pressure by giving up your job? If so, imagine the stresses and pressures that come with having no, or reduced, income.
Let's get back to the gym. Kevin didn't really have that crazy, suicidal workout session, of course. That was just a silly example - an analogy of sorts. Telling someone not to go to extremes in the gym is fine. Telling them to avoid extreme pressures in life that result from sudden unexpected events - say the death of someone close, followed by a serious accident for example - isn't realistic. By definition, you cannot avoid the unexpected. And telling someone to avoid the ordinary everyday pressures of life - the job, relationships, home maintenance, or whatever it is that gets your goat - is dangerous advice. If you tell someone to avoid those pressures, you are effectively telling them to withdraw from life. To isolate themselves. This is bound to be a recipe for further depression.
So, let me summarise a little here. I had a conversation with someone who suggested that 'Kevin' might suffer less from depression if he avoided stressful circumstances. Which may seem legit at first glance, but just doesn't stand up to examination. Kevin (or anyone else for that matter) can't avoid the unexpected stuff, and he'd be hurting himself more if he withdrew from a normal life to avoid normal stresses. Particularly when he's shown he can handle the normal day to day thing, anyway.
It is possible to give useful advice to people with depression on things to do or not do. Alcohol and drug abuse is known to exacerbate depression, so yes, you can advise that.
Exercise is known to help alleviate depression, so you can advise that. But telling someone to, for example, give up their job, or stay out of relationships, is dangerous, stupid, and is not helping.
*** There is a serious logical flaw present in the idea that Kevin should avoid some of the ordinary stresses of life to avert depression.(We'll ignore the unusual and unexpected stresses because they are by definition unavoidable.) By making the issue a question of what Kevin should, or should not, do to avert depression, one attaches a sense of causality to Kevin himself. It creates an implication that he is to blame; that his depression is the result of him not doing what he should, or of him doing what he should not. The word 'should' here is tricky. Who decides what Kevin should or should not do? Who are what is the external arbiter to decide on the ethics of Kevin's behaviour? The suggestion that Kevin is to blame for his own depressive illness is just one more example of the stupid preconceptions and silly attitudes that surround mental health problems today.
Tweet © Darren R. Scothern 2015