To make matters worse, the reliability of the Hamilton Rating Scale for Depression (HRSD), widely used by the mental health establishment, is highly problematic.
So then a way out could lie in trying to make life that much simpler, cutting down on your needs, argues Bruce E. Levine in his latest book Surviving America's Depression Epidemic: How to Find Morale, Energy, Community in a World Gone Crazy.
Buddha, Spinoza, and Jesus, to name a few of those savants who rebelled against societal norms and religious orthodoxy, all concluded that the source of our misery was avarice, material attachment, and self-absorption.
Latterly, psychoanalyst and social critic Erich Fromm (1900-1980), felt that the increase in depression in modern industrial societies is connected to their economic systems. Financial success in modern industrial societies is associated with heightened awareness of financial self-interest, resulting in greater self-absorption, which can increase the likelihood for depression; while a lack of financial self-interest in such an economic system results in deprivation and misery, which increases the likelihood for depression. Thus, escaping depression in such a system means regularly taking actions based on financial self-interest while at the same time not drowning in self-absorption -- no easy balancing act, points out Levine.
Technology has increasingly become the supreme value, he says of American culture, but should be true of the modern world in general.
Technology is all about control. The more people singularly worship technology they also, even if unknowingly, worship control. And they pay a psychological price in the process. They feel increasingly powerless. And the feeling of powerlessness is highly associated with depression.
In his To Have or to Be? (1976), Fromm contrasts the depressing impact of a modern consumer culture built on the having mode (greed, acquisition, possession, aggressiveness, control, deception, and alienation from one's authentic self, others, and the natural world) versus the joyful being mode (the act of loving, sharing, and discovering, and being authentic and connected to one's self, others, and the natural world).
Fromm's penetrating social criticism of an alienating society resulting in increased depression was, during his lifetime, widely respected by many mental health professionals.
Today, however, the mental health profession has come to be dominated by biopsychiatrists: those who see depression as a matter mainly of brain chemistry.
Drugs have become a first option for many doctors, electroconvulsive therapy has made a comeback, and psychosurgery is no longer frowned upon. Technology fundamentalists demand speed and efficiency. By the early 1990s, two-thirds of doctor visits were less than fifteen minutes, and a 2001 RAND Corporation survey revealed that the majority of physicians were diagnosing depression in less than three minutes.
Levine, a clinical psychologist, insists that the technology for assessing depression lacks the basic elements of science -- including objectivity and verifiability.
The Hamilton Rating Scale for Depression (HRSD), is routinely used in antidepressant studies evaluated by the FDA for drug approval. However, even the American Journal of Psychiatry, the American Psychiatric Association's own journal, concluded in 2004, "Evidence suggests that the Hamilton depression scale is psychometrically and conceptually flawed." And the Journal of Clinical Psychopharmacology noted in 2005, "When looking closely at the construction and content of the HRSD, it is clear that this is a flawed measure." When legitimate scientists examine the HRSD, they immediately notice its biases in how depression is defined, the arbitrariness of a point total for qualifying a person as depressed, the arbitrariness of what qualifies as remission of depression, and the subjective nature of how responses are interpreted and evaluated.
In the HRSD, clinicians and researchers rate subjects, and the higher the point total, the more one is deemed to be suffering from depression. There are three separate items about insomnia (early, middle, and late), and one can receive up to six points for difficulty either falling or remaining asleep; however, there is only one suicide item, in which one is awarded only two points for wishing to be dead. The HRSD is heavily loaded with items that are most affected by psychotropic drugs, and thus it is not surprising that pharmaceutical-company-sponsored researchers use the HRSD in their antidepressant studies. And it is therefore especially damning for antidepressants that even with such measurement dice loading, these drugs routinely fail to outperform placebos.
Even with depression measures that reflect the standard psychiatric view of depression more accurately than the HRSD, there are interpretation problems. Standard depression symptoms such as depressed mood, loss of interest and pleasure, sleep difficulties (too little or too much), activity difficulties (agitation or lethargy), lack of energy, guilt and self-reproach, poor concentration, indecisiveness, and suicidality are not objectively quantifiable in a scientific sense (and weight gain or loss, a standard symptom that can be objectively measured, is routinely assessed via interview -- without a scale or baseline weight.)
Most certainly science cannot accurately quantify the emotional impact of a given trauma on any given person or the love required for healing that wound. And authenticity, spontaneity, compassion, and other variables involved in morale and healing are too subjective to be captured with any scientific certitude. But rather than acknowledging the limitations of quantification, powerful nonquantifiable antidotes to depression are too often simply neglected.
There are many possible reasons for the increasing rate of depression among Americans, but the one important cause is perhaps a culture that demands happiness. The pressure to be in a good mood can make people ashamed of not being in one. This "pain over pain" can then result in normal low moods becoming prolonged bouts of despair.
The unhappiness taboo has dominated the United States since it became a nation primarily of consumers rather than citizens, a gradual process that accelerated with the ascent of advertising in the beginning of the 1900s, and which dramatically spiked with the consumer boom following World War II. The belief that people should be either happy or trying to be happier is a fundamental principle of modern consumerism -- the never-ending search for products and services to bring happiness and prevent unhappiness.
When people label a natural component of their existence as "sick," they run the risk of alienating themselves from a part of who they are, making that component far more problematic than it naturally is. By contrast, when we accept the whole of our humanity, we are often rewarded with greater joy -- and almost always receive increased wisdom about life, concludes Levine.