Age of depression

In social situations and as a psychologist, I am often asked: 'Are you reading my mind right now?' My response is usually something along the lines of: 'Yes, and you ought to be ashamed of yourself.' This usually has the desired effect of lightening the tone of the conversation.

But, actually, I find ignorance or misconceptions about psychology are a chance to think about and defend its usefulness in lay terms. Giving a bare-bones account of the accomplishments of their science is not something you often catch any individual psychologist doing. It is often implied that the very notion of 'success rate', for example, is too crude for any serious practitioner or academic to consider seriously. The mind is so complex, the prevailing intellectual tone suggests, that even number-crunching experimental psychologists cloak statistical evidence in complex descriptions.

Laypeople tend to zero in on the subject of personal problems when they run into a psychologist because they feel that being human and having experienced problems largely qualifies them on the matter. So, it is reasonable that they should want to know whether psychology actually does its job in that domain.

The answer is a conditional yes, but often indirectly. To illustrate what I mean, I will take the mental illness most characteristic of our age and the one I am most asked about: depression.

Depression is 10 times more prevalent than it was a century ago, when anxiety was all the rage. Why the change? Because anxiety and depression are triggered by differing sets of social conditions. Anxiety typically emerges from chaos. Consequently, anxiety dominated in Freud's day when centuries-old values and traditions were being undermined by momentous changes leading up to and following the first world war.

What sets the psychological tone of our day is the struggle for empowerment by the previously disenfranchised, such as women, the poor, immigrants and the disabled. The foremost fight is to avoid feelings of helplessness. So, how well does psychology cope with depression? Only moderately well, according to former American Psychological Association president Martin Seligman.

He divides the symptoms of depression into four clusters. The first is a pessimistic way of thinking. The second is a negative, sad and irritable general mood. The third concerns behaviour, like passiveness and indecisiveness; and the fourth is somatic symptoms such as loss of appetite and lethargy. To be clinically depressed, you need to have symptoms in all four areas.

Clinical depression is severe depression that requires treatment. The prevailing view is that 'normal' depression - the sort everyone has felt at some point when things are not going well in their lives - is qualitatively distinct from clinical depression, which is an illness.

But others believe that the distinction between the two is simply one of degree. Whether a person is labelled as depressed or clinically depressed may depend on cultural norms, on a particular therapist's diagnosis, on how comfortable a person is about seeking psychological help or - of course - the scope of a client's medical insurance.

Dr Seligman sees depression as less deeply rooted and, therefore, easier to change than, say, alcoholism, but harder to fix than relatively curable troubles like sexual dysfunctions or phobias.

Statistically, researchers claim that electroconvulsive shock treatment is far more effective than popular therapies, such as cognitive therapy, to relieve acute depression. But it has some side effects and a creepy reputation. Cognitive therapy works best on depression based on severely distorted beliefs, which are fairly easy to dislodge - with no side-effects.

In a nutshell, then, psychology has had moderate success in finding ways to treat severe depression. One of its most important roles has been to help 'normalise' depression, making it possible for people to feel less shame or guilt about feeling depressed. This has helped facilitate open discussion and made more available effective ways for people to cope with severe and milder versions.

However, if depression really is a response to the zeitgeist of the day, psychologists can only hope to treat its symptoms and help people recognise and put them into social and personal perspective. A pretty depressing thought in itself, perhaps, but more realistic than the hope of any definitive 'cure' - a word which deceptively characterises depression as a medical problem at the cost of considering how embedded it is socially.

Jean Nicol is a Hong Kong-based psychologist and writer