Depression as pain

By Giovanna Pompele PhD

So much talk of disease these days. Depression is a disease. Mental illness is a disease.

The language of disease is soothing: there is nothing wrong with you, you are not crazy, you are not different, you are not “less.” You just have a disease. Like diabetes.

Type 1 diabetes is a lifelong condition: you take your insulin, you are fine (well, sorta: you also have a shorter life expectancy and likelihood of nerve damage, eye damage, etc.). So is the “disease” of mental illness. Nothing to be ashamed of. It doesn’t mean you’re weak, or that someone hurt you. It’s no one’s fault.

So here’s what’s wrong with this lovely, guilt-free approach to mental pain. one: it dooms you to a lifetime of disability. You are a lifetime depressive, bipolar, OCD sufferer, schizophrenic. The disease is here to stay. (I would like to acknowledge all of those who “had” the disease but are now okay: clearly, there are cases in which the disease goes away, unlike, say, diabetes and more like, say, cancer — those useful medical metaphors; but indulge me for a bit and let me simplify things).

Two: you’d better stay on your meds. This presents a host of problems. Like, meds have shitty side effects. Like, you need a mental health professional to prescribe them to you. Like, you may not want to take your meds (they have undesirable side effects). Do you know that, increasingly, you can be made to take your meds? doctors can force you to take your meds and if you don’t take them you can be hospitalized against your will.

Psychiatric hospitals are not the loving, caring places you expect them to be. They are glorified prisons and you get treated pretty much as you would if you were in prison. Why this should be the case baffles me endlessly, but, hey, don’t take my word for it. There are many first person accounts of psych hospitalization. Read Kate Millet’s The Loony-Bin Trip. Read Daphne Sholinski’s The Last Time I Wore A Dress. Read Elyn Saks’s The Center Cannot Hold.

And if your doctor finds you particularly “noncompliant” in taking the medication that is apparently so necessary to the treatment of your illness, he or she can go to court, and, more and more, a judge will put you under court order to take your meds (or run your course of ECT treatment). Go to and click on the “personal stories” tab.

Three: there is no medical marker for mental illness as chemical unbalance. That’s right. none. it’s a good, absolving theory, but it has absolutely no empirical evidence. Read Robert Whitaker’s Mad in America or Anatomy of an Epidemic. Read the pieces published a few years ago in the New York Review of Books by Marcia Angell, former editor in chief of the New England Journal of Medicine. This is not a secret among psychiatrists. They are desperate to find the evidence. But it’s kept secret from you because…

Four: psychiatric medications are top-selling drugs in America. According to IMS Health Abilify, an antipsychotic, is the highest selling drug in the United States in 2014. The American Medical Association and the Pharmaceutical Research and Manufacturers of America are among the top ten lobbies in the country. The USA and New Zealand are the only two countries in the world that allow direct-to-consumer advertising of prescription medication. Ask yourself: why do I “know” that psychiatric illnesses are lifetime diseases caused by a chemical imbalance for which a lifetime regimen of medication is necessary, when there is in fact not a jot of evidence for it?

Five: there is serious evidence that psychotropic medication alters your brain chemistry in ways that make it very hard (and in some cases extremely dangerous) to discontinue it. There is conclusive and observable evidence that, under the right circumstances, antipsychotic drugs can cause irreversible brain damage.

Six, and most importantly: we are doing away with pain. Human pain. Sorrow. Grief. Inner lacerations. Confusion. Loss. Thought distortions that result from the mind’s attempt to adapt to intolerable circumstances. We are doing away with all that. It’s a disease. It’s an illness. Take your meds. (Notice how regularly we use the word “brain” when we really mean to use the word “mind.” “Brain” has become the default terms for the locus of one’s thoughts and feelings. We no longer talk to people: we do brain scans.)


I am not sure what we all mean when we talk about depression. There are some feelings or mind-states we describes as if their commonality between all human beings were understood: love, grief, sadness, jealousy, envy. Depression. But all of these feel so dramatically different to each one of us. Just ask someone to tell you why they love someone else. Allow them to get to the nub of it. Give them time. What they tell you might surprise you. If they manage to come up with anything at all.

So: depression. Depression is a catch-all term for all sorts of different feelings and mind-states. Depression can be profound sadness; loss of meaning; not wanting to live; feeling too much; feeling too little; not being able to get out of bed; not being able to sleep; being unable to eat; eating too much; not being able to move; exercising compulsively. How do we catch in one word the mystery of human pain? How do we dare?

And how do we dare offer clear and final solutions, as if what works for me should automatically work for you?

Why not, instead, listen? Pace the American Medical Association, pain doesn’t sprout in the brain like a fungus, like a virus, like a metabolic disorder. Pain has a history. Our entire culture is hell-bent on making us deny the existence of this history. Don’t over-analyze. Don’t blame. It’s no one’s fault. Nothing happened. I wasn’t raped/abused/maimed/bombed/starved. I’m okay. Stay positive. Don’t go down that path. Think happy thoughts. Go out and take a walk.*

Listening is a scarce commodity. We are all in a hurry. People drown in sorrow but there is no time. I’m not blaming anyone except a culture that is designed to keep us apart. And policy. The cuts to mental health. Imagine a society in which, when life becomes really, really bad, really, really intolerable, you are guaranteed a nice bed in a nice room, paid leave from work, reliable social services to take care of your family’s needs, a professional who’ll sit down and talk to you while you rest and catch your breath and grieve whatever it is you need to grieve. Imagine a society in which long-term, respectful, listening therapy is available and affordable, and professionals of all stripes (we don’t all have the same needs) can sit down with you for as long as you need, without driving you to bankruptcy.

There are countries where this happens. No, seriously. All of it. Including substitutes for your job. Paid substitutes taken from a pool, while you go on paid sick leave. Countries in which the presence of subs is taken for granted so no one complains (no more than that regular complaining that characterizes us as human). Countries in which getting sick or feeling too sad to work is considered as much part of the human experience as being well and ready to take on the world.

We need to refashion our culture’s understanding of mental pain. We need to move away from made-up medical models. We need to move away from the omnipresence of drugs. We definitely need to move away from coercion and fear. And we absolutely need to clamor so that our legislators will copy what Finland, Italy,** and many other countries are already doing without financial loss and with great human gain.

Will people stop killing themselves? Will people stop suffering terribly for myriad reasons? Of course not. It’s all part of the human condition, alongside love, happiness, companionship and a feeling of being accomplished. But we need to put way more energy into helping each other or, at the very least, soothing each other. We need to acknowledge that inner pain exists and make proper room and accommodations for it. We need to staunch the bleeding. Because we are not doing well, we are not doing well at all.***

* Walks are often a good idea!

** i’m mentioning these two countries because i happen to have direct or indirect knowledge of how their mental health systems work.

*** Most of the links in this article are provided by the blog owner. 

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