The Worried Well

I’ve had some bad experiences with recent Quarterly Essays, so was reluctant to pick up the latest one by Gail Bell, entitled The Worried Well: The Depression Epidemic and the Medicalisation of Our Sorrows. So if the following comments are off the mark, I will humbly accept criticisms from readers.

My guess is that Gail Bell, like Richard Eckersley, Clive Hamilton, Tom Cruise, and various other commentators, is arguing that the number of people self-identifying as depressed (and increased use of anti-depressants) is a sure sign that mental illness is on the rise.

But there’s another explanation, put forward by Harvard academic David Cutler in Your Money or Your Life. This is that an alternative explanation is that since the 1980s, depression has been regarded differently – as a treatable illness rather than a moral failing. Cutler attributes this change to the fact that drugs like Prozac work a whole lot better than their predecessor drugs. This theory would also lead to a rise in the number of people self-identifying as depressed.

How can we distinguish the two theories? One way would be to look at suicide as a proxy for depression, and look at long-run trends in suicide rates. If suicide is going up, we’re probably getting more depressed. If it’s going down, it’s more likely that increased use of anti-depressants says more about the drugs than depression itself.

The following chart (click to expand) shows suicide rates for Australia over the C20th. For women, rates have been steadily falling over recent decades. For men, rates rose in the mid-80s, and have been falling over the past decade.

Suiciderates

I admit, it’s possible that we’re getting more depressed, but killing ourselves less often. But it does seem unlikely.

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3 Responses to The Worried Well

  1. Andrew Norton says:

    Andrew – There is probably something to Cutler’s argument, but over the time period in which depression rose objective correlates of depression such as family breakdown and unemployment also rose. I would not be surprised if some of the increase was real. I’m not sure about the suicide indicator, because how do you factor out more effective drugs stopping people getting to the point where they want to kill themselves?

  2. Carol Leung says:

    What about how suicide was considered a sin in the past (no going to heaven etc)? Would that significantly jag the stats?

  3. Andrew Leigh says:

    Andrew, you could be right – though for Richard Eckersley to be correct (ie. underlying depression is rising), Tom Cruise and Gail Bell must be really really wrong (ie. the drugs must be great).

    I think it’s more likely that depression is stable (divorce is stressful, but most divorcees are ultimately happier to get out of bad marriages), and that the drugs are modestly reducing suicide rates.

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