To think the high levels of anxiety and depression we experience is down to loss of community?

[joogle]

As in humans are 'designed' to live in communities/tribes and nowadays a lot of us live very solitary lives, getting a large portion of our input from the internet or the telly. I guess this is also why mumsnet does so well, our own cyber community.

I reckon the lack of social interaction (and generally just being around others and extended family) is responsible for the rise in depression and anxiety, especially affecting people when they need their tribe the most, i.e. post natal women and the elderly.

Is this an unreasonable conclusion and if not what can people do to minimise the isolation apart from joining a commune?

Depression is a chemical imbalance in your brain

That doesn't appear to be accepted as being quite as clear cut as it used to be.

Bad Science

I absolutely promise i am not coming at this in a (currently fashionable) "anti psychiatry" sort of way. If there was a worldwide shortage of lithium and anti depressants I would be the first stockpiling for the rest of MIL's natural life, gibbering in terror if I thought we didn't have enough.

But there does seem to be some discussion about the validity of the "chemical imbalance" hypothesis and the quality of the evidence to support it.

I live in a gated community private estate in the middle of the countryside. It was built in the 70's to make a community with a range of houses from a few small bungalows, mews to massive houses. We have to pay a maintain e fee annually (£500) and have a free indoor pool, squash courts, tennis courts, cheap bar and park. It works really well as there are loads of clubs- from book clubs to tennis ladders and the older residents are very active (indeed the majority of the residents are the origional inhabitants)
We organise coach trips to the theatre etc which helps people mix etc
Yes it can be annoying ( everyone knowing your business, talking to neighbours for ages when your in a rush) but it really works!

Goodness me, fastweb, I am to read that! Very interesting! I love Ben Goldacre - I feel a bit of an idiot now :)

Surely there are different types of depression - chemical imbalancy type ones, reactive ones (cos things are shit), and a combo.

Also about this golden age of community stuff. People often hark back to the war/postwar period as a time when community thrived, and examples where people are poor (but not "about to starve" poor) and are tight knit. People come together in the face of adversity. It gives people something to talk about, a reason to talk to strangers, a shared goal, a sense of all being in it together and needing to pull together to get through.

Being at war or in a shattered postwar situation (thinking the situation for UK after WW2, not the situation for other types of conflicts) seems to bring out the best in people. Ditto if eg there's a big fire or an axe murderer on the loose or the local hospital is shutting down or whatever it might be.

In the UK not a lot ever actually happens - we don't have much in the way of extreme weather or people attacking us here or forest fires or anything really. We are all quite well off comparatively and we have the NHS and free schools. People who are struggling are stigmatised rather so people don't tend to pull together with them and we have the welfare state which salves the national conscience. So there's no need for this mass group all working together stuff.

If we want everyone to feel together then maybe we need a good natural disaster or for someone to blow us up or something. But of course that would be a bad thing.

Maybe this low level dissatisfaction / feeling not part of a community is the price we pay for being safe and prosperous?

Just thinking out loud really so feel free to rip that to shreds!!!

you can have depression without a chemical imbalance but it usually has a known cause; whereas depression without a known cause is more than likely caused by a chemnical imbalance.

Yes that's what I thought thumbwitch.

Although I imagine that there are people with imbalances who also have an obvious reason, and people with no obvious reason but there is one knocking around somewhere really IYSWIM.

Can they diagnose the chemical imbalance through blood tests or similar, or is it worked out through other ways does anyone know? I mean, do they look at a brain scan and say "look! an imbalance" or something else concrete or is it inferred from other not so concrete things?

I feel a bit of an idiot now

Oh you are absolutely not an idiot love, well not unless I am too.

I was wibbling on at MIL's psych not so long ago about chemical imbalance (cos that was given as the definitive answer for quite a long time so unsurprisingly, I thought it was true) and he told me that thinking was changing. If we hadn't had that conversation I'd still be totally unaware that things weren't so cut and dried as they used to be presented.

Keeping up with changes in medical thinking is something that happens to me by accident rather than design (=

Can they diagnose the chemical imbalance through blood tests or similar, or is it worked out through other ways does anyone know? I mean, do they look at a brain scan and say "look! an imbalance" or something else concrete or is it inferred from other not so concrete things?

MIL, who has severe bipolar 1 and suffers from long lasting bouts of crippling depression to the point of becoming catatonic sometimes, gets regular blood tests. But I think more to check various levels because the cocktail of psych meds can have really bad side effects, so they have to keep an eye on what changes are going on so they can act if things look iffy.

She has had several brain scans too, but again they were looking for other things, like Parkinson's and dementia, which both showed up.

I don't have a great deal to do with the medical side of her condition, that's BIL's role, but it doesn't half look to me like the method is trial and error with various drugs that are deemed worth trying depending on her mood and behavior. Which can be a tad hit and miss to say the least.

I wish there was a depression\mania home kit that was the equivalent of the way we manage the diabetes meds with a little blood sugar testing machine.

@ 'home kit' - thank goodness there is NO such thing; can you imagine the testing that would go on?!

Re chemical imbalance: there is so much not understood about depression. There is clearly a difference between unhappiness and depression although depression can get triggered by Life (reactive) or just happen out of the blue (endogenous) - or is it out of the blue?? Or for some reason we do not know to look for?? I don't know and am no specialist or scientist.

There do seem to be 'happy' people in life and 'unhappy' ones - the 'happy' ones seem to get on with whatever life throws at them; a trait that might be at times annoying for others, but v useful to get you through Bad Things happening.

Re aspiration: it is so difficult to know what is ill-making 'keeping up with the Jones's' and what is positive ambition and drive, isn't it? Not sure where to draw the line, TBH - I suppose, if you are happy you must be doing something right, whether you are pursuing riches and fame or whether you are slobbing about .

I know there is science challenging the chemical imbalance in the brain theory for depression. But I thought bipolar with psychosis was still seen as physiological causes alongside a trigger of adverse environment, stressful situation, etc. I thought it was viewed this way because people with serious bipolar don't get better - although it can be well controlled. Basically you will have it until you die.

It's always going to be about individual experience. I have suffered far less from social isolation as an adult than my mum did when she was my age and bringing up her children in a different town from the one her family lived in.

But neither of us suffered as badly as my great-aunt (stuck on an isolated farm with her claustrophobic and controlling family). I have recently read extracts from her letters from the early 20th century: this was a woman who was unhappy and knew it.

One thing one always forgets is that not everybody liked the close community they found themselves in- and it was far less easy to get away in those days when there were fewer opportunities to train and have a career. My granddad firmly resisted all attempts to make him come home and take over the farm because he'd hated living at close quarters with his family. His sister didn't have a choice because women didn't in those days. Either someone came and married you or you stayed with your parents. And one daughter was usually expected to stay with her parents to look after them in their old age quite regardless of her own preferences.

From her letters my great-aunt knew this was unfair- but there was nothing she could do about it, not unless she wanted to run away and end up on the streets. In other words, she had a standard to compare herself against- if I had only been born a man I could have got out of here....

She was severely depressed for much of her adult life and developed dementia quite early. I am glad I am not her.

Also, there was far more movement for work reasons in earlier generations than people realise. I have been doing dh's family tree back to the 17th century- and surprisingly they don't often stay in the same village for more than a generation or two. But people had less choice in those days, most couldn't choose their careers- and of course there were far less ways of keeping in touch once they'd had to move.

In my generation, at least I could decide what I wanted to do in life. If I did not like the place I lived I could have a decent chance to move and do something else somewhere else. Thanks to modern technology and cheap travel I can also keep in close touch with my family and any friends I care about retaining. Even the last few decades have made an enormous difference: I remember what it was like to keep a long-distance relationship going when international phone calls were an unaffordable luxury.

can you imagine the testing that would go on?!

Oh I can (=

MIL also has OCD and one of the things she can get obsessive about is testing her blood sugar. I'd imagine any chemical imbalance kit would get much the same treatment. But so often we have no idea that things are about to take an up or down turn that I kind of long for a way to see the writing on the wall before it happens, so we can try to adjust the meds before it goes completely out of control.

But I thought bipolar with psychosis was still seen as physiological causes alongside a trigger of adverse environment, stressful situation, etc

That is one possible explanation we've heard. But we've also been told it might be genetic. And chemical imbalance gets bandied about as well. With quite a lot of "we don't really know, could be any of the above or a combination of some or all of the above" chucked in for good measure.

It could be MIL's bipolar is organic, possibly something genetic (looking at the family history, her older brother has a milder version, by all accounts her mother, her maternal grandmother and maternal great grandmother had it too), or a result of her upbringing, or a bit of both. There was enough dysfunction to sink a battleship going back for generations to justify that idea. But was the dysfunction the cause of the illness running in the family for generations, or was the illness the cause of the generational dysfunction ..?

Of course it must have been nice for my greatgrandparents not to have to be isolated in their old age, to have somebody stay at home and look after them, and for their life not to change as they grew older. But it means there was one person -my great-aunt- whose whole life was sacrificed to that. And by all accounts, she was not a particularly pleasant person to be around as she herself started growing older.

I think it has a lot to do with the media/tv/advertising/entertainment/films. They create a false level of expectation: people expect that their life will be like on the telly. And when it's not, they are sad.

Obviously, it's not quite as simple as that. But I certainly think it plays a part. And yes, I do think less social contact can be a problem.

depresion/anxiety as a purely organic/chemical imblanace problem is a dead duck theory. I know that all the people who are heped by the service I work for would love it to be true becasue then they could simply pop a pill (or the right combo of pills) and then voila... no more depresion/anxiety...
Like anything to do with our minds (actauly like most things to with our bodies actauly) it is a complicated interaction between genes and environment. The genes build proteins in out brains and they can cause a susceptibiity to depresion/anxiety, then the environment kicks in... this can be stress related (ecenomic stress, relationhsip strees) be developmental (parental abuse leaves you vulnerable to depresion) and a number of other things. The two interact and it's a different interaction in each individual. I can't remember the exact stats but the heritability of depresion (ie how much on average is down to genes, thus an unaviodable biological/chemical process) is around 30% (more for women). What is also clear is that environmental factors can also cause changes in your brain chemistry....
So in answer to the original OP, mmme maybe, but as a part of a much bigger more complex interactional process...

My suspicion is that PND and the depression suffered by parents of babies / small children is sometimes/often situation rather than organic. The number of people I know who have really struggled with it all - including myself - people who have always been quite cheerful and just got on with it types. Some people have been miserable and for some this had tipped over into what might be depression.

I think that it would be pretty unthinkable though for it to be announced that having babies can make women miserable to the point of depression and worse. The idea that it's hormonal imbalances and whatnot make it easier to deal with IYSWIM. I'm sure some of it can be imbalances... but how much is situation? We don't know do we.

I found it very interesting that depression, while its close to 25% per year in the UK, is much lower in other countries - below 10% in Germany and Spain.

Apparently its very closely related to the level of inequality in a society, and also the set of values that allow inequality to thrive; valueing material possesions and wealth highly, allowing money to determine social status, causing distress to those who dont have much.

It creates bitterness and shame, envy and fear. This results in low levels of trust and weaker community life.

I'm not sure that they are the things that allow inequality to thrive, are they? I thought that inequality in our country was due to wage disparities, regional differences, failure of governments to effectively redistribute, that kind of thing. The things that you list I would see more as the results, the symptoms, rather than the cause.

Sardine - its sometimes difficult to distinguish cause and effect. Eg, tory values will mean damaging policies which increase inequality are put into action.

The things you mention would also contribute to increase inequality and therefore increase distress levels in society.

erm..isn't france reportedly more miserable than anywhere else in Europe?

though cross-border comparisons seem a bit weak - the diagnostic system in each country is v. different.

Surestart anyone? Cuts?

Nope, France has lower levels of depression than the UK too.

The US has higher levels of depression.

The data on this was collected by the World Health Organisation, and therefore is consistent and comparable across countries.

I don't think it has a hell of a lot to do with social isolation I think people don't have to ever COPE with anything anymore without expecting a hand up from someone or other - the people who I see who are depressed have lots of different reasons as to why they are depressed - some I look and think bloody hell am surprised you haven't jumped off a bridge and some I think FFS is that it, is that all you have to cope with, is that all that is getting you down?

I think it was always the same, MadameCastafiore. Some of the medieval people I work on are the same, expect a lot and get depressed easily; others, like some people I know today, get on with it. Drama queens are not an invention of the 21st century.

Depends on your definition of 'depression:

• ?nr of people taking antidepressants (no surprises there that the US as 1st )
• ?nr of self-reported 'depression'
• ?nr of people receiving specialst care for depressive illness

Or any number of other possible criteria.

And then there is the whole subject of discontent etc. which IMO is related to social circumstance.

If I had a penny for every person I see (I am a GP) who on top of having fairly significant depression feels even worse because they don't feel they have the 'right' to be depressed: "I have a lovely life/house/DH/DCs/foreign holidays etcetc, how dare I feel like this?".

I do think it is most likely that it will turn out that a lot of mental illness is due to a complex network of genes, environment, social factors and bad luck or somthing as difficult to quantify as that.

Also IMO there is a huge difference between absence of mental illness and mental wellbeing ie I am sure I never had PND, but I struggled a lot in the first year of looking after all of mine, so was certainly at times quite discontented and unhappy, but never ill.