Under the Chairmanship of its founding father Jeff Kennett, Beyond Blue, the hitherto respected initiative, has been highly successful in countering the stigma attached to a diagnosis of depression.
Recently the organisation and Kennett seemed to have come to a fork in the road. There was an outcry and calls for Kennett's resignation in the wake of his assertion that only children in the care of heterosexual parents could achieve optimum mental health.
Despite being criticised as alienating and exhibiting bias against the gay community, Kennett was re-elected by the Beyond Blue board.
Nonetheless this controversy should not eclipse more important questions. After ten years of good groundwork, do we need something new from Beyond Blue and other key mental health institutions?
According to the World Health Organisation, depression affects 'about 121 million people worldwide', is 'among the leading causes of disability worldwide', and, although it 'can be reliably diagnosed and treated in primary care', 'fewer than 25 per cent of those affected have access to effective treatment'.
Beyond Blue and the current zeitgeist has largely been identified with the medical disease model. Treatment has favoured a limited number of sessions — six to 18 sessions under Medicare, now reduced to ten. It has promoted a cognitive behavioural approach plus medication.
There are strengths and limitations in this approach.
The promotion of understanding, removal of stigma and encouragement to seek help requires the countering of stereotypical and unhelpful attitudes. In the bad old days those suffering from debilitating depression have been regarded as having character or personality flaws. People in a depressed state often have been judged as lazy, unsociable, and just not willing to make an effort.
It has therefore been necessary for Beyond Blue and similar groups to package a fairly simple message. The disease model is readily understood and has been progressively less imbued with moral condemnation.
However the one-size-fits-all view can foster problematic misconceptions. The notion that mental ill health is a bundle of symptoms and neurological processes can exclude the full range of human distress. Depression is not always readily or lastingly addressed by current approaches, and may remain intractable (in 20 to 40 per cent of cases, according to WHO).
How does this fit with the intimations of 'cure' implied by the statement that 'depression is treatable'?
The highest price paid for depression is suicide. Suicide Prevention Australia has emphasised the importance of social inclusion, having a sense of belonging, and feeling part of a community as being crucial in the reduction of suicidal depression.
The notion of inclusiveness captures the importance of paying attention to the anguish that may be engenderd by being part of a marginalised group, such as same-sex attracted groups, displaced persons, Indigenous peoples and people from diverse cultures.
Culturally sensitive, humanistic, spiritual and longer-term psychotherapy may have much to offer those afflicted.
Esteemed clinical psychologist Dorothy Rowe cautions against an oversimplified view of depression. In her view, the real problem arises from some kind of threat or insult to the sense of being a person. 'This can be hard to uncover, and difficult to ameliorate. It is never amenable to a quick fix.'
In Rowe's view, unprocessed sad events that become imbued with self blame and guilt can become depression. She emphasises the importance of truly hearing the person's story and their experience. This takes time.
The current disease models run the risk that sadness, mourning and grief may be unrecognised and treated only as symptoms. And the problem with the notion of eradicating and preventing depression as though it was a viral disease, is that it sidelines the 'human factor'.
One of my clients, a young woman aged 22, had been prescribed anti-depressants when her father was diagnosed with cancer. When he died two years later and she was referred to me, I suggested that her medication should be reviewed.
She told me of her session with the psychiatrist who had prescribed the medication. 'He asked me a lot of questions, was writing a lot but didn't look at me. He said "You are not saying much" and that he thought I was resistant. He said "You don't want to be here do you?" I said, "My father died four weeks ago!" He didn't even say "I'm sorry" or something normal like that. He just went on writing.'
We are all born to wrestle with the indisputable existential realities of life. We all suffer innumerable losses, and we all eventually surrender die. Depression is a state of mind that is reductionist. Its amelioration will thrive on expansion of our collective understanding.
Lyn Bender is a Psychologist and a former member of the Suicide Prevention Australia Board.