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Mental Black Lung

© John McManamy

"Has Prozac Nation, in effect, replaced equal justice under law?"

The news coverage of the Surgeon General's Report on Mental Health, released earlier this month, stressed the biological roots of mental disorder. The Report, itself, however, gave great weight to environmental factors. In this third and final of a series of articles, we look at all the elements that underlie the environmental causes of depression:

The brain can sometimes be seen as a drama replicating one's own, mirroring the stress of the outside world and translating the fears and worries and heartbreaks that shape a person's existence into an array of chemical reactions that we are only just beginning to understand.

Certain biological abnormalities may predispose some people to depression more than others, but this still does not explain the whimsical and selective nature of this beast and why it spares one person and so mercilessly savages another.

According to the Surgeon General's Report on Mental Health, stressful life events loom large in depression. For the elderly, grief following the death of a loved one is an important risk factor for both major and minor depression. At least 10 to 20 percent of widows and widowers develop clinical depression during the first year of bereavement.

But just as significant are the 80 to 90 percent of those widows and widowers who escape the wrath of full-blown depression, suggesting that some of the victims may bear more than their own personal loss. According to the Surgeon General:

"The compelling impact of past parental neglect, physical and sexual abuse, and other forms of maltreatment on both adult emotional well-being and brain function is now firmly established for depression."

Research in both rodents and primates shows maternal deprivation stresses young animals and may predispose them to a lifetime of overreaction to stress.

But man is a thinking animal. According to cognitive theories, depression arises from a subjective feeling of helplessness and entrapment. The critical factor is the interpretation of the stressful event rather than the actual event, itself. For example, the Report states, a romantic breakup will trigger a much stronger emotional response if the affected person believes: "I am incomplete and empty without her love," or "I will never find another who makes me feel the way he does."

Adolescent girls suffer from depression in far greater numbers than boys, possibly because they are more socially-oriented and more dependent on positive social relationships. Also, girls may dwell more on negative events than do boys.

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