What our Study Told Me

24 comments

In my original post summarizing our study of medication at Kenyon, I included just enough of “me” to ruffle some feathers without adequately explaining myself. I felt that simply putting out the statistics that one in four Kenyon students have a prescription for an anti-depressant, and that one in three had used study drugs, among other things, wouldn’t get people thinking. This was especially the case given the fact that, as I pointed out, we implicitly knew those statistics already. I was shocked at the levels of anti-depressant prescriptions we found (I was expecting high reported levels of ADD/ADHD medication use, both prescribed and non-prescribed); I wanted to take a stab at why I thought I found them, and why my findings should lead us to do some serious soul-searching about the way we live our lives. I should have either said more or nothing.

So here is more:

I found it particularly interesting that my points concerning ADD/ADHD medication went essentially unchallenged while similar points concerning anti-depression were described as “highly offensive” “illness shaming.” Because of this, I will talk about depression, although most of these points are transferable to ADD/ADHD.

I think that we live in a culture that tells us we have a right to be comfortably happy, and that children of high-achieving parents live in a culture that tells them that they have a right (and responsibility) to be a good student. We’ve been told since we were two years old that everyone is equally special, and we’ve been told since we were five years old that we, in particular, are rightfully above average. The moment we don’t feel special anymore, or the moment we don’t feel above average anymore, we aren’t told that it’s okay; we’re told that we have a problem, a problem that can be solved with medication. And I think that there is something seriously problematic with a culture that sends these messages as they are, by definition, mutually exclusive. If we are going to have a serious conversation about our prescribed lives, one of these cultural axioms is going to have to give.

I think that medication such as Prozac and Adderall are supposed to be last resorts. Taking them comes with serious side effects, not the least of which is dependency, and even many who need such medication to function decide that the negative side effects aren’t worth the benefits. While there is no doubt that they do a lot of good for the people who really do need them, since when do one in four people revert to their last resort for anything? But when we are bombarded with ads for Prozac and Vyvanse on a literally minute-by-minute basis (I can’t watch anything on Hulu without seeing seven ads for Vyvanse per episode) and are surrounded by our friends, parents, teachers and doctors who, with the best intentions, tell us that we don’t have to feel the way we do, is it any wonder that what is considered a last resort becomes a second or even first resort? It is any wonder that the awkward phase in high school becomes a medical condition?

The funny thing about rights is that they define our terms for the way the world “should” be. If I have a right to be happy, but I’m not, then something is inherently wrong with the way that the world is working. If I’m supposed to be doing well in school, but I’m not, then clearly there’s a problem outside of my lack of interest in Social Studies that is causing the world to be out of whack. It would appear that we, the budding American elite, can’t be unhappy and can’t under-perform. We are self-defined joyful overachievers who sometimes need help self-actualizing.

*At the risk of offending those who actually do have a chemical imbalance irrespective of circumstance and are predisposed to feelings of depression, THIS IS A GENERALIZATION. And, to address a pet peeve of mine, “generalization” doesn’t have to be a dirty word.*

When I was diagnosed with situational depressive disorder early this semester after an excruciatingly rough week that involved a romantic tragedy of epic proportions, I found myself thinking exactly that: my life was “supposed” to be different because I was “supposed” to be happy. But, after a while, I started sleeping regularly again, got my appetite back and accepted the fact that I was going to be unhappy for a bit and that was just the way things were going to be. Emotionally, I was a wreck: I couldn’t focus in class, I lost interest in the things that made me happy and I felt like nothing would ever get better. But, biologically, there was nothing inherently wrong with me. I let myself hurt, and then I let myself get better. Life is supposed to suck sometimes.

But when the American Psychiatric Association prepares to modify its guidelines for diagnosing major depressive disorder to include feelings of depression brought on the by death of a loved one within two weeks of the loss, it encourages us to see hardships as medical conditions. You should feel unhappy when you lose a loved one. That’s natural. The idea that such feelings constitute a disorder is, to me, distressing.

And what makes me so certain that this is a cultural phenomenon at least as much as it is a medical one is the feedback I have gotten from international students. Practically unanimously, they have described their amazement at the pervasive use of medication among American students, usage levels that are unheard of for them. Like me, they didn’t realize when they first got here that there was a pill for literally any mental hurdle you could come across. And before you stop me to say that our lives are harder or more stressful than those from abroad, ask yourself whether life in suburban New York or rural Ohio is really that difficult compared to places that, in some cases, have been struggling to provide basic services and civil liberties for their citizens for decades. Being happy is a preference; it isn’t a right. If you don’t believe me, ask someone who isn’t from this country.

But let’s say I’m wrong, and that each and every prescription filled out for an anti-depressant is completely necessary. Then look around New Side and tell me if two people at every full table (one each at the wall tables) has a chemical imbalance that, after all other options have been exhausted, a prescription is necessary to remedy. Then, tell me that there isn’t anything wrong with that, and that this is “just how it is” at a liberal arts college with a competitive admissions process. If this is the case, it is perhaps even more indicative of something being seriously wrong with the lifestyles we have been told to lead. If getting into a school like Kenyon can’t be done without tripling your chances of picking up a prescription for anti-depressants along the way, maybe we as a culture should re-evaluate the premium we place on being above average.

At any given point in February, it wouldn’t surprise me if a quarter of the student population had the Krud; I find it incredibly hard to believe that such a proportion would, or should, exist for a psychological disorder. As I mentioned in my previous post, a proportion that high calls the use of the word “disorder” into question. If a quarter of Kenyon students really are depressed then our depression isn’t a disorder, it’s an epidemic.

24 comments on “What our Study Told Me”

  1. Wow. I’m guessing Jon’s last post was the most trafficked and commented in TKO’s internet-era history. Fine job striking that nerve!

  2. People mentioned on the other post that there are some other things to consider – that perhaps depressed people are more likely to choose kenyon or schools like it, and that perhaps kenyon makes people depressed. Another issue is that less than a quarter of the student body took the survey. This, I’m sure, is pretty good for a survey like this, so I’m not saying no results can be drawn from it, but we have to remember that there was a self-selection bias at work here. It is entirely possible that people who do use antidepressants etc were just more likely to choose to participate in this survey, maybe because they saw that it was about medication and though they’d have valuable information to contribute, or maybe for some other reason. So this sample isn’t random and probably not the best representation of kenyon’s student body as a whole, for whom rates of diagnosed depression could be significantly lower.

    You probably couldn’t have done anything about the small sample size, just something to remember. I know you’re not a psych major but it’s a pretty important factor to consider when doing research like this.

    1. This is a really good point. Not only is the Kenyon community not reflective of national statistics on mental health, survey participants aren’t reflective of the Kenyon community.

      1. a funny note on our sample:

        we first sent the link out over allstu the first 100-150 responses we got showed WAY higher rates of medication, 50/50 for study drugs, nearly 40% for anti-depressant prescriptions. Then, Josh sent the link out to the residential listservs and the next 100-150 responses we got sent the numbers way down. the last “wave” of responses, the ones that came in at the end of the week the survey was live for, didn’t change our numbers all that much.

        There’s no doubt that selection bias was taking place with our first 100-150 data points, but I’d argue that a lot of that was ironed out by leaving the survey open for as long as we did and hitting the residential listservs.

        also, i’d be more than happy to send out our demographic data showing that we had a very representative distribution of male/female, income level, class standing, etc. in fact, the only group that seemed underrepresented in our sample was smokers, which correlated with study drug abuse. arguably, had we had a representative sample of kenyon’s smoking population our numbers with respect to study drugs may have been even higher.

  3. i respect that you have an interesting sociological perspective on the prescription drug culture in the US. however you really have to be careful about how you frame these issues in opinion articles like this. i don’t think it’s fair to refer to anti-depressants and other medications as “last resorts”. you seem to be inferring that issues like depression, anxiety, and other mental issues have been “created” by society. in some cases, you may be right. yet there is widespread evidence that these issues are not new or novel, look at historical figures if you doubt it. we have developed a way to help people who could otherwise be struggling their entire lives with something that affects you all day, every day, in everything you do or try to do but can’t. it’s dangerous to assume that most individual cases are false or over medicated because you’re putting individuals who do take these medications in a sort of “out group”. there is nothing wrong with accepting help in the form of medication and your tone repeatedly suggests that you see those people as shameful or weak/entitled for doing so.

    1. “there is nothing wrong with accepting help in the form of medication and your tone repeatedly suggests that you see those people as shameful or weak/entitled for doing so.”

      ^ yes. thank you for saying this.

    2. “*At the risk of offending those who actually do have a chemical imbalance irrespective of circumstance and are predisposed to feelings of depression, THIS IS A GENERALIZATION.”

      I do not believe John is saying either a) depression or other mental illnesses have never existed/have been “created” by society, or b) people who deal with issues of depression and anxiety are weak individuals who shouldn’t need medicine. I think he is most afraid of the upward trend in the diagnosis of depression, ADHD, and other mental illnesses:

      “But when the American Psychiatric Association prepares to modify its guidelines for diagnosing major depressive disorder to include feelings of depression brought on the by death of a loved one within two weeks of the loss, it encourages us to see hardships as medical conditions. You should feel unhappy when you lose a loved one. That’s natural. The idea that such feelings constitute a disorder is, to me, distressing.”

      When the DSM V [all American psychiatrists/doctors use it to diagnose mental illness] includes a clause where grief becomes a disorder, that isn’t ok. Jon and I are not alone in thinking this:

      “For example, a study using data from the National Epidemiologic Survey on Alcohol and Related Conditions showed that persons who had a bereavement-related depressive syndrome at baseline were no more likely over a 3-year follow-up period to have a major depressive episode than those who had no lifetime history of major depression at baseline. In contrast, subjects who had had an episode of major depression at baseline were significantly more likely to have a recurrence of depression during the 3-year follow-up than those without a history of depression or those who had only had bereavement-related depression.” (Source: http://www.nejm.org/doi/full/10.1056/NEJMp1201794)

      However, Jon, read this footnote on the page:

      Editor’s note: On May 9, 2012, the APA announced that although the bereavement exclusion will still be eliminated from the definition of major depression, a footnote will be added indicating that sadness with some mild depressive symptoms in the face of loss should not necessarily be viewed as major depression.

      Still, this does not erase the point Jon, myself, or the article are trying to make: while it is good to seek help during times of need, these medications should be used ONLY when needed. They are very, very dangerous, and if the grief or depression is not prolonged and chronic, why subject yourself [general ‘you’, not singular] to a life of daily pill regiments, horrible side effects, and social stigma? I would give anything to not have those three things be a part of my life [I suffer from Bipolar, ADHD, and on the OCD spectrum].

      Basically, I think we all agree with each other, just that you thought Jon was attacking you. Happy ending!

  4. I think there is something very revealing about this article:
    You use the term ‘depression’ in a very stylized manner. As someone who has major depression, whose sibling had/has depression, whose best friend suffers from depression, I don’t believe what you describe as being treated is depression (I’m not saying ‘you’ as in your experience, but your comments on hardships, achievement, etc). You’re working on the idea that what the world treats as depression is a profound unhappiness due to certain specific events or not living up to expectations that affects concentration, enjoyment, etc. I guess you can say depression shares those traits, but it’s much, much more. Being prescribed medication for that kind of thing makes no sense, especially time wise, medication takes at least 2 weeks to truly kick in, plus finding the right drug and fiddling with the dosage.

    I linked your last article to some of my friends at different schools who have depression, and we got to having a conversation last night. None of us have ever heard the term ‘depression’ being used as lightly as people apparently use it today. It’s not something just talked about, thrown around, culturalized. You don’t get get meds, take them, feel better, and are done. The idea of being treated for the ‘awkward high school phase’ is both disturbing and unknown to us. When people start using the word ‘depression’ for cases like that…that’s when it becomes dangerous–when the world is over-medicated, when people dismiss those who truly need ‘drugs’ to continue living, existing. Perhaps we’re naive, we decided, for not realising how the idea of depression is viewed in the ‘outside’ world, but then, depression isn’t really about the *word* depression for us. It’s about something else.

    I talked to my psychiatrist about the DSM-V, and he acknowledges the changes can be viewed as problematic, but it’s all in how the psychiatric world interprets the diagnosis criteria–and that’s what’s important. Medications for depression are only prescribed (in responsible situations) when nothing else is helping in the long term. Long term being the key phrase. Most psychiatrists (as I have been informed) don’t prescribe unless you have months upon months of experience to go on, until you have talked and analyzed and prodded for much more than one hour, five hours, seven hours. Or at least the highly responsible ones do. Look, I’m just repeating what I’ve been told by my psychiatrist , but it’s what should happen in the best case scenarios. The problem is, people don’t exist in those scenarios. If you’re at a college like Kenyon, can you really get the treatment you need? I’m sorry counseling center, but no. If you’re in a big city, you have places to go, you have choices of who to see, but most small college centers are not well equipped to deal with certain cases.

    Okay, and that was a long ramble in places, but I just thought I should finally respond to one of these articles.

    1. With all due respect, while your psychiatrist may be talking about his/her practice in a credible fashion, the mass of mental health care in this country is not set up this way in the slightest. The largest prescribers of psychiatric meds are general practitioners who, while obviously qualified medical practitioners, are not specialized in the overall care of mental health issues. Institutionally our cultural is set up to pass along responsibility for mental health care to the least trained and therefore least expensive practitioners. For example, the major state university I work at (I’m a clinical psychologist, btw) employs 3 psychiatrists a total of about 18 hrs/week for a student body that closes in on about 30,000. Out of necessity, “simple depression” cases are passed down the chain to one of the 3 or 4 nurse practitioners that are employed full time. NP’s are very competent, but again, not often trained specifically in mental health care (or at least our are not).

      Two other key parts of this discussion, in my opinion: 1) the medicalization of deviance and 2) the avoidance of other forms of full-person growth and recovery in mental health care. Point 1 I thought was raised sufficiently in some of the discussion, with the main question being around where does one draw the line with emotional/psychological experiences that are considered “deviant” from the norm. Of course this begs the question of what is normal to begin with, which is opens a quagmire of discussion, particularly in the world of liberal arts study. I share the concerns noted about the next generation of the DSM, in that it will be quicker to diagnose individuals and then hand them a pill. Big pharma’s involvement in creating the next version of the DSM has only fueled these concerns.

      Point 2 from above is one I hope others will raise more in future discussions. Our current mental health care system was in large part birthed by Freud’s development of the “talking cure” over 100 years ago. Feelings about Freud’s theories aside, the aspect of personal growth and recovery as available through a disciplined and consistent course of self-study and analysis seems to be at a nadir in our culture currently. Yet, as brain studies continue to show, the possibility of achieving long-lasting rewiring of the brain through insight, emotional processing, and behavior change, is real and compelling force that is often overlooked in people’s approach to mental health care.

      1. “NP’s are very competent, but again, not often trained specifically in mental health care (or at least our are not).”

        ^ And thus we get to the heart of the problem with prescribing. These type of people shouldn’t be prescribing meds for mental health care. Period. It’s irresponsible and dangerous. I don’t care how well trained you are in other aspects of medicine. If you don’t have specific training in mental health care, don’t dabble in it. Just don’t. I don’t care if it’s your job, if you’re ordered to do it, whatever–ethically, when doing this you’re putting people’s lives at risk.

        “…[T]he possibility of achieving long-lasting rewiring of the brain through insight, emotional processing, and behavior change, is real and compelling force that is often overlooked in people’s approach to mental health care.”

        While that may be, it takes a long time to rewire the brain. That’s not feasible for someone in a serious situation. Do it as you take the meds, fine, but for many people it can’t work by itself.

        I would reply to more of your comment, but I’m rather pressed for time right now. (I apologize if this response seems rather pointed and sharp.)

  5. “If getting into a school like Kenyon can’t be done without tripling your chances of picking up a prescription for anti-depressants along the way, maybe we as a culture should re-evaluate the premium we place on being above average.”

    Why are you assuming that Kenyon students taking antidepressants were prescribed them during their time at Kenyon?

    I honestly think that you are using terms such as “disorder” and “depression” incorrectly and very loosely. Frankly, on a topic like mental health with the high potential for misinformation, misunderstanding, illogical generalization, and offense, one should leave the sweeping statements and conclusions to the professionals. Although I found the survey results interesting in the data they provided, you probably shouldn’t have tried to analyze the data or draw conclusions from it– that seems to be where the trouble started.

    1. That sentence refers to the lifestlyes we lead before we get to college. If anything, I’m assuming that these prescriptions are being written before we get here, not after.

  6. Jon,

    While I think your research has produced some interesting results, and certainly merits further study, it seems to me that you need to decide whether you want to be a journalist or a scientist in this instance. Putting aside the many strong opinons that people have shared, I dont think it was appropriate to meld an initial report of findings with an opinion article on public health. As a scientist, it is your responsibility to report data that could be of value to the research community. As most of us with research experience know, it is customary to then draw some conclusions about the implications of one’s findings as well as to point out directions for further study. Often times we learn about new research through news articles, and these typically include some element of value-based judgement of the findings. At this point, it becomes an issue for the public to debate, whether or not it be scientific in nature.

    When one decides to share their work with the public for the first time, it is crucial (to maintain the integrity of the scientific process and keep focus on the issue at hand) to avoid blurring the line between thoughtful conclusions and value-based judgements. No doubt you can see the results (in the expanding comments section) of your interpretations on this page in that the focus frequently strays from what is important here: your research has shown some potentially concerning aspects of college society and further research should be done in this area.

    TLDNR: Interesting study. Separate this into two pieces: an initial report of findings, and (if you want) a subsequent opinion article on the public health implications of your research. Blurring the line between these two takes away from the credibility and potential value of your research.

    1. Quickly passing over the obvious point that this is all taking place on a college op-ed blog and is therefore unlikely to be mistaken for a professional scientist’s findings, I’d like to point out that all research is subject to bias and Jon was responsible enough to include his bias up-front. The data itself is still credible and valuable whether accompanied by his conclusions or not; while less elaborate than the scientific process you expect of the psych research community, it still confirms with impressive numbers and a diverse sample size what any (truthful) show of hands in our classrooms would reveal, and contextualizes the anecdotal evidence that Jon’s hypothesis was inspired by. His conclusions are then reasonably based on his testing and retesting of the premise.

  7. The issues with your research methods and the conclusions you drew from your data have been pointed out by others, so I won’t bother typing them out. The main issue I want to bring up is your readers. In your article, you state that 23.4% of respondents reported having a prescription for antidepressants, and that about 70% of those people take these medications on time or most of the time. How do you think those people felt when they read your article (as most of them undoubtedly have by now) and were faced with words such as “there’s a fine line between having an awkward phase in high school and having a persistent clinical disorder – a line that probably isn’t crossed as often as we think it is” and suggestions to spend more time “talking out” our depression? I did not respond to your survey, but I am diagnosed with moderate to severe clinical depression and am on antidepressants. Reading your article, I was shocked and even personally hurt by your words. The stigma against mental illness in our culture is real and hurtful. Hearing friends of mine, after finding out I take antidepressants, say things like “Ugh, Western medicine. Everyone is so medicated these days. Why don’t you just, like, get some fresh air or something?” is a fairly frequent occurrence, and every time it happens, it stings. This article was essentially a poor attempt to back up a statement like that with numerical evidence. Its ignorant statements and presumptuous tone took me by surprise, and realizing that there are people at Kenyon who have these opinions made me feel embarrassed and ashamed of my depression. But only momentarily. Then I read the comments and was extremely grateful that people took the time out of their days to type out exactly what was so wrong with the article. The conversation generated here is compelling and relevant, and I am so glad to see so many people sharing their thoughts–whether they line up with mine or not.

    Therefore, in conclusion, I would like to thank Jon for conducting this survey, compiling the data, and writing this article. Although I disagree with his personal opinions about depression and medication, he started a valuable debate, which made me quite proud to go to school with so many smart, vocal people.

  8. “Being happy is a preference; it isn’t a right.”

    Jon, have you considered what Americans stand for? Life, liberty, and the PURSUIT OF HAPPINESS.

        1. That was exactly my point: Everyone would rather be happy, but just because we want to be (as Stella says, we “pursue” happiness) doesn’t mean we always get to be.

      1. The pursuit of happiness is distinct from being happy.

        Being happy takes some application–planning, effort, investment–and that’s the pursuit.

  9. Jon–your last comment (I can’t reply to it directly, for some reason) is, I think, indicative of the root of the problems in this discussion. This comment, I mean:

    “Everyone would rather be happy, but just because we want to be doesn’t mean we always get to be.”

    There is a massive difference between depression and unhappiness. I think if your point is that young people today are being taught that situational unhappiness (ie, about a breakup or the death of a loved one) is a chemical imbalance that requires medication, that’s an interesting topic to explore/research. It would be interesting to study young people’s attitudes about what actually constitutes depression, if those attitudes have been influenced by drug company’s pervasive ads, etc.

    But your anecdote about feeling depressed after a “romantic tragedy” but then “letting yourself get better” is conflating unhappiness, which is an ultimately useful part of life, and depression, which is decidedly not useful or normal. You were unhappy because of a difficult situation; you were able to “get better” because you don’t have depression. The reason people seek out the drugs you’re maligning, as well as talk therapy, is because some of the feelings you enumerated (not sleeping, not being able to focus, not having an appetite) as well as many, many others (crying all the time, panic attacks, weight loss/gain, feelings of numbness) will NOT go away. For some people, these feelings don’t go away for years. These people have what the DSM calls major depression, and the reason these people continue to suffer when you did not is NOT because they’re weaker than you, or just decided not to “let themselves get better.”

    I think you’re clearly trying to be thoughtful about this, but putting that anecdote in this post is a little like equating the one time you fell asleep in class with someone who has narcolepsy. Being unhappy–even being really, desperately unhappy–is a normal and essential part of the human condition, and it’s totally true that American culture shies away from that and tries to distract us from it in every way possible. But being unhappy really has very little to do with being depressed–speaking from experience, the feelings are acutely different.

    I think this story is the best explanation I’ve found of the difference between depression and unhappiness, and it’s especially relevant as it was written when the author was a college student.

    http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0CDkQFjAC&url=http%3A%2F%2Fquomodocumque.files.wordpress.com%2F2008%2F09%2Fwallace-amherst_review-the_planet.pdf&ei=ziiHUeB3xLfKAY6lgJgM&usg=AFQjCNEGozKs4JesQIFRBa7Pzj2FcnnNag&bvm=bv.45960087,d.aWc

    1. So don’t you think the question ought to be raised whether some might be blurring the distinction between depression and unhappiness, given the 25% figure.

      As Jon has said countless times before, depression is a real affliction. The question is, and has always been, has the threshold for receiving anti-depressant medication been lowered to a worrying point?

      That being said, I understand why this post may have been seen as offensive especially given how intimate Kenyon’s community is.

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