In the context of the sad suicides of a number of young people in Geelong, the well known psychologist, Dr Michael Carr-Gregg, has exaggerated the relationship between depression and suicide.
He goes so far as to claim that one girl’s death “is not about suicide. It is about depression.”
Although he presumably never examined her, Carr-Gregg tells us that “The internet did not kill her. Neither did cyber bullying. She was suffering from an illness and had it been diagnosed, she could have been treated.”
Carr-Gregg also perpetuates the discredited notion that depression is caused by a “chemical imbalance”, incorrectly claiming that “sometimes the biochemistry in their brain can go wrong and nothing anyone can say or do will alter that”.
But perhaps the most misleading of Carr-Gregg’s claims is that “undiagnosed and untreated depression” underlies 90 per cent of suicides. This claim ignores the fact that a minority of suicide victims are both diagnosed with depression and treated (almost always with antidepressants).
Furthermore, support for the relationship between depression and suicide comes mostly from psychological autopsy studies with problematic methodology.
Relatives, the primary source of information in such studies, often seek more socially acceptable explanations, and may be unaware of or unwilling to disclose certain problems, particularly those that generate shame.
Additionally, the presence of a psychiatric history would increase the likelihood of an ambiguous death being classified as suicide. Despite these biases, several psychological autopsy studies (here and here) have found rates of depression of only around one-third in suicides.
Carr-Gregg continues a strong tradition of denying the relevance of social factors (poverty, unemployment, racial discrimination, homophobia, internet bullying) in favour of tenuous and reductionist psychiatric explanations.
In order to reduce youth suicide, we need a population focus on addressing its social antecedents, not a clinical focus on diagnosing and treating individuals.
Jon Jureidini is a clinical associate professor in psychiatry at the University of Adelaide, and Melissa Raven is a lecturer in drugs and public health at Flinders University.
Extremely well put – here’s hoping the new health reforms will create an environment where a more holistic videw is taken, rather than reliance on tertiary / treatments models put forward by respectable health professionals who happen to like the media just a little too much.
Jon Jureidini and Melissa Raven have shed some sunlight on an approach to suicide reduction and prevention which is long overdue.
Whilst the connection between systemic abuse – such as racial discrimination or homophobia – and suicidal ideation is well documented in the research, it is also equally clear that the community resolve, at least at a political level, pulls up well short of what is required to make some headway in preventing suicide at the source.
Jureidini and Raven could do a lot worse than try and get themselves in front of the board at Beyondblue, The National Depression Embarrassment. Perhaps the various academics on the board there will listen to their peers and take what they have to say on board, rather than be dragged kicking and screaming in the media.
The fact of the matter is that unless we as a community are prepared to have some tough, and in some cases, very combative conversations with vested interests such as religious and quasi-religious organisations eg The Salvation Army nothing will change.
Dr. Jureidini has published & campaigned strongly against the efficacy of antidepressant drugs for people seeking help and diagnosed clinically as suffering from depression. He should acknowledge his lack of scientific disinterest in the treatment of depression.
Congratulations to J Jureidini and M Raven for their sensible comments. We only have the media reports of M Carr-Gregg’s claims, but there would appear to be a prima facie case for the Psychologist’s Registration Board of Victoria to investigate.
As an emergency psychiatrist I can only agree with Jureidini and Raven on this issue. While significant depressive illness (including that subset which is amenable to treatment with anti-depressants) lies behind a minority of adult attempted suicides I see, more often it is a complex mix of real-life stressors and problematic coping strategies that lead to the kinds of crisis situations which then push people to try to kill themselves.
This is not to make a case that these people are not sad, down or upset at the time, but to draw out the specificity of their problems rather than lump them all under the rubric of “depressive illness”. I’d be doing my patients a disservice if all I did in response to their situation was prescribe tablets that are likely to be ineffective (or at best minimally effective) in the majority of cases.
David Christie misrepresents Jureidini’s campaigning around these issues. I don’t think Jureidini has ever rejected either the diagnosis of depression or medication as an effective treatment for some patients. Rather, he has pointed to the limitations and risks of using too simplistic a model of diagnosis and treatment (something perhaps more important in his subspecialty area treating children and adolescents).
Understanding the limitations of medical treatments for psychological and psychiatric problems is surely just as important as understanding their potential benefits. One of the negative aspects of the popularisation of “depression” as an illness is that it lumps together a wide variety of types of human suffering and suggests there is a single pathway to wellness. Life is more complex than that. We psychiatrists owe it to our patients to deal with that complexity in order to provide them with the best possible treatment and support options.