Depression: The causes, treatment, stigma, and Jeff Tweedy of Wilco

I was surprised and delighted today to find out that Wilco front man Jeff Tweedy was interviewed on comedian Marc Maron’s WTF Podcast. For anyone who aren’t in the know, Maron is a long time stand up comedian turned highly respected interviewer via his podcast. Wilco has been a band for over 25 years now, and people joke that Wilco is the “the greatest band that you’ve never heard.”

I regularly enjoy Marc Maron’s interviews and am a Wilco fan. In my opinion, Maron, who has become a very good interviewer, reaches moments of greatness when he interviews people who have things in common with him, which often come from discussions of comedy, music and culture, addiction, and mental health.

In a couple of points in the interview, Maron and Tweedy dive into conversation about addiction and mental health. At one point, Jeff Tweedy states that he heard that “depression is anger turned inward.” Maron responds that that phrase is commonly cited in addiction treatment.

I have heard that description of depression before and this interview has inspired me to explore depression further, as it has such a huge impact on people, but often comes with a stigma. Depression being “anger turned inward” is attributed to Sigmund Freud (although I cannot find a source of where Freud actually said this), is believed, now, to be an overly simplified definition. Freud’s statement doesn’t consider that depression is widely believed by the medical community to come from factors beyond a person’s ego strength and environmental factors, and is more often attributed to biological factors and genetics. Evidence supports that claim that clinical depression is thought to be more of a medical issue than a mood, mindset, or emotional issue — in that it can be treated with medication, although, it can be diagnosed by a mental health professional and it can be treated with or without medication along with lifestyle changes and therapy.

Depression is tricky, in that, it looks different for everyone, impacts people who you might not suspect would have depression.

People who suffer from depression might exhibit behavioral issues such as:

  • anger

  • sadness

  • a lack of motivation,

  • not being able to sleep or sleeping too much

  • thoughts of suicide

Depression can also be disguised as appearing to be memory loss in older adults. Severe cases of depression can also present with psychotic symptoms such as paranoia, delusions, hallucinations, and in the most extreme cases, catatonia.

Historically, people have been reluctant to seek treatment for depression because of stigma that surrounds it. Depression is not dissimilar to serious medical issues like cancer, strokes, or even the flu. No one asks for those diseases, and people empathize with those who are afflicted with those diseases. However, depression is a real monster, in that, the cause of depression is considered to be biological, but the symptoms are behavioral. People with depression present with self destructive behaviors as discussed above.

Further, people with depression can negatively impact those around them. Loved ones of individuals with depression can feel like they are failing because attempts to support, motivate, and help their loved ones with depression can be ineffective, and can make others feel like they are failing. People with depression can also outwardly express negative attitudes towards the people around them, making them feel unappreciated. Also, being depressed around people can make other people feel depressed.

Historically, people, especially men, believe that depression is something that can be treated by “pulling yourself up by your bootstraps” or “toughing it out.” Recent attention to mental health issue has brought more public awareness to the importance of mental health treatment and is helping to dismiss the stigma that was once associated with depression and other mental health issues. We now know that trying to overcome depression by “toughing it out” is not a adequate treatment and by ignoring or trying to treat it by not acknowledging that it exists can perpetuate the harmful symptoms of depression.

I just read this interesting article published by the British Medical Journal where the author, developmental biologist Lewis Wolpert, describes his own experiences with depression in a concise yet extremely informative account. The article is a bit older (published in 2001) but still appears, to me, to be relevant. In the article, he speaks about the stigma associated with mental illness by saying:

“…there are many attempts to account for stigmatisation of mental illnesses. Mental illnesses are perceived as different as they express themselves through those very characteristics that make us human – cognitive and affective and behavioural – and thus differ from physical illnesses. Mental illness is thus seen as embodying the core of the person and not just affecting some organ like the heart or lungs. But different mental illnesses each have their own characteristics in relation to stigma. For example, unlike depression, people with schizophrenia or addictions are perceived as being dangerous. But depressives are seen as unpredictable people who, if they really tried, could pull themselves together.”

People who try to treat depression or mental health issues on their own are at high risk of developing bad habits for treatment. People commonly resort to treating depression by using harmful coping mechanisms such as smoking, drinking alcohol, drug use, overeating, sleeping, watching too much television, spending money, isolating, or treating themselves or others badly. The issue with unhealthy coping mechanisms is that they can provide easily accessible and momentarily relief from the symptoms of depression. However, they are considered unhealthy because they will only treat the symptoms and not the disease itself. The actual disease will get worse, and the unhealthy coping mechanisms are risky in that they can cause further health complications and can harm relationships with people you care about.

What do you do if you have depression, and you decide that today is the day to get treatment?

In the interview I cited at the beginning of this post, Tweedy mentions that he spent time in inpatient treatment for a co-occurring disorder or a dual diagnosis. A co-occurring disorder is when an individual is dealing with a mental health issue and substance abuse issue that perpetuate one another. It is common for people with mental health disorders to cope by using substances to treat the symptoms. This is dangerous in that, substance abuse can also cause mental health issues. Tweedy says that he was surprised that he had never heard of this before he needed the help.

Tweedy is someone who, at the time of needing services, had financial resources and a support system, and he still had trouble identifying how to get help for his issues. Finding help is difficult for the average person, and it gets even harder for people who are under-insured or uninsured, or people that do not have financial security, as treatment can be expensive. If you do not know where to go for help or how you will pay for help, a safe place to start is with your doctor. If you do not have a doctor, or cannot afford a doctor, every county in Missouri has at least one government funded mental health center, commonly referred to as a Community Mental Health Center that has to provide services to you if you show up there for help. I would recommend, that if you are seeking help from one of these facilities, do not call them, as I have had experiences with clients where some facilities will try to dissuade people from coming in for help by saying there are long wait lists or that they are not accepting new patients. The bottom line is that, due to the government funding, they have to help you. However, some places have limited hours in which they provide intake services, so you may want to call to ask “what are your intake hours?” and show up at those times.

Treatment for depression

Treatment for depression varies from person to person depending on the severity of the depression. Moderate to severe depression is best treated by a combination of medication and therapy. Mild cases of depression, such as Seasonal Effective Disorder, can be treated by therapy alone without the use of medication. If someone seeks treatment for depression with me, I would assess the individual for severity of depression and the individual’s strengths to develop an individualized plan for treatment. Therapy would likely consist of creating a plan to change negative thought patterns, increase motivation, and support to make healthy lifestyle changes. If you are experiencing depression, I can help you. Please contact me for a free phone consultation.

Recommended for further consumption:

I, admittedly, am a huge Wilco fan. For those unfamiliar with the band, they are probably most known for the story surrounding their 2002 album Yankee Hotel Foxtrot, an album that, at the time of it’s originally intended release date in September of 2001, was rejected by their record label, Warner Brothers, as it was considered by the label to be unlistenable and a financial liability. The record label provided Wilco with the ultimatum of changing the album to have commercial appeal or taking the album and leaving the label. The band took their album, left Warner Brothers, and streamed it for free through on their website, which in recent years, has become more common for mainstream artists, but at the time, was unheard of. Yankee Hotel Foxtrot found an official release nearly a year later in April 2002, unchanged, and went on to be the Wilco’s most successful album finally and critically. The media went on to the paint of Yankee Hotel Foxtrot as a story of underdog success. The story is documented with behind the scenes footage of the recording of the album in the Sam Jones documentary I am Trying to Break Your Heart. The band has gone on to release numerous critically acclaimed albums to a large cult following.

If you are interested in more about the band, start here:

“I am trying to break your heart” documentary.

Yankee Hotel Foxtrot 10 year anniversary

Jeff Tweedy was recently on an interview tour to support his new autobiography, Let’s Go (So We Can Get Back). I recently attended an event at The Pageant in St. Louis where Tweedy was interviewed by actor Jon Hamm.

Thank you for reading