Although it was a very personal account, the following quote from the book has almost become an expression of an open secret in the US: “Sometimes it feels like we’re all living in a Prozac nation. The United States of Depression.” After the book, which was also made into a film, Prozac has been the symbol of antidepressants, while the less-developed parts of the world were almost relieved that “going to a shrink” is something Americans need more, while almost pitying them.
“Every American has a shrink that s/he sees regularly” has long been an urban legend among Turkish people who wanted to take pride in our culture, which does not necessitate therapy, thanks to the abundance of social networks comprising relatives and friends leaving little room for privacy, hence alienation.
However, based on the latest figures, the picture is not that bright in Turkey anymore. When you watch multiple-Emmy-winner “Mad Men,” you cannot help but think that today’s Turkey resembles 1960s America in terms of sexism, smoking habits and the role of women in society. It seems that Turkey follows the problems of the industrialized world such as depression with a lag, too.
It is true the insatiable appetite of the pharmaceutical industry triggers the use of medications, but the rise of antidepressant use in Turkey is unprecedented, according to the statistics. Dr. Halis Ulaş of the Turkish Association of Psychiatry confirms there has been a significant increase in the consumption of psychiatric medications, particularly for depression, in the country. According to statistics of the IMS (Intercontinental Marketing Services), the number of packets of antidepressant pills consumed increased from 26 million to 34 million between 2006 and 2010. Similarly, on a global scale, three out of the 10 most profitable medications are psychiatric medications.
Today, it is not clear whether we have also become a Prozac nation, but without a doubt we are a much more depressed and lonely society. Psychiatrist Dr. Nihat Kaya, who specializes in panic attacks and depression, confirms a significant increase in cases she sees of anxiety disorders and depression. “The sense of security, which is one of the core needs of human beings, is in decline especially in big cities,” says Kaya, “due to factors such as heavy traffic, a decrease in green space and oxygen, as well as excessive competition in the workplace.”
“Sometimes, I get so consumed by depression that it is hard to believe that the whole world doesn’t stop and suffer with me,” writes Wurtzel, describing the depression that millions of people, especially women, suffer every day. Modern lifestyle and the constant encouragement to “have it all” put more pressure on people. As a result, even over-achievers like Wurtzel, who was studying at Harvard when she wrote her memoir, become susceptible to depression. “I am so tired. I am 20 and I am already exhausted,” says Wurtzel in her book, and apparently she is not the only one who feels vulnerable at that age.
More production requires more consumption. “The pharmaceutical companies are not independent from this cycle,” says Kaya as he directs attention to a dangerous trend of “over-categorizing the psychiatric diseases and classifying even normal human conditions as diseases” in an attempt to produce and sell more medications. Kaya warns about a new trend of encouraging people to “avoid pain in any case,” saying such an attitude leads to selfishness and “removes the feeling of pity for others,” which is a necessary emotion for a more meaningful life. “There are various human conditions. We will suffer pain when we are lovelorn, feel sad when things go wrong,” says the doctor, who seems concerned about this trend of escaping pain and focusing only on joy. Apparently, hedonism might backfire and cause even more depression if normal human feelings are repressed.
Although moderate levels of feeling sad and even pain are normal, when things seem to get out of control, consulting a therapist or getting help from medication should be expected. An İzmir-based professional says she easily asked for help from a therapist when she “thought she was not able to cope with the sense of helplessness,” but it was not so easy for her to start using antidepressant pills because of her bias towards them. “I was afraid of becoming addicted to pills,” says the young women, who overcame depression after a combined treatment of therapy and pills.
“Am I this weak and unable to solve my problems without pills?” was what she asked herself before taking the medication, and apparently she is not alone in her doubts. Nedret Öztan, former president of the Turkish Psychological Association, says that women are more open-minded about consulting a psychologist while men tend to perceive it more as a weakness. “A man in depression does not easily consult us; his wife brings him to us because they have fights and only then his depression is discovered as the underlying reason. Women, on the other hand, seem to confront their feelings more openly and want to solve their issues as soon as possible,” adds Dr. Öztan.
Aside from the gender gap, undoubtedly more and more people are asking for psychological help especially in big cities, not only because of a stronger bias in Anatolia but also because people have easier access to consulting services in the cities. “The taboo about seeing a psychiatrist has been overcome to a great extent,” says Kaya, pointing out the contribution of popular TV shows in which people consult doctors as well as the celebrities who admit they receive psychological support. Öztan says people consult them in growing numbers, although such a service is “still considered a luxury” because psychological consulting is not covered by state-sponsored health insurance in Turkey.
Demographically, young people, women and those who are financially better-off tend to see doctors and therapists more, but there is one more interesting observation that Kaya makes: “There used to be a belief among some religious people that needing a psychiatrist [when you are depressed] is a sign of weakness in faith. Fortunately, this is also changing.”
Whether it is the capitalist encouragement for more consumption and thus more pressure to work hard, or our life conditions that have become ever more difficult, or the increasing loneliness among urban dwellers; depression is on an unstoppable rise. Not everyone is as vocal and courageous as Wurtzel to announce that “sometimes I wish I could walk around with a HANDLE WITH CARE sign stuck to my forehead,” but one thing is certain: More and more people are suffering from a sense of helplessness and despair. As the woman from Izmir says, for people like her, antidepressants are “the last resort for help.”
The Prozac nation of Turkey is on the rise, which is probably to be expected in a country with seemingly perpetual problems in a difficult neighborhood.