More than two decades ago, on the opening page of the book We’ve Had a Hundred Years of Psychotherapy—And the World’s Getting Worse, psychologist James Hillman told his coauthor, writer Michael Ventura, why he thought psychotherapy was—already, back then!—at a dead end. “We’re working on our relationships constantly, and our feelings and reflections, but look what’s left out of that . . . a deteriorating world. . . . By removing the soul from the world and not recognizing that the soul is also in the world, psychotherapy can’t do its job any more. The buildings are sick, the institutions are sick, the banking system is sick, the schools, the streets—the sickness is out there.”

I’m half-inclined to stop right there, since what Hillman was saying is still true today— except that it’s so much truer now than it was even then. If the world’s mental health was “getting worse” in 1992, it’s gone catastrophically downhill since. The numbers cited in Jonathan Rottenberg’s cover article in this issue are stunning. The suicide rate for adults is up 25 percent since 1999. Depression is expected to produce more death and disability by 2030 than war, accidents, cancer, stroke, and heart disease. This is in spite of the fact that antidepressant use has increased 400 percent since 1988—not to mention the vast industry of self-help books published since then! Depression is becoming the most important public health issue in the world.

Furthermore, as Hillman suggested way back then, depression doesn’t happen in a social vacuum. It may be our civilization itself, our high living standards, but also the stresses and strains of modern life and our relentless competition and unflagging desire for more—more money, more status, more power, more stuff, more happiness—that create the conditions for chronic low mood.

And yet, in spite of profound historical changes that make us more vulnerable to depression, the entire mental health establishment still regards the condition much as it did more than two decades ago—as an individual problem, confined within an individual skull, best approached with individual therapies or nostrums. In the face of massive evidence that “individual” depression is really a vast social and cultural problem inextricably linked to the habits, mores, and expectations of our era, our tunnel vision is remarkably unchanged. So why do we continue to use a relentlessly individualized remedy to fight a socially mediated disorder?

Therapy’s individual focus can be a weakness, certainly, but that focus is also its glory. A particular kind of personal, individual (to use those “bad” words) relationship is what makes it work, what helps people, including depressed people, get better. And it hardly needs mentioning that people experiencing suicidal despair won’t be helped much by getting a lecture on the downsides of 21st-century civilization.

Still, it seems reasonable to ask whether as therapists we don’t have a public health responsibility to educate people about the role played by our society in generating unprecedented levels of depression. We should be aware—and make our clients aware—that they’re not in some way abnormal or deficient because they’re depressed. Just the opposite. If we accept Rottenberg’s persuasive account of the evolutionary impulses of our brains—that depression and anxiety are built into our genome—and we live in a time that specifically evokes them, being depressed is, sadly, a pretty normal way to be!

While this issue of the Networker offers no Big Answers to what we can do as a field to address the growing problem of depression, at the very least it proposes that we begin to bring a broader social consciousness into our work than simply assigning DSM-5 labels to the clients who pass through our offices.

Rich Simon

Richard Simon, PhD, founded Psychotherapy Networker and served as the editor for more than 40 years. He received every major magazine industry honor, including the National Magazine Award. Rich passed away November 2020, and we honor his memory and contributions to the field every day.