I've started to write this post on a number of occasions, but drawn back each time, because I don't want to add to the noise on the blogosphere about a topic I find innately distasteful. Tom Harris MP on his blog suggests that even to mention the subject of the Prime Minister's health is to add to the rumour-mongering, and I have a great deal of sympathy with that view.
However Andrew Marr asked 'the' question of the Prime Minister yesterday (according to Iain Dale, he asked specifically "A lot of people use prescription painkillers and pills to help them get through, are you one of those people?) and Nadine Dorries MP wrote what I thought was a splendid response to him this morning. If you read no further, read Nadine's thoughts. They're more or less the same as mine. I think 'prescription painkillers and pills' was a surrogate for 'antidepressants'.
I spend my working life trying to find a cure for clinical depression. I've worked in psychiatric R&D for more than ten years, so while I'm no way a physician, I've got a fair bit of understanding about the current state of our knowledge regarding a disease which will affect about 15% of the population at least once in their lives, the currently available pharmacotherapies for the disorder (and their inherent limitations), and the experience of people who suffer the disease. You know me as a statistician, here, I think, because generally I don't talk about what I do for a living. In fact my most important function at work is leading a team that is developing a new medicine to treat depression. So I know a little about this topic.
What we don't know: why human beings suffer from depression; what organic changes in the brain cause it to manifest itself; how to treat it in everyone in whom it is manifested (let alone how to cure it); how to predict its activation with certainty; how long it will last in any individual; how often it will recur for any individual. And so on. We have some hypotheses about all these matters - some with huge bodies of evidence to support them, others with less. You can find lots of people on the net or down the pub who will claim to answer these questions with certainty. That's not the same thing as scientific knowledge.
What we do know: dopaminergic, serotonergic and noradrenergic systems seem implicated (all current drug therapies seek either directly or indirectly to target the relevant transporters). There may be an inflammatory process involved. There appear to be different subtypes of depression ('atypical', 'melancholic' and so on) though not all psychiatrists agree that such subdivisions have utility. If a patient receives psychiatric care for an episode of major depression, they will have on average a further four such episodes in their life. And so on.
Do you get the picture? All mood disorders are inherently difficult to assess, because - at this stage in our knowledge - they are measured directly through the symptoms expressed by the patient rather than through any organic, physical 'thing' (contrast with, for example, atherosclerosis or other 'mechanical' disorders). This makes them inherently fascinating to study (I often feel guilty at the intellectual pleasure my work gives me) - not least because they go to the core of that which makes us human - but it also makes it completely ridiculous for anyone to make any assertion (about outcome, behaviour) about any individual (with whom they are not intimately concerned) who has been given the diagnosis.
My point is that if I were to tell you Graeme has been diagnosed with depression and is taking a course of SSRIs you would no more be able to predict how I would react to any decision I had to make in my life than had I not told you of the diagnosis. Blogosphere smearing about my likely behaviour would be just that - smearing.
I haven't been so diagnosed, by the way. But I did spend eight years of my early adult life heavily involved with a family that suffered from severe mood disorders. I saw the reaction of people whenever C or K dislosed their condition. It still makes my blood boil with anger. They weren't judged on what they did. They were judged on some hideous counter-factual construction of what other people's prejudices thought they might do.
And I direct that anger too at any online 'expert' trying to make the assertion that if the Prime Minister has depression, his fitness for office is in some sense reduced. They don't know the first thing they're talking about, no matter how many quotes they conjour up from the adverse event labels of drug therapies.
It's worse than this of course. The very idea that we have a right to peer into the medical history of our politicians is wrong. Are the medical records of every MP to be published online?
This is all part of what you might call the 'psychopathologisation' of British politics. Our media is obsessed with gossip, and with the endless, pointless discussion about hidden motivations in individuals (like X said Z because he wants to help Y achieve W, it is said in the bars of Westminster - what does such a phrase add to our total of political knowledge? Nothing).
What actually matters are those things which individuals say and do. Their motivations are a matter for themselves and their loved ones; their physical and mental wellbeing a matter for themselves and their physician. Making a window into the soul of another human being was a target too far for Elizabeth the First. It certainly outstrips the abilities of our political media class. Andrew Marr should apologise to Gordon Brown.