Have we got depression all wrong?

Depression is very common. In any given year around 1 in 50 of us will suffer from it, and over an entire lifetime up to 1 in 10 people will have experienced at least one episode of depression.[1]

Viewing depression through a medical lens, you get a story of how your brain has stopped functioning properly. So you take a pill, such as an SSRI, to return your brain to its normal function and treat the depression.

Medical language uses terms such as disorder, dysfunction, and abnormality, to describe this idea. 

But what if depression wasn't an abnormal state at all? What if it was a normal, everyday response to certain situations and circumstances?

Depression as a disorder

Psychiatry has long had a problem.

With physical diseases, such as cancer and heart disease, it's pretty easy to see what has gone wrong. You can see on the X-ray, autopsy, or on the MRI the part of the body which has changed. 

With psychiatry finding the changes in the brain has proved much more difficult and much more fraught. So much so, that even psychiatrists have questioned whether there is in fact any kind of disease going on at all.[2]

The way psychiatry works is by grouping together symptoms, and then assuming that there is a disease process which explains them. In psychiatry the symptoms being looked for are actually problem behaviours.  

If you don't have a strong scientific basis for choosing which problem behaviours you are going to pay attention to, then the lines can get very blurred. You can get caught up dealing with what are in reality social problems, and psychiatry can end up being no more than somebody's opinion.

So in 1971 the DSM (Diagnostic and Statistical Manual of Mental Disorders) had to resort to a vote of its members to decide whether homosexuality should still be considered a mental health disorder. It wasn't completely removed until 1987.[3]

Since then they have added some new ones, such as ADHD. The problem with ADHD is the complication that the observed changes you can see in the brain could have more to do with the treatment than with the disorder.[4]

The same problems which apply to other psychiatric diagnoses also apply to depression. The chemical imbalance theory of depression, while initially promising has not stood up to scientific scrutiny. It's more a case of acquiring a chemical imbalance when starting medication to treat the depression, than having one to begin with. 

Depression as part of the human condition

Depression has been known for a long time, although ancient thinkers such as Aristotle and Hippocrates would have known it as melancholia.

Francis Zimmerman is interested in how the history of melancholia has a bearing on our more modern understanding of depression.[5] In his essay he draws out two main points. 

The first is that illness is a cultural phenomenon, because as he argues,
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As a mood or emotion, the experience of being melancholy or depressed is at the very heart of being human: feeling ``down'' or blue or unhappy, being dispirited, discouraged, disappointed, dejected, despondent, melancholy, depressed, or despairing many aspects of such affective experiences are within the normal range.

Source Francis Zimmerman via The Journal of the National Institute

This normal range of human emotion becomes melancholia, the illness, when it is seen to last too long.

The second point he makes is one of substitution, which is where the description of melancholia as a movement of black bile becomes substituted for the feeling of melancholy.

So Aristotle's vivid description of black bile being like wine which is collecting and fermenting in the brain, becomes a substitute for the heavy dull feeling of depression.

Notice how Aristotle's melancholia, caused by an imbalance of humours, becomes our more modern version of an imbalance of neurotransmitters in the brain. 

This chemical imbalance substitutes for the feeling of imbalance caused by depression. So our low mood becomes caused by the lack of the 'feelgood' serotonin, rather than a surfeit of the mood depressing black bile.

What has depression ever done for us?

By taking a more critical look at depression, and how it is understood, allows us to ask some different questions.

Because once we stop seeing it is as a disorder, something that has gone wrong, and start seeing it as part of the human condition, then we can start asking questions like,

Does depression do something useful?

This may seem like a strange question to ask, and your immediate response is likely to be no. Depression is extremely unpleasant and debilitating. What could possibly be useful about it?

In 2002 Watson and Andrews proposed something called the Social Navigation Hypothesis.[6] They argued that depression removes external interference so you can focus on your problems - it's supposed to make you inward looking, so you can really get to grips with what is going wrong. 

Their other argument was that things like loss of pleasure in activities (anhedonia) makes depression noticeable to people around you, which persuades them to be more flexible - i.e. other people notice that something is up, and generally try to help. 

They then argued that because we live in a society which values production, and has become focused on the individual, depression is less adaptive than in the past - i.e. not only does depression stop us going to work, we have fewer people to rely on when times are bad. 

Depression as a vehicle for change

In the counselling room, I not only see depression as one possible element of the human condition, I also see it as a vehicle for change.

Let me explain,

Depression is a life or death crisis, because lets face it depression not only carries a suicide risk, it also robs people of the joy of living.

Of course we generally don't seek a crisis, rather we find ourselves ending up in one. However a crisis demands change. When we emerge from one we will be different, often radically, from when we went into it.

Counselling generally focuses on these 3 questions,

• How did your depression get here? It can feel like depression comes on suddenly and with no warning, especially if your depression waxes and wanes. Carefully exploring what factors were involved, can help you recognise what needs to change.

 

• What's your depression trying to achieve? While depression ultimately ends up as a very blunt instrument, recognising the early signs of it building up, are a valuable early warning sign. It serves as an alert that you need to start doing things differently.

 

• How are you going to live your life differently? This is perhaps the most important question of all. Something has to change, so what is it going to be? 

There are many, many different answers to the last question. The one that you come up with will be unique and individual to you.

I would like to leave you with the words of Rachel Griffin, talking about the upsides of depression,
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​Struggle sucked (don’t get me wrong!) but from it I gained so much wisdom, compassion and strength. The new version I built of myself was a better version. Pain that was my enemy became my ally... my beauty and my strength. As Rumi said, “The wound is the place where the light enters you.”

Source Rachel Griffin via The Huffington Post

main image by skeeze via pixabay.com

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The intention of the article is to promote a counselling approach to depression. While I have been critical of some elements of psychiatry,  this should not be used as the basis of a decision to stop or reduce medication. You should only do so under the guidance of a suitably qualified professional, such as your GP or psychiatrist. Sudden withdrawal of medication can cause serious harm.

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References

​[1] Fundamental facts about mental health via The Mental Health Foundation
[2] The difference between a medical diagnosis and a psychiatric diagnosis via CCHR International
[3] When Homosexuality Stopped Being a Mental Disorder via Psychology Today
[4] There Is No Such Thing as a Psychiatric Disorder/Disease/Chemical Imbalance via PLOS
[5] The History of Melancholy via The Journal of the National Institute
[6] The Social Navigation Hypothesis of Unipolar Depression via University of New Mexico

Is depression stopping you living your life?

I am an experienced therapist in private practice in the Southampton area of England, UK. Counselling is... ​

walking alongside you until you find your way again.

Counselling with Mark

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