Charting the Depths

Reflections on the science of depression.

Misunderstood Depression: The Human Toll

Stories of misunderstood depression

People who face depression must be prepared for at least two long journeys. One journey is to face depression itself. The symptoms of depression --despondency, lethargy, nightly insomnia, an inability to concentrate - are painful and difficult to manage. The second journey, is in many ways, harder, and often longer, which is to face other people's misunderstandings of their depression, misunderstandings that are sometimes insulting, confusing, and often unhelpful in getting the symptoms under control.

Depressed people are extraordinarily vulnerable to others' misunderstandings because the symptoms of depression themselves are often bewildering and because depression compromises one's ability to think. Depressed people typically have little confidence in their own interpretations of their mood. They naturally turn to experts for opinions about the causes of their depression.

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Most likely, the person is told their symptoms reflect a defect or disease.

Mainstream psychiatry presents the idea of a correctible biological defect, a ‘chemical imbalance.' The media, patient groups, and mental health professionals have widely embraced this comforting and optimistic notion. It would be fine to be told you have a chemical imbalance if it were true, as it is for other health conditions in which blood or urine is needed to establish the diagnosis. In the case of depression, chemical imbalance is just a metaphor, and psychiatrists are generally not in a position to prove the physical causes of a given person's episode of depression; again, this is in contrast to other health conditions where biological assays can speak to the etiology, or origins, of the disease.

The field of psychology is not blameless either. Cognitive therapists will also tell the depressed person that they are deficient. This time, it is faulty thinking that is to blame. We can at least credit cognitive therapists with attempting to present evidence to the patient of specific distortions in thinking as part of the therapy, but again, the therapist is not in a position to strongly establish what the exact causes of the symptoms are for a given person.

I am struck that, just about anywhere a depressed patient turns in contemporary society, the answer remains much the same: Your symptoms signal a deficiency. That deficiency may lie in the person's childhood (says the psychoanalyst), in the person's soul or relationship with god (says the priest, pastor, or rabbi), or in the person's relationships with significant others (says the marital or family therapist).

The experts mean well and experts certainly have an important place. Each expert opinion may capture a part of why some people become depressed. But my concern is about the unintended consequences of ideas that are incomplete understandings at best and often outright misunderstandings of what caused a person's depression. Our current treatment outcomes are reason enough for greater modesty. For most, consulting an expert will not result in an answer that leads to a fully effective treatment or yield real enlightenment about their depression. In our contemporary environment, a depressed person may over time receive 8 or 9 or 10 very confident opinions from different experts about the causes and maintaining factors of their depression. When opinions are rendered without due modesty and are proven faulty, a depressed person can lose faith, not only in experts but in ever understanding the roots of their depression. I believe there is an untold story, that when experts overreach, the depressed person can end up in a worse place than if he/she had been more self-reliant.

I am currently writing a book about depression. I would like to include the theme of the second journey  --  what are the human costs of these intellectual misunderstandings of depression? I am interested in hearing more about people's second journeys. The stories of how people gradually came to grips with the real causes of their depression often in the face of other people's misunderstandings.

I will blog about this again in the next few months.

If you are comfortable sharing your story via email or are interested in being interviewed for the book please email me at chartingthedepths@gmail.com

Jonathan Rottenberg is an Associate Professor of Psychology at the University of South Florida, where he directs the Mood and Emotion Laboratory.

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