Theory of Knowledge

A unified approach to psychology and philosophy

Depression and the Disease-Pill Model of Mental Health

The Disease-Pill Model of mental health reduces neurotic conditions like depression to brain diseases. Ironically, this tragic error—which is driven far more by economic forces than either science or clear thinking—may be one of the key reasons there has been such dramatic a rise in depressive and anxious conditions in the last three decades. Read More

Not so simple.

1. When you say:

"It rewards the patients because now the depressive symptoms are the result of a problem (chemical imbalance) that has nothing to do with their environment or their character; thus they can be told they are not to blame and rather than examine their lives they can just take two pills and feel better in the morning."

You are saying that ~90% of depressed people ARE to blame for being depressed. This is highly problematic in my eyes for at least two reasons:

A. At a time when people are feeling more helpless and hopeless than ever, I don't think it's going to help them in any way to tell them that either something is seriously wrong in their environment that they presumably can't presently change (or they would likely already have done so when they felt good and it started stressing them), or they have a maladaptive behavioural management method. In fact, I'd say that telling them such things is only going to make their depression even worse.

B. Too many depressed people don't seek help because of the "It's all your own fault for being so weak/dysfunctional" stigma attached to it. Feeding that stigma doesn't look like a good idea to me.

2. When people are in pain, it's just as important to alleviate the pain as to figure out where the pain comes from. When I went to see my doctor about my increasingly painful lower back, he started me right away on painkillers and anti-inflammatories; he didn't wait for the scan results to determine what it was, nor did he just send me to a physical therapist to decontract my muscles or whatever else. No: he right away treated both the pain and the part of my body which was obviously inflamed judging by my symptoms, and THEN he waited for the scans to determine what was my problem and what the long-term therapy was going to have to be.

It's the same with depression. Just because the pain of depression is psychological rather than physical doesn't change the deal. Yes, depressed people ARE going to need actual therapy to solve the root problem, but in the meantime, they are in pain and need help - and it just so happens that we DO have pills which can alleviate that pain. So I think it would be unethical not to make good use of them at least in the short term, to help people get to a less painful place where they can fully benefit from a proper therapy.

3. I have a problem with the way you keep insisting that the first two types of depression are not brain illnesses.

What you really mean, is that in these two types, the brain did not spontaneously, out of the blue, start misfiring and sending people into depression.

However, this is not the only type of illness that exists out there. For example, putting too much demand on ANY part of the body is very likely to lead to some type of illness in that part of the body or a part connected to it (tendinitis, bone deformation, organ inflammation, and so on).

Similarly, it seems logical to me that putting too much demand on the emotional regulation part of the brain is likely to lead to a very real illness of the brain. There's only so long (a time different for each person) that the brain can keep functioning normally in abnormal circumstances or under excessive stress. Sooner or later, just like all other organs in the body are susceptible to doing, it might get sick - at which point, the depression will have very much become a brain illness AS WELL AS whatever else it was originally.

So, yeah, I do think you bring up good points, but I also think you make the same mistake as Big Pharma does, in wanting to completely separate the environmental/behavioural causes of depression from the biological ones. Big Pharma says all depression is biological; you seem to argue that almost all depression is due to environmental/behavioural causes.

What about the very simple and really not revolutionary idea that it's most often a messy mix of both?

Brilliant response

"Not so simple," indeed! In my opinion, the truth is that mind and body are one, and it is a mistake to treat them as distinct entities. Many in the medical profession go even farther and treat them as if they don't interact at all. A similar issue arises with those who try to classify chronic "physical" pain as either having a "physical" cause or a "mental" one, with drastically different treatment approaches depending on which box you are put in.

Reply to 'not so simple'

Hi Del,
Thanks much for your comments. You make a lot of good points. And I agree that the complete picture is “not simple”. Let me be clear about the point of the blog, which is that at the level of society, it is a very bad idea to communicate to people that mild to moderate depressive conditions are “brain diseases/illnesses” and that the proper treatment is a pill. It is a bad idea because it is not good science, and evidence is now strong, IMO, the D-PM has played a causal role in the explosion of neurotic conditions over the past three decades. If you agree with that, then you agree with the gist of the blog.
Now to reply to your specific points.
1. Just because I commented that one of the key advantages of the D-PM is that it removes blame, IT DOES NOT logically follow that I think we should blame people for their depression. Thus you have jumped to a conclusion that does not follow from the premises of the argument. As a competent therapist, I can tell you that there are ways to help people understand how their depressive feelings relate to who they are and their environmental circumstances without blaming them for it. Indeed, I like to think through greater understanding they become empowered in ways they were not before.
2. Just because the D-PM is not a good way of thinking about many instances of depression at the level of society, it does not mean that pills should never be prescribed. If I am working with a depressed individual, I inform them about medication options. Regarding your point about back pain, I had the same kind of issue with my back and certainly took pills before we knew what was going on. But I was very clear that the pills were not fixing my back. If psychiatry/Big Pharma framed it this way, then I would be much more on board. But recall that I am attacking the Disease/Pill model—they are yoked in ways that psychiatry should know that they are not.
3. I am not sure you followed my argument regarding biological disease/illness fully. Let me state for the record that I believe all psychological phenomena are, in some ways, biological phenomena. This exchange is, in some ways, due to our brains. I prefer to think of psychological phenomena as being mediated by biological phenomena, but this is admittedly a complicated philosophical problem. An aspect of my unified theory of psychology attempts to address this directly, but it would take us too far astray.
Also, for the record, I am not attacking the value in understanding the brain for understanding our psychology, although I do believe it is often glorified in a way that is problematic. Sometimes it does make sense to “reduce” psychological processes to biological malfunctions. My grandfather had serious dementia. At an explanatory level, it makes sense to attribute his marked mental decline to biological malfunctions and breakdowns. But it often does not make sense to reduce psychological behavior to biological behavior. It is no more helpful to reduce stress/anxiety/minor depression to “brain illnesses” than it is to reduce arguments between spouses to “brain illnesses” or exchanges on blogs as “brain processes”. It adds very little to our understanding to constantly repeat the claim that the psychological is also biological and it actually detracts from our understanding to make claims about biological “illness/disease/malfunction” in such cases.

I hope this clarifies my position. Thanks for the thoughtful reply.

Best,
Gregg

I'm an anti-depressant newbie, and I'm depressed about it!

Thank you for this article. I resisted going on anti-depressants for a very long time, but my problem was frequent and uncontrollable crying. I have always recognized that it is basically my life that sucks, not that I have a "chemical imbalance" (although two doctors actually gave me that old comparison about diabetics and insulin).

Now that I am on them I am more stable, but they have had unpleasant physical side affects (the worst of which is I'm having trouble with my normal, strenuous workouts).

I feel like I was coerced into going on them. Everyone had a motive - my therapist to make his job easier, my sister so I'd stop complaining to her, my friends because they're all on them, my doctor because I had a disease that she could fix...that might all seem harsh, but it's how I feel.

My hope is that I can fix some major things in my life while I'm feeling stronger, and then get off them as soon as possible. I'm so scared about them though.

Natural energy source

It's very complicated problem as there is a deep relation between health and mental freshness.If you are mentally not depressed,you will become the victim of least diseases and it will also enhance to recover from your pre-existing diseases.
energy source

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Gregg Henriques, Ph.D., is a Professor of Psychology at James Madison University.

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