An unscripted appearance on a radio show always leaves me a bit shaken. Was I too vague? Too assertive? I thought that the discussion Friday with Jim Gordon and Ira Flatow went well. Still, there’s always the problem of what the French call l’esprit de l’escalier, the mot juste that comes to you on the staircase, after you’ve left the salon. The great thing about writing a blog is that you get to speak in public from the staircase.
On “Talk of the Nation: Science Friday,” we were considering two topics: whether depression is a disease and whether alternative medicine offers a superior approach to depression. I wish I had said that these topics are separable.
After all, the great claim of alternative medicine is that it treats disease. Who would care about alternative medicine if it didn’t?
I have had psychiatric patients who swear that meditation has done wonders in decreasing the frequency of their asthma attacks. I have believed these patients, although a recent trial of yoga-related meditation for asthma has shown weak results — no significant effects after two months. More generally, it has been difficult to demonstrate that meditation has important benefits for any medical condition. But if meditation were found to mitigate asthma, that result would not change asthma’s status conceptually. No one who employs the notion of disease would exclude asthma from the category.
Of course, a proponent of alternative medicine might reject the disease model entirely and say that both asthma and depression are best seen as signs of disruption of spiritual forces. But then the claim that depression is not a disease would need, under full disclosure, to be accompanied by acknowledgment of that more radical stance, one that still leaves depression in the same category as other serious complaints.
Either way, to recommend alternative treatments for a condition says nothing about its standing as a disease.
As for why a doctor might say that depression is a disease, and an ordinary, if devastating, one — I outlined some of my reasoning on the radio show; and I discussed one element in the train of thought in my most recent prior post here. A full argument appears in my book, Against Depression. But I do want to make a point I omitted on “Talk of the Nation,” concerning the importance of the label disease.
If the findings of recent decades are to be believed, depression is a progressive ailment, behaviorally and neurologically. Episodes are themselves risk factors. The more episodes you have, and the longer they last, the more likely you are to have subsequent episodes. The later bouts tend to be more severe and harder to treat. And then chronic depression predisposes to the painful outcomes I did mention, from heart disease and stroke to impairments of love and work.
That’s the problem with the “at least they’re not harmful” argument, regarding meditation, yoga, and the like. If they’re not helping, and if they’re forestalling a more conventional treatment that would help, then they are causing grave harm. A benefit of the disease label is that it directs people to the medical system, where they can receive expert attention.
If I sounded forceful on “Talk of the Nation,” that’s why. The disease category matters.
I do wish that Dr. Gordon, who who is an experienced and thoughtful physician with wide-ranging interests, had shared the premise that depression is a disease. Then we could have concentrated on one issue only: what works for depression. As for whether alternative treatments should be in the mix and how we would know, I hope to turn to those questions in a later posting.