The theory that depression is a biological disease, caused by an imbalance of serotonin and the other neurotransmitters is invalid. It is a house of cards promoted by Big Pharma and its influence peddling in academic psychiatry. It has been completely accepted by the American Psychiatric Association with its DSM_5 and the culture at large. And the treatment for ‘clinical depression’ is promoted to be antidepressants. Beyond recognizing that this theory is untrue, it is incumbent to present a valid understanding of depression, the brain, and consciousness and the appropriate treatment.

            The pharmaceutical industry has been exposed having been engaged in study suppression, falsification, strategic marketing, and financial incentives. Sales of antidepressants in 2011 was 11 billion dollars. Ben Goldacre is his illuminating Ted lecture, “What doctors don't know about the drugs they prescribe” addressed the issue of study suppression. A fifteen year review of antidepressant studies showed that 50% of the 76 studies were positive and 50% were negative. All of the positive studies were published and all but three of the negative studies were suppressed and not published. In 2004 approximately half of all studies that weren’t already suppressed by the pharmaceutical industry concluded that antidepressants are not significantly more effective than placebo alone. And two thirds of studies for children given antidepressants show the same.  Even the standard for the positive studies by which effectiveness is scientifically accepted is that if  antidepressants work 40% of the time and Placebos work 30% of the time, it is deemed to be an effective drug. This means that the antidepressants apparently work 10% of the time. So much for this evidence based theory. In real science, the exception proves the rule.For a theory to be correct it has to be correct 100% of the time. I will not go into the negative effects of these drugs here – in addition to not being efficacious there are considerable side effects, habituation, drug tolerance and addiction. [See the download “Do No Harm”, the Appendix of my book.]  

            The real cause of depression, and all the rest of psychiatric symptoms, follows from the way one’s unique consciousness is formed in the brain all through development from embryonic life to age twenty. Our developmental experience is mapped in the limbic-cortex as incredibly complex circuits of neuronal maps that reflect the impacts of love, respect, deprivation, and abuse as digested by one’s unique temperament. These brain maps generate human consciousness - which is organized in as a drama in the theater of the brain with a cast of personas, feeling relationships between them, scenarios, plots, set designs and landscapes. The internal play is the consummate creation of the human genome. Once established, beginning at age three, the representational play operates via top down cortical processing, and is the invisible prism through which we live our lives.

Serotonin and the other neurotransmitters operate in the synapses of our limbic cortical maps connecting the trillions of neurons that create the mappings that form our plays. Serotonin has no life of its own. It is merely a brain mechanism that serves the neuronal organization of consciousness, the play itself. The way the limbic-cortical brain maps our experience reflects the actuality of our experience. If our character play is too damaged by deprivation and abuse, it generates an invisible sadomasochistic play that is filled with attack and humiliation, endless war. Consequently the activated internal play is one of continuous internal fighting between personas. As such it feeds on the serotonin supply on an ongoing basis. It is inevitable that the supply will be overtaxed. This is not the result of a serotonin problem. It is built in from a damaged characterological play. It is not a question of ‘if’, but only ‘when’ serotonin will be overused and depression will appear.

Depression is the signal that there are problematic fault lines in one’s characterological play. It does not mean there is a neurotransmitter problem. It means there is an internal play problem. If one feeds more serotonin into the system, one actually feeds and builds the internal war which only worsens the situation. In fact, the antidepressants actually harden people and makes them unconflicted about selfishness, which can be experienced as feeling better. But the real problem is the damaging problematic play. This is what needs to addressed and healed rather than fueled.

The treatment is the psychotherapy of character. Psychotherapy operates in exactly the same way as our plays were created in the first place. In therapy, one mourns one’s problematic experience within the boundaries and emotional holding relationship with the therapist. A patient digests and relinquishes his old play, and then writes a new play that is not sadomasochistic. Symptoms disappear all by themselves as the old play, where serotonin was being over consumed, is no longer activated. In its place, a new play, grounded in authenticity and love is established and activated. The brain is dynamic and responds to psychotherapy in its characteristic way. Studies have repeatedly shown than that the brain changes from psychotherapy. How can that be if symptoms are a serotonin disease?

For a theory to be valid, it has to conform to the actual brain-body in its development and organization. It has to correspond to the actualities of the human genome as it orchestrates morphogenesis into the mature adult brain-body. Likewise, in order for an understanding of the operations of the brain-body to be meaningful, it has to be consonant with actualities of human life and struggle. There has never been any evidence for the neurotransmitter disease model. On the other hand, I propose a model that is consonant to the realities of human life and development. It is a unified field theory that encompasses dreams, myths, art, human character, religion, and beliefs. 

Robert A. Berezin, MD is the author of Psychotherapy of Character, the Play of Consciousness in the Theater of the Brain

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