Why I Don't "Disease" Depression

If forced to choose between labeling immobilizing depression as either a character weakness or a disease, it's understandable that disease would be the preference. But there is a third choice, one that normalizes depression and which -- for people such as myself -- feels more respectful and better reduces suffering.

I regularly do battle with right-wing talk show hosts who mock depression sufferers as crybabies. Fundamentalist pull-yourself-up-by-your-bootstrap yappers are often heartless and uninformed, and I tell them just that. However, fundamentalist depression diseasers also need to be confronted.

"I have written a polemic, an insistent argument for the proposition that depression is a disease," is how psychiatrist Peter Kramer describes his Against Depression (2005). Kramer argues that depression must be a disease because of how devastating it is. He is certainly correct that depression can result not only in suicide but can ruin careers, destroy families, and stress the body so as to jeopardize physical health. However, such nondiseases as war and poverty also have a devastating impact; and there is a long list of noncontroversial illnesses, including the common cold, that do not have a devastating impact.

Kramer's other disease arguments are just as shaky. According to Kramer, biological markers -- the sine qua non of disease -- for depression have been discovered. He tells us that brain scanning techniques focusing on the size of the hippocampus and amygdala can differentiate the depressed from the nondepressed. However, five months after Against Depression was published, The New York Times ("Can Brain Scans See Depression?" October 18, 2005) concluded: "After almost 30 years, researchers have not developed any standardized tool for diagnosing or treating psychiatric disorders based on imaging studies."

Kramer also proclaims, "Deplete serotonin, and depression is unmasked." But researchers have depleted serotonin, and it did not cause depression in nondepressed subjects nor did it worsen the depressive symptoms of those already depressed. By 1998 The American Medical Association Essential Guide to Depression had reported that there is no clear link between levels of serotonin and depression, "as some depressed people have too much serotonin."

Finally, Kramer tells us about the defective genes of depressives, "By the mid-1990s, scientists had identified genes that might lead to both conditions, neuroticism and depression." Kramer leans heavily on behavioral geneticist Kenneth Kendler; however, two months after the publication of Against Depression, Kendler reviewed the evidence for "gene action in psychiatric disorders" in the American Journal of Psychiatry (July 2005), where he concluded: "Although we may wish it to be true, we do not have and are not likely to ever discover 'genes for' psychiatric illness."

While symptoms of depression can be caused by a variety of medical conditions (for example, anemia and hypothyroidism), such medical conditions, according to the American Psychiatric Association, actually rule out the psychiatric disease of "depression." What psychiatrists call depression has not in fact been linked to any biochemical markers.

Depression is neither a character defect nor biochemical defect but rather a strategy to shut down overwhelming pain. Used in excess, it can lead to immobilization and greater pain.

Depression is by no means the only strategy people use to shut down overwhelming pain. People use alcohol, marijuana, television, food, gambling, and worse. A depressed Sigmund Freud, pained by failure, used cocaine, then turned his friends on to it, but ultimately discovered its adverse affects and rejected it. Joseph Goebbels, even more pained by failure than Freud, shut down his pain by embracing fascism; but, unlike Freud, Goebbels couldn't have cared less about the adverse effects of his strategy.

Labeling depression as a disease gives some people relief, but such labeling creates grief for others. I have met many people who have been failed by antidepressants and electroshock. They talk about the adverse physiological effects of their treatments, but they also talk about something else. By becoming compliant patients to a medical authority, they describe losing control over their lives. Depression is an experience of helplessness and hopelessness, and for these people, accepting depression as a disease makes them feel even more helpless and hopeless.

Instead of labeling depression as weakness or illness, we might better decrease depression by understanding it as a normal, albeit painful, human reaction. When we label a part of ourselves as either "weak" or "sick," we alienate ourselves from a part of who we are, and this can create even more pain. In contrast, when we accept the whole of our humanity, we are more likely to be freed up to resolve and heal the source of our pains.

Bruce E. Levine, Ph.D., is a clinical psychologist and author of Surviving America's Depression Epidemic: How to Find Morale, Energy, and Community in a World Gone Crazy (Chelsea Green Publishing, 2007). brucelevine.net

Comments

[Researcher44]

Depression can be shown to be one of the outcomes of Subliminal Distraction exposure. It is an altered mental state in which the subject of the depression may be delusional, psychotic depression.

In the 1960's designers working on prototypes of the first close-spaced office workstations were surprised when those workers using the new designs began to have mental breaks. The cubicle was created to deal with normal features of human physiology and the mental breaks stopped.

Cubicles have been used for forty years to prevent what designers believe is a harmless episode of confusion and psychotic-like behavior. But when you look at what causes the mental break, repeated triggering of the vision startle reflex, you can search and find other activities outside crowded business offices that have those "special circumstances."

Two activities, Qi Gong and Kundalini Yoga, have centuries of experience with mental problems caused by too many group exercise sessions in a compact time frame. Each user in group situations is concentrating to perform the movements correctly while subliminally detecting movements of those close beside.

The meditating moving users are replicating the situation of those 1960's failed workstation designs.

Those users ignorantly believe powerful paranormal forces, Chee and Prana, are responsible for the mental breaks. But Subliminal Distraction is the true cause.

Fear, depression, panic attacks, and thoughts of suicide are the outcomes of this exposure.

If you have episodic depression, panic attacks, or short periods of psychotic-like behaviors search your activities for Subliminal Distraction.

VisionAndPsychosis.Net is a five-year psychology project to define Subliminal Distraction. Visit the site and perform the demonstration of Subliminal Sight and habituation in peripheral vision to understand how exposure begins.

http://VisionAndPsychosis.Net

[flawedplan]

Sorry about that, should read,

The "unintended consequences" of reducing human beings to disease-carriers is the dehumanization and stigma the pharma driven disease model claimed it would eradicate.

[flawedplan]

Yes Thorn, the totality of this construct is a point to consider. What the medical model does is "disease" the suffering, who are regarded not as full human beings, but "diseases" (bi-polar, schizophrenic, borderline, etc). The "unintended consequences" of reducing human beings to is the dehumanization and stigma the pharma driven disease model claimed it would eradicate. Thanks to the medical model chronicity, hopelessness, discrimination and voicelessness is precisely what many of us deal with in the mh system every day, in sorrow and whatever shred of resistance we can manage to call up.

[gblair]

I'll buy a "normal human reaction" when I lose my dog or my job; but is it "normal" when this horrible pall hangs over you for months/years/decades?
I have a disease and medicine helps me.

[EnigmaCat]

As someone who has lived with dysthymia and recurring major depressive disorder for decades, please let me assure you that there is a physiological "disease" component to depression. Just because science has not yet pinpointed the root cause(s) of the condition, does not mean that it does not exist.
Emotional pain does not adequately explain how a person submerged in the fog of a severe depression can be incapable of making compound sentences using multi-syllable words -- the effort at which can cause a very physical headache. There is nothing normal about being in that situation.
I will totally buy that there very likely are too many people being treated for a depression that is just part of the normal wax and wane of life.
Still, don't discount that depression is a very real ongoing struggle for some of us.

[BruceLevine]

Thank you, Otay Panky, for what I believe is a wise comment.

I think your AA analogy is an excellent one. While there are many people who feel that AA was a Godsend for them, the statistical reality is that only a small minority of people who try AA find success there. AA is not the only place where the disease model of a severe problem works for some people but fails many more.

There are different human temperaments, and that is why we need more than one belief system. It is my hope that we all become more tolerant.

For those of you who believe in the disease model of depression, I have absolutely no interest in convincing you to believe otherwise. I am clear in this piece that "labeling depression as a disease gives some people relief," and of course there are people who believe that their antidepressants have helped them.

However, there are many depression sufferers who have not been helped by the disease model and antidepressants. These people have found it to be not only nonproductive but counterproductive, and they have found other frameworks and other paths that were helpful.

Live and let live"Bruce

[Shock]

If you follow this line of reasoning all other psychiatric diseases such as Schizophrenia, PTSD etc. are also "a painful human reaction".
Even some "real diseases" such as somatic illnesses e.g. migraine are also "a painful human reactions", no biological markers nor evidence from CT scans.
This is dangerous stuff, before you know it we are back in the seventies of the last century, it is even more insulting for them suffering from these diseases.
Regards Dr Shock

[OtayPanky]

The only thing that really matters to someone struggling with depression is: does what the person think, say and do about their depression leave it better, worse or unchanged?

In whatever way we frame depression, some depressives are going to feel disempowerd by the frame, while others will find it useful.

It's just like how some alcoholics find the AA frame of alcoholism disempowering - while others find it helpful.

There's just no pleasing everybody in this world.

The larger point is: we each bear our own responsibility for figuring out what paradigms, protocols, interventions and approaches we want to accept. There are lots of choices.

[HoweyPartner]

As in the past, Dr Levine seems to exhibit the predisposition of one who is not a medical doctor toward the medical field. Depression may well be just a painful reaction, but do we not use aspirin and anesthesia? Let us continue with controlled studies of treatments so that we can let all people realize their fullest potential. Medicine's mission has been described as "to cure occasionally, relieve often, and comfort always." I'll be satisfied with 2 out of 3.

[DianeDfromPhoenix]

Thank God the disease model is finally being questioned. It started as a useful way to remove the stigma of real emotional pain; however, it has been manipulated by big pharma to push their products. Moreover, it frequently prevents individuals from making necessary changes in their lives and reinforces the false notion that a "healthy" person is never depressed.

[Atticus]

Ah, I see! Now depressed folks simply need to get a grip on their life! And, apparently, cowards are simply cowards and those unfortunates shoud merely do "the manly thing", or disappear into the dark backwaters of civilization.

Sounds pretty good? Thank God we are past the 19th Century!

[tbone99]

Some depression is just profound exhaustion as when we find that the energy we spend to stay afloat is not giving us much return psychically and for many even materially .I'm thinking of the millions who have just lost their homes to foreclosure but also the mobility needed to stay afloat financially , requiring us to sacrifice family and community ties in order to earn a living...When human values are not respected we become mere machines for the corporate profitmakers. . And when there's no one to turn to but doctors for succor they turn us over to the pharmaceutical profit machine., after taking their cut.

[tbone99]

Some depression is just profound exhaustion as when we find that the energy we spend to stay afloat is not giving us much return psychically and for many even materially .I'm thinking of the millions who have just lost their homes to foreclosure but also the mobility needed to stay afloat financially , requiring us to sacrifice family and community ties in order to earn a living...When human values are not respected we become mere machines for the corporate profitmakers. . And when there's no one to turn to but doctors for succor they turn us over to the pharmaceutical profit machine., after taking their cut.

[sigrid13]

"Instead of labeling depression as weakness or illness, we might better decrease depression by understanding it as a normal, albeit painful, human reaction."

Great...so we're back to people sneering at us to "just get over it"?

[Thorn]

"Disease" is a verb now?