Viewing depression as a “brain defect” rather than a “character defect” is supposed to reduce the stigma of depression, according to the American Psychiatric Association, the National Alliance for the Mentally Ill, and the rest of the mental health establishment. But any defect can be stigmatizing. What if depression is the result of neither a brain defect nor a character defect?
At one time in U.S. history, Americans actually elected a known depression sufferer as president. In Lincoln’s Melancholy, Joshua Wolf Shenk reports that Abraham Lincoln’s long-time law partner William Herndon observed about Lincoln that “gloom and sadness were his predominant state.” And Shenk reports that Lincoln experienced two major depressive breakdowns which included suicidal statements that frightened friends enough to form a suicide watch. However, in Lincoln’s era, when depression was seen as neither a character defect nor a brain defect, Lincoln’s depression actually helped him politically more than it hurt him. Lincoln’s depression gained him sympathy and compassion, and drew people toward him, as it “seemed not a matter of shame but an intriguing aspect of his character, and indeed an aspect of his grand nature,” according to Shenk.
Today, when we treat depression as a brain defect, it appears unlikely that anyone with Lincoln’s temperament would receive a U.S. presidential or vice presidential nomination. In 1972, George McGovern’s vice presidential running mate Thomas Eagleton was shoved off the ticket because of his history of depression and medical treatment for it. And today, it would seem near impossible for a candidate who had received electroshock for depression to be elected president.
Lincoln’s words, humor, and face revealed a man who suffered from deep pains. This is also true for Winston Churchill, William Tecumseh Sherman, and other critically thinking leaders who have suffered from depression. Lincoln, Churchill, and Sherman visibly experienced pain but inspired people because of, in part, their capacity to overcome their pain. Today, we reject leaders who visibly suffer from pain.
While Lincoln, Churchill, and Sherman were certainly not without flaws, so too are the “compulsively upbeat”— the “bright-sided,” to use Barbara Ehrenreich’s term. The U.S. political preference for the compulsively upbeat became clear with the ascent of Ronald Reagan. Reagan’s reputation as a “great” and a “transformative” president has been cemented not only by the corporate media and Republicans but by Democrats such as Bill Clinton and Barack Obama. All this despite Reagan’s committing one of the most heinous offenses in U.S. presidential history—selling arms to Iran in violation of an embargo so as to illegally fund the Nicaraguan Contras. Reagan’s offenses have been largely ignored by present America; but not ignored, especially by modern American politicians, is the fact that Reagan’s sunny disposition defeated his more downbeat political rivals and helped create the Reagan legacy.
Americans have been increasingly socialized to be terrified of the overwhelming pain that can fuel depression, and they have been taught to distrust their own and other’s ability to overcome it. This terror, like any terror, inhibits critical thinking. Without critical thinking, it is difficult to accurately assess the legitimacy of authorities. And Americans have become easy prey for mental health authorities’ proclamation that depression is a result of a brain defect. But what does science actually say about the brain defect theory of depression?
Science and the Brain Defect Theory of Depression
The reality is there is as no scientific proof that depression is caused by either a character defect or a brain defect.
Medical conditions such as hypothyroidism and anemia can cause depression, but the American Psychiatric Association’s diagnostic manual, the Diagnostic and Statistical Manual of Mental Disorders (DSM), states that a patient should not be diagnosed with the psychiatric disorder of depression when the symptoms of depression are due to a general medical condition. The mental health establishment is committed to the idea that depression is a separate brain disorder, and it has declared several biological-chemical-electrical theories for it.
For nearly a generation, doctors and the general public have been told that depression is caused by an imbalance of neurotransmitters, most notably serotonin. However, in the 1990s, this theory was disproved, but the National Institute of Mental Health made no serious effort to communicate this to the general public until 2007, and even today today, the National Alliance for the Mentally Ill, an influential U.S. institution that disseminates mental health information, keeps this truth buried. Here’s the details of this history.
For quite some time, unknown to most of the general public and even many doctors, researchers have used a variety of methods to test the serotonin (and other neurotransmitter) imbalance theory of depression. Research methods included comparing serotonin metabolites in depressed and nondepressed people, and depleting serotonin levels through a variety of means and then observing whether this caused depression. The results? Elliot Valenstein, professor emeritus of psychology and neuroscience at the University of Michigan, in Blaming the Brain, reported in 1998 that it is just as likely for people with normal serotonin levels to feel depressed as it is for people with abnormal serotonin levels, and that it is just as likely for people with abnormally high serotonin levels to feel depressed as it is for people with abnormally low serotonin levels. Valenstein concluded, “Furthermore, there is no convincing evidence that depressed people have a serotonin or norepinephrine deficiency.”
In 1999 the journal International Clinical Psychopharmacology ( in “Antidepressants and the Brain”) reported on serotonin, norepinephrine, and dopamine depletion studies, and stated that “depletion in unmedicated patients with depression did not worsen the depressive symptoms, neither did [depletion] cause depression in healthy subjects with no history of mental illness.”
In 1996 Pharmacopsychiatry (in “The Revised Monoamine Theory of Depression: A Modulatory Role fo Monamines, Based on New Findings from Monamine Depletion Experiments in Humans”) reported that nonmedicated subjects—whether depressed or nondepressed —do not suffer depression deterioration in response to depletion of serotonin, dopamine, or norepineprhine. Ironically, subjects previously medicated with antidepressants do suffer depression deterioration in response to depletion of these neurotransmitters. In other words, a person’s naturally occurring level of serotonin (and other neurotransmitters) is unrelated to depression but, as psychiatrist Grace Jackson writes in 2005 in Rethinking Psychiatric Drugs, “The available evidence suggests that antidepressants may induce persistent sensitivities in the brain which increase a patient’s vulnerability to recurrent depression beyond that which would occur naturally.”
Thus, by the 1990s, it was known in the scientific community that the serotonin (and other neurotransmitters) imbalance theory of depression had been disproved. Yet, as detailed in Society in 2008 (“The Media and the Chemical Imbalance Theory of Depression”), the general public continued to hear—through antidepressant commercials, the mainstream media, and some mental health authorities—about the neurotransmitter imbalance theory of depression. Even today, the National Alliance for the Mentally Ill states on its Web site, “Scientists believe that if there is a chemical imbalance in these neurotransmitters [norepinephrine, serotonin and dopamine], then clinical states of depression result.”
So, many Americans are surprised to discover that by 2007 the National Institute of Mental Health had moved on to another theory. Newsweek, in its February 26, 2007 cover story, reported that:
For decades, scientists believed the main cause of depression was low levels of the neurotransmitters serotonin and norepinephrine. Newer research, however, focuses [on something else]. . . . A depressed brain is not necessarily underproducing something, says Dr. Thomas Insel, head of the National Institute of Mental Health—it’s doing too much. . . . Instead of focusing on boosting neurotransmitters. . . scientists are developing medications that block the production of excess stress chemicals.
Stress can stimulate the release of cortisol, which can negatively affect both body and mind. And many other medical conditions can also result in symptoms of depression. However, as noted, the DSM states that a patient should not be diagnosed with the psychiatric disorder depression when the symptoms of depression are due to the “direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).” If hypothyroidism is considered a medical condition, it’s unclear why the overproduction of cortisol would not also be considered a medical condition.
Thus, rather than a specific psychiatric brain disorder causing depression, we are simply talking about the uncontroversial reality that certain physical, familial, and societal pains can trigger depression.
While individuals vary in their belief about the benefits and costs of continuing to view depression as a psychiatric disorder caused by a brain defect, as long as depression is considered a psychiatric disorder caused by a brain defect, Americans are unlikely to ever elect another pained depressive such as Abraham Lincoln as president. I can’t help but wonder what American political leadership would be like if Americans had been led to believe that it’s actually the insipidly upbeat who have a brain defect.
Bruce E. Levine, a practicing clinical psychologist, writes and speaks about how society, culture, politics and psychology intersect. His latest book is Get Up, Stand Up: Uniting Populists, Energizing the Defeated, and Battling the Corporate Elite. His Web site is www.brucelevine.net
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
“neither a brain defect nor a character defect?” Excessive sadness is an “illness” because a person can’t make money ( or go to school) when under its influence. Everyone has to make money or be productive every day, like a machine, or else. That is seven days a week of work now, no Sundays off.
Modern western society and how it is organised is really to blame partly for the explosion of depression. You have to comply or else. You have to fit the criteria of what is thought-by whom?-to be normal. Being shy and self-sufficient is not considered normal. Being gragarious and loud is: why? The so called normal ones are often selfish and destructive. People are pushed into fitting in a few stereotypes – no wonder they get depressed: their needs haven’t been met.
Great comments Mark & Arta
I have a favorite piece of graffiti art that says, “It’s tough to make a living when all we do is work.”
It is the term “defective” that is the problem. The term suggests the problem is located stictly WITHIN the individual and that external reality, other people and events are irrelevant. That is the problem with ALL of the labelling processes which promotes the idea of containment just like a “real” disease…like diabetes
A very interesting article flawed only by the gratuitous peek into the author’s political preferences…
I don’t mind a peek into his politcal leaning, that’s not a problem for me. I agree with him totally. It doesn’t matter what you say is the cause of mental anguish, people who have never experienced it to the level that some of us have do not want anything to do with us. It’s like they’re afraid that it will rub off on them if they get too close to us. It is easier to blame us than it is to take a long, hard look at society and deal with the issues there which are often the causes of our problems. The prevalence of child abuse in all its horrible forms has caused trauma that caused many of us to develop our difficulties in the first place; but no one wants to deal with it. It’s the same with racism, poverty, the list goes on and on of things we don’t want to deal with. It’s easier to blame those of us who manifest these problems visibly for people to have to look at who are punished and mandated “treatment,” which is no treatment at all. One of the huge reasons that we have revolving doors in psych hospitals is that the actual cause of the difficulties is not dealt with; only the symptoms are dealt with by means of numbing, tranqualizing, chemical lobotomies. Until you get at the root of the problem, nothing will change. Most of today’s psychiatrists are not helping people get to the root of the problem.
I couldn’t have said that better myself.
I don’t think we can blame Reagan for the fact that Americans no longer accept depression as somewhat normal. It probably can be blamed on the mental health profession. Now, everyone must be constantly cheerful, or they will be diagnosed and drugged. I agree, the idea that mental illness results from brain defects which can be corrected by drugs is very wrong.
However, I also think that depression and other mental illness is very often caused by an unhealthy lifestyle, which causes chronic inflammation. It is more often physical than psychological. We all suffer from disappointments at times, but it is less likely to lead to a downward spiral if our physical health is relatively good.
Emotional pain is a fact of life that no one can avoid, but some experience more than others. Would we have any great literature at all if everyone were as naturally cheerful as Reagan? Probably not.
I strongly disagree with your second paragraph…
Researchers at Auburn University did a highly interesting study focusing on whether the diseased brain model of the “illness” reduces stigma.
Résumé / Abstract
This study examined the widely held belief that a disease view of mental disorder reduces stigma. Behavioral and self-report measures were used to assess 55 male students’ treatment and attitudes toward another, whom they believed either to be a typical student or to have a history of mental disorder. The mental difficulties were characterized in either disease or psychosocial terms. The results indicate that the way in which mental disorder is represented does have an effect on behavior and on some aspects of evaluation. In general, the disease view did not improve attitudes, except in terms of blame. It did, however, tend to provoke harsher behavior. In contrast, the psychosocial view induced treatment no different from that toward normal others. The results provide little support for the claim that regarding the mentally disordered as sick or diseased will promote greater acceptance and more favorable treatment.
Journal of social and clinical psychology ISSN 0736-7236 CODEN JSCPFF
I’m very glad you included this damning exposure that the bogus stigmas psychiatry inficts to push their lethal treatments to aid and abet the oppression by those in power tend to discredit, silence, disempower, ostracize, dehumanize and destroy the stigmatized, causing them to be feared, rejected and despised as subhuman as psychiatry intends so they can continue to push their lethal torture treatments on those they target with impunity with public/legal support they promote like zealots. Their hypocritical, ludicrous antistigma campaigns are a total farce as they well know based on this study.
They probably promoted this study to ensure their real evil motives to destroy anyone in the way of the power elite is universally forsaken and abandoned to their torture treatments through the use of fear, force and fraud to ensure their early death by about 25 years after living as a drugged or ECT brain fried zombie for the miserable years they have left thanks to biological psychiatry, the police of our totalitarian dictatorship with psychiatry acting as their police and SS.
Donna, I think you are absolutely correct. There are so many things tied up in this “mess” that psychiatrists call “Treatment” that it isn’t funny. So much of it has to do with their own egos and with power, authority, and control, than it does actual treatment geared towards recovery and well being. Peers, on the whole, do a much better job of walking with people on their journeys of recovery than the psychiatric establishment does. We can talk the talk and walk the walk becasue we’ve been there and back again. Thanks for your posts; I always look for yours since they are always well informed and right on target. Thanks for being here and sharing your ideas and expertise.
A brain defect theory / idea / concept will put a limit on any other observation or consideration – and as treatments are formulated, they will do more harm than good if the original theory / idea / concept was false.
“The mental health establishment is committed to the idea that depression is a separate brain disorder, and it has declared several biological-chemical-electrical theories for it.” This is truly ignorant.
Several years ago i ran a “label-free”, drug-free camp for kids diagnosed with psychiatric disorders. The labels clearly had stigmatized them and only served to reinforce the very behaviors that were causing problems in their lives. Yet, with kids being kids, all you had to do was get them involved in real life activities (fun stuff like fishing and bicycling and building things) and truly disregard their offical diagnoses, and before long they too were able to forget they had some kind of ‘brain defect.’ (By the end of the camp i didn’t have any kid saying, I’m ADHD, or I’m bipolar, etc); Unfortunately, the parent(s) weren’t so eager to drop the labels. Often it was easier to work with them to wean their kids off the drugs than to get them to reject the diagnosis…)So maybe it’s families who feel less stigmatized. If parents (teachers & counselors) can blame it all on a child’s brain – everyone’s off the hook…. while the kid is potentially ruined for life.
Thanks Bruce! Another great blog.
Steve Clark, great observation & comment re: the desire of many family members to be let off the hook for any failings or mistreatment that may have caused/contributed to their family member’s distress. This is why NAMI exists, to deflect blame off of families by propping up the medical model.
Excellent post from someone who has been unethically medicated against my will for over 20 years. I am finally waking up from a bad dream called “psychiatry’s ignorance and arrogance”. With all the scientific evidence disproving a chemical imbalance theory, it hasn’t stopped my current psychiatrist from prescribing unnecessary and harmful drugs. In fact,the chemical imbalance theory is alive and very well in my neck of the woods – Toronto, Canada.
I also happen to suffer from Hashimoto’s disease – an autoimmune condition that affects thyroid functioning thus leading to hypothyroidism thus leading to depression. Sadly, when I was diagnosed 24 years ago with Bipolar Disorder (a time when the diagnosis was less common), no one thought to have my thyroid checked out before prescribing Lithium Carbonate for the rest of my life. Guess what? Lithium contributes to hypothyroidism and hence depression. Isn’t that rich? So then I am prescribed various SSRI’s to deal with a lithium/thyroid induced depression. Of course, as this article poignantly points out, there is no direct relationship between serotonin and depression, so those drugs weren’t of any value other than an initial placebo effect.So then comes attempted withdrawal from the SSRIs which spins you into crazy depression and irrational behavior unseen by the likes of my “naturally occurring” depression. So then psychiatry tells you that this confirms that you need more drugs to manage your chemical imbalance!
I have to hand it to psychiatry that it is an ingenious theory that unfortunately always lands on the patient to deal with the horrific consequences of irresponsible drug dispensing.
I am not suggesting at all that my physical conditions (hashimoto’s, hypothyroidism) were the sole cause of my severe states of depression. These factors contributed no doubt, but the emotional pain of an extremely dysfunctional family environment took its toll on me.
The problem with psychiatry (and all areas of modern medicine) is that there is little incentive for a patient to get well. If this were the case, then patient’s would be listened to and allowed to process their emotional distress in a supportive empathic environment.For all the psychotherapies out there, it is the caring relationship between a therapist and patient that can lead to emotional healing. But where’s the money in that?
My family is still very much attached to the chemical imbalance theory – no surprise there. It absolves everyone of responsibility for causing any unintentional pain. After all, it’s all in my head. No need to worry about the social environment!
Dr. Levine you make some very interesting observations and certainly back them up with profound medical evidence. I both agree with you and disagree with you and here is why: I completely agree that there is no medical “evidence” for something that we call depression. There has never been chemical evidence for a depressive state and the public is misled on this subject largely because they are misinformed about mental illnesses, as we know.
I do however, have to point something out that counters your belief. There is a reason why people take anti-depressant medication even though there is no medical evidence for their success. They take them because they work, because they save lives. I am in recovery, and also a mental health worker, and I have seen many many individuals who were on the proverbial “edge of the cliff” whose lived were turned around with the administering of medication. Does this prove that chemically there is a legitimate scientific connection going on in these case? No, it doesn’t. Does taking these meds save lives? You bet. There are other medical instances in which “medication” is given without there being a confirmed biological basis in terms of their efficacy. When someone undergoes chemotherapy, the “medicine” is basically a poison that is injected into a cancerous body. Doesn’t make sense medically to me? But it works, sometimes.
The theoretical biological viewpoint is a tricky one. No one wants to assume something that isn’t proven, however, it is also damning to give total weight to the environment as the sole cause of mental illness. Believe me, it is much easier to tell someone that they have a biological illness called depression than one that has no biological basis. Without the medical explanation, at least partially, the cause is on the consumer and his or her environment. If it isn’t medical, than the consumer’s environment (and hence the consumer) is to blame. There is no way around this problem as the stigma in our society dictates. The beauty of recovery is that it has a “medical ring” to its sound and people go for that, they like it, consumers and non-consumers. It combines both elements.
Finally a comment on your list of political heroes who were depressed. I agree that society limits those with mental illnesses from entering office. But please consider this – the goal is not to venerate Lincoln for being a depressed man who became President. The goal is to conceive of a world in which Lincoln could be President as someone who has depression AND get treatment for it!! Lincoln would have been just as sensitive and probably have suffered much less if there were meds for his illness or even holistic treatments back them.
Consider Vincent Van Gogh – we all love his art work right? Did the man have to cut off his ear (clearly psychotic) in order to paint the way that he did? Let’s not get carried away with idolizing the mentally ill heroes of our past. They were brave, but they didn’t need to suffer as they did.
dstine, I disagree with your comment “If it isn’t medical, than the consumer’s environment (and hence the consumer) is to blame.” The ‘consumer’ (person) is not necessarily to blame because his/her environment is deficient or unhealthy. How do you make that jump?
Yes, while you people beat around the bush, ignoring the fact that many of our lives were ruined by antidepressants.
Lincoln and Van Gogh most likely would not have been in touch with that aspect of their brilliance if they had been medicated in order to be made “happier.” Just my humble two cents…
You could say the same about Beethoven or Churchill. Thank God they didn’t get “treatment”. Beethoven probably wouldn’t have written his 9th Symphony with all of that toxic crap in his body. A world without the 9th symphony wouldn’t be a world worth living in..
There are often physical factors that contribute to depression, and these factors often do not originate in the brain. Here are 13 blood tests I recommend people get done if they struggle with depression: http://www.optimallivingdynamics.com/blog/13-important-blood-tests-to-get-done-if-you-have-depression
Unfortunately, people are simply given antidepressants without any tests.