In its January 23 Morning Edition segment on depression, Alix Spiegel of National Public Radio (NPR) made two statements which are not supported by scientific evidence and which are harmful to people. The two statements are:
“Everybody agrees that depression is caused by biology to some extent.”
“Researchers don’t know what causes depression.”
The first statement is not supported by scientific evidence. Clearly, depression is biological as is everything that goes on in the human body. But there is no evidence that depression is caused by biological dynamics. It is more likely that depression is caused by psychological dynamics. If we use the scientific principle of parsimony, i.e. when developing hypotheses we should be informed by what is already clearly established, our hypothesis would be that depression is caused by the reaction of a person to a life situation. After all, that is what happens with the stress response, the mind-body dynamic which has been most widely and deeply studied.
The stress response is a profound physiological dynamic. The heart begins beating more rapidly; the blood carries more oxygen; adrenalin and other hormones which increase strength and quickness are secreted; blood flow to the extremities is reduced; the pain threshold increases; blood goes to the heart, brain and muscles and not to the digestive organs; the immune system is compromised.
But the stress response doesn’t come out of the blue. Rather, it is triggered by a perception that something is threatening the person or the person is going to have to do something that is very difficult and demanding and a cognition that the threat and the demand are real.
If this is true of the stress response, why wouldn’t we think it is true of depression and other mind-body dynamics?
And there is plenty of reason to believe that it is true of depression. It is clearly established, for example, that depression is triggered by the loss of something precious to a person: a spouse, a child, a parent, a friend, a job, financial security, a sense of self-worth and adequacy, a sense of certainty and security in the world. This view is supported by the following research findings:
People with the following characteristics are more likely to become depressed than other people:
- People who derive their sense of self-worth from social relationships and who have suffered an interpersonal loss.
- People who score low on self-esteem and high on stress.
- People who score high on a Self-Defeating Personality Scale.
- People who had poor social functioning as adolescents.
People who have high levels of emotional strength and resiliency and a higher level of ego control are more likely to be able to handle being depressed than others would be.
This is evidence that depression is a reaction to life situations that are troubling, stressful, difficult, discouraging and even tragic. So the statement that researchers don’t know what causes depression is untrue. Of course, some people are more vulnerable to depression than others because they have a more difficult time dealing with stress, because they react more strongly to “hard times”, because they lack a support system that can help them weather the storm, perhaps because they are not as resilient as other people.
Ms. Spiegel and others may respond by saying that NPR was referring to “clinical” depression, not the kind of depression that is caused by loss or difficulties in dealing with troublesome and scary life issues. That is an invalid distinction. There is only one way that depression is diagnosed by psychiatrists and psychologists. The person is asked the following questions:
During the past two weeks, have you experienced the following?
- Depressed mood most of the day, nearly every day;
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day;
- Significant weight loss when not dieting or weight gain or decrease or increase in appetite nearly every day;
- Insomnia or hypersomnia nearly every day;
- Psychomotor agitation or retardation nearly every day;
- Fatigue or loss of energy nearly every day;
- Feelings of worthlessness or excessive or inappropriate guilt nearly every day;
- Diminished ability to think or concentrate or indecisiveness nearly every day;
- Recurrent thoughts of death, recurrent suicidal ideation without a specific plan or a suicide attempt or a specific plan for committing suicide.
If the person answers “Yes” to five or more of those questions, the person is diagnosed with “clinical depression”. There are no laboratory tests or physiological markers. And there is no difference between the diagnosing of the so-called “garden variety” of depression and “clinical” depression.
Thinking that depression is caused by chemical dynamics is like thinking a home run is caused by a bat. It is confusing a mediative variable with a causative one. Just as focusing on the bat is a mistake with homeruns, focusing on chemistry is a mistake with depression. The important variable in a home run is the batter. The important variable in depression is how the person is reacting to hard times, loss and deep concerns about his or her life. To focus on the bat is to lose sight of the most important variable, the batter. To focus on chemistry is to lose sight of the most important variable in depression, what is going on with the person who is experiencing it.
To say that nobody knows what causes depressed mood is just as ludicrous as saying that nobody knows what causes good mood.
The statements made by Ms. Spiegel are damaging to people for the following reasons.
They reinforce the belief that depression is caused by some unknown biological dynamic and that belief dissuades people from realizing that depression is caused by a life situation they are facing, by difficulties with spouses, bosses, jobs, parents, children; by significant loss; by deep concerns over whether one is going to be able to live the life one wants to live. And since it has to do with their life situation and how they are reacting to it, depression is an opportunity for people to learn some valuable lessons, i.e. what is precious to them and worthy of being nurtured and protected in the future, what is missing from their life and what they want to do about it, how to use the stress response to recognize and deal with threat, how to manage their thoughts, feelings, intentions and perceptions in ways that will enable them to live more the way they want to live.
They make it more likely that people will opt for taking psychotropic drugs instead of seeking help in learning how to manage their thoughts, feelings, intentions and perceptions, in learning about what makes them tick so they can manage themselves more effectively. Psychotropic drugs are harmful to people for the following reasons:
They impair the very faculties that people need to use in facing their depression and learning from it, i.e. the ability to experience and learn from emotions and the ability to think clearly.
They don’t address the causes of depressions. They only address the symptoms of depression.
They have serious side effects – mania, akathisia, sexual dysfunction, suicidal ideation, violence and suicide.
They cause the brain to compensate for increased levels of neurotransmitters thereby reducing the density of receptors, thereby causing serious withdrawal effects.
They send a cynical message: when you are feeling bad, take a pill. In fact, antidepressants work in the same way that cocaine does. Whereas Selective Serotonin Reuptake Inhibitors (SSRI’s) inhibit the reuptake of only serotonin, cocaine inhibits the reuptake of a whole host of neurotransmitters. That is the only difference.
There is a very high relapse with people who are treated with drugs. When they stop taking the drugs, the symptoms of depression return. That is not true with people who are treated with non-drug psychotherapy.
To believe that depression is caused by chemistry is to hold a cynical view of human beings. It turns them into bunches of neurons, neurotransmitters and synapses that operate in some kind of random, unfathomable fashion rather than meaning-making, desiring organisms who suffer when they are not able to live the way they want to live, when they are not able to love the way they want to love and work (express themselves) the way they want to work. And the suffering is potentially useful because it induces people to take stock of their lives, realize what is precious to them and needs to be protected and learn how to mange their thoughts, feelings, intentions and perceptions so they can live more the way they want to live.
The widely held belief that depression is caused by a chemical imbalance in the brain has not been supported by scientific evidence. Doctors are not able use laboratory findings to diagnose depression. Researchers have not been able to induce complaints of depression by directly altering neurochemistry in ways consistent with the chemical imbalance theory. The “normal balance of neurotransmitters” has never been established. So how can we know what an imbalance is?
National Public Radio is looked upon by many Americans as a source of accurate reporting, as a spokesman for the truth. This is especially important when it comes to the truth about health issues. By making the two erroneous statements about depression, NPR has let down its listeners in a way that is harmful to them.
Al Galves is a retired psychologist who lives in Las Cruces, New Mexico. He is Executive Director of the International Society for Ethical Psychology and Psychiatry.
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.
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“Of course, some people are more vulnerable to depression than others because they have a more difficult time dealing with stress, because they react more strongly to “hard times”, because they lack a support system that can help them weather the storm, perhaps because they are not as resilient as other people.”
This is where the proponents of a biological view of “depression” (and other “mental illness”) often take their last refuge when you confront them: “Others have experienced the same, and did not become depressed. So, it must be biological!” The stress-vulnerability model. What is it that causes some people to have a more difficult time dealing with stress, to react more strongly to “hard times”, to not be as resilient than others? Or, why is it that, for instance, some people have had poor social functioning as adolescents? Is it biology, genes?
My own reply to this “argument” is that there are no two people in this world who have exactly the same life story, and that, when you take the investigation beyond what caused the present bout of “depression”, you will, sooner or later, also find a good reason in the life story of the person for them to, for instance, have had poor social functioning as adolescents, to have become less resilient than others, and to react exactly in the way they react to their life here and now. Biology is just another “symptom”. The body is a metaphor (indeed! They just “forgot” to tell us, didn’t they?!).
The “We don’t know anything” “argument” only holds as long as you stick to asking people “What’s wrong with you?”, instead of asking “What happened to you?”, i.e. it’s not about not knowing, but about not wanting to know.
I too was concerned and put off by the citing of “blaming the victim” traits that supposedly make one more susceptible to depression. I agree that no life story is the same and how can any professional determine that one’s past or current life stressors were more or less than anyone else’s. I read that ironically mental health experts don’t even bother to investigate situations causing their so called patients’ distressed while routinely demanding the highest impossible proof of the patient’s story and usually dismissing it. Odd that these experts have a far less standard of credibility to meet than their so called “mental patients.” Who is to judge that one person’s life or recent events causing too prolonged toxic stress leading to depression was more or less stressful, traumatic or tragic in assessing who is more vulnerable to stress, fragile, lacking in esteem and other blaming the victim factors that can’t be proven.
People who have been mobbed and bullied at work and other environments are known to suffer PTSD with this nightmare frequently driving the victims to suicide. Dr. Heinz Leymann who coined the term “mobbing” for when a group of bullies gang up on one person with a variety of degrading behaviors to literally destroy the victim and drive him/her out of the work place or other environment, states that these victims have been even more taumatized than rape victims and conductors who hit people with a train making them a literal train wreck of their former selves. Often, such mobbing and/or bullying is done to excellent workers who invoke jealousy and other negatives while the perpetrators may be psychopaths, narcissists or just very nasty people. The bottom line is that Dr. Leymann says that such people will often be misdiagnosed with manic depressive illness, paranoia and other false labels for their PTSD since the psychiatrist can’t be bothered truly investigating what really happened making it easier to blame the victim and collue with those in power. Dr. Leymann says that such a horrific experience has so traumatized the victim, that their original personality cannot even be found for quite some time. Such traumas happen all too often as with the infamous case of Phoebe Prince of South Hadley bullied to the point of suicide by her high school peers or a mob of “mean girls” out of jealousy and competition for centain boys. Many mental health experts are not familiar with how work, school and other bullying and mobb can so traumatize and destroy the victim so they tend to blame the victim as required by biological psychiatry and retraumatize and further destroy them with life destroying stigmas, lethal drugs and total invalidation.
I agree with much of this article and applaud the author for exposing the truth about the so called clinical depression diagnosis or any for that matter. But, I think the author also inadvertently blames the victim by accepting nonprovable labels and theories that are not necessarily true. Since women suffer more depression than men for obvious reasons like rampant sexism and misogyny, feminists have had a field day with sexist labels mainly applied to abused women like self defeating personality disorder or borderline…I believe the whole list of what makes people more susceptible to depression is another blaming the victim enterprise that cannot be proven and makes the error of biological psychiatry of assuming certain environments with no evidence or way to verify it objecitively.
I point out these factors based on tons of research and reading since society and psychiatry tends to blame the victim based on the bogus “just world theory” so they can delude themselves that they are superior, more entitled, the victim deserved what he/she got and such a thing would not happen to such a worthy, superior person like themselves, which could be called delusional or psychotic thinking.
Any attempts to claim that some people are more susceptible to stress, trauma, depression or other so called mental ailments leads us back to the bogus road to hell of biological psychiatry with its fraudulent assumption that everyone has the same environmental stressors/situation to justify its fraud stigmas with the pretense of biological causation. Toxic stress is known to lead to depression from sheer exhaustion.
Finally, I applaud the author for exposing the truth about the fact that typical difficult life stressors or crises like divorce, job loss, death, illness, drastic change, moving and other major changes cause the most stress leading to depression rather than the bogus chemical imbalances claimed by BIG PHARMA ad ploys. Yet, I hope the author carries such truths to their final conclusion that depression is not caused by one’s biological defects, but rather life’s many defects and toxic stressors and losses.
Good commentary, Al Galves.
If people really adhered to a sensible interpretation of what is going on, an etiological-based dynamic of how the person is responding based on the empirical pre-cursors which set up that current dynamic, there would be no confusion. The answer would be clear.
The other sensibility that keeps getting lost in the mix is the simplicity of identifying what that energy looks like and what transforms it effectively into its counterpart so a balance can be recreated.
If a person is puddling, the addition of the leaping energy of fire helps to counterbalance.
Bouncing on a minitrampoline may seem to be a strange thing for a depressed person to do, but it is exactly what a depressed person doesnt’ do——–their energetic state reflecting their lack of desire to be in higher motion. So, you get them bouncing on trampolines or those bounce castles children love. You get them moving in a way that facilitates the energy shifting within. Cold showers help—-the body responds by internally producing more heat energy, a higher kinetic state of being. Exercise, etc.
Anything which provokes the person to begin moving and empowers them to begin moving for themselves.
Initially it is WITH another, a therapeutic motivator…. then they learn they can do it for themselves.
But always, always, the need to thoroughly rule out environmental toxins/pathogens which may first have to be redressed in order that the energy again can start to rebalance. Good, sane medicine starts with knowing what is actually wrong—or else the confusion continues.