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As a North American (and I suspect this describes much of the rest of the Western society) one almost seems hard-pressed to find anyone who doesn't have a family member or friend who has been diagnosed with some sort of behavioural or emotional dis-ease, if they haven't already been diagnosed with one themselves. According to a 2010 study nearly half of American adolescents now meet the criteria for a mental health disorder and according to a study that examined American adults between 2001 and 2003, it was found that 46% of the participants met criteria established by the American Psychiatric Association for having had at least one mental illness within four broad categories at some time in their lives.
So does the fact that so many people are "meeting the criteria" for depression, anxiety, bipolar disorder, ADD, OCD, schizophrenia, autism, etc., just mean that all of us are getting sicker en-masse? Could there be a societal cause? Could the cause be environmental? Could it be that big pharma has colluded with the psychiatric industry to to invent new dis-eases by pathologizing the extremes of normal human emotion? Or were there already basically the same percentage of people with these dis-eases in existence over most of human history but we just didn't have the criteria and field of study to classify them?
Classify me
Given the somewhat skeptical, sardonic and pessimistic views expressed in this blog, it would probably be of no surprise to any returning visitors that I have been diagnosed with depression. But what does this diagnosis really mean? Did I get a brain scan of any sort? Did they take any blood? Were there any attempts to observe or measure the amounts of dopamine and serotonin flowing through my brain? Nope. Some dude just listened to me talk for a while then prescribed drugs that would slow my brain's re-uptake of serotonin.
Wait... What?
A psychiatrist spoke to me and asked me questions then gave me a pill to fix the re-uptake of a specific chemical in my brain...
It's funny how so few of us question this type of diagnosis, yet imagine if you had a serious pain in your chest and your doctor just asked you questions over an hour then prescribed you a pill; wouldn't you be seeking a secondary opinion or at least ask "aren't you going to do some physical test of some sort?" I think it's kind of scary that doctors can prescribe psychoactive chemicals to someone based simply on self-reported symptoms. How does the doctor even know if the patient is being completely honest or accurate in relaying their situation? When there are no physical tests involved, it seems to me that it leaves an uncomfortably thin line between medically treating someone for an actual imbalance in their brain, and simply deciding that someone's emotions fall outside the supposed norm and therefore the cure is to treat them medically. It begins to sound dangerously like a Brave New World, where the solution to a person's displeasure and failure to conform to social norms is to give them a pill.
And who gets to classify what is normal and what is abnormal? How does one decide what is a logical reaction and what is a reaction that is only explainable by an abnormal chemical process?
The Western "bible" of mental disorder classifications is the Diagnostic and Statistical Manual of Mental Disorders, or DSM for short. Produced by the American Psychiatric Association, it is a fundamental document for much of the psychiatric community worldwide. The manual was first published in 1952, and has undergone many revisions since then.
In this video psychologist Bruce E. Levine discusses the tenuousness of the official diagnoses for psychological disorders listed in the DSM and how some so-called disorders are added to the DSM purely based on political and social reasons – a big example being homosexuality, which was finally removed from the DSM in the 1970s.
Levine also argues that the ever more common diagnoses among children of such "mental disorders" as ADHD, and (my favourite) Oppositional Defiant Disorder, boil down to kids not acting as their society wants and expects them to. He points out that very few disorders in the DSM can be observed and determined by a lab test, and asserts that conditions which can be tested and observed in this manner are truly neurological and not psychiatric. Levine argues that many of these "disorders" listed in the DSM are simply behaviours that society at large doesn't like – things in others which bother us or inconvenience us in some way. He refers to this as the "medicalizing and diseasing of normal human processes."
Another Psychiatrist who is critical of the psychiatric industry is Thomas Szasz. Szasz is a proponent of self ownership and warns how "the classification of (mis)behavior as illness provides an ideological justification for state-sponsored social control as medical treatment." He also points out that mental illness is in effect a "metaphorical disease": "Individuals with brain diseases (bad brains) or kidney diseases (bad kidneys) are literally sick. Individuals with mental diseases (bad behaviors)...are metaphorically sick." (And as an aside: I love the quote at the top of the main page of Szasz's website: "If you talk to God, you are praying; If God talks to you, you have schizophrenia.")
I'm also extremely curious as to how those who create the classifications in the DSM decide what is socially and psychologically "normal". What or who is the litmus test? What previous data do they use to compare today's patients to, especially considering the drastic changes in the social environment of people living in Western society today, compared to those living just a half-century ago? In just the last 25 years alone, the advent of the internet and the increase and saturation of media has drastically changed how people identify themselves, how they express themselves, and how they interact with others. Some believe that the internet is literally changing the way our brains our wired, and yet the psychiatric community is still treating patients today using theories, principles and treatment methods that are several decades old, not to mention using a class of drugs that was by and large developed in the 1970s.
Speaking of drugs...
I'm even beginning to wonder if the drugs do anything at all or whether both the illness and the cure are in the mind. A couple of bees in Big Pharma's bonnet are some recent studies which have shown that some antidepressants have the same success rate or sometimes perform worse than placebos and that the placebo effect overall is getting stronger. Another study has shown that even if the participants in a drug trial are advised that the pills they are being given are placebos, their condition still improves over those who took no pill at all.
To think that the key to happiness might just be a lie and a sugar pill....
Optimism is the madness of insisting that all is well when we are miserable. –Candide
Another angle to consider is whether depression is a neurological problem or simply a logical reaction. In other words: Are one's depressive symptoms the result of a biochemical misfiring in the brain or a logical reaction to outside stimuli?
When we look at Western society today and the influence of the American Empire–with it's reality TV shows, rampant waste, plastic surgeries, violent movies and TV programs, laughable "news" media, idolatry, corporatization and centralization, environmental destruction, war mongering, etc... – wouldn't it seem that depression would be a logical (albeit, not the most constructive) reaction?
A study published by Professor William Vega in the 1998 American Medical Association's Archives of General Psychiatry would seem to echo that idea: Vega studied Mexican nationals, recent immigrants, Mexicans living in the US for several years and US-born Mexicans and he found that the longer Mexicans lived in the US, the higher their rates of mental illness – more than two-times the rate of Mexican nationals or new immigrants. Not only that, but they discovered "that the rate of mental illness climbed consistently after immigration, so that Mexicans who had been in this country for more than 13 years had nearly the same high rate as native-born Americans." Although to be fair, this is but one study and I didn't find any information on how Vega discounted other possible environmental factors, or changes in diet and activity levels in this study, but I found it difficult to find any information on studies pertaining to the effects of Western society on depression, which in itself is troubling. It would seem to me that this is a rather large piece of the puzzle that is being omitted, and leaves me to ask "why?"
Could it be that as our access to information widens and the veils of mystery over many subjects become lifted, we can no longer live under the spell of cognitive dissonance that our illogical and destructive society has relied so much upon? As much as our modern media and the internet are often blamed for turning our brains to an ADD mush, I also wonder if having almost instant and unlimited access to information is making us all more cynical and skeptical and and less likely to fall for the illusion of the sanitised and idealised life of leisure and luxury that is being sold to us by our media.
Certainly there have been those who have espoused the concept of depressive realism–currently defined in Wikipedia as "the proposition that people with depression actually have a more accurate perception of reality, specifically that they are less affected by positive illusions of illusory superiority, the illusion of control and optimism bias."
In this Slate interview with Joshua Wolf Shenk (the author of a book titled Lincoln's Melancholy in which he puts forth that Abraham Lincoln struggled with major depression), he quotes a science journalist on an experiment whose results seemed to coincide with the idea of depressive realism: "One cognitive symptom of depression might be the loss of optimistic, self-enhancing biases that normally protect healthy people against assaults to their self-esteem. In many instances, depressives may simply be judging themselves and the world much more accurately than non-depressed people, and finding it not a pretty place."
And in reading the Wikipedia article on dysthymia – the "mental illness" with which I personally have been "officially diagnosed" – I was amused to find this statement: "When treating diagnosed individuals, it is often difficult to tell whether they are under unusually high environmental stress or the dysthymia is causing them to be more psychologically stressed in a standard environment."
Granted the abovementioned comment has no attached reference and could just have been a regular Joe's opinion, but statements like these do make me wonder: How much does the rise in the number of people diagnosed with mental disorders have to do with confusing correlation with causation? How many times does a psychiatrist have someone sit down in their office, tell them their life's story and the psychiatrist says: "Wow. You've really had some tough experiences. No wonder you're depressed!" then goes on to help them with coping methods, without so much as mentioning the use of drugs?
Or is it all in the genes?
..."It's all in the genes": an explanation for the way things are that does not threaten the way things are. Why should someone feel unhappy or engage in antisocial behavior when that person is living in the freest and most prosperous nation on earth? It can't be the system! There must be a flaw in the wiring somewhere. –Louis Menand, from his 2006 New Yorker review of a Timothy Leary biography by Robert Greenfield
After having said all of this, I do not discount the existence of biologically-based depression. I do believe that chemical imbalances in the brain can exist and that such imbalances would undoubtedly affect one's emotional responses and thought processes, sometimes in a detrimental manner, however the question remains as to what percentage of those suffering from chemically-based depression have the illness due to genetic or biological causes, versus external, environmental reasons.
As Menard stated in the aforementioned quote, the genetic excuse is certainly the preferable one. Not only does it mean that society doesn't have to step back and take a look at itself, but it also means a heck of a lot more money for the drug companies and psychiatric profession.
Physician Gabor Maté is one who is critical of the idea that there is a genetic basis to mental illnesses; he places far more weight on the role that experiences in childhood play in the development of the human brain. He also speaks more towards the relationship between stress and abuse and mental illness, such as in this 2011 interview with Amy Goodman of Democracy Now! Much like Western Society's take on crime, we prefer to treat the symptoms of mental illness, but not so much the cause, because that might mean totally rethinking the basic structures of our society, including how we raise and educate our children. It's much easier to give a pill to someone later in life than it is to invest time, funds and effort towards providing a better environment in which their brains could develop from the start. It's also much easier than addressing whether the adults in a child's life may be abusing or neglecting them in some way and, if so, why that is.
Commenting on a study I mentioned earlier, Maté states in the Democracy Now! interview that the fact that nearly half of American adolescents meet criteria for mental health disorders means that "we’re talking about a massive impact on our children of something in our culture that’s just not being recognized."
In his book In the Realm of Hungry Ghosts: Close Encounters with Addiction, he puts forth the idea that the human brain does not develop on its own according to a genetic program, and that its development depends very much on the environment. And as he asserts in the Democracy Now! interview, the essential condition for the physiological development of the brain circuits that regulate human behaviour is "the presence of emotionally available, consistently available, non-stressed, attuned parenting caregivers." Maté points out that prior to the advent of the Nuclear Family, "the normal basis for child development has always been the clan, the tribe, the community, the neighborhood, the extended family," and that "essentially, post-industrial capitalism has completely destroyed those conditions. People no longer live in communities which are still connected to one another. People don’t work where they live. They don’t shop where they live. The kids don’t go to school, necessarily, where they live. The parents are away most of the day. For the first time in history, children are not spending most of their time around the nurturing adults in their lives. And they’re spending their lives away from the nurturing adults, which is what they need for healthy brain development."
On a much funnier note, here is a great (NSFW) bit from comedian Doug Stanhope about how our society tends to medicalise the effect rather looking at the cause.
Last thoughts
Yes, once again I have expressed my opinion and have cherry-picked a bunch of references and links to support them, but alas that is one frustration of having a human mind (but that is also the benefit of having a personal blog!) As always I encourage any and all commentary.
There are a couple of things that I recognise about my own issues: I don't doubt that my diet and lack of physical activity play a part and I have yet to get those two issues under control for long enough to see how much of a difference improvements in those areas would make. I also don't discount the negative cycle that arises from negative thoughts due to that irksome propensity of the human brain known as confirmation bias.
And at times I wonder if I really would have been better off if I had never suffered from depression. If I was never depressed or dissatisfied with life, would I ever have felt the need to question any of it? Would this blog have existed at all? Would I have ever bothered to think outside the box if I was comfortable with the box we call "normalcy"? Which brings me back to the question: Who decides what is okay for us to tolerate about life versus what we find unacceptable? What is the benchmark?
And when I am in my deepest pits of despair and I am feeling at my most hopeless, I often think of more centred and positive people in my life and wonder: What is it that keeps people wanting to live on? What makes life so great that one is willing to put up with the many frustrations and obstacles in life? How do people living life sentences in prison live on? How do people living in war-torn third world countries live on? How do people who have lost everything live on?
One book that has piqued my interest, whose title I came across somewhere along the way to making this post, is Man's Search for Meaning – a book written by neurologist, psychologist and the father of Logotherapy Viktor Frankl about his experiences as a Nazi concentration camp survivor. I hope to garner some wisdom from his ideas. I have definitely added Man's Search for Meaning to my long list of books I would like to read. If I gain any insights I will be sure to share them in a future post.
