According to the Diagnostic and Statistical Manual of Mental Disorders, you have Major depression if you experience five or more of the below symptoms during a two week period. Let’s have a look at them:
- Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, or hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
- Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
- Insomnia or hypersomnia nearly every day.
- Psychomotor agitation or retardation nearly every day (observable by others; not merely subjective feelings of restlessness or being slowed down).
- Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
- Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
- Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
Needless to say, this seems like a fair summary of a depressed person’s behavior. However: Does ticking off some of these boxes really warrant labeling a person with a mental disorder?
After all, there are innumerable roads leading to the above described symptomatology - ranging from psychological impactful life events to physiological detrimental states. The self-reinforcing quality of depression further complicates the situation. For instance: Not getting enough sleep has been proven to cause lots of mental distress and leads to poor decision making. Poor choices may manifest themselves in one’s eating behavior, which can then lead to nutritional deficiencies that make an optimally working of the brain impossible.
However - If it’s chronic insomnia causing the sleep deficit, it would be technically wrong to diagnose the person with depression. It might well be that the resulting bad mood causes the most detriment to the patient’s life. Yet this is just an accompanying effect of the lack of sleep. He or she might not even realize the degree to which their sleep is out of the ordinary - as in people with sleep apnea - or takes sleeping pills, not knowing that they make their shut-eye more akin to a coma rather than regeneration. Psychiatrists are quick to leave this information by the wayside: They label the symptom of depression as the disease itself.
This is haphazard procedure at best and right out reckless at worst. Why?
First of all, imagine we did this with other kinds of symptoms - say, fever. We’d call every disease carrying it by the same name - as fever happens to be the most prominent symptom of many diseases. Not only would that take away the incentive of finding its cause, treating this superficial manifestation of a physiological problem would allow any other effects the pathology has on the body to remain undetected. In the case of bad quality sleep, the increased likelihood of developing alzheimers would be one such example. Arguably, the phenomenology of depression is much more complex in its nature, which makes the compartmentalizing partially understandable - for the layman. When it comes to health care authorities though, our current approach becomes an irredeemable act of medical unprofessionalism, with all the consequences being offloaded onto the people suffering the most.
Mind you: This is not an attempt to deny the phenomenology of depression - suffering is undeniably a part of our existence, warranting the term “depression” as a descriptor for an intense and sometimes chronic experience of a negative state. Yet - except for the rarest of occasions - it’s counterproductive to describe it as a disease per se. Doing so sends the message that there is one single cause and it should be treated as such, throwing it all into a box and putting a label on it.
How common of a practice this has become points to a conceptual shift in the public conception, as evidenced in our language: Being depressed means feeling a slew of negative emotion that interferes with your life. It is an indication for a number of underlying dysfunctional processes in the body and psychological environment of the person. Having depression on the other hand, frames the feeling as a one-size-fits-all disease that can be caught like a cold. Which is the way we tend to talk about it nowadays.
Depression isn’t any more of a disease than fever, stomach pain or a cough - all of which are diseases’ manifestations. Which is why we don’t treat everyone exhibiting these symptoms the same way. Even in the cases where we’re unable to find the pathology’s origin, we go out of our way to call it idiopathic - yet we don’t do that with depression. In the eyes of psychiatry, every depression is seemingly created equal. Considering how easy it is to disprove this faulty assumption, the DSM’s self-referential manner of defining depression begins looking redundant and disingenuous. It facilitates an atmosphere in which the goal becomes to veil the outward manifestation of a potentially deeper cause. And if that wasn’t bad enough, an arrogant disregard for depression’s physiological roots arise as a consequence.
In the context of identifying the right treatment method - which is essentially any healthcare practitioner’s existential justification - it’s of highest priority to identify the source of the suffering. Yet one is left searching for the mentioning of any indicative biomarkers or behavioral patterns pointing to its potential cause. This further lessen the objective to investigate the patient’s situation, which could reveal the perhaps trivial changes in lifestyle necessary to set a stop to one's misery. Instead, the DSM paints a picture of a mood disturbance that came out of nowhere and can be exiled to the same place again, with no regard for the how’s and why’s behind it.
One might argue that it’s not the manual’s job to present any causal relationships between disorders and their causes - after all, it functions primarily as a diagnostic tool. That’s what the “D” stands for, right? It’s the psychiatrist's job to draw conclusions. While I would agree that this is a sensible argument to make, the fact that the DSM is accepted and recommended as the authority on which psychiatrists ought to base their decision of the patients further treatment upon makes it bear a certain responsibility. One, it doesn’t fulfill: Depression’s rhetorical profile evokes a disease-like notion that made the person ill. It thereby leaves out the multitude of causes for it, which would make it a generic symptom. What’s left is nothing but a collection of lies by omission.
This begs the question: How did we get to this point?
Better Living Through Chemistry
A successful shift to pharmacological interventions in the midst of the 20th century opened the door for a variety of materialist explanations for the nature of the disordered mind. When it came to depression, the dawn of antidepressants pointed to a “neurochemical imbalance” as the suspect, since correcting it was supposedly how they worked their magic. Psychiatry’s scientific appeal of brain engineering thus awarded the profession valuable points in the public's perception, generating a sense of legitimacy for those already entranced by the numerous other wondrous products modern science had to offer; in general and the medical disciplines alike.
Much of the psychiatrist’ prestige was build upon the trust people had in the foundations of other proven health care disciplines and their respective specialists, as if dentist for the brain popped into existence. If you had a problem with your teeth, you knew where to go. If you had a problem with your mood, now you knew as well, because it quickly became engraved in the public’s mind that the brain is the culprit.
The Introduction of SSRIs in the late 1980s strengthened the bond between the mentally unwell and the immediacy with which pharmaceuticals got prescribed: With a lower risk profile than their predecessors - namely MAOIs that imposed limiting dietary restrictions on the patient - they quickly rose in popularity, for the consequences of preventatively writing prescriptions were less acutely obvious. In fact, their safety profile and alleged efficacy in turning down people’s despair knobs widened their scope of application to many items included in the catalog of disordered behaviors, such as body dysmorphia, eating disorders or the frequent succumbing to panic attacks.
So, how do they work?
Their Mechanism of Action (MOA) is hypothesized to primarily revolve around increasing the amount of the “feel-good” neurotransmitter serotonin in the synaptic cleft between neurons, the brain’s underlying cellular fabric. (That is, the neural highway on which signals travel from one place to another.) A Serotonin molecule get released by the presynaptic neuron - transiting through the synaptic cleft - and docks onto the receptor side of the postsynaptic neuron, where it exerts its effect. Under normal circumstances, a protein called the serotonin transporter (SERT), recycles some of the Serotonin accumulated in synaptic cleft, transporting it back to the presynaptic neurons, so it can be reused. What a drug like Fluoxetine (aka Prozac®) does is blocking some of the transporter’s reabsorption effect, a way of achieving higher concentrations of serotonin that in turn lead to higher activation of the receptors.
The drug also happens to work on GABA (GABA A to be precise). Also a neurotransmitter, GABA is associated with a feeling of relaxation and anxiolysis. Fluoxetine’s additional pharmacological property of being a positive allosteric modulator for this receptor type allows it to induce an increased sensitivity for any GABA activity on the receptor site, be it endogenous or externally induced. In essence, this is just another way to achieve higher levels of GABA’s effects on the brain. A drink does the job just as well.
Other pharmacological effects were also observed, but the entirety of their pharmacology remains unknown. It looks like no one knows exactly what they do - but who cares as long as they work?
Well, first of all, for most people, the efficacy of those drugs is mostly modest. At least that’s what the double blind trials tell us. While it’s finally proven that they work better than a sugar pill coadministered with some reassurance, their prospect of the very real risk of side effects - the only completely undisputed effects - make them a subpar solution either way.
Among the reported side effects of SSRIs, Eli Lilly (the manufacturer of Prozac) lists the following in their official Summary of Product Characteristics: sexual dysfunction, headaches, nausea, vomiting, insomnia, drowsiness, diarrhoea, sweating, dry mouth, seizures, mania, anxiety, impaired concentration, panic attacks, fatigue, twitching, tremors, dizziness, anorexia, dyspepsia, difficulty swallowing, chills, hallucinations, confusion, agitation, photosensitivity, urinary retention, frequent urination, blurred vision, hair loss, pain in the joints, hypoglycaemia, rashes and serious systemic events involving the skin, kidneys, liver or lungs. Furthermore, these are only the more common side effects that have been associated with SSRIs. Lilly reports other undesirable effects, such as hepatitis and haemorrhages, as occurring ‘rarely’.
Like the majority of drugs in existence, SSRIs effects aren’t immune to the homeostatic regulations of the brain either: As an organ, the brain employs adaptive mechanisms that serve the means of intervening with any potential dysregulation of its chemical composure. In real life terms this means that, after a few weeks, the receptors end up getting down regulated as a result of the continuously increased amount of serotonin, lessening its effect. This leads to either an increased dose or a relapse into depression and especially, a warning for everyone planning to abruptly discontinue taking the medication.
With all that in mind, antidepressants don’t sound like such a great deal anymore. That said, I don’t want to bash on them too much. It’s much more the idea they represent: They cemented the concept of depression as an illness in its own right, because they are effective in curing part of the symptomatology.
Depression as an Epiphenomenon
The idea that a proposed neurochemical imbalance can be counteracted locally and thereby let its negative psychological impact vanish is so naive that it can only be a relict of decades ago - yet it still runs strong in the belief systems surrounding depression. While the existence of such an imbalance is a factual claim, it doesn’t transcend the value of an observation that can be made when looking at the last instance in the causal chain leading up to the depression.
The way it is dealt with provokes flashbacks to the misguided demonisation of cholesterol: Take heart attacks, for example. What causes them? Too much cholesterol and the walls of your arteries. So the thinking goes that reducing cholesterol should get rid of the issue. Which is true, in theory. Problem is, that the cholesterol comes in much later in the chain of events leading to the pathology. In fact, cholesterol is the body’s way to repair the damage done to the arteries by too much inflammation. It’s like assuming the police to be criminals, just because they were at the crime scene at a much later date.
Similarly, lack of certain signaling molecules answered the wrong question for the cause of depression. The actual question worth posing is also to be found much earlier in the sequence: What causes a neurochemical imbalance? What throws it off in the first place? What is it a symptom of?
Well, as I alluded to in the beginning: Of a lot of things. So many, in fact, that most any physiological unfavorable state can cause it.
Try and think of consciousness as a sense organ in itself - one that makes the body’s health levels psychological apparent through guiding your thoughts, emotions and thus behavioral patterns. Although you may have no explanation for your sad mood or motivation, that doesn't mean that on a microscopic level there aren't reasonable causes for their existence.
Depression, conceptualized as an emergent a response of the body, can have its roots in the many detrimental physiological states induced by lifestyle factors or biographically impactful events. Any of these things may be facilitated by genetic predispositions, complicating things tremendously - like how the most benign-seeming mutation of an enzyme can have dramatic downstream effects on the rest of the system. Therefore, it’s worth taking a look at what kind of physiological dysfunctioning could tilt this perception into the dismal outlook on life depressed people have. Not with the purpose of revealing every potential cause of depression - but to grant the insight that they are abound.
For a start, let’s consider that our species lives in a radically different world today than it had for most of its existence. Not to purposefully become a victim of the naturalistic fallacy, but in the light of our rapid technological advances - able to make the environment unrecognizable with each new generation - biological adaptations necessary to function optimally in modern society haven’t caught up, and won’t do so for many generations to follow. The malleable fabric of our psyche may make us indifferent to those changes; but the indirect effects of the absence or presence of certain external factors may still leave us depressed. It’s a simple matter of interrupting the symbiotic relationship of body and mind evolution selected us for.
One just needs to think of how innocuous seeming factors can and will have an impact on your mood: From the impact of refined foods on out gut bacteria to how much sun exposure you get to how well you brush your teeth. And that isn’t even mentioning the possible negative effects the loss of a social fabric might have on the balance our emotional wellbeing rest on. Which certainly exists.
Since this is all very theoretical, let’s drive the point home with some examples.
One explanation for the pervasiveness of depression in the population can be found in inflammation, an over response of the body’s immune system to harmful stimuli like chronic stress, a bad diet and a lack of sleep. Since numerous of those detrimental lifestyle choices are associated with the average first world population, this suggestion doesn’t seem too far off.
Let me present you a quote of Dr. Charles Raison’s investigation on the topic. His book makes a hard to refute case for the argument that inflammation is the prime candidate for an increasingly depressed demographic:
Consistent with animal data, studies in humans show that even small doses of a proinflammatory stimulus produce depressive symptoms in most individuals. For example, a dose of LPS [lipopolysaccharide] too small to produce obvious sickness nonetheless induced feelings of depression and anxiety and impaired memory in healthy volunteers. The more proinflammatory cytokines increased in response to the LPS, the more depressed and anxious the volunteers became. [...] Short-term decrements in mood and cognitive ability have also been reported following typhoid vaccination.
You might sense a meaningful argument for the existence of depression when viewed in the context of evolution - being sick tells people to conserve energy, or their suffering will continue. This theory gets underlined by the conceived pointlessness of depression, for it certainly doesn’t induce the drive to spread one’s genes, as poignantly exemplified in people with anhedonia - a subcategory of depression where all joy got exchanged for an emotionally numb mind. O
On the other hand, this trade-off starts looking like a reasonable idea when viewed as a feature to prioritize one’s survival: As a defense mechanism, the body starts employing one of its most basic principles to secure livelihood - the conservation of energy. By overwriting other desires, it taints cognition with a kind of mental fog, deactivating the desire to expose oneself to an unpredictable environment - as in a social gathering. This defense mechanism of avoidance interferes with the wilful encounter of a risky situation - say, living. Further strengthening this argument, depression decreases libido as well. Just like the thought of sex becomes less interesting in times of starvation.
Please don’t express your frugality through not sleeping enough either. The Book “Why We Sleep” outlines some of the problems associated with bad sleep habits as well as practical tips on how to resolve them - the bottom line being that you should never compromise on sleep. Any time won will be a poor trade, considering that on the following day, you’re going to suffer from the monumental impact sleep deprivation has on almost every biological marker of your acute and chronic health. If you want to dive further into the topic of sleep, I highly recommend his book. It’s full of disconcerting sentences like these:
Inefficient sleep is no small thing, as studies assessing tens of thousands of older adults show. Even when controlling for factors such as body mass index, gender, race, history of smoking, frequency of exercise, and medications, the lower an older individual’s sleep efficiency score, the higher their mortality risk, the worse their physical health, the more likely they are to suffer from depression, the less energy they report, and the lower their cognitive function, typified by forgetfulness.
A nutritional deficiency can cause emotional ripples of despair and frustration with ease. Not getting enough Vitamin D is a bad offender in terms of disinhibiting the optimal production of various endocrine signaling molecules that are essential for mood levels. Magnesium deficiency, important in many respects to wellbeing, is the most common of all deficiencies in the western world. In addition to a lack of sunlight, our once blossoming consumption of omega-3 fatty acids - found in high quality vegetables/animal products and fish - needs to return in a big way if we value our brain functions and immune system that are so dependent on them - which are most of them.
Since human anatomy is highly individual in some respects, it is vital to know if one has any autoimmune reactions to certain types of food, which could be found out by an elimination diet - in extreme cases, their presence in one’s diet could be a hidden culprit to psychological well being.
While genetic dispositions certainly can be responsible for chronic depression, their influence over our mood plays an indirect role as well. To highlight one especially illustrative example of how gene differences can make or break the integrity of one’s psychological health (without directly being responsible for it), contemplate the existence of a genetic mutation of methylenetetrahydrofolate reductase (MTHFR), affecting about 40% of the global population:
This gene produces an enzyme allowing the body to convert folic acid into its methylated form, l-methylfolate, which in turn enables the conversion of the amino acid homocysteine into another amino acid called methionine, an essential compound to make (amongst other things) neurotransmitters (like the famous serotonin). An impaired methylation ability induced by this gene polymorphism is associated with a variety of health problems, including psychological problems like the symptoms described by depression, ADHD, schizophrenia and bipolar disorder.
That’s just one relatively well known instance in which intricate differences of human bodies manifest themselves in their reaction to a certain environment. Since the probability is high that there are a lot of those of which we don’t know about it’s a good idea to see how changing your dietary habits, for instance affect your health and to observe them carefully. (Knowing about this exact gene mutation, one could intervene by supplementing with an already methylated form of folate and trying to reduce eating foods containing folic acid, since it will reduce the absorption of the former better compound.)
Mind and Body
Now, if your sensors aren’t genetically determined to giving off false positives - which does happen, but less often than we are lead to think - chances are that one or more of the foundational variables for health, like diet, exercise and sleep don’t get the attention needed. It may even be the lack of certain enzyme to metabolize critical vitamins or a case of sleep apnea, which would have a top down effect on your mood, for it disturbs the sleep stages regenerative power, essential for mood regulation and the correct functioning of the immune system.
Since your psychology functions as somewhat of a perceptual system for your health levels - indicating the state of your body by affecting your motivational levels, cognitive ability and mood in general - optimizing the various environmental factors your subjected to will result in a beneficial effect on your behavioral patterns. It’s also this intricate connection between body and mind that makes me dislike the psychiatric notion of differentiating between psychology and physical health - most often, what makes you healthy is what makes you feel psychologically satisfied and motivated, more attractive and cognitively sharp, with currently no antidepressant available that is able to achieve similar changes until one enters the market that is able to undo the detrimental effects of a bad lifestyle. I thus believe that diagnosing someone with a disorder isn’t warranted, if not preceded by a careful investigation of the major lifestyle vectors delineating a person's life or coadministered with lifestyle interventions.
For what it’s worth, a lot of unnecessary suffering and self-doubt could have been avoided by spreading awareness about these things. Yes, we are told that eating well, sleeping enough and exercising is important - what we aren’t told is the enormous impact this has on the way one perceives life. The glass is always half-full and half-empty, and much of how we see it is a function of our physical health. People unknowingly prioritize those foundational compounds too low - but who could blame them? It’s not as if any of the direly need Public Service Announcements explaining the basics of foundational physiological strategies with their mood stabilizing effects would exist in the first place. We’re told about the risks of depression - but we’re not told that not sleeping enough risks depression.
Although we’re equipped with a wealth of information, one thing the internet doesn’t have is quality control, making public institutions the alleged prime candidate to take on this important job - like they did when introducing the upside-down nutrition pyramid. Though completely wrong - as in, not exactly a prime example of a display of omniscience coming from the people leading the state - it goes to show what can be instituted when political leaders engage in major concerns of public health like diet, which is one of the pillars the populations wellbeing rests on.
Not only would public awareness on a mood-beneficial lifestyle (as well as its counterpart) decrease people's tendency to visit the psychiatrist and thus decrease healthcare costs, psychiatrist could focus on the patients that are in real need of pharmacological assistance and highly specialized medication plans. The betterment of the people would follow suit, which should be the government's prime agenda anyway. You don’t need to be philanthropically inclined to recognize people’s happiness as the main contributor to a society's flourishing.
The Depressing State of Psychiatry
Unfortunately, most psychiatrists express a lack of awareness of the subtler aspects of the linkage between physiological processes and how it affects psychological well being. A lack of education on the topic simply doesn’t motivate a meticulous investigation of available biomarkers by the doctor.
Putting the blame on the help seeking would be misplaced though - after all, it’s not as if people who seek help for a bodily complaint - located somewhere that a finger can point at - weren’t treated by particular specialists all the time. The title of those professionals reveals their expertise in a certain region of human anatomy. Since most people nowadays have the literally correct, but practically useless idea of the brain as the main hub for emotions, the logical conclusion is to search for the person who can deal with its perceived malfunctioning in the appropriate manner. A role assigned to the psychiatrist, who sadly gets closer to the state of a caricature with every unnecessary prescription made.
Nothing and no one suggests to visit a dietician when suffering depression, even though one might be better served by one. The same goes for sports psychologist and sleep doctors. Or even a psychologist, for that matter. Yet psychiatrists, who should unify aspects of these roles, aren’t the all-knowing craftsmen many people would like them to be and the blind trust their authority inspires can have devastating consequences. They simply don’t get equipped with the whole story, since it is not yet established wisdom that there even is a whole story to depression.
But why? The research apparently exists. Why pretend it doesn’t?
First of all, the awareness that there is a problem with the way mentally distressed people are handled isn’t as widespread as one would hope. The long time that psychiatrists currently practicing makes for a generation of mental-health authorities with old-school ideas. And while their time-credit might make them appear trustworthy, there’s no reason to think that someone who's in the business for a long time is still adequately suited for the job, regardless if he or she used to be, as Professor Anders Ericsson argues in his book “Peak: Secrets from the new Science of Expertise”.
[People] assume that someone who has been driving for twenty years must be a better driver than someone who has been driving for five, that a doctor who has been practicing medicine for twenty years must be a better doctor than one who has been practicing for five, that a teacher who has been teaching for twenty years must be better than one who has been teaching for five. But no. Research has shown that, generally speaking, once a person reaches that level of “acceptable” performance and automaticity, the additional years of “practice” don’t lead to improvement. If anything, the doctor or the teacher or the driver who’s been at it for twenty years is likely to be a bit worse than the one who’s been doing it for only five, and the reason is that these automated abilities gradually deteriorate in the absence of deliberate efforts to improve.
After years of encountering menial and routinized patient cases, the earned privilege of being a doctor transforms into a socioeconomic commodity; subject to his own “professional bias”, the psychiatrist reassures his or her convenience based assumption, never being required extend educational duties and update obsolete sets of belief. (Similarly, it’s not unusual to hear wrong dietary advice from a state-legitimized health authority, as they often and prominently display the outdated dogma to avoid cholesterol in foods.)
What should be particularly unease-generating for anyone concerned with the matter is the way how the misunderstanding of Depression mutually satisfies desires of both patient and doctor:n The patient feels accomplished for deciding to seek help. The doctor feels as if fulfilling his purpose as an authoritative health entity worthy of consultation - through the simple act of giving the suffering what they think they want: A diagnosis and a drug. This further reinforces the affirmation the psychiatrist needs to confirm his right to exist as a health care practitioner without challenging and upgrading his or her knowledge - or, to be frank, do anything of value. A behavior not that different from a soulless pill vending machine, ironically threatening their own right to exist.
Aside from that, there are many conspiratorially fashioned arguments explaining the deranged status quo. The easiest one to make would probably be one of financial motives: Of course, pharmaceutical companies have their own interest in mind when telling doctors about the greatness of their new product and give out some free samples. But it doesn’t stop there. As a matter of unsurprising fact, all the monetary incentives are seemingly directed in the way of preserving the status quo:
Thanks to a 2008 investigation by Iowa senator Charles Grassley, the public got a glimpse of the amount of money that the pharmaceutical companies pay their KOLs [short for key opinion leaders, salesmen for the pharmaceutical enterprise]. The academic psychiatrists regularly receive federal NIH grants, and as such, they are required to inform their institutions how much they receive from pharmaceutical companies, with the medical schools expected to manage the “conflict of interest” whenever this amount exceeds $10,000 annually. Grassley investigated the records of twenty or so academic psychiatrists, and he found that not only were many making much more than $10,000 a year, they were also hiding this fact from their schools.
Supporting this outrageous idea is the language used in the diagnosing criteria: Its unashamed usage of broad-termed descriptions of emotional discontent evokes the feeling of a deliberate effort to cast a wide diagnostic net of the mentally unwell - but not the mentally disordered. Which I can’t help but find appalling:
If we’re conversing about the human experience, we’re inevitably evoking all the different elements that go into it, as well as their associated emotions. We can’t discriminate between the struggle that goes into striving upwards and the joy of feeling progress, if our objective is to lay out what it’s like to be human. In the academic circles of psychiatry however, subscribing to the concept of sadness, anxiety and frustration as a normal, in fact, non-pathological aspect of life, got out of vogue pretty rapidly.
Radiating outwards is a sense of denial of all those darker emotional fringes; negative emotion ought to be counted as originating from the same category of psychopathology rather than an expression of reactionary behaviors to the tragedies that are inherent to life itself. As if all the worries one could have can be traced back to a single demonic entity, exhibiting any signs of bad emotions must undergo a pharmacological exorcisement with no respect left for the wound-healing abilities of psychological fulfillment, physiological necessities and not to mention, time itself.
But you tell me: Is a month of grief appropriate after the death of a loved? Not according to the DSM. Two weeks is the cut off time after which it becomes officially pathological.
If one is trying to express the source of his mental disturbances, he gets to choose from a catalog of many-colored words, in service to approximate his description to the origin of one’s negative emotions. To the modern psychiatrist, any communicative, self-therapeutic approach is nothing more than an eccentric psychological vestigiality, only to be identified as such by the ones who have transcended the need for recognizing affective nuances, in turn making way for a much more efficient processing of a disturbed human being. An agenda, mainly consisting of adapting to whatever precisely voiced concerns the individual remarked and levering their negative mood to the less complexity demanding option of attributing Depression® to him or her.
You might have noticed the somewhat arbitrary distinction guidelines between disorders:
In a sense, ADHD and anxiety are indiscernible from depression, hence why they’re called co-morbid. If I were to assume malevolence on the authors part, it appears like an attempt to find the least common denominator of the different sets of symptoms collections, in order to expand the arbitrary borders to a confusion inducing, elitist-jargon mess of a disorder catalog. Similar enough to make more people realize the possibility of a havoc wrecking disease within themselves; different enough to warrant the expansion of general unease and dysfunctional cognitive ability to a set of numerous divergent disease states - whose real differences are most likely a contextual triviality.
The diagnosing criteria are written in an abstract, yet very emotional manner - almost as if to ease people into the process of self-diagnosing whatever burden seems the most fitting for the current, bad circumstances. The groundwork already done in the moment you step into the office, thanks to the propaganda-like omnipresence of those concepts in the media. Let's not forget that it’s also easier to do marketing if most of the world suddenly fits your demographic. A thought, not so easily dismissed, once considered that the proposed treatment methods for the generic list of symptoms is of similar straightforwardness of getting painkillers prescribed (another quite lucrative enterprise for the companies behind those drugs).
Even if not by malicious design, this byproduct of the diagnosing craze certainly creates another financial advantage: For one, it achieves a more diverse looking demographic of the mentally unstable. A strategy that, for one, succeeds in signaling the validity of the concepts to the population - avoiding the public’s recognition of an all-too obvious lack of knowledge on the part of the institutions - and allows for each new disorder to demand a different set of prescriptive instructions - monetized, of course.
As a matter of fact, most of the supposed diseases can be deducted from a simple conversation rather than an inquiry by a doctor making themselves apparent less by sounding like a legit disease, but rather a too-well-known aspect of the ever so tragic human experience. Therefore, having a wide range of scientific speak covering a certain emotional fact is paramount to legitimize the diagnosing experience for doctor and patient alike. How convenient that the DSM’s appreciation of science is only resembled the coldness that characterizes the language used.
Now, it’s up to anyone to decide whether this is a product of the modern denial of suffering found in developed countries, or a subtle attempt by some bad actors to make every living person a customer. Yet since this process gets easier with each new revision of the manual - disfiguring the individuality of their life problems as the societal machinery it may please - the disturbing image the second option creates becomes hard to unsee. ‘Cause if you wanted to make money of people’s psychological problems, that’s exactly what you’d do:
Pathologize normal emotions while encouraging the prescription of counteracting medicine, albeit not in the most efficient or effective manner. They will certainly work - not at least for people believing that they will - for some people better than for others. Tolerance and dependency make these calculations seem even more financially enticing and some people may even feel comfortable with the outlook of taking them for the rest of their lives, if that is the only way to soothe their mental distress. The not so pretty consequences for some of those band-aid solutions lie within the now owned inability to investigate the origin of the suffering due to its now disguised, non-intruding nature - until bad health starts to manifest itself in one of the many other possible ways.
Furthermore, the idea of tackling the root of the distress would be an act inversely proportional to the interest of those who profit from the consumption of said pharmacological interventions. After all, there would be a significant difference in financial gains to be made between solving the root of the problem for once rather than constantly cover up the symptoms for a lifetime - learning someone to fish instead of selling them the fish. By ignoring the manifold different possible sources for the depressed mood, further medical assessment becomes obsolete. Instead, construing depression as a disease on its own allows for the targeted selling of symptom-masking solution.
Eliminating the perceivable part of a disease is not generally a bad thing - except when the problem is as multifaceted as depression is, with a whole book of different causes and solutions in conjunction with an apparent refusal to integrate them in psychiatric practice. There's negligence of the knowledge demanding analytical aspects that go into the description of a diagnosis, the mechanics taking place at a deeper level - the place where we like to imagine healthcare practitioners operating. Especially when the amount of precision in their attitude is so overtly proportional to our wellbeing.
Rigid systems with the inbuilt possibility to forego ethics for monetary gains are corrupting the health care system to a degree that the public should be informed, for they are the ones suffering the errors made due to recklessness. A hazard that may warrant governmental intervention in the way prescriptions are handed, even if the alleged innocuousness of those drugs holds true most of the time, that doesn’t make for a good excuse to carelessly prescribe a risk that is the potential degradation of the medium to long term quality of a patient's life. Not only through side effects per se, but by the industry’s actors establishing a negligent attitude of real psychological and physiological factors in the mind of the sufferer as a triviality for mental health.
Throwing in some mildly understood psychoactives introduces an additional layer of complexity in the patient’s already not optimally functioning body, closing the door to any prospect of finding a solution with a much cheaper (!) and more optimal risk-reward ratio. So, even if there wasn’t any prime agenda of financial reward, upholding the current state of affairs against one’s better judgement makes this practice not any less morally condemnable.
Though having reached an antiquated age in the calendar of science, the tradition of treating mental health problems by isolating the brain as the sole offender for its alleged dysfunction remains to this day. This imprecise attitude towards the roots of psychological problems - partially caused by the immaterial appearance - is flabbergastingly unscientific and stands in stark contrast to the otherwise meticulous precision applied in other disciplines in the domain of science. Supposedly the source of malfunctioning, the philosophy following it is of similar kind as one would expect when dealing with a broken leg: Assume a clear-cut path and put things back where they belong until the thing starts to heal itself.
This may be a legitimate perspective in the case of a fractured bone, but such isn’t of the physiological complexity that the material habitat of your consciousness is. There’s neither the complex web of neurological machinery surrounding it, nor can a leg be said to govern most everything you do-, ranging from the food choices you make to your ability to breathe and swallow. Issues of mental instability lack the mechanical overt nature of problems such as a scar or a crooked tooth, troubles paling in comparison to the complications of a psychological disorder and it’s myriad of potential causes. Yet, as we handed ourselves the hammer that are modern psychiatric drugs, the seduction to view every problem as a nail has become magnified.
The brute force strategy of throwing psychotropics at the brain until one sticks doesn’t appear sophisticated enough to fool the central governing agent of your body. At least, not without fooling ourselves in the process first. Our minds might believe it for some time - but our bodies will continue to suffer the problems that caused the depression in the first place, and they won’t stop influencing our psyche until we pay attention to them.
For sure, if they work, antidepressants indeed aren’t not too far off from a miracle cure. For certain individuals, they are of inconceivable importance - but for most of us, the overzealous pharmacological interventions and the resulting dis-concern with standard physiological needs is counterproductive. The most relevant shift for the psychologically distressed this world can only occur if the perception becomes a health centered one, focusing on the deeply intermingled relation of what you do with your body and your body does to you. If we don't know where the attack is coming from, we have to attack on all fronts. It’s well worth taking a look at the various factors shaping your psychological and physical environment. By prematurely choosing the option of antidepressants, one may compromise the chance of gaining a better understanding of their body and psyche - things a person is bounded with for the rest of their lives and would profit to know better.
I get it: Embracing health centered behaviors is probably a lot easier said than done, especially for those people who find themselves in an emotional abyss, suffering bouts of intense hopelessness. Yet the foundational principles of satisfying your body's less obvious needs should be a mandatory part of any treatment, even when using psychiatric medication and/or psychotherapy, since applying those rules is necessary to maximize their potential. They might just not be capable to compensate for bad health on their own, but combined, they may. So at least, it's worth a try.
To that end, I’d also like to add that SSRIs and - if carefully used - even stimulants - are a useful tool for bridging the gap toward a healthy lifestyle that's able to translate into a healthy mental state. The potential of a drug to rectify someone’s dismal outlook on life is never to be underestimated, even when limited to a one time experience only. Nevertheless, one needs to be certain that there are no avoidable physiological hindrances to a stable and content mood that could interfere with the medications assistance to realize a better version of oneself.
Getting diagnosed isn’t an inherently bad thing. For some people, an outsider’s opinion on their mental health might be a good thing for it can help realize the possibility of a brighter reality - a possible kickstart able to lead to the active pursuit of psychological betterment. It’s much more the way psychiatry generic procedures get imposed upon the individual, whose imperfection often work to the detriment of the patient. Unfortunately, the value of the DSM doesn’t transcend a collection of easily made observations. With no distinct biomarkers contained in the descriptive attempts, this supposedly assistive guide is more reminiscent of a dictionary rather than an encyclopedia; a sobering fact making itself apparent in its superficial definitions of disorders. It’s a manual solely of use when one already has suspicions reassurable through the mutual believe in the law book of psychiatric diagnosing.
Without trying to be too blanket, if society works in favor of the majority, or at least subscribes to the concept as one of its ethics, the first mentioned treatments should be ones that fit the greatest part of the demographic and not statistical outliers. It shouldn't need mentioning that those people have problems that need particularly specific treatment plans, which our scientific understanding might enable them. It’s undeniable that the solutions are as unique as the individual - the fact that we're sharing basic traits doesn’t warrant the reckless prescription of potentially harmful pharmaceuticals.
Individual problems demand individual solutions - just because people use the same language to describe negative affective state doesn’t mean their state of mental unwealth originates from the same source. Attempting to further this narrative will only widen the gap between what works and what we wish to work, leading the people behind the corrupt parts of the mental health institutes to pull their strings even harder, until the machinery will be unveiled as the emblem of modern absurdity that it converges to - leaving behind millions of mentally unwell people and a detestable footprint on the history of psychiatry.
Hopeful thinking could one lead to believe that the introduction of easier blood sampling, genetic testing and education will allow for a more personalized access to strategies and treatments, possibly replacing the money made from being deceiving to money made from genuinely improving people’s life. A far more humanistic and sustainable way of generating money.
Ultimately, are many explanations for the ongoing trend of overdiagnosing. While we can’t point to a single one, the first and most important step would be to impregnate the public conscious with the diverse range of incentives the whole industry is driven by, so their decision can be more informed. In addition, education about how psychology conducts your psychology - and the other way around - is paramount to give people more control caring for their health. We tend to forget that mind and body work in tandem.
Most of all, Humans - not at least for their reliance on many different bodily venues to express themselves - shouldn’t have their negative feelings reduced to a single, generic label that only succeeds in describing an affective commonality with other individuals. We’re all in despair from time to time, for a whole bunch of different reasons. Instituting a fit-all term that pathologized the occurrence of any signs of sadness and frustration may allow for better batch-processing of the people who exhibit a certain mood, but certainly endangers the multifacetedness that emerges when contemplating one's life situation in mono-, or dialogue - something thought to be essential for the therapeutic effects of self-reflection and talking with companionship. Not to mention the hindrances that it lies in the way for deeper physiological investigation, that get stamped as obsolete. Which is exactly what happened over the past few decades.
The small proportion of genuinely mentally ill people in the number of people who seek mental help does not justify the current leveraging of a big part of the population to the status of clinical disordered individuals, threatening the health of the majority of the population. The DSM, with all its makers unknown motivations, tries to make an ingenuine point about how widespread this disease really is, ironically making it more real than it needs to be.
Construing the occurrence of depressive symptoms as a disorder - rather than the umbrella term for a collection of symptoms that it is - is a tautological conception. It defines an illness into existence to gain the illusory pleasure that categorizing things provides us with. Obviously, mental health problems aren’t to be dismissed a sense that people's suffering isn't real. However, precaution is advised considering the way official diagnosing guidelines capitalize on the limited understanding of the causes for depression to make it more concrete, reassuring people in their (self-)diagnoses to satisfy a range of questionable incentives.
Legal disclaimer: This is not medical advice. It’s a collection of my thoughts on the topic of depression and the way it is treated. This includes my personal experience, information I stumbled upon and the conclusion it led me to. I am not responsible for the implications if you take any of it seriously. If you’re feeling depressed, go seek out a mental health professional.