A Post for Mental Health Awareness Week
A Brief History of Depression
Back in the 1980s, when I was studying for my psychology degree, the state of knowledge about mental health at that time defined two different types of depression: clinical depression (endogenous) which was assumed to have an enduring biological base, or reactive depression (exogenous) a response to difficult life events. This classification was later relinquished in the absence of any evidence of a biological basis for depression. It was argued that most depressions are reactive, but the activating event may be very distant in time: childhood traumas, for example, are known for their potential to impact on wellbeing over a lifetime, as events serve as reminders to trauma, re-igniting the stress and anxiety of the original event: post traumatic stress disorder as it’s now termed.
During the 1960’s, R D Laing and the anti-psychiatry movement had already challenged the idea that mental disturbance resulted from biological or neurological conditions: their view was that disturbance resulted from dysfunctional family dynamics. This idea (now largely, but not entirely, discredited) gathers some credence currently, given the widely held belief that mental stability and balance result from functional family dynamics that breed secure attachment in relationships.
Three books this year have raised similar questions: what is depression? how does it start? how can it be cured?
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) – The fifth version of the psychiatric classification bible, was published in 2011 to a clamour of criticism and challenge, largely based on the rather startling fact that the DSM-5 diagnoses are made solely on the basis of behavioural symptoms and subjective emotional states: how you say you feel, and what you do. Despite decades of research, there are no biological correlates, or brain chemistry that can be seen, scanned, or measured. Depression is real, there is no question of that, but research thus far has largely failed to find anything physiologically wrong with sufferers of mental illness.
Cracked: Why Psychiatry is Doing More Harm Than Good by James Davies, is an expose of the psychiatric profession’s over-medicalisation of what can be seen as a normal range of human emotions, and a narrowing down of what constitutes normal, allowing for the development of a pharmaceutical drug for conditions not previously considered pathological, just variations on the human theme. Davies uncovers the nakedness of the psychiatric profession by pointing out that, not only are the vast majority of depressive illnesses NOT based in any biological, neurological or chemical correlates, but also that the anti depressants that are routinely prescribed work only marginally better than a placebo pill (a sugar pill, with no chemical content that has an impact due to patient hope and expectation). And when they do work, nobody really understands why.
Davies proposes a paradigm shift in the understanding of mental illness: change the question:
NOT What’s wrong with you? BUT What happened to you?
Darian Leader, in his book Strictly Bi-Polar, extends this idea even further. It’s not just a case of asking What Happened to You? It may also be a case of asking What Happened to Your Ancestors? He suggests that some cases of bi-polar may be the result of a generational scar, specifically an unpaid psychic debt, that is inherited and expressed through the extremes of emotion seen in bi-polar: the suicidal state resulting from the guilt of this psychic debt, and the manic high expressing the state where the sufferer feels temporarily freed from the guilt. For Leader, the potential cure for bi-polar (manic depression as it was previously called) lies less in modern psychiatric drugs, and more in the careful and sensitive exploring of family history to uncover the dynamics that live on through generations of a family.
Both Davies and Leader are calling for the What Happened to You? approach, rather than the What’s Wrong with You question. And of course, something has happened, to all of us. Life has happened: we have been born, raised, loved and hated our parents, our siblings…. been hurt, betrayed, been happy, been loved, succeeded, failed. This was captured in a recent tweet by Alain de Botton:
“Our dreams show we are never finished, it’s all in there”
Dreams reveal we never quite get over anything. It’s all in there somewhere, biding its time, waiting for you.