What is depression? Is it a disease? A mental illness? Biochemical imbalance? A brain dysfunction? A mental syndrome? An existential or spiritual crisis? Numerous of my fellow PT blog writers posted on depression recently. I want to talk about anxiety here as a scientific and forensic psychologist who has been practicing psychiatric therapy for more than three decades.
For me, the sixty-four-thousand-dollar question of whether depression ( unipolar( link is external) or bipolar) is a disease originates from the somewhat dubious application of the medical model to the theory and practice of psychiatry and psychology. What is the “medical model”? The medical model is the paradigm on which the practice of scientific medication is established: Signs are seen as manifestations of pathological physiological procedures (disease) which are diagnosed and after that treated with whatever techniques offered. The purpose of medical treatment is to remove, reduce or control the symptoms of illness. To, as much as possible, minimize suffering and prolong life. Physicians have actually been consistently adhering to this respectable paradigm and practice given that the time of Hippocrates.
The medical model is a specific way ofing human suffering, decay, dysfunction and, eventually, death. It is a paradigm, a lens through which doctors and others view particular abnormal or aberrant phenomena like leukemia, diabetes, and now, anxiety and many other mental disorders. Regardless of the enormous contribution of the medical design in identifying and dealing with illness, its literal application to stereotypical human experiences such as depression, psychosis, and anxiety is problematical.
There is no rejecting that those who experience severe depression are ill. Anxiety can be crippling and, in many cases, fatal. Physical signs such as nausea, throwing up, tiredness, chronic discomfort, diarrhea, insomnia and so on are common concomitants to major depression. “Treatment,” to utilize the medical terms, is demanded. The genuine concern is what type should that treatment take? The response to this depends in part on how one comprehends the etiology or reason for depression and other significant mental disorders such as bipolar disorder and psychosis. There are numerous theories as to the reason for anxiety, none of which have actually been unequivocally proven. These causal theories consist of biological, mental, social and spiritual descriptions. Research shows the possibility of at least some genetic predisposition to unipolar and bipolar depression, along with psychotic conditions such as schizophrenia and schizoaffective disorder. But biological predisposition is not causation Other (often unrecognized) catalysts are required: loss, stress, seclusion, injury, meaninglessness, disappointment, drug abuse, and chronically repressed rage can be, and regularly are, considerable if not main contributing consider these disorders.
The recently found evidence that brain scans show a substantial signature for bipolar disorder, mentioned by Dr. Lawlis in his recent post, is yet another phenomenon which, like biochemical theories, pleads the timeless concern of chicken or egg: Could biochemical imbalances or aberrant blood flow patterns in the brain be extra symptoms rather than reasons for depression? Physiological manifestations of underlying psychological conditions? Again, as every scientist understands, connection is not necessarily causation.
However whatever the essential cause of anxiety, clinicians owe it to clients to supply the most aggressive and effective treatment methods presently offered. The use of psychopharmacology in dealing with major depression, despite its downsides, has actually been revolutionary and life-saving. Antidepressants and mood supporting drugs do something that psychotherapy can not: they supply reasonably fast relief of the painful and incapacitating symptoms of depression and stabilize otherwise alarmingly labile state of mind swings. Does this show that depression is mostly a biological illness? Not. It just shows that we have fortunately discovered biochemical means to counteract and control the most severe symptoms of anxiety: sleep and cravings disturbance, absence of inspiration, apathy, depressed or manic moods, stress and anxiety, suicidality, etc. As Dr. Kramer acknowledges in his current post, even when the signs of depression are mitigated by medication, the underlying depressive condition seemingly remains, rendering even medicated patients prone to future episodes. More than half of those suffering a first major depressive episode are likely to experience subsequent episodes at a long time. The probability of reoccurrence increases considerably (90%) after three such episodes. What is this underlying vulnerability? It seems to suggest the presence of something biochemical treatment does not deal with. What is this latently continuing vulnerability? It is the depressive core of the personality It is the figurative heart of the Hydra.
Some mental disorders, consisting of anxiety, can be likened to the legendary Hydra: an enormous mythological beast with nine snake-like heads, each breathing out a deadly toxin. Lots of clients experience myriad symptoms– e.g., anxiety, depression, chronic pain, irritable bowel, insomnia, tiredness, headaches, anxiety attack, etc.– which, after probably being pharmacologically vanquished, return with a revenge. The Greek hero Hercules needed to do battle with the fatal Hydra. Tempting it from its lair, he began lopping off the Hydra’s serpentine heads. No sooner had he done so, 2 more appeared in their location. Furthermore, the horrible Hydra had one head which was never-ceasing and indestructible. How did Hercules finally defeat the deadly Hydra? Hercules cauterized the decapitation points out with fire to avoid more heads from restoring. He buried the never-ceasing head of the Hydra under a massive stone in order to render it harmless. However due to the fact that this head was immortal, the Hydra might never be entirely damaged. Just attenuated and subdued.Major anxiety is a little like the Hydra. You can try pharmaceutically (and even use electroconvulsive treatment in cases unresponsive to medications) to exterminate its signs, however they tend to return. Can major depression be defeated? Not without getting to the heart of the Hydra. Anxiety’s roots are, from my own clinical observations, more frequently generally psychological than biochemical– though one clearly impacts the other. Typically at the very heart of anxiety is repressed hatred, anger, rage, bitterness. Desertion. Betrayal. Discouragement. Unsettled grief Meaninglessness. Nihilism. Loss of faith Without aggressively attacking this mental, spiritual and psychological core or heart of depression, it can not be permanently dispatched. Just momentarily suppressed. Which is why pharmaceutical treatment of major anxiety by itself, while vital, is no alternative to real psychiatric therapy integrated with psychopharmacology. Such an ongoing two-pronged attack on the Hydra of anxiety avoids or reduces major problems, and can keep the dreaded Hydra in check. While the client might always be biogenetically and/or mentally predisposed to another depressive episode in the future, such psychotherapeutic treatment can empower the patient to nip such dips in the bud, in result defeating the Hydra.
Can depression be cured? Should it be dealt with like any other illness? I think that depends. Some types of moderate to moderate and even serious depression are clearly situational responses to tension, trauma, loss and other life events. These so-called modification disorders or perhaps major depressive episodes can be completely recovered from in most cases with adequate treatment, specifically psychiatric therapy. Chronic and extensive depression such as dysthymia, reoccurring major depressive condition, cyclothymic and bipolar disorders( link is external) are more Hydra-like, needing intensive treatment over prolonged periods of time. However even in these apparently relatively intractable conditions, penetrating to the heart of the Hydra with psychiatric therapy integrated with pharmacology can reduce both the seriousness and frequency of depressive and/or hypomanic or manic episodes. By psychotherapeutically enhancing the individual’s inter-episodic standard, the frequency and severity of future episodes can be reduced. However whereas utilizing just medications to ward off this Hydra tends to need increasing dosages and multiple kinds of drugs to keep it docile, psychiatric therapy of the sort I recommend in my book( link is external) can really minimize dependence on psychotropic medication, as the significance of the anxiety and its psychological sources are therapeutically rooted out.
Thus, I submit that anxiety is not an illness that ought to be treated in the exact same way as say, diabetes (which itself is understood in many cases to be stress-related). It is a biopsychosocial syndrome requiring much more than pharmacological intervention. The unfortunate fact that a lot of modern psychotherapy– consisting of CBT— fails to penetrate to the heart of the Hydra in major unipolar and bipolar anxiety underscores the desperate requirement for more efficient psychiatric therapy instead of showing a biological cause for these destructive disorders.