The Myth of Major Depression – Why Depression is not an Illness…

depressed person

The Rise of Major Depressive Disorder

It has become common nowadays to think of depression as a medical condition. If you visit your general health practitioner, she might ask a few questions about your energy level, appetite, sleep, and mood and, if you answer these questions in a particular way,  tell you that you have “Major Depressive Disorder”. Major Depressive Disorder, you will be told, is a real illness. And like any real illness, it even comes with its own pill prescription (SSRIs)…

This way of thinking about depression, however, is really the product of a medical discourse that has been spoken so many times that it is has begun to ring true. And yet, as a psychologist with many years of experience helping people who are depressed, I am here to tell you that the emperor has no clothes on…

The Reduction of Subjective Distress to Objective Symptoms

The talk about depression as an illness is really the result of a more overarching trend in the mental health field to reduce life to objective behaviors or symptoms. We take two individuals and observe how they act, talk, or say they feel. We extract the behavior they have in common, and bam! we have arrived at a symptom. One person’s sleepless nights, for example, are equated with another person’s sleepless nights, and what we now have is the symptom of “reduced sleep”. When we observe a collection of such abstract symptoms that appear to frequently occur together, we end up with a “syndrome”, or a certain cluster of symptoms. And when we give a name to such a cluster, by inventing nouns like “Major Depressive Disorder” or “Generalized Anxiety Disorder”, these nouns then take on the status of illnesses that appear to preexist and explain the appearance of the symptoms.

The Loss of the Subjective Meaning of Depression

So what is the problem with this way of thinking? Well, for one, we have abstracted the symptom from the life of the person, and without this person, the symptom has lost its meaning. It is for example quite different to have a sleepless night because one feels empty inside and can’t stand the stillness of the night, and to have a sleepless night because one lies awake beating oneself up about things one should have done differently during the course of the day. In the one case, the sleeplessness announces to the person that they have become too alienated from their own experience (emptiness being the result). In the other case, the sleeplessness may bear witness to a traumatic event that the person has resolved to deal with by feeling eternally guilty…

The idea of the symptom as some abstract behavior erases these differences and treats each individual’s behaviors as if they were the same. Reduced sleep thus becomes a rather hollow concept. In its abstractness, it hides more than it reveals. To say of both instances of sleepless nights that they refer to the same phenomenon is a stretch, for what looks the same on the surface, betrays significant differences when an understanding of the life of the person is taken into account.

When depression becomes a universal construct or set of behaviors, its true meaning is lost. For in reality, there can be no depression outside the concrete life of an individual. And even though we may label two people’s behaviors as depressed, the meaning of their depression can vary widely. One person may be depressed because they are faced with a life situation that demands they assert themselves, but have fears about doing so, and therefore can do nothing but admit defeat. Another may be depressed because they have cut out social contacts to deal with their social anxiety and now find themselves devoid of meaningful relationships. In short, there are as many types of depressions as there are people who are depressed. There is always a unique story to be told…

The problem with a construct like Major Depressive Disorder is that it gives us the illusion that it exists as some “thing” in itself. It conveys that the “wizard behind the curtain” is a disease process and not a person.

A Faceless Healthcare…

In line with this view, “treatment” of depression becomes a rather impersonal endeavor. One treats “symptoms” not “people”. Instead of taking time to listen and understand, to help people figure out what depression means in the context of their other life problems, one now gets prescribed an SSRI or gets education about sleep hygiene…

Constructs like Major Depressive Disorder, and the philosophical assumptions that underlie them, lead to a faceless kind of healthcare that is devoid of the subjectivity of the person. They trade an abstract category, for the real deal…

Depression is, and always will be, shorthand for a multitude of particular ways that people struggle. Only when we understand the life of each struggling person, will we succeed in understanding what depression really is, for it is many different things to different people. Depression is not a “thing”, and is not an “illness”. Instead it is a marker of a particular stuckness in a person’s life. It  acts as an invitation or perhaps a dictate to discover something deeper about ourselves…

About me: I am a clinical psychologist in Houston Texas. Visit my therapy website to read more about my treatment approach to depression.

10 thoughts on “The Myth of Major Depression – Why Depression is not an Illness…”

  1. I really like this: ” In short, there are as many types of depressions as there are people who are depressed. There is always a unique story to be told…”
    To see my contributions to the mental health debate in national as well as local media go to http://www.thomasroddy.com

  2. Wow. Not even sure where to begin.

    Depression is not an illness? If you were talking about mild bouts of depression that could, more often than not, be alleviated with session with a good cognitive behavioral therapist — then ok. It’s an argument I might not necessarily agree with, but I would respect that position. It’s also an argument that Major Depressive Disorder shouldn’t even have a ‘mild’ category.

    But no, you have opined that Major Depressive Disorder is not an illness. Any severity (mild, moderate, or severe) is not an illness. It’s a ‘marker of a particular stuckness in a person’s life.’ Setting aside that ‘stuckness’ is a made-up word, it’s not at all a relief to discover that I’m not sick….I’m stuck.

    It ‘acts as an invitation or perhaps a dictate to discover something deeper about ourselves.’ That’s actually a pretty good definition of therapy, but a ridiculous one of Major Depressive Disorder.

    Yes, my illness is somewhat unique to me, just as my mother’s cancer was unique as well. Her symptoms were often different than other sufferer’s, just as mine often are. She had a ready drug available (chemotherapy, Tamoxifen, radiation, gamma knife surgery), as I have SSRIs, anti-anxiety medications, mood stabilizers, etc. But no, neither one of us is (or was) a unique snowflake. Our diseases can both be witnessed via medical equipment or testing. We each have a mortality rate higher than the general population who do not suffer from any illness. I’m lucky that I have a psychiatrist who insists on regular therapy sessions with him, along with sessions with a cognitive behavioral therapist, and a medication regime.

    Your post angered me because it took a reasonable point and extrapolated it beyond all recognition. I understand that many psychiatrists are ‘med-check’ doctors, and can be too quick to prescribe medication when it may not be needed. That’s not a unique problem for depression; studies show that patients LIKE leaving a doctor’s office with a prescription – thinking that medicine will always cure the illness.

    The NIH has described Major Depressive Disorder as ‘…a heritable neuropsychiatric syndrome characterized by relatively subtle cellular and molecular alterations localized to a complex network of neural substrates.’ Bad therapists, lazy psychiatrists, and a culture of a dosage for every -dosis do not equal ‘MDD is not an illness.’ It’s a irresponsible claim for a mental health professional to make. Saying I’m ‘stuck’ is just as horrifying as ‘just cheer up’ or ‘other people have it worse than you’. I can excuse people that utter those bromides because they don’t really understand the biology, neurology, and psychology of mental illnesses. I hope your patients don’t feel, as I might, that you believe that my ‘stuckness marker’ means I better work hard to get ‘unstuck’.

    1. Kellie, I really appreciate your contribution to this debate. I by no means intend to invalidate your suffering. Being depressed sucks. I’ve been there…

      I also do not mean to imply that the brain does not change when we are feeling depressed and that there is not a biological component to the state of being depressed.

      Being depressed and having “major depressive disorder” are, however, two separate things. I advocate the view that depression is a human response to events around us; that we become depressed for a reason.

      My countless experiences of working with depressed people in longer-term, meaning-centered psychodynamic psychotherapy, is that depression always begins to make sense as a “symptom” once other problem-areas of a person’s life are uncovered. The examples in my article show how varied these psychological causes can be.

      Often these problem areas are not initially conscious, and it may therefore often seem like there is no psychological issue that is causing my depression. All that we are then left with is the belief that the brain causes it.

      However, the brain is “plastic”, meaning that it responds to the environment and to our interactions with the environment. Our brain is a living, ever-changing thing that cannot exist outside of the life of the person who interacts with the world. Unless there is a physical damage to the structures of the brain, I would therefore venture the viewpoint that the brain cannot “cause” depression.

      Viewpoints espoused by institutions like NIMH take scientific studies that show measurable and demonstrable changes in brain chemistry when a person is depressed, and sneak in a causality that is not itself evident from the facts. Just because the brain changes when you are depressed does not mean that the brain changes by itself outside of person-world interactions.

      My view is that modern medical science performs an unnatural and uncanny separation of psychological life from brain chemistry, leaving people with no real sense of their own agency. I choose a different point of view that opens up the possibility that brain chemistry can change through the process of therapy. As we are listened to and begin to discover our own inherent psychological knots, difficulties, and compromises through the long and painstaking road of self-discovery, our brain can change and so can we…

      This is not about blaming the person who suffers, but about giving people the tools to become agents rather than patients…

      Thank you again for letting your voice be heard…

      1. As far as causation is concerned, you might perhaps want to consider that genetic factors do play a crucial role in MDD (see adoption studies comparing depression rate amont offspring of depressive and non-depressive parents). Given this, the hypothesis that (unconscious) mental, rather than biological causes are at work in causing MDD becomes somewhat questionable.

        More importantly, your argument somehow ignores the fact that for something to be malleable, it first of all needs to exist; and to exist means to exist with certain pre-existing structures. Hence, since you agree that acquired structures can correlate with depression, what makes you believe that pre-existing structures cannot correlate, or even cause depression? Evidence from genetics suggests that they very much do.
        Frankly, what irritates me most is that you say that you “choose a different viewpoint” because you like the implications of your chosen viewpoint better than the current scientific consensus on MDD. So much for evidence-based healthcare

        PS: I wonder how you account for bipolar disorder within your causation model.

        1. Evidence is a funny thing. I have evidence through my many years of direct clinical observations of clients in psychotherapy that depression that in principle could meet DSM criteria for MDD makes more sense when you understand it as a reaction to meaningful life events. Through the interventions that I do, and the process of becoming more aware of the totality of one’s life circumstances, people cease to be depressed. When this is a fact, why would I limit myself to a static definition of MDD as a biologically based disorder? And how can you explain that talk therapy can help people become less depressed, if depression is solely a genetic condition?

          The problem with scientific studies is that they rely on biased assumptions that are not themselves part of the studies. The assumption that one can reduce all variations of depression to the same underlying phenomenon, and abstract it from the multitude of lives or contexts of the people who live it, is a simplistic assumption that cannot itself be scientifically proven.

          The same can be said for Bipolar Disorder, which, as we have seen, has required multiple revisions and additions over the years to account for variations: Bipolar I, Bipolar II, Cyclothymia, Childhood Bipolar, mixed episode, etc etc. As a therapist, I believe strong evidence exists for a biological component of Bipolar I Disorder, which some have argued is really much more affiliated with a psychotic spectrum of disorders, ranging from Schizophrenia, to Schizo-Affective, to Bipolar, than with normal variations of depression. Richard Bentall has argued that these divisions (from schizophrenia to Bipolar) are really quite arbitrary and that actual people tend to display symptoms across categories, making it much more difficult to argue for such a thing as “Bipolar I Disorder” as a discrete phenomenon (Read Richard P. Bentall’s book: Madness Explained: Psychosis and Human Nature).

          The reference to science as some higher form of knowing without any need for justification (evidence pure and simple), ignores the fact that science cannot study anything that has not first been admitted into awareness through a cultural and hermeneutic context. In other words, science is a human activity, and must borrow its foundation from philosophy and human/ historical self-understanding. As Hermeneutic philosopher Hans Georg Gadamer has stated: “The fundamental prejudice of the Enlightenment is the prejudice against prejudice itself, which denies tradition its power”…

  3. In essence, this is very good: I would just like to make the rather obvious point, to Kellie, that being ‘stuck’ is not meant to placate the sufferer, the subject, with a label to make oneself feel better about it! Just that it is far more articulate…Moreover, ‘stuckness’ is a word, something that I can vouche for as an English language teacher, English being what words people actually use, informally, to each other! Moreover, we ALL know what it means!!
    And, as I think the article implies, I think that it is an illness only in so far as the neural pathways can be well-trodden (-a crystallisation of unpleasant experience can be equated with an illness), and the person can become ‘used’ to it… But for any sensitive person who feels different from the norm, a norm which is, in some ways, far from Sane… e.g. most people cannot really be themselves at work (-or, at least, honest to the boss); where people feel ashamed of their problems, and not only can’t/don’t feel safe to communicate about them, but are next to another who may be quite likely doing the same! To some of us, this state of affairs, chips away at one, and makes us feel very regretful about the sort of world we are living in…
    This raises another question of mine: there is the authentic experience of melancholy in life; and then there is the years of ‘depression’; are these different? Has the latter case just been someone who had some of the former, melancholy experience, but this was labelled as ‘depression’; they were not really heard in their individual experience, &/or weren’t able to articulate it sufficiently… And then they were medicated, and their ‘depression’ became solidified…
    Also, in just about every culture I have witnessed, people inevitably say ‘I’m fine’, ‘very well’ when you ask them how they are, whereas the truth is probably not quite this! i.e. socially, most people (-almost as a collective albeit unconscious game,) pretend away, avoid, the authentic melancholy in life… I find this problematic, and wonder if it is a lack of fundamental strength in the person that cannot afford to say (lest s/he lose face, will be judged as ;’weak’ by the other) that s/he feels, perhaps momentarily, unhappy… This is my kind of humanistic understanding. (I also feel it is a shame that when one feels genuinely happy, truly joyous, etc. these same people don’t like it to much, because they sense you are being honest -as indeed you are, and they know they don’t have it in their experience sat the moment, but they have just offered a ‘I’m doing fine, thanks’, which now feels rather ‘plastic’, hollow… I suppose, one has to have had positive self-experience in order to have this strength…

  4. I have been a research psychologist and psychotherapist using fMRIs to study Epilepsy, Brain Tumours and yes Mental Health and a wide variety of Neurological conditions.

    Major Depression has both a physiological, genetic component and does lead to structural changes in the brain. I can appreciate the different opinions about the causes but it is a recognised illness. Great to have theories of mind over matter and talk therapy being effective in managing depression.

    So what is MDD but an illness . I can look at an fMRI of a person with MDD and identify the physiological changes. So hence I can prescribe the appropriate treatment regime.

    I could never talk the brain into curing itself even though I am a Quantum Healer , Reki Master and EFT Master as my sideline. Lets us not get lost in the reality of severe mental health problems with real structural and biological causes and give the appropriate treatment to some very ill people before they decide to end their lives themselves.

    Joseph Grennell
    Clinical Psychologist and Psychotherapist. Epilepsy and Neurology Sprcialist

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