Depression: a medical illness?
Terry Lynch, Limerick-based author, mental health activist, physician and psychotherapist, recently brought out an excellent book entitled Depression Delusion: The Myth of the Brain Chemical Imbalance. Like his other books, Selfhood and Beyond Prozac, (http://doctorterrylynch.com/my-books/)this is an excellent read, an exposé of the widespread belief that brain chemical imbalances are a feature of depression and how this false belief has greatly hampered progress in increasing our understanding of depression.
In an article published on http://wellbeingfoundation.com/pedestal.html, Terry Lynch says:
“…in our society there is little real dialogue about what depression really is — about the actual experience of depression. People who are experiencing mental health problems such as depression often feel marginalised or excluded, because there is such reluctance to discuss mental health problems openly. This came up recently with a young man who attends me. Over the course of 18 months he had undergone the most important journey of his life — the journey from ever-present terror, anxiety, loneliness, depression, despair and hopelessness to inner peace, intimacy, self-confidence. Yet, only two people apart from himself know about this transformation — his partner and me.
Herein lies the irony of depression within our society. It is widely accepted that depression is very common. Depression is at the forefront of GPs’ and psychiatrists’ diagnostic categories. But for all this seeming focus on depression and mental health problems in general, there is little discussion around the experience of depression. People experiencing depression frequently feel they cannot talk about this in public, for fear of judgement and alienation.
The current preoccupation with interpreting mental health problems as medical illnesses may seem plausible. However, this approach is problematic on many fronts. Contrary to the expressed views of many doctors, the links between mental health problems and biological causation remains a hypothesis; it is an unproven theory.
No person, anywhere in the world, has ever had their supposed biochemical brain abnormalities confirmed with any form of laboratory testing. It seems to me that the only truly scientific approach is to remain open to this possibility, whilst ensuring that all other legitimate possible causes and approaches to mental health problems receive appropriate attention.
One serious consequence of the medical preoccupation with biology and illness is that mental health problems tend to be treated in a vacuum, as if they have little or no relevance or input into the person’s everyday life. It seems to me that this is a very unrealistic approach to mental health and mental health problems.
There is little evidence that all this medical focus on depression and mental health problems is achieving results. Prescription rates for antidepressants have risen consistently and substantially over the past 15 years, since Prozac and the other SSRI drugs came on the market. Approximately 300,000 people in Ireland take antidepressants. Surely, with so many people taking them, and given how enthusiastically doctors have been prescribing them over the years, it should be relatively easy to establish beyond all doubt that these drugs are making a difference in the ‘fight’ against depression.
Surprisingly perhaps, there is little or no evidence of this. Suicide, said to be a consequence of depression, remains a social scandal of enormous proportions despite the ever-increasing prescribing of these drugs. Hospital admission rates for depression, outpatient attendances for depression and rates of disability from depression have risen steadily over the past 15 years. If antidepressant drugs were as effective as we have been told they are, all of these indices should be decreasing, not increasing.
In fact, clear evidence has been emerging in recent years that the value and effectiveness of these drugs have been oversold considerably. This is not to say that medication has no role. Many people report that medication has helped them greatly. Some people say that medication was essential for them, that it was a life-saver for them. However, mental health services which provide little other than medication are inherently seriously deficient.
If we are to stem the tide of suicide, depression and mental health problems which engulfs Ireland and other countries, a major overhaul of the intervention and support services for depression and mental health services is urgently required, as is a major review of the nature of mental health problems. In my opinion, what is called for includes greater input from people experiencing depression; a much greater focus on the experience of depression and on the process of recovery.”
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