The
Myth of Biological Depression
by
Lawrence Stevens, J.D.
Unhappiness or "depression" alleged to be the
result of
biological abnormality is called "biological" or "endogenous"
or
"clinical" depression. In her book The Broken Brain:
The
Biological Revolution in Psychiatry, University of Iowa
psychia-
try professor Nancy Andreasen, M.D., Ph.D., says "The older
term
endogenous implies that the depression `grows from within' or
is
biologically caused, with the implication that unfortunate and
painful
events such as losing a job or lover cannot be considered
contributing
causes" (Harper & Row, 1984, p. 203). Similarly, in
1984 in the
Chicago Tribune newspaper columnist Joan Beck
alleged: "depressive
disorders are basically biochemical - and
not caused by events or
environmental circumstances or personal
relationships" (July 30, 1984, Sec.
1, p. 16).
The concept of biological or
endogenous depression is important
to psychiatry for two reasons.
First, it is the most common
supposed mental illness. As Victor
I. Reus, M.D., wrote in 1988:
"The history of the diagnosis and treatment of
melancholia could
serve as a history of psychiatry itself" (appearing in: H.
H.
Goldman, editor, Review of General Psychiatry, 2nd Edition,
Appleton
& Lange, 1988, p. 332). Second, all of psychiatry's
biological "treatments"
for depression - whether it is drugs, electroshock,
or
psychosurgery - are based on the idea that the unhappiness we
call
depression can be caused by a biological malfunction rather
than life
experience. The erroneous belief in biological
causation justifies the
otherwise unjustifiable use of biological
therapies. And the biological
therapies justify the existence of
psychiatry as a medical specialty
distinguishable from psychology
or counselling.
Many professional and lay people today think depression
can be
caused by "chemical imbalance" in the brain even though
none of the "chemical
imbalance" theories of depression have been
verified. Some of them are
discussed by Dr. Andreasen in her
book The Broken Brain.
One of the theories she describes is the belief
that
"depression" (what I think should be called simply unhappiness
or
severe unhappiness) is the result of neuroendocrine
abnormalities
indicated by excessive cortisol in the blood. The test
for this
is called the dexamethasone-suppression test or DST. The
theory
behind this test and the claims of its usefulness were found to
be
mistaken, however, because, in Dr. Andreasen's words, "so many
patients with
well-defined depressive illness have normal DSTs"
(pp. 180-182). An
article in the July 1984 Harvard Medical School
Health Letter reached
a similar conclusion. The article, titled
"Diagnosing Depression: How
Good is the `DST'?", reported that
"For every three office patients with an
abnormal DST, only one
is likely to have true depression. ... [And] a large
fraction of
people who are depressed by other criteria will still have
normal
results on the DST" (p. 5). Similarly, in an article in
the
November 1983 Archives of Internal Medicine three
physicians
concluded that "Data from studies currently available do
not
support the use of the dexamethasone ST [Suppression Test]"
(Martin F.
Shapiro, M.D., et al., "Biases in the Laboratory Diagnosis of
Depression in
Medical Practice", Vol. 143, p. 2085). In 1993 in her book
If It
Runs In Your Family: Depression, Connie S. Chan, Ph.D.,
acknowledges that
"There is still no valid biological test for
depression" (Bantam Books, p.
106). But despite its having been
discredited, some biologically
oriented psychiatrists are (appar-
ently) so eager for biological
explanations for people's unhappi-
ness or "depression" that they continue to
use the DST anyway.
For example, in his book The Good News About
Depression, pub-
lished in 1986, psychiatrist Mark S. Gold, M.D., says
he
continues to use the DST. In that book Dr. Gold claims the DST
is
"highly touted as the diagnostic test for biologic
depression"
(Bantam, p. 155, emphasis in original).
In The Broken Brain, Dr. Andreasen also describes
what
she calls "the most widely accepted theory about the cause
of
depression...the `catecholamine hypothesis.'" She emphasizes
that
"the catecholamine hypothesis is theory rather than fact"
(p. 231). She
says "This hypothesis suggests that patients
suffering from depression have a
deficit of norepinephrine in the
brain" (p. 183), norepinephrine being one of
the "major catechol-
amine systems" in the brain (pp. 231-232). One way
the catechol-
amine hypothesis is evaluated is by studying one of the
breakdown
products of norepinephrine, called MHPG, in urine. People
with
so-called depressive illness "tended to have lower MHPG" (p. 234).
The problem with this theory, according to Dr. Andreasen, is that
"not
all patients with depression have low MHPG" (ibid). She
accordingly
concludes that this catecholamine hypothesis "has not
yet explained the
mechanism causing depression" (p. 184).
Another theory is that severe unhappiness
("depression") is caused by
lowered levels or abnormal use of
another brain chemical, serotonin. A
panel of experts assembled
by the U.S. Congress Office of Technology
Assessment reported in
1992 that "Prominent hypotheses concerning depression
have
focused on altered function of the group of neurotransmitters
called
monoamines (i.e., norepinephrine, epinephrine, serotonin,
dopamine),
particularly norepinephrine (NE) and serotonin. ...
studies of the NE
[norepinephrine] autoreceptor in depression
have found no specific evidence
of an abnormality to date.
Currently, no clear evidence links abnormal
serotonin receptor
activity in the brain to depression. ... the data
currently
available do not provide consistent evidence either for
altered
neurotransmitter levels or for disruption of normal
receptor
activity" (The Biology of Mental Disorders, U.S. Gov't
Printing Office,
1992, pp. 82 & 84).
Even if it was shown there is some biological change or
abnormality
"associated" with depression, the question would
remain whether this is a
cause or an effect of the "depression".
At least one brain-scan study (using
positron emission tomography
or PET scans) found that simply asking normal
people to imagine
or recall a situation that would make them feel very sad
resulted
in significant changes in blood flow in the brain (Jose V.
Pardo,
M.D., Ph.D., et al., "Neural Correlates of Self-Induced Dysphoria",
American
Journal of Psychiatry, May 1993, p. 713). Other
research will probably
confirm it is emotions that cause biological changes
in the brain
rather than biological changes in the brain causing
emotions.
One of the more popular theories
of biologically caused
depression has been hypoglycemia, which is low blood
sugar. In
his book Fighting Depression, published in 1976,
Harvey M. Ross,
M.D., said "In my experience as an orthomolecular
psychiatrist, I
find that many patients who complain of depression have
hypo-
glycemia (low blood sugar). ...Because depression is so
common
in those with hypoglycemia, any person who is depressed without
a
clear cut obvious cause for that depression should be suspected
of
having low blood sugar" (Larchmont Books, p. 76 & 93). But in
their
book Do You Have A Depressive Illness?, published in
1988,
psychiatrists Donald Klein, M.D., and Paul Wender, M.D.,
list
hypoglycemia in a section titled "Illnesses That Don't
Cause
Depression" (Plume, p. 61). The idea of hypoglycemia as a cause
of
depression was also rejected in the front page article of the
November
1979 Harvard Medical School Health Letter, titled "Hypo-
glycemia -
Fact or Fiction?".
Another theory of a
physical disease causing psychological
unhappiness or "depression" is
hypothyroidism. In her book
Can Psychotherapists Hurt You?
psychologist Judi
Striano, Ph.D., includes a chapter titled "Is It
Depression - Or
An Underactive Thyroid?" (Professional Press, 1988).
Similarly,
three psychiatry professors in 1988 asserted "Frank
hypo-
thyroidism has long been known to cause depression" (Alan I.
Green,
M.D., et al., The New Harvard Guide to Psychiatry, Harvard
Univ. Press,
1988, p. 135). The theory here is that the thyroid gland,
which is
located in the neck, normally secretes hormones which reach
the
brain through the bloodstream necessary for a feeling of
psychological
well being and that if the thyroid produces too
little of these hormones, the
affected person can start feeling
unhappy even if no problems result from the
endocrine (gland)
problem other than the unhappiness. The American
Medical
Association Encyclopedia of Medicine lists many symptoms
of
hypothyroidism: "muscle weakness, cramps, a slow heart rate, dry
and
flaky skin, hair loss ... there may be weight gain" (Random
House, 1989, p.
563). The Encyclopedia does not list unhappiness or
"depression"
as one of the consequences of hypothyroidism. But
suppose you began to
experience "muscle weakness, cramps...dry
and flaky skin, hair loss ...
weight gain"? How would this make
you feel emotionally? - depressed,
probably. Just as hypo-
thyroidism (hypo = low) is a thyroid gland that
produces too
little, hyperthyroidism is a thyroid glad that produces too
much.
Therefore, if hypothyroidism causes depression, then it
seems
logical to assume hyperthyroidism has the opposite effect,
that
is, that it makes a person happy. But this is not what
happens.
As psychiatrist Mark S. Gold, M.D., points out in his book
The
Good News About Depression: "Depression occurs in
hyperthyroid-
ism, too" (p. 150). What are the consequences of
hyperthy-
roidism?: Dr. Gold lists abundant sweating, fatigue, soft
moist
skin, heart palpitations, frequent bowel movements,
muscular
weakness, and protruding eyeballs. So both hypo- and
hyper-
thyroidism cause physical problems in the body. And both
cause
"depression". This is only logical. It is hard to feel
anything
but bad emotionally when your body doesn't feel well or
work
properly. It has never been proved hypothyroidism affects
mood
other than through its effect on the victim's experience of
feeling
physically unhealthy.
Some people think
chemical imbalance related to
hormonal changes must be a possible cause of
"depression" because
of the supposed biological causes of women's moods at
different
times of their menstrual cycles. I don't find that argument
con-
vincing, because I've known so many women whose mood and state
of
mind was consistently unaffected by her menstrual cycle.
Psychology
professor David G. Myers, Ph.D., labels premenstrual
syndrome (PMS) a myth in
his book The Pursuit of Happiness
(William Morrow & Co., 1992, pp.
84-85). Of course, some women
experience physical discomfort due to
menstruation. Feeling
lousy physically is enough to put anybody in a
bad mood.
Some people believe women
experience undesirable mood
changes for biological reasons because of
menopause. However, a
study by psychologists at University of
Pittsburgh reported in
1990 found that "Menopause usually doesn't trigger
stress or
depression in healthy women, and it even improves mental
health
for some". According to Rena Wing, one of the psychologists
who
did the study, "Everyone expects menopause to be a stressful
event,
but we didn't find any support for this myth" ("Menopausal
stress may be a
myth", USA Today, July 16, 1990, p. 1D).
It is also widely believed that women go through a
period of
depression for biological reasons after giving birth to
a child. It's
called postpartum depression. In his book The
Making of a
Psychiatrist, Dr. David Viscott quotes Dr. George
Maslow, a physician
doing an obstetrical residency, making the
following remark: "Come on,
Viscott, do you really believe in
postpartum depression? I've seen
maybe two in the last three
years. I think it's a lot of shit you guys
[you psychiatrists]
imagined to drum up business" (Pocket Books, 1972, p.
88). A woman
who had given birth to eight (8) children, which in my
opinion
qualifies her as an expert on the subject of
postpartum
depression, told me what she called "postpartum blues" are
real,
but she attributed postpartum blues to psychological rather
than
physiological causes. "I don't know about the
physiological
causes", she said, but "so much of it is psychological."
She
said "You feel awful about your looks", because in our society
a
woman is "supposed" to be thin, and for at least a short time
after
giving birth a woman just isn't. She also said after
childbirth a woman
feels considerable "physical exhaustion".
Childbirth also is the beginning
of new or increased parental
obligations, which if we are honest we must
admit are quite
burdensome. The arrival of new or additional
parental
obligations and the realization of the negative ways new
or
additional parenthood obligations will affect a woman's (or
man's) life
is an obvious non-biological explanation for
postpartum depression. It
may not be until the actual birth of
the child that parents realize how
parenthood changes their lives
for the worse, but a letter from a female
friend of mine who at
the time was only three months pregnant with her first
child
illustrates that depression associated with childbirth may come
long
before the postpartum period: She said she was frequently
breaking down in
tears because she thought with a child her life
would never the same and that
she would be a "prisoner" and
wouldn't have time to do what she wanted in
life. A reason these
psychological causes are often not candidly
acknowledged and
postpartum (or pre-partum) blues instead attributed to
unproven
biological causes is our reluctance to admit the downside
of
parenthood.
Another theory of
biologically caused depression is
based on stroke damage in the left front
region of the brain
causing depression. What makes it seem possible
this might be
neurologically caused rather than being a reaction to
the
situation a person finds himself in because of having had a
stroke is
stroke damage in the right front of the brain allegedly
causing "undue
cheerfulness." However, a careful reading of
books and articles about
neurology for the most part doesn't
support the allegation of undue
cheerfulness from right front
brain damage. Instead, what most
neurological literature
indicates sometimes results from right front
stroke-related brain
damage is anosagnosia, usually described as lack of
concern or
inability to know their own problems, not happiness or
cheer-
fulness (e.g., Dr. Oliver Sacks in The Man Who Mistook His
Wife
for a Hat and Other Clinical Tales, Harper & Row, 1985, p.
5).
Perhaps the most often heard argument
is that
antidepressant drugs wouldn't work if the cause of depression
was
not biological. But antidepressant drugs don't work.
As
psychiatrist Peter Breggin, M.D., said in 1994, "there's
no
evidence that antidepressants are especially effective"
(Talking
Back to Prozac, St. Martin's Press, p. 200). In studies
placebos often
do as well. Even if so-called antidepressants did help,
that
wouldn't prove a biological cause of "depression" any more than
would
feeling better from taking marijuana or cocaine or drinking
liquor.
A careful reading of the books and articles
by
psychiatrists and psychologists alleging biological causes of
the
severe unhappiness we call depression usually reveals
purely
psychological causes that explain it adequately, even when
the
author believes he has given a good example of biologically
caused
depression. For example, in Holiday of Darkness: A
Psychologist's
Personal Journey Out of His Depression (John Wiley &
Sons, 1982), an
autobiographical book by York University
psychology professor Norman S.
Endler, Ph.D., he alleges his
unhappiness or so-called depression "was
biochemically induced"
(p. xiv). He says "my affective disorder was
primarily
biochemical and physiological" (p. 162). But from his own
words
it's obvious his depression was due primarily to unreturned
love
when a woman he got emotionally involved with, Ann, decided to
"wind
down" her relationship with him (pp. 2-5) and when he
suffered a career
setback (loss of a research grant) at about the
same time (p. 23).
Despite his claims of biochemical causation,
nowhere does he cite any
medical or biological tests showing he
had any kind of biological,
biochemical, or neurological
abnormalities. He can't, because no valid
biological test exists
that tests for the presence of any so-called mental
illness,
including allegedly biologically caused unhappiness
(or
"depression"). Similarly, in The Broken Brain,
psychiatry
professor Nancy Andreasen gives the example of Bill,
a
pediatrician, whose recurrent depression she thinks illustrates
that
"People who suffer from mental illness suffer from a sick or
broken
brain [emphasis Andreasen's], not from weak will,
laziness, bad
character, or bad upbringing" (p. 8). But she seems
to overlook the
fact that Bill's allegedly biologically caused
recurrent depressions occurred
when his father died, when he was
not permitted to graduate from medical
school on schedule, when
his first wife was diagnosed with cancer and died,
when his
second wife was unfaithful to him, when he was arrested
for
public intoxication during an argument with her and this was
reported
in the local newspaper, and when his license to practice
medicine was
suspended because of stigma from psychiatric "treat-
ment" he received (pp.
2-7).
One of the reasons for theorizing
about biological
causes of severe unhappiness or "depression" is sometimes
people
are unhappy for reasons that aren't apparent, even to them.
The
reason this happens is what psychoanalysts call the
unconscious:
"Freud's investigations shocked the Western world ...
Comparing
the mind to an iceberg, largely submerged and invisible, he
told
us that the greater part of the mind is irrational and uncon-
scious,
with only the tip of the preconscious and conscious
showing above the
surface. He maintained that the larger,
unconscious part - much of it
sexual - is more important in
guiding our lives than the rational part, even
though we deceive
ourselves into believing it is the other way around"
(Ladas, et
al., The G Spot And Other Recent Discoveries About Human
Sexuality, Holt,
Rinehart & Winston, 1982, pp. 6-7). In An
Elementary Textbook of
Psychoanalysis, Charles Brenner, M.D., says "the
majority of
mental functioning goes on without consciousness... We
believe
today that...mental operations which are decisive in
determining
the behavior of the individual...even complex and decisive ones
-
may be quite unconscious" (Int'l Univ. Press, 1955, p. 24). A
news
magazine article in 1990 reported that "Scientists studying
normal
rather than impaired subjects are also finding evidence
that the mind is
composed of specialized processors that operate
below the conscious level.
...Freud appears to have been correct
about the existence of a vast
unconscious realm" (U.S. News & World
Report, October 22, 1990,
pp. 60-63). People's unhappiness or so-
called depression being caused
by life experience is not always
obvious, because the relevant mental
processes and memories are
often hidden in the unconscious parts of their
minds.
I believe unhappiness or so-called
depression is always
the result of life experience. There is no
convincing evidence
unhappiness or "depression" is ever biologically
caused. The
brain is part of our biology, but there is no evidence
severe
unhappiness or "depression" is sometimes biologically caused
any
more than bad TV programs are sometimes electronically caused.
"[T]he
question is not how to get cured, but how to live" (Joseph
Conrad, quoted by
Thomas Szasz, The Myth of Psychotherapy, Syracuse
Univ. Press, 1988,
title page). "When mental health professionals point to
spurious
genetic and biochemical causes," of depression and
recommend drugs rather
than learning better ways of living, "they
encourage psychological
helplessness and discourage personal and
social growth" of the sort needed
to really avoid unhappiness or
"depression" and live a meaningful and
happy life (Peter Breggin,
M.D., "Talking Back to Prozac" Psychology
Today magazine, July/
Aug 1994, p. 72).
THE AUTHOR,
Lawrence Stevens, is a lawyer whose practice has
included representing
psychiatric "patients". His pamphlets are
not copyrighted. Feel
free to make copies.