How we have been misled about the nature of depression

Joanna Moncrieff’s abstract for her Sowerby Project 10 year anniversary public lecture, ‘Changing our minds: How we have been misled about the nature of depression and mental disorder’, emphasises that most people generally have come to accept that it’s reasonable to believe that depression is a brain disorder which is specifically targeted by antidepressants (see lecture information). But they are being misled about the nature of depression and functional mental disorder in general (see eg. previous post). Depression has psychosocial not neurobiobiological causes. Antidepressants can tend to leave people feeling that there is a sense in which their psychosocial problems, which caused the depression, have not really been solved. However much they may feel that antidepressants may have helped stabilise their mood, they may, therefore, also feel emotionally flat and not back to their real self (see eg. another previous post). In fact there is a sense in which taking antidepressants can be identity altering, because reducing people to their brain does not help them to recognise and deal with the personal situation in which they find themselves. They are instead indoctrinated into believing the biomedical myth that they have a brain disorder. But their brain is only part of them, not their whole self. However difficult dealing with emotional problems may be, blaming the brain is not the right solution.

There can, nonetheless, seem to be advantages in taking on the biomedical myth. Not that people should necessarily be blamed for what has happened to them or who they are. But by believing that their problems have been caused by their brain, their difficulties may then be seen as out of their control and not their responsibility. However much that may well be the case, it’s still wrong to do so for biomedical reasons and cannot justify such speculation. Psychiatry has always had a tendency to encourage biomedical thinking because it seems to simplify reasons for depression and other mental disorders (see eg. previous post). Understanding reasons for such problems can be difficult and can never actually be proven, whereas the biomedical myth offers an apparent underlying physical scientific cause.

The biomedical myth will therefore survive. People will continue to wish that the cause of functional mental illness will eventually be found in the brain. But the disadvantages, not just the truth, of the biomedical myth need to be considered. People are being made too dependent on antidepressants. Withdrawal problems are common and can be severe if only because of what antidepressants have come to mean to people. Psychiatric patients often stay on medications, maybe several at once, even though their actual benefit is questionable. Any change threatens an equilibrium related to a complex set of meanings that their medications have acquired. People are being made to think that they need a pill and become fearful about trying to manage without the drug. These issues of dependence should not be minimised, yet commonly treatment is reinforced by emphasising that antidepressants are not addictive. 

There’s no point looking to mainstream psychiatry to resolve the increasing use of antidepressants, because the profession exists currently to defend the use of psychotropic medication. This is not likely to change soon. Psychiatry may have had phases of being more open minded and pluralistic in its approach, but it has always been attracted to biomedical understandings of mental illness. People find it difficult to accept there are limits to our understanding of human nature, which they think should be explicable in physical terms. Powerful vested interests in defending this belief mean psychiatry does not really want to change.