Daring to argue that depression is not a physical disease

I mentioned the Sunday Times magazine article about Joanna Moncrieff in my last post, where I focused on the issue of whether antidepressants work. I also wanted to pick up what the article says in its introductory rubric about Jo daring to argue that depression is not a physical disease.

At face value, saying that depression is not a physical disease may not appear to be so much of a challenge to psychiatry. After all, depression is a mental not a physical illness, isn’t it? Why should psychiatry find such a view so threatening?

Jo emphasises in the article that making appropriate changes in one’s life is a way of tackling depression. Mainstream psychiatry does not always promote such social treatment of depression. Instead it encourages antidepressant medication, which tends to rely on regarding depression as a physical illness. Antidepressants are seen as having physical effects on the brain, correcting, or at least helping to correct, the brain problem causing depression. 

The chemical imbalance theory is therefore a way of promoting the idea that antidepressants counteract the brain problem causing depression. Most psychiatrists, if pressed, will admit this theory is too simplistic (see eg. previous post). But nonetheless they continue to look for brain abnormalities in depression, even being unprepared to give up implicating serotonin in the mechanism (see eg. another previous post). 

Psychiatry has always been caught in the philosophical mind-body problem. There has always been a fundamental conflict between psychic and somatic approaches to mental illness. It’s just that mainstream psychiatry has become too dependent on physical approaches, particularly over recent years with the development of psychopharmacology. This is why it finds it such a challenge that psychotropic medication may be no better than placebo, as I discussed in my last post.

I have always argued that psychiatry should not find such a challenge so threatening (see eg. my edited Critical psychiatry book). Before the psychopharmacology era, psychiatry did have a broadly conceived view of mental illness as having psychosocial caused. Of course this did not mean that physical factors were ignored. But most presentations to psychiatrists were accepted as having functional rather than organic causes. Over recent years this differentiation has become fudged (see eg. previous post). In fact, DSM-IV wrongly abolished the distinction (see eg. another previous post). Psychiatry is too keen to avoid metaphysical questions about how the mind relates to the brain.

The trouble is that this means that people can be reduced to their brains. The truth is that primary mental illness cannot be reduced to brain disease (see eg. previous post). Brain language has wrongly permeated our conception of ourselves over recent years (see eg. another previous post). But altered subjective experiences and disturbed reactions to others are essential elements of functional mental illness and not merely epiphenomena of a causal organic process. As I keep saying, psychiatry must stop reducing people to their brains. Restricting its interventions to psychopharmacology inevitably does so.