A philosophy of depression

This article by Justin Garson on the American Philosophical Association's blog is extremely relevant to my life at the moment. A few months ago, shortly before receiving a diagnosis of Overtraining Syndrom from a consultant, my GP prescribed me an SNRI deal with both physical and mental symptoms that I was experiencing. I'm still on it.

While the SNRI reduces the lows, it also seems to reduce the highs. In other words, it medicates me into a "keeping on the straight and narrow" in a way where I'm less of a problem to my family, friends, and the medical establishment. But it hasn't dealt with the underlying issues. Why did I overtrain in the first place? What is it that I'm seemingly trying to prove to myself and others?

I'm persuaded by Garson's view that the "chemical imbalance" theory seems to be an outdated and somewhat harmful approach of depression and anxiety:

Our beliefs about the causes of depression aren’t neutral. They shape prognosis in profound ways. In this respect, they’re somewhat different from, say, beliefs about the causes of multiple sclerosis (MS) or Alzheimer’s disease, where what I believe is unlikely to affect outcomes as much. Intriguingly, a large amount of research conducted over the last decade shows the same pattern: the idea—embodied in the chemical imbalance view—that depression is a brain dysfunction tends to harm patients in multiple ways. These harms include the following:

• Prognostic pessimism: the belief that mental health problems are due to brain dysfunctions tends to lead people to pessimism about healing. It leads people to think, “maybe depression is just how my brain works, so it’s probably not going to change.”
• Limiting treatment options: people who believe that their depression stems from a chemical imbalance are more likely to think that pills are necessary and that talk therapy is ineffective.
• Duration of antidepressant use: people who think their depression is a brain abnormality tend to stay on antidepressants for longer and are less likely to try to stop taking them.

[...]

In contrast, numerous studies... suggest that seeing one’s depression either as a meaningful response to a life crisis or as the brain’s functional signal that one’s needs aren’t being met have the opposite effect. People who believe their depression is purposeful (rather than pathological) tend to be more optimistic about therapy, tend to feel less stigma about sharing their depression with other people, and tend to stay on antidepressants for shorter periods of time.

What I like about Garson's article is the philosophical framing. For example in this next extract, he talks about identity, agency, and responsibility – and how perhaps depression, much like our pain response, can be a call to action to get back on a better track.

As I contemplated these results, I started to think that what was really helping people was, in the first place, a certain philosophical or conceptual shift they made about the meaning of their depression. This philosophical leap had to do with changing conceptions of agency, selfhood, and the good life.

First, consider selfhood. What are the boundaries of the self? Where does my “self” begin and end? The brain dysfunction view invites us to think of depression as something like an external affliction. It’s not part of who I am; rather, it’s a terrible accident that has befallen me, but that can potentially be reversed by medications or therapy. In co ntrast, the functional signal idea invites us to think of depression as a part of my very self. My “self” is wide enough to include my depression. Depression is like a part of my self trying to communicate with me.

This notion of the self as a community of somewhat fragmented agents, rather than a simple, unified whole, has long been part of the psychoanalytic tradition. From very early in his career, Freud concluded that one couldn’t understand mental health problems without seeing the mind as consisting of somewhat disparate agents pursuing different goals. The idea of the self as a community is more explicit in Internal Family Systems, a therapeutic approach which encourages patients to give names to the different parts of their selves.

Second, consider the way notions of responsibility and agency differ between the two paradigms of depression. Is depression, at least to some extent, my responsibility? One alleged benefit of the brain dysfunction model is that it removes responsibility. I’m no more responsible for my depression than I would be for having Alzheimer’s disease or MS. In the 1980s and 1990s, doctors, journalists, and mental‑health advocacy groups held the optimistic view that the brain dysfunction paradigm would liberate depressed patients from shame and blame.

But the last decade of research on public messaging about mental health... has led to a far more nuanced picture. While the dysfunction paradigm can reduce the sense of blameworthiness, it can also give rise to pessimism about getting better, along with the other harms outlined above. If depression is the symptom of a broken brain, then it seems like there’s nothing I can do of my own accord to fix it. I need an expert to come along and heal me.

In contrast, the functional signal view puts agency and responsibility front and center. Depression is, in the first place, a call to action. It may be a call to end a relationship or transform it. It might be a call to change life goals or career paths. Although I might not be responsible for becoming depressed, I am responsible for the choices I make, choices which can impact the duration of depression.

Finally, these two paradigms involve different ideas about the good life, that is, what kind of life I ought to aspire to. The brain dysfunction view presents the good life as one in which, among other things, people don’t get depressed. It’s one in which people can pursue their life goals freed from this terrible affliction. (Incidentally, if you do a Google image search for “overcoming depression,” you’ll often see a stock photo of a man or woman outdoors with arms outstretched, apparently embracing the good life that comes with conquering depression.)

In the functional signal view, a good life isn’t one in which you never get depressed. It’s one in which depression serves its proper role—it does what it’s supposed to do. For an obvious analogy, consider physical pain. A child might think that a good life is one where nothing ever hurts. But adults recognize that a good life is one in which the pain response does what it is meant to do: namely, alert us to the fact that, say, we’ve stepped on a piece of glass or been stung by a bee, so that we can take appropriate corrective action. On the functional signal view, depression works a bit like physical pain: it alerts us that our lives have gone off track.

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Source: blog.apaonline.org
Are.na block: ↗
Collection: finds-au723pdfugg