The broken brain hoax: when depression turned into a disease

The mind depressed: a matter of chemical imbalance?

Previously I’ve been called on my temerity to insist that depression is not a disease. I’ve also been known to roll my eyes a little too keenly and a little too conspicuously every time I hear the two d words (depression and disease) in the same sentence, but I’ve never openly stated my case. (It’s England and one must observe the mores, even if one is a legal alien.) Now, I think, is a good time to do exactly that. The old myth must die.

“It’s depression speaking”, said a chap in the audience of some or other mental health event/conference/festival. His point: it’s not me, it’s the disease. 
 I’ve heard a version of this line uttered many times during my interviews for this publication. People seem to be convinced that something is off or sorely missing in their brains, that the mechanism is somehow faulty, the cogs and wheels not quite fitting together.

“I am broken, yes”, one person told me. The resignation in his voice still haunts me.

To be sure, a diagnosis of illness can help to recognize the problem in the first place. It can be the thing that jerks you out of the stupor of depression, the impetus to seek help — a prospect terrifying in itself. To seek help, one therapist told me, is an act of extreme vulnerability that people will resist with all they’ve got; it’s only when all else fails and the pain of doing more of the same becomes unbearable that one surrenders to reality. A diagnosed illness can lend depression the legitimacy, tangibility and urgency to take action.

There’s also a comforting depersonalization, a sort of exhale, in being diagnosed as ill. Left to fester and unspoken, depression can feel like a weakness undermining our very worth; it’s the lurking suspicion that there’s something wrong with us, that we are different, aberrant even. 
An illness, on the other hand, is impersonal; it befalls — it happens to — us; it’s not our fault.
 I get that and I do believe that you should do whatever helps you get up in the morning and get through the day. This is hard enough already. It’s sometimes the hardest thing.

But there are problems. One is that it’s easy to grow dependent on medication, even on therapy, as a palliative or a fix. You may fall into learned helplessness, get stuck into self-victimization and shirk the messy, soul searching work of healing. You may even think that you are doomed by your faulty brain chemistry and give up all effort to change.

I believe in change. But I also believe that it takes toil and that we won’t get out until we wade in — in to the woods, in to the swampland, in to the cupboards with the skeletons from years past; we won’t get out until we uncork our hurt and raise our dead and own our story in its entirety. This is hard as hell and I’ll readily admit to the lure of popping a pill and waiting for the dull, drug-induced sedation to set in.

But here’s another problem with the notion of depression as a disease: no matter how hard you look and where, you won’t find a shred of credible scientific evidence that it is, in fact, true.

We can manufacture enough diagnostic labels of normal variability of mood and thought that we can continually supply medication to you…But when it comes to manufacturing disease, nobody does it like psychiatry.
Dr. Stefan Kruszewski, clinical & forensic psychiatrist

I have to mention that I’m using illness and disease interchangeably here, even though some theorists disagree on the definitions. For example, disease can be used in the strict sense of a biological dysfunction, an impairment of normal functioning, while illness would sometimes denote the personal experience of un-health, with or without an underlying disease.

In the disease model of depression, it’s the brain’s neurochemistry that’s ostensibly at fault. You may have heard of the chemical imbalance theory: key chemical messengers known as neurotransmitters are deficient at the gaps between nerve cells, which interferes with the normal passing of signals from one cell to another.

Low levels of, mainly, serotonin — a chemical related to mood, sleep, memory, learning — are thought to cause depression and most antidepressants work by boosting these levels (hence these drugs are known as SSRIs — or Selective Serotonin Reuptake Inhibitors).

The chemical imbalance theory is often treated as an unassailable truth by the general public, GPs and psychiatrists alike. However, for years now scientists have been retreating from this view as there’s simply no evidence to support it.

All psychiatrists have in common that when they are caught on camera or on microphone, they cower and admit that there are no such things as chemical imbalances/diseases, or examinations or tests for them. 
— Dr. Fred Baughman Jr., Pediatric Neurologist
The theories are held on to not only because there is nothing else to take their place, but also because they are useful in promoting drug treatment. The perpetrators are, of course, feeding at the public trough.
 — Dr. Elliott Valenstein Ph.D., author of Blaming the Brain
In short, the whole business of creating psychiatric categories of ‘disease, […] is nothing but an extended racket furnishing psychiatry a pseudo-scientific aura. — — Dr. Thomas Dorman, member of the Royal College of Physicians of the UK

Take, for example, the existing studies on serotonin levels in depressed patients. While some have shown that these patients have lower amounts of serotonin, others indicate no difference compared to the normal population, and still others — watch this — have found abnormally high levels of serotonin in depressed patients. These results might be easier to believe if you consider a new drug called Stablon (Tianeptine), which has been proven effective in clinical trials even though it actually decreases serotonin levels.

While we are on the topic of antidepressants, I should mention Irving Kirsch and his studies spanning over 8 years and covering perhaps the largest data sets available on antidepressants. Kirsch did something fascinating: he dug up and analyzed clinical trials previously hidden by the drug companies that had sponsored them. He found that almost half of the existing trials went unpublished (and remained known only to the pharma companies and the Federal Drug Administration), and for good reason: they failed to show a significant benefit compared to a placebo.

In fact, it turned out that as much as 82% of the therapeutic effects of antidepressants were also experienced by patients taking dummy drugs. More arrestingly still, in follow-on studies Kirsch discovered that the slight advantage of antidepressants over placebo was, in fact, misleading: 89% of the study participants could guess, by certain side effects, that they were taking the real drug, which shored up their belief in the efficacy of the experiment, which, in turn, increased the placebo effect of the antidepressants well beyond that of the dummy drugs.

None of this is to say that depression has no roots in the brain or that neurotransmitters and chemicals are unimportant. It’s just that matters of the mind are more complex that they appear.

Neuroscientists can indeed look at brain scans and show us regions that are shrunk or underactive in depressed patients, but they cannot yet tell correlation from causation, nor can they even put a finger on what a normal chemical balance looks like. There are many clues but no conclusions; not yet.

This is not me pointing fingers or preaching. This is me wondering and also worrying. Wondering about depression, what it is, how it comes to be and why; worrying about misunderstanding and overmedicating it because of ignorance and hidden agendas.

Rather than trapped in a mental disease, I think that we are entangled in a bad story. I think that depression is an experience, a way of being in the world, as one therapist explained it to me, perhaps even a relationship to the human condition. Maybe the brain is to blame, maybe it’s not about blame at all. Maybe it’s about facing up to and owning the messiness and madness of being alive, and trying to stitch together a better story out of it.

If this post resonated with you, consider helping me out by recommending it so we can start a wider conversation.

You can also follow my journey to the bottom of depression as I talk to therapists, scientists, doctors and a bunch of extraordinary human beings here:

Adore and Endure: Stories of Staying Alive

A few words of gratitude

I am forever grateful to all of you who have shared your story with me. You are already whole and you have so much to give to the world and you don’t always know it.

I am also indebted to the therapists without whose generosity and contributions I’d not have been able to keep on this journey. Special thanks to Annie Broadbent, Aaron Balick, Joshua Miles, Fiona Riley and Joan Fogel.

Photo credit: SplitShire