Why I Don’t “Disease” Depression

If forced to choose between labeling immobilizing depression as either a character weakness or a disease, it’s understandable that disease would be the preference. But there is a third choice, one that normalizes depression and which — for people such as myself — feels more respectful and better reduces suffering.

I regularly do battle with right-wing talk show hosts who mock depression sufferers as crybabies. Fundamentalist pull-yourself-up-by-your-bootstrap yappers are often heartless and uninformed, and I tell them just that. However, fundamentalist depression diseasers also need to be confronted.

“I have written a polemic, an insistent argument for the proposition that depression is a disease,” is how psychiatrist Peter Kramer describes his Against Depression (2005). Kramer argues that depression must be a disease because of how devastating it is. He is certainly correct that depression can result not only in suicide but can ruin careers, destroy families, and stress the body so as to jeopardize physical health. However, such nondiseases as war and poverty also have a devastating impact; and there is a long list of noncontroversial illnesses, including the common cold, that do not have a devastating impact.

Kramer’s other disease arguments are just as shaky. According to Kramer, biological markers — the sine qua non of disease — for depression have been discovered. He tells us that brain scanning techniques focusing on the size of the hippocampus and amygdala can differentiate the depressed from the nondepressed. However, five months after Against Depression was published, The New York Times (“Can Brain Scans See Depression?” October 18, 2005) concluded: “After almost 30 years, researchers have not developed any standardized tool for diagnosing or treating psychiatric disorders based on imaging studies.”

Kramer also proclaims, “Deplete serotonin, and depression is unmasked.” But researchers have depleted serotonin, and it did not cause depression in nondepressed subjects nor did it worsen the depressive symptoms of those already depressed. By 1998 The American Medical Association Essential Guide to Depression had reported that there is no clear link between levels of serotonin and depression, “as some depressed people have too much serotonin.”

Finally, Kramer tells us about the defective genes of depressives, “By the mid-1990s, scientists had identified genes that might lead to both conditions, neuroticism and depression.” Kramer leans heavily on behavioral geneticist Kenneth Kendler; however, two months after the publication of Against Depression, Kendler reviewed the evidence for “gene action in psychiatric disorders” in the American Journal of Psychiatry (July 2005), where he concluded: “Although we may wish it to be true, we do not have and are not likely to ever discover ‘genes for’ psychiatric illness.”

While symptoms of depression can be caused by a variety of medical conditions (for example, anemia and hypothyroidism), such medical conditions, according to the American Psychiatric Association, actually rule out the psychiatric disease of “depression.” What psychiatrists call depression has not in fact been linked to any biochemical markers.

Depression is neither a character defect nor biochemical defect but rather a strategy to shut down overwhelming pain. Used in excess, it can lead to immobilization and greater pain.

Depression is by no means the only strategy people use to shut down overwhelming pain. People use alcohol, marijuana, television, food, gambling, and worse. A depressed Sigmund Freud, pained by failure, used cocaine, then turned his friends on to it, but ultimately discovered its adverse affects and rejected it. Joseph Goebbels, even more pained by failure than Freud, shut down his pain by embracing fascism; but, unlike Freud, Goebbels couldn’t have cared less about the adverse effects of his strategy.

Labeling depression as a disease gives some people relief, but such labeling creates grief for others. I have met many people who have been failed by antidepressants and electroshock. They talk about the adverse physiological effects of their treatments, but they also talk about something else. By becoming compliant patients to a medical authority, they describe losing control over their lives. Depression is an experience of helplessness and hopelessness, and for these people, accepting depression as a disease makes them feel even more helpless and hopeless.

Instead of labeling depression as weakness or illness, we might better decrease depression by understanding it as a normal, albeit painful, human reaction. When we label a part of ourselves as either “weak” or “sick,” we alienate ourselves from a part of who we are, and this can create even more pain. In contrast, when we accept the whole of our humanity, we are more likely to be freed up to resolve and heal the source of our pains.

Bruce E. Levine, Ph.D., is a clinical psychologist and author of Surviving America’s Depression Epidemic: How to Find Morale, Energy, and Community in a World Gone Crazy (Chelsea Green Publishing, 2007). brucelevine.net