By Turnquist, Kevin
The Humanist , Vol. 62, No. 5
Psychiatrists have taken the position that the apparent increase in the incidence of depression is just a mirage--that this much depression has always been present in the population; it is simply better diagnosis and the decreased stigma associated with our treatments that are responsible for the escalating numbers of reported depressed people. Some of us remain unconvinced.
Research indicates that in any given year over seventeen million Americans experience major depression. In fact, fifteen percent of the population is diagnosed with depression at some point in their lifetime. The treatment of depression has become an enormous industry in the United States. Sales of antidepressant medications have tripled in just a decade and now total over $13 billion annually. In many parts of the country, people wait for several months or longer for a fifteen-minute appointment with their psychiatrist so that they can continue to receive their antidepressant pills. Family practitioners are dispensing even more of these medications than psychiatrists. Yet the consistent message to the treaters of depression is that only a small portion of the people who are suffering from depression are receiving treatment for it. Countless others are suffering, and it is our responsibility to bring treatment--almost always in the form of expensive new drugs--to the untreated.
This view of depression raises questions in the minds of many observers. Why should this disorder be on the rise despite the treatment efforts of several generations of psychiatrists and the combined resources of multibillion-dollar pharmaceutical companies? Is there something new about depression itself, or does this represent a problem inherent in modern Western society? How did humans manage to get through life before Prozac? Fortunately, some preliminary answers are beginning to emerge. Startling discoveries from basic research in neuroscience have forced us to begin thinking about the problem of depression in new and different ways. Before looking at these new findings, however, a review of how we got to our present state may be worthwhile.
Part of the helping profession's difficulty in dealing with depression is that we have never really understood what would cause one person to be depressed while another in similar circumstances remains symptom-free. A number of theories have had their day: anger turned inward results in depression; depression is a reaction to real or imagined loss; depression represents the gap between our real view of ourselves and our unconscious, idealized version of how our lives should be; depression is a genetically inherited disorder; depression is a result of "chemical imbalances" in neurotransmitter systems that can only be understood by trained psychiatrists. Since each of these models undoubtedly have some truth in them, any new model of depression will have to explain why each of these diverse viewpoints has led to the relief of suffering in at least some individuals.
Clouding our view of depression even further is the fact that bona fide depression can arise from a variety of "physical" causes. Pancreatic cancer, heart attacks, strokes, thyroid problems, side effects of a host of nonpsychiatric medications, even changes in exercise routines have all been clearly linked to the onset of depression in some individuals.
Modern psychiatry has dealt with this uncertainty about the root cause of depression largely by ignoring it. The sequence of Diagnostic and Statistical Manuals released by the American Psychiatric Association have been, by design, heavy on description and devoid of explanatory theories. The most recent manual requires that at least five of nine key symptoms--depressed mood, decreased interest in activities, significant weight loss or gain, disturbed sleep patterns, physical agitation or lethargy, fatigue, feelings of worthlessness or excessive guilt, decreased ability to concentrate or make decisions, and recurrent thoughts of death or suicide--be present for at least two weeks for major depression to be diagnosed. …