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The Myth of Biological
Depression
by Lawrence Stevens, J.D.
Unhappiness or "depression" alleged to be the result
of
biological abnormality is called "biological" or "endogenous"
or
"clinical" depression. In her book The Broken
Brain: The
Biological Revolution in Psychiatry, University of Iowa psychia-
try professor Nancy Andreasen, M.D., Ph.D., says "The older
term
endogenous implies that the depression `grows from within' or
is
biologically caused, with the implication that unfortunate and
painful events such as losing a job or lover cannot be considered
contributing causes" (Harper & Row, 1984, p. 203). Similarly,
in
1984 in the Chicago Tribune newspaper columnist Joan Beck
alleged: "depressive disorders are basically biochemical
- and
not caused by events or environmental circumstances or personal
relationships" (July 30, 1984, Sec. 1, p. 16).
The concept of biological or
endogenous depression is important
to psychiatry for two reasons. First, it is the most common
supposed mental illness. As Victor I. Reus, M.D., wrote
in 1988:
"The history of the diagnosis and treatment of melancholia
could
serve as a history of psychiatry itself" (appearing in: H.
H.
Goldman, editor, Review of General Psychiatry, 2nd Edition,
Appleton
& Lange, 1988, p. 332). Second, all of psychiatry's
biological "treatments"
for depression - whether it is drugs, electroshock, or
psychosurgery - are based on the idea that the unhappiness we
call depression can be caused by a biological malfunction rather
than life experience. The erroneous belief in biological
causation justifies the otherwise unjustifiable use of biological
therapies. And the biological therapies justify the existence
of
psychiatry as a medical specialty distinguishable from psychology
or counselling.
Many professional and lay people
today think depression
can be caused by "chemical imbalance" in the brain even
though
none of the "chemical imbalance" theories of depression
have been
verified. Some of them are discussed by Dr. Andreasen in
her
book The Broken Brain.
One of the theories she describes
is the belief that
"depression" (what I think should be called simply unhappiness
or
severe unhappiness) is the result of neuroendocrine abnormalities
indicated by excessive cortisol in the blood. The test for
this
is called the dexamethasone-suppression test or DST. The
theory
behind this test and the claims of its usefulness were found to
be mistaken, however, because, in Dr. Andreasen's words, "so
many
patients with well-defined depressive illness have normal DSTs"
(pp. 180-182). An article in the July 1984 Harvard Medical
School
Health Letter reached a similar conclusion. The article,
titled
"Diagnosing Depression: How Good is the `DST'?", reported
that
"For every three office patients with an abnormal DST, only
one
is likely to have true depression. ... [And] a large fraction
of
people who are depressed by other criteria will still have normal
results on the DST" (p. 5). Similarly, in an article
in the
November 1983 Archives of Internal Medicine three physicians
concluded that "Data from studies currently available do
not
support the use of the dexamethasone ST [Suppression Test]"
(Martin F. Shapiro, M.D., et al., "Biases in the Laboratory
Diagnosis of
Depression in Medical Practice", Vol. 143, p. 2085). In
1993 in her book
If It Runs In Your Family: Depression, Connie S. Chan,
Ph.D.,
acknowledges that "There is still no valid biological test
for
depression" (Bantam Books, p. 106). But despite its
having been
discredited, some biologically oriented psychiatrists are (appar-
ently) so eager for biological explanations for people's unhappi-
ness or "depression" that they continue to use the DST
anyway.
For example, in his book The Good News About Depression,
pub-
lished in 1986, psychiatrist Mark S. Gold, M.D., says he
continues to use the DST. In that book Dr. Gold claims the
DST
is "highly touted as the diagnostic test for biologic
depression"
(Bantam, p. 155, emphasis in original).
In The Broken Brain, Dr.
Andreasen also describes what
she calls "the most widely accepted theory about the cause
of
depression...the `catecholamine hypothesis.'" She emphasizes
that "the catecholamine hypothesis is theory rather than
fact"
(p. 231). She says "This hypothesis suggests that patients
suffering from depression have a deficit of norepinephrine in
the
brain" (p. 183), norepinephrine being one of the "major
catechol-
amine systems" in the brain (pp. 231-232). One way
the catechol-
amine hypothesis is evaluated is by studying one of the breakdown
products of norepinephrine, called MHPG, in urine. People
with
so-called depressive illness "tended to have lower MHPG"
(p. 234).
The problem with this theory, according to Dr. Andreasen, is that
"not all patients with depression have low MHPG" (ibid).
She
accordingly concludes that this catecholamine hypothesis "has
not
yet explained the mechanism causing depression" (p. 184).
Another theory is that severe
unhappiness
("depression") is caused by lowered levels or abnormal
use of
another brain chemical, serotonin. A panel of experts assembled
by the U.S. Congress Office of Technology Assessment reported
in
1992 that "Prominent hypotheses concerning depression have
focused on altered function of the group of neurotransmitters
called monoamines (i.e., norepinephrine, epinephrine, serotonin,
dopamine), particularly norepinephrine (NE) and serotonin. ...
studies of the NE [norepinephrine] autoreceptor in depression
have found no specific evidence of an abnormality to date.
Currently, no clear evidence links abnormal serotonin receptor
activity in the brain to depression. ... the data currently
available do not provide consistent evidence either for altered
neurotransmitter levels or for disruption of normal receptor
activity" (The Biology of Mental Disorders, U.S. Gov't
Printing Office,
1992, pp. 82 & 84).
Even if it was shown there is
some biological change or
abnormality "associated" with depression, the question
would
remain whether this is a cause or an effect of the "depression".
At least one brain-scan study (using positron emission tomography
or PET scans) found that simply asking normal people to imagine
or recall a situation that would make them feel very sad resulted
in significant changes in blood flow in the brain (Jose V.
Pardo,
M.D., Ph.D., et al., "Neural Correlates of Self-Induced Dysphoria",
American
Journal of Psychiatry, May 1993, p. 713). Other research
will probably
confirm it is emotions that cause biological changes in the brain
rather than biological changes in the brain causing emotions.
One of the more popular theories
of biologically caused
depression has been hypoglycemia, which is low blood sugar. In
his book Fighting Depression, published in 1976, Harvey
M. Ross,
M.D., said "In my experience as an orthomolecular psychiatrist,
I
find that many patients who complain of depression have hypo-
glycemia (low blood sugar). ...Because depression is so
common
in those with hypoglycemia, any person who is depressed without
a
clear cut obvious cause for that depression should be suspected
of having low blood sugar" (Larchmont Books, p. 76 &
93). But in
their book Do You Have A Depressive Illness?, published
in 1988,
psychiatrists Donald Klein, M.D., and Paul Wender, M.D., list
hypoglycemia in a section titled "Illnesses That Don't Cause
Depression" (Plume, p. 61). The idea of hypoglycemia
as a cause of
depression was also rejected in the front page article of the
November 1979 Harvard Medical School Health Letter, titled
"Hypo-
glycemia - Fact or Fiction?".
Another theory of a physical
disease causing psychological
unhappiness or "depression" is hypothyroidism. In
her book
Can Psychotherapists Hurt You? psychologist Judi
Striano, Ph.D., includes a chapter titled "Is It Depression
- Or
An Underactive Thyroid?" (Professional Press, 1988). Similarly,
three psychiatry professors in 1988 asserted "Frank hypo-
thyroidism has long been known to cause depression" (Alan
I. Green,
M.D., et al., The New Harvard Guide to Psychiatry, Harvard
Univ. Press,
1988, p. 135). The theory here is that the thyroid gland,
which is
located in the neck, normally secretes hormones which reach the
brain through the bloodstream necessary for a feeling of
psychological well being and that if the thyroid produces too
little of these hormones, the affected person can start feeling
unhappy even if no problems result from the endocrine (gland)
problem other than the unhappiness. The American Medical
Association Encyclopedia of Medicine lists many symptoms of
hypothyroidism: "muscle weakness, cramps, a slow heart rate,
dry
and flaky skin, hair loss ... there may be weight gain" (Random
House, 1989, p. 563). The Encyclopedia does not list
unhappiness or
"depression" as one of the consequences of hypothyroidism.
But
suppose you began to experience "muscle weakness, cramps...dry
and flaky skin, hair loss ... weight gain"? How would
this make
you feel emotionally? - depressed, probably. Just as hypo-
thyroidism (hypo = low) is a thyroid gland that produces too
little, hyperthyroidism is a thyroid glad that produces too much.
Therefore, if hypothyroidism causes depression, then it
seems
logical to assume hyperthyroidism has the opposite effect,
that
is, that it makes a person happy. But this is not
what happens.
As psychiatrist Mark S. Gold, M.D., points out in his book The
Good News About Depression: "Depression occurs in hyperthyroid-
ism, too" (p. 150). What are the consequences of hyperthy-
roidism?: Dr. Gold lists abundant sweating, fatigue, soft moist
skin, heart palpitations, frequent bowel movements, muscular
weakness, and protruding eyeballs. So both hypo- and hyper-
thyroidism cause physical problems in the body. And both
cause
"depression". This is only logical. It is
hard to feel anything
but bad emotionally when your body doesn't feel well or work
properly. It has never been proved hypothyroidism affects
mood
other than through its effect on the victim's experience of
feeling physically unhealthy.
Some people think chemical imbalance
related to
hormonal changes must be a possible cause of "depression"
because
of the supposed biological causes of women's moods at different
times of their menstrual cycles. I don't find that argument
con-
vincing, because I've known so many women whose mood and state
of
mind was consistently unaffected by her menstrual cycle.
Psychology professor David G. Myers, Ph.D., labels premenstrual
syndrome (PMS) a myth in his book The Pursuit of Happiness
(William Morrow & Co., 1992, pp. 84-85). Of course,
some women
experience physical discomfort due to menstruation. Feeling
lousy physically is enough to put anybody in a bad mood.
Some people believe women experience
undesirable mood
changes for biological reasons because of menopause. However,
a
study by psychologists at University of Pittsburgh reported in
1990 found that "Menopause usually doesn't trigger stress
or
depression in healthy women, and it even improves mental health
for some". According to Rena Wing, one of the psychologists
who
did the study, "Everyone expects menopause to be a stressful
event, but we didn't find any support for this myth" ("Menopausal
stress may be a myth", USA Today, July 16, 1990, p.
1D).
It is also widely believed
that women go through a
period of depression for biological reasons after giving birth
to
a child. It's called postpartum depression. In his
book The
Making of a Psychiatrist, Dr. David Viscott quotes Dr. George
Maslow, a physician doing an obstetrical residency, making the
following remark: "Come on, Viscott, do you really believe
in
postpartum depression? I've seen maybe two in the last three
years. I think it's a lot of shit you guys [you psychiatrists]
imagined to drum up business" (Pocket Books, 1972, p. 88).
A woman
who had given birth to eight (8) children, which in my opinion
qualifies her as an expert on the subject of postpartum
depression, told me what she called "postpartum blues"
are real,
but she attributed postpartum blues to psychological rather than
physiological causes. "I don't know about the physiological
causes", she said, but "so much of it is psychological."
She
said "You feel awful about your looks", because in our
society a
woman is "supposed" to be thin, and for at least a short
time
after giving birth a woman just isn't. She also said after
childbirth a woman feels considerable "physical exhaustion".
Childbirth also is the beginning of new or increased parental
obligations, which if we are honest we must admit are quite
burdensome. The arrival of new or additional parental
obligations and the realization of the negative ways new or
additional parenthood obligations will affect a woman's (or
man's) life is an obvious non-biological explanation for
postpartum depression. It may not be until the actual birth
of
the child that parents realize how parenthood changes their lives
for the worse, but a letter from a female friend of mine who at
the time was only three months pregnant with her first child
illustrates that depression associated with childbirth may come
long before the postpartum period: She said she was frequently
breaking down in tears because she thought with a child her life
would never the same and that she would be a "prisoner"
and
wouldn't have time to do what she wanted in life. A reason
these
psychological causes are often not candidly acknowledged and
postpartum (or pre-partum) blues instead attributed to unproven
biological causes is our reluctance to admit the downside of
parenthood.
Another theory of biologically
caused depression is
based on stroke damage in the left front region of the brain
causing depression. What makes it seem possible this might
be
neurologically caused rather than being a reaction to the
situation a person finds himself in because of having had a
stroke is stroke damage in the right front of the brain allegedly
causing "undue cheerfulness." However, a careful
reading of
books and articles about neurology for the most part doesn't
support the allegation of undue cheerfulness from right front
brain damage. Instead, what most neurological literature
indicates sometimes results from right front stroke-related brain
damage is anosagnosia, usually described as lack of concern or
inability to know their own problems, not happiness or cheer-
fulness (e.g., Dr. Oliver Sacks in The Man Who Mistook His
Wife
for a Hat and Other Clinical Tales, Harper & Row, 1985,
p. 5).
Perhaps the most often heard
argument is that
antidepressant drugs wouldn't work if the cause of depression
was
not biological. But antidepressant drugs don't work.
As
psychiatrist Peter Breggin, M.D., said in 1994, "there's
no
evidence that antidepressants are especially effective" (Talking
Back to Prozac, St. Martin's Press, p. 200). In studies
placebos often
do as well. Even if so-called antidepressants did help,
that
wouldn't prove a biological cause of "depression" any
more than
would feeling better from taking marijuana or cocaine or drinking
liquor.
A careful reading of the books
and articles by
psychiatrists and psychologists alleging biological causes of
the
severe unhappiness we call depression usually reveals purely
psychological causes that explain it adequately, even when the
author believes he has given a good example of biologically
caused depression. For example, in Holiday of Darkness:
A
Psychologist's Personal Journey Out of His Depression (John
Wiley &
Sons, 1982), an autobiographical book by York University
psychology professor Norman S. Endler, Ph.D., he alleges his
unhappiness or so-called depression "was biochemically induced"
(p. xiv). He says "my affective disorder was primarily
biochemical and physiological" (p. 162). But from his
own words
it's obvious his depression was due primarily to unreturned love
when a woman he got emotionally involved with, Ann, decided to
"wind down" her relationship with him (pp. 2-5) and
when he
suffered a career setback (loss of a research grant) at about
the
same time (p. 23). Despite his claims of biochemical causation,
nowhere does he cite any medical or biological tests showing he
had any kind of biological, biochemical, or neurological
abnormalities. He can't, because no valid biological test
exists
that tests for the presence of any so-called mental illness,
including allegedly biologically caused unhappiness (or
"depression"). Similarly, in The Broken Brain,
psychiatry
professor Nancy Andreasen gives the example of Bill, a
pediatrician, whose recurrent depression she thinks illustrates
that "People who suffer from mental illness suffer from
a sick or
broken brain [emphasis Andreasen's], not from weak will,
laziness, bad character, or bad upbringing" (p. 8). But
she seems
to overlook the fact that Bill's allegedly biologically caused
recurrent depressions occurred when his father died, when he was
not permitted to graduate from medical school on schedule, when
his first wife was diagnosed with cancer and died, when his
second wife was unfaithful to him, when he was arrested for
public intoxication during an argument with her and this was
reported in the local newspaper, and when his license to practice
medicine was suspended because of stigma from psychiatric "treat-
ment" he received (pp. 2-7).
One of the reasons for theorizing
about biological
causes of severe unhappiness or "depression" is sometimes
people
are unhappy for reasons that aren't apparent, even to them. The
reason this happens is what psychoanalysts call the unconscious:
"Freud's investigations shocked the Western world ... Comparing
the mind to an iceberg, largely submerged and invisible, he told
us that the greater part of the mind is irrational and uncon-
scious, with only the tip of the preconscious and conscious
showing above the surface. He maintained that the larger,
unconscious part - much of it sexual - is more important in
guiding our lives than the rational part, even though we deceive
ourselves into believing it is the other way around" (Ladas,
et
al., The G Spot And Other Recent Discoveries About Human Sexuality,
Holt,
Rinehart & Winston, 1982, pp. 6-7). In An Elementary
Textbook of
Psychoanalysis, Charles Brenner, M.D., says "the majority
of
mental functioning goes on without consciousness... We believe
today that...mental operations which are decisive in determining
the behavior of the individual...even complex and decisive ones
-
may be quite unconscious" (Int'l Univ. Press, 1955, p. 24).
A news
magazine article in 1990 reported that "Scientists studying
normal rather than impaired subjects are also finding evidence
that the mind is composed of specialized processors that operate
below the conscious level. ...Freud appears to have been correct
about the existence of a vast unconscious realm" (U.S.
News & World
Report, October 22, 1990, pp. 60-63). People's unhappiness
or so-
called depression being caused by life experience is not always
obvious, because the relevant mental processes and memories are
often hidden in the unconscious parts of their minds.
I believe unhappiness or so-called
depression is always
the result of life experience. There is no convincing
evidence
unhappiness or "depression" is ever biologically
caused. The
brain is part of our biology, but there is no evidence severe
unhappiness or "depression" is sometimes biologically
caused any
more than bad TV programs are sometimes electronically caused.
"[T]he question is not how to get cured, but how to live"
(Joseph
Conrad, quoted by Thomas Szasz, The Myth of Psychotherapy,
Syracuse
Univ. Press, 1988, title page). "When mental health
professionals point to
spurious genetic and biochemical causes," of depression and
recommend drugs rather than learning better ways of living, "they
encourage psychological helplessness and discourage personal and
social growth" of the sort needed to really avoid
unhappiness or
"depression" and live a meaningful and happy life (Peter
Breggin,
M.D., "Talking Back to Prozac" Psychology Today
magazine, July/
Aug 1994, p. 72).
THE AUTHOR, Lawrence Stevens, is a lawyer whose practice has
included representing psychiatric "patients". His
pamphlets are
not copyrighted. Feel free to make copies.