What is anxiety? Is it a disease? A mental disorder? Biochemical imbalance? A brain dysfunction? A mental syndrome? An existential or spiritual crisis? Several of my fellow PT bloggers posted on anxiety just recently. I want to discuss depression here as a clinical and forensic psychologist who has been practicing psychiatric therapy for more than three years.
For me, the crucial question of whether depression ( unipolar( link is external) or bipolar) is an illness originates from the rather dubious application of the medical design to the theory and practice of psychiatry and psychology. What is the “medical model”? The medical model is the paradigm on which the practice of scientific medicine is established: Symptoms are viewed as manifestations of pathological physiological procedures (illness) which are identified and after that treated with whatever methods available. The purpose of medical treatment is to get rid of, reduce or manage the symptoms of disease. To, as much as possible, lower suffering and extend life. Physicians have actually been consistently sticking to this respectable paradigm and practice given that the time of Hippocrates.
The medical design is a particular method ofing human suffering, decay, dysfunction and, ultimately, death. It is a paradigm, a lens through which doctors and others perceive certain irregular or aberrant phenomena like leukemia, diabetes, and now, anxiety and numerous other mental illness. But despite the tremendous contribution of the medical model in detecting and dealing with illness, its actual application to archetypal human experiences such as depression, psychosis, and anxiety is problematical.
There is no rejecting that those who experience extreme anxiety are ill. Anxiety can be crippling and, sometimes, lethal. Physical symptoms such as queasiness, throwing up, fatigue, persistent pain, diarrhea, insomnia and so on prevail concomitants to significant anxiety. “Treatment,” to use the medical terms, is required. The real concern is what type should that treatment take? The response to this depends in part on how one comprehends the etiology or cause of depression and other major mental illness such as bipolar affective disorder and psychosis. There are different theories as to the reason for anxiety, none of which have actually been unquestionably shown. These causal theories include biological, psychological, social and spiritual descriptions. Research shows the likelihood of at least some genetic predisposition to unipolar and bipolar depression, as well as psychotic conditions such as schizophrenia and schizoaffective condition. However biological predisposition is not causation Other (in some cases unrecognized) drivers are required: loss, tension, seclusion, injury, meaninglessness, aggravation, drug abuse, and chronically repressed rage can be, and regularly are, significant if not main contributing consider these conditions.
The recently discovered evidence that brain scans reveal a substantial signature for bipolar illness, cited by Dr. Lawlis in his recent post, is yet another phenomenon which, like biochemical theories, begs the traditional concern of chicken or egg: Could biochemical imbalances or aberrant blood flow patterns in the brain be extra symptoms rather than reasons for depression? Physiological manifestations of underlying psychological conditions? Once again, as every scientist knows, connection is not always causation.
But whatever the basic cause of anxiety, clinicians owe it to clients to supply the most aggressive and effective treatment methods presently available. Making use of psychopharmacology in treating severe depression, despite its drawbacks, has actually been revolutionary and life-saving. Antidepressants and mood stabilizing drugs do something that psychiatric therapy can not: they provide relatively rapid relief of the painful and incapacitating symptoms of depression and stabilize otherwise precariously labile state of mind swings. Does this prove that depression is mainly a biological disease? Not. It just shows that we have actually luckily discovered biochemical means to counteract and manage the most acute symptoms of anxiety: sleep and cravings disruption, lack of motivation, apathy, depressed or manic moods, stress and anxiety, suicidality, etc. As Dr. Kramer acknowledges in his recent post, even when the signs of depression are reduced by medication, the underlying depressive condition seemingly stays, rendering even medicated clients vulnerable to future episodes. More than half of those suffering a first major depressive episode are most likely to experience subsequent episodes at some time. The possibility of reoccurrence increases drastically (90%) after 3 such episodes. What is this underlying susceptibility? It appears to suggest the existence of something biochemical treatment doesn’t deal with. What is this latently continuing vulnerability? It is the depressive core of the personality It is the figurative heart of the Hydra.
Some mental illness, consisting of anxiety, can be compared to the legendary Hydra: an enormous mythological beast with nine snake-like heads, each exhaling a deadly poison. Numerous clients experience myriad symptoms– e.g., anxiety, anxiety, chronic discomfort, irritable bowel, sleeping disorders, tiredness, headaches, panic attacks, etc.– which, after presumably being pharmacologically beat, return with a vengeance. The Greek hero Hercules had to do battle with the fatal Hydra. Drawing it from its lair, he started lopping off the Hydra’s serpentine heads. However no sooner had he done so, 2 more appeared in their location. Moreover, the ugly Hydra had one head which was never-ceasing and unbreakable. How did Hercules lastly defeat the fatal Hydra? Hercules cauterized the decapitation points out with fire to avoid more heads from regrowing. He buried the never-ceasing head of the Hydra under a huge stone in order to render it harmless. Because this head was immortal, the Hydra might never be entirely ruined. Just attenuated and subdued.Major depression is a little like the Hydra. You can attempt pharmaceutically (or perhaps use electroconvulsive treatment in cases unresponsive to medications) to exterminate its symptoms, but they tend to return. Can significant depression be beat? Not without getting to the heart of the Hydra. Depression’s roots are, from my own medical observations, more frequently generally psychological than biochemical– though one plainly impacts the other. Typically at the very heart of depression is repressed hatred, anger, rage, resentment. Desertion. Betrayal. Frustration. Unsettled grief Meaninglessness. Nihilism. Loss of faith Without strongly attacking this psychological, spiritual and emotional core or heart of anxiety, it can not be permanently dispatched. Only temporarily reduced. Which is why pharmaceutical treatment of significant anxiety by itself, while invaluable, is no replacement for genuine psychiatric therapy integrated with psychopharmacology. Such an ongoing two-pronged attack on the Hydra of anxiety prevents or alleviates significant problems, and can keep the dreaded Hydra in check. While the patient might always be biogenetically and/or psychologically predisposed to another depressive episode in the future, such psychotherapeutic treatment can empower the client to nip such dips in the bud, in result beating the Hydra.
Can anxiety be cured? Should it be dealt with like any other illness? I think that depends. Some types of mild to moderate and even extreme depression are clearly situational actions to stress, trauma, loss and other life occasions. These so-called change disorders and even significant depressive episodes can be entirely recovered from in most cases with appropriate treatment, particularly psychiatric therapy. Chronic and profound depression such as dysthymia, recurrent significant depressive condition, cyclothymic and bipolar illness( link is external) are more Hydra-like, requiring extensive treatment over prolonged time periods. Even in these apparently relatively intractable conditions, penetrating to the heart of the Hydra with psychiatric therapy integrated with pharmacology can lower both the seriousness and frequency of depressive and/or hypomanic or manic episodes. By psychotherapeutically enhancing the individual’s inter-episodic standard, the frequency and intensity of future episodes can be decreased. Whereas utilizing just medications to fend off this Hydra tends to require increasing dosages and multiple types of drugs to keep it docile, psychotherapy of the sort I recommend in my book( link is external) can in fact decrease dependence on psychotropic medication, as the meaning of the anxiety and its psychological sources are therapeutically rooted out.
Thus, I submit that depression is not an illness that needs to be dealt with in the same way as say, diabetes (which itself is understood in most cases to be stress-related). It is a biopsychosocial syndrome needing far more than pharmacological intervention. The unfortunate reality that the majority of modern psychotherapy– consisting of CBT— stops working to permeate to the heart of the Hydra in significant unipolar and bipolar depression highlights the desperate need for more effective psychotherapy instead of proving a biological cause for these disastrous conditions.