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Rethinking Depression
by Eric Maisel


When you make every unwanted experience a piece of pathology, it becomes possible to knit together disorders that have the look but not the reality of medical illness


I think we can agree that most people are made anxious by public speaking. Aren't you therefore "normal" if public speaking makes you anxious? And aren't you "abnormal" if you're able to give a speech without breaking a sweat? Since that's the case, why would we consider feeling anxious before giving a speech a symptom of a mental disorder ("generalized anxiety disorder")? Have we stepped into Wonderland, where common reactions, such as feeling anxious, are considered abnormal, and uncommon reactions, such as not feeling anxious, are considered normal?
  
Our anxiety in these situations is common, understandable, and normal. If it is common, understandable, and normal, how can it also be used as evidence of a mental disorder? Just by virtue of the anxiety being unwanted. That is the key: Unwanted ≠ abnormal.
  
As soon as you employ the interesting linguistic tactic of calling every unwanted aspect of life abnormal, you are on the road to pathologizing everyday life. When you make every unwanted experience a piece of pathology, it becomes possible to knit together disorders that have the look but not the reality of medical illness. This is what has happened in our "medicalize everything" culture.
  
Mel Schwartz wrote in his blog for Psychology Today:
I would offer that what would otherwise be a normal experience of the ups and downs of being human are now viewed through the prism of dysfunction. Every challenge and travail has a diagnostic label affixed to it and we become a nation of victims-both to the malaise and [to] the pathologizing of what it means to be human.
  
It is a grave mistake to make every unwanted aspect of life the symptom of a mental disorder. A heart attack may come with symptoms such as chest tightness and shortness of breath. These symptoms occur because an artery is blocked, a valve is failing, and so on. In the case of a heart attack, there is a genuine relationship between an organic malfunction and the symptoms of that malfunctioning. Unhappiness too may come with certain "symptoms," such as sleeping a lot and eating a lot. But these symptoms are not evidence of organic malfunctioning. They are what come with unhappiness.
  
For thousands of years human beings have made the sensible distinction between feeling sad for certain reasons (say, because they were jobless and homeless) and feeling sad for "no reason," a state traditionally called melancholia. Some people got sad occasionally, and some were chronically melancholic. Today both varieties of unhappiness, the occasional and the chronic, have been gobbled up by the mental health industry and turned into disorders.
  
With the rise of four powerful constituencies-the pharmaceutical industry, the psychotherapy industry, the social work industry, and the pastoral industry-and their handmaidens (advertising, the media, and the political establishment) it has become increasingly difficult for people to consider that unhappiness might be a normal reaction to unpleasant facts and circumstances. Cultural forces have transformed almost all sadness into the mental disorder of depression.
  
In fact, the word depression has virtually replaced unhappiness in our internal vocabularies. We feel sad but we call ourselves depressed. Having unconsciously made this linguistic switch, when we look for help we naturally turn to a "depression expert." We look to a pill, a therapist, a social worker, or a pastoral counselor-even if we're sad because we're having trouble paying the bills, because our career is not taking off, or because our relationship is on the skids. That is, even if our sadness is rooted in our circumstances, social forces cause us to name that sadness "depression" and to look for "help with our depression." We are seduced by the medical model, in which psychiatrists dispense pills and psychotherapists dispense talk. It is very hard for the average person, who suffers and feels pain because she is a human being but who has been trained to call her unhappiness depression, to see through this manipulation.
  
Tens of millions of people are tricked into renaming their unhappiness depression. Charles Barber elaborated in Comfortably Numb:
"In 2002, 16 percent of the citizens of Winterset [Iowa] were taking antidepressants....What is compelling one in six of these generally prosperous and stable citizens to go to their doctor, get a prescription, and go to the...pharmacy? And Winterset is by no means alone...for Ames it is 17.5 percent; for Grinnell, 16 percent; Des Moines, 16 percent; Cedar Rapids, 16 percent; and Anamosa, Red Oak, and Perry, 15 percent."

Isn't that something? Not the fact that so many people feel unhappy-the number of people who are unhappy is huge. What is quite astounding is that folks in the heartland, where stoicism and common sense are legendary, should have swallowed whole hog the idea that unhappiness is a medical condition.
  
The first linguistic ploy is to substitute the word abnormal for unwanted. Next, since it is almost certain that profound unhappiness will make it harder for you to get your work done and deal with your ordinary responsibilities, one way to ensure that your unhappiness will be labeled "depression" is to name as a significant diagnostic criterion an "impairment of function." Maybe you're unhappy with your unsatisfying job and you start skipping work. That is certainly not a symptom of a mental disorder unless we make it one-which we can do by calling it "impairment of function."
  
Let's say that you're a mystery writer. You've written three mysteries and managed to sell them. But they haven't sold well enough to justify your publisher's buying a fourth mystery from you. Your literary agent is certain that no other publisher will buy that fourth mystery, either. You get that news right in the middle of writing mystery number four. What happens? You grow seriously unhappy and you stop writing your fourth novel. Why bother? The thought passes through your mind: Why bother to live? Suddenly you have no chance of ever escaping your day job. You somehow manage to go to your day job, but you find yourself working listlessly and carelessly. Nothing amuses you. Nothing interests you. You begin to chain-eat Twinkies.
  
In this contemporary culture of ours, you are almost certain to call yourself depressed. The instant you do so, you reduce your chances of effectively handling your painful situation. Having called yourself depressed, you'll probably take yourself to a mental health provider to whom you'll explain your situation. You'll say, reasonably enough, that you're sleeping too much, eating too many Twinkies, not writing your novel, and performing carelessly at your day job. The first two, by virtue of being unwanted, become "symptoms of a mental disorder"; the second two become evidence of "impairment in functioning." You are diagnosed with depression-which, of course, is exactly what you expected to hear. Any other outcome would have been very surprising!
  
The American Psychiatric Association defines mental disorder as "a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom." This definition is specious. Critics of the mental health industry have pointed out time and again that virtually anything unpleasant meets these pointedly empty criteria.
  
In The Myth of Biological Depression, Lawrence Stevens discussed the relationship between cause and effect:
"Even if it was shown that 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 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. Other research will probably confirm it is emotions that cause biological changes in the brain rather than biological changes in the brain causing emotions."
  
Define the disorder broadly. Say that anything might cause it. Provide no tests. Mislead about cause and effect. Now comes the clincher: create a laundry list of symptoms that anyone who can read can use to diagnose the disorder. This is a crucial step because without this laundry list in hand the mental health provider would have no way to turn a new client's self-report of unhappiness into the mental disorder of depression. This checklist, created by industry professionals sitting around a table, is gold.
  
In Before Prozac, Edward Shorter wrote:
"Many of the diagnoses of mood disorder today really don't make a lot of sense...Medicine is supposed to make progress, to go forward in scientific terms so that each successive generation knows more and does better than previous generations. This hasn't occurred by and large in psychiatry, at least not in the diagnosis and treatment of depression and anxiety, where knowledge has probably been subtracted rather than added."  
  
Knowledge has been subtracted for the sake of a profit. The game is very easy to play. If we were in a position of power and influence within the mental health industry, we would have absolutely no trouble creating innumerable mental disorders and foisting them on an unsuspecting-and all too willing-public.

Reprinted with permission from Rethinking Depression 2012 by Eric Maisel, published by New World Library in Novato, CA. Available in stores or visit www.newworldlibrary.com


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