I plead guilty to expounding on the biochemical vulnerabilities and abnormalities in neural wiring of depression to make the case that it is a legitimate illness alongside lupus, breast cancer, or psoriatic arthritis. I thought I was doing a good thing by quoting experts like Peter Kramer, M.D, who believes that because depression can be associated with the loss of volume in parts of the brain, it is the “most devastating disease known to mankind.”
My intention, like so many other mental health advocates I know, was to use science as a tool to lessen stigma. But is that really effective?
Proof of the Madness
I am relieved by clinical reports that explain why my efforts at cognitive-behavioral therapy aren’t enough to correct certain behaviors or thoughts — that brain imaging reveals the breakdown in normal patterns of processing that impedes the ability of depressed people to suppress negative emotional states and that high levels of activity in the amygdala part of the brain (the fear center) persist despite efforts to retrain thoughts. I would rather know that depression involves a problem in the wiring pattern of my brain than to know I simply wasn’t trying hard enough.
I get excited about the progress of finding genomic biomarkers for different types of mood disorders and about twin studies that show if one twin developed depression, the other twin also suffered from depression in 46 percent of identical twins. I am delighted that experts have found a common genetic mutation associated with a person developing clinical depression when faced with traumatic events in his or her life because it means that I’m not making this stuff up, that genetic variations exist that increase a person’s vulnerability to depression and other mood disorders.
No illness, please.
But apparently, people want their distance from those with illnesses or defined diseases. According to some research, concentrating on the biological nature of mood disorders can actually worsen stigma.
In his article, “Hyping biological nature of mental illness worsens stigma,” Patrick Hahn cites several studies that have shown public attitudes toward those who suffer from mental illness have worsened with the promotion of bio-genetic theories. One was a German study that found that between 1990 and 2001, the number of respondents who attributed schizophrenia to hereditary factors increased from 41 to 60 percent. In the same report, an increased number of respondents said they didn’t want to share a building, job, or neighborhood with a schizophrenic.
In the U.S. the General Social Surveys of 1996 and 2006 say pretty much the same. As the neurobiological explanation of mental illness gained approval, there was an increase in the number of people who didn’t want to be closely associated with someone with a mental illness, not as a co-worker, neighbor, friend, or in-law.
Extreme versus Sick
Hahn explains the two ways of looking at mental illnesses:
We could regard them as more extreme versions of the despondency, fear, wrath, or confusion that we all experience, as perfectly understandable reactions to overwhelming abuse and trauma. Or we could regard them as brain diseases, probably genetic in origin, requiring the sufferer to take powerful mind-altering drugs, quite likely for the rest of her life.
One approach emphasizes our common humanity, and the other seems to regard the sufferer as a mere biological specimen. One approach invites us the consider the societal and economic factors that lead individuals to feel despondent, fearful, wrathful, or confused, and to think about ways of changing them, while the other seems to regard society as basically sound, but unfortunately plagued by those individuals with faulty genes or guilty brains who can’t fit in.
I see room for both perspectives. While I regard some of my symptoms as exaggerations of the human condition — allowing me to explore the societal and psychological causes — I also recognize when my despair falls into the category of illness, an assessment that offers me a kind of relief — to know that my brain scans look different than the average Joe’s, and that there is a reason therapy and meditation and all my other efforts can’t fix it.
Embracing All Illness
Mood disorders are thorny and different from other biological illnesses in that some of their symptoms can be experienced by persons who are not diagnosed with them and their symptoms can overlap with a variety of conditions. For example, a person without major depressive disorder can feel lethargic, sad, and irritable.
But I’m not going to let the complicated nature of depression stop me from promoting research about biomarkers or genetic studies. I firmly believe that depression and all mood disorders need to be understood in their biological context. In my perspective, if the stigma increases with the acceptance of the bio-genetic model, then we need to work harder at embracing everyone who is ill, whether they have cancer, lupus, or depression.