Sometimes you might hear a person talking about mental disorders like depression or bipolar disorder without really understanding what they mean. What is depression? What is bipolar disorder? Why do we refer to these things as mental health issues or mental disorders rather than a medical disease? And does it matter what we call a thing?
Depression is a Mental Disorder, not a Disease
While psychiatric medications and their resulting television commercials in the 1990’s and this decade have done much to help people seek treatment for a mental disorder like depression, they haven’t done much to help people understand the complexities of things like “depression” and “bipolar disorder.” These things are called disorders, not diseases, for a reason. A disorder simply means something that is out of the ordinary, which depression and other mental disorders are. They are more specifically a cluster of symptoms that research has shown to correlate highly with a specific emotional state.
A medical disease, on the other hand, according to Webster’s, is
a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms
Diseases are manifestations of a problem with some physical organ or component within the body. And while the brain is also an organ, it is one of the least understood and easily the most complex organ within the body. Researchers and doctors refer to a diseased organ when something is clearly wrong with it (via a CAT scan or X-ray or laboratory test). But with our brains, we have no test to say, “Hey, there’s something clearly wrong here!”
One could make the argument, as many have, that because brain scans show abnormalities in certain biochemical levels within the brain when they suffer from depression or the like, this “proves” that depression is a disease. Unfortunately, research hasn’t gotten quite that far yet. The brain scans show us something, that much is true. But whether the scans show the cause or the result of depression has yet to be determined. And more tellingly, there is a body of research that shows similar changes in brain neurochemistry when people are doing all sorts of activities (such as reading, playing a video game, etc.).
The Bio-Psycho-Social Model of Mental Disorders
While brain biochemistry and genetic makeup are important components of most people’s battle with a mental disorder, there are two other equally important components that are all too often left out of the picture – the psychological and the social. The most commonly accepted model of mental illness today takes these three components into account – the biopsychosocial model. This is the model most mental health professionals who practice subscribe to.
The Bio-Psycho-Social Model Continued…
The first component of the model is biology, which includes acknowledging both the biochemistry makeup of the brain, as well as its inherited genes. While gene research hasn’t resulted in any treatments to-date, influencing the neurochemistry of the brain has been the cornerstone of modern psychiatric medications. When properly prescribed by a knowledgeable mental health professional – such as a psychiatrist – these medications are often an important treatment component for many mental disorders, such as depression, bipolar disorder and schizophrenia.
The second component of the model is psychological, which includes things like a person’s personality and how they were raised to deal with stress and their emotions. This component is often just as important as medications, because while medications are great at helping a person out with symptoms of a disorder, they don’t address our own personal coping skills or ways we handle stress. While there may be no single incident that brings about a depressive episode, for instance, a lot of “minor” issues could easily come together to cause depression. Things like psychotherapy help people understand how to enhance their existing coping skills and learn better ways to express emotions.
The third and final component of the model is social, which includes things like our relationships with a significant other, our friends, and even our co-workers. We learn how to socially interact with others as we grow up, through interactions with our friends and family. Sometimes our ways of interacting and communicating with others isn’t clear, leading to problems in life, and in the worst case, social isolation. Again, psychotherapy is a treatment method that helps a person learn to understand how they interact with others, and then find ways to help the person become more successful in those interactions.
Why Does It Matter What Depression is Called?
What we call something is important because people tend to put as much effort into changing something as they’re told it needs. If a person is told that it’s a brain chemical problem, they’ll more easily and readily believe it when the physician says, “Here, take this pill and that should make things better.” And this is exactly what millions of Americans do every year, to devastating effect – most of them don’t feel any better.
If, however, people understand that mental disorders like bipolar disorder, anxiety, panic attacks, and such are complex, biopsychosocial problems, they will be more likely to approach the treatment of these problems more seriously and with greater effort. Psychiatric medications are often an important component of treatment of many disorders, but in most cases, they are not enough. To simply be prescribed an antidepressant or anti-anxiety medication without additional treatment options, such as psychotherapy, is to be getting one-third to one-half of the acceptable treatment for these disorders.
If changing a mental disorder were as simple as taking a psychiatric medication, the practice of psychotherapy would already be out of business (and large government research studies such as the STAR*D trial would show similar results). The research, however, shows that these are complex disorders that usually have no single cause and therefore also have no single treatment.
Understanding this complexity before you seek treatment will help you when your psychiatrist wants to try a number of different medications to see which one works best for you, or when the doctor recommends psychotherapy in addition to medication for treatment. This is to help you feel better, sooner, reducing your time in pain or confusion.