Disease Model of Depression Can Limit Treatment

by Lyn Bender
The Age
November 16, 2010

Lyn Bender is a pychologist in private practice and former manager of Lifeline Melbourne and a former director on the board of National Lifeline.

Her voice is monotonic, her face holding one expression, as though older than her years. She tells me that she has been depressed "forever" and on antidepressants for years.  She is having thoughts of wanting to die.  This is our first counselling session.

Characterising depression as like the common cold is a neat, catchy message, which does, however, belie the true complexity of the myriad of feelings, emotions and events that attach to the phenomenon of depression.
 

An increased awareness of the illness has been helped by beyondblue, which this month celebrates its 10th birthday.

The organisation's chairman, Jeff Kennett, is rightly proud of its achievements, which include Australia-wide bipartisan support and increased awareness of the illness. The initiative provides a simple framework — we may all be afflicted by this diagnosable medical condition and there should be no shame attached to seeking treatment.

But has making depression part of common parlance elevated it in seriousness to the point where normal sadness in response to events in one's life is characterised as depression, for which treatment is then sought, usually in the form of a pill?
 

Depression can range from sadness, most often characterised as the "blues", to feeling like one is entombed in a black hole, often called being in the grip of "the black dog".

A medical model of depression identifies a cluster of symptoms.  These include eating and sleep disturbances, social withdrawal, crying, agitation, emotion-numbing relentless fatigue and difficulty in managing everyday living.

Also, more seriously, people can experience suicidal thoughts and actions and a high degree of dysfunction to the point of becoming immobilised.  Sufferers may describe themselves as in a fog or a haze or constantly distressed and not seeing any meaning in their life.  They may see themselves as outsiders and disconnected from friends and family, set apart and not like other people who seem "normal" and "happy".

These are all states of mind that deserve attention and compassion.  Yet if we regard the diversity of experience that can be called depression as a narrowly and rigidly defined disease we are ignoring a vast part of the human condition.
 

Even a privileged affluent lifestyle will not provide immunity from the reality of the non-negotiable trio of uncertainty, loss and death.  There is societal inequity particularly in marginalised groups, but none of us get through life unscathed.

One should seek help for sadness and grief and learn to manage intense feelings, as this will prevent entrenching a low mood or depressive states.

Many people I see have suffered from early traumatic loss that is repeated in the pattern of their lives.  There is no justice, as deprivation, trauma and loss in early experience may bring ongoing emotionally disruptive consequences through out life.  The disease model of depression can be useful, but limiting, and discounts the importance of the person's life story.
 

In his book Manufacturing Depression, Gary Greenberg suggests that we may choose to consider biography (our stories) not just biochemistry (serotonin and hormone fluctuations) as a significant way to understand, treat and alleviate depression.  This is valuable advice.
 

There can be pressure under current mental health care to regard depression as a cluster of symptoms that can be "fixed" with medication, simple strategies and six to 18 counselling sessions.  The preferred style is cognitive behavioural, which is frequently presumed in an oversimplified way to change dysfunctional thinking.  The thrust of this is pressure is to get the person back on track to where they were before the crisis, breakdown or catastrophic event.  The emphasis is on functionality rather than meaningfulness.  If there are massive gaps in the person's emotional literacy, skills and integration of early loss and trauma, any improvement is unlikely to hold.
 

Dan Siegel proposes this integration of past experience in his book MindSight as the key to resolution of pain and conflict and lasting, deep change.

Siegel alerts us to the significance of neural pathways and the integration of emotions held in the right hemisphere of the brain with the capacity to consciously reflect on painful experiences in the left hemisphere of the brain.  Both sides of the brain must be in communication so to speak. Siegel uses insight, meditation, body awareness and holistic health regimes.  This also fits with "talk therapy" that encourages the person to examine their life story and comprehend anew experiences for which there may have been no words at the time.
 

Therapy can bring emotional literacy, can help us manage strong feelings, and make new choices. It can provide a resolution of grief that gives deep loss a place in an ongoing life story and future happiness. It can be a pathway between excessive rigidity and emotional chaos.
 

Lyn Bender is a pychologist in private practice and former manager of Lifeline Melbourne and a former director on the board of National Lifeline.

This article can be found on The Age website at: http://www.theage.com.au/opinion/society-and-culture/disease-model-of-depression-can-limit-treatment-20101116-17v9m.html