Depression is one of the most common psychological problems, affecting nearly everyone at some stage or another throughout their lives. In The Road Less Travelled, Scott Peck suggests that the source of depression is a feeling of giving up something we love and that depression is a normal and healthy part of life unless it becomes prolonged because the giving-up is delayed or stopped (Peck, 1975). But ‘giving up’ what; the beliefs and values that give meaning to our lives and the conflicts that arise out of them? beliefs that have enslaved our values and concealed the knowledge that within the labyrinth of our thinking, there is a choice in how we respond to these conflicts and the depth of our despair will often lie within that choice.
However, the cost in human suffering cannot be estimated. Depression often interferes with normal functioning, and frequently causes problems at work, socially, and within the family. It causes pain and suffering not only to those who experience it, but also to the people around them. Serious depression can destroy family life as well as the life of the depressed person.
Depression has been described as a psychological condition that affects the way one thinks, feels, and behaves as well as a sense of physical well-being. Everyone may feel sad at one time or another throughout their life, or feel stressed out from work or serious problems. This is not considered to be depression because these feelings usually pass in a few days or weeks. However, once these feelings linger, intensify, and begin to interfere with normal, everyday life, it may be depression and can affect anyone. The medical community suggests that once identified, most people with depression are successfully treated. The question becomes by what and how?
The debate between nature and nurture is very common in all aspects of psychology. The medical community, for the most part, is only concerned with the biology of depression and has sought to treat it with a catalogue of toxic drugs, as well as electroshock therapy (ECT). More recently, however, much consideration has been given to the idea that depression may be a thought disorder that is triggered as a result of ones environment, otherwise known as ‘environmental triggers.’ The term ‘environmental triggers’ is quite vague but aims to include everything from ones upbringing to recent traumatic life events and of course details of the clients lifestyle. There is a large amount of evidence identifying the crucial role that the environment plays such that life events can be referred to as ‘triggers’ with the potential to trigger or even initiate depression.
Major depressive disorder is characterised by one or more major depressive episodes with the absence of manic episodes. A major depressive episode is defined by a depressive mood or loss of interest or pleasure in almost all usual activities, accompanied by other depressive symptoms. These include disturbances in appetite, weight, and sleep; psychomotor agitation or retardation; decreased energy; feelings of worthlessness or guilt; difficulty concentrating or thinking; and thoughts of death or suicide (Roth & Fonagy 1996). DSM-IV specifies that at least five of nine specific depressive symptoms must be present nearly every day for at least two weeks to make a diagnosis of major depression, and that the symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (APA, 1994).
To date, Psychiatry has sought to study and treat depression as a mental disorder. Anthony Clare describes this as an evolving model or scientific method of investigation that aims to pin down the essential symptoms of a disorder, determine the causes and formulate a successful treatment (Clare, 1980). However, there are several pitfalls in the study of depression. The National Institute of Mental Health (NIMH) have conducted many studies to ascertain the prevalence of depression, notably, The Epidemiologic Catchment Area Study (ECA) by Robins & Regier, (1991) in which it was estimated that during a six month period, at least 6% of the population received a diagnosis of depression. The prevalence varied by gender and age – major depression was shown to be almost twice as high in women than in men and greater in younger adults, which was attributed to a greater willingness of younger adults to admit to experiencing mental health problems. Trends suggest that rates of depression are increasing and may be accounted for as a consequence of changes in family composition and mobility which may contribute to increased stress and reduced social support (Klerman and Weissman, 1989).
Much attention has been given to the biological perspective of depression and the supposed chemical imbalances that occur in the brain, suggesting that depression is a medical illness without psychological causes. It is proposed that brain images can show the structures of depression. The left prefrontal cortex malfunctions only during bouts of depression, and the amygdala – a small inner brain structure thought to regulate emotional reactions – operates abnormally during and between depressive episodes. This serves as a biological marker of susceptibility to severe depression. A study by Dr. Gregory Miller of Carnegie Mellon University suggests that depression could also be associated with abnormal levels of norepinephrine and estradiol, hormones that are known to help regulate the immune system (Miller, 199). An unhealthy mind can lead directly to an unhealthy body, therefore the old medical tag “treat the patient, not the disease” takes on a new significance.
Thomas Szasz fervently rejects the concept of mental illness and questions the suitability of the medical model in dealing with psychological problems. He argues that mental illness cannot exist because disease or illness can only affect the body (Szasz, 1974). However, his argument is flawed from an existential perspective as it implies a dichotomy of body and mind (Visser 2002). Yet, one cannot ignore the role that psychiatry and the pharmaceutical industry have had in marketing depression as a ‘real disease’ in need of medical treatment. In Toxic Psychiatry, Peter Breggin draws further attention to this in outlining that despite its familiarity with depression as a natural response to living, the public have been bombarded with medical explanations for depression. The media have been filled with claims for the discovery of a gene for manic depression. And, of course, there is the biochemical imbalance theory, a veritable psychiatric gospel (Breggin, 1991).
While there may be some biological factors that occur during the onset and during depressive episodes, to date, the medical community has sought to extract a generic representation of depression which is solely based on the commonalties of symptoms and causes. While this may be helpful for scientific research, it is not helpful in understanding a client’s world. From an existential point of view, a diagnosis may hinder the therapist’s ability to understand the client. Rollo May (May et al, 1958) quotes Binswanger as saying that psychiatrists have paid too much attention to the deviations of their patients instead of focusing on the patients’ private worlds (Visser 2002).
As feelings of depression are common following traumatic experiences, much research has focused on the aetiological significance of adverse life events. Most studies show that individuals with a diagnosis of depression report more life events prior to the onset of depression. The most common of which are ‘exit events,’ such as a relationship break-up, which are related to loss (Lemma, A. 1996). However, many other environmental factors can contribute to the onset of depression and should not be overlooked; particularly the conflicts one might experience in familial and social relationships, increases in social stresses, isolation and economic hardship. These experiences can often become difficult to adjust to and the challenge of renegotiating the environment differently than what is familiar can be overwhelming.
There are many social-environmental issues that may contribute to depression. It is important to remember that even though stresses are more common before the onset of depression, occasionally, this association is not found. The reaction to stress or environmental triggers is very personal and varies greatly. Usually depression results from a combination of physical, psychological, social, cognitive and behavioural difficulties. How one chooses to respond is often a choice that eludes them because of the powerful and prestigious influential profession of psychiatry. Western culture has given up its will to look at the possible reasons why depression exists, if any. Instead, it has invested millions of dollars to try and come up with a ‘quick fix’ to all of life’s difficulties. The new breed of anti-depressants have been hailed in reputable journals such as the British Journal of Psychiatry as the path to happiness. Psychiatry prefers to believe that there is such a thing as mental illness instead of encouraging people to take responsibility for their own lives (Breggin 1991).