Deconstructing Depression

The intention of this essay is to articulate my reasons for rejecting depression as a medical condition. I believe that Major Depressive Disorder is a fundamentally specious and aporetic concept; and that it’s usage has led to bewilderment for researchers and tragedy for patients. This is a difficult argument to make, but not because the repudiation of depression is difficult in and of itself. Once you frame the problem correctly, it is straight-forward. Rather, the argument is difficult make heard. Our cultural’s understanding of activism has degenerated into a stale singularity in which all social problems are contorted into the framework of “marginalization”. As such, we see the discourse surrounding madness, a long and storied philosophical domain, bastardized into the notion of “mental health advocacy”. In this myopic framework, the only problem surrounding madness (which is unquestioning assumed to be a “disease”) is a lack of external help. These poor “mentally-ill” need medical resources and a callous society is refusing to provide them. As implied by such a framework, the only conceivable form of activism is the provisioning of resources. “We are going to get you the help that you need!” This is the context in which depression is presented as a medical diagnosis. The medical diagnosis legitimizes the suffering that the patient experiences and as such demands the provisioning of resources. We do not think to give accomodations to someone who is sad; but now that the sad person is conceived of as “ill”, he will be provided aid (time off of work, disabilty compensation, therapy sessions etc). Already, we see this ostensible “diagnosis” operating more as a bureaucratic function than a disease (depression, as presented, is closer to a FOIA request than it is to diabetes; it is a quasi “document” which is used to interface with bureaucratic apparati).

Therefore, we see the diagnosis of a depresion itself as a kind of advocacy. Depression is diagnosed, so as to legitimize suffering and provide ostensibly necessary resources. As such, when someone like myself makes the argument that depression is medically fallacious, many advocates immediately assume that I am attempting to delegitimize suffering. They crudely and immediately assume that I must not care about the people who have been diagnosed with depression. They assume that I think the suffers are just overreacting or perhaps are just lazy. This is barrier which prevents American society from hearing people like Szasz or Foucault. When they come across a title like “The Myth of Mental Illness”, they automatically assume that the author is just being a jerk and ignore the book before trying to understanding the argument it makes. Allow me to label this problem “apocryphal opposition”. What I mean by this term is that, the mental health advocates assume incorrectly that their opposition is making a particular argument. They then rebuke that argument and move on without addressing or even acknowledging that actual argument made by their opposition. Such is a frustration of modern antipsychiatry.

No, I do not think the suffers are weak. No, I do not think they are lazy. I think they are dangerously misinterpreted. I think labeling these people “clinically depressed” misleads them into believing a medical falsehood. This falsehood pushes them towards ingesting useless and often neurotoxic substances, which they are further mislead to believe are “medications”. Moreover, it disempowers the mad into a capitulation to the psychiatric system - particularly on a bizarre dependency to a clinician (Foucault calls this the “doctor-patient couple”) - and a general learned helplessness. As such, my intention in repudiating “depression” is solely for the sake of the mad (of which I myself am included). The concept of “depression” snares the sufferer into a false paradigm, pathologizes private intuition he discovers about his suffering, and damns him to a life of pseudo-illness. There’s an old buddhist saying that which states that, when the enlightened man is shot by an arrow, he simply suffers the arrow; but when the unenlightened man is shot by an arrow, it is as if his mind pulls out a bow an shots him with a second arrow. In a similar sense, the mad in our culture all suffer a doubled-madness. They suffer madness which naturally afflicts them. And then they suffer the madness which is inflicted by psychiatry’s nonsense. This second madness is usually more severe.

Allow me to continue with this buddhist analogy. An important component of the Zen tradition form of poetry known as the “koan”. This enigmatic parable depicts a bizarre and surrealist scene in order to breakdown, and perhaps see beyond, conventional thinking. In a similar sense, I believe that entire concept of “Major Depressive Disorder” can be refuted by a single question: “Is depression a disease or a symptom?”

People are diagnosed with “depression” because they experience chronic sadness; but is the sadness itself “depression”? Or is the sadness a symptom of “depression”? When a man discloses that he has been struggling with “depression”, there are actual two quite different things he could mean. One, is that he has been experiencing chronic sadness. The other is that has a medical condition which causes chronic sadness.

One would assume that differentiating between these two possibilities would be of the utmost importance for a medical provider. Treatment would assumedly be quite different depending upon which interpretation is correct (in fact, the first option is unlikely to need “treatment” at all). One would assume that the psychiatrist would perform some kind of neurological testing to identify the presence any nature of a potential brain does; but he doesn’t. No investigation is taken; No tests are run. Moreover, the distinction between sadness and a sadness-provoking disease is not even acknowledged.

I believe that psychiatrists fail to investigate this distiction not because of the ineptitude of any particular providers, but because psychiatry, as a field of medicine, as paradigmatically overlooked the distinction. The truth is that psychiatry has not realized the internal contradiction inside it’s own nosology. Psychiatry therefore proceeds to haphazard blur the definition of depression. Sometimes depression means chronic sadness, other times it means a neurological disorder which causes chronic sadness. And at yet other times, it means some awkward mixture of the two.

We see this concept of “depression” fall apart further when it is used in medical discourse. Psychiatrists casually say “insomnia is a symptom of depression” as if this is a coherent medical statement. But what does this actually mean? If we take depression to simply mean chronic sadness, then the sentence translates to “being sad for a long period of time can interfere with your sleep”. If we interpret “depression” to denote a neurological disorder, then the sentence means “the neurological disorder that makes you chronically sad also interferes with your sleep”. The question that arises here is one of causation. Does the chronic sadness cause the insomnia, or does the neurological disorder (which itself causes chronic sadness) cause the insomnia? But even here, there are further interpretations. If insomnia is caused by chronic sadness, where is “depression”? Is “depression” the chronic sadness? Or is “depression” the insomnia (and other health issues like loss of apetite and libido) that are caused by chronic sadness? On the other hand, if depression is a neurological disorder - which itself causes chronic sadness - does this disorder also causes insomnia as an additional symptom? Or is that case the neurological disorder causes insomnia, and that insomnia makes the patient chronicly sad?

Let us now pause and clarify this line of inquiry. I have demonstrated that that “depression” can actually mean at least four differnt things:

1. Chronic sadness

2. A neurological disorder which causes chronic sadness

3. The secondary effects (insomnia, loss of apetite etc) that are caused by chronic sadness

4. A neurological disorder which causes uncomfortable symptoms (insomnia, loss of apetite etc) which in turn causes the patient to feel chronically sad

It is humorous to continue this process and come up with exotic definitions of “depression”. For example, one could derive depression as “a neurological disorder which causes insomnia which itself damages the brain and creates a second neurological disorder which causes erectile dysfunction which is distressing to the patient so he becomes chronically sad”. But these estoreic nosologies are not the point of this essay. The point of this essay is to show that the term “depression” has no fixed meaning in psychiatric practic. Psychiatrists haven’t thought through the implications of what they are actually saying when they use the term. And they use it in different ways at different times. This is why “depression” is an illegitimate medical diagnosis. It is not illegitimate because patient suffering is unimportant. It is illegimate because it’s meaning is incoherent. “Depression” bundles together a wide scope of human suffering - some portion of which is probaly biological, some portion psychosocial, some other partion contains various mixtures - and stamped it under one singular label. Then, to further obfuscate the situation, psychiatry speaks as if this opaque basket of a label is a coherent medical disorder - in the same sense that diabetes is a coherent medical disorder.

From the incoherence of “depression”, we can quite easily derive the incoherence of “antidepressants.” Antibiotics of have a coherent meaning. They kill (hence “anti”) bacteria (hence “biotics”). Before even getting into the discussion of what antidepressants truly do (they are neurotoxic placebos), we might first ask the question of what they are even intended to do. What does “anti” mean in this context? And what is referenced by “depressant”? Are antidepressants intended to eliminate chronic sadness in general? In this sense, it seems we would have to conclude that alcohol and cocaine are antidepressants because they reliably reduce sadness. On the other hand, perhaps antidepressants are intended to cure a neurological disorder which sometimes is the cause of chronic sadness? In this sense, we would have to concede L-DOPA, the treatment for Parkinson’s, is an antidepressant. And what of the so-called secondary symptoms of “depression”? Are antidepressants intended to cure insomnia? Is ambien an antidepressant? Moreover, from the vaguery of these definitions, it seems that any treatment for any disease (so long as tjat disease causes the patient chronic sadness) would to be considered an antidepressant. For example, if I get pneumonia, and am chronically sad about having pneumonia, then I take an antibiotic which cures the pneunomia meaning I am no longer chronically sad, must we then consider the antibiotic to also be an “antidepressant”?

We have now broadened the incoherence from psychiatric diagnosis to psychiatric treatments. Psychiatrists don’t actually know what they are treating and they don’t actually know how they are treating it. From here, it is only a small step to recognize that psychiatry itself is incoherent.

Let me elaborate on this point. At the end of his life, Nietzche notoriously went “mad” developing bizarre delusions and regressing into a non-verbal state. There is a theory that this condition was the result of neurological damage from an underlying syphilis infection. This theory might not actually be true, but let us entertain it for sake of argument. Let me now offer another antipsychiatry koan: “At the end of his life, was Nietzche ‘mentally-ill’?”

Of course, he was! He was acting crazy and had a brain problem. Of course, he was not! He had an illness similar to Parkinson’s - that’s not being crazy!

Oh, wait.

Do you see the internal contradiction? If you argue that Nietzche was mentally-ill, then you concede that any neurological disorder ought to be considered a mental-illness. If you instead argue that Nietzche was not mentally-ill, then you concede that neurological disorders, once medically understood, are not mental-illnesses. What then is mental-illness? How does it differ from non-psychiatric neurological disorders? The truth is that the concept of mental-illness is incoherent. In it’s usage, mental-illness pretty much just means that someone is acting weird and we don’t have a good explanation for why he is acting weird. Once we have a geniune medical explanation for someone’s weird behavior, it is no longer called “mental-illness” but instead “neurological disorder”. Therefore, as neuroscience advances, and we have more legitimate neurological explanations for behavior, we will see less and less “mental-illness” - not because human behavior is getting any less bizarre but because we now can diagnosis this bizarre behavior with precise biological etiology; and we do not need to resort to the witchcraft language of psychiatry. We can now see the fundamental paradox which underlies and characterizes psychiatric practice. Psychiatry is field of medicine, but a problem is only considered psychiatric if it is bereft of any medical explanation. Neil deGrasse Tyson once criticized religion, in the age of scientific advancement, saying “God is an ever-receding bubble of scientific ignorance.” In a quite similar sense we could say “Psychiatry is an ever-receding bubble of neuroscientific ignorance”.