Rethinking Depression

How to Shed Mental Health Labels and Create Personal Meaning

Eric Maisel

• Publisher: New World Library
• Year: 2011
• ISBN:
  9781608680214
• Topic: Desarrollo personal
• Subtopic: Salud mental y bienestar

In this provocative and pathbreaking distillation of a career spent working with individuals seeking help with mood and motivation, Eric Maisel reveals the implications of one of the most dramatic cultural shifts of our time. In recent decades, much of the unhappiness inherent in the human condition has been monetized and labeled as the disease of depression and related "disorders." Maisel persuasively critiques this sickness model and prescribes a potent new therapy. The existential cognitive-behavioral therapy (ECBT) he details here marries the proven methods of CBT with the powerful meaning-based orientation of existential therapy. The result is a revolutionary reimagining of life's difficulties and a liberating model of self-care that optimizes the innate human ability to create meaning and seize opportunity — in any circumstance.

PART ONE

RETHINKING DEPRESSION

CHAPTER 1

CREATING MENTAL DISORDERS

I THINK WE CAN AGREE that most people are made anxious by public speaking. Aren’t you therefore “normal” if public speaking makes you anxious? And aren’t you “abnormal” if you’re able to give a speech without breaking a sweat? Since that’s the case, why would we consider feeling anxious before giving a speech a symptom of a mental disorder (“generalized anxiety disorder”)? Have we stepped into Wonderland, where common reactions, such as feeling anxious, are considered abnormal, and uncommon reactions, such as not feeling anxious, are considered normal?

Our anxiety in these situations is common, understandable, and normal. If it is common, understandable, and normal, how can it also be used as evidence of a mental disorder?

Just by virtue of the anxiety being unwanted.

That is the key.

Unwanted ≠ abnormal.

As soon as you employ the interesting linguistic tactic of calling every unwanted aspect of life abnormal, you are on the road to pathologizing everyday life. When you make every unwanted experience a piece of pathology, it becomes possible to knit together disorders that have the look but not the reality of medical illness. This is what has happened in our “medicalize everything” culture.

Mel Schwartz wrote in his blog for Psychology Today: “I would offer that what would otherwise be a normal experience of the ups and downs of being human are now viewed through the prism of dysfunction. Every challenge and travail has a diagnostic label affixed to it and we become a nation of victims — both to the malaise and [to] the pathologizing of what it means to be human.”

It is a grave mistake to make every unwanted aspect of life the symptom of a mental disorder.

A heart attack may come with symptoms such as chest tightness and shortness of breath. These symptoms occur because an artery is blocked, a valve is failing, and so on. In the case of a heart attack, there is a genuine relationship between an organic malfunction and the symptoms of that malfunctioning. Unhappiness too may come with certain “symptoms,” such as sleeping a lot and eating a lot. But these symptoms are not evidence of organic malfunctioning. They are what come with unhappiness.

For thousands of years human beings have made the sensible distinction between feeling sad for certain reasons (say, because they were jobless and homeless) and feeling sad for “no reason,” a state traditionally called melancholia. Some people got sad occasionally, and some were chronically melancholic. Today both varieties of unhappiness, the occasional and the chronic, have been gobbled up by the mental health industry and turned into disorders.

With the rise of four powerful constituencies — the pharmaceutical industry, the psychotherapy industry, the social work industry, and the pastoral industry — and their handmaidens — advertising, the media, and the political establishment — it has become increasingly difficult for people to consider that unhappiness might be a normal reaction to unpleasant facts and circumstances. Cultural forces have transformed almost all sadness into the mental disorder of depression.

In fact, the word depression has virtually replaced unhappiness in our internal vocabularies. We feel sad but we call ourselves depressed. Having unconsciously made this linguistic switch, when we look for help we naturally turn to a “depression expert.” We look to a pill, a therapist, a social worker, or a pastoral counselor — even if we’re sad because we’re having trouble paying the bills, because our career is not taking off, or because our relationship is on the skids.

That is, even if our sadness is rooted in our circumstances, social forces cause us to name that sadness “depression” and to look for “help with our depression.” We are seduced by the medical model, in which psychiatrists dispense pills and psychotherapists dispense talk. It is very hard for the average person, who suffers and feels pain because she is a human being but who has been trained to call her unhappiness depression, to see through this manipulation.

Tens of millions of people are tricked into renaming their unhappiness depression. Charles Barber elaborated in Comfortably Numb: “In 2002, 16 percent of the citizens of Winterset [Iowa] were taking antidepressants.…What is compelling one in six of these generally prosperous and stable citizens to go to their doctor, get a prescription, and go to the…pharmacy? And Winterset is by no means alone…for Ames it is 17.5 percent; for Grinnell, 16 percent; Des Moines, 16 percent; Cedar Rapids, 16 percent; and Anamosa, Red Oak, and Perry, 15 percent.”

Isn’t that something? Not the fact that so many people feel unhappy — the number of people who are unhappy is huge. What is quite astounding is that folks in the heartland, where stoicism and common sense are legendary, should have swallowed whole hog the idea that unhappiness is a medical condition.

The first linguistic ploy is to substitute the word abnormal for unwanted. Next, since it is almost certain that profound unhappiness will make it harder for you to get your work done and deal with your ordinary responsibilities, one way to ensure that your unhappiness will be labeled “depression” is to name as a significant diagnostic criterion an “impairment of function.” Maybe you’re unhappy with your unsatisfying job and you start skipping work. That is certainly not a symptom of a mental disorder unless we make it one — which we can do by calling it “impairment of function.”

Let’s say that you’re a mystery writer. You’ve written three mysteries and managed to sell them. But they haven’t sold well enough to justify your publisher’s buying a fourth mystery from you. Your literary agent is certain that no other publisher will buy that fourth mystery, either. You get that news right in the middle of writing mystery number four. What happens? You grow seriously unhappy and you stop writing your fourth novel. Why bother? The thought passes through your mind: Why bother to live? Suddenly you have no chance of ever escaping your day job. You somehow manage to go to your day job, but you find yourself working listlessly and carelessly. Nothing amuses you. Nothing interests you. You begin to chain-eat Twinkies.

In this contemporary culture of ours, you are almost certain to call yourself depressed. The instant you do so, you reduce your chances of effectively handling your painful situation. Having called yourself depressed, you’ll probably take yourself to a mental health provider to whom you’ll explain your situation. You’ll say, reasonably enough, that you’re sleeping too much, eating too many Twinkies, not writing your novel, and performing carelessly at your day job. The first two, by virtue of being unwanted, become “symptoms of a mental disorder”; the second two become evidence of “impairment in functioning.” You are diagnosed with depression — which, of course, is exactly what you expected to hear. Any other outcome would have been very surprising!

The following transaction occurred: You visited a mental health professional because you were feeling unhappy and because you had already affixed the label “depression” to your state. Having affixed that label, you naturally went in search of someone trained to diagnose and treat depression. What you reported were exactly the sorts of things contrived by the mental health industry to prove that you have a mental disorder. You came in “depressed” and you received the diagnostic label “depression.” Transaction completed.

That there are many things going on in your life that you wish would change or go away does not make them abnormalities. They may even “impair your functioning,” but to use that phrase is to medicalize your situation. These linguistic ploys, which are now fully embraced by millions of Americans and growing millions worldwide, have transformed the human landscape, making countless people sicker and weaker than they otherwise might be.

Creating Mental Disorders

When you define something with a series of ors rather than a series of ands, you do a poorer job of distinguishing among things. If you define a table as an object with a top and four legs, you exclude cattle. But if you define a table as an object with a top or four legs, you include them. Has the thing got four legs? It’s in! If you intend to include a lot of things, perhaps because that makes you more money, it makes sense that you would define those things with a lot of ors.

That is exactly how mental disorders are defined, with a lot of ors. The American Psychiatric Association defines mental disorder as “a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom.”

This definition is specious. Critics of the mental health industry have pointed out time and again that virtually anything unpleasant meets these pointedly empty criteria. If I run too many marathons and hurt my knees, I’ve met the criteria for a mental disorder. (I have a “clinically significant behavioral syndrome with present distress.”) If I feel elated and I treat myself to a climb up a steep mountain, I’ve met the criteria for a mental disorder. (I have a “clinically significant psychological syndrome with a significantly increased risk of suffering death, pain, and disability.”)

You may think that in presenting these absurd examples I’m not keeping to the spirit of the definition. In fact, that is exactly the spirit of the definition, to create such a large tent that virtually anything can qualify — your son’s restlessness in math class, your worry about your dwindling retirement account, your daughter’s unhappiness with her college choice, your sister’s trips to the casino, your brother’s boredom on the weekends. Countless critics of the mental health industry have pointed out that mental disorder is a term used as a professional opportunity and not as a marker of a genuine medical condition.

The first step in creating mental disorders out of ordinary human experiences is to define those ordinary experiences as pathological by using phrases such as “clinically significant behavioral or psychological syndrome.” The second step is to refuse to say what causes the disorder or, alternatively, to assert that just about anything might cause it. If you say that it takes sawing and joining and so forth to create a table, then you’ve excluded cattle from the mix of things called tables. But if you include any four-legged thing and you refuse to distinguish among causes (say, between natural selection and carpentry), your cattle can’t be excluded. If you say that anything with four legs created any which way is a table, a cow is a table.

If you are in the business of creating mental disorders, it is very important to throw up your hands in a kind of ecumenical fervor of allowing and make sure not to say what is causing the mental disorder you’ve created. The mental health industry does this by saying that depression may be caused by any number of things — psychological things, biological things, social things, spiritual things, the weather, hormones, motherhood, genes, childhood, anything. This makes some kind of sense because if what they are talking about is human unhappiness — and it is — then naturally that unhappiness might be caused by anything that makes human beings unhappy. But it makes no sense whatsoever as scientific explanation. Imagine that your physician looked at a tumor growing on your arm, shrugged, and said, “Could be caused by anything” — and took zero interest in ascertaining what was causing it.

This leads to ...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• Contents
• Introduction: The Reality of Unhappiness
• Part One: Rethinking Depression
• Part Two: Your Existential Plan
• Conclusion: Cracking the Depression Code
• Notes
• Bibliography
• Index
• About the Author