I was recently reading an article on Medium that argued that to fully treat depression, one must do the inner work to get to the root cause. That didn’t sit particularly well with me, hence this blog post.
I’m of the perspective that mental illness is complex, and the causes are just as complex, so if we get too reductionistic we lose sight of what else could be in the picture.
By reductionistic, I mean simplifying the cause down to 100% attributable to one thing. That could go in a medical/biological direction, or it could go in a situational/trauma direction. I don’t see either as particularly helpful.
I conceptualize the causes of depression on a continuum from fully biological to fully situational. A few people are at either extreme, but a lot of people are somewhere in the middle. I also like the idea of a diathesis-stress model, which looks at the interaction between genetic and psychological factors to produce illness.
Whether it’s saying that everyone only needs meds, or everyone needs to do a psychotherapeutic deep dive to get at their deepest inner wounds, saying that depression only exists a certain way excludes and can even alienate people who don’t experience depression in that particular way.
It makes a lot more sense to me to consider everyone with depression as a unique individual who may have multiple factors contributing to their depression. When those factors are identified, they can be addressed in whatever way seems most helpful for the individual.
Trying to fit people into a particular box is most likely going to end up leaving some people undertreated. Throwing meds at someone whose depression is primarily related to unaddressed trauma is likely to be just as ineffective as having someone whose illness is quite biologically rooted go to psychoanalytic therapy to try to figure out if their depression is because they were sexually attracted to their opposite-sex parent (okay, that’s my anti-Freudian bias jumping in there).
Personally, I think my own illness has a strong biological component. I say that for a few reasons. I have experienced trauma since the onset of my illness, but not before. Sure, there were some difficult things scattered here and there throughout my life, but nothing significant. I was happy, secure in who I was, had a core group of good friends, had a career that I found very meaningful… And then everything fell apart. There was a situational stressor, but certainly nothing so significant that an expected response would be me psychotic and trying to strangle myself while locked in a seclusion room.
My symptoms tend to lean towards melancholic depression, which is thought to be more biologically rooted. I have responded best to biological treatment, particularly ECT. While I may have negative thoughts related to my situation and the effects of my illness, I don’t have self-esteem issues or any sort of obvious lingering psychological disturbance.
Does that mean I think people don’t have depression linked to trauma? Of course not. But I think it’s rather unhelpful when people say depression is always linked to trauma, because I (and many others) just don’t fit in that box.
So let’s throw away the boxes, and recognize people for the complex individuals that they are.