The Mechanics of Depression ― Administering Hope: Placebo and the Magic Potion

R3 Files Podcast ― The Success of Failure

Previously I explained the underlying arguments of the CIT (Chemical Imbalance Theory), in particular the CIT’s claim that neurotransmitter deficiencies within the brain’s bio-chemistry are the primary cause of depression. I also presented a critique of the CIT, which referenced the academic work of controversial scholar, David Healy. According to Healy, the CIT conveniently provided doctors with a simple narrative to explain depression and its treatment to patients, but unfortunately the hypothesis could not predict many effects. Most notably, the time lag for antidepressants to bring about the first signs of change (around two to six weeks) while mono-amine levels in the brain are usually altered within an hour, pointing to clear evidence of a placebo effect.

In this installment, I expand further on Healy’s argument that many of the “side effects” of these medications disproportionately outweigh any purported positive effects provided by the antidepressant. I also examine another fierce critic of the CIT, Irving Kirsch who is widely regarded as one of the world’s leading experts on psychiatric drugs and the placebo effect. He challenges the effectiveness of antidepressants arguing that, they are no more effective than placebos or sugar pills. The placebo effect is a very powerful tool when treating depression because it offers a substitute for hope, given that depression is characterized by a pervasive sense of hopelessness. In addition, Kirsch believes the numerous side effects and prolonged dependency on anti-depressant drugs represents a dishonest approach by health practitioners. That’s because, safer and in some cases more effective treatments such as psychotherapy can and should be promoted. One of the main points advocated by Irving Kirsch is that mental illness may not be an illness at all. Indeed, it may be a perfectly normal reaction to abnormal circumstances.

I also present an ‘Alternative Viewpoint’ known as social constructionism which sheds further light on the diagnosis and etiology of depression. Viewed from this perspective, mental illness is deemed to be a ‘social construct’ because knowledge and meaning are socially constructed concepts within the society or cultures we live in. In particular, I consider the compelling views of Michel Foucault, Thomas Szasz, Mikkel Bork-Jacobsen and Allan V. Horwitz. Proponents such as Horwitz argue that many of our more common disorders have been made “fashionable” by the culture of psychotherapy. One good example of this practice is “social phobia” which has been transformed from a naturally occurring temperament of shyness, into a fully classified mental disorder. Hence many advocates of social constructionism argue that this ‘change of status’ or ‘categorizing’ brings into question, the underlying premise of mental illness as a disease to be cured. Hence, its existence as a valid health phenomenon becomes highly suspect. In fairness though I also emphasize the point, that just because mental illness cannot be defined unequivocally, that in itself does not disprove its existence.

Furthermore, I offer my own perspective of social construction which is largely informed by the post-modernist viewpoint which argues that, through language and semantics we create an entirely new sense of reality. Again, it is important to note that depression as a ‘mental condition’ is certainly not a social construct, because it encapsulates unique problems faced by individuals afflicted by this very fragile human condition, in particular those affected by schizophrenia or bipolar disorder. Indeed, one way to further examine the concept of depression as a ‘mental condition’ (as opposed to a disease) is by taking a closer look at one of the major causes of depression, which is loneliness.

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