I’ve decided once more to write about the mind. In particular, the point must be made that we are not our brains. We are our minds, a rich, alive, constantly changing mystery. The brain carries out what the mind wants. To mistake the brain, a lump of proteins, sugar, and water, for a mind is a drastic mistake.
But it also happens to be the mistake of choice for modern science. It will help the mind side of the debate to read the recent cover story in Newsweek, which proclaimed, in stark terms, “Antidepressants Don’t Work.”
The support for this bold and disturbing claim comes from previous articles in scientific journals, where the whole rationale for giving a pill to treat depression was undermined. First, when a patient comes to the doctor complaining of mild to moderate depression (the kind most commonly encountered, as opposed to the crippling disorder known as severe chronic depression), for up to 50% of people, the standard antidepressants offer no improvement. Some studies indicate that the placebo effect is just as reliable and offers just as much relief as these medications.
Yet for the mind-brain debate, it’s another research finding that stands out. The brains of depressed people aren’t different from the brains of undepressed people. It has long been assumed that depressed brains are deficient in two vital neurotransmitters called serotonin and dopamine. Taking an antidepressant was supposed to rectify this imbalance. But studies indicate that the genes responsible for the secretion and regulation of neurotransmitters are the same in depressed people as they are in undepressed people. This means that your brain may be used to being depressed. It may even be used to a chemical imbalance of some sort. But to focus solely on the brain is to miss major causes of depression that are mental instead. Think of the experiences that can make a person depressed, meaning someone with a mind:
—Sudden life changes
—Accidents and unforeseen setbacks
—Loss of job or money
—Negative religious beliefs leading to guilt and shame
—Other causes of guilt and shame
—Rejection in love
—Being around other depressed people, particularly family members
—The X factor
This is a long list. Even if we discount some undiscovered cause (the X factor), the mind is faced with the complexity of life, and numerous experiences can engender depression. If I tell you that you’ve just been fired, it’s not your brain that will make you depressed. It’s a sudden jolt of devastating bad news. Nobody knows why some people convert bad experiences into depression while others don’t. It is equally true, after all, that the glass is half empty and half full. Studies show that when shown neutral photos of various people and situations, depressed people habitually see them as negative, disappointing, sad, and unlikely to lead to a positive outcome.
Thus depression has a large circular component of response and habit. A person learns to respond to ordinary situations by being depressed, and once learned, this response becomes a habit that reinforces itself. The habit of depressions is as hard to break as addiction. And in both cases one hears the cry, “I can’t help it. I have to be this way. This is me.” Telling someone that they are prisoners of their sick or damaged brains only reinforces this belief and the circle of depression.
Those who focus on the brain seem to be right that habitual responses form neural pathways that constantly reinforce the same depressed reaction. These pathways are like ruts in the road that a wagon wheel falls into automatically. But brain researchers are misguided to ignore the mind. That’s like saying that the road made its own ruts.
I’ve said enough to provoke scorn from the materialists and outrage among some depressed people, who accuse me of saying that they have caused their condition. I am robbing them of hope. I am saying nothing of the sort, however. Severe depression requires medical treatment of the most intensive kind. Millions of people testify that antidepressants have relieved their suffering. Nobody is trying to counter such testimony. Nobody is offering despair in place of hope.
But the research that has undermined antidepressants cannot be wished away. In many ways the brain has been a cop out for the therapeutic community. Instead of undertaking long, expensive cognitive therapy which tries to get to the bottom of why a person is depressed, it is much easier to write a prescription. This despite the fact that talk therapy has proven to work in cases of mild to moderate depression. But Prozac, the first billion dollar drug, seemed to cut the Gordian knot.
Going the route of antidepressants, behind all the hype and the millions spent by drug companies to boost their products, was always far from perfect. There were side effects. There was drug tolerance, which causes a medication to become less effective over time. There was the stark reality that antidepressants only relieve symptoms; they were never a cure. Finally, the same research that undermined the efficacy of antidepressants also found that taking them doesn’t aid with other therapies used at the same time.
I’m not deliberately painting a dismal picture. The drug route leads to its own dead end (discounting, once again, those who are actually helped). Let’s keep exploring the use of psychotropic medications. It would be naive to believe that America is going to abandon a belief system that puts materialism ahead of everything else. But discounting the mind while constantly referring everything to the brain is folly. It defies common sense, for reasons we will go into in the next post.
(To be continued)
Posted at the San Francisco Chronicle