Epidemic depression is occurring at a time when the field of mental health appears very robust. There are more mental health professionals treating more people than ever before in history: psychiatrists, clinical psychologists, licensed social workers, counselors, and therapists of all kinds. We have a powerful “therapeutic arsenal” of drugs to make us happier, calmer, and saner. Depression and anxiety should be as fully conquered as smallpox and polio. But more of us than ever are discontented and not experiencing optimum emotional well-being. What is wrong with this picture? Why is the vast enterprise of professional mental health unable to help us feel better?
I want you to consider the possibility that the basic assumptions of mainstream psychiatric medicine are obsolete and no longer serve us well. Those assumptions constitute the biomedical model of mental health and dominate the whole field.
The dominant model of disease in our time is biomedical, built on a foundation of molecular biology. It leaves no room within its framework for the social, psychological, and behavioral dimensions of illness. The biomedical model not only requires that disease be dealt with as an entity independent of social behavior, it also demands that behavioral aberrations be explained on the basis of disordered somatic (biochemical or neurophysiological) processes. Thus the biomedical model embraces both reductionism, the philosophic view that complex phenomena are ultimately derived from a single primary principle, and mind-body dualism.”
There is no question that over the past century, biomedicine has advanced our knowledge of human biology, but the real test of a scientific model---the measure of its superiority to an alternative belief system---is whether or not it increases our ability to describe, predict, and control natural phenomena.
Although some psychiatrists still rely on talk therapy, of all medical specialties, the profession as a whole is the most dominated and, to my mind, hobbled by blind faith in biomedicine. Psychiatrists were easily seduced because of a collective inferiority complex with regard to their place in the medical hierarchy. Still referred to as witch doctors and shrinks (from headshrinkers), they themselves have a history of questioning whether they are real doctors and whether they need the same basic medical training as cardiologists and surgeons. With the spectacular rise of biomedicine, their discomfort increased, and, not wanting to be left behind, they looked for ways to be even more biologically correct than their colleagues in other specialties. They saw their ticket to acceptance in the new and rapidly developing field of psychopharmacology---the study of the effect of drugs on mental and emotional disorders.
The biomedical model explains depression as the result of a chemical imbalance in the brain, specifically of neurotransmitters affecting our moods. How well does that explanation enable us to describe, predict, and control depressive illness? In other words, just how effective are the antidepressant drugs that psychopharmacologists have developed, that the big pharmaceutical companies sell such quantities of, and that so many people today take? The answer, I’m afraid, is not very.
Like coronary heart disease, depression is a multifactorial health problem, rooted in complex interactions of biological, psychological, and social variables, best understood and managed through a broader biopsychosocial model.
The New Model
I have written about possible causes of epidemic depression in our society, among them such lifestyle factors as diets high in processed foods, lack of physical activity, social isolation resulting from affluence, and altered brain activity from information overload. In its narrow focus on molecular biology, the biomedical model fails to capture any of this, and practitioners under its spell cannot give depressed patients the advice they need to address the complex causes of their problems. All they can do is dispense drugs that for the majority of patients might as well be sugar pills.
In an effort to give mental health professionals more and better options, I convened the first national conference on integrative mental health in March 2010. Together with Victoria Maizes, M.D., executive director of the Arizona Center for Integrative Medicine, I invited psychiatrists, psychologists, social workers, and other health professionals to attend a three-day event in Phoenix to “learn how to treat their patients within a new paradigm of integrative mental health care that utilizes scientifically proven alternative methods in combination with drugs and traditional therapy to address patients’ physical, psychological, and spiritual needs.”
On the closing day of the conference, I spoke about the failure of the biomedical model and the great advantages of the new integrative model of mental health. I quoted Albert Einstein on the subject of conceptual models:
“Creating a new theory is not like destroying an old barn and erecting a skyscraper in its place. It is rather like climbing a mountain, gaining new and wider views, discovering unexpected connections between our starting point and its rich environment. But the point from which we started still exists and can be seen, although it appears smaller and forms a tiny part of our broad view gained by the mastery of the obstacles on our adventurous way up.”
The new integrative model of mental health does not ignore brain biochemistry. It takes into account correlations between imbalances in neurotransmitters and mood disorders. Nor does it reject psychopharmacology. Integrative treatment plans for depression, particularly for severe depression, may well include medication, but my colleagues and I prefer to try other methods first and to use antidepressant drugs for short-term management of crises rather than rely on them as long-term solutions.
In retrospect, seeing human beings as nothing more than the sum of biochemical interactions was probably a necessary stage of medical evolution. But it is impossible to restore or promote human health unless we begin with a complete definition of a human being. An incomplete definition will always result in incomplete diagnoses and less-than-optimal treatments.
Our health or lack of it is the result of biochemical interactions and genetics, dietary choices, exercise patterns, sleep habits, hopes, fears, families, friends, jobs, hobbies, cultures, ecosystems, and more. Chemical imbalances in the brain may well correlate with depression, anxiety, and other emotional states but the arrows of cause and effect can point in both directions. Optimizing emotional wellness, by improving attention, changing destructive patterns of thinking, and finding contentment within, can also optimize brain chemistry, correcting any deficiencies in neurotransmitters. Now is the time to ascend the mountain and see the biomedical model as one part of our broadening view.
This blog is excerpted from “Psychotherapy at the Crossroads." Want to read more articles like this? Subscribe to Psychotherapy Networker Today!
Arizona Center for Integrative Medicine