A new book challenges the idea of depression as a biochemical disorder, writes Sylvia Thompson
'Depression is an emotion, just like fear, anger or love. It is the imprint felt after a stressful or traumatic experience. Depression is natural. It is not a disease process reflecting a change in brain chemistry, disconnected from individuality, race, colour, creed, upbringing, belief system, environment, relationships, socio-economic factors, life events and coping skills."
This definition of depression taken from the Depression Dialogues website, set up by psychiatrist Dr Michael Corry and psychotherapist Dr Aine Tubridy may be liberating and even empowering for some sufferers of depression who previously perceived their illness to be a brain chemistry disorder, the cure of which was beyond their control.
Defining depression as a "legitimate emotional response to life's difficulties" rather than a biochemical disorder is the central thesis of Corry and Tubridy's new book, Depression - an Emotion not a Disease (Mercier Press, €14.99).
"Depression is a valid and normal response to the uncontrollability of the poverty trap, the frantic juggling required to keep normal family life afloat," they write. "Many histories of depression lead back to bullying in the past, often as far back as the young childhood years," they say.
The authors dedicate chapters of their book to bullying, sexual abuse and another to fear, panic, post-traumatic stress disorder and obsessive compulsive disorder, explaining and giving examples (through case histories) of how depression can be a valid response to all of these experiences.
Corry and Tubridy, both practising psychotherapists, draw on psychotherapy as a means to explain why depression develops. And, in so doing, they place a big challenge on those suffering from depression to be proactive in their treatment and find solutions within themselves.
In the chapter on suicide, they write: "Get a psychotherapist who is skilled to take you beyond hand-holding and the tissue box, reconnecting you with your survival instinct, your feeling world, your will and motivation, your heart, your creativity, your insight and the bigger picture."
Such an holistic model of treatment for depression is, on the one hand, worthy of high praise but, on the other hand, inaccessible for many, both on a practical and financial level (the dearth of public psychotherapeutic services is well documented as is the cost of private services) and also because, quite simply, it requires a desire and will to change which is sometimes the exact emotional and mental state which depressed people cannot reach.
Despite these constraints, Corry and Tubridy subtly dismiss those who succumb to drug therapy as a form of treatment as being incapable of facing up to the life crisis that provoked their depression.
Overall, Corry and Tubridy are harsh critics of traditional psychiatry and are polemical and at times highly disrespectful of established drug therapies used in the treatment of depression.
"The sick-brain model of depression is a hideous and terrifying concept as it turns us into cogs in a machine where, if we find the going difficult, the need to disengage, our distress is silenced by an emotional painkiller and we are encouraged to carry on regardless. We believe this is nothing short of chemical-induced slavery," they write.
They call on GPs to be "honest when they are prescribing anti-depressants" asking them to say to their patients "you are going through a difficult time because of your circumstances and I will prescribe something to give you a lift" rather than "you are suffering from a chemical imbalance, a deficiency in serotonin".
Despite this plea, Corry and Tubridy acknowledge the value of drugs as a short-term treatment. "No one is arguing that in some cases, anti-depressants can create the sought-after lift in mood and enhance a person's feeling of wellbeing," they write. Yet, they are keen to point out that so do other drugs such as cocaine and ecstasy and that they all share addictive features and withdrawal effects.
Vehemently opposed to electroconvulsive therapy (ECT), they have started a campaign to have it banned. Quoting a journal article by American psychiatrists, H.A Youssef and F.A Youssef (Time to Abandon Electroconvulsion as a Treatment in Modern Psychiatry), they write: "In the United States, 92 per cent of psychiatrists do not use it. Modern psychiatry has no need of an instrument that allows the operator to zap a patient by pressing a button." In 2003, 859 patients received ECT in Ireland, according to Health Research Board statistics.
All in all, Depression - an Emotion not a Disease is part of an ongoing effort by Corry and Tubridy, who practise from the Institute of Psychosocial Medicine in Dún Laoghaire, Dublin, (Corry is also psychiatrist at Clane General Hospital, Co Kildare) to shift the treatment of mental illnesses away from drug therapy towards psychotherapy.
Fans of this approach see the authors at the vanguard of a new movement towards a holistic treatment of depression which also incorporates yoga, breathwork, homeopathy and many other complementary therapies.
Critics perceive them to be part of a global "anti-psychiatry movement" which is fudging the boundaries between depression as a normal response to life's difficulties and clinical depression as an illness, which has an altogether more complex set of psychological and physical symptoms, which are arguably much more difficult to overcome.