There is no evidence of genetic causes

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Depression: Part III

Many people still believe that the cause of depression is something ‘in the genes’. This is a remnant of the school of thought (‘nature’) that oscillated upwards again in the 1980-ties when researchers assumed that more or less everything was genetically determined. Nowadays most scientists don’t accept this explanation anymore. As a matter of fact, there are no known genes for any psychiatric disorder (for instance ADHD, depression, schizophrenia, etc.).

For all these illnesses there exists no robust body of research in favor of genetics. Although there are illnesses that occur comparatively more frequently with relatives, there is a frustrating lack of progress in understanding the genetics of mental disorders. Even twin research (applied to this field), what used to be the hallmark of the ‘nature’ school, has come under serious methodological criticism. Experts are in severe doubt whether the underlying genes regarding for instance mood disorders will ever be found.

On the contrarily, the support for the school of ‘nurture’ is becoming stronger and stronger. For example, when you grow up in a family where one or more family members are depressed, it is more likely that if and when you yourself become depressed it has more to do with the circumstances and family dynamics you grew up with, than with genetics. If there are any genes involved, then they play a very distant and minor role. With psychiatric disorders there usually is a complex interaction between nature and nurture, but the ‘gene part’ is much less than previously assumed., the medical model that psychiatrists use is based upon a number of certain symptoms (five out of nine, four out of seven, etc.), which determine what kind of illness-label they should place upon these. With physical illnesses this usually works, but most mental illnesses are too complicated for this model. For starters, mental illnesses are typically ill-defined; nobody knows for example what schizophrenia exactly is. Also, with mental illnesses one should view the symptoms in the context of the personal history and circumstances. If the story fits and explains the symptoms in a different way, then there is no ‘innate’ disorder and many of the ‘ill’ persons should be labeled ‘normal’. And unlike physical diseases, the connection between the different possible causes and treatment options is not very clear. In research terms: the explained variance with mental illnesses is much less than with physical diseases.

Take for example, a 35-year-old man who comes to a doctor’s office. He has a high temperature, muscle pains, headache and loss of appetite. The doctor bundles these symptoms to an objective general syndrome called ‘fever’. He administers medicine and in a few days the patient is well again.

But in the following example a 35-year-old man brings his wife to a psychiatrist and tells him that she is depressed. In the Sri Lankan context, the psychiatrist has little time and the wife usually doesn’t speak until she is spoken to. So the end result would probably be that the husband receives a prescription for antidepressants for his wife.

A psychologist would probably have taken the trouble to ask the husband to leave the room and subsequently have spoken with the wife separately and confidentially. Perhaps then the wife would have told him that she suspects her husband of infidelity and that she feels angry, hurt and lonely and not depressed. Then a couple-therapy instead of focusing on the wife would be appropriate. Both of their personal histories and the marriage itself would be addressed.

In the medical model one works from the individual person to generalized diseases. The symptoms (high temperature, muscle pains, etc.) lead to the conclusion of fever (a very common condition, N=millions). Psychologists on the contrarily start and end with N=1. Mental conditions are typically very individual and are extremely difficult to generalize.

When you combine this with the failure of the ‘chemical imbalance theory’, the questionable independence of pharmaceutical industry funded research, and the fact that antidepressants don’t perform better than placebo tablets then you can ask yourself whether the treatment of depression should be left out of the repertoire of psychiatrists and medical doctors. Depression is too complicated and too serious to be ‘treated’ by non-effective tablets with side-effects and withdrawal-effects.

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