Against the Medical Model of Depression
There is an emergent trend in mainstream culture to view depression as a kind of medical illness. It is not uncommon to hear analogies between a mind “suffering” from depression and a broken bone. “Seek help” is the advice that is most often touted along with such diagnoses’. Though seemingly well intentioned, this paradigm for viewing depression is deeply flawed for it carries some implicit suppositions that do more to aid the problem then to solve it.
Before we get into that, however, it is worth noting that depression, like all other mental states, exists on a spectrum ranging roughly from mild irritation to being on the cusp of suicide. Consequently, the kind of solution that may be appropriate for one person might very well be the last thing another needs. It should be a startling statistic then, that 1 in 6 adults in the U.S. have been prescribed an antidepressant or anti-anxiety medication. This may be due to a cultural tendency to view doctors as deities and pills as long-term solutions, but even still this number strikes me as unreasonably high.
The reason for this unfortunate reality may well be the end goal of the medical model itself, which is to readjust the “patient” so that that they can function normally within society. This is warranted for a person who suffers an injury or grave illness. Here we are right to use medical methods to heal the ailments and return the patient to their previously mobile and independent state. However, there are very important differences between how the body functions and how the mind functions.
For example, it is quite evidently true that a body that is able to function well in its environment is a better body. A fast, strong, and flexible body is better than the antithesis. But, consider for a moment if the environment we were trying to get our body to strive in was a 1-meter by 1-meter metal cage. Here, strength, speed, and flexibility (admittedly to a lesser degree) are not such useful attributes. In fact, the simplest and surest way for a body to thrive in such a small space would be to pulverize the bones so any regular sized human could be crammed into the cage. In this case, instead of trying to determine a method to get a body to fit into the cage, it is probably more prudent to question why you would pursue such an end in the first place?
We may be able to say something similar about the mind, that is, that one which functions well in its environment is a better mind. But to make this claim we need to have an understanding of what kind of environment we are operating in. I’m not exactly suggesting that contemporary society is analogous to a cramped metal cage, but the method by which we go about nursing our minds back to normality assumes that the environment we operate in is a valuable one. And to that end it uses dubious and perhaps dangerous means (e.g. pills and prescriptions).
The goal of the medical model is to treat depression “patients” so that they may return to society as happy and proactive participants, but this assumes that it is a good thing that a person is functioning well in society, which in turn carries the assumption that society is functioning well (otherwise, why would it be a good thing that a person was functioning well in it?). Neither of these is a given assumption, and we should be wary to proceed in any course of action that takes them as granted.
A separate but equally pernicious problem lies within the medical model as well. The idea of depression being a sickness does little to help the depressed person feel as though they have any control over their environment. Since depressed persons reliably communicate feelings of helplessness and hopelessness it seems any solution designed to help them should aim to return some semblance of control to their lives. Though the cry to “seek help” may be rooted in good intentions it seems to send a mixed signal. Is the message we want to send to a person who feels hopelessly out of control, that they really are so? This strikes me as a counterproductive position, which may hobble the depressed mind more than it already is.
Let me be clear here. I would not suggest that it is ideal for a depressed person to become solipsistic and desperately grope for a solution to their suffering in isolation. I would not be writing this essay if that were the case. Open communication is vitally important in any crisis in a person’s life. I’d simply argue that a more productive course of action would be to restore as much autonomy as possible rather than foster dependence. Do everything to encourage the idea that people who feel depressed can help themselves. Let’s not enforce the idea that a puppet needs to visit a puppeteer to fix its strings, rather let’s act to transform the puppet into his own puppeteer.
Before we get there however, I want to briefly describe my understanding of what depression is. Partly because my solutions will best apply to my experience of depression, and partly because I feel it is another area in which the medical model falls short.
The Logic of Sadness
Because the medical model treats the depressive mood state as something that is wrong (i.e., like a brain malfunction), we are forced to understand depression as something de facto of negative value. The upshot here suggests that the antithesis, joy or contentment, is something that should be strived towards. This conclusion is not self-evident.
The famous French philosopher Albert Camus dedicated his intellectual career to addressing the question of suicide. In his analysis his pushes logic to its extremities and shows that it is not irrational to see suicide as an appropriate response to the absurdity of life. I can personally attest to a kind of lucidity during bouts of depression. Things are not confusing or mysterious; they are, quite the contrary, starkly clear. The illusions that grant meaning to our lives are quietly stripped away to reveal the barren truth of human existence. Depression is a wrestling match with the singular, inalienable, axiomatic fact of life; we are all born to die.
But why should we avoid this fact? Why should we treat it like a disease when it is a conclusion of the upmost importance? Why should we bury our heads in the sand and pretend such questions are not worth asking? To claim that these ponderings are “wrong” is willful self-deception. There is nothing intrinsically “good” about feeling happy; it is just a state of mind. Likewise with depression, there is nothing intrinsically “wrong”, it is just a state of mind.
Still, either mind state in excess is not useful or pragmatic. Feeling too much of anything is bondage of the mind. It limits you to experience life through a single filter. Just as mania deprives a person their ability to live fully and function effectively, so too does depression. A balance must be struck between the two, a logical understanding of the tragic elements of life, and an unsubstantiated and unreasonable desire to be happy despite that.
Towards a Solution
I think the merit of the medical model is that it provides an actionable solution to the feelings associated with depression. The only other salient solution that seems appropriate is suicide. But, if we are to agree with Camus that despite its reasonableness, suicide is not a tenable solution, then an alternative needs to be found. The trick then is not to change the desire for an actionable solution, but to find an actionable solution that does not have the negative repercussions associated with the medical model or with suicide.
Fortunately for us, past thinkers far wiser than us have already solved these problems. All we need do here is repeat them and remind ourselves of their usefulness. Depression is nothing new, and our concerns are less pressing today than any day in history. So too are our lives more decadent, so any solution devised for harsher times should serve us twice as well now.
Take it in.
The primary goal here is to regain some semblance of control in your life, or at least the illusion of it. The first step is to completely disregard the medical model of depression. You are not sick. You are not ill. You are not broken. You are confronting a reality of existence, and you best bet is to embrace it.
Instead of a disease, it is helpful to think of a depressive state as a self-indulgent period of narcissism. Introverted people are more likely to grapple with these kinds of problems than extroverted ones, and for good reason. The neurotic attitude that accompanies a deeply introspective person is bound to make them believe that their experience is infinitely important. Self-awareness and introspection are important, but remember that your perspective is only half the story. Your feelings alone are not an accurate representation of what is actually going on. There is a world outside of you, and you would benefit from tuning into it. By doing so you allow yourself some respite from the vigil of sadness that a depressed mind feels obligated to uphold.
To this end the teachings of the Buddha cannot be overstated. The guru who lived millennia ago imparted possibly the greatest antidote to perpetual suffering ever devised, and that is simply to live in the moment. If one is truly able to do this then the feelings and inclinations that seem so burdensome during a bout of depression merely dissolve into the ether. This is because these feelings are intimately tied to the ego, and the ego concept is stubbornly present when we think of ourselves as an individual being moving through time. Destroy the illusion of yourself and you solve the problem.
Meditation was the Buddha’s prescription for achieving this, but meditation is not everyone’s cup of tea. I for one have an irritable and restless mind, so it is difficult to motivate myself to meditate. Luckily there are other ways to enter that esoteric and illusive place called the “moment”. My personal shortcut is to divide your experience of time into fragments as small as you can manage, like a breath or a heartbeat. When depression is truly at its zenith this is an onerous task because each moment tends to feel like an infinite expanse, but in a single second of experience there are so many details that can distract you away from this feeling.
The intake of breath, the movement of a leaf, or the buzz of a fly all serve as adequate distractions that will carry you through the present moment so you can deal with the next. You will also notice that pain is much more bearable when you are experiencing it in this fragmented state. It is when we extrapolate and project our current mood into the indefinite future that depression truly becomes overwhelming.
Eventually, and if you are persistent, this process will make you less aware of yourself, and more aware of what’s happening. You may still feel depressed but this method allows you to move from the belief that these feelings are happening to you, to the understanding that these feelings are just simply happening, and there is a world of difference between the two. The most profound difference being that in the latter stage you can come to the awareness that depression is not some evil burden you are forced to endure, but rather a window of experience, ripe with insights, which you have been blessed to look through.
Work it out.
Exercising your body is also a tremendously effective technique to shake off the melancholy. Aside from the well-established scientific studies that make valid the psychosomatic connection between mind and body, a philosophic understanding of what exercise is should help to alleviate the depressive burden. Recall the importance of feeling in control during depression. The process of fragmenting time explained above is meant to force the mind to focus on objects external to it, thereby jolting oneself out of the absolute self-absorption of a depressed state.
While exercising, wallowing is difficult to do precisely because you are too busy interacting with the physical world. Focusing your attention and will on small repetitive tasks like lifting a weight, or running, or swimming imparts a command of the body that nothing else matches. Even something as mindless and tedious as swinging an axe to chop wood can be an extraordinarily cathartic experience. Merely focus on the fact that you lifted that weight, or you took that step, or that you swung that axe and you can’t help but feel that you are overcoming something. It is a small amount of control true, but it is something to hold onto all the same.
The more one persists at a particular physical task the more command they have over their body and environment. Pushing a weight once more than you believed you could, or running the extra 100 yards when you thought your feet would collapse under you are the surest and most sublime illustrations of power and self-control an individual can preform.
It’s no wonder that the ancient Greeks (who were infinitely wise in so many things), put such an emphasis on the gymnasium. The act of overcoming an opponent in a feat of physical strength, was and is, as much an act of overcoming yourself. Today, the modern manifestation of the gymnasium is often looked at with derision by those who would fancy themselves high-minded or academic. I submit that the same ideals and noble spirit that governed these buildings millennia ago still do today. Do not consider a gym a place where ego mad competitors go to flaunt and showboat their strength. Instead consider it a place designed to resist your will and effort. Consider this place a challenge that can be overcome, and with that mindset enter the gym with the determination to prove to yourself that nothing can resist your will.
Write it down.
Emile Cioran was a Romanian philosopher who waged war with depression and anxiety for most of his adult life. In addition to having to deal with these problems during the waking day, he was also forced to endure endless nights of torment because of a persistent case of insomnia. His solution? Write.
He details his experience of lying awake during the dark, dead hours of the night, haunted by feelings of immense sadness and horror. One only need think how irritable they become at the loss of a few hours sleep to empathize with this. Nevertheless, in his twilight hell Cioran took to writing, transcribing his feelings and experiences to better understand them. Because I will never possess the capacity to form a passage as elegant and insightful as he could, I shall simply quote him directly.
“Direct or disguised, confession by word, sound, or colour halts the agglomeration of inner forces and weakens them by projecting them back towards the world outside. It is a salutary diminution which makes every act of creation into a coefficient of escape.”
Cioran wrote extensively about the inner landscape of the soul and the nature of feelings. In his analysis he presents us with the insight that feelings can have an infinite scope of potential and influence when they live inside of us. This is certainly true of depression. When in a bout of depression it feels as though ones sorrow extends to the far corners of the universe. Our entire world becomes painted with the feeling that is imprisoned within us.
Creation and art are ways to dilute this harrowing sensation. By objectifying our internal feelings we make them something tangible, and once tangible they can be dissected. You can make yourself the surgeon of your own sadness. Simply take what you have pulled out of yourself and criticize it, attack it, admire it, and ruminate on it. Inside of you this feeling is infinitely complex. Because of this it is evasive and can hang over you despite your best attempts to rationalize with it or understand it. But here in front of you, it is solid; it is an object in the world that can be overcome, just like all others.
Play with a dog.
This one really needs no explanation.
Remember that the medical view of depression is a relatively new one. Historically, depression has often been viewed as nothing more than a personality trait or disposition. It may well be that our views of this fascinating phenomenon will evolve again, and perhaps the solutions presented by future methods will have more sophisticated insights.
I mentioned earlier in this paper that depression exists on a spectrum. Solutions will differ depending on the persistence and intensity of the feelings one has. I do not want to claim that my advice has universal applicability, I merely want to lend it out in the hopes that it may have pragmatic value to anyone who feels ostracized by the current state of discussion surrounding depression.
In truth this paper’s primary audience is myself. Having thought about these issues in great depth, I decided to try my own advice and “write it down”. Now it is available for myself and others to criticize, to attack, to admire, and to ruminate on.