Archive for the ‘blame’ Category

Some therapists do not “get” the difference between having life problems, and having mental illness (plus, often, life problems).  My suggestions for dealing with this, if you are mentally ill and seeking therapy, are:

1) Look for therapists affiliated with hospitals, they tend to have more experience with psych patients.

2) Be leery of anyone who makes a big deal out of “situational” versus “chemical” depression.  It’s all chemical; it all happens in your brain and body.  Peter Kramer, a psychiatrist who is pro-therapy and writes books about therapy and books about medication, argues that research shows that depression triggered by repeated situational events comes to look no different from depression with a heavier genetic component.  It’s just that some people start higher or lower down the slope.

Those who start further down the slope – who some people would say have “chemical” depression – can still be helped by therapy.  For example, people who are more prone to depression following negative life events can learn to better anticipate and/or avert those events, and cognitive therapy can help people interpret those events in ways that are less damaging.  It’s not always enough, but it can be very helpful.

Continue reading ‘Situational versus chemical depression, and what it (doesn’t) mean for treatment’ »

This is post 2 of Dichotomy Week. Post 1 was on the psychological concept of a division between biological and situational depression.

Conflating what causes depression with whether behavior is someone’s fault is detrimental to everyone, because confusing science about etiology (and subsequent treatment) with moral judgments about blame confuses the science and confuses public understanding about science, and makes developing appropriate treatment and getting people to use it harder, because in that environment treatments also carry undertones of blame (medication = not to blame, meditation/yoga = to blame somewhat, nebulously-defined “life changes” = it’s your fault and you don’t need medication, rather than seeing all of these as useful, some of them as infeasible for some people at some times, and some of them both feasible and necessary, not necessarily in that order).

It’s very hard to disentangle moral judgments from science in most peoples’ minds, as opposed to working within the framework by trying to reclassify depressed people in terms of whether their depression is biological/real versus situational/to blame. I think the framework is the problem, but I’m not sure there’s a lot we can do about it; finding who deserves blame for their problems is a ubiquitous human thing to do, even when blame does not contribute to solving problems and other things do.

On the other hand, maybe giving people a distinct classification system to channel moral judgments into might help keep those judgments away from etiology. Personally, if we have to have one, I favor a system classifying people into those who are pursuing vs those who are not pursuing effective treatment, as measured by lowered depression, not by whether they’re pursuing a particular kind of treatment. If we’re going to have blame no matter what, we might as well try to channel it into a better, albeit still very imperfect and problematic, path.