Chapter 1: The Origins of Depression

Recently, while tuning into one of my favorite advice podcasts, Danny Lavery's Big Mood Little Mood, I encountered a discussion regarding the various factors contributing to depression. The advice-seeker, a burned-out lawyer feeling adrift after prolonged isolation during the pandemic, expressed feelings of disillusionment about a future filled with monotonous routines. They sought guidance on how to inject meaning back into their life, which appeared to consist solely of work, cooking, exercising, and sleeping.

Lavery immediately recognized that the seeker’s feelings stemmed from both personal and broader societal issues. Many individuals have endured extended periods of solitude, leading to a lack of stimulating interaction and anticipation, resulting in pervasive feelings of despair. Co-host Inkoo Kang recommended that the seeker seek out novel experiences and intellectual challenges to rediscover the joy reminiscent of their college days filled with engaging courses and leisure.

Lavery highlighted the challenge of disentangling the existential anxiety tied to adult awareness of mortality and the pressures of capitalism from the genuine depression stemming from a dissatisfying job. He also suggested that the seeker might benefit from using cannabis to alleviate some of their distress in the interim.

What resonated with me about Lavery's and Kang's insights was their acknowledgment that depression is not merely an internal struggle, but also a response to external circumstances. Kang characterized depression as a "biochemical blankness," encouraging the seeker to consider mood stabilizers. However, her intention was not to imply that depression is solely rooted in an internal chemical imbalance. Instead, she emphasized that while the seeker’s circumstances were undeniably bleak, these external factors could indeed have measurable biological effects.

Lavery pointed out that medication might not resolve the underlying life issues the advice-seeker faced, but it could provide the clarity needed to make thoughtful decisions moving forward. They also suggested therapy, recognizing the potential financial means of the seeker, but there was never an assertion that the individual's mind or brain was the exclusive origin of their struggles. Individualized treatment could enhance current living conditions, yet genuine healing might require changes in the seeker’s life circumstances.

After their discussion, I felt a sense of relief. They had successfully bridged the gap between biological and social explanations for depression without positioning them as mutually exclusive. Such balanced discourse is unfortunately rare. The prevalent narrative often portrays mental health solely through a biological lens, neglecting the interplay of environmental factors.

The public has been conditioned to believe that mental health disorders, including depression and anxiety, are primarily caused by chemical imbalances. I frequently encounter people asserting that mental illnesses are purely biological, often citing popular science claims about brain functions. Just recently, someone on social media insisted that Borderline Personality Disorder is a "brain disease," which misrepresents the complexity of emotional and relational dynamics involved.

The allure of biological explanations for mental health is understandable. Ascribing mood disorders to biological factors can provide a moral reprieve for those afflicted, framing their challenges as beyond their control. In a society that valorizes hard work, it becomes comforting to believe that conditions like depression or ADHD stem from biological deficiencies rather than personal failings.

People often gravitate toward biological explanations because they seem more scientific than discussions of psychological and social influences. It’s easy to document brain activity or measure stress hormones, yet the multifaceted impacts of economic systems, cultural practices, and familial dynamics are more challenging to quantify. Research suggests that neuroimaging studies are frequently viewed as more credible than psychological studies lacking such data, despite the fact that brain scan results often lack reliability.

Biochemical and neurological studies are still in their nascent stages, with many findings failing to replicate. Observing brain activity can illuminate aspects of human behavior but often doesn’t provide comprehensive explanations. For instance, noting that a child with autism experiences distress during eye contact isn't groundbreaking; we already understand that such interactions can be overwhelming for them.

The brain functions as a biological entity, while the mind represents a process manifested through the brain. All mental activities, whether related to love, fear, or even the mundane task of reading about Batman, involve biological processes. However, many mistakenly equate the presence of biological markers with causation. Just because a particular brain region activates during certain tasks doesn’t mean it is the sole cause of those tasks.

Misunderstandings arise when we claim that conditions like depression stem from imbalances in neurotransmitters. Saying that anxiety is merely a lack of GABA is akin to asserting that digestion results solely from excessive stomach acid. Moods and thoughts are processes facilitated by the brain, much like digestion is a process involving various bodily systems.

While the brain plays a crucial role in emotional and mental states, it’s essential to recognize that these states are influenced by a myriad of factors, including social and contextual conditions. When discussing mental health openly, critiques of the biomedical model can provoke strong reactions. Some may view such critiques as conspiratorial, akin to Scientology rhetoric.

Acknowledging that mental illness labels are socially constructed doesn’t invalidate the real experiences of those suffering from conditions like depression or anxiety. Recognizing the external factors contributing to these issues doesn’t preclude access to necessary medications. As illustrated by Lavery and Kang, a dual approach that considers both internal and external factors is often the most effective.

However, many people cling to biological explanations, feeling defensive when these views are challenged. For instance, a colleague recently highlighted that ADHD is often attributed to dopamine deficiency. While dopamine plays a role in various cognitive functions, it’s not a definitive biological indicator of ADHD. The assertion that inadequate dopamine causes attention deficits lacks empirical support. Moreover, an individual's response to stimulants does not validate a diagnosis; rather, it reflects a common physiological reaction to stimulants.

When this colleague shared their insights, they faced backlash, particularly from individuals who identify with ADHD and rely on stimulants. Many have faced stigma for their challenges, finding solace in the notion that their difficulties stem from a biological condition. Such explanations can offer relief but can also perpetuate stigma by suggesting that individuals with certain diagnoses lack autonomy over their lives.

As a social psychologist who navigates mental illness, I understand that the pain of depression and sensory overload is real. Therapies and medications can enhance well-being, but I also recognize that many responses generated by our brains are not universally adaptive or pleasant. Much of my distress as an autistic individual is a product of navigating a loud and unyielding neurotypical world. While I might wish for a pill to alleviate some of my distress, I believe that advocacy for social change is a more effective solution.

In my experience and that of many neurodiverse individuals, the biomedical model often fails to provide a path to relief. I seek acceptance and accommodation for my authentic self rather than a complete overhaul of my identity. Similar to the advice-seeker's situation, my struggles are influenced by social, economic, and contextual factors as much as my neurological makeup. Long hours of work increase my stress and burnout, just as an individual with ADHD may require stimulants to cope in an unaccommodating environment.

Our brains may process the emotions tied to exclusion, anxiety, or sensory overload, yet the roots of these feelings often lie in external circumstances.

Depression Is Not Caused by a Chemical Imbalance

This video discusses the misconception that depression is solely the result of a chemical imbalance, emphasizing the multifaceted nature of mental health.

The Chemical Imbalance Myth of Depression

In this video, experts break down the chemical imbalance theory of depression, exploring its limitations and the importance of considering social and psychological factors.