On depression: psychosocial vs. psychiatric viewpoints (an excerpt from a book by Dr. Breggin)

Today I’d like to transcribe an excerpt from Dr. Peter Breggin’s book Toxic Psychiatry (1991), beginning on page 130 in chapter 6:

Depression in Two African Communities

Sometimes, if we look at communities that seem somewhat unfamiliar or alien to our own, we are more readily able to see common human principles at work. Outside the usual psychiatric literature, I did locate two books about “primitive” jungle cultures in which the authors approach depression as a psychosocial and even spiritual phenomenon pertaining to loss of companionship and love.

The famous doctor who authored the first book describes the roles of “friendship,” “love,” and “altruism” in the community, citing, for example, how relatives and friends risked their lives for each other against frightening attacks from wild animals. Males cooperate in the hunt and females share in the raising of any orphaned offspring.

Little Flint, the subject of a touching vignette, was eight and a half years old at the time of the death of his mother, Flo. Flo was the matriarch of the family, but little Flint was born when Flo was seemingly too old to bear children. She was becoming ill as well, and in her infirm state she had “insufficient strength to enforce the independence” of little Flint. For example, “she continued to give in to his demands to sleep with her at night” and, despite her infirmity, she also acceded to carrying him about on her back “like an infant” when he was old enough to walk by himself.

The study includes photographs of Flint and his family. They show a surprisingly aged-looking mother with a heavily lined face, a sagging countenance lacking in animation, and a body that has lost its strength of carriage. The older siblings are full of sparkle in these pictures, and so is the small child Flint, who looks bright eyed, endearing, and eager for attention.

The unexpected death of a sibling when Flint was only five frightened and disturbed him and, combined with his mother being increasingly “unable to cope,” made Flint more excessively dependent on her. He indulged in “very little play” and became especially “nervous” around bigger, older boys. Meanwhile, Flint’s father paid little or no attention to him; but this was a routine phenomenon in their culture, and perhaps not that different from ours.

The doctor—whose name I will withhold for the moment—said of Flint, “He was unusually dependent upon his very old mother” and “when she died in 1972, Flint was unable to cope with his state of depression.” Flint “showed gradually increasing signs of lethargy.” He suffered a “loss of appetite” and had “sunken eyes.” Finally he died of an inflammation of the gastrointestinal tract. His doctor concluded, “It seems likely that the psychological and physical disturbances associated with loss made him more vulnerable to disease.”

Other members of the community had recognized Flint’s need and reached out to him, but because of his immaturity and history of losses, he had been unable to respond to their love.

By any standard, Flint died of a major depression. Indeed, he perfectly fits the official criteria of the APA’s DSM-III-R. Major depression is frequently considered genetic and biochemical, and the usual treatment is drugs. In Flint’s depressed state he might have been given shock treatment, even as a child.

But the doctor who told the story of Flint did not see him as having a genetic or biological vulnerability to depression; he had a family vulnerability based on the death of a sibling, his ailing mother’s incapacity to raise him properly, and her premature death.

The great irony about this analysis of Flint’s all-too-human response to a difficult childhood is that he’s not a human being. The doctor was not a physician or psychiatrist. Not even a psychologist. She was the world-renowned ethologist Jane Goodall. Her marvelous 1983 book is The Chimpanzees of the Gombe. Yes, Flo and Flint were chimps. And it’s true that, unlike any modern psychiatric textbook, Goodall’s book has subchapters on themes like “Helping and Altruism” and “Love and Compassion.”

While Goodall acknowledges the role of genetics in influencing broad behavior patterns, such as aggressivity in males, even in his arena she points out the importance of environment. But with no psychiatric ax to grind, she recognized that obvious psychosocial experiences, such as depression, are not genetically based.

Ethologists studying primates have discovered their many fundamentally psychospiritual qualities, including the capacity for altruism and love, and their corresponding darker side of “depression” and even madness. At the same moment, psychiatrists studying human beings are discarding psychospiritual concepts as outmoded. In short, the ethologists see their animals in human terms, while psychiatrists see their patients in what we used to think of as animal terms.

Jane Goodall’s loving approach to primates, including her psychospiritual understanding of depression, is echoed among other ethologists. In Gorillas in the Mist (1983) Dian Fossey tells a very similar story about a depressed young ape, Simba, who was abandoned by her mother. An uncle did his best to help Simba recover, but after her mother finally died, she lapsed into a lifetime of withdrawal and depression. Fossey and her biographer Farley Mowat (Woman in the Mists, 1987) described how Fossey herself nursed an orphaned ape out of depression and near death through love, physical intimacy, and constant attention. Again, these animals met the technical criteria for major depression.

Before she became involved with gorillas, Fossey worked in human rehabilitation, and she apparently learned some of her more gentle and cautious approaches to the animals from helping autistic children. But human kids rarely are given this kind of attention by professionals in the field of autism. Increasingly there is little place for loving approaches in conventional psychiatric practice because they are being ruled out by biopsychiatric dogma.

Flint and Simba Meet the Psychiatrist

In addition to their meeting the diagnostic criteria for major depression, modern psychiatry would find other compelling reasons for treating Flint and Simba with drugs and even electroshock. First, they had many physical signs associated with their depressions, including loss of appetite and cosmetic and physical deterioration. Often these are assumed to indicate a physical origin. More important, they had recurrent depressions. Flint’s problems seemed to start or to worsen with the death of a sibling, and then to worsen again with the death of his mother. Similarly, Simba had two distinct depressive episodes, one on the disappearance of her mother and another on her death. In modern psychiatry, as Ronald Fieve argues in Moodswing (1989), the fact that Flint and Simba suffered recurrent depression would be taken as further proof that each suffered from a physical illness. That Flint died and Simba never recovered would be used as additional evidence that these were not “normal” or “natural” responses but rather the product of disease, thus strengthening the psychiatric argument that individuals like them need drastic physical interventions.

Imagine the outcry is a captive Flint or Simba became depressed after the loss of a parent and was scheduled for shock treatment at the local city zoo? There would be picket lines. Outraged citizens would offer to adopt the animals to give them proper foster care. Animal protection advocates would chain themselves to the cages. There are many local “zoos” filled with human children and adults being subjected to precisely that sort of abuse, and very few people are protesting.

Every time I have gotten to know someone suffering from so-called major depression I have found a story similar to that of the primates and human beings described in this chapter. There has been no need to resort to genetic or biological theories. Without elaborate explanations, their life stories tend to explain their desperate feelings. The deepest depressions, if anything, are often the most easy to understand. People who suffer severely from emotional problems usually have been exposed to very destructive life experiences, often starting early in childhood.

That depression is typically precipitated by losses and other stresses was confirmed by all three psychiatric experts at the April 6, 1991, “U.S. Depressive Disorders Update” conference in New York City sponsored by Eli Lilly. Nonetheless, all three promoted the use of drugs along with psychotherapy. That all three included psychotherapy in the treatment program may signal changing policy within psychiatry as the profession loses increasing numbers of patients to psychologists, social workers, counselors, and other nonmedical talking therapists. The continued insistence that drugs are important serves the purpose of convincing people to go to medically trained psychiatrists for both talk and drugs (see chapter 15 for a further discussion on psychiatric economics).

Meanwhile, a whole new body of research based on direct observation is confirming the negative effects on children of poor maternal nurturing. Not surprisingly, depressed parents produce depressed or withdrawn children. Recent studies are presented in D. Cicchetti and V. Carlson, eds., The Effects of Maltreatment on the Development of Young Children (1989).

Let’s stop there for now on page 133.

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