Depression: The Truth About Science and Mindset
For years, we have believed that symptoms of depression and anxiety are chemical imbalances. That these disorders are in fact brain disorders, and we have even learned to personalize these disorders as “my depression,” or “my anxiety.”
Within the scientific literature, there’s a proper name for this: Neuroessentialism. Is it possible that this conceptualization is damaging to clients of mental health professionals? Different scientists with backgrounds in neuroscience, psychology, and philosophy conclude that it is possible, and so does William Schultz.
William Schultz published an article titled “Neuroessentialism: Theoretical and Clinical Considerations” which argued that neuroessentialistic conceptualizations of depression are both misleading and potentially dangerous.
In this article, Schultz compresses theoretical concerns as well as empirical studies that support the conclusion that “biological explanations of mental illness can actually have relevant negative consequences among health clinicians.”
From this, the article can be sectioned into five separate parts —
- Part 1 breaks down the definition of neuressentialism
- Part 2 examines what came before neuroessentialism
- Part 3 reviews theoretical concerns about neuroessentialism
- Part 4 reviews empirical studies that support the theoretical concerns
- Part 5 discusses new implementations for mental health professionals
According to Schultz, three factors nurtured the ideology behind neuroessentialism, including reductionism in psychiatry — (trying to make something simple out of something complex), the desire to combat stigma, and the economic market for psychiatric medications — medications like anti-depressants.
In Schultz’s article, you’ll find that what propelled this conceptualization is NIMH’s research program known as RDoC.
Schultz states in the article that RDoC was an “attempt to ground psychological experience and disorders in the methodology of neuroscience”
RDoC launched efforts to better understand biological and neuroscientific contributors to depression in humans — fueled by concerns, they concluded that relying on psychological factors alone is primitive medicine.
The conclusion that RDoC came to — in sum, was this:
However, Schultz and many other researchers, neuroscientists, and other psychologists can securely state that — while it’s true biology and neuroscience are important when considering depression, biology and neuroscience alone can’t comprehensively explain the full scope of illness. In other words, there’s a variety of outside factors that contribute to depression.
Schultz gives a great example pulled from a neuroscientific study — you can examine someone’s neural circuitry that associates with the thought it is hopeless, but you wouldn’t be able to identify the neural manifestation without examining the person who had the thought. Numerous other important examples are found in the article.
Another important motivation of neuroessentialistic conceptualization is an effort to stop the stigma around mental illness. Yet, Schultz points out that a survey conducted in 2014 showed that stigmatizing attitudes increased instead of decreased. This contradicts one of the main factors that contribute to the academic and psychological attraction to neuroessentialism.
Schultz also makes a notable mention that advertisements that portray depression as a biological conditions suggest that it can be successfully treated with medication.
The Direct-to-Consumer Ads do two things —
- 1. It increases the perception that someone who has depression is at a higher risk that they originally perceived.
- 2. It increases brand promotion.
Schultz’s research concludes this is why neuroessentialistic conceptualizations are so common and why psychiatric medication sales are worth tens of billions of dollars annually.
Schultz’s claim that neuroessentialism conceptualization of depression can have negative impacts that need to be considered by clinicians is rooted in the Humanistic tradition within psychology.
The Humanstic tradition within psychology predominantly grew out of frustration with the behaviorist and psychoanalysis ideologies. Humanistic psychologists support the claim that psychology shouldn’t be limited to only observable behavior. It can be more simply explained that humanism doesn’t completely rule out science — they just focus more on self-awareness and responsibility coupled with the scientific information.
In Schultz’s article, he discusses a perspective discussed by Frankl, another humanistic thinker —
Frankl explains that the issue with reductionists that base human quality of behaviorist models or scientific methods is that it’s an attempt to understand humans from an incredibly limited perspective.
Frankl argues that our human capacities and values such as “ethics, truth, beauty, wholeness, spontaneity, and creativity,” and trying to understand the psychology of the human mind without reference to the surrounding environment is impossible.
Critically, Schultz’s article focuses on how neuroessentialist conceptualizations of depression can fuel naive notions that are detrimental to a client’s perspective on how treatment for depression will go. He pointed out that neuroessentialist conceptualizations increase prognostic pessimism.
In 2009, a study was conducted by Deacon and Baird that supports the claim that neuroessentilism has negative clinical impacts. They recruited 90 college students to complete 1 of 2 possible questionnaires, and they divided the mass into 2 equal groups. The questionnaires had 3 sections.
For both surveys, the first section included demographics and mental health history. The questions in the mental health history included asked whether the participant believed depression was primarily caused by biological or psychological factors.
In the second section, also for both groups, the participant was asked to imagine that they felt depressed, sought professional help, and received a diagnosis of major depression.
This is when the study diverged — in the first group, their survey gave the biological explanation of depression before the biopsychosocial explanation. This order was reversed on the survey for the second group.
The biological view point was retrieved from NAMI’s website that claimed depression is a chemical imbalance while the biopsychosocial view point of depression claimed that there’s a wide variety of factors that influence the causes of depression.
The third section collected statements from the participants that asked them about prognosis, stigma, and treatments. Questions like “to what extent would you feel able to manage depression on your own,” and “how effective would you think psychotherapy would be in treating your depression?”
In sum, the study found that those who received the biochemical explanation before the biopsychosocial explanation of depression expected symptoms of depression to last longer, that they thought there were lower odds of recovery, and it showed they were more vulnerable to pessimism.
Schultz emphasized the importance of this pessimism by relating it to other research which demonstrates that client expectancy impact client outcomes. Schultz summed this up stating that that clients that expect to do better, do better — just like the other research he cited which shows that those who choose to believe in free will are more apt to be less aggressive, practice self-control, and seek to find more meaning in life.
In Schultz’s discussion, he also proposes a solution for mental health professionals to stop neuroessentialistic conceptualization. Schultz explains that it’s important for professionals to inform clients that there is no definitive reason as to why depression occurs — — that it’s a series of factors that contribute to the illness, and that there is evidence to support how neuroessentialism conceptualization can lead to negative clinical impacts.
Overall, I think that knowledge is power in tough circumstances such as depression. As someone who has managed the illness for years finding treatment can be daunting, but denying that there could be changes that I have to make in order to see improvement would be naive. I’ve heard for so many years that there’s life and death in the words we speak, and I have experienced the outcomes of both. When I set my goals in therapy and talked aloud about how I can see that I’m getting to the place I want to be, I saw greater improvement. Just like when I experienced the thought that I’m never going to get through this, I experienced a deeper cycle of negative thoughts the more I entertained that single one.
Do I think science compliments Schultz’s argument? Absolutely. I think that for the period of time I was on antidepressants, and taking the medication while receiving professional treatment — there was improvement there. However, I also knew I didn’t want to stay on the medication forever. I’ve never liked the idea that a pill could be a fix-all solution.
When reviewing the information in this summary, I hope that you do your own research and find your own standing on this battle so many of us face in the realm of mental health. Schultz offered a fantastic and fresh perspective on the subject matter. I hope it challenges you, and allows you to explore new understandings on depression. In this season, continue to take care of yourselves, seek to find solutions, and be open-minded to different forms of treatment.
Should you decide that you or a loved one are in current crisis with depression — the National Suicide Prevention Line is available 24/7 at 1–800–273–8255.
