My last post received several interesting comments, which, as always, I’m extremely grateful for. It really is a wonder to me that there are people who are interested or bothered enough to reply to something I’ve written. As always, I tried to have a bit of a discussion with the people who had commented, but two comments engaged with what I had said in such detail that I felt I wanted to take the space of a whole new post to reply. I’m hoping this will be interesting to the rest of you because these commenters took a fairly different view of a number of things that I wrote about in my original post, and I’m hoping that to see the discussion more ‘up close and personal’, as it were, might make some of the issues a little clearer.
Before I get going, there’s just a couple of things I want to add. First of all, although I disagree fairly profoundly with the two commenters I’m replying to here, I have tried not to single them out for unfair attack. In fact, the reason this post is appearing two days after I first promised it is that the dismissive and contemptuous tone of the responses made me rather angry, and I’ve deliberately allowed some time to pass in order to, hopefully, filter most of that anger out.
Secondly, although I’ll be quoting from the comments, I won’t be reproducing them in full here. There’s a danger with this approach that I will end up misrepresenting what has been said. I’ll be trying not to do this, but it’s for this reason I’d encourage you to follow the links to the full comments – you may well find you agree with them and not me, after all. Oh, and just in case it’s not clear, the sections appearing in italics are quotes from the comments, the sections in blockquotes are from my original post, and everything else is fresh material written by me for this post.
Anyway, enough prefacing, let’s get on to the main event. First up is npal (read the full comment here)
So, you mean to tell me you can actually rule out every and all possible interferences (genes aside) that differentiate you from your siblings
I never claimed I could. What I said is that the genetic model seems able to account rather elegantly for things that a psychological model seems to struggle with. My personal experiences are a subjective and anecdotal illustration of my ideas, not the basis of them.
Since personality and mood disorders have become pretty much a plague
It’s a mistake, I think, to include personality disorders and mood disorders in the same category. My feeling (and it’s one that I believe is quite widely shared) is that personality disorders have been very largely invented to explain clusters of hard-to-treat symptoms that psychiatrists otherwise find it difficult to account for. Also, the ‘plague’ you refer to results, in my opinion, from the inaccurate description of people who are merely experiencing a temporary and reactive drop in mood as being ‘depressed’, when they are not in fact mentally ill.
does that mean that there’s this common gene going around that somehow has eluded discovery as the main or major cause for depression?
Again, you seem not to have paid attention to what I said:
It’s perhaps unlikely that a single defective gene is responsible for depression – if it was, it would probably have been at least tentatively identified already. If depression does have a genetic cause, it’s much more likely to be the result of the interaction between several genes.
You’ll note that I specifically addressed the issue of why the ‘depression gene’ has not yet been discovered, and also acknowledged the possibility that depression may in fact not have a genetic cause at all.
The research on schizophrenia, which is thought to be heavily influenced by genetic factors hasn’t pointed beyond the shadow of a doubt to one or more genes responsible for it.
Indeed. The situation we have with schizophrenia is that statistical analysis suggests that the condition may be inherited, but the specific genes involved have not been identified. This is precisely the point I was making with regard to my own family’s history of depression. One story like mine is, of course, nothing more than anecdote, but I believe it was an interesting illustration of why the possibility of a genetic cause might be worth considering.
I have little doubt that as far as schizophrenia and its derivatives are concerned, research will eventually point out exactly what’s the genetic factor.
I am curious as to how you can be so confident that schizophrenia does have a genetic cause, but that mood disorders do not. The evidence for bipolar disorder (which is a mood disorder) being inherited is really very strong – a point DeeDee Ramona highlighted in a comment on the original post.
Depression though is far too complicated to be reduced to a mere genetic flaw.
This is an unsubstantiated assertion. Why is it too complicated? How? In particular I would be interested to know on what evidence you base the assertion that schizophrenia is less complicated than depression, as this would seem to run counter to fairly widely-held opinions.
Also, I am unclear as to why you refer to ‘mere’ genetics. Genes have created every functioning mind that has ever existed, after all. Why is it impossible that they might produce a malfunctioning mind?
Certainly there might be genetic factors that make you more positively predisposed to mood disorders
Can you explain to me why, if a mood disorder can be partially genetic, it cannot be fully genetic? And by explain, I mean provide evidence, not just an assertion that it’s obvious, or that it must be true just because some other people have said it is.
to deny the environmental/social contribution in favor of genes seems as much nonsense as acquiting the knife because your body is made in such a way as to be susceptible to wounds.
No. To suggest that environmental factors cause mental illness the way a knife causes a knife-wound is nonsense, however. Or rather, to be fairer to you than you have been to me, a currently unsubstantiated assertion.
Also, the Clinical Psychologist belief is moot. If everyone could learn and do everything, we’d have just GPs doing all the work.
I think you may have misunderstood me. The reason I believe there will be no such job title as ‘Clinical Psychologist’ is because the things that clinical psychologists (as opposed to counselors) do will no longer be done by anyone. There will be no need for the specialists, because the specialism will, I believe, have been exposed for the (well-meaning, for the most part) confidence trick it is.
The psychologist exists to claim those cases that can either be helped by some sort of psychotherapy in combination with psychiatric medication or whose illness is such as to avoid medication entirely
I refer you to the point I made in my original post:
I also think there will be counsellors, but these will be limited to helping with sub-clinical problems (someone who is finding it difficult to cope with grief, for example), and to helping the mentally ill manage their symptoms. Counselors will not seek to claim, as many psychologists currently do, that they are able to divine the cause of mental illness, or to cure it.
I believe counselors will do these things, not psychologists. The difference? Counselors do not claim to have a clinical understanding of what causes disease, or how to cure it. They simply offer advice on how to cope.
As far as brain research on mental illness goes, the best I’ve seen is symptom description and the assumption that neurotransmitter density and movement is somehow related to a mental illness. Well, if it were that simple, how come anti-depressants don’t really work that way for all patients?
The fact that the current medical model is inadequate, which I would agree it is, does not mean the whole idea of a medical cause is wrong. Historically, physicians treated all kinds of physical ailments with blood-letting and leeches, treatments which were largely ineffective, or even counter-productive. This does not mean those physicians were also wrong in their assertion that illnesses had a physical, as opposed to moral or spiritual, cause.
And how come electrospasmotherapy sessions can actually work in some cases of severe depression that doesn’t seem to respond to medication?
Well, I googled ‘electrospasmotherapy’, and it returned only one hit – your comment on my original post – so I don’t know what it actually is.* That said, I’m assuming it’s either a different name for, or a new version of, ECT.
To answer your question: I would guess that applying an electrical current to the brain has an effect on its electrical functioning. As you will know, nerve impulses are propagated along the length of a neuron (nerve cell) electronically, and when they reach the end of the neuron, are transmitted across the gap to the next neuron (known as a synapse) by means of a biochemical agent known as a neurotransmitter. In other words, medication and ECT both have an impact on the transmission of nerve signals, but via different methods. It would seem reasonable to speculate that this difference of methodology explains why the different treatments are effective in different patient populations, although there is (as I understand it) no evidence for precisely how or why each treatment works.
Do note that even if medication did work without fail as in most physical illnesses, the difference is that your organism will never make antibodies for mental illnesses. You will eventually NEED some form of therapy to practice the behaviors that will shield you from being re-exposed to the same illness.
You seem to be confused as to the nature of physical illness. In particular, you seem to think that all physical disease is infectious disease – at least, your reference to antibodies only makes sense if you do. There are many examples of physical diseases that are not caused by an infectious agent (diabetes, haemophilia, cystic fibrosis, etc.). Some of these diseases require constant treatment with medication. Would you say that a person with one of these diseases needs therapy (in the psychological sense of that word), and not medication? My own feeling is that this approach would be rather less effective.
Please also note that you are (once again) making the assertion that it is ‘behaviour’ and not physiological factors that cause mental illness. You are yet to put forward any evidence in support of this assertion, even the sort of partial, speculative, apply-lots-of-caveats ‘evidence’ I put forward for an alternate view in my original post. Things don’t become true just because someone keeps saying them.
Remember that I’m talking about mood disorders and a number of personality disorders. Illnesses like of the schizo- kind seem to always need medication.
Again, on what basis can you be so certain that schizophrenia will ‘seem to always need medication’, but bipolar disorder (a mood disorder, don’t forget) will not?
Lastly, if you wanted to acquit yourself of the blame people place on you because many have this retarded belief that somehow the mental patient is responsible for his illness
Although I suspect you did not intend any disrespect to the learning disabled, referring to beliefs you do not share as ‘retarded’ does rather stigmatise this group of people. It is particularly unfortunate that you used this word in a sentence talking about how the mentally ill may overcome stigma. For the record, I have never felt that anyone with a learning disability has stigmatised me. On the contrary, it is almost always so-called ‘normal’ people who apply stigma.
you didn’t need to go as far as to outright deny the psychological contribution. It’s no one’s fault in the end
I refer you to the point I made in my original post:
For me, the greatest stumbling block encountered by the psychological model is that it struggles to explain why some people who experience negative life events are mentally ill and others are not. […] It seems to me that the psychological model is going to struggle to explain this in terms that don’t end up blaming the victim (i.e. me) for a personal weakness, or an inability to cope.
You are yet to suggest a solution to the problem I raised here. Simply saying that one exists somewhere is not enough. If you want me to take you seriously, you will need to actually identify the solution, and, as a minimum, offer convincing speculation as to how it might manage to overcome the difficulties I identify.
Opinions in what’s supposed to be hard science is really pathetic, but people choose to avert their eyes from that fact.
At last, something we agree on!
I must point out, though, that the whole of the psychological model of mental illness is based on opinion, unsubstantiated assertions, and unfounded conjecture. I will also point out that my original post advances (partial, incomplete and speculative) evidence for its assertions, and specifically emphasises that the conclusions drawn are both personal and provisional. That is to say, I never claimed them as hard science. I do feel it is rather unfair that you should have leveled this complaint at me, when you are not also leveling it at those who support the psychological model, who would seem to be rather more guilty of the thing you are complaining about.
Overall, the most interesting thing about your comment, npal, is what you have chosen not to mention. You haven’t, for example, offered any specific criticism of those parts of my argument where I have attempted to show how my opinions and beliefs might fit into established and emerging scientific knowledge and speculation. In particular, you haven’t challenged my assertion that a genetic model would seem to be able to account very neatly for why I am depressed and my siblings are not, and I and my grandmother suffer(ed) from depression, but my father did not. If I’m honest, I do find myself wondering: is this because you can’t?
Next up, NiroZ (read the full comment here)
Not your best article. […] you work in a straw man attack (nobody I know holds that psychological view, including psychologists)
I would invite you to consider that, in my original post, I specifically acknowledged that, in addition to those who defended the psychological and medical models, there were those who supported a ‘third theory’, which I described as ‘an uneasy synthesis’ of the psychological and medical models. This seems to me to be reasonably close to what you assert psychologists actually believe.
Now bear in mind that the key thing about a ‘straw man‘ argument is that you deliberately misrepresent the points put forward by your opponents, substituting their actual case for one that is easier to argue against. Since I made it clear that my attacks were aimed at the psychological model, and so were not aimed at the ‘third theory’ I had also outlined, is it really fair to say that I have ‘worked in a straw man attack’? In other words, that I have deliberately misrepresented my opponents? Mightn’t it be more fair (and, indeed, more accurate) to say that I identified a range of opinions, and then chose to concentrate upon a part of that range?
you made a false dichotomy (genes must be it, because upbringing can’t be it)
This, on the other hand, really is a straw man attack. You see I emphatically did not say ‘genes must be it, because upbringing can’t be it’. I said:
Depression may not have a genetic cause […] The fact remains, however, that a medical model like this is able to provide an elegantly simple account of why I suffer from depression, but my three siblings do not. It is also able to explain how the depression skipped a generation, and how I ‘caught’ it from a grandmother I never knew – she died 8 years before I was born. The psychological model, on the other hand, isn’t able to provide an answer to any of these questions, except to fall back on the unsubstantiated assertion that there is some deficiency within my character or personality that explains my illness. It’s for this reason that I’m inclined to believe – until compelling evidence to the contrary comes along – that major depression, in common with all other mental illnesses, has a physical cause.
I’m sure you have noted the difference there. In your straw man version, there are two categorical assertions – one that upbringing can’t be the cause of mental illness, the other that genes must be. Whereas what I actually said is that it seems difficult for the psychological model to explain some things that a medical model seems able to explain rather elegantly. Neither is a categorical assertion. One is an expression of doubt, the other a speculation.
you made a reverse post hoc ergo propter hoc fallacy (other people had the same upbringing as me, therefore it can’t be the causation).
Another straw man attack. I did not say that upbringing ‘can’t be the causation’ of mental illness. I said that the psychological model struggles to explain some things which a medical model seems to be able to explain rather elegantly. The difference, as above, is in the level of certainty I express. Your knowledge of Latin terminology is very impressive, but you should realise that it doesn’t help your case if, either through ignorance or a deliberate attempt to mislead, you misapply the terms you use.
The real most popular psychological theory on depression is the cognitive theory of depression. […] (5th entry on google, if you’d bothered doing actual research
Oh dear, NiroZ, you’ve done this in a previous discussion, you know – that is, accused me of failing to carry out sufficient research. That was when we were talking about atheism, if you remember. You attacked me then, too, claiming that I did not understand agnosticism, and that I was guilty of failing to carry out a basic level of research. Do you remember how that discussion ended? I’ll jog your memory: you seemed to be entirely unable to back up your claim that I did not understand agnosticism, and ended up saying ‘I guess your right regarding god’.
In the same way, you are entirely wrong to suggest that the kind of basic, entry-level information contained in the encarta article you link to is something I’ve never heard of, or do not understand. The alleged ‘cognitive errors’ this theory makes so much of I include in the category of ‘poor coping skills’. That’s all the presumed predisposition to think the worst is, after all – a suboptimal response to life events.
I also second jono’s comments on this point – where is the evidence for the cognitive model? Specifically, where is the evidence that negative thought processes are the cause of depression, rather than symptoms of it? In fact, to make use of some of the Latin terminology you’re so keen on, isn’t this an example of a cum hoc ergo propter hoc argument? That is to say, one that’s based on the mistaken assumption that correlation equals causation? In other words, where is the evidence that, because people who are depressed have negative thoughts, negative thoughts must be the cause of depression? How do you prove that this is anything more than a straightforward logical fallacy?
As with agnosticism, it would seem there is a chance that I actually understand the cognitive model better than you, not worse. Certainly, I have been able to point out flaws in the argument which seem to have escaped either your understanding or your attention, or both.
I thought you said you figured out CBT in 10 minutes.
Perhaps you can explain to me where I have demonstrated a lack of understanding of how CBT works? This would appear to be one of your wilder and more irrelevant accusations.
Just because it wasn’t the upbringing doesn’t mean it wasn’t the environment.
And yet another straw man. I didn’t talk about upbringing in isolation. I talked about what I called the psychological model, which I defined like this:
it holds that mental illness […] results from a combination of negative life events and poor ‘coping skills’.
It’s you, NiroZ, who have oversimplified, and have up to this point written only about upbringing. Presumably, therefore, you are criticising yourself here.
It could be the peers you interacted with, the adults in your life, it could be an event that you experienced, it could be something that happened in your school grade. It could be something that happened after you left home.
Again, all of these fit absolutely within the definition of the psychological model I reproduce above. It follows, therefore, that my criticisms of the psychological model apply to these potential causes you mention. Just to remind you, this criticism takes the form of a question, not a categorical assertion: why do only some people who experience these kinds of things get ill?
It could be something you ate (like that neuroparasite that lives in cat feces), it could be a disease you suffered that got to your brain.
Well, you’ve got me bang-to-rights on this one, NiroZ – I didn’t discuss the possibility that depression is caused by an infectious agent or a parasite. There was actually a good reason for that, since no-one has seriously suggested that it might be. And there’s also a good reason why no-one has raised it as a serious suggestion. You see, if depression was caused by a parasite, you’d expect it to exist in geographical clusters, reflecting the areas where the parasite exists in greater numbers, as happens with, for example, elephantiasis.
Similarly, if depression was caused by an infectious agent, there would likewise be evidence of clusters, reflecting the fact that the pathogen was circulating more freely within particular populations. There would also be ‘good’ and ‘bad’ periods for depression (or new diagnoses of depression, if you believe the damage caused by the pathogen is permanent, and persists even after the infection has been cleared). All infectious diseases, even ever-present ones like tropical Malaria, have peaks and troughs of activity.
I also can’t help but notice that you are now proposing solutions to the problem that actually undermine your own preferred psychological explanations. I would suggest that, all in all, raising this possibility has perhaps not been your smartest move.
you jumped straight to genetics.
And one last straw man, just for old time’s sake.
I didn’t jump straight to anywhere. I highlighted something that I felt the psychological model struggled to explain, and suggested that a genetic model seemed able to explain this same phenomenon simply and elegantly. I note, as with npal, you haven’t actually challenged the specifics of this idea. I feel forced to ask, in your case too – is it because you can’t?
Well, I hope my responses to these responses have been interesting. I also hope anyone who disagrees with me will feel free to say so in the comments – this has been an attempt to continue the discussion, not close it down. That said, I hope you can all understand that I am unlikely to stand quietly to one side where I feel I am being unfairly attacked. In addition, I’m likely to respond with greater vigour where I feel I have been deliberately misrepresented, or my understanding of basic concepts has been called into question, without any evidence to back up these assertions. Where I am proven wrong, I am always happy to acknowledge the fact – we all have more we can learn, and I probably have more to learn than many.
* – For the record the ‘electro spasm therapy’ that google suggests as an alternative to ‘electrospasmotherapy’ seems to be a group of treatments for muscular and circulatory problems. From the context of the remarks, it seems unlikely that this is what npal is referring to.