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Is Depression Real? (Book Review)

In our belief that depression is a “mental disorder” or “mental disease,” Dr. Eric Maisel believes that we’ve been “sold a bill of goods.” In Rethinking Depression, he sets out to explain why. 

The first part of Eric Maisel’s Rethinking Depression (2012) explores whether “depression” as a medical diagnosis is even real. He marshals some impressive arguments that it is not in fact real. Rather, according to Maisel, depression is a matter of profound unhappiness, which can ultimately be traced back to a lack of meaning. He lays out this thesis in more detail in the second half of the book. 

If depression is a medical problem, why is there no on physical test for it? And why are the symptoms so vague and arbitrary? It seems as though the diagnosis of “depression” was tailor-made to ensure lots of potential patients with the convenient cure of antidepressants.  

As for antidepressants, Maisel holds a dim view of them. While he never full-throatedly disavows antidepressants, he doubts their effectiveness, citing studies in which placebos have similar efficacy. And if they do work, well that is no wonder. Any chemical could have an effect on your body. Therefore, even if antidepressants make a supposedly depressed person feel better, that is not proof that there is such a thing as “depression,” nor is it proof that antidepressants are treating such a disorder. Instead, merely it is a drug having a chemical reaction in your body.  Furthermore, according to Maisel: 

“...drug companies regularly suppress research demonstrating the ineffectiveness of the antidepressants they sell, thus producing an inflated sense of their effectiveness” (32) 

Another issue which Maisel discusses is the high rate of relapse with antidepressants, with 80 percent relapse rate after patients stop taking them.  This leads Maisel to the following conclusion: 

“...the extremely high relapse rate after patients discontinue antidepressants suggests that effectiveness is being defined by the temporary alleviating or masking of symptoms” (32). 

According to Rethinking Depression, antidepressants may work insofar as chemicals can change your body, make you alert, even make you hallucinate. But the fact that chemicals change your mood or affect your body doesn’t necessarily indicate that one is treating “depression.” 

Maisel ventures a valid opinion on antidepressants, and later develops his thesis, which is that profound unhappiness is an existential problem rather than a medical or chemical one. It’s a profound theory in itself, which doubtless has some truth to it. That said, I am not totally convinced that there isn’t some “chemical” or biological aspect to depression, especially considering that it’s genetic and heritable. True, scientists don’t know exactly what causes it, and recently there was a controversial study which apparently showed that serotonin might have nothing to do with depression. But despite that, it does seem that drugs which interact with serotonin have a big effect on depression, if one can deal with the side effects. 

This doesn’t invalidate Maisel’s views on the importance of existential questions in addressing depression, or “profound unhappiness” as he calls it. It is at least a useful frame for looking at these questions, even if there is more of a medical basis for depression than he allows for. 

What about psychotherapy? Maisel holds less of a dim view of psychotherapy as opposed to antidepressants.  Yet he denies that psychotherapy holds any special medical significance; rather, it helps to the extent that talking helps. Chatting with someone knowledgeable and savvy in psychological matters is bound to have a positive effect, just as talking with a good friend can. Psychotherapy per se is rarely practiced anyway; rather, most psychiatrists engage in something more akin to simply talking with patients, and this seems to help; though Maisel still does not concede that this proves that a “mental disorder” is being treated. 

In sum, Maisel attributes what we call “depression” as a mental disorder instead to mild to profound unhappiness. It stems, he believes, not from a chemical problem in the brain, but rather from a failure to address what is meaningful in one’s life, and a failure to identify what is important in one’s subjective experience of reality. The way that we diagnose depression is perfectly random, a grab-bag of symptoms. Therefore, no one has adequately addressed what depression is or how to treat it with medicine. Instead, Maisel regards all this as “human sadness” and describes his plan for how to address it in part II of his book. 

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