Consider this segment of a debate between Thomas Szasz and several other academics concerning depression as a mental illness:
GOODWIN: As you yourself said, we don't involuntarily treat people for medical diseases. I'd like to as you . . . do you think Alzheimer's is a disease?
SZASZ: Of course it is a disease.
GOODWIN: And it involves behavior?
SZASZ: Of course it involves behavior. Doesn't having a cold involve behavior?
GOODWIN: You said if it involves behavior it couldn't be a disease.
SZASZ: No, you don't diagnose it, Alzheimer's, if I may remind you. Who discovered Alzheimer's? A pathologist, on the corpse.
GOODWIN: Now they are close to diagnosing with brain imaging . . .
SZASZ: Brain imaging is a great scientific discovery.
GOODWIN: Now they do that with depression as well, you are aware of that?
SZASZ: Of course I am aware of that.
GOODWIN: So here you have two illnesses, one we call Alzheimer's which you say is a disease, it involves a whole range of behaviors, feelings, thinking, behaviors. There's another one that involves behavior, feelings, thinking, behaviors . . .
SZASZ: But depression is a highly reversible phenomenon.
GOODWIN: Is that your criterion for disease? What about pneumonia?
SZASZ: No, but Alzheimer's is not.
GOODWIN: Does that mean diseases are not reversible?
SZASZ: Look, the criterion for disease is not made by you and me. As you know, depression is not listed in textbooks of pathology. Maybe when it's listed in textbooks of pathology I might be willing to concede, like Dr. Klein suggests, that it's like neuro-syphilis or epilepsy, the history of medicine, it's quite correct, you discover new diseases, like AIDS.
Why would Szasz classify Alzheimer's as a disease, and not depression, given the apparent involuntary physiological effects (lower serrotonin levels, brain scan differences) that are present in both conditions?
The full debate is here:
www.szasz.com/isdepressionadiseasetranscript.html
EDIT: Clarified some points, improved my question.
Szasz seems far closer to being right, if the other dude is in opposition.
Psychology is a limited subject. Most people in the social scienes have their panties in a bunch and try to "mimic" fancy medical words by using lots of greek, latin, and fancy science jargon where it does not need to be used. So we end up with idotic theories like behaviorism and elimantive materialism (maybe evo psych, not so sure on this though). These all insisting and all embracing approaches, where the science becomes a chincy, substandard metaphysical setting has always been bizzare to me.
Economics and sociology are sometimes just as bad - though of all the subjects mentioned economics seems to have the most sane outllok as a whole (maybe that's just because what I have formally studied the least).
"As in a kaleidoscope, the constellation of forces operating in the system as a whole is ever changing." - Ludwig Lachmann
"When A Man Dies A World Goes Out of Existence" - GLS Shackle
I think you are cherry picking an exchange from a large, unstructured live debate to extract a deeper meaning that isn't there. Debates that occur in that fashion rarely evoke the best types of answers, so even though the intent is noble the value of the results should be taken with a grain of salt.
I doubt upon reflection that Szasz would have considered that the best way to handle that exchange, especially where Goodwin was trying to walk him down a line of deceptive reasoning.
Could someone just answer my question?
Fine. I'll answer your question again in a different way. An association of psychology with the "medical model" is a dubious claim. It looks as if Szas is stating this from the snippet you gave. If this is the case, I agree.
*PS depression can be an early symptom of Alzheimers.
Also, In order for something to be an actual depression diagnosis, it has to conform with a DSM IV diagnosis. This diagnosis is already categorically different than Alzheimer's
Also, you really have to know the diagnostical differences between signs and symptoms. Depression can only be treated as a symptom. It is a phenomena, a "mere idea". This is what makes phenomnology oh so important in the social sciences.
I am of the opinion (as were Kant, Freud, Misses, and Husserl among many many others) these things are impossible to prove on a "physical" basis - even when one says a fancy latin medical word - it is simply turned into an "idea" in this case. Szasz seems to be hinting at this as well.
EDIT
jordan161:Could someone just answer my question?
That's kind of the point you don't seem to understand; answering the question is somewhat meaningless given the context.
Nonetheless, the effects observed from Alzheimer's and the effects observed from "depression" are completely different in nature. Changing your mood and developing better techniques for dealing with life will not change the effects of Alzheimer's, whereas they will (most likely) change them for depression. Stress causes bodily harm under any circumstances.
Nonetheless, the effects observed from Alzheimer's and the effects observed from "depression" are completely different in nature.
Correct
I really wouldn't mind doing an article on what psychology is and what it isn't. I really think predetors can use it to rear end and manipulate some poor naive unsuspecting rubes. No social science seems to turn to junk so quickly and inflame the "pop" mind as much as psychology.
I would suggest to anybody who does not pay real money and time to study psychology (i.e. college psych courses and / or degrees, professional recomendations) to stay as far away from it as posssible.
jordan161: Could someone just answer my question? Why would Szasz classify Alzheimer's as a disease, and not depression, given the apparent involuntary physiological effects (lower serrotonin levels, brain scan differences) that are present in both conditions? What is (your/their) definition of disease, and what is the signifficance of classifying a certain phenomenon as such (or not) in a binary fashion? | Post Points: 20
I doubt upon reflection that Szasz would have considered that the best way to handle that exchange
+1
The real issue here is one of competency. In general, the Alzheimer's patient is incompetent. So he must have someone else decide on his behalf what are the appropriate treatments.
The depressed individual, on the other hand, is not incompetent. He can make decisions in the broadest sense. He is experiencing spiritual/mental unease, which is why he sought help from a counselor. Where the counselor oversteps the bounds of ethics is when he starts using medicalese to daze his client and persuade him that he needs drugs which cannot be proven to cure anything.
Depression is not a disfunction of any well-understood aspect of the body. Statistical studies showing correlations between depression and blood-flow in the brain do not assist in helping us find treatments and, in any case, they are looking in the wrong place. You can't cure a fever by turning down the thermostat, yet this is precisely what psychiatric drugs do. Without anything even remotely resembling a causal theory, psychiatry is just random, groping about in the dark.
Clayton -
Clayton: You can't cure a fever by turning down the thermostat, yet this is precisely what psychiatric drugs do.
You can't cure a fever by turning down the thermostat, yet this is precisely what psychiatric drugs do.
Yay! This is the answer I hoped for - so I think you're saying that depression is a symptom like a cough, and maybe that it is a symptom of a mental state, if I can elaborate further?
myhumangetsme: That's kind of the point you don't seem to understand; answering the question is somewhat meaningless given the context. Changing your mood and developing better techniques for dealing with life will not change the effects of Alzheimer's, whereas they will (most likely) change them for depression. Stress causes bodily harm under any circumstances.
Changing your mood and developing better techniques for dealing with life will not change the effects of Alzheimer's, whereas they will (most likely) change them for depression. Stress causes bodily harm under any circumstances.
Thanks! You're saying that depression is more of a physical state, then?
I would like to add that I presented the debate as background; I'm not grading either opponent. I like Szasz's ideas but I found myself unable to answer that question.
I going through Szasz's work right now, and am not in a position to answer those questions to the best of my ability. Thanks for the input though.
jordan161: Why would Szasz classify Alzheimer's as a disease, and not depression, given the apparent involuntary physiological effects (lower serrotonin levels, brain scan differences) that are present in both conditions?
Note: we don't actually know that depression is caused by lower serotonin levels, or that serotonin levels are indeed low. We know that blocking serotonin reuptake seems to alleviate some depression symptoms, but that doesn't mean we are reversing the cause of the symptoms; we could just be masking it. For instance, if your car's engine is overheating, and you pour water on the engine, you have cured the symptom; you haven't cured the cause (e.g., broken antifreeze tank).
Also, the brain scan differences don't mean anything. There is a difference between your brain scans depending on whether you're thinking about a chicken or a mouse. So, since of course "the internal mental states" of depressed people are different from the normal ones (they tend to be... more sad), their brain activity will be different.
In other words, saying that there are different brain scans is the same as saying "my car is driving slower than usual, and also the speedometer shows a lower value".
I.e., we don't really know what causes depression.
As to whether it's a disease or not, I would say that it's a subjective definition. Baldness is a disease if it cases lower quality of life for the person. Clearly, depression does that. So, I would say it's a disease. There seems to be an argument that a condition is not a mental disease if it doesn't remove freedom of will from the person. I don't see why that's the case. If one cannot recognize faces, or forgets numbers, or can only perceive right part of his visual field, has recurrent nightmares, or cannot move his right arm -- all these conditions are diseases (or abnormalities, or dysfunctions). Yet, one's freedom of will is not comrpomised in them.
jordan161:You're saying that depression is more of a physical state, then?
Quite the opposite. Alzheimer's exists in a physical state, despite the fact that its source has not yet been identified. Sad feelings (which are a metaphor, mind you) do not. Sad feelings may influence your physical state, but they are not a physical state in and of themselves.
To look at this a different way: Do people who feel ugly have a disease? If so, is plastic surgery considered to be the cure that doctors prescribe for it? If doctors are allowed to do so and the patient refuses it, should doctors be able to force them to have that plastic surgery? What if someone who agrees to have plastic surgery has it and they still feel ugly? What if someone is coerced to have it and still feels ugly?
Awesome!
This can be extended to the behaviorist idea that drugs can cure "mental illness" by simply altering behavior: If the doctor prescribes a drug for the ugly person that messes them up mentally so they are a zombie and don't care about anything - let alone whether they are ugly or not - can we say that the doctor has "cured" their ugliness??
myhumangetsme: jordan161:You're saying that depression is more of a physical state, then? Quite the opposite. Alzheimer's exists in a physical state, despite the fact that its source has not yet been identified. Sad feelings (which are a metaphor, mind you) do not. Sad feelings may influence your physical state, but they are not a physical state in and of themselves.
Apologies - I meant mental, not physical.
I really like that plastic surgery example.
Actually, I think we have a pretty good idea. If someone says, "I'm depressed" and you ask why, they might say "My Dad passed away." Of course, this isn't what the psychiatrists call depression, it's just sadness or grief.
So what is depression? All the psychiatric descriptions have one common thread: feelings of powerlessness, loss of control in one's life. Depression is a natural response to disempowerment. This is why it's so politicized. We are living in a tyranny and this fact manifests itself through widespread depression. There is a quote from Etienne de la Boetie that always sticks with me:
"From all these indignities [of tyranny], such as the very beasts of the field would not endure, you can deliver yourselves if you try, not by taking action, but merely by willing to be free. Resolve to serve no more, and you are at once freed." [emphasis added]
I think Molyneux did a bit on this where he points out that even animals kept in cages become lethargic and dispirited. The propaganda of "freedom" is so successful that people literally cannot figure out why they are lethargic and dispirited. But Big Pharma has a cure... it's called Xanax and Prozac. Just take that and you won't give a shit about anything, let alone that you are living in a soul-sucking tyranny.
vive la insurrection: Also, you really have to know the diagnostical differences between signs and symptoms. Depression can only be treated as a symptom. It is a phenomena, a "mere idea". This is what makes phenomnology oh so important in the social sciences. EDIT
Thanks, this explanation also works (depression as a symptom of something else, maybe a mental state), although I'm not sure about the "mere idea" part. Could you elaborate as to why depression is a "mere idea"?
I think the plastic surgery analogy perfectly shows the stupidly of declaring depression a disease. If depression is a disease is low self-esteem also a disease? Promiscuity? Laziness? There would be no end to the temporary afflcitions which could be labeled diseases.
I was looking for something I read of Szasz's that really hit home with me in my more economic frame of mind, but I couldn't remember it thoroughly nor where I read it. After furiously skimming my collection I found it in the Introduction to The Theology of Medicine:
Human life—that is, a life of consciousness and self-awareness—is unimaginable without suffering. Without pain and suffering, there could be no pleasure and joy; just as without death, there could be no life; without illness, no health; without ugliness, no beauty; without poverty, no riches; and so on ad infinitum with the countless human experiences we categorize as undesirable and desirable. All our exertions—moral and medical, political and personal—are directed toward minimizing undesirable experiences and maximizing desirable ones. However, if the calculus of personal conduct could be reduced to such a simple prudential principle, human life would be much less complicated than it is. What complicates it of course is the fact that many of the things we regard as desirable are opposed by, or can be secured only at the cost of, others that we regard as also desirable. There seems to be no limit to the internal conflicts and contradictions among the things we abstractly value and wish to maximize. For example, enjoyable eating or drinking often contlicts with good health, sexual pleasure often conflicts with dignity, liberty often conflicts with security, and so on. This is, quite simply, why the pursuit of relief from suffering, reasonable though it may seem, cannot be an unqualified personal or political goal. And if we make it such a goal, it is certain to result in more, not less, suffering. In the past, the greatest unhappiness for the greatest number was thus created by precisely those political programs whose goal was the most radical relief of suffering for the greatest number of human beings. While those campaigns against suffering were in progress, people viewed them with unqualified approval; now we look back at them as the most terrifying tyrannies.
Brilliant.
Depression can only be treated as a symptom. It is a phenomena, a "mere idea".
A good way to think of it, is depression is depression - NOT neccessarily low dopamine levels, etc.
Depression is also tricky to easily pin down for a simple answer- there are many forms of it (bipoler, cyclothimia, etc) - many have very real signs and symptoms of their own (of which quite a few are physical). In many cases depression may be more aptly looked at as a syndrome or disorder than a disease - but that is beside the point (this should be uncontroversial). The point is that the "medical model" by itself tends to be insuffucient for many of these psychological ailments (which are very real)- though pharmacology can indeed help, in many cases, particularly mixed with therapy.
People just have a tenedcy, especially in the popular mindset, but also within certian schools of psych thinking - to turn a method into a mindset. This is bad and not good for patient care.
As to whether it's a disease or not, I would say that it's a subjective definition.
No it isn't. If someone asks if ALS is a disease, it is. In this case an unqualified "no" is going to be judged by the medical model which actually tells us what diseases are. You cant obsucrant or skepticize your way out of functional language.
To give an econ analogy (i think?) this was part of Hayek and Mises problem with market socialism