This is a continuation from Part 1 of this article.
Psychotropic medication is used because of the view that psychological problems, like anxiety or depression, are “chemical imbalances,” a very vague concept. What “chemicals” are they talking about? And what is the “right” balance? No one can answer this, because no one knows. There’s no medical test to identify an imbalance of this sort, if an imbalance even exists. And, even if someone could actually prove an imbalance of some chemical (say serotonin), then how would they know what caused the imbalance in the first place? This is a theory, a hypothesis, with very little if any scientific support. Nonetheless, it’s accepted by many in my profession (and unfortunately, by much of the public) as scientific fact. In my view, it is irresponsible on the part of professionals to present as fact something that is theory.
If medication works for you in managing your anxiety and depression, then fine. I’m for anything that truly helps resolve the problem. In my experience, however, I have seen hundreds of clients with anxiety, depression, or both, and only a couple (maybe two) reported that it actually worked to resolve their problem and left them functioning at a level they were happy with; however, they eventually discontinued its use because the side effects were so unpleasant (which is why they were seeing me). Every other client I have seen that had taken or were still taking medication reported it was not enough to fully manage their depression or anxiety. Many had tried multiple types of medication at various doses, but that didn’t work either. At best, some report that it helps somewhat, and some are not sure if it’s the medication or something they’re doing. Nonetheless, it wasn’t enough on its own.
What you report is rare in my experience—that the medication completely resolves the problem. I’ve heard the same from other colleagues. Maybe other mental health professionals and clients have had better results, and my experience is somehow weirdly skewed. But then why are there still so many people with anxiety and depression? If it were actually true that medication was that effective, then why hasn’t depression or anxiety been eradicated?
In your case, assuming the medication gets all the credit, this does not prove that the cause of depression or anxiety is biological. Taking any drug will have an effect on how you feel, whether you’re depressed, anxious, or feeling normal. The fact that an anti-depressant makes you feel better doesn’t prove the primary cause of the depression (or anxiety) is biological. It only proves that taking the drug changes how you feel. Taking a pain killer numbs your pain, but that doesn’t tell you the original cause of the pain. Snorting cocaine gives you a euphoric feeling whether you’re depressed or not.
Overcoming depression or anxiety is not just an intellectual process, which makes me think you’ve never seen a good cognitive therapist. Cognitive therapy does not just address a person’s thinking; it addresses the connection between thoughts, feelings, bodily sensations (like you mention) and behavior. All of these affect one another, but the cognitions are viewed as primary. I agree that no amount of just thinking will eradicate anxiety, depression, or any other problem. You can’t think your way out of depression or anxiety. The thinking is the primary, so has to be addressed, but then you have to act on that thinking. When depressed, one might hold a hopeless view of the future. This has to be challenged cognitively, but then the client also has to take action toward a future goal and see in reality if things get better. If a client’s depressed because he’s unemployed, the therapist might, for example, work with him to create a plan to take action to find a job, which would help to change how he feels.
This is also true for anxiety. Changing thinking and beliefs is usually not enough. With phobias, for example, one of the most effective treatments is exposure therapy (a part of cognitive-behavioral therapy), which has the anxious person face his fears through exposure to the thing or situation he’s afraid of. For example, all the thinking in the world usually won’t eliminate someone’s fear of riding on elevators. In addition to some cognitive work, you would have the client get on an elevator (or imagine it) and stay on it until his anxiety spikes and then eventually goes down. Through experience, he learns there’s nothing to be afraid of.
Outside of an identifiable physical problem (i.e., hyperthyroid, brain tumor, or some other organic problem), there’s no reason to blame one’s brain for depression, anxiety, or any other psychological problem. It also doesn’t follow to give up on rational thought followed by action as the primary means to resolve these issues, just because it hasn’t worked so far.
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Dr. Steve Orma is a San Francisco-based licensed CBT clinical psychologist, recognized mental health expert, and specialist in the treatment of anxiety, stress, and insomnia.
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