01. Is depression not a disease? But was it "medicalized"?
Recently, I saw an article written this year by Peng Xiaohua, a traveling scholar, writer and translator, "Vigilance! The phenomenon of "medicalization" of depression is continuing to spread in China."
In this article, she said that from diagnosis, causes to treatment, the "physio-psychiatric" model of depression is not reliable, but relies on the "human-psychological" model. From the latter's perspective, depression is not of unknown etiology, but is the result of interpersonal conflict/injury, life challenges, or negative life events.
Moreover, because depression is still not diagnosed by laboratory tests and imaging tests, only by symptoms, and does not pay attention to the root cause of the disease, she believes that this diagnosis is also unreliable, subjective and arbitrary.
She pointed out that whether in China or the United States, the overdiagnosis of depression and the excessive use of antidepressants have become important issues, "doctors do not ask about the cause, only deal with emotional symptoms, just like doctors regardless of the cause of fever, directly give patients antipyretic drugs." This goes against common sense."
She believes that many so-called depressions are actually life difficulties and challenges, and what they have to do is to learn to face and cope with these difficulties and challenges, and deal with interpersonal relationships. But this phenomenon is "medicalized", "constructed" by psychiatry and drugs as "depression", and then prescribed drugs to depressed patients.
Finally, she said that the really effective treatment methods that can touch the root cause should be psychological counseling and talk therapy; And families, schools, institutions, and society should strive to improve the construction of good interpersonal relationships with patients, and at the same time, patients should also exert subjective initiative to face problems and learn to regulate their emotions.
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In addition to being a translator and writer, Ms. Peng Xiaohua is also a psychological counselor and psychotherapist. She prefers to interpret the formation and treatment of depression from the perspective of psychosocial factors, which is completely understandable.
Moreover, many of the points in her article are shared by me. For example, the root cause and cause of depression are indeed psychosocial factors, psychiatric drugs can indeed only relieve symptoms, but can not solve the root cause of the disease, it is difficult to move towards real recovery by taking medicine alone.
In the United States, for example, there is indeed a problem with overuse of antidepressants, a phenomenon that has been criticized for many years. If antidepressants are overused, it is indeed not conducive to the patient's recovery, and may even cover up the psychological root problems and the aggravation of the disease due to the side effects of the drug.
Moreover, if the root cause of depression is solved, patients can indeed truly recover, and they do not necessarily have to take drugs for life, let alone "lifelong chronic diseases" as Academician Lu Lin once said.
However, because she is a practitioner in the field of "humanities-psychology", her understanding of psychiatry and depression is actually biased, and her understanding of the causes of depression is not deep enough.
Is depression a disease at all? What is the root cause? Has it been "medicalized"? What can be done to better solve "depression"?
I think this is to be addressed through a multidisciplinary approach (MDT) that combines psychiatry, psychology, and pedagogy, and our breakthrough discovery through deep hypnosis (TPTIH).
02. Acknowledge and understand the disease of depression, in fact, the benefits outweigh the disadvantages
Although Peng Xiaohua did not say directly in the article, I speculated from between the lines that she tended to think that psychiatry established the diagnosis of "depression" as an inappropriate disease, because it has no observable physiological lesions, diagnosis mainly depends on symptoms and scales, the so-called "neurotransmitter theory" is still only a hypothesis, unproven.
From the depression patients she contacted, these patients encountered negative events such as interpersonal conflicts, life difficulties and challenges, and they felt pessimistic, painful, and hopeless is normal, and human beings have been facing and coping with these problems.
At this point, I think her view is biased and possibly biased against psychiatry. "Depression", which is originally just the discipline of psychiatry for people with certain symptoms, it only represents psychiatry, not psychology, let alone philosophy, sociology and other humanities.
And depression is originally a "symptomatic diagnosis", not a etiological diagnosis, that is, as long as the patient has the corresponding symptoms, reached the corresponding length, and also ruled out physical causes (such as low thyroid hormones can also cause patients to have symptoms similar to depression, but this is obviously not depression), then the diagnosis can be made.
Most disorders in psychiatry are symptomatic, including obsessive-compulsive disorder, ADHD, bipolar disorder, schizophrenia, and even autism. Only a small percentage of diseases are etiologically diagnosed, such as post-traumatic stress disorder (PTSD).
The goal pursued by clinical medicine is etiological diagnosis, but now psychiatry cannot do it, and the development of the discipline is relatively backward, which is indeed the limitation and embarrassment of this discipline.
Now clinical medicine has developed to the stage of precision medicine, and in recent years, psychiatry has also emerged "precision treatment", but this refers to genetic testing of patients to see which psychiatric drugs are more likely to work on TA, rather than precision treatment for the cause.
As for the so-called "depression gene" research, countless scientists have been conducting research for many years without reaching convincing conclusions, and in recent years have begun to turn to epigenetic mechanisms to try to find answers.
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However, the limitations of this discipline in the diagnosis and treatment of depression do not mean that it should not establish such a diagnosis; Otherwise, symptomatically-diagnosed disorders such as schizophrenia and autism will also be overturned. These diseases are not identified by physiological lesions in the first place.
Moreover, the diagnostic criteria for depression in psychiatry are very specific, clear and strict, leaving little room for subjective or arbitrary judgment by doctors.
When a patient is diagnosed with depression, it means that their emotional symptoms have become serious to a certain extent, and they need to be highly valued by medical staff and those around the patient, treating it like a major disease, rather than thinking that the patient has just encountered some difficulties, that the patient is drilling the horn and so on.
As for whether to take medicine at the beginning, patients and families can discuss with their psychiatrist. Now many doctors also believe that mild to moderate depression can not take medicine first, but through professional psychological counseling or psychotherapy, or the support and understanding of relatives and friends, gradually towards recovery, if the condition worsens then take medicine.
From this point of view, I think that popularizing the disease "depression" to the domestic public is more beneficial than harmful, which helps people to detect and diagnose early, pay attention to it early, and deal with it early, which is actually a good thing on the whole.
Many adolescent parents do not have this knowledge, do not notice the signs of depression in their children, think that the child is just adolescence, rebellion, thus missing the best time to deal with it, and when they realize it, the child has reached major depression.
In addition, there is a problem, many people understand that "depression" and "depression" are not the same thing.
Peng Xiaohua's article cites a piece of data. According to the "Report on the Development of Chinese National Mental Health (2019-2020)" released by the Institute of Psychology of the Chinese Academy of Sciences, the detection rate of adolescent depression was 24.6% (including 7.4% for severe depression).
Peng Xiaohua believes that this data and proportion are so large, but experts still point out that it has not been fully detected, that is, the actual number of patients is more! By implication, she thinks it's overdiagnosis.
In fact, this is a misconception, depression detection rate refers to adolescents who have had "depressed mood" or "depressive state", not adolescents who have suffered from depression. Many of us may have experienced depression when we encounter difficulties or setbacks in life, which is called "emo" on the Internet, but this is not the same as depression.
However, these adolescents are indeed at high risk of depression, and if psychiatric examination is carried out, it is very likely that there may be real depressed patients. Parents and teachers should pay close attention to their mental and psychological state.
Also, in psychiatry, not only depression can cause major depressive episodes, but also bipolar disorder. If post-traumatic stress disorder (PTSD) is not effectively relieved, it can also lead to a major depressive episode.
That is to say, we see that someone around us has a depressive episode, and TA is not necessarily a depressed person. When we see people commit suicide in the social news, they don't necessarily have to be depressed.
Just because the public is relatively familiar with depression, it is easy to confuse other mental disorders with depression. Even sometimes individuals are only briefly depressed, sullen, and have some abnormal behavior, and the public also thinks that TA has depression. This is actually a misunderstanding among the public.
03. The role of mainstream psychological counseling/psychotherapy is also limited, why?
As mentioned above, depression in psychiatry is indeed a symptomatic diagnosis, only looking at the symptoms, not paying attention to the cause. Therefore, the main treatment methods of psychiatry for depression are drug treatment and physical therapy, which aims to relieve the patient's emotional symptoms, make the patient look better and feel more stable.
The limitations of this treatment are obvious, and it does not solve the problem of the psychological root. The patient's mood is better after taking the medicine, but when encountering some external stimuli, the mood is easy to fluctuate, which is manifested as repeated disease and easy recurrence.
However, are the mainstream psychological counseling/psychotherapy techniques, or the "talk therapy" mentioned by Peng Xiaohua in the article, more effective when used to treat depression? Not necessarily.
If mainstream psychological counseling/psychotherapy techniques were really so efficient and effective, patients and families would have already sought out psychological counselors and psychotherapists, instead of waiting in long lines at the door of the consultation room of famous psychiatrists.
We have seen many patients with depression, and when they come to us, they also see many counselors/psychotherapists, most of whom say that it does not work much, and a small number of people say that it is useful. And to say useful, often also feel that someone can comfort themselves, understand themselves, the heart will be more comfortable, but in fact can not solve the substantive problem, the condition is still repeated, many patients and families call it "psychological massage".
Of course, in reality, are there any depressed patients who did not take medicine, but went to recovery by receiving psychological counseling/psychotherapy? Of course, there are, but there are not many of them, and they are mainly adult patients who are not particularly anxious to recover and whose cognition is relatively rational.
For adolescent patients, they often affect their schooling after illness, and they urgently need more efficient treatment methods to help them return to the growth track as soon as possible, and mainstream psychological counseling/psychotherapy has little effect on them. Moreover, many adolescent patients have certain paranoid personality changes, involve a lot of knowledge, and it is difficult to get their agreement with what the general counseling / psychotherapist says.
Therefore, many psychiatrists do not recognize the role of psychological counseling/psychotherapy, not entirely because they do not understand the subject, but because they find that the effect of this therapy on patients with depression is not ideal and unstable.
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Especially when the depressive symptoms are very serious, the patient's catastrophic thinking is very serious, and they cannot listen to the words of psychological counselors/psychotherapists, then drug treatment is more advantageous and can stabilize emotions faster.
Some readers may find it strange to read this. Dr. He, as you said above, you also believe that the root cause of depression is indeed psychosocial factors, so why is it still difficult for mainstream psychological counseling/psychotherapy to cure depression?
This is mainly because the mainstream counseling/psychotherapy school techniques still do not have a deep enough understanding and treatment of depression.
For example, Peng Xiaohua mentioned the humanist school in his article, the founder of which Rogers believes that emotional disorders are fundamentally caused by poor relationships and communication.
Baker, the founder of the cognitive behavioral therapy (CBT) school, believes that depression is related to an individual's irrational cognition, and if cognition can be changed, patients can get rid of emotional pain and get out of depression. The irrational cognition of patients often comes from negative experiences in childhood and childhood.
Also, Basil van der, an American psychiatrist and author of "The Body Never Forgets", said that he found that more than half of depressed patients experienced more serious psychological trauma such as being beaten, neglected, or even sexually assaulted and subjected to domestic violence in childhood, which is the main source of their illness.
All of the above understandings have some truth, and they are also different problems faced by the group of depressed patients. Moreover, Beck and Van der knew each other relatively deeply, and they saw negative events in the patient's life experience, that is, psychological trauma.
However, in the practice of psychotherapy, cognitive behavioral therapy (CBT) has little effect on many patients with depression. There are many misperceptions in patients and they are difficult to correct. They sometimes get into sophistry with counselors/psychotherapists, or they get into a "I understand the truth, but I just can't do it, my mood is still terrible."
The psychological trauma Van der Cocker said are obvious and significant events that patients can remember, and many of them are comparable to the level of post-traumatic stress disorder (PTSD). But the problem is that many depressed patients want to think about it, they have not experienced so much trauma, in the eyes of the public, their lives are quite smooth, their parents are very good to them, and their grades are good, why do they have depression?
For these patients, mainstream counseling/psychotherapy is more difficult to work.
So, what exactly is depression? According to the current scientific psychological theories, especially the theory of pathological memory and memory reconsolidation, as well as our breakthrough findings in clinical deep psychological interventions, the etiology of depression should be understood at the level of implicit memory.
Depression is caused by the superimposed psychological trauma that patients have suffered since childhood, and their constant self-denial.
However, many of these superimposed psychological traumas are not major events, but very small negative events, which are easily ignored by the patients themselves and those around them. When patients grow up, they don't remember at the explicit memory level.
When these superimposed psychological traumas accumulate, they are prone to show symptoms of depression. Although patients can name some unsatisfactory events in life, by comparing with their peers, it seems that these events are not enough to cause them to get depression, and they do not understand what is going on with them.
Therefore, if you want to help depressed patients recover more efficiently, repairing the main superimposed psychological trauma is the most critical.
In our clinical psychological intervention, we use deep hypnosis trauma repair technology (TPTIH) to achieve this, which can help patients recall the traumatic events corresponding to their symptoms and get efficient and precise repair.
After the main psychological trauma has been repaired, we can guide patients to understand the root cause of the disease more deeply and rationally through intensive cognitive and behavioral intervention, and at the same time see their current shortcomings, strengthen self-reflection and the more courageous adverse quotient.
In addition to this, in-depth family therapy is also very important. Because many of the superimposed psychological traumas suffered by depressed patients are often from the original family. If parents do not change the way of family education, it will continue to cause new superimposed psychological trauma to the child, and it is still difficult for the child to truly recover.
Also, if it is a student patient, after the symptoms of depression are eliminated, it is likely that there will be a learning disability, and it is still difficult to recover a good learning state. In the later stage of intervention, the use of clinical psychological intervention techniques to help them establish an efficient learning state and return to school more smoothly is also an important part of rehabilitation.
Therefore, if depressed patients want to recover efficiently and quickly, it is difficult to rely on mainstream psychological counseling/psychotherapy alone. Just the accurate and efficient repair of psychological trauma, mainstream psychological counseling/psychotherapy is difficult to do.
However, our set of clinical psychological intervention technology with "deep hypnosis trauma repair technology (TPTIH)" as the core is still difficult to replicate, and it cannot provide services for most patients with depression. This is also a major limitation of this technology.
04. If you want to speed up the recovery from depression, this road is the right way
Having said so much, the treatment methods that can be popularized are relatively inefficient, and the efficient methods cannot be popularized for the time being, what should patients and families do?
I believe that the way out lies in the multidisciplinary diagnosis and treatment model (MDT) that combines psychiatry, scientific psychology and education, and cannot blindly deny or exaggerate the role of a certain discipline, but to collect the strengths of each family according to the nature and root causes of depression.
First, we must see the enthusiasm of the diagnosis of depression in psychiatry, pay attention to the disease in time, and receive psychiatric treatment if necessary.
For example, when the patient is seriously ill, it is best to use drug therapy or physical therapy to quickly control the condition, alleviate the patient's suicidal thoughts and avoid tragedy. If the patient also has symptoms such as delusions and hallucinations, it is even more important to receive psychiatric treatment in time.
From this point of view, the recently approved esketamine nasal spray has positive significance, which can quickly relieve the condition of patients with major depression and buy time for subsequent treatment.
Second, regardless of the severity or severity of the patient's condition, family therapy is very key, which can be to find a professional family therapist, or the patient's parents can learn scientific spiritual psychology knowledge in time, strengthen self-reflection, change and improvement, and achieve "self-family therapy".
Because as mentioned above, many of the superimposed psychological traumas suffered by depressed patients often come from the original family. If parents change the way of family education, it can not only repair the child's past psychological trauma to a certain extent, but also try to avoid causing new superimposed psychological trauma to the child.
This is one of the ways to address the causes of depression at its root. Of course, if parents find that their children have also suffered superimposed psychological trauma in school and society, the same reason, they must also find ways to repair it.
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Third, for student patients, especially those from middle school to university, it is necessary to alleviate their learning disabilities as much as possible and let them return to the normal learning track as much as possible.
Otherwise, although they are in a better mood and some of the psychological trauma has been repaired, but they have not been able to recover their learning ability, they are depressed in their hearts, and it is easy to form new psychological trauma in the aspect, and there is still a lot of risk of recurrence in the future.
If you do it more deeply, we must also find ways to gradually improve the inverse quotient of patients to avoid superimposed psychological trauma when they encounter major setbacks and difficulties in the future.
The above three points correspond to psychiatry, scientific psychology and education, which is what we call the "multidisciplinary diagnosis and treatment model (MDT)", which is the most ideal direction to help patients recover faster and better.