Every time I post something like this I catch a ton of shit from people on SSRI’s so let me clarify something to lead this off. I’ve suffered from sudden bouts of severe acute depression my entire adult life (although it’s been really rare in the last 5 years or so, probably because I drink like 1/16th as much as I used to).
Somewhere around the age of 26 I realized something though. This shit only happens to me when I’m at work. So really, I don’t suffer from depression, I suffer from capitalism. That’s just my story. Stories vary. What I will say is that since we all suffer from capitalism, who’s to say whether that’s what’s behind all this internal misery in the first place? Who’s to say indeed. (from Quartz):
“The attention on the brain faded in the 20th century, when phrenology was supplanted by Freudian psychoanalysts, who argued that the unconscious mind (rather than brain) is the predominant cause of mental illness. Psychoanalysis considered environmental factors such as family and early childhood experiences as the key determinants of the characteristics of the adult mind, and of any mental illness.
“Beginning with Freud’s influence, through the first half of the 20th century, the brain almost disappeared from psychiatry,” says Allan Horwitz, a sociology professor at Rutgers University who has written on the social construction of mental disorders. “When it came back, it came back with a vengeance.”
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A conglomeration of factors, beginning in the 1960s but having the largest effects in the ‘70s and ‘80s, contributed to psychiatry’s renewed emphasis on the brain. Firstly, in the US, conservative presidents disparaged as liberal causes any political efforts to alleviate social conditions that contribute to mental health, such as poverty, unemployment, and racial discrimination. “Biologically-based approaches became more politically palatable,” says Horwitz, noting that the National Institute of Mental Health largely abandoned its research on the social causes of depression under president Richard Nixon.
There was also growing interest in the role of drugs, for good reason: Newly developed antidepressants showed early success in treating mental illnesses. Though Freudian psychoanalysts did use the drugs alongside their therapy, the medication didn’t neatly fit with their theories. And while individuals had previously paid for mental health care themselves in the US, the 1960s saw private insurance companies and public programs, such as Medicaid and Medicare, increasingly take on those costs. These groups were impatient to see results from their investment, notes Horwitz—and drugs were clearly both faster and cheaper than years of psychoanalysis.
Psychoanalysis also rapidly went out of fashion in that time. Organizations such as the National Alliance on Mental Illness, which advocated for the interests of those affected by mental illness and their families, were distrustful of psychoanalysis’ blame on parental figures. There was also a growing distaste for psychoanalysis among those on the left side of the political spectrum who believed psychoanalytic theories upheld conservative bourgeois values.
At the time, psychoanalysis was deeply entwined with the field of psychiatry (the medical specialty that treats mental disorders.) Until 1992, psychoanalysts were required to have medical degrees (paywall) to practice in the US—and most had MDs in psychiatry. “Psychiatry has always had a tenuous position in the prestige hierarchy of medicine,” says Horwitz. “They weren’t regarded by doctors and other specialties as being very medical. They were seen more as storytellers as opposed to having a scientific basis.” As Freudian psychoanalysis became increasingly rejected as a pseudoscience, the entire field of psychiatry was tarnished by association—and so it pivoted, creating a new framework for diagnosing and treating mental health, founded on the role of the physical brain.
The theory of chemical imbalances was a neat way of explaining just how brain malfunctions could cause mental illness. It was first hypothesized by scientists in academic papers in the mid-to-late 1960s, after the seeming early success of drugs thought to adjust chemicals in the brain. Though the evidence never materialized, it became a popular theory and was repeated so often it became accepted truth.
It’s not hard to see why the theory caught on: It suited psychiatrists’ newfound attempt to create a system of mental health that mirrored diagnostic models used in other fields of medicine. The focus on a clear biological cause for depression gave practicing physicians an easily understandable theory to tell patients about how their disease was being treated.”
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