When it comes to depression, the schism between psychology and psychiatry is basically this: therapists influenced by Freud's psychology see depression as a product of the mind and talk about it in terms of drives, defenses, regressions, and problems of identification and self-esteem. Those influenced by biological psychiatry see depression as a product of the brain, caused by shifts that take place among hormones and neurotransmitters. Shephard Kantor, a psychiatrist on the faculty of the Columbia University College of Physicians and Surgeons, looks for ways of bringing the two approaches together. Kantor believes the mental "productions" of depressed patients--negative thoughts and, in the case of psychotics, hallucinations--come from chemical changes in the central nervous system and are not psychologically caused. He no longer believes that the crazy thinking that accompanies depression is triggered by external events or is the residue--for example--of childhood interactions with parents. He believes the crazy thinking that accompanies depression is caused by the chemical state itself.
But what is the effect of childhood trauma? we may ask. Surely it can't be totally unrelated to depression. Kantor suggests that the mental changes of depression may be due to certain sensations and memory traces that go back to "the calamities of childhood". Such calamities produce changes in neurotransmitter levels or receptor sites, he theorizes. And it isn't just childhood trauma that does this. Emotional wounds at any point along the way might produce similar chemical alterations in the brain.
Studies with primates show that circuitry linking structures in the central nervous system is responsible for perception, memory, and emotion. With this in mind, Kantor says, it isn't such a big jump to imagine how the tiniest of biochemical disturbances at any of these sites might evoke memories and moods whose origins lie in childhood.
Kantor has another idea. One of the breakthroughs of modern neurology was Wilder Penfield's discovery that stimulating certain areas of the brain with electrical impulses produces visual and auditory images and memories. Kantor asks this provocative question: Isn't it possible that the signals generated by neurotransmitters might function as "the internal equivalents" of Penfield's externally applied stimulating electrodes? If so, he says, it "would cause patients to report feelings, recollections and ideas generated not by conflict, fantasy, or drive derivatives, but by chemical stimuli."
Kantor's ideas have not yet been substantiated by research but his thinking is far from wild, for much that has already been learned points in the same direction. In the meantime, Kantor stands firm in his conviction that psychiatrists should learn to understand--and accept--the chemical nature of mood disorders.
Clearly, childhood events produce inner experience--feelings and attitudes that stay with us, affecting our lives immensely. The question psychiatry wrestles with is how these powerfully resonant events interact with neurotransmitter deficits to produce shifts in mood state that are sometimes volatile, sometimes subtle. There are differences, after all, among all of us--differences in the amount of trauma or stress we experience and in the degree of chemical vulnerability we inherit. No one exists in a perfect state of chemical balance. Where, then, should the line be drawn with respect to neurotransmitter deficits? Do they exist in all who become mood disordered or only in those suffering from severe forms of these illnesses?
These are some of the important questions being addressed, currently, in the fields of psychaitry and psychology.
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This article is excerpted from Colette Dowling's book, You Mean I Don't Have to Feel this Way?: New Help for Depression, Anxiety and Addiction.
"Beautifully documented... Dowling backs up her theories with facts."
"This really excellent book deals sensitively and directly with culturally imbued fears of biological therapies for emotional disorders."
Donald F. Klein, Professor of Psychiatry, Columbia University College of Physicians and Surgeons
"A down-to-eaerth, hopeful, useful--and,from the point of view of this "recovered" depressive--accurate account of how to treat depression.
Mike Wallace, 60 Minutes