I want to talk about mental distress and its causes as well as give you some information you may be unaware of. It may be deeply challenging to hear, because what I want to say contradicts much we are told about mental illness.
There are alternative ways to view psychological distress and experiences that we call disordered. I would urge you not to take my word for it. If you are interested there is a lot of information about this available online. I will include some links at the end of this article so that you can make your own decision. My intention here is simply to offer a different perspective.
Current medicine is driven by a positivist philosophy, which is to say that it requires empirical scientific evidence to support its claims. In terms of biological and physical conditions, this makes sense: it is possible to evidence a broken leg or a cancerous tumour. Through research and development, we know that particular treatments will alleviate symptoms and cure biological conditions. These medical treatments are rigorously explored and investigated over many years, and their efficacy is quantifiable.
Successfully viewing and treating the human body in this way, human distress has been explored from the same positivist approach. This is loosely how psychiatry was born. We needed a way to identify particular sets of unusual and sometimes highly distressing experiences, both to communicate and learn about them, and to begin to treat them. In this way, we approached mental distress from what is termed the medical model. Using the medical model to understand psychological distress is deeply flawed as there are no biomarkers for any psychiatric disorders (Boyle and Johnstone, 2020).
Psychiatric diagnoses remain unevidenced theories, one of many ways to view and talk about specific experiences. This includes depression and anxiety. Although there is an observable correlation between depression and low serotonin, for example, we do not know the relationship between the two, and so the theory that there is a chemical imbalance which causes depression is just that - a theory. It is not evidenced and it is deeply misleading to offer it as truth.
Anti-depressants and other medications which are used to treat mental distress remain important. If they help to manage what can be extreme and very distressing experiences, they may be invaluable. But the drugs manage distress and do not cure any illness, primarily because there is no empirical evidence that mental distress has a biological cause, and therefore cannot be viewed as an illness (Moncrieff, 2007).
So, what does this mean in terms of how we view mental distress? How are we to make sense of it? Rogers (1977), founder of person-centred theory, talks about distress caused by ideas about how we should think and behave that we have absorbed from our surroundings. Bessel Van der Kolk (2015) discusses how traumatic events can alter our physiology such that we experience our reality very differently. Psychoanalysis suggests that there are causative events at various points in our human development. There are many other ideas and many other models of therapy, but what they all have in common is reference to society and to external events. It is vital that we acknowledge the impact on us of the world we live in, and the society in which we exist.
My own view is that living can be extraordinarily hard. In the West we have built societies whose systems and institutions are rife with power imbalances. These imbalances create incredibly difficult circumstances for many people; economic uncertainty, ideas about how men and women should be, class and racial inequality and so on and so on. In their revolutionary theory the Power Threat Meaning Framework, Boyle and Johnstone (2020) make clear the relationship between imbalances such as those described above and human distress.
In addition to these external pressures, and at least partly in reaction to them, we all have internal ideas about how we should be and what our lives should look like. As if this wasn't enough, many of us have also experienced trauma, be it a specific event or a sustained, long-term experience. In these circumstances, feelings, thoughts and behaviours that we call depression (for example) are perfectly rational and understandable. I would argue that they are not disordered and they do not make you ill. They simply make you human.