Callahan states “depression is a killer.” He goes on to say that it is a killer NOT just in the physical (human body) sense, but also in terms of “dreams and marriages” “as well as people” (Callahan 3). I’m glad the author made this point (and distinction) because most people do not realize the impact depression can have (like killing dreams) and that it not only significantly affects the diagnosed individual but also almost every person that individual has any kind of relationship with. Callahan goes on to describe how depression does not discriminate and affects “both rich and poor countries” (Callahan 4). Unfortunately, treatment is generally very expensive, and despite the fact that there are most likely just as many people in poor countries with depression as rich countries, they are, generally, less likely to have any kind of access to treatment because there is most likely no option or opportunity for treatment of depression at all. I’m very curious to know information about the rates of depression in different countries – comparing GDP, healthcare systems/types, etc.
Callahan feels that highlighting the physical aspects of depression makes the illness seem less abstract (Callahan 5). I would be interested to see data that supports this claim/idea. Callahan also separates depression into 1. The Disease, 2. The Symptom, and 3. The Experience (Callahan 5). This helps to show the complexity of depression.
In 2002, WHO said they did not know what causes depression (Callahan 6). I found this interesting since it seems that the medical establishment, in the US at least, is very convinced that chemical imbalances cause depression. Apparently, there is also a “lack of supporting evidence” that neurotransmitters cause depression (Callahan 7). It sounds like these theories of chemical imbalances causing depression were created after most antidepressants (targeting neurotransmitters) were developed in order to support/validate their use/creation. Callahan also states that the idea that depression is a chemical imbalance is an “oversimplification” (Callahan 7). I wholeheartedly agree with this. There is so much more that goes into depression, which is why it can be so difficult to treat, let alone understand. There are definitely social/environmental factors that also cause/affect depression that can never truly be controlled. Instead, patients have to learn to cope with them. Callahan asserts that the neurotransmitter explanation is biological and validates mental illness as a “real illness” because it makes it similar to other illnesses’ biological causes (like heart disease, diabetes, cancer, etc.) (Callahan 8). Despite this biological explanation, which could be inaccurate, there is still a significant stigma surrounding mental illness.
Callahan then explains why the continued study of depression matters: 1. Depression is common and disabling 2. Nature has a strong effect on/causes depression, which is not accounted for in the current treatment model 3. The current treatment model is limited (Callahan 12). Callahan’s argument shows that there is a lot of work that needs to be done in order to gain a better understanding of depression, and in order to treat it more effectively, and work towards a cure for a great number of those diagnosed with the disease. The way depression is treated needs to be significantly altered.
Callahan then goes on to discuss depression treatment by PCPs and states PCPs in the mid-twentieth century felt a sense of “demoralization and deprivation” regarding their work because they didn’t have the resources they needed (Callahan 45). We have come a long way, but I think this is still true, at least to some extent. Did only American physicians feel this way? How does the current state of health insurance play into this? Would it be better or worse if there was universal healthcare? Also, how would a plastic surgeon versus a Doctors without Borders volunteer differ in their feelings – assuming they have different motives when it comes to their career? Maybe depression/anxiety is under/mis-diagnosed because doctors (specifically PCPs) themselves are depressed/anxious and/or cannot imagine anyone in a different career having any cause to be distressed/anxious because their own job is so incredibly demanding?
The general United States culture has evolved into one where a “patient has a need to take something [medication],” rather than work towards a well-balanced diet and/or exercise, which applies to all illnesses, including, possibly at least, mental illness as exercise is one of the first recommended therapies for depression (Callahan 49).
The different schools of psychology, and later psychiatry, led to different takes on how to best approach/treat mental illness in terms of whether the mind (brain) could be treated the same way as other “simpler” human organs, such as the heart or lungs (Callahan 94). This lends to the question of where the mind is located (the brain?) and if the mind/brain is attached to human consciousness, human personality, the human soul. If all of these components are located in the brain, I, personally, would be very apprehensive to supervise any deliberate alteration of the brain in any way.