Nassir Ghaemi's "On Depression"

Nassir Ghaemi, M.D., M.P.H., is a professor of psychiatry at Tufts University School of Medicine and the director of the Mood Disorders Program at Tufts Medical Center in Boston. He is author of the bestseller A First-Rate Madness: Uncovering the Links between Leadership and Mental Illness, as well as The Rise and Fall of the Biopsychosocial Model: Reconciling Art and Science in Psychiatry and The Concepts of Psychiatry: A Pluralistic Approach to the Mind and Mental Illness.

Ghaemi applied the “Page 99 Test” to his latest book, On Depression: Drugs, Diagnosis, and Despair in the Modern World, and reported the following:

On Depression could have been more academically titled “An existential approach to depression”. On page 99, I begin to describe the existential approach of the American psychologist Rollo May. Throughout the book, I’m trying to explain to readers that “depression” is not one thing – that sometimes it is a medical disease, and sometimes it isn’t but instead reflects the despair that we normally feel about many aspects of life and death. It is important to know the difference. This is why I think so much that is written about depression and psychiatry tends to be mere cant, based on a “postmodernist” ideology where science/medicine/psychiatry are distrusted as mere tools of power. Critics claim a wish for humanism, but they don’t really seem to appreciate how a humanistic approach to people – the existential method – can be taken, while still remaining scientifically sound and medically oriented when diseases, like manic-depression, are present.

From page 99:

Many people act as if existential approaches to psychiatry are just completely at odds with medicine and science. All persons are patients to doctors. Some justify this usage in the sense that to be a “patient” means to “suffer” and the claim is that all those who seek help with doctors suffer in some way or another. But this is not true. Many of us feel quite fit, and then, on some routine visit, the doctor informs us that we have a disease; our suffering comes after the doctor visit, not before. (Is not hypertension the “silent killer”?)

It is the sign of the scientific physician, as Leston Havens informs us, that we are more often told we are healthy than ill. The doctor runs some tests; congratulations, on 25 tests you are normal; but on this one, you are sick. Even sickness is identified only in the context of larger health.

This is how medicine functions, when it is scientific. Health is a normative and common concept in medicine. It is usually the case; illness is the exception.

In psychiatry, matters are the reverse. No one goes to a psychiatrist or a psychotherapist without leaving the office pathologized; some “disorder” is labeled, and if not, some psychological complex or problem is identified. Existential psychotherapy is the only approach that begins with a premise of health, with the view that we are all normal human beings, and even our problems are the results of the same (“normal”) challenges that all human beings must face as part of existence. Existential psychiatry, by beginning with the person rather than the patient, is in fact much more in line with scientific medicine than the pseudoscience of universal patienthood that afflicts psychiatry in all its other forms – biological, psychoanalytic, cognitive/behavioral, and so on. I say “scientific” medicine because unscientific medicine is practiced – not just in psychiatry but also by many internists – whereby health is not respected and tests are excessively ordered, until something looks wrong enough to merit intervention, producing the corresponding monetary payment to the doctor, typically the ultimate goal of the whole process.

Learn more about the book and author at the Johns Hopkins University Press website and Nassir Ghaemi's website.

--Marshal Zeringue