The Table Video

Curt Thompson M.D., author of Anatomy of the Soul, comments on the nature of mental disorder and illness—depression, anxiety, and other disorders—and how human agency, medication, and the self factor into the healing process.

Transcript:

Part of the challenge in, trying to be helpful for, and walking with people who really do suffer from real experiences. Experiences of, intense anxiety, debilitating, depressive states. Having things like Obsessive Compulsive Disorder. Having Bipolar Disorder. One of the challenges is, the tendency that we have to want to package things in ways that enable those things to be conveniently manipulated and handled.

And so, it’s much simpler and understandably so, much simpler, if we say I have depression. And this has come to us from research that has come to us from other fields of study that talk about depression. In such a way that the culture picks up on this language and they begin to believe that for instance depression is this independent thing that exists apart from their behavior, their actions, their stories, their memory, all those kinds of things.

And so, part of the challenge in working with anyone is helping them to discover, what really it is, that they are suffering with. And one of the things that we tell folks is that ultimately we are suffering with ourselves. When I am depressed, as many people are who come to see me, I don’t simply have depression that is separate from my brain, that is separate from me, that is separate from what I feel and think and sense.

It’s also not separate from my will, it’s not separate from the things that I choose to do perhaps not even consciously, that add to that experience. Not because I want to, not because I’m consciously aware that I’m doing that, but there are many, many different layers of the minds activity, that eventually converge to add up to this thing that I call depression.

And I give it a name, and I do so because it makes it more portable and more convenient for me to talk about this with my Doctors and my friends and so forth and so on. The challenge is, that depression, anxiety, any of these other disorders, if we’re not careful, we can start to talk about them as if they are separate from us and as if we don’t have much agency ourselves in doing anything about them.

This is where, psychopharmacology, for instance, has both been our friend and has also made things more complicated because, if I have a problem, that is understood to be separate from my will, separate from any choices I’m making, even on none conscious levels, something else outside of me, because I have no control over this, something else outside of me, is going to have to be done, to help me feel better.

Hence, the use of psychopharmacology which in many instances is necessary and helpful, is sometimes seen as the only thing, that can be done. And so, I can tend then to automatically assume that if I have depression, the solution for that is an antidepressant. This is not to say that antidepressants, are not necessary. There are those clinicians, in the world, who would say that there are probably a lot of people who are taking antidepressants, who may not need to be on them.

That’s difficult really to discern and I wouldn’t want anyone here to think that we’re saying that. But I think it is true to say, that we have come to a place where we’ve separated, our awareness, of what it is that I experience, from anything that I have to do with that experience. One of the reasons why this is not helpful, is because it leads me to believe that I’m rather powerless in this, there’s nothing I can do.

There’s nothing that can be done to transform me, short of taking certain medication. What I would wanna say that the good news is, about the discoveries of interpersonal neurobiology are that, not only does it enable us to see realms of the mind and pay attention to realms of the mind, that enable people to be more proactive in their work on these things. But it also supports the use of medication, in those places where it’s really necessary.

Because we can help more appropriately discern, how much of this picture isn’t about the person and their need for medication and how much of it is. And so, I think it helps guide even more clearly, a more appropriate and judicious use of medication when it’s necessary and it often is.