Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-23T07:16:11.519Z Has data issue: false hasContentIssue false

Medical models and metaphors for depression

Published online by Cambridge University Press:  16 February 2015

S. B. Patten*
Affiliation:
Department of Community Health Sciences and Department of Psychiatry, University of Calgary, Mathison Centre for Research & Education in Mental Health, Hotchkiss Brain Institute, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Drive NW, Calgary, AB, CanadaT2N 4Z6
*
*Address for correspondence: Scott B. Patten, MD, PhD, Department of Community Health Sciences and Department of Psychiatry, University of Calgary, Mathison Centre for Research & Education in Mental Health, Hotchkiss Brain Institute, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Drive NW, Calgary, AB, CanadaT2N 4Z6. (Email: [email protected])

Abstract

Background

The aetiology of depression is not fully understood, which allows many different perspectives on aetiology to be adopted. Researchers and clinicians may be attracted to concepts of aetiology that parallel other diagnoses with which they are familiar. Such parallels may assume the role of informal models or metaphors for depressive disorders. They may even function as informal scientific theories of aetiology, energising research activities by guiding hypothesis generation and organising new knowledge. Parallels between different types of disease may ultimately prove valuable as frameworks supporting the emergence and maturation of new knowledge. However, such models may be counterproductive if their basis, which is likely to lay at least partially in analogy, is unacknowledged or overlooked. This could cause such models to appear more compelling than they really are. Listing examples of situations in which models of depression may arise from, or be strengthened by, parallels to other familiar conditions may increase the accessibility of such models either to criticism or support. However, such a list has not yet appeared in the literature. The present paper was written with the modest goal of stating several examples of models or metaphors for depression.

Method

This paper adopted narrative review methods. The intention was not to produce a comprehensive list of such ideas, but rather to identify prominent examples of ways of thinking about depression that may have been invigorated as a result parallels with other types of disease.

Results

Eight possible models are identified: depressive disorders as chemical imbalances (e.g., a presumed or theoretical imbalance of normally balanced neurotransmission in the brain), degenerative conditions (e.g., a brain disease characterised by atrophy of specified brain structures), toxicological syndromes (a result of exposure to a noxious psychological environment), injuries (e.g., externally induced brain damage related to stress), deficiency states (e.g., a serotonin deficiency), an obsolete category (e.g., similar to obsolete terms such as ‘consumption’ or ‘dropsy’), medical mysteries (e.g., a condition poised for a paradigm-shifting breakthrough) or evolutionary vestiges (residual components of once adaptive mechanisms have become maladaptive in modern environments).

Conclusions

Conceptualisation of depressive disorders may be partially shaped by familiar disease concepts. Analogies of this sort may ultimately be productive (e.g., through generating hypotheses by analogy) or destructive (e.g., by structuring knowledge in incorrect, but intellectually seductive, ways).

Type
Special Article
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abramson, LY, Seligman, MEP, Teasdale, JD (1978). Learned helplessness in humans: critique and reformulation. Journal of Abnormal Psychology 87, 4974.Google Scholar
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th edn. Washington, DC: American Psychiatric Publishing.Google Scholar
Angoa-Perez, M, Kane, MJ, Briggs, DI, Herrera-Mundo, N, Sykes, CE, Francescutti, DM, Kuhn, DM (2014). Mice genetically depleted of brain serotonin do not display a depression-like behavioral phenotype. ACS Chemical Neuroscience 5, 908919.Google Scholar
Anonymous (2014a). Scientific theory 2014 [updated: 16 October 2014; cited: 24 October 2014]. Available from: http://en.wikipedia.org/wiki/Scientific_theory Google Scholar
Anonymous (2014b). Definition: ‘biomedical model’ 2014 [cited: 24 October 2014]. Available from: http://www.medilexicon.com/medicaldictionary.php?t=55643 Google Scholar
Anonymous (2014c). Social psychiatry 2014 [updated: 30 January 2014; cited: 24 October 2014]. Available from: http://en.wikipedia.org/wiki/Social_psychiatry Google Scholar
Baumeister, AA, Hawkins, MF, Uzelac, SM (2003). The myth of reserpine-induced depression: role in the historical development of the monoamine hypothesis. Journal of the History of the Neurosciences 12, 207220.Google Scholar
Beck, AT, Rush, AJ, Shaw, BF, Emery, G (1979). Cognitive Therapy of Depression. Guilford: New York.Google Scholar
Bennell, KL, Hunter, DJ, Hinman, RS (2012). Management of osteoarthritis of the knee. British Medical Journal 345, e4934.CrossRefGoogle ScholarPubMed
Bennett Johnson, S (2012). President's Column. Medicine's paradigm shift: an opportunity for psychology. Monitor on Psychology 43, 5.Google Scholar
Boldrini, M, Santiago, AN, Hen, R, Dwork, AJ, Rosoklija, GB, Tamir, H, Arango, V, John Mann, J (2013). Hippocampal granule neuron number and dentate gyrus volume in antidepressant-treated and untreated major depression. Neuropsychopharmacology 38, 10681077.Google Scholar
Brooks, C, Pearce, N, Douwes, J (2013). The hygiene hypothesis in allergy and asthma: an update. Current Opinion in Allergy and Immunology 13, 7077.Google Scholar
Calabresi, P, Picconi, B, Parnetti, L, Di Filippo, M (2006). A convergent model for cognitive dysfunctions in Parkinson's disease: the critical dopamine–acetylcholine synaptic balance. Lancet Neurology 5, 974983.Google Scholar
Charles, ST, Piazza, JR, Mogle, J, Sliwinski, MJ, Almeida, DM (2013). The wear and tear of daily stressors on mental health. Psychological Science 24, 733741.Google Scholar
da Silva, J, Goncalves-Pereira, M, Xavier, M, Mukaetova-Ladinska, EB (2013). Affective disorders and risk of developing dementia: systematic review. British Journal of Psychiatry 202, 177186.Google Scholar
Eder, W, Ege, MJ, von Multius, E (2006). The asthma epidemic. New England Journal of Medicine 355, 22262235.CrossRefGoogle ScholarPubMed
Engel, GL (1980). The clinical application of the biopsychosocial model. American Journal of Psychiatry 137, 535544.Google ScholarPubMed
Foster, JA, Neufeld, KAM (2013). Gut-brain axis: how the microbiome influences anxiety and depression. Trends in Neuroscience 36, 305312.Google Scholar
France, CM, Lysaker, PH, Robinson, RP (2007). The ‘chemical imbalance’ explanation for depression: origins, lay endorsement, and clinical implications. Professional Psychology: Research and Practice 38, 411420.CrossRefGoogle Scholar
Hagen, EH (2011). Evolutionary theories of depression: a critical review. Canadian Journal of Psychiatry 56, 716726.Google Scholar
Kessler, RC, Berglund, P, Demler, O, Jin, R, Merikangas, KR, Walters, EE (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 593602.Google Scholar
Ladea, M, Bran, M, Medrea, M (2014). Brain derived neurotrophic factor levels and hippocampal volume in depressed patients treated with escitalopram. Farmacia 62, 183193.Google Scholar
Larsen, PR (1982). Thyroid-pituitary interaction: feedback regulation of thyrotropin secretion by thyroid hormones. New England Journal of Medicine 306, 2332.Google Scholar
Laurin, M, Everett, ML, Parker, W (2011). The cecal appendix: one more immune component with a function disturbed by post-industrial culture. The Anatomical Record 294, 567579.CrossRefGoogle ScholarPubMed
Lin, A, Reniers, RL, Wood, SJ (2013). Clinical staging in severe mental disorder: evidence from neurocognition and neuroimaging. British Journal of Psychiatry (Supplement) 54, s11s17.CrossRefGoogle ScholarPubMed
Linden, W, Vodermaier, A (2012). Re-rethinking the article by Thombs and colleagues. Canadian Medical Association Journal 184, 438.Google Scholar
Marshall, BJ, Warren, JR (1984). Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet 1, 13111315.Google Scholar
McLaughlin, KA, Conron, KJ, Koenen, KC, Gilman, SE (2010 a). Childhood adversity, adult stressful life events, and risk of past-year psychiatric disorder: a test of the stress sensitization hypothesis in a population-based sample of adults. Psychological Medicine 40, 16471658.Google Scholar
McLaughlin, KA, Kubzansky, LD, Dunn, EC, Waldinger, R, Vaillant, G, Koenen, KC (2010 b). Childhood social environment, emotional reactivity to stress, and mood and anxiety disorders across the life course. Depression and Anxiety 27, 10871094.Google Scholar
Needleman, H (2004). Lead poisoning. Annual Review of Medicine 55, 209222.Google Scholar
Owens, M, Herbert, J, Jones, PB, Sahakian, BJ, Wilkinson, PO, Dunn, VJ, Croudace, TJ, Goodyer, IM (2014). Elevated morning cortisol is a stratified population-level biomarker for major depression in boys only with high depressive symptoms. Proceedings of the National Academy of Sciences of the United States of America 111, 36383643.Google Scholar
Raison, CL, Miller, AH (2013). Malaise, melancholia and madness: the evolutionary legacy of an inflammatory bias. Brain, Behavior and Immunity 31, 18.Google Scholar
Rose, S, Bisson, J (1998). Brief early psychological interventions following trauma: a systematic review of the literature. Journal of Traumatic Stress 11, 697710.Google Scholar
Sackett, DL, Rosenberg, WM, Gray, JA, Haynes, RB, Richardson, WS (1996). Evidence based medicine: what it is and what it isn't. British Medical Journal 312, 7172.Google Scholar
Schildkraut, JJ (1995). The catecholamine hypothesis of affective disorders: a review of supporting evidence. 1965. Journal of Neuropsychiatry and Clinical Neuroscience 7, 524533; discussion 3–4.Google Scholar
Sheline, YI, Wang, PW, Gado, MH, Csernansky, JG, Vannier, MW (1996). Hippocampal atrophy in recurrent major depression. Proceedings of the National Academy of Sciences of the United States of America 93, 39083913.Google Scholar
Shonkoff, JP, Garner, AS, Committee on Psychosocial Aspects of C, Family H, Committee on Early Childhood A, Dependent C, Section on D, Behavioral P (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics 129, e232e246.Google Scholar
Speerforck, S, Schomerus, G, Pruess, S, Angermeyer, MC (2014). Different biogenetic causal explanations and attitudes towards persons with major depression, schizophrenia and alcohol dependence: is the concept of a chemical imbalance beneficial? Journal of Affective Disorders 168, 224228.Google Scholar
Taylor, PC, Feldmann, M (2009). Anti-TNF biologic agents: still the therapy of choice for rheumatoid arthritis. Nature Reviews Rheumatology 5, 578582.Google Scholar
Taylor, SE (2010). Mechanisms linking early life stress to adult health outcomes. Proceedings of the National Academy of Science 107, 85078512.CrossRefGoogle ScholarPubMed
Taylor, SE, Lerner, JS, Sage, RM, Lehman, BJ, Seeman, TE (2004). Early environment, emotions, responses to stress, and health. Journal of Personality 72, 13651393.CrossRefGoogle ScholarPubMed
Thombs, BD, Coyne, JC, Cuijpers, P, de, JP, Gilbody, S, Ioannidis, JP, Johnson, BT, Patten, SB, Turner, EH, Ziegelstein, RC (2012). Rethinking recommendations for screening for depression in primary care. Canadian Medical Association Journal 184, 413418.Google Scholar
Vythilingam, M, Heim, C, Newport, J, Miller, AH, Anderson, E, Bronen, R, Brummer, M, Staib, L, Vermetten, E, Charney, DS, Nemeroff, CB, Bremner, JD (2002). Childhood trauma associated with smaller hippocampal volume in women with major depression. American Journal of Psychiatry 159, 20722080.Google Scholar
Walboomers, JM, Jacobs, MV, Manos, MM, Bosch, FX, Kummer, JA, Shah, KV, Snijders, PJ, Peto, J, Meijer, CJ, Munoz, N (1999). Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. The Journal of Pathology 189, 1219.Google Scholar
Weinberger, DR, Goldberg, TE (2014). RDoCs redux. World Psychiatry 13, 3638.Google Scholar
Wells, JCK (2012). The evolution of human adiposity and obesity: where did it all go wrong? Disease Models and Mechanisms 5, 595607.Google Scholar