My learning excursion last week really brought home how little I know about so many aspects of mental illness and the perplexities of treating it. While I was already aware I knew little, I am humbled by just how little.

I am not alone in my bewilderment it seems. How does one get a better grasp of the role of science and the environment as the source of mental illness when confronted with these polarities:

For the people who blame their genes for their depression, they have lost scientific support for their belief that there’s nothing they can do because of their presumed genetic destiny.

Let’s face it directly: Depression is mostly a socialized phenomenon. We learn ways of thinking, coping, relating, being, that increase our vulnerability and put us at a higher level of risk. Depression has many causes, some of which are biological to be sure, but most of which are psychological and social. Consider these facts:

• Depression is striking people at younger and younger ages.
• As societies westernize, the rates of depression go up.
• As relationships decline in quantity and quality, depression increases.
• As people learn prevention skills, they show remarkable ability to prevent episodes from developing in the first place.
• As they go through psychotherapy to learn better coping skills as well as other mood management skills, they have fewer and less severe episodes and their brains change in measurable ways.
http://blogs.psychcentral.com/managi...he-heck-is-it/

Evidence from neuroscience, genetics, and clinical investigation demonstrate that depression is a disorder of the brain. Modern brain imaging technologies are revealing that in depression, neural circuits responsible for the regulation of moods, thinking, sleep, appetite, and behavior fail to function properly, and that critical neurotransmitters -- chemicals used by nerve cells to communicate -- are perhaps out of balance. Genetics research indicates that vulnerability to depression results from the influence of multiple genes acting together with environmental factors. Studies of brain chemistry and of mechanisms of action of antidepressant medications continue to inform the development of new and better medical and psychotherapy treatments.
http://psychcentral.com/disorders/de...onresearch.htm

Mr. Hunter in his article on research and depression further states:

Increasingly, the public as well as health care professionals are recognizing these disorders as real and treatable medical illnesses of the brain.

What health care professionals recognize too is the subject of debate:

While clinical psychology has to some extent leaped onto this same biological bandwagon driven by contemporary psychiatry, seeking prescription privileges, some psychologists and other non-medical mental health professionals have practically written off the relevance, value and importance of psychodiagnosis today--in part precisely due to its inherent medicalization, biological bias, dehumanizing labeling, and notorious inaccuracy. As a result, I suspect many psychologists and other psychotherapists may be less than enthusiastic about participating in improving the standardized diagnostic system they despise yet are nonetheless forced to use by the insurance companies and other third party payors. But this professional apathy is itself a big part of the problem. And such resigned passivity on the part of psychologists at the present moment would be a major mistake.

I believe it is time for the leadership of the American Psychological Association to take a far more active and public role in the revision and direction of the DSM-V. Clearly, the publication of this diagnostic manual should be a collaborative effort between the American Psychiatric Association and the American Psychological Association. Yet, one wonders exactly what, if anything, the American Psychological Association is doing about DSM-V. Or about the hypermedicalization of psychology. As Dr. Frances, former chair of the DSM-IV Task Force indicates, the next six months or so is a window of opportunity for both the American Psychological Association, clinical and forensic psychologists, and other mental health professionals to provide vitally needed feedback about the proposed DSM-V revisions. And, due to external criticism about the revision process thus far, the American Psychiatric Association is apparently more receptive than ever before to such feedback.
http://www.psychologytoday.com/blog/...dsm-v-response

Although older, this excerpt is critical also:

Clinical psychology at least has its roots in experimentation, but it is drifting away from science. Concerns about cost–benefit issues are growing, especially in the United States. According to a damning report published last week (T. B. Baker et al. Psychol. Sci. Public Interest 9, 67–103; 2008), an alarmingly high proportion of practitioners consider scientific evidence to be less important than their personal — that is, subjective — clinical experience.

The irony is that, during the past 20 years, science has made great strides in directions that could support clinical psychology — in neuroimaging, for example, as well as molecular and behavioural genetics, and cognitive neuroscience. Numerous psychological interventions have been proved to be both effective and relatively cheap. Yet many psychologists continue to use unproven therapies that have no clear outcome measures — including, in extreme cases, such highly suspect regimens as 'dolphin-assisted therapy'.
http://www.nature.com/nature/journal...l/461847a.html

The American Psychological Association's Preamble to its Ethical Principals of Psychologists and Code of Conduct provides:

Psychologists are committed to increasing scientific and professional knowledge of behavior and people's understanding of themselves and others and to the use of such knowledge to improve the condition of individuals, organizations, and society. Psychologists respect and protect civil and human rights and the central importance of freedom of inquiry and expression in research, teaching, and publication. They strive to help the public in developing informed judgments and choices concerning human behavior. In doing so, they perform many roles, such as researcher, educator, diagnostician, therapist, supervisor, consultant, administrator, social interventionist, and expert witness. This Ethics Code provides a common set of principles and standards upon which psychologists build their professional and scientific work.
http://www.apa.org/ethics/code/index.aspx

Makes me wonder is this sentiment fits: If, of all words of tongue and pen, The saddest are, "It might have been," More sad are these we daily see: "It is, but hadn't ought to be." ~Bret Harte

More for those so inclined:

http://psychcentral.com/lib/2006/cha...ve-counseling/
http://blog.beliefnet.com/beyondblue...s-your-th.html
http://blogs.psychcentral.com/therap...rapy-and-life/
http://blogs.psychcentral.com/therap...the-beautiful/
http://blogs.psychcentral.com/therap...e-sixth-sense/
http://www.psychologytoday.com/artic...your-therapist