On the 'disease model' of mood and unhappiness, the mathematical network model that may predict optimal treatment strategies, and the quest for a unified theory of mood 'disorders': A conversation between an acolyte and a devil's advocate with an ecumenical bottom line.
Co-written Ana x Jehan Ganachaud*
An inspiring talk got us thinking about how academia converges with what we know from grassroots work with clients: there's no single cause for feeling unhappy—there are as many causes as there are life situations, and it's not (always) a disease (nor should the classic disease model always be applied). We are sharing some snippets —see what you think.
The talk in question was given by Eiko Fried, a top guy doing data science (mentioned in a previous blog post).
Jehan (The Acolyte) breaks it down for you:
The Common Cause Theory
Eiko discusses how his life work in academia has been to move psychiatry away from a “common cause” theory for mental illness to a complex system where emergent properties of that system are the mental illness. The common cause theory has been the core principle of the medical model for centuries. It posits that a list of symptoms is caused by a single element, such as a bacterium or a virus (see the illustration below).
Because psychiatry has emerged as a branch of medicine, the same model has been applied to mental illnesses. I am using mental illness and disorder here for simplicity while recognising that it is a problem-saturated narrative.
Why The Common Cause Medical Pradigm Does Not Apply Well on Human Mood Problems
So if you look at the ICD-11 or DSM-5, you have a list of symptoms associated with a diagnosis. The difficulty is that those diagnoses do not actually underly one specific common cause. As you, I, and other mental health practitioners will know, when we work with individuals, we look at a variety of factors, bio-psycho-social, societal, cultural, ancestral, etc. This is what also what Eiko argues. Many factors interact together, not in a causal, but rather probabilistic way, and all together those factors' interactions create the disorder.
This is what emergent properties of complex system mean. It is that the parts of a systems create something greater than the sum of its components.
For me, this makes so much sense because if we look at linear systems vs. complex systems, we, as human beings, and our environment are definitely complex. Which means it’s not: A causes B. Rather, A and B interact together and the interaction itself can sometimes create something new.
The Control Theory Network Model
Later in his talk, Eiko shares the idea of a cool network model using the control theory that enables researchers to run simulations to determine which node within the system is most likely to produce the desired outcome. My mind was blown away! I thought, "Perhaps in the future, we could develop network models of mental health challenges where practitioners and individuals can collaborate to identify the most effective nodes to target".
The possibilities are great!
Ana (The Devil's Advocate) deconstructs it for you:
Notwithstanding the big fuss to reach an obvious conclusion, it is one I completely embrace.
Bad Feelings Are Not Bad, They Are Part of Being Human
The considerable number of people to walk through my office door will have been ad hoc diagnosed with depression by their GP and prescribed antidepressants. Are they really experiencing a depressive mood "disorder"? I say: are they heck. After we complete a deep-dive tour of their life, more often than not we can find a reason to the pervasive negative affect they are experiencing (I know, I know, not everyone, but considerable proportion). With some luck and perseverance, we also get to change that in therapy.
Moreover, the negative feelings are not bad as such. Come on, man! Life is there to be lived, and who has not been badly bruised by pain of love, loss, or other struggles has not lived.
We cannot think of it as something that can be "surgically"(or chemically) removed from life.
Maybe because it can't be done but also because it should not be done. Eternal sunshine of the spotless mind does not exist (and Charlie Kaufman knew that).
The Quest For a Unified Theory of Mood
However, the idea of the 'common cause' is still very much well and alive. In fact there is new impetus to find the unified theory of mood (tongue-in-cheek). Sadly, as the profession we (psychotherapists/counsellors) were omitted from the list of experts invited to this noble quest 😔 (with an aftertaste of Sleeping beauty's eighth fairy).
Some of the Many Ways Psychotherapists Approach Low Mood And Unhappiness
I don't think I am being overly emphatic if I say that just about every psychotherapist understands: mood 'disorders' DO NOT have a single origin. In fact, the myriad of therapeutic approaches exist for a reason; each one addresses a specific need or challenge that comes with being a human.
Can you recognise some of the psychotherapy paradigms below by the way they would approach a client presenting with low mood, depression, lack of happiness? I adapted these from Jeffrey A. Kottler’s book, Change:
It is about coming to terms with unresolved issues of the past.
It is all about changing the cognitive interpretations of experience to be more based in reality.
Forget the past, forget the future. The action takes place here and now by being fully engaged with our authenticity.
People are suffering because of lack of meaning in their lives.
People suffer because they have lost the connection with transcendental in them.
All personal issues take place within a given culture and family and it is only by exploring those systems that something can change.
Relationships are everything in our lives. If we lack connection and intimacy we will be unhappy. Only through connection we can heal.
People suffer because of disempowering narratives they were taught about themselves.
We are not happy if the Child in us is not happy.
People suffer because they have been coerced into accepting the roles of oppression by those who dominate the power.
__________(add your own favourite paradigm)________
Which one wins? "Everybody wins and all must have prizes." - it is the Dodo bird verdict of psychotherapy ( reference to a famous race from "Alice's Adventures in Wonderland").
The Ecumenical Bottom Line
The network model proposing to create a "black box" that incorporates all known sources of distress and tests them against the client's history to determine the optimal treatment strategy? We say: the concept is fascinating! It will be intriguing to observe when and if its implementation can indeed provide clients with precisely what they need to improve their mood and be happier.
But until that happens, we are left with the good old therapist's instinct.
Or hang on a second... On reflexion, the two approaches - therapist's instinct and the black-box of the statistical model- don't need to clash. They can co-exist or even maybe, you know...co-operate, be synergetic?
And while we are waiting for the future minds to become spotless, what are your go to strategies/approaches to help your clients with their mood? Are they included in the list above? Something completely different?
We would love to hear your thoughts.
As always, thank you for reading. For updates from Ana on BlueSky or Twitter or subscribe to my mailing list.
To contact Jehan: jehan.ganachaud@gmail.com
Jehan Ganachaud is a mental health practitioner working with developmental trauma. Jehan is also a bona fide neuro-geek, often sacrificing his down time, evenings and weekend lie-ins to his geek obsession. 🤓✊
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