If Depression Is Not An Illness, What Is It?

Elsewhere on this site, I have argued that depression is not an illness, but rather is an adaptive mechanism that encourages us to make changes in our habits or our circumstances.

I have written about what I call the seven natural anti-depressants:  good nutrition; fresh air; sunshine (in moderation); physical activity; purposeful activity; good relationships; and adequate and regular sleep.

But the question has often been posed:  Why does this adaptive mechanism apparently not work in some cases?  Why is it that for some people the unpleasant feeling fails to act as a spur to make changes, and instead the person sinks further into despondency and inactivity?

My general response to this argument is that in general, we do what we’ve been trained to do.  I’m using the word “trained” here in a very wide sense to include not only the habits instilled by our parents and other significant adults, but also the habits that were “taught” to us by our experiences.

I thought it might be helpful to illustrate this by sketching the progress of a person who came to me several years ago for help with depression.  To protect the person’s privacy, her name and various details have been changed.

Jean was 34 years old, married, mother of three children, and manager of a popular and successful restaurant.  She had been feeling increasingly despondent for a few years, and finally, on a friend’s recommendation, went to see a psychiatrist in another town.  He talked to her for thirty minutes and prescribed an anti-depressant (Paxil).  Her next appointment was in two weeks.  She told the psychiatrist that she wasn’t feeling much better.  He said give it time.  Two weeks later she was back in the office and told the psychiatrist that she was so down that she could see little point in going on.  He arranged for her to be involuntarily committed to a private mental hospital.

She stayed at the mental hospital for four weeks.  Her Paxil dose was increased and additionally, she was given an anti-anxiety drug.  She received art therapy, which consisted of sitting in a room with other residents painting pictures, and music therapy, which involved listening to music.  Every day she had group therapy.  This consisted of sitting in a group with eight or ten other residents and “just talking.”

At no time during the four weeks did anyone ask her why she was depressed.

On discharge, the hospital referred her to me because I worked at the community mental health center in her home town.

I scheduled two hours for Jean’s first visit, and we talked.  Or more correctly, I encouraged her to talk, and I listened. Here’s her story.

Jean was raised in a small mid-west town, the eldest of four siblings, in what she called a “conventional” family.  Her mother was a stay-at-home Mom, and her father worked as a manager at a feed store.  They weren’t wealthy, but with the frugality that was common for the time, they weren’t poor either.

In the home, her father was the boss to whom her mother deferred routinely.  Her mother was devoted to her husband and her children, and worked tirelessly pretty much all day.

Jean said that her childhood had the normal ups and downs, but that there were no great traumas or horrific incidents.  As the eldest daughter, she helped her mother a great deal with childcare of the younger siblings and with household chores generally.

At school she did well, finishing with a GPA of 3.5.  She had considered college, but decided against it.  She took a job waiting tables at a restaurant, and at age 20, married her high school sweetheart, George.  He worked as a mechanic.

About two years later, George got an offer of a better mechanic job at a town about 100 miles away.  They talked it over and decided to go.  Jean had no difficulty finding a job as a waitress.  They settled into their new surroundings fairly well, but Jean missed her family (especially her mother), and although she got along OK with people, she discovered that she was not too skillful in the area of making new friends.  (Up till then she had lived in her home town and her friends were ready-made, so to speak.)

They rented a home but within a year were able to make a down-payment on a home of their own.  The mortgage was high but with both of them working, they could manage.

Two years later Jean was promoted to assistant manager at the restaurant, and adapted to the new responsibilities without difficulty.

By this time life had settled into a routine.  George worked as a mechanic, and when he came home, he pretty much considered that his day’s work was done.  Two or three evenings a week he would go out to the bar to “unwind” with his friends.  He would mow the yard and a few other outdoor chores, but all the cooking, laundry, cleaning, etc., fell to Jean.  She accepted this as her womanly lot, and never complained – or even thought of complaining.

A year after buying their house their first child was born, followed by two more at two-yearly intervals. Jean adored the babies, and felt terribly torn at having to leave them with sitters and daycare when she went to work.

Then she was promoted to manager at the restaurant, and sometimes, if there were problems, she had to work late.

Meanwhile the children were growing, and their needs were becoming more complex.  Jean found that she was routinely getting up at five a.m. and seldom getting to bed before midnight.  Sometimes she would be doing laundry at one a.m.  She was drinking enormous quantities of coffee.

On her thirtieth birthday Jean realized the she was very unhappy.  This made her feel guilty.  After all, she had a good husband, three beautiful, healthy children, a great job, and a nice home.  What more could she rightfully expect?  She resolved to stop feeling sorry for herself (as she put it) and try harder.  She limped along like this for another four years.  During this time her two older children started getting into trouble at school, and her husband started “looking at” one of the secretaries at his place of work.  With regards to the latter, Jean decided that she had been neglecting her appearance, and resolved to pay more attention to make-up, dress, etc., and to work harder at retaining George’s affection.

By this time, for Jean, the meaning of life was simple:  try to keep it together; try to get through the day.

She had one close friend, Betty.  They got together for a chat about once a week, and during one of these sessions Jean started to sob disconsolately.  Betty, who had herself consulted a psychiatrist a few years earlier, recommended that Jean do the same.  And so to the pills, the mental hospital – and my office.

It didn’t take any great intelligence or insights to see why Jean was depressed.  What’s staggering about her case, however, is that neither the psychiatrist nor the hospital staff bothered to ask her why she was feeling down.  The reason for this is that as far as they were concerned, they already knew the reason.  She had a brain illness, and she needed to take pills “just like a diabetic has to take insulin.”  (Yes, they did actually say this!)

At the end of the first session, I told Jean that given the load she was carrying, it was not surprising that she was feeling down; rather, the surprising thing was that she was managing to cope at all.  She told me that she didn’t feel that the pills were doing her any good, but that she was afraid to stop taking them for fear that “they” would send her back to the mental hospital.  She explained that that had not been a positive experience, and that she didn’t belong there.

I suggested that she come back to see me weekly for a few weeks, and I made sure that she had our phone number in case she needed help outside office hours.  When she left the office, she seemed lighter than she had seemed initially, and she stated that it had been helpful just talking about things.  I suggested that she bring her husband to the next session if he was willing.

Next week she showed up on time with George.  I asked George for his perspective, and he said that he had known things weren’t great for about the last year.  He had had no idea what was wrong, but now that he knew Jean had a brain disease (and the pills to treat it), everything would be OK.

Somebody – I’ve forgotten who – once said that therapy is the art of presenting the facts to a person in a way that they can accept.  So I spent the next hour trying to let George hear the message that I had received loud and clear from Jean the week before.  It was clear, however, that Jean was reluctant to be particularly confrontive in this regard, and I was careful to respect her lead.  Towards the end of the session, however, I did point out that Jean was in effect working the equivalent of about 100+ hours per week.

George had been raised in a conventional household also.  Dad went out to work.  Mother was a stay-at-home Mom.  He felt that if his mother could do it, his wife should also be able.  I pointed out that his wife’s situation was not quite the same, in that she had a full-time job managing the restaurant.  To which George expressed the view that this wasn’t real work because all that managers do is sit around and tell other people what to do.  Jean listened to all this quietly and respectfully.

Next week Jean came in alone.  She asked me what I thought she should do.  I said that I couldn’t make her decisions for her, but that in my view it was clear that something had to change.  I explained that we all need some activities in our life that we enjoy and/or give us a sense of success.  I expressed the view that her life had become so grueling that even activities that otherwise might have been pleasant and rewarding were no longer so.  Jean agreed with this.

We spent the next few sessions exploring options – looking for ways in which Jean could reduce her workload and find more joy and meaning in her life.  Each week she would update me on what she had managed to achieve.  She began to feel better.  She started to smile, and her general demeanor seemed brighter and more positive.

On week eight she came in and told me that she had told George that she wasn’t going to do any more laundry – that from now on this was his job.  “Wow,” I said.  “How did he take it?”  “He didn’t like it at first, but then he agreed.”

And so it went.  On week ten she told me that she had been tapering the pills and wasn’t going to get any more.  On week twelve I expressed the belief that she probably didn’t need to come in any more.  She agreed.  She phoned me several months later and told me that she was still doing fine.

And Jean is by no means an isolated case.  Up till about 1950 or so, most mothers were stay-at-home Moms.  Then, for various reasons, this started to change.  Women entered the work force in large numbers and began to develop careers to an unprecedented degree.  All of which is fine, but it took several decades for our cultural ethos to adjust to this huge demographic shift.  Throughout my career I have worked with scores, perhaps hundreds, of women who, like Jean, were working a full job in the workplace and a second full-time job at home.  I don’t know anyone who wouldn’t find that depressing and debilitating.

But the mental health system seldom even bothers to ask the critical question:  “What’s got you down?”  In my experience, most people can provide clear, cogent answers to this question, and with a little encouragement can come up with remedies.

Nothing succeeds like success.  When a person realizes that he/she has solved one problem, they are empowered to tackle others.  Pills on the other hand, with their implied message of helplessness, disempower people and encourage excessive dependency.

Jean was not ill.  She was just over-worked and under-appreciated.  Her circumstances had changed drastically, and the skills, attitudes, and habits she had developed in her formative years were no longer sufficient to bring her a sense of joy, fulfillment, or success.

There are millions of women like Jean in America.  Many of them have been systematically deceived, disempowered, and drugged by psychiatrists.

  • Sweet63

    Great post, Phil. Funny how the “therapy” she got provided such a facile excuse for the husband…what is your opinion of NAMI? Their purpose seems to be similar, to reassure parents that their kids’ “illnesses” are biological rather than due to some family dynamic.

  • Phil_Hickey


    Thanks for coming back.

    A great many people draw comfort from the brain illness notion. But comfort bought at the expense of truth is usually a poor bargain in the long run.

    In my view NAMI is well-intentioned, but is little more than a mouthpiece for the pharmaceutical companies from whom, incidentally, they receive most of their funding.

    Best wishes.

  • lonewolf

    I am an engineer and I usually deal with anomalies, defects, bugs, and strange behaviour from hardware, software, or whatever other machines i happen to be working with. When something is acting strange, and I can’t figure out what it is, I ask myself: “if i WANTED to create this behaviour, what would i do?”.

    I think it’s a useful question to ask. It has helped me diagnose many issues. And I think it might be helpful to ask it for some people’s unproductive behaviour. If I wanted to make a normal, healthy, productive person, ACT like a schizophrenic person, how would I do so? What can I do to make that person exhibit those behvaiours? Or what can I do to make a normal happy person exhibit behavaiours of a person labelled as depressed?

    If I wanted to make someone “act schizophrenic”, I would start by putting the person in situations which they weren’t prepared for. I would provide no teaching. I would work on making sure the person’s confidence was defeated. I would isolate the person and tell them that the world is a scary place and they have no skills to navigate through it. I would give the person only junk food, cigarettes, alcohol and would force the person to have irregular sleeping habits. I’m pretty sure that after some time of being subjected to this, that person will be talking to themselves, “seeing” things, depressed, agitated, frustrated, angry, etc.

    So we need to ask ourselves with children, what are we doing, maybe even unknowingly, that is not in the best interest of our children? How many bad habits do parents have? How often do parents do the easy and lazy thing with their children instead of the right thing?

    It’s easy to slip into this behaviour. I think we need to be vigilant and always fighting against our natural urges to do things the easy way.

  • Phil_Hickey


    This is a very insightful notion. Whenever we interact with a child, we are
    training that child whether we are conscious of our training role or not. And of course the mental health system is training people in how to be “patients,” rather than training them in how to succeed, cope, etc…

  • Great article, felt like I was reading the work of Joseph Glenmullen who, pretty much takes the same stand as you [see Prozac Backlash].

    I’ve recently wrote something along similar lines, basically an argument of whether children should be prescribed psychiatric medication first line or offered alternative therapy.

    Shameless plug – http://fiddaman.blogspot.co.nz/2013/02/psychiatric-medication-or-play-therapy.html

  • Phil_Hickey


    Thanks for coming in. I think the article is great and have posted about it on my site.

    Keep writing.

  • Thanks Phil. Yup, the article is also on OpEd News now.

  • Francesca Allan

    I had two tangles with the mental health system and both times the professionals took a problem and turned it into an absolute nightmare. Both times started with situational depression, the factors of which were completely disregarded. Of course, we went the chemical and hospitalization route. The result: mania and psychosis.

    After the first go round, I walked away and had 13 years symptom-free with no medication. Unfortunately, at that point, I got myself into a bad situation again. Once again, my life circumstances were completely negated and we did the conventional route. And, not surprisingly, I became sicker and sicker.

    I’ve had just about every psychiatric label there is applied to me. I have pointed out to my current psychiatrist that he is overlooking the very simple explanation I have laid out above. His response was for me to get my medical records so I could “stop being misguided.” Well, okay, I now have half of my records and the only thing they have done is confirm what I think happened. There is absolutely no evidence that my problems have been biochemical. Psychiatry has yet to explain how my neurological problem could have spontaneously abated for 13 years while I was off medication.

    Psychiatry has stolen over a decade of my life. What can I do to ensure this stops happening to others?

  • Phil_Hickey


    The fact is that psychiatry is drug-pushing, and you got caught in their web through no fault of your own. I imagine it’s hard not to feel angry sometimes. What you can do is keep writing. Keep spreading the word. My writings resonate with certain people, but not with others. Some of the people who don’t get my stuff will get yours. The word spreads like ripples on a pond.

    Bigotry and spuriousness always wilt under scrutiny. It doesn’t happen overnight, but the process has started – in fact it is well under way. We just need to keep saying it.

    Best wishes.

  • Cledwyn B’stard

    None of them are as good as the best anti-depressant of all; death, which is the only real way you can escape the tragi-farce of existence.

  • barry

    I think Jean has to take quite lot of responsibility for being drugged herself, so I am not particularly sympathetic. Many people can’t afford to be so incompetent.

  • Phil_Hickey


    Were there some issues in this post that you wanted to discuss?

  • Francesca Allan

    Do you have any sympathy for those forced to take psychiatric medications?

  • Anonymous

    I happened to come here the same second as you! let’s chat


  • barry

    As I have said elsewhere, I am only interested in severe problems. I don’t think banning antidepressants because psychiatrists and patients abuse them is fair on those for which they save their lives.
    If you take women with an extensive history of sexual abuse or incest, they frequently become very depressed. They might not seek help from healthcare providers for years. They can be unable to cope with the stress of their experiences, and can deteriorate in therapy. In fact, therapy might not be a good idea until they are feeling a bit stronger.

    Sometimes its not what is on a blog but what isn’t. It would not be right to lose the antidepressant treatment arsenal for the sake of those who abuse it.

    I am very interested to hear your views because I don’t see how anyone could credibly argue against the use of antidepressant for this group.

  • barry

    In your case, No. You are clearly a vengeful and disturbed individual who has no concept of the severity of distress of those sexually abused and would make others suffer horribly for no good reason. In fact forcibly drugging you would be a good idea considering how dangerous your views are.

  • Francesca Allan

    What a bizarre comment you have made here, Barry! I think it is you who is disturbed. This is really quite shocking.

  • barry

    It’s not bizarre at all. It is cold logic. You are a sad and vindictive loser who would take your revenge no matter who gets hurt.

    Try and answer my question to Hickey below so we can all see what a sad, perverted loser you are. Or maybe you are too cowardly?

  • Francesca Allan

    “Sad, perverted loser” is your cold and logical assessment? If you wish me to answer a question, you’ll have to frame it without being an abusive bully. So please try again: What is the specific question you wish me to answer?

  • Anonymous
  • barry

    Ha ha.

  • Francesca Allan

    So your question is “ha ha”? That’s a toughie to answer.

  • barry

    Zzzzzzz. Zzzzzz

  • barry

    Zzzzzzzz Zzzzzzzz

  • Francesca Allan

    Is there a point you’re trying (and failing) to make, Barry? In answer to your earlier question, I think in the scenario you have described, the best approach applies to any depressed person, regardless of the cause of their distress. In a completely supportive environment, SSRIs can be offered (and I stress the word *offered*) with the explanation that although their side effects are often damaging, they do seem to help some patients in the short term. But medication is just one option.

  • cledwyn goodpuds

    Respectfully, I don’t think I’ll ever be convinced of the teleological conception of depression you advance here, but I perhaps can see the value in qualified usage of the term.

    Such a view posits a cosmology where everything follows a purpose that sits uncomfortably with my own belief in an essentially meaningless and purposeless universe, and I can’t help but feel this is rooted in man’s aversion to the notion that suffering has no purpose, which for many years I’ve felt intuitively to be the case.

    I can certainly see the utility of such a teleological outlook, indeed, one could say that the notion that depression is an adaptive mechanism could itself help people to deal with their suffering.

    The way in which we conceive of the world, and the words with which we frame that world, are impregnated with associations and correlative ideas, emotions and attitudes that unconsciously intrude on our behavior and enter upon our decision-making. The notion that depression is an adaptive mechanism could, with the foregoing in mind, lead to a more a positive attitude that may allow people to exercise greater control over their misery, just like telling people they have a brain disease could be said, also with the foregoing in mind, to lead to a more fatalist counter-productive attitude..

    I’m not sure about the validity of the list of anti-depressants you advance either. My problem here is firstly the presupposition that there are solutions to some of the problems depressed people deal with. Also, success regarding the solution of a problem largely consists in the extent to which we successfully identify the cause of that problem, and I think these problems often go far deeper than the problems your solutions imply.

    I think a tripartite division of depression would help us to understand the fundamental kinds. For me (I use qualifiers like this and “in my opinion” not because I am unaware of the reader’s knowledge that this is just my opinion, but to disclose my awareness that this is just my opinion, as well as to avoid the impression of dogmatism, and to try to maintain sceptical distance between myself and my own beliefs where I at least believe it necessary, one of the plagues of contemporary language usage being the employment of factual, descriptive terms to express what are essentially opinions, and, given the reciprocal relationship between language and thought, the erroneous use of such apodictic expressions, as are commonly encountered in popular discourse, does nothing to instill the requisite distance scepticism requires between oneself and one’s own opinions, and gives a bad example to our thoughts, inculcating misplaced arrogance and certainty), these are; depression whose object is the self; depression whose object is the world; and depression caused by some underlying medical condition.

    Regarding depression in relation to the world, under this heading can be brought all types of misery occasioned by existential and aesthetic dissatisfaction.

    Examples of the former are the Weltschmerz that inexorably proceed from intense inquiry into the world, into man’s and nature’s ways, and misery occasioned by the disproportion between the immensity of our desires, demands and designs, and the means with which we try, unsuccessfully, to fulfill them, though there is some overlap here, because this latter pertains equally to depression related to the self.

    For any eye that wishes to see (and such eyes are rarely found in human heads), the world abounds with occasions for the sentiments under discussion, though they are often just as likely to excite fear and nausea.

    The injustice of the world is one such occasion. As Isaiah Berlin once pointed out, poetic justice is called such precisely because it is not to be found in reality, though men, inclined as they are to dream of things that have no counterpart in reality, and to map the contours of the former onto the latter, nevertheless lull themselves into a state of false security with their delusions of a just world where every phenomena corresponds to an overarching purpose; where everything happens for a reason and is a part of some glorious, life-affirming metanarrative.

    Which brings us onto absurdity, that is, the immense gulf separating man’s longing for meaning from a world that seems meaningless, a big bowl of nothing, as Celine said, though this absurdity consists in the contradiction betwixt many different particulars relative to one another.

    It is absurdity we are confronted with when, through the contemplation of the dialectical tension between the self and the world, the disproportion betwixt (I’m not being pretentious, just varying my language) our ends and the means with which we try to attain them is conjured in full relief; it is absurdity we are also confronted with when fate maliciously demolishes the castles we have carefully built in the sky.

    Men yearn for meaning, but without the gullibility and want of humility (which, along with fear, are the necessary conditions of metaphysical-cosmological beliefs of a religious or ideological stamp) which are required to believe in the artificial cosmologies proffered by religion and ideology, man only finds that “state of mind in which the the void is eloquent” (Camus).

    The same applies with justice. Men yearn for a just universe, providentially ordered, yet everywhere the eye is confronted with evidence of the dominion of its opposite. The absurdity is heightened by the fact that, as Jean Renoir said, every man has his reasons, so that men, from the most depraved gangster, to the most charitable saint, all think think they are right, which absurdity is further heightened by the inverse relationship that usually obtains between the extent of the conviction of one’s righteousness, and the true measure in this respect, such inverse relationships being the very stuff of absurdity.

    This absurdity also consists in the tension between man’s true self and the moral values and precepts which he pays lip service to, a tension which reflects back to him as if in a mirror the spectacle of his own evil. Once again, this straddles the divide between depression related to world and self.

    All these different species of absurdity converge on the fact that they are apt to occasion misery and despair.

    As for aesthetic reasons, it is with good reason that doctors often prescribe getting away to the country.

    The most obvious reason for this is that rustication has a salutary effect on the spirits.

    Another is that the novelty of a place makes one more attentive to the beauties therein. Familiarity often breeds contempt.

    Yet rarely discussed is the simple fact that the modern world is ill-adapted to elevate the emotions of those who live in it. Indeed everything about it is pretty depressing. The information conveyed through one sensory organ comments upon that conveyed through another, heightening or depreciating it, so that the sensations created thereby either reinforce or attenuate each other. The city looks depressing enough, what with its endless proliferation of ugly geometric shapes and unnatural colors, but when you factor in the sounds and smells, it all conduces to a feeling of depression.

    Time does not permit me to go further, so I shall confine my present comment to depression whose object is the world, leaving discussion of depression related to the self to another time, drawing upon the work of David Hume in this regards, who perhaps understood as well as anyone the origins of the extreme emotional pain associated with depression in the self.

  • Phil_Hickey


    Thanks for coming in.

    I agree with you that there is no great cosmological purpose, and I recognize your point, that the assertion that depression is an adaptive mechanism, could be construed along those lines. But that is not what I meant.

    In my view, biological evolution is not some purposeful drive towards perfection, but rather a blind, purposeless staggering with lots of dead ends and “errors”. It is the fact that individuals and species compete that gives evolution the appearance of purpose, in that, in a truly competitive environment, those species, and those members of a species, that possess more adaptive traits, are, on average, more likely to survive and reproduce. In a non-competitive context (e.g. an ecosystem in which there were no carnivores and an over-abundance of vegetation), evolution would be more clearly seen as the random thing that it is.

    One of humanity’s adaptive traits is our tendency to discern patterns. But it’s a two-edged sword, because it often results in us “seeing” patterns that aren’t really there.

    I often wonder about our early ancestors – hunter- gatherers in central Africa. It’s speculation and conjecture, of course, but I envisage them generally enjoying one another’s company (an adaptive feeling in that it encourages teamwork and cooperation), but at the same time developing negative feelings (depression?) as the clan grows in size. But although this is a negative feeling, it is also adaptive, in that it might encourage some individuals to leave and start a new clan some distance away. This is similar to swarming activity in bees, and it is tempting to speculate that swarming activity in bees is driven by some kind of negative feeling triggered by perceived overcrowding: a kind of evolutionary precursor to human depression.

    I agree with your general point that there is so much about the modern world that is inherently depressing, exploitative, and ugly, and in a “natural” state, people would be migrating to remote areas in the way of our ancestors. However, there aren’t that many places left to go, and people generally have been persuaded, through a lengthy history, that they can’t get away – that they’re stuck on the treadmill and that this is the ideal life for which we should all be grateful.

    You write:

    “Yet rarely discussed is the simple fact that the modern world is ill-adapted to elevate the emotions of those who live in it.”

    With this, I couldn’t agree more, and I commend the clarity with which you have expressed such a profound and far-reaching idea.

    Indeed, part of the rationale for psychiatry – also rarely expressed – is that the constraints under which people live are such that they must have drugs just to survive. It’s rarely expressed, because it exposes the entire fraud for what it is, but it is, nevertheless, part of the reality. Psychiatrists, of course, can never acknowledge this, because it undermines their contention that they are healers dispensing medications, rather than dealers dispensing drugs.

    Where we differ – or perhaps we don’t – is my belief: 1. as individuals we can create personal oases or havens (not necessarily in a geographical sense) in a world that is often hostile and difficult; and 2. that we can, collectively, make things better. With regards to the latter, though, I would certainly concede it does often appear that we are not making much headway.

    Which takes me back to the original issue – depression as an adaptive mechanism. In my view, depression is adaptive in the sense that it provides motivation to make changes, in the same way that feelings of hunger motivate us to seek food. But the constraints of the world – indeed the oppression of the world – are such that the change activity often doesn’t occur. An abused woman, for instance, often opts to stay in an inherently depressing situation because she feels trapped. This, I suggest, is similar to a hungry person ceasing to look for food if he becomes convinced that there is no food within reach. One could argue that his hunger has driven him to the point of despair and inactivity, when in fact it is his inability to assuage his hunger that has led to this condition.

    Similarly with depression, it is part of psychiatry’s position that depression causes people to become inactive, when in reality, the failure to become active (i.e. to make needed changes in their lives) stems from their long-standing and well-grounded perception that they can’t actually improve their lot. It is perhaps psychiatry’s greatest flaw, that they actively encourage this disempowering perception.

    Best wishes.