Take a Chill Pill: Investigating Psychiatry’s Philosophy of Mood

Rosen, Aaron. 2011. “Emmanuel Levinas and the Hospitality of Images.” Literature and Theology 25, no. 4: 364–78.

Take a Chill Pill: Investigating Psychiatry’s Philosophy of Mood

Holly Tengelis, Masters Student (Ryerson University)

Introduction

Over the last 50 years, significant advancements in psychology and neuroscience have encouraged and allowed many individuals to receive unprecedented treatments for mood disorders. Various treatment options were developed, including cognitive based therapy, neurotherapy, general psychotherapy, electroconvulsive therapy, and most notably, medication (Crumby, Harper and Reavey 2013, 160). While medication was initially developed as a mental health treatment for serious cases of psychosis, it has become an increasingly common form of treatment, in and of itself (O’Donnell 2017). The medicalization of mental-health treatment has recently come under scrutiny as some question whether it prioritizes the needs of those experiencing a mental disorder or the legitimacy of the psychiatric organization (Horwitz 2003, 66; 69; Pick 2015, 14). Critically evaluating contemporary psychiatric treatments, this paper analyzes the philosophy of mood underlying medication-based treatment courses for mood disorders, including major depressive and bi-polar disorder. This paper first interprets the philosophy of mood implicit in psychiatry’s usage of medication as a sole form of treatment for mood disorders. Psychiatry’s philosophy of mood is understood as the theoretical understanding of moods underlying their practices. This paper argues psychiatry implies an inadequate philosophy of mood by prescribing medication alone because it incorrectly reduces the experience of a mood to a neurotransmitter imbalance, unjustifiably treating only one cause of the disorder. This paper proceeds by first positioning the psychiatric diagnostic and treatment process within philosophical discussions of mood and representationalism in §1. In §2, these psychiatric practices are shown to employ an understanding of moods that is incomplete and inconsistent with the experience of a mood. An alternative understanding of moods is suggested in replacement. Lastly, §3 introduces and argues against psychiatry’s treatment of neurotransmitter imbalances alone.

§1.1 – Psychiatry’s Directedness of Moods

There is disagreement in the philosophy of mood about whether moods are directed at or about something and are thereby representational. It is frequently believed the main difference between moods and emotions is their directedness; while emotions have intentional objects and are clearly directed at things, moods are a more generalized case. Moods seem to arise without stimulus, generally colouring all experience as opposed to being obviously attached to a specific object. In determining whether moods are indeed directed, there is the further question of which direction moods face. Moods may be directed inwardly at the self, outwardly at the world as an abstract whole, or at concrete objects in the world (similar to emotions) (Kind 2014, 117;120). For instance, moods might be about oneself, the general state of the world, or a specific interaction with one’s neighbour. Additionally, moods may have a hybrid-directedness, as a combination of both inward and outward directions. If moods are representational, then there is some mental representation associated with what the mood is about, which is known as its representational content (Mendelovici 2014, 135-6). This representational content can either wholly determine the phenomenological experience of a mood (pure intentionalism) or determine the phenomenological experience together with some other features or functional modes (impure intentionalism) (Mendelovici 2014, 137-8). The fundamental difference is whether the phenomenology of moods is fully or partially determined by and reducible to a mental representation.

Mood disorders are the experience of irregularly fluctuating or prolonged moods, where one’s abnormal mood is significantly impacting their everyday functioning (Crumby, Harper, and Reavey 2013, 13; Alberta Mental Health Board (AMHB) 2010, 1:2). An exceptionally elated mood is referred to as mania, and significantly miserable and low moods are called depressions. Psychopathy in Canada considers a mood disordered if the abnormal mood is prevalent and significantly impeding one’s life for at least two weeks, suggesting at this point that an individual seek psychiatric help for further assessment (AMHB 2010, 3:1; American Psychiatric Association (APA) 2013, 155). The two most common types of mood disorders are bipolar and major depressive disorder, where the former involves cyclic episodes of mania and depression, and the latter is a continued experience of depression (APA 2013, 155). Contemporary thought identifies and emphasizes the role of neurotransmitters in the formation of mood disorders (Crumby, Harper, and Reavey 2013, 76-7; 129; Horwitz 2003, 3; Kirsch 2010, 82).

To receive the proper treatment for a mood disorder, a diagnosis is made by a psychiatrist. During a diagnostic meeting, the psychiatrist first asks questions regarding one’s inner emotions and thoughts to determine whether they are overly negative, erratic, or wrought with guilt. The psychiatrist then determines whether an individual exhibits specific outward behaviour, such as an excess or lack of sleep, impulsivity, or social isolation (APA 2013, 160-1; Crumby, Harper, and Reavey 2013, 106). In these enquiries, the psychiatrist attempts to identify the mood the patient is experiencing. The psychiatrist then compares the patient’s communicated general mood, feelings, thoughts, and behaviours to the symptoms listed under various mood disorders in the Diagnostic and Statistical Manual of Mental Disorders, 5th Ed. (DSM-V). If an individual exhibits enough symptoms, they are diagnosed with the relevant mood disorder (Crumby, Harper, and Reavey 2013, 103; Horwitz 2003, 2).

By referencing a patient’s thoughts, feelings, and behaviours in order to come to know their mood, psychiatrists suggest these features of experience must somehow contain or reflect a person’s mood. For instance, knowledge of an individual’s feelings of isolation, thoughts of selfhatred, and acts of self-harm would not provide information about an individual’s depression, unless these features of experience represent and express their depression. As such, moods must be directed through one’s thoughts, feelings, and behaviours. Thoughts can be about the self, specific external objects, and the world as an abstract whole. Similarly, emotions and behaviours are directed at the self and external objects. Psychiatry’s diagnostic model therefore employs a hybrid-directedness of moods, where one’s mood is directed at inward as well as outward objects and circumstances through their thoughts, feelings, and behaviours. Accordingly, these same features of experience would collectively create the representational content of a mood. This means that which one’s thoughts, actions, and emotions are about while in a certain mood account for the representational content of the mood. For instance, the representational content of depression would be a mental representation of self-directed thoughts about suicide and feelings of hopelessness together with object-directed sleeping (among other features). Psychiatrists similarly think they can come to know which mood a patient is experiencing phenomenologically by referencing the individual’s communicated thoughts, feelings, and actions. This suggests these features of experience likewise account for the phenomenological experience of a mood. So, the phenomenological experience of a mood is determined by the same features which represent the mood. For instance, the same thoughts of suicide, feelings of

hopelessness, and excessive sleeping both represent and phenomenologically describe the experience of depression.

§1.2 – Psychiatry’s Hybrid Pure Intentionality

When psychiatrists treat by medication alone, they subscribe to pure intentionalism by claiming the phenomenological experience of a mood is wholly determined by a neurotransmitter imbalance. As discussed above, psychiatry considers the patient’s shared thoughts, feelings, and behaviours as both the representational and phenomenological features of their mood. However, when psychiatrists treat with just medication, they only treat a neurotransmitter imbalance (aan het Rot, Mathew, and Charney 2009, 305-313; Crumby, Harper, and Reavey 2013, 129; 160; Kirsch 2010, 82). As such, the mental representation of a mood disorder is simply a neurotransmitter imbalance, and the representational content of an individual’s mood is completely reducible to their neurological levels. Psychiatrists thus think that which one’s thought’s, feelings, and behaviours are about while in a certain mood is ultimately reducible to and determined by neurotransmitter-levels. For instance, a patient’s thoughts of suicide, feelings of guilt, and diminished eating are wholly determined by their depleted levels of serotonin. Furthermore, one’s phenomenological experience of a mood disorder is likewise entirely determined by a neurotransmitter imbalance. Since there is nothing more than a neurological imbalance causing a patient’s mood disorder, their neurological levels must be completely determining their experience of the mood disorder. As such, what it feels like to be in a mood is entirely reducible to one’s neurotransmitter-levels. Both the phenomenological and representational features of a mood are therefore wholly reducible to and determined by a neurotransmitter-level. If psychiatrists thought there was some additional, non-representational content of the mood, they would also prescribe some form of therapy to acknowledge an attitudinal or functional aspect of the mood. Furthermore, an impure intentionalist would likely proceed by considering the individual in a less formal setting to notice their bodily conduct, in addition to personally conversing with them. In so doing, some further features of the mood would be recognized, instead of just one’s communicated thoughts, feelings, and behaviours. The DSM-V provides an additional detail of psychiatry’s employed philosophy of mood. For diagnostic reference, psychiatrists have grouped similar experiences and created a “set of

descriptions of the disorders frequently observed by clinicians” for each mood disorder (among other mental illnesses) (Crumby, Harper, and Reavey 2013, 5). The DSM-V is thus an accumulated list of commonly communicated features of experience for each mood disorder (Ibid; Horwitz 2003, 20-1). As such, the DSM-V provides the “official” representational and phenomenological features of each mood disorder. It follows that these features of experience are relatively universal while in a certain mood; what one’s thoughts, feelings, and behaviours are directed at (or about), and the feeling of being in a mood can be widely compared and normalized.

§2.1 – Questioning pure intentionalism

While psychiatry reduces the phenomenological and representational features of an individual’s mood disorder to a neurotransmitter imbalance, this is incompatible with the current diagnostic process. There are several reasons to think that the thoughts, feelings, and behaviours shared in a diagnostic meeting do not exhaustively characterize all features of their experience. As such, psychiatrists would be amiss to reduce a patient’s mood solely to a neurotransmitter imbalance, since they have not even come to know the patient’s entire mood. Furthermore, employing the DSM-V while maintaining pure intentionalism has unjustified implications. First, psychiatry does not account for the countless barriers and tensions present during a diagnostic meeting. Without having established a prior connection to a psychiatrist, individuals are expected to be vulnerable and truthful with them. Thus, while a patient may share certain thoughts, feelings, and behaviours with the psychiatrist for a diagnosis, they are assuredly not transparently sharing all these features; levels of extroversion, critical self-evaluation, honesty, and clarity affect a person’s ability to comfortably communicate with the psychiatrist. But similarly, a psychiatrist’s levels of observation, openness, and patience (among other skills) alter whether they accurately and completely recognize as well as record the features of a patient’s experience. Relatedly, mood disorders such as depression often also cause issues with an individual’s short and long-term memory. There is thus the further potential that the patient misremembers or simply forgets their actual behaviours, thoughts, or emotions. If Freudian psychology is correct, many of an individual’s most primal and motivating desires occur in the unconscious mind and cannot be easily conceptualized (Pick 2015, 4-5; 910). While extensive amounts of psychoanalysis allow a person to eventually articulate the

underlying root of their thoughts, emotions, and actions, these remain in the unconscious during a diagnostic meeting. Therefore, even if a patient is honestly communicating their thoughts, feelings, and behaviours to a psychiatrist, they are not communicating the underlying features of their experience. As such, both the communicated representational and phenomenological features are not fully capturing one’s true experience. Furthermore, pure intentionalism seems altogether unable to account for the unconscious mind; the aspects of the unconscious contributing to the experience of the mood disorder would be reducible to a neurotransmitter imbalance. But if this is the case, pure intentionalism cannot maintain a distinction between the conscious and unconscious mind since fundamentally they both are determined by the same neurotransmitter-levels. It was previously noted that psychiatry’s employment of the DSM-V implies moods are comparable. Following from psychiatry’s hybrid intentionalism, this means there are relatively universal phenomenological and representational features of mood disorders. But psychiatry’s endorsement of pure intentionalism additionally suggests the list of symptoms in the DSM-V is wholly reducible to a neurotransmitter imbalance. Following from this, there must be a neurotransmitter imbalance that is likewise comparable and relatively universal. However, contemporary studies show this is not the case; neurotransmitter imbalances are not necessarily present, and neither is one specific imbalance consistently associated with a certain mood disorder (Crumby, Harper, and Reavey 2013, 78). Studies report some people with depression have depleted levels of serotonin, others have heightened levels, and others have no change in serotonin levels (Ibid). Consequently, individuals can express the same representational and phenomenological features as those for a specific disorder in the DSM-V and yet not have the neurotransmitter imbalance associated with these features. There is thus a tension between psychiatry’s pure intentionalism and their usage of the DSM-V for diagnostic purposes.

§2.2 – Consulting Phenomenology

Psychiatry omits some underlying features of experience in its diagnostic and treatment process. Phenomenology suggests these features cannot be reduced to mental representations. Matthew Ratcliffe explains moods as pre-supposed conditions of experience (Ratcliffe 2012, 361; 368). According to Ratcliffe, moods provide one’s fundamental connection to the world, constituting a sense of belonging and the potential for connection (Ibid, 350; 367). Moods colour

the lens through which everything is experienced. Tuning the body to the world in a specific way, moods project a person’s space of possibilities and felt sense of “I can” (Ibid). When in an elated mood, the world may be alive with potential, as one’s body is primed to act and connect, while a depressed mood fundamentally closes the body off from participating or engaging with the world in a meaningful way. One individual experiencing depression writes: “I feel disconnected from the rest of the world, like a spectator. I only see I was depressed when it stops. It’s like dust, you don’t notice it until you wipe it off and see the difference” (Ratcliffe 2015, 32). But this means moods are not reducible to a mental state or representation because they are pre-supposed by all thought and awareness; moods are “comprised wholly of pre-intentional, non-conceptual feeling” (Ratcliffe 2012, 368). As more than just an emotion, there is a phenomenological aspect of one’s mood which determines how the world seems to the individual, and how their body is fundamentally rooting them in the world, making all experience possible. This phenomenological experience is a bodily tuning and sense of being in the world; it is not reducible to a specific level of neurotransmitters. In these instances, separate from cognition or the mind, the body is taking a stance toward the world. This phenomenological aspect of a mood provides one’s fundamental connection to the world, and since it is presumed by cognition, it must have distinct roots. Following Ratcliffe’s account, there is thus significant amounts of a mood which are not easily explained or articulated because they underly the very formation of thought. For the purpose of this paper, it is sufficient to acknowledge that at least some of the features of a mood are not captured by pure intentionalism; this is enough to show that psychiatry cannot maintain pure intentionalism. So, it is not necessary to completely accept Ratcliffe’s position and wholly explain moods through a phenomenological lens. Ratcliffe’s key contribution is to support the position that a mood cannot be completely reduced to a neurotransmitter level, as psychiatry attempts. As such, there is reason to think the features of experience which psychiatry omits during the diagnostic process are non-representational, thereby implying impure intentionalism.

§2.3 – Introducing Impure Intentionalism

Impure intentionalism holds that the phenomenological experience of a mood is reducible to the representational content of a mood together with further non-representational features (Kind 2014, 117; 120). A mood is determined by the combination of a mental representation of

the mood and some attitudinal or other functional modes (Mendelovici 2014, 137-8). While there are different accounts of what this additional feature may be, the distinguishing characteristic is that the phenomenological experience of a mood can only be fully accounted for by combing the mental representation of a mood with a bodily mode or attitude. Impure intentionalism thus reduces the experience of a mood to a neurotransmitter imbalance together with some other bodily or non-mental representation. In “The Intentional Structure of Moods”, Uriah Kriegel provides an account of impure intentionalism which may suit psychiatry. Kriegel suggests that in a mood, the representational content is ascertained through a representational attitude (2019, 12). Certain attitudes or guises are associated with specific moods and represent the intentional content of the mood in a certain way (Ibid, 17). Depression, for instance, would be associated with meaningless or hopeless representational guises, under which the world, its aspects, and the self are represented while in the mood. While Kriegel’s account may ultimately be too basic, it could account for both the mental and non-mental representational content of moods, including a neurotransmitter imbalance and a basic bodily connection. The most noticeable drawback of employing Kriegel’s thought with Ratcliffe’s is that Kriegel does not think these attitudes are as basic as Ratcliffe. Kriegel easily conceptualizes and names the attitudinal guises under which things appear, while Ratcliffe suggests a more foundational bodily connection that is difficult to articulate. While both thus acknowledge a bodily aspect of moods that is ultimately irreducible to a mental representation, whether Kriegel and Ratcliffe are referring to the same bodily element of moods is for further investigation. However, this is not directly relevant to this paper; Kriegel’s interpretation merely serves as a suggested potential understanding of impure intentionalism to model its strengths for psychiatry. This paper will not take a position on whether Ratcliffe or Kriegel’s interpretation is more correct; it will simply combine both of their thoughts to consider the non-representational aspects of moods as a foundational bodily attitude that is in some sense difficult to articulate. Furthermore, to fully integrate impure intentionalism with psychiatry, more investigation is necessary to determine how to recognize and modify our bodily attitudes and connections. This would perhaps proceed by prescribing activities which re-establish a more positive bodily connection to the world, including certain physical or creative activities. Talk-therapy may also initiate the recognition of one’s representational guises or bodily attitudes needed to ultimately conceptualize and alter them.

§2.4 – For Impure Intentionalism

Accounts of impure intentionalism may provide an explanation as to why long-term recovery from mood disorders is so difficult, as there are multiple representations of the mood which must be treated. While the mental representation may be acknowledged through the treatment of a neurotransmitter imbalance, one’s attitudinal features persist. The opposite may be true as well; while one’s bodily attitude has been treated, their neurological factors remain. As such, individuals may be struggling to ameliorate their bodily attitudes despite having treated their neurological representation. In these cases, although one’s mental representation may be less prominent after receiving medication, their representational guises are still causing the world to be represented as hopeless or meaningless. While a person’s mood may ameliorate slightly, they still need more treatment to establish a more positive bodily connection to the world. To fully recover, both representations require acknowledgement and treatment. Another strength of impure intentionalism is its apparent accommodation of the Freudian unconscious. When certain thoughts and feelings are unconscious, they do not seem reducible to a mental representation; they have not yet been actualized as a mental state. As such, the unconscious mind could serve as non-representational content in some way. For instance, the unconscious mind could create the attitudinal modes through which one experiences. Psychoanalytic therapy would thus allow individuals to recognize and work through these preconceptual bodily attitudes produced by the unconscious. Alternatively, the unconscious could serve as completely different non-representational content. Nonetheless, impure intentionalism seems better suited to accommodate for the difference between the conscious and unconscious mind as it would not reduce both to a neurotransmitter imbalance. This section has shown that when psychiatry treats mood disorders by medication alone, they endorse a form of pure intentionalism. However, evidence was cited to show that psychiatry cannot consistently maintain pure intentionalism because their current diagnostic process does not account for the full phenomenological experience of a mood. Furthermore, their employment of the DSM-V is questionably consistent with pure intentionalism. Ratcliffe’s phenomenology of mood was considered to explain the non-representational aspect of moods, and Kriegel’s thought was used to exemplify some strengths of impure intentionalism in psychiatric processes. This section concludes that the treatment of mood disorders by medication alone implies an

inconsistent understanding of mood’s phenomenological and representational features. The current understanding ought to be replaced by an account of impure intentionalism, such as Kriegel’s.

§3.1 – Psychiatry’s Use of Medication

After an individual is diagnosed with a mood disorder, a psychiatrist creates a treatment plan to stabilize the patient’s mood by treating the cause or causes of the disorder (aan het Rot, Mathew, and Charney 2009; Crumby, Harper, and Reavey 2013, 160-1). Contemporary thought emphasizes the role of neurotransmitters in the manifestation of mood disorders. Neurons are the nerve cells that compose the brain and use chemicals called neurotransmitters to communicate with one another. Each chemical is responsible for a different type of communication, and those which are involved in mood-feeling are serotonin, dopamine, and norepinephrine (aan het Rot, Mathew, and Charney 2009; Crumby, Harper, and Reavey 2013, 77; Kirsch 2010, 82; 85). Psychiatry maintains that mood disorders are caused by an imbalance in these neurotransmitters. For instance, depression is typically associated with depleted levels of serotonin. Following the modern stress on neurobiological Mechanisms in mood disorder causation, medication has become an increasingly common form of mood disorder treatment. Medication functions as a mood disorder treatment by regulating one’s levels of neurotransmitters, where balanced levels are thought to produce proper mood variations and control (aan het Rot, Mathew, and Charney 2009). While different types of medication affect the brain differently in an attempt to establish balanced levels, medication only alters a person’s neurotransmitter levels (aan het Rot, Mathew, and Charney 2009). The experience of a mood disorder is supposed to be alleviated by regulating neurotransmitter-levels through the proper medication. Sometimes medication is prescribed in conjunction with other forms of mood disorder treatment, such as psychotherapy, cognitive based therapy or neurotherapy. But in contemporary psychiatry, medication is commonly prescribed as an effective treatment without any additional treatments. According to a 2014 survey, 75% of Canadians experiencing a mood disorder were taking medication for the disorder (O’Donnell et al. 2017). The same 2014 survey showed that of the individuals taking medication for a mood disorder, 47.6% were taking medication as their sole form of treatment while 27.3% were additionally pursuing some form of talk or interactive therapy (Ibid). But when psychiatrists treat by medication alone, they are only treating an

individual’s neurotransmitters. As such, some psychiatrists are only recognizing one’s neurology as a causal factor of the mood disorder. While there may by other constitutive or more basic causes of the disorder, treating by medication alone only treats one’s neurotransmitter-levels.

§3.2 – Questioning Psychiatry’s Medication Usage

Although some psychiatrists are only treating neurological causes with medication, studies show mood disorders may have several other potential non-neurological causes. Additionally, studies show neurotransmitter imbalances are caused by something external and more fundamental. Furthermore, some causes manifest mood disorders without the presence of a neurotransmitter imbalance altogether. It is therefore unclear why some psychiatrists only treat the neurobiological cause of a person’s mood disorder; this cause is not always present and typically accompanies constitutive or more basic causes when it is. Studies show neurotransmitter imbalances are neither necessary nor sufficient in accounting for the experience of a mood disorder (Crumby, Harper, and Reavey 2013, 78; 84-5; 129; 134; Pick 2015, 16).34 In one study, medication was distributed to induce depletions in serotonin, dopamine and norepinephrine in individuals who were not depressed, and very few developed an experience of depression (aan het Rot, Mathew, and Charney 2009; Crumby, Harper, and Reavey 2013, 134). Triggering the neuro-chemical imbalance was thus not sufficient for experiencing the associated mood disorder. In addition, although depression is associated with depleted levels of serotonin, some people with depression conversely have heightened levels of serotonin or even normal levels (Crumby, Harper, and Reavey 2013, 78; 160; 166; Kirsch 2010, 91). As such, the neuro-transmitter levels associated with depression are also not necessary for the experience of the mood disorder. Some causes of mood disorders thus manifest the disorder independent of neurotransmitter imbalances. For instance, studies show childhood trauma causes the repression of memories which often surface by way of mood irregularities (Crumby, Harper, and Reavey 2013, 129; Pick 2015, 4; 22; 24-5; 27). Similarly, learned behaviours by social pressures or family values cause disordered moods and serious impediments to one’s ability to function (Crumby, Harper, and Reavey 2013, 84; 134). Studies have also shown certain individuals possess genetic pre-dispositions to developing mood disorders, activated by a combination of external and internal triggers; the most common among these triggers are stress and environmental trauma (aan het Rot, Mathew, and Charney 2009; Crumby, 58 Gnosis | 19.1 (2021)

Harper, and Reavey 2013, 127). Studies are also currently exploring the link between blood folate levels and the formation of depression (Sathyanarayana Rao et al. 2008, 77). When neurotransmitter imbalances are present, they are typically accompanied by other causal factors. For instance, lifestyle choices including stress-levels, drug usage, and lack of sleep have been shown to contribute to the formation of depression, alongside a neurotransmitter imbalance (Crumby, Harper, and Reavey 2013, 76-7; 84). Low levels of physical activity have also been shown as contributory factors in the formation of mood disorders (Ströhle 2009, 7789). Critics may claim these studies mistake contributory causes with the effects of a neurotransmitter imbalance. While a lack of sleep or physical activity may appear to be constitutive causes, they are really the effect of deficient serotonin. As such, psychiatry may be treating a neurological imbalance because it is the most basic or primary cause. However, studies show neurotransmitter imbalances have an external cause, as they are not likely caused by genetics; for instance, very low rates of identical twins have the same mental illness and thus the same neurological imbalance (Crumby, Harper, and Reavey 2013, 79-80). According to contemporary research, neurotransmitter imbalances may be caused by diet, physical fitness, or physical trauma (aan het Rot, Mathew, and Charney 2009; Crumby, Harper, and Reavey 2013, 84-5; Lopresti, Hood, and Drummond 2013, 16-7; Ströhle 2009, 779). Recent developments in nutritive studies stress the importance of a balanced diet to produce the proper levels of neurotransmitters (Lopresti, Hood, and Drummond 2013, 16-7; Sathyanarayana Rao et al. 2008). Consuming excessive amounts of sugar has been connected to the formation of depression as the foods people consume affect the sensitivity of their neuro-receptors (Lopresti, Hood, and Drummond 2013, 19). Furthermore, studies show diets low in fatty acids may impair the brain’s ability to effectively use neurotransmitters (Sathyanarayana Rao et al. 2008). Likewise, physical activity has been shown to influence production of dopamine in the body (Lopresti, Hood, and Drummond 2013, 19). However, even if genetics do cause neurotransmitter imbalances, new scientific developments relating to the role of epigenetics show that elements of one’s environment and behaviour effect the way genes are expressed (aan het Rot, Mathew, and Charney 2009; Crumby, Harper, and Reavey 2013, 92). Accordingly, a neurotransmitter imbalance is initiated by one’s external environment. Therefore, even if a neurotransmitter imbalance is present and caused by genes, it is still not the most basic cause. In this case, treating the neurotransmitter imbalance

alone would not rectify the environmental factors which initially and continuously contribute to the disorder. If the environmental factors remain unacknowledged and untreated, the neurotransmitter imbalance will persist despite being medicated. Psychiatry’s sole treatment of neurotransmitters thus appears confused, prioritizing the neurological component of mood disorders as opposed to other contributory or more basic causes.

§3.3 – Considering Justifications

To justify their treatment choice, some psychiatrists may claim medication is the easiest treatment course. Alternatively, medication may be the only possible treatment, or the most urgently effective. Furthermore, psychiatrists may claim a neurotransmitter imbalance is the only treatable cause or medication is the most generally effective treatment. However, the ease of medication’s usage is irrelevant if treating by medication alone is an unjustified position. Ease will thus not be seriously considered as a justification for a method of treatment since it is not a viable reason if the underlying philosophy is untenable. Similarly, in uncommon circumstances, people may be unable to pursue other treatments for some reason. However, these circumstances do not justify treating with medication alone; they simply exemplify instances in which psychiatrists may have fewer treatment options to prescribe. Even by offering medication as a treatment alone, some psychiatrists are endorsing its efficacy and underlying understanding of mood. Psychiatrists may then claim medication is the most urgently effective. This justification seems true in comparison to alternative treatment methods; however, many individuals are prescribed medication alone for their mood disorder for long periods of time. While medication may be initially justified, long-term usage is still in question. This inquiry will thus be considering non-urgent intervention. Psychiatry cannot maintain that a neurotransmitter imbalance is the only treatable cause of a mood disorder because the different causes distinguished above are treatable by various means. For instance, there are different types of therapy which allow an individual to heal. In talk therapy, one discusses destructive thought-patterns, repressed memories, diet, and level of physical activity, among other potential causes of mood disorders (Pick 2015, 3-4; 18). Personal trainers can also suggest feedback and lifestyle changes which will treat several of the potential physical causes of mood disorders. Additionally, dietary psychology has emerged as a field of psychology which treats mood disorders primarily through adjustments in diet. Furthermore,

cognitive based therapy targets and ameliorates false beliefs and thought patterns which perpetuate mood disorders (Crumby, Harper, and Reavey 2013, 174). Art and music therapy allow patients to explore and confront identity and communication issues, re-learning how to express their emotions. The other causes of mood disorders thus appear treatable. While psychiatry may cite the supreme efficacy of medication to justify its usage, this is not representative of current data. Medication as a sole treatment is not consistently effective; studies show responses to mood disorder medication are unpredictable and generally negative (aan het Rot, Mathew, and Charney 2009; Crumby, Harper, and Reavey 2013, 166; Hollon and Ponniah 2010, 910). The performance of anti-depressants versus placebos is clinically insignificant. In long-term studies spanning from six months to a year, placebos were found to be 95% as effective as medication (Kirsch 2010, 30; 67).53 While it may be claimed that perhaps the in-effectivity of medication is the result of poor medication choices, further studies show this to be unlikely. In one study of individuals monitored with depression, 37% had positive results after initially taking their first type of medication, 19% then had success with their second, 6% after their third, and 5% their fourth; however, within a year, all but three of the monitored people had relapsed (Ibid, 59). Studies show antidepressants are more effective when combined with psychotherapy (Hollon and Ponniah 2010; Kirsch 2010, 162-3). Furthermore, cognitive therapy has been shown to be at least equally as efficacious as medication, often outperforming medication long-term (Hollon and Ponniah 2010; Kirsch 2010, 166; 171; 177). Evidence thus suggests medication is not more effective than alternative treatments, so its efficacy cannot justify its usage as a sole form of treatment. Having considered and rejected several potential justifications psychiatry may provide for prescribing medication alone, psychiatry’s practice seems unjustified. By prescribing medication as a mood disorder treatment alone, some psychiatrists only treat an individual’s neurotransmitter imbalance. But it was shown there are many other causes of mood disorders which may be an independent or constitutive causal factor. Furthermore, even when neurotransmitter imbalances are present, they may be caused by an external factor. Therefore, psychiatry’s usage of medication alone is neither consistent with nor justified by contemporary studies.

Conclusion

This paper revealed the theoretical understanding of mood underlying the prescription of medication alone and showed it to be incomplete and unreflective of relevant evidence. When psychiatrists prescribe medication as the only form of treatment, they endorse a form of hybrid pure intentionalism and unjustifiably solely treat the neurological cause of mood disorders. However, evidence was presented to support the argument that mood disorders have multiple causes. Furthermore, it was shown psychiatry omits some aspects of a mood and therefore cannot maintain pure intentionalism. Reasons were then given to think that there are aspects of a mood which cannot be reduced to a neurotransmitter imbalance. Following this, impure intentionalism was considered as a replacement. While this paper only considered the case of medication as the sole treatment of a mood disorder, since the consequent philosophy is inaccurate, further investigation is due. If this paper is correct, we have reason to question the motivations of the medicalization of mood disorder treatment. With high stakes, it is thus strongly suggested that there be further inquest into the philosophies surrounding psychiatry and the medicalization of mental-health treatments.

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