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Seduced by biology: The BBC, black dog and biological bias.

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Seduced by biology: The BBC, black dog and biological bias.

Sue Holttum suggests that biological explanations for distress may easily be over-emphasised.

A couple of mornings ago (Tuesday 18th Feb) there was an item on Radio 4’s Today programme about depression. Specifically, it related to the discovery that teenage boys with mild (non-clinical) depression, and higher-than-usual levels of the stress hormone cortisol, were 14 times more likely to develop clinical depression than other boys of similar age. Presenter, Evan Davis, interviewed respected neuroscientist, Prof Barbara Sahakian, from Cambridge University. Instead of asking the obvious question about why these youngsters are suffering enough stress to raise cortisol levels and be mildly depressed, Mr Davis asked about possibly correcting cortisol levels and whether cortisol was the cause of the depression.

On many issues, I respect the BBC’s coverage and feel that it tries hard to be balanced. However, on this occasion – as is often the case with reports about mental health – I felt that the balance was highly questionable. In particular, by focusing on the glamorous technology of brain/biological science, the BBC was promoting the mistaken idea that distress is entirely caused by our biology going wrong.

Let’s be clear: depression is not caused by an imbalance of cortisol. Cortisol is a stress hormone and raised levels of it are our body’s normal response to stressful events and circumstances. Life events and the ‘stuff’ that ensues are the cause of cortisol levels rising, and if the ‘stuff’ goes on too long, depression can be the result.

There is a mass of evidence to suggest that depression and other kinds of mental distress are caused by events such as bullying (including via the internet), neglect, parental over-control and lack of care. For a few examples, see here, here, here, here and here. These references constitute just a fraction of the research linking mental health problems to adverse live events. There are also wider issues such as poverty, gang culture, lack of mentoring, employment or training opportunities, loneliness and homelessness; which are all significant.

Simply looking to ‘correct’ people’s cortisol levels would leave the many social causes of depression and unhappiness unexamined and only make things worse for all of us. The only beneficiaries are likely to be drug companies who are looking for ever wider markets for their products, as the psychiatrist Dr Joanna Moncrieff has eloquently highlighted. Of course a drug can sometimes alleviate the worst of the emotional pain. But if we only focus on biological explanations and treatments, other reasons for distress remain unaddressed and more psychological and societal ways of addressing problems will be underfunded. These things may be less glamorous. In many ways they simply reflect ordinary human kindness. But through the over-focus on ‘sexy’ technology, we are in serious danger of forgetting the importance of ordinary such fellow-feeling, of psychological therapies, of community and equality.

This is only one item on one radio show but it happens over and over again, (an article from The Daily Telegraph from the 17th of February reports a similarly biological focus on depression in children). These stories are indicative of something bigger and more pervasive. It seems we have a need to believe biological explanations for all sorts of human problems, perhaps along with the belief that someone will develop a pill that can eliminate it. It’s worth looking at this article by Ilan Dar-Nimrod and Steven J. Heine, about the way we tend to over-value genetic and explanations for human phenomena. Such explanations may seduce us and squeeze out other ways of seeing things.

We should beware the simplification of these issues, especially the desire for one-dimensional explanations. They serve someone’s interests, but not necessarily ours.

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5 comments on “Seduced by biology: The BBC, black dog and biological bias

  1. Thank Sue, for taking the time to articulate this so clearly. You speak for the thousands of us who put our frustration with uncritical media reporting of this issue (and particularly the Today programme's) to no better use than shouting at the radio…

  2. Thanks for this really interesting post which alerts us to the dangers of biological essentialism in psychiatry (I agree that the Dar-Nimrod and Heine paper is worth reading, as well as some of the responses to it). The findings from the research are interesting but, of course, cortisol is properly interpreted as a stress marker and not a biomarker. It is true that trying to 'correct' affected children's cortisol levels would leave the social roots of depression unaddressed. It would also be very unlikely to alter their subjective experience of being depressed which includes numerous well-documented cognitive changes (e.g. pessimism, rumination) which are also understandable reactions to adverse environments. Let's not forget that cortisol is part of the individual's defensive attempt to muster the biological resources necessary for dealing with threatening and unsupportive environments. We need to understand which aspects of the environment are toxic, and to find ways of emerliorating them. In order to find out how to help individauls, we also need to understand the mechanisms which link specific risk factors to specific outcomes, research that the Wellcome Trust appears to be reluctant to fund. At the University of Liverpool we have a vibrant research group working on these problems, mostly on a shoestring.

  3. Searching for bio-markers for depression strikes me as a similar enterprise to trying to find bio-markers for experiences such as frustration, anger or excitement. Inevitably, they'll be biological correlates floating around in the blood stream or within the brain's synapses, but it would be more sensible to look at life experiences, and the meanings attached to them, for clues at to why someone is feeling frustration/anger/excitement.

  4. just read this, and by looking at the linked articles discovered "affectionless control" which sums up my childhood. This helps explain my depression, low self esteem and feelings of helplessness. It also explains my brothers need to prove himself by doing well in his career. Thanks, I've just ha a lightbulb moment that has confirmed some of my own analysis of my life.

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