Inner Critics, Antidepressants, and the Medicalization of Emotions

7.01.19

By Adam Zwig, PhD

Everybody Must Get Stoned
Diagnoses of depression have skyrocketed since 2013. New statistics released by Blue Cross Blue Shield state that diagnosis rates have risen 47 percent for millennials and 63 percent for adolescents. Depression is the second most impactful condition affecting Americans, putting it right behind high blood pressure. It’s already being predicted to become the leading cause of loss of longevity or life by the year 2030.

As of 2017, 54 million Americans were on psychiatric drugs, mostly antidepressants. That’s 1 in 6! Tweet: As of 2017, 54 million Americans were on psychiatric drugs, mostly antidepressants. That’s 1 in 6! - Dr. Zwig https://drzwig.com/blog/detail/inner_critics_antidepressants_and_the_medicalization_of_emotionsTweet This Of these, 8.4 million were children, including infants and toddlers. From 1988-1994 and 2005-2008 the rate of consumption increased by almost 400%. Twenty-three percent of women in their 40s and 50s take antidepressants, a higher percentage than any other group (by age or sex).

Move Over Opiate Crisis—Here Comes the Antidepressant Crisis
Most people who take antidepressants do so for many years despite the growing list of long-term adverse effects. Researchers have identified increased risk of brain, cerebrovascular, cardiac, gastrointestinal, sexual and reproductive disorders, increased risk of Type 2 diabetes, and, paradoxically, psychiatric problems, including increased risk of suicide in teens.

In 2017 there was a major meta-study done in Canada that analyzed sixteen studies which included 375,000 participants. The results were scary. The analysis found that in the general population, people taking antidepressants had a thirty-three percent higher risk of dying prematurely than people who weren’t taking the drugs. In addition, antidepressant users were fourteen percent more likely to have a stroke or a heart attack.

Antidepressants disrupt your serotonin and dopamine levels which have important functions not only in the brain, but all over the body. For example, serotonin affects growth, reproduction, digestion, immune function, and lots of other things; it’s found in almost every major organ. So, while these drugs alter your brain chemistry they also have unintended effects on your body in a way that can increase your risk of death.

False Prophets
One of the causes of this antidepressant mania is the fact that anyone with a medical degree can prescribe these powerful drugs; no training in mental health is required. Primary care physicians and pediatricians routinely write prescriptions without having any idea of what’s going on with the patient. Writing a prescription makes everyone feel like the problem is being taken care of; the physician makes a diagnosis and the patient gets the “cure.” But does this meteoric rise in pill popping really mean depression is now being successfully treated? Or does it mean the pharmaceutical industry has given doctors enough financial incentive to convince the public that a pill which numbs out their problems is the correct and healthy way to go?

Peering into the Hidden Psych Lab
In 2008 a research study led by Dr. Irving Kirsch of Harvard Medical School analyzed the results of thirty-five drug trials submitted to the FDA to get approval for antidepressants. They were testing Paxil, Prozac, Effexor, and Serzone - really popular meds. Kirsch used the Freedom of Information Act to gain access to everything that was in the studies. What he discovered was shocking.

For patients with mild to moderate depression, which is most people who take antidepressants, the results were basically the same as placebos. Sugar pills! Those with severe depression felt only a bit better, and only the totally out-of-it folks noticed some improvement. In 2010 the Journal of the American Medical Association reported the same thing. The statistical results of these double-blind clinical trials (where people don’t know if they’re being given a drug or a placebo) showed that almost the entire effect of antidepressants is placebo. But the FDA still approved the drugs for marketing.

Serotonin’s Fake News
The painful experience of depression makes the intuition that you have a “chemical imbalance” seem reasonable. But it’s a wrong intuition. Unconscious psychological processes can produce the most severely messed up states of mind you can imagine—no chemical imbalance required. Antidepressants are supposed to work by increasing serotonin in the brain. Only problem is there are no studies demonstrating that depression is actually caused by a serotonin deficiency nor that antidepressants fix it. Tweet: Antidepressants are supposed to work by increasing serotonin in the brain. Only problem is there are no studies demonstrating that depression is actually caused by a serotonin deficiency nor that antidepressants fix it. - Dr. Zwig https://drzwig.com/blog/detail/inner_critics_antidepressants_and_the_medicalization_of_emotionsTweet This It’s an idea that’s never been proven. But this doesn’t stop doctors from prescribing drugs that alter serotonin levels.

The depression-serotonin idea has become so commonplace that people have stopped questioning it. They believe it to be a proven theory when, in fact, it’s still just a hypothesis. There’s a profound disconnect between the true status of the research and the public’s understanding. Drug companies amplify this confusion by doing advertising campaigns that reframe negative states of mind as “symptoms” which the drugs are designed to cure. The ads frame your emotions in terms of two choices: Either you have a mental illness or you don’t. They don’t provide a third option that perhaps feeling sad and hopeless isn’t an illness at all. If you’re depressed, feel vulnerable, or don’t happen to be a rigorous scientist, it’s easy to buy into these deceptive messages.

Symptom-Free or Self Aware
Now, don’t get me wrong. Many people claim they can function better when they’re on these drugs. For mild to moderate depression, however, an increasing number of studies show that people could achieve the same results just with changes in diet, sleep, and exercise. In my own practice I have helped hundreds of depressed clients completely turn their lives around, and we did it by processing their experiences, not by numbing them with medications. I've done this with many severely depressed clients, as well.

So, the real question is: Is our goal merely to be “functional” at all times?” The pharmaceutical industry has succeeded in convincing us to settle for “symptom-free” living instead of getting to the root of what’s really going on in our psyches. Many people have given up the pursuit of true self-awareness, understanding, and happiness in exchange for not having to deal with their processes. They've opted for the medicalization of their emotions over participation in the conscious evolution of their lives. They've bought into the false message that they should always be happy, and that normal states of sadness and pain are caused by a chemical imbalance of the brain.

We're embarking upon the same kind of dangerous path we entered when opioids became widely prescribed without warnings of harm and addiction. This time we're attempting to erase selfhood in people in order to get rid of their psychological symptoms; it will take a few decades for a new crisis to emerge. Tweet: We're embarking upon the same kind of dangerous path we entered when opioids became widely prescribed without warnings of harm and addiction. This time we're attempting to erase selfhood in people in order to get rid of their psychological symptoms; it will take a few decades for a new crisis to emerge. -Dr. Zwig https://drzwig.com/blog/detail/inner_critics_antidepressants_and_the_medicalization_of_emotionsTweet This

Bad Brain Science
The claim that depression is caused by a "brain disorder” sounds compelling but there is simply no scientific evidence for it. Brain imaging of depressed people shows correlation, not causation. Every emotion has a correlative brain state but this tells us nothing about whether the psychological process causes the brain state or vice-versa. The mere observation of two things happening at the same time gives no data on what causes what to happen. Otherwise you could say eating ice cream causes crime since the incidence of both rise when the weather is hot. There has never been a biochemical study that even remotely demonstrates the cause of depression.

The fact that a drug can numb your mental anguish says nothing about why you’re depressed. The same is true of someone who manages their so-called Social Phobia Disorder by using alcohol; it would be illogical to claim that their phobia was caused by a chemical imbalance which the alcohol cured. This confused notion of causality puts psychiatrists in a dilemma: They want to promote the disease / medication model but their official definition of mental illness says it's cluster of symptoms without any specific underlying cause. Since they they don’t know the cause they focus solely on masking the symptoms.

A powerful example of this confusion is psychiatrists’ dilemma over how to treat grief. The second most recent version of the psychology manual had a grieving clause that said you were allowed to grieve for loss of a loved one for two weeks and after that you have clinical depression. However, the newest manual took this out because it went against the chemical imbalance theory by saying depression can be caused by psycho-social factors. Think about it: Someone close to you dies and your grieving is considered a mental illness. The cure? Drugs. Now that’s some bad science!

To Repress with Pills or to Process
Buying into the chemical imbalance idea dissociates you from your process and encourages you to ignore it. Covering over your symptoms with drugs is a superficial, short-term fix. It misses the fact that behind depression, even severe cases, is a meaningful psychological process sounding the alarm for change and growth.

Taking meds is okay in an extreme crisis but you absolutely need to work on the problem. Long-term use of pills, while helping you function better, turns a blind eye and a deaf ear to the underlying problem, and the more you ignore what’s going on in your psychology the more you plant the seeds for future mental and physical health issues. Processing your depression takes you far beyond merely being functional; it makes you feel whole again and transforms your life in ways you never thought possible. Tweet: Processing your depression takes you far beyond merely being functional; it makes you feel whole again and transforms your life in ways you never thought possible. -Dr. Zwig https://drzwig.com/blog/detail/inner_critics_antidepressants_and_the_medicalization_of_emotionsTweet This It also frees you from having to deal with the all-too-common side effects of downing antidepressants.

Bob’s Mysterious Depression*
A client of mine, Bob, a thirty-nine year-old waiter, complained of chronic depressed moods despite the fact that nothing particularly depressing had occurred in his life. He couldn’t figure out why he always felt down since everything seemed to be in order—he had a good marriage, a decent job, and great friends. He claimed he was depressed “for no reason” and told me he had a chemical imbalance in his brain. In a rare moment of rudeness, I laughed, and said “In the words of the great Tom Petty, ‘You believe what you wanna believe’. Let’s work on your depression and find out what’s going on. What’s it like to be depressed?”

He drew back at my gruffness but nodded, seeming to sense what I had meant. He described his depression, saying, “It feels weird, bad..."

“Tell me more,” I said.

“I’m out of it…”

“Can you give me more details? Imagine I’m an alien from another planet and have no idea what depression is. Describe it in a way I can experience.”

He looked down and pondered my question. “I don’t know... I feel useless.”

“Hmm…I’m still not quite getting it,” I replied.

We went back and forth like this for a while. I wanted him to convey a sensory description of his experience, for example, a feeling like, “I feel empty and lost," or a picture such as, “It’s like there’s a huge stone I’m dragging around,” or a body expression like a gesture of collapsing— something I could relate to. But the more I tried to get him to do this the vaguer he got.

If you don’t have a precise sensory description of an individual’s problem you can’t work on the process because you don’t have real data; all you can do is come up with generic ideas and try to superimpose them over what’s happening. That’s what psychologists and psychiatrists do when they ask people preconceived questions about apathy, hopelessness, loss of interest or pleasure in things, sleep problems, appetite and weight changes, lack of concentration, social isolation, and my favorite—repeatedly going over thoughts. It’s a way to gather general information that could mean anything but is useful for concocting a diagnosis that requires medication.

So, I tried something different. I asked, “What would you have to say to someone to make them feel like you do?”

“What do you mean?” he replied.

“Imagine you could say something to me that makes me feel like you feel. What would you say?”

He thought about my question for a minute, and said, “If I was going to make you feel depressed and fucked up like I feel, I’d say, ‘You’re a piece of shit. You’re no good.’ But I wouldn’t say that to you...or to anyone. That’s mean.”

“Right, that’s mean. Say it to me more.”

“More?”

“Yeah. Amplify this mean, nasty character.”

“Um… 'You’re the worst person in the world. You don’t deserve to live. You’re useless. Worthless'… But I’m not mean like that.”

“Right, but this meanness is in you somehow. If it’s okay I’d like to role-play this meany and say these things to you.”

“But why? What’s that going to do?”

“I don’t know but this is what’s making you feel depressed, so let’s explore it.”

He looked a bit confused but agreed to try. I pointed at him and said, “You’re a piece of shit, the worst man in the world, a good-for-nothing dumbass, a failure.” I went on like this for a few minutes and encouraged him to just notice what he feels. At one point he looked to the side and then down, putting his head in his hands. Then he looked up at me with a tear in his eye. He shook his head.

“I can’t believe it. This is so weird. I actually feel like this toward myself in some way, but I didn’t know. I can’t explain it.”

“Say more.”

“I love myself!” he blurted out. “But I guess I don’t really… I mean I tell myself everything is great but deep down I sort of feel like a failure.”

“Why?”

“I don’t know…like I’m going to be forty soon and I’m a waiter.”

“What’s wrong with that? Sounds fine.”

“I know. That’s what I think too. But something in me says I’m fucked up, like I should be doing something else with my life.”

“Like what?”

He didn’t answer. I waited a minute for him to reply, and finally, he said “I wanted to be a lawyer but didn’t think I could do it, so I didn’t.”

“Why did you think you couldn’t do it?”

“I don’t know... Because I’m a loser?”

“Oh, I see. The same mean voice that said you weren’t good enough to become a lawyer now says you’re not good enough because you’re not a lawyer.”

Bob opened his eyes wide and nodded. “Screwed if do, screwed if I don’t...”

“Right.”

“Are you saying that’s why I’m depressed?”

“Yes. You have an unconscious critic.”

“What does that mean?"

“You have an inner critic that makes you depressed but you haven’t been conscious of it. You’re reacting to an invisible enemy. There’s a critic and a victim of the critic. Up to now you’ve been the victim but you haven’t known what you were being victimized by. Now you know.”

He nodded. “So, what should I do?”

“I don’t know. What do you want to do with a critic that says you’re no good, you suck, being a waiter is bad, and you could never be a lawyer?”

Bob scratched his head but didn’t respond.

“Think about it. In the meantime I’ll put you down,” I joked.

“Fuck you!” he suddenly shot back.

I was a bit shocked, and immediately asked, “Are you saying that to me personally or to me playing the critic?”

“The critic!”

“Ah great! Well, I say, shut up, don’t talk back to me. I’m the all-powerful critic oppressing you. You can’t stand up to me.”

“Yes, I can.”

“No way. You’re too weak.”

Bob had been leaning back in his chair but suddenly sat up straight.

“I like your posture. Do that more,” I said.

He sat up even taller and puffed out his chest but didn’t say anything. Then for some reason I decided to do the same thing and sat up tall and also didn’t speak. We both laughed at this funny non-verbal face-off. Then I continued, saying, “You suck.”

“Fuck you. I do not suck.”

“Yes you do. You’re were born no good and will always be no good.”

“Shut up.”

“No. You’ll never amount to anything.”

As we argued, our postures grew taller until at one funny moment we both stood up. Suddenly, there was silence. I asked him what it felt like to stand face to face with me like this.

He thought for a moment, and then smiled. “It’s like the weigh-in.”

I shook my head, not understanding what he meant.

“The stare-down before the fight.”

“Oh, yeah? Tell me what happens.”

“‘They stare each other down. Then the next night the announcer says, ‘Let’s get ready to rumble!’ and they beat each others’ face in,” he said with a laugh.

“You like that, huh?”

“Yeah, for some reason I do.”

“Well, let’s get ready to rumble, Bob! Time to really fight the critic.”

Transforming the Critic
For the rest of the session and in many subsequent ones we worked on him fighting back against his critic. It was a two-part process: First, he had to become aware that there was a silent voice—an unseen thought pattern—spooking him from his subconscious, and second, he had to react, argue, wrestle, debate, and dialogue with it. Outside of therapy each time he felt depressed he imagined and felt into what the critic was saying to him and then responded. He spent a lot of time writing down these inner conversations in his journal.

A few months later the critic had lost much of it’s power over him, and his depressed moods began to fade. They didn’t go away completely but now he had a way to work on them. Eventually, he had no more depression at all because he inhabited the power that the critic had once used against him.

Everything You Experience Has a Sender and a Receiver
Did Bob have a chemical imbalance in his brain? Did he have a mental illness? Did I cure his disease? The answer to all three questions is no. He didn’t have a chemical imbalance nor a disease needing to be cured. There was nothing wrong with him, nothing needing to be changed, corrected, or fixed. The only thing he needed was awareness of his process. My interventions didn’t help him get rid of an illness; they simply helped him engage with his subconscious.

The way I did this was to ask him the simple question, ‘What would you have to say to someone to make them feel like you feel?’ The reason I asked him this is because every process has two parts—a sender and a receiver. You don’t feel a certain way for no reason; something makes you feel that way even if you’re completely unaware of what it is. Tweet: You don’t feel a certain way for no reason; something makes you feel that way even if you’re completely unaware of what it is. -Dr. Zwig https://drzwig.com/blog/detail/inner_critics_antidepressants_and_the_medicalization_of_emotionsTweet This You’re the receiver of some kind of information communicated to you either internally or externally. As the receiver your job is to identify the sender and it’s message. By asking this question, Bob was able to tap into his subconscious and become aware of the negative thoughts he hadn’t known were there.

In information and communication theory events occur only as a result of a signal traveling from one source to another. There’s no such thing as an event without a signal transfer. In the human process every experience happens as a result of a signal transfer of information that’s constantly being communicated between various parts of your mind, and between you and your environment. There’s no such thing as a one-part process, or, in the words of my  first blog post, one-note music. Bob’s depression was only one part within a two-part process. I helped him uncover the other part—the hidden sender of information that made him feel depressed. Doing this enabled him to bring his inner critic to consciousness and process it.

Three Kinds of Critic Processes
There are three kinds of processes with the inner critic. The first was illustrated by how Bob initially suffered the effects of the critic but had no awareness of the critic itself. This is why he said he was depressed “for no reason.” “No reason” means you’re simply unaware of your process.

The second type of process happens when someone doesn’t have a critic, he or she is the critic. One doesn’t say, “I have an inner critic saying mean things to me and it makes me feel bad,” but rather, “I’m no good, I’m unattractive, nobody loves me, I’m never going to amount to anything,” as if these are self evident truths. There’s no dialogue, only a monologue. I’ve had clients with whom I tried to dialogue but it didn’t help because they were so identified with the critic that its voice was experienced purely as their own thoughts. There was only one part, one note present, instead of two. In these cases, I had to use other interventions.

In both of these examples the person isn’t conscious of the critic. In the former, the critic makes him feel depressed but he doesn’t know it’s there; in the latter, he is the critic, he's one with it, and therefore has no conscious awareness of or relationship to it.

The third kind of process is what Bob eventually discovered, which is awareness of the critic as a part of your mind you can interact with and transform. When you do this you’ll be able to not only integrate your power like Bob did but also discover something else: Critics aren’t only bad. Often they convey an important message you need to hear—wisdom that will help you grow. Sometimes a critic starts out nasty because it wants to get your attention, but if you dialogue long enough you discover that it has a nugget of gold for you. However, you never know what you’ll learn until you jump into the process.

Chemical Imbalance Baloney
The notion that you feel a certain way for no reason except for a random and mysterious chemical imbalance in your brain (that nobody’s been able to even remotely prove) is purely a hypothesis, a guess, a stab in the dark, in lieu of real knowledge of psychological processes. Tweet: The notion that you feel a certain way for no reason except for a random and mysterious chemical imbalance in your brain (that nobody’s been able to even remotely prove) is purely a hypothesis, a guess, a stab in the dark, in lieu of real knowledge of psychological processes. -Dr. Zwig https://drzwig.com/blog/detail/inner_critics_antidepressants_and_the_medicalization_of_emotionsTweet This Sure, take an antidepressant, drink a beer, smoke a joint, take a bath, go for a run, make love, eat ice cream, work out, listen to your favorite music, or forget to sleep like I do, and you’ll alter your brain chemistry. But this has nothing to do with the meaning and purpose of your moods, emotions, and thoughts. To relate to these things you have to work on your process. It’s up to you if you want to medicalize yourself or discover who you really are.

Let’s get ready to rumble!

*Client names have been changed

©2019 Dr. Adam Zwig

Dr. Zwig - psychotherapist, singer-songwriter, and author - is an internationally renowned workshop leader and lecturer, has had 9 Top Ten hit singles on the U.S Adult Contemporary charts, and has over 70 million views on YouTube. He has been featured in Billboard, Huffington Post, CNBC, MSNBC, ABC, CBS, Forbes, and Gibson. Dr Zwig has released 7 albums and his songs can regularly be heard on NBC, Fox, and Fuel TV. His forthcoming book, Music in the Mayhem: Tales of Total Transformation from a Rock n Roll Psychotherapist, arrives soon.