Written by: Shemya Vaughn, PhD, Executive Contributor
Executive Contributors at Brainz Magazine are handpicked and invited to contribute because of their knowledge and valuable insight within their area of expertise.
In the United States, if a person wants their health insurance company to pay for therapy sessions, the person must meet specific psychiatric criteria to prove they have a medical necessity for therapy. Do we have mental health disorders as suggested by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) or are we responding to our environment in an emotional way?
“An abnormal reaction to an abnormal situation is normal behavior.” –Victor Frankl
When insurance companies require a therapist to state that a person has a medical necessity for therapy, this means their therapist must diagnose them according to the symptoms they present in the therapy sessions that meet criteria for a diagnosis. However, if we reflect on the symptoms that people bring to therapy and look at the criteria that the DSM-5 require for a diagnosis, we may want to question if these symptoms are biological occurrences due to neurotransmitter mishaps or a response to lived experiences. Bains and Abdijadid stated that “GABA, an inhibitory neurotransmitter, and glutamate and glycine, both of which are major excitatory neurotransmitters are found to play a role in the etiology of depression…” Does this explain the experiences of people with major depressive disorder?
Criteria for major depressive disorder
According to the DSM-5, people experience major depressive episodes if they meet the following criteria:
1. They report experiencing five or more of the following symptoms within a two-week period and these symptoms are different from how they usually function. Of the nine symptoms listed below, one of the symptoms for criteria must include either a depressed mood or the loss of interest in most activities.
a. The person has a depressed mood most of the day, nearly every day.
b. The person reports a decreased interest in all, or almost all activities most of the day, nearly every day.
c. The person has experienced at least a 5% weight loss or weight gain in month or reported an increase or decrease in appetite nearly every day.
d. The person sleeps too little (insomnia) or too much (hypersomnia).
e. The person is restless or moving so slowly others have noticed nearly every day.
f. The person is tired nearly every day.
g. The person feels worthless, feels inappropriate or excessive guilt nearly every day.
h. The person has trouble concentrating, thinking, or making decisions nearly every day.
i. The person has thoughts about death nearly every day, has suicidal thoughts nearly every day, has a specific plan to kill themselves, or they have already made a suicide attempt.
2. The symptoms the person report must also cause significant distress or impairment in functioning in their social lives (for example, maintaining relationships), at work or school, or in another major life area.
3. These symptoms cannot also be related to the effects of drugs, alcohol, or medication side effects, or another medical condition.
In 2022, Kamran et al. investigated the genetic causes of major depressive disorder. If there is a genetic cause for depression, where did it start? Why did patient zero have the symptoms?
Again, did the person have major depressive disorder or were they responding to environmental factors in an emotional way?
For example, in the US, a person can graduate from high school and obtain a job earning minimum wage. Working 40 hours each week at minimum wage, their take-home pay after taxes means the person cannot afford to do all the things that make life comfortable for adults such as renting an apartment in a safe neighborhood; buying a car with cash or leasing a car, buying food and gas each week; buying clothes and shoes; and spending time with friends. The person would be classified as a low-wage worker, a low-income individual, or living below the poverty level. Some would recommend the person go to college or get job training to get a higher paying job. Both options cost money and do not guarantee an employer will offer the person a job upon completion of a college degree or certificate in a specialized field. In the meantime, the person is usually in a work environment that is emotionally unhealthy and based on productivity; not providing paid sick time, paid vacation days, paid paternal leave, or health insurance. This only describes the financial part of their life. Who would not meet the criteria for major depressive disorder at certain times of the year if this was the financial pressure and employment outlook they experienced?
In my therapy practice, I specialize in working with people of color and individuals in the queer community. I meet people who have health insurance, a college degree (or two or three) and live financially comfortable lives. They are often recovering from childhood or relationship trauma, plus the minority stress of living in a society of oppression, marginalization, capitalism, patriarchy, and white supremacy that can leave them feeling emotionally exhausted, invisible, and disconnected from themselves. Some individuals report symptoms such as insomnia, the inability to concentrate or experience joy, a decreased or increased appetite, or a feeling of hopelessness. I question if these symptoms are due to chemical imbalances in the brain or a response to a society that does not welcome BIPOC and LGBTQ+ folks into many community spaces, work environments, and global conversations about human rights. Melissa Marie Lopez said that “institutional and structural systems that are steeped in race, white supremacy, and colonialism work to divide us and conquer us, often without us even realizing it.” Lopez spoke about our inability to heal as a collective because the systems can divide us. In therapy, it is the health insurance companies dividing the therapist and the person needing mental health services.
While I understand the capitalistic need for insurance companies to only provide mental health services for people experiencing severe symptoms, I wonder if we, as a society, may abandon those diagnoses and labels and focus on navigating this unhealthy puzzle of systems to achieve some semblance of joy and pleasure in the present. I wonder if we can move past surviving the workplace and learning coping skills to thrive in our own lives.
Shemya Vaughn, PhD, Executive Contributor Brainz Magazine
Dr. Shemya Vaughn is a Certified Rehabilitation Counselor, Licensed Professional Counselor in Missouri, and Licensed Clinical Counselor in California with a doctorate in rehabilitation counselor education from Michigan State University. She has taught at three community colleges and four universities. Her book, Transgender Youth, was published in 2016 and she also co-authored a book, Trauma-Informed Care in 2021. She currently operates an online private practice providing therapy for anxiety, depression, and trauma to individuals in the BIPOC and LGBTQ+ communities.
