Review of Dr. Jantz's whole-person approach to treating depression
by A. Hoffer MD PhD FRCP(C)

Depression as I knew it in 1950 was not the same as the depressions we see today. It was much more severe, carried a greater suicide risk and was narrower in range. Not as many people were caught in its diagnostic web. It was probably just as common but fewer people with depression thought it was a disease and sought medical or psychiatric help. The patients whose disease w a s so severe they had no option found that treatment was very primitive as the only treatment that was really effective was electro convulsive therapy (ECT) recently intro-duced into psychiatry and given to patients who had been admitted to hospital. We had no antidepressant drugs. The only treatment that had widespread acceptance was psychotherapy which was rarely very effective but at least provided support to these patients until by unknown natural recovery processes they came out of their depressions. Many controlled studies had difficulty proving that psychotherapy alone was of any great value and it did not matter which particular type of psychotherapy was used. I remember one of my patients, a rancher in Sas-katchewan, who was dreadfully depressed. I was then in my psychotherapy mode and in the hospital I saw him three hours each week . Nothing happened. I got tired seeing no response and I am sure he also dreaded it until one day I began to talk about playing bridge. He was a good player and that became the topic of our discussions. He began to improve and in one month I was able to discharge him well. I still think that he was going to get well anyway and that I made it less tedious for him by talking about something that meant something to him. All that stuff about his childhood was meaningless to him.

W e recognized two types of depression. Psychotic depression for which ECT was the treatment of choice and probably still is and neurotic depression for which psychotherapy was the treatment of choice. The vast number of people who now and then suffered moderate or severe depression was left undiagnosed and untreated and apparently they did just as well.

Psychoanalysis was considered an advanced form of psychotherapy and was widely used for dealing with depression. I was never convinced that it was helpful from what I had read and after hearing Dr. Karl Menninger, the great American psychoanalyst tell us at a seminar that in his opinion psychoanalyses was not a treatment but a research procedure. And even if it had worked it was only available in larger centers for the few who could afford the time and money.

The fact that ECT was effective for so many suggested that there was a physiological basis for depression. This was reinforced when the first serendipitous antidepressant was discovered. A drug used for treating tuberculosis also made many patients more cheerful. This led to the amine oxidase inhibitors which are still in use and later the tricyclics such as Elavil. These were follow-ed by the modern drugs such as prozac which in my opinion are not generally any better but provide a much wider variety of choice for the patients who no longer respond to the older medication.

Between 1950 and 1970 psychological theories and treatment were so well ingrained that companies advertising the new drugs insisted that they were there only to be used as adjuncts to psychotherapy. Looking back at that period I believe they were on the right track in making these claims. But the new drugs when they worked were rapidly effective. It took a few weeks rather than months of psychotherapy. Eventually the emphasis was almost entirely on the use of drugs and psychotherapy, which is helpful, fell by the wayside. Psychiatrists still pay lip service to the need for psychotherapy but their behavior does not support this.

The dichotomy physical and psychological was replaced by the trichotomy by introducing biochemistry as another important aspect of depression. Orthomolecular psychiatry showed that there is no single disease called depression. The mood depression, that terrible feeling of sadness, anxiety, futility and suicidal ideas is the end result of a number of biochemical ab-normalities, which had not been recognized. These include those depressions caused by food allergies, by vitamin deficiency by vitamin dependencies, by excess of some toxic mineral, by deficiency of zinc for example. What we now need is a different term-for each one-of these depressions. Eskimos have about a dozen terms to describe snow. Why should a person depressed for years because they are eating a food to which they are allergic be labeled the same way as a person how is depressed because they have lost a loved one or failed in business, or are depressed because they are dying of Cancer. We do not have these terms but we do know much more about these other factors that cause depression and which must be taken into account when treating these patients.

This book by Dr Jantz is really wholistic. He recognizes these factors, which cause depression, as well as the psychosocial factors. Of the ten chapters the first six deals with these psycho-social factors such as pressure of life, family dynamics, relationships and in the remainder of his good book he also deals with biochemical factors. He is practicing orthomolecular psychology using the right diet, the correct nutrients as supplements and putting them all together with an excellent psychotherapy. For the novice in this integrated wholistic approach he has a very useful resource list of books, many of which I have and approve.

I wrote a brief foreword for this book. This I would not have done had I not liked the book.