The Idea of Depression

Bob Fancher, PhD
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Not so very long ago—certainly when I was in training—mental health professionals generally considered most depression to be symptom or sign—not a disorder unto itself, except in rare cases of major depression. Depression was like fever or pain or swelling—an indicator, though not a very specific one. And like fever or pain or swelling, it could come and go. Of itself, it told us little, but it got our attention. Once we paid attention, we could look for the source of the distress.

Depression was a state of mind, just as inflammation is a state of tissue. In my training, we learned that generally depression would yield in three to six months, if we established a good therapeutic alliance and provided insightful support. Once that happened, we could get on with the real work of understanding the patient’s difficulties and changing his or her life. We weren’t “treating depression.” We were working out the patient’s difficulties.

That was a working hypothesis, not a discovery—a guiding principle of our work. The idea grew out of the psychoanalytic tradition and spread far beyond it, as different schools of thought gave different accounts of people’s suffering. But clinical experience showed that this approach, in all sorts of forms, “works.” Plenty of clinical research supported that claim.

However, as many critics (including me) pointed out, depression tends to be self-limiting, and it responds well to general support. So maybe all our talk about “issues” was mistaken. Maybe we just gave people the support they needed to get better, or to sustain themselves while the depression ran its natural course, and then kind of hoodwinked them into learning how to live the way our school of thought they should. People came to therapy, felt better, gave the therapy credit for their better mood, and became receptive to our ideas about what constitutes “health.”

Nowadays, “depression” has become a dread malady in its own right, a disorder, not a symptom. It’s apt to last forever, demanding that one learn to “manage” it through medication and various “skills.” Mental health care becomes less and less about understanding one’s self and one’s life, so that one can become better, and more and more about learning to manipulate one’s moods. Mental health professionals learn less and less about life, and more about mood manipulation.

Has this change come about because of scientific discovery? Well, no. It’s a shift in perspective—a different way of envisioning a vast swath of human suffering.

What we know is that depression, as an experience, is horrible. In a bout of full-blown depression, our emotional processes can come unraveled, losing their proper function of indicating the significance of circumstances and preparing us to deal with them appropriately. Our moods may go into free fall, throwing us into abject terror. The self seems to disintegrate, actively and inexorably, its pieces collapsing into fiery despair. As we experience it, nothing we do changes or slows or stops the agony, because the self itself, so to speak, loses purchase on its own functional integrity.

Depression in this sense is an experience, a state of mind, a complex phenomenon. It’s a stone fact about the world. We know it exists because we observe it, whether we understand it or not.

The current concept of depression as a mental disorder is different from the experience. Supposedly it explains the experience, but it does much more. It claims that an underlying disorder manifests itself in the experience, and in many other experiences—all the items on the DSM diagnostic checklist. Many of those don’t much resemble the experience of depression. “Depression” is the thing underneath. That’s why we have to be “diagnosed as” depressed.

Psychiatric researchers have decided to designate more and more states of mind, activities, or physical changes as signs of depression. They’ve made a list of mental, emotional, and physical events (low energy, pessimism, thoughts of suicide, sleep problems, etc.), given the list a name (depression), then told us that the things on the list are manifestations of the name.

Giving a list of items a name is perfectly fine—e.g., ‘grocery list,’ ‘fitness regimen,’ ‘travel itinerary.’ But the name is just a convenient way of referring to the list, not the cause of the things on the list. The name doesn’t explain anything.

Let me be very clear about what I’m saying. I’m not saying there’s no such thing as depression. Not at all. Having felt the horrid maw of major depression a couple of times myself, I would never say such a thing. But the concept of a disease entity named “depression,” a “depressive disorder” that underlies and accounts for the various items on the DSM checklist, is a different thing altogether. It’s an idea, not an experience.

Whether that idea will eventually bear fruit remains to be seen. So far, mostly it justifies whatever current theory researchers and clinicians want to pursue and indoctrinate patients to believe—the chemical imbalance theory, the serotonin dysregulation theory, the hippocampus-neuronal-death theory, the cognitive distortion theory, the failures of attachment theory, etc.

Someday, we may be able to identify, measure, and intervene in the postulated underlying disorder, if there actually is one. Some or all of the signs and symptoms on the DSM checklist may turn out to be manifestations of that underlying thing, and that thing may be changeable by direct intervention. We don’t know–but it’s worth noting that the track record for this effort isn’t very good.

The experience of depression is horrific, and when we’re in it, we want—need—it to stop. I am not convinced, though, that postulating a depressive disorder helps much with that. It serves the purposes of the mental health industry—it gives us an air of esoteric knowledge, a rationale for the claim that we can spot and explain this underlying disorder. It’s intellectually interesting, as we try to create new theories of just what this disorder comprises. But it’s not clear to me that it helps much with people’s suffering.

In fact, I would suggest that when we lump many different elements of experience into the general category “signs of depression,” and we see that “underlying depression” as the “real problem,” we tend to become ham-handed and obtuse in how we analyze experience, how we listen to clients, and how we respond to distress. I suspect it leads us to see disparate sorts of suffering, with disparate causes and avenues to relief, as “signs” of something other than themselves. And I suspect that leads us to overlook important distinctions, and important ways of helping.

I’ll explain that suspicion in future blog posts.

14 COMMENTS

  1. I really like your focus on describing the very different meanings that can be put behind a single word like “depression”. In discussions that are pro or against the DSM, I am under the impression that not everybody understand the term in the same way. One understanding of the DSM that seems acceptable in many contexts is a way to briefly summarize some past mental states, and behavioral experiences during a specific period of time with “syndromes”. The numerous abusive ways to use the DSM are familiar to any reader of this site. I believe the real debate is not whether the DSM nosology is helpful or harmful (it can be both). The real debate is what usage/understanding is harmful, and what usage/understanding is helpful.

    • I diagree! The DSM is a dangerous fraud and is only used to stigmatize, force lethal tortures on people wiht drugs and shock ECT, and deprive people of all their civil, democratic and human rights!!! It has no validity whatsoever as even admitted by those in this so called profession including Allen Francis, ed. of DSM IV and great critic of his own creation of false epidemics like bipolar and DSM 5 guaranteed to target every person around the globe. It does not have a shred of scientific evidence behind it and is 100% fraud created with BIG PHARMA for for the nefarious purpose of giving psychiatry only the pretense of practicing medicine when they are really practicing death for greed, profit, power and status.

  2. The DSM IV itself states exactly this in the introduction: “[In DSM,] there is also no assumption that all individuals described as having the same mental disorder are alike in all important ways.” So just because people are described as having “major depression” does not indicate that they have the same thing wrong with them nor that the same interventions will be helpful. Which kind of begs the question of why we bother to diagnose anyone at all?

    Great blog! You really hit the fundamental issue – does naming these things really help us do a better job, or hinder it? My experience says it’s the latter.

    —- Steve

  3. Let’s not overlook the influence of big PHARMA, as I know you are aware !!!!!!

    Remind me to tell you about my experience with the VA when they diagnosed me
    with PTSD and depression.

    I told them they should worry about people who don’t have depression or PTSD after
    debacle we refer to as VIet Nam. .. they they made another chart note: combative!

    I agreed but left without meds.

    Please let me also state I know some of my brother veterans do, in fact, suffer from PTSD
    in very significant ways and I do not intend to diminish their malady.

    PEACE

    • I believe PTSD is valid because it is about the only diagnosis that isn’t supposed to blame the victim for a bad brain or chemical imbalance BIG PHARMA ad ploys to push lethal drugs to cover up all the harm done to society by the power elite. PTSD was created to describe the symptoms of war veterans, rape and domestic violence victims and other normal reactions to abnormal, horrific events. However, most psychiatrists updiagnosed such trauma as bipolar, borderline or other more serious stigmas to get maximum insurance or other payments and deny the victims any justice especially before these toxic drugs were approved for PTSD, so they could push more of these poisons. Recent articles on this web site show how useless and deadly these drugs are for PTSD as they are for other psych labels like bipolar and schizophrenia. To add insult to literal injuries of trauma survivors, there have been many bogus studies to claim that those with PTSD are more vulnerable due to typical eugenics theories or other false claims to blame the victim per usual. Again, the reason is to deny the victims any justice or compensation while psychiatry makes a profit center out of the victims’ suffering.

      When psychiatry adopted the medical model, it was a complete betrayal and fraud because people saw psychiatrists as therapists who could validate and help them with life crises or problems in living like bullying, abuse, divorce, job loss or other types of stressful situations. We still see this on TV even now with the SOPRANOS, IN TREATMENT, etc. People knew exactly what their problems were in many cases. But, as Dr. Peter Breggin warned in TOXIC PSYCHIATRY, the most dangerous thing you could do was visit a psychiatrist once it switched to the medical model. The reason is these psychiatrists knew what these people expected, so they hoodwinked them and pretended to listen while inflicting a bogus stigma, gas lighting the vulnerable person to believe they weren’t suffering abuse or injustice, but were really mentally ill and needed drugs to relieve their now abnormal depression, anxiety, distress, trauma, etc. By the time the person realized they had been hoodwinked and they now had a permanent stigma that could destroy their lives in many ways, it was too late.

      All that I can say is that this was the worst fraud and betrayal of people by so called doctors ever!! I agree with the blogger that depression was not the problem, but a symptom of a person suffering a normal response of SADNESS or GRIEF to a common life problem, loss or crisis. And psychiatrists and other so called mental health experts who sold out to the DSM blaming the victim fraud wonder why their victims are so angry with them!! I read that the trust level for psychiatrists among the public is about 37% and that’s with most people not having a clue about all the harm done by psychiatry selling out to the so called medical model and BIG PHARMA without giving “informed consent.”

  4. Thank you for this! I just read a great quote by Jeff Foster that is relevant:

    “It’s interesting that the word ‘depressed’ is spoken phonetically as ‘deep rest.’ We can view depression not as a mental illness, but on a deeper level, as a profound (and very misunderstood) state of deep rest, entered into when we are completely exhausted by the weight of our own identity. It is an unconscious loss of interest in our story. It is so very close to awakening – but unfortunately rarely understood as such. Or as one friend put it, ‘depression has awakening built-in…'”
    ~ Jeff Foster, http://www.lifewithoutacentre.com

    (Supporting conceptual evolution in the healing of mental and emotional suffering is a large part of our mission at Healers Unbound.)

  5. I wonder what you mean when you say “In a bout of full-blown depression, our emotional processes can come unraveled, losing their proper function of indicating the significance of circumstances and preparing us to deal with them appropriately.”

    I’m not sure if this common insistence that depression means that *something’s not working right* is accurate. Maybe things are working naturally/exactly as they should, based on the situation at hand. just like when someone loses a loved one, their grief– though chaotic and difficult– is exactly what they SHOULD be feeling and going through if they loved that person. Loss is difficult and can even be life-threatening. Depression has a lot to do with loss. When I’m depressed, it’s my situation that is not working right, not my emotional processes. my emotional processes are working as they should: I have no desire to go out and do activities that do not address the pain and predicament that I’m in at the moment, that do not get me closer to being where I need to be. That makes total sense. I can’t be wasting my precious resources and effort on things that are not very likely to help me get to where I need to be. The emotional processes are working normally, it’s the situation that’s unfortunate.

  6. I guess what I mean is that I disagree with the constant second-guessing that goes on of people experiencing emotional distress, as if they don’t *really* have a right to be feeling that way or their bodies/minds don’t *really* have reason to feel that way – it’s all a cruel trick our minds play on us – it’s not! Social factors and conditions are extremely important to our mental health and state of mind, and when they are messed up, bad things happen, just like bad things happen to our health when we don’t take care of it – no one acts as if the body is playing a cruel trick on them when they get lung cancer after smoking for 40 years, or have a heart attach when they’re 300lbs and under constant stress. That’s normal. It’s also normal to feel like you’re half-way dying (sort of what depression is?) when you’ve been neglected, abused, or trauamatized in a way that is almost too much for you to handle. Your reactions are “normal” given your circumstances. Not dysfunctional or abnormal.

    • Thanks for validating my reality! I thought I was saying something similar to the blogger here, but perhaps not. Nice to know that you get it and don’t allow normal reactions to life’s ups and downs to be medicalized, stigmatized and used against the person already reeling from loss, crisis, trauma, etc.

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