The diagnosis of depression is made based on the presence of “symptoms” said to be characteristic of the disorder. The diagnosis does not provide a causal explanation for the presence of the symptoms, as there is no known biological marker that explains the underlying reasons for those symptoms. Yet, in a recent study, Jani Kajanoja and Jussi Valtonen found that prominent health organizations regularly present depression as a condition that causes its symptoms, which—as they write—is misleading and scientifically inaccurate.
By analyzing authoritative mental health websites, the researchers found that many leading organizations, including the World Health Organization and the American Psychiatric Association, contribute to this misunderstanding by conflating descriptive diagnoses with causal explanations. This common practice on authoritative health websites perpetuates a fundamental misunderstanding about the nature of psychiatric diagnoses.
“We’d noticed that people often talk about psychiatric diagnoses as if they were explanations for the difficulties they describe,” Jussi Valtonen, a professor at the University of the Arts Helsinki, said in an email correspondence about the study.
“So we were intrigued by this discrepancy between what psychiatric diagnoses are and how people talk about them, and we wanted to see how clearly the descriptive nature of psychiatric diagnoses is communicated to the general public by trusted health organizations,” Valtonen continued.
“It’s crucial from a science communication standpoint that the information people are given be scientifically accurate – both because truthfulness is intrinsically important in science communication, but also because information disseminated by authoritative health organizations affects our cultural understandings of what psychiatric diagnoses are and what it means to receive one.”
“We had expected that the line between descriptions and causal explanations might sometimes get blurred. We were astonished, however, to see how extremely common it was to see authoritative health organizations using blatantly causal language on their websites.”
“It was clearly not the case that the line just sometimes gets inadvertently a little blurry here and there. Rather, what we found is that many health institutions, in fact, quite widely and actively promote an understanding of depression that’s not only scientifically inaccurate but also based on circular logic. Similarly to how ‘a headache’ does not explain what’s causing the pain in an individual’s head, a diagnosis of major depression does not explain what’s causing the low mood and other symptoms the individual is suffering from.”
Kajanoja and Valtonen’s research analyzed the content of leading mental health websites and discovered that a majority inaccurately depict depression as causing the symptoms it describes. This circular reasoning is not only scientifically flawed but also potentially harmful, as it obscures the true nature of mental health issues and reinforces stigma. The study calls for health organizations to provide clearer, more accurate information that distinguishes between descriptive diagnoses and causal explanations.
The classification of psychiatric diagnoses is a topic of ongoing debate, with recent discussions highlighting a critical issue: the common confusion between descriptive diagnostic labels and causal explanations. While medical diagnoses typically identify a specific cause, such as a microbe or tumor, psychiatric diagnoses like depression are defined solely by their symptoms and lack an identifiable underlying pathology.
This distinction is often misunderstood, leading people to incorrectly assume that diagnoses like depression cause the symptoms they describe. A descriptive diagnosis of depression lists the symptoms observed, whereas a causal explanation identifies the underlying reasons for those symptoms; conflating the two can mislead people into thinking the diagnosis explains the cause, which can hinder proper understanding and treatment.
“At least in Finland,” Valtonen explained, speaking to MIA, “the public media constantly publishes stories about individuals who have struggled all their life, and now, after receiving a psychiatric diagnosis, they finally have an explanation for their problems.”
A thorough examination of psychiatric literature reveals a common error where symptoms are mistaken for causes, even by professionals. Read and Moncrieff have highlighted this issue, noting that depression is often inaccurately described as causing the very symptoms that define it. This misunderstanding underscores the need for accurate information to be provided to the public. While laypeople may easily confuse descriptions with causes, it is crucial for medical authorities and professional organizations to guide societal understanding. However, professionals often conflate these issues as well. Valtonen, in his comments to MIA, added:
“In the clinical field, at least where I used to work, even mental health professionals would often seem to attach a certain significance to psychiatric diagnoses that they technically don’t have, as they’re just lists of symptoms. We found this interesting because the DSM states explicitly that psychiatric diagnoses are (apart from a few exceptions) mere descriptions – something presumably everyone knows.”
To explore whether authoritative health institutions contribute to this confusion, Kajanoja and Valtonen analyzed content from prominent health websites, focusing on the portrayal of depression. They examined whether depression was accurately presented as a descriptive label or misleadingly depicted as a causal explanation for its symptoms.
To investigate how depression is portrayed on educational websites, researchers conducted a comprehensive search using Google, the most widely used search engine. They ensured replicable results by disabling personalized search settings and using Google Chrome in Incognito mode. The search terms included “Depression,” “What is depression?,” “Clinical depression,” and “Major depressive disorder.” To capture a broad range of commonly accessed sites, they analyzed the top 30 search results, focusing on websites from medical, governmental, non-governmental, and academic organizations in English-speaking Western countries, excluding advertisements and for-profit companies. The analysis classified descriptions of depression into three categories: causally explanatory, descriptive, and unspecified. The study found that among the selected sites, 13 were from governmental institutions, nine from non-governmental organizations, three from professional psychiatric associations, three from universities, and two from United Nations bodies. The results aimed to assess whether these websites accurately presented depression as a descriptive label or misleadingly as a causal explanation for symptoms.
Their analysis found that none of the reviewed educational websites accurately presented depression as a descriptive label for a cluster of symptoms, which would have been scientifically accurate.
Instead, 53% of these organizations, including the World Health Organization, described depression as causing the very symptoms it is meant to describe. For instance, the WHO states that depression “can cause the affected person to suffer greatly and function poorly,” a circular claim since significant distress and impairment are criteria for diagnosing depression according to the DSM. This type of causal language misleads the public by implying that the diagnosis itself causes the symptoms rather than describing them.
Similarly, the American Psychiatric Association’s website claims that “depression causes feelings of sadness and/or a loss of interest in activities you once enjoyed,” perpetuating the misconception that depression is a causal explanation for these symptoms rather than a descriptive diagnosis.
Meanwhile, 46% of other analyzed websites, such as the Royal College of Psychiatrists, used ambiguous language that did not clarify whether depression is a cause or merely a descriptive label. For instance, the Royal College’s website states, “Everyone has times in their lives when they feel fed up or miserable… However, if these feelings go on for weeks or months or become so bad they start to affect every area of your life, you may have depression and need to get help.” This lack of clear communication can contribute to public misunderstanding about the nature of psychiatric diagnoses.
The findings suggest that misleading information is widespread among trusted health authorities, which may have several negative consequences.
First, scientific accuracy is crucial for maintaining public trust in science and medicine; misleading information can erode this trust and reduce compliance with public health recommendations.
Second, accurately identifying the source of one’s suffering is essential for effective response and treatment. If people are given incorrect information about the causes of their symptoms, they cannot make informed decisions about their health. Misleading causal claims can prevent people from finding the real sources of their distress, discourage them from understanding their mental health issues, and promote negative outcomes.
In addition, these erroneous beliefs can impair clinicians’ ability to respond to patients with compassion, as they obscure the true nature of mental distress and its links to personal history and cultural context.
The researchers speculate that circular causal claims about depression are common because our intuitions often mislead us into viewing psychiatric diagnoses as having inherent causes. This misconception is reinforced by a cognitive bias called essentialism, where people naturally believe that categories, including mental illnesses, have a core essence responsible for their characteristics.
They also suggest that professional interests and a lack of emphasis on scientific accuracy in education contribute to the persistence of these claims.
The authors do provide some positive examples. The British Psychological Society (BPS) offers a clear example by describing depression as a collection of feelings and thoughts, emphasizing that it is a form of distress rather than a causal agent. This approach helps individuals understand their experiences without misleadingly attributing them to an external pathological cause. Another effective method is to frame depression as an adaptive response to life events, which can reduce self-stigma and empower individuals by highlighting their agency over their symptoms.
One limitation of the study is its narrow scope, focusing only on top-ranked English-language health websites. The authors emphasize that while it is incorrect to say a descriptive diagnosis like depression causes its symptoms, those symptoms can lead to other effects. For example, a depressed mood might cause someone to skip social events, leading to loneliness and further distress. Similarly, insomnia can cause fatigue, impairing cognitive function. While it is circular to say depression causes a depressed mood, it is not circular to say depression can lead to social withdrawal, illustrating how symptoms interact. It’s crucial to distinguish between symptoms causing other symptoms and the mistaken belief that the diagnosis itself is the cause.
“We realize that this may sound like nitpicking – our argument does hinge on the somewhat technical difference between descriptions and causal/etiological claims,” Valtonen wrote to MIA. “However, we believe that depictions of what mental health diagnoses mean are an important form of science communication. These depictions can either help or hinder people in their attempts to understand what their difficulties mean and how to address them. When you’re suffering, it’s critical to learn how to make sense of what’s causing it. Otherwise, it’s difficult to make informed, sober decisions about your life.”
This study is significant in the wider literature of critical psychiatry and psychology as it underscores a fundamental misunderstanding perpetuated by trusted health organizations, including the World Health Organization and the American Psychiatric Association. By misrepresenting depression as a condition that causes its own symptoms, these organizations inadvertently promote circular reasoning that can mislead both the public and professionals. The study calls for a shift in how psychiatric diagnoses are communicated, advocating for a clearer distinction between describing symptoms and explaining their causes. This distinction is crucial for fostering accurate public understanding, improving mental health literacy, and guiding more effective and compassionate clinical practices. The findings contribute to the ongoing debate about the limitations of current psychiatric classification systems and highlight the need for scientifically accurate, transparent communication in mental health care.
Valtonen underlined the importance of the study this way:
“We need to make decisions as societies about how to respond to mental health problems together, and to be able to do so, it is also critical that our shared understandings of what psychiatric diagnoses mean are accurate.”
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Kajanoja, J., & Valtonen, J. (2024). A Descriptive Diagnosis or a Causal Explanation? Accuracy of Depictions of Depression on Authoritative Health Organization Websites. Psychopathology, 1–10. Advance online publication. https://doi.org/10.1159/000538458 (Link)
As one whose former psychologist eventually told me she could not help me, because I was – according to her medical records – “hyperactive about the etiology” of my “illness.” (Brain zaps are actually a common symptom of antidepressant discontinuation syndrome, NOT a “life long incurable genetic mental illness.” And anticholinergic toxidrome poisonings make one hyperactive, not inactive. Hint, hint, “mental health professionals” … etiology matters … so does the truth.)
Thank you for pointing out the circular logic (which is commonly known as insane) of the DSM “disorders,” Justin. Great blog.
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It seems hard to separate the misrepresentation of the cause of depression from the biomedical model. A person experiences the symptoms of depression, they’re prescribed an antidepressant that (if they’re fortunate) lifts the depression, plus the distressing symptoms go away. It’s not at all surprising that people would assume the depression caused the symptoms since they disappeared when the depression was medically treated. This is first and foremost how I came to believe that depression caused its symptoms. The chemical imbalance fallacy lives on, despite the fact there is no scientific evidence supporting it. Antidepressant commercials often reinforce this outdated belief. There needs to be a unified message, but I think that’s going to be a hard sell with the drug companies, who have done quite well by using the erroneous depression message in their advertising.
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