I. What is Depression?
The Medical Model
The American Psychiatric Association has conceptualized depression as a brain “disease,” and in its Diagnostic and Statistical Manual, a diagnosis of depression is to be made if a person has certain “symptoms” said to be characteristic of the disease. These symptoms include low mood, loneliness, feelings of guilt and worthlessness, and thoughts of suicide. Other “symptoms” include over-eating, not eating, over-sleeping, and not being able to sleep. A person does not need to have all, or even most, of the symptoms in order to be diagnosed with depression.
Thus, the individual experience of a depression diagnosis varies. For one person, it might mean feeling hopeless about the future, not sleeping, and over-eating; for another it might mean feeling isolated from others, not eating, and sleeping all day.
As it is conceived of as a disease, the treatment is focused on diminishing the symptoms, as opposed to assessing whether the treatment helps a person make changes in his or her life that might better promote well-being. Antidepressants are used as a first-line therapy for this purpose of reducing the symptoms of the disease.
The Psychosocial Model
Most psychosocial interventions conceive of depression differently. While there may be many physical causes that lead to the “symptoms” associated with depression, the understanding is that the context of a person’s life is also of primary importance. There are many difficulties in life that can lead a person to feeling depressed—divorce, loss of a job, social isolation, loss of a loved one, poverty, and so forth—and thus psychosocial interventions often focus on understanding that context, and making changes in one’s life to alter that context.