The Rise of Major Depressive Disorder
It has become common nowadays to think of depression as a medical condition. If you visit your general health practitioner, she might ask a few questions about your energy level, appetite, sleep, and mood and, if you answer these questions in a particular way, tell you that you have “Major Depressive Disorder”. Major Depressive Disorder, you will be told, is a real illness. And like any real illness, it even comes with its own pill prescription (SSRIs)…
This way of thinking about depression, however, is really the product of a medical discourse that has been spoken so many times that it is has begun to ring true. And yet, as a psychologist with many years of experience helping people who are depressed, I am here to tell you that the emperor has no clothes on…
The Reduction of Subjective Distress to Objective Symptoms
The talk about depression as an illness is really the result of a more overarching trend in the mental health field to reduce life to objective behaviors or symptoms. We take two individuals and observe how they act, talk, or say they feel. We extract the behavior they have in common, and bam! we have arrived at a symptom. One person’s sleepless nights, for example, are equated with another person’s sleepless nights, and what we now have is the symptom of “reduced sleep”. When we observe a collection of such abstract symptoms that appear to frequently occur together, we end up with a “syndrome”, or a certain cluster of symptoms. And when we give a name to such a cluster, by inventing nouns like “Major Depressive Disorder” or “Generalized Anxiety Disorder”, these nouns then take on the status of illnesses that appear to preexist and explain the appearance of the symptoms.
The Loss of the Subjective Meaning of Depression
So what is the problem with this way of thinking? Well, for one, we have abstracted the symptom from the life of the person, and without this person, the symptom has lost its meaning. It is for example quite different to have a sleepless night because one feels empty inside and can’t stand the stillness of the night, and to have a sleepless night because one lies awake beating oneself up about things one should have done differently during the course of the day. In the one case, the sleeplessness announces to the person that they have become too alienated from their own experience (emptiness being the result). In the other case, the sleeplessness may bear witness to a traumatic event that the person has resolved to deal with by feeling eternally guilty…
The idea of the symptom as some abstract behavior erases these differences and treats each individual’s behaviors as if they were the same. Reduced sleep thus becomes a rather hollow concept. In its abstractness, it hides more than it reveals. To say of both instances of sleepless nights that they refer to the same phenomenon is a stretch, for what looks the same on the surface, betrays significant differences when an understanding of the life of the person is taken into account.
When depression becomes a universal construct or set of behaviors, its true meaning is lost. For in reality, there can be no depression outside the concrete life of an individual. And even though we may label two people’s behaviors as depressed, the meaning of their depression can vary widely. One person may be depressed because they are faced with a life situation that demands they assert themselves, but have fears about doing so, and therefore can do nothing but admit defeat. Another may be depressed because they have cut out social contacts to deal with their social anxiety and now find themselves devoid of meaningful relationships. In short, there are as many types of depressions as there are people who are depressed. There is always a unique story to be told…
The problem with a construct like Major Depressive Disorder is that it gives us the illusion that it exists as some “thing” in itself. It conveys that the “wizard behind the curtain” is a disease process and not a person.
A Faceless Healthcare…
In line with this view, “treatment” of depression becomes a rather impersonal endeavor. One treats “symptoms” not “people”. Instead of taking time to listen and understand, to help people figure out what depression means in the context of their other life problems, one now gets prescribed an SSRI or gets education about sleep hygiene…
Constructs like Major Depressive Disorder, and the philosophical assumptions that underlie them, lead to a faceless kind of healthcare that is devoid of the subjectivity of the person. They trade an abstract category, for the real deal…
Depression is, and always will be, shorthand for a multitude of particular ways that people struggle. Only when we understand the life of each struggling person, will we succeed in understanding what depression really is, for it is many different things to different people. Depression is not a “thing”, and is not an “illness”. Instead it is a marker of a particular stuckness in a person’s life. It acts as an invitation or perhaps a dictate to discover something deeper about ourselves…
About me: I am a clinical psychologist in Houston Texas. Visit my therapy website to read more about my treatment approach to depression.
