mcmanweb overhaul, I have just started writing new articles on depression to replace the old ones on the site. Following is an extract from an article-in-progress:
The depression check-list dates from the DSM-III of 1980, and is basically a camel designed by committee. To give you one example:
Four of the symptoms can be considered physical in nature. So imagine, your doctor checks off "depressed mood most of the day" (whatever that may mean) PLUS weight gain, hypersomnia, psychomotor slowing, and fatigue. What does that tell us?
For one, it tells us nothing about our state of mind (stressed? overwhelmed? feeling empty?) Nor do we get a good read on our emotions (blunted? over-sensitive? fearful? not caring?). Nor do we get a sense of how we're thinking (over-ruminating? unable to put two thoughts together?).
Only four symptoms actually probe for state of mind, and these hardly contribute to a complete picture. But for the purposes of the DSM it doesn't matter. Five symptoms, and - voila! - we are "depressed."
Look at those same four symptoms again. Granted, they don't tell us what is going on inside our head; nevertheless they represent fairly good markers of the brain in a state of distress. But what kind of distress? Three of the symptoms are presented as sets of opposites, too much or too little - appetite, sleep, activity. Obviously, someone who can't eat and sleep and is pacing about like an over-cranked wind-up toy is in very different mental shape than someone who someone who can't stop eating and sleeping and can't move (and almost certainly has no energy).
Yet - get this - according the DSM, both these individuals have the exact same condition. One is exhibiting outward signs of being an over-ruminating fearful nervous wreck, the other is showing signs of needing to be on life-support. Yet a doctor - with the full authority of psychiatry's diagnostic Bible - will diagnose each one with "depression" and send both out the door with the same prescription.
How crazy is that?