mcmanweb overhaul, I am in the process of writing new articles on depression to replace the old ones on the site. Following is an extract from an article-in-progress:
The old DSM-II of 1968 distinguished between “endogenous” and “exogenous” depression, namely between what it saw as depression occurring as a result of the mysterious biological processes of the brain and depression as a result of how one reacts to one’s environment. In one sense, the DSM-II was making a naive “mind-brain” distinction.
Yes, it is useful to think in terms of the mind. But every decision we make, every thought process, every emotional reaction, is mediated through the meat housed inside our skulls. And some meat is not as well-equipped as others to handle the load our environments dump on us.
But the endogenous-exogenous distinction does encourage us to examine where our depression might be coming from. If your marriage is falling apart, for instance, or your situation at work is going badly, it is obviously worth exploring this association. Sort of like investigating whether a person with a pulmonary disorder is working in an asbestos mine. For some crazy reason, the “modern” DSM-III of 1980 and its successors didn’t think this was important.
A personal example:
In November, 2004, I went out for the evening happily thinking I had fired the President, only to have Dan Rather inform me a few hours later that my optimism had been unfounded. Immediately, I felt like Augustine of Hippo after Alaric the Visigoth sacked Rome in 410 AD. (See My Augustine Depression.)
Was I “depressed”? Sure. But was it clinical depression? No. We all have our bad hair days. The DSM mandates at least two weeks for a depressive episode. But suppose my bad hair day had triggered something far more pernicious, a depressed state that persisted for weeks and months? Clearly, I would be in a state of clinical depression.
I knew I could ill-afford to assume that I would rebound from my bad hair day. The situation was not going to go away. There would be post-election follow-up. Days on end of mindless blah-blah-blah. Days on end of exposure to that same stupid grin. For me and my biologically vulnerable brain, this was the equivalent of sending me back down into an asbestos mine. My obvious solution was to immediately change my environment: A total news black-out. No discussing politics.
Also, as a result of my depressive funk, I found myself unable to concentrate on my usual work. So I turned to a different project. This turned out to be my neglected draft to a book I had in mind. The change in routine reanimated me and booted me out of my depression. I completed the manuscript a couple of months later, then found a publisher.
Maybe I should have dedicated “Living Well with Depression and Bipolar Disorder” to George W Bush.