Depression

When we see depression in such symptom pictures as biphasic mood shifts or chronic mild malaise , masked depression disguised as behavioral disturbances, even difficult bereavement, it is not clear that we are dealing with a disease. To be sure, lithium, for example, evens out mood swings for bipolar patients. We do not know how it works except that it changes some physiology in the brain. This type of treatment, however, does not make moods into diseases.

Alcohol and benzodiazapines also affect the brain to change moods, and we also do not know exactly how they work because we do not understand the brain in enough detail. Further, losses during infancy , suicide in adolescence , midlife crises , and deteriorations of old age fall within what we have called, simply, depression. But these are not diseases; they are, perhaps, human tragedies or travails; they are difficult and people need help with them and manipulating brain chemistry can work.

But one depression is not like another, if one takes into account the life events that one is coping with. Losing a child is not like losing a parent or losing a job. A person in each of these situations may act similarly, but these life crises are not diseases; each person is struggling with tragedy, pain, loss - and each of these is unique. Does a single disease, called depression, underlie all these? Or are these phenomena better understood in their own right? Do they all simply express sadness? Or is what they express more particular than even that? In fact, it appears that entertaining even an intuitively valid common denominator risks falsifying the dynamics of particular situations. Calling depression a spectrum disorder is certainly an acceptable convention, but we see here also an intrusion of a disease label into places where other themes are more central.

It makes considerably less sense to explain the phenomena as caused by a disease called depression that appears as a spectrum disorder, even though Karasu supports his argument that depression underlies many states. He claims that support for the disease model lies in the traditional distinction between neurotic and normal depression, which can be seen in in the work of Sigmund Freud (1920). This claim is weak. Andreasen (1980) also calls attention to much confusion here.

Such a phrase as "pretending to be" makes the phenomenon sound childish, as in "let's pretend," which is not at all what I mean. Pretending is nothing more than what we all do everyday merely by the fact that we are intrinsically aware of being seen by others and that we cannot avoid knowing that. Thus, some aspects of our behavior are addressed to others as a coded communication. This involves psychology in a way different from the medical diagnosis and treatment of depression.