Letters

Depression should be managed like a chronic disease: What exactly is “depression”?

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7550.1154-a (Published 11 May 2006) Cite this as: BMJ 2006;332:1154
  1. Derek A Summerfield (derek.summerfield{at}slam.nhs.uk), honorary senior lecturer
  1. Institute of Psychiatry, Maudsley Hospital, London SE5 8AP

    EDITOR—Scott implies that depression is always a timeless, free-standing, internally coherent, universally valid, pathological entity with a life of its own out there.1 Classification systems (generally called international but in fact merely Western) provide definitions which seem to assume this. However, disclaimers in small print say in effect that diagnostic categories are not facts of nature (as, say, a tree is) but cobbled together phenomena emerging as committee decisions. Indeed, it was not inevitable that depressed mood should be seen as the cardinal symptom and name the whole syndrome. Other symptoms could have been used: sleep disorder syndrome or concentration and drive disorder syndrome.

    What is the evidence that depression is under-recognised and undertreated? Some might point to a few community surveys using quantitative instruments supposedly tapping depression. Such instruments, with their demand characteristics and narrow focus on symptoms, generate inflated estimates of prevalence because of their structural inability to assess the whole person in the context of his or her life. We do not have an epidemic of depression but an epidemic of antidepressant prescribing (up two and a half times in a decade) in an age of medicalising and professionalising unhappiness and the problems of living. Good news for the pharmaceutical industry.2

    Sociological, anthropological, philosophical, and, indeed, political frameworks are needed to understand properly human pain and distress in all its nuances and ambiguities, shaped by context and culture and above all centred on meaning (no medical model captures meaning). The depression as disease model does have some purchase (there is a subset of seriously ill people) but as a general formulation it says less about the world than the dominance of medicalised ways of seeing.

    Footnotes

    • Competing interests None declared.

    References

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