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Patient Commentary: Online screening for depression—old (paternalistic) wine in new (digital) bottles

BMJ 2017; 358 doi: (Published 13 September 2017) Cite this as: BMJ 2017;358:j4207
  1. David Gilbert, director, InHealth Associates
  1. davidgilbert43{at}

When you are in mental and emotional distress, part of the agony is because the mind cannot make sense of what is happening inside or outside.1 In this situation I have wanted a diagnosis to help explain what I am going through and to give a semblance of choice and control. If what I am feeling is something others regard as real, maybe it becomes more amenable to being fixed. Diagnosis is a key that might unlock the prison cell of suffering.

On the other hand, I have also hated being given a diagnosis. Questions such as whether I’m “really” depressed ignore my wider unhappiness and what matters in my life. Diagnostic labels imprison me as a passive patient rather than consider me as a person.

So, does Google’s offer of the PHQ-9 test help to unlock or lock the prison cell? This diagnostic tool focuses on physiological and biomedical symptoms. It puts firm emphasis on dysfunction and frames distress from the outset as an illness. “Significant” scores position your problems as being amenable to doctors’ treatment. Maybe that’s fair enough, but let’s look at context.

The underpinning …

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