Thanks for coming in with such interesting comments.

First, the disorder/illness terminology.  The reason the APA uses the word “disorder”
is that at the time the first DSM was drafted (1952) there was no real consensus
among its members that these various problems should be considered illnesses. The
term “disorder” was chosen precisely because it was neutral with regards to this issue – merely implying that something was not optimal.  In fact, almost all the so-called diagnoses in the first DSM contained the word “reaction” – schizophrenic reaction,
depressive reaction, etc. – the implication being that the problem behavior was
in some way a reaction to an environmental stressor.  This was probably the most sensible thing the APA ever did, but they abandoned it in DSM II (1968).  And they abandoned it for the simple reason that they wanted to promote an illness model – so that they (physicians) could corner the turf in this emerging market.  Competition from psychologists, social workers, counselors, etc., was already evident, but medicalizing the field ensured that these other workers could never acquire more than auxiliary status.

So today the APA is stuck with the term “disorder” (for historical reasons), but individual psychiatrists routinely present these so-called diagnoses to their clients as if they were real illnesses.  Psychiatrists routinely tell clients, “You have major depressive disorder – this is a real illness just like diabetes – and you need to take anti-depressants in the same way that a diabetic needs to take insulin.”  And so on for the other “diagnoses.”

Another indication of the APA’s dishonesty in this regard can be seen by asking the question:  Which conditions in the manual are mental illnesses and which are not?  As of this time, there has never been any clarification from the APA on this – indeed there has never even been an acknowledgement that there is an issue here.  The only way to interpret this is that either there are no mental illnesses, or the terms mental illness and mental disorder are synonymous.  Obviously the latter is the APA’s position.

Now the APA could resolve this entire issue tomorrow.  All they have to do is issue a press release saying that the “disorders” listed in the book are not illnesses – that they
simply represent sub-optimal clusters of behavior.  But they will never do this because their intention is to medicalize as many human problems as public opinion will stomach.  Also, in order to prescribe a drug, you have to have a “diagnosis.”  You can’t prescribe a drug for a sub-optimal cluster of behaviors.  And DSM-5 is just around the corner, promising even more of this dishonest self-serving rubbish. 

Your comments concerning physical illnesses that are difficult to detect is beside the point.  In those cases there is a reasonable assumption of an injury, malfunction,
structural abnormality, etc..  And the diagnostic procedure consists of searching and educated guesswork to establish the nature of this pathology.  But take the example of the condition known as ADHD.  The DSM lists this as a “diagnosis,” and although the APA uses the term disorder, psychiatrists routinely tell their clients that they have a brain illness and that the stimulant drugs treat this illness.  The fact, however, is that all the criteria for making this “diagnosis” are behavioral – if the child misbehaves in the specified ways, he has the “illness” known as ADHD.  Now compare this to your example of tendonitis.  Suppose a patient goes to his doctor complaining of shoulder pain.  The doctor probes around, asks some questions, and comes up with a diagnosis of tendonitis.  Now lets say next visit, some other piece of information emerges, and the doctor revises his diagnosis – say to torn muscle.  The point is that there is an underlying pathology which can confirm or refute the initial diagnosis.  Nothing comparable can be said of the condition known as ADHD.  If the child emits the behavior, he has the illness – period.  There is no deeper reality to check the “diagnosis” against.

And that’s the problem.  The commonplace assumption is that misbehavior is usually the result of lax discipline/parenting.  But what the APA have done is re-label this misbehavior as a disorder (read illness), and they – in concert with the pharmaceutical companies – have sold this lie unashamedly to the public and to the medical community generally.  The drugs produce compliant behavior on the part of the child, but do not help with the acquisition of personal control/discipline which is so necessary for success in adult life.

You mentioned anti-depressants.  Now I never said that people get the same kind
of high from anti-depressants as from alcohol or cocaine.  What I say is that street drugs and pharmaceutical psychotropics have this in common:  that they artificially alter people’s moods and/or behavior.  They are not medicines – they are drugs.

Anyway, these are complex issues.  It’s clear that you disagree with me, and that’s ok.  But I do encourage you to browse around the website.  Many of the issues you raised, I have treated in greater detail in various places.

Please feel free to come back.

As far as I know, the DSM-IV uses the term “disorder”, not “illness” because the term “disorder” means there is demonstrable harm despite no presence of any underlying classical pathology.  That’s right! I agree with you that there’s no “physical problem”. The problem with your argument is that a lack measurable objective evidence of a physical problem is not a basis on which to say that one is not suffering from an “illness”.  If that was the case, most soft tissue injuries like tendinitis, strains and sprains, and conditions like chronic pain, IBS, fibromyalgia could not be recognized as “illnesses” because there undetectable by any test and based solely on the patient’s description of symptoms and complaints.  Need I remind you that ulcers were believed to be caused by stress and poor lifestyle habits until the 80s when doctors discovered it was the result of H. Pylori?  Just because a “physical problem” has not yet been discovered doesn’t discredit someone’s suffering as “not an illness” and it doesn’t mean no physical cause exists.  The mental health industry is not a big money grab, at least not in Canada where I live. Healthcare is free here, our tax dollars pay the doctor’s reasonable salary and doctors help patients save on drug costs by prescribing less expensive generic antidepressants.  Also, antidepressants are not pills like alcohol, cocaine and amphetamines.  You don’t just pop one and get high. I’m stunned you’re a psychologist and don’t know this! They take weeks to take effect and when they do, the patient slowly start to feel like his normal self again.   Back up for a moment and look at the big picture:  wouldn’t you rather money line the pockets of doctors and pharmaceutical companies who help sick people instead of spending tax dollars to cover the cost to society caused by untreated mental disorder? 

And as far as psychotherapy is concerned, talk therapy isn’t for everyone.  Some patients fare worse when forced to recall traumatic experiences in their lives.  It can also take years before any improvement is seen, whereas antidepressants can improve a depression in 6 weeks.  There’s place for both types of treatments, sometimes apart, sometimes together.  Someone with a severe Axis I diagnosis simply won’t be able to participate in psychotherapy.  However, someone with an Axis II diagnosis can benefit a lot from psychotherapy.  If your article had been “A Personality disorders is not an illness” I might have been more inclined to agree with you.What saddened me the most is how you fail to recognize how damaging and hurtful your post and comments are to those who suffer from depression and other mental disorders. Depressed individuals are already feeling awful and guilty for how they feel; shame on you for telling them it’s not an illness, that it’s their own fault for not taking better care of themselves!  Major depression isn’t a motivator for change, it paralyzes its victim with profound hopelessness and despair to the point where some sufferers end their own lives.  Or is that what you mean by depression creates a mechanism for change? 

Thanks for coming in, and for your very helpful observations.  Certainly too much sunshine can be damaging.  Also the concepts “adequate nutrition” and “healthy lifestyles” need to be approached from an individual perspective.  I agree with you that there isn’t one nutritional formula that’s right for everybody.  Nor is there one daily routine that’s right for everybody.  But having said that, there are diets and lifestyles that are truly disastrous and depressive.

Again, thanks for coming in, and best wishes.

Thanks for your very interesting comment.  You raise lots of interesting issues.

1.  You say that feeling blue is not depression.  Well I disagree.  People use various words to describe a feeling of sadness: depression, melancholy, blue, morose, downcast, troubled, discouraged, etc.. Words mean what people use them to mean, and that is the way people use these words.  The words blue and depressed have essentially the same connotation.  Merriam Webster gives the following meaning for blue:  low in spirits; melancholy… marked by low spirits; depressing….  The notion that the depression described in DSM is not the same as “ordinary” depression has become an accepted part of the bio-psychiatric model.  But there is no evidence to support this notion.

2.  You mention correlations between depression and neurological activity.  I’ve discussed this issue in considerable detail in some of my responses to the comments above, but essentially my position is this. All behavior has neural correlates in the sense that every movement of a muscle is triggered (i.e. caused) by the action of a neuron.  Neurons are also involved in feelings.  Sadness or depression or blues or whatever you want to call it is a combination of feelings and behaviors.  Typically a person experiencing depression is experiencing certain feelings and is also behaving in certain ways.  (Sitting morosely on the couch; casting his gaze downwards; speaking slowly and quietly; saying things like “woe is me,” etc.) And meanwhile the brain and the rest of the neuron system are functioning in a characteristic manner.  So when researchers find neural correlates with depression, this is not surprising.  It would be surprising if they didn’t.

These correlates, however, do not establish the notion that depression is an illness.  There are almost certainly specific neural activities associated with long distance bicycle
racing.  But you wouldn’t conclude from this that long distance bicycle racing is an illness.  Even 105,000 such correlates wouldn’t convince you of this.  Well the same logic applies to the phenomenon we call depression.

3.  It doesn’t matter how often an erroneous statement is repeated. It is still false.

4.  As to an “alternative diagnostic tool,” I fear that you have missed the point.  My point is hat there are better ways to conceptualize unusual/disturbing behavior than the illness theory.  It is the illness theory that requires diagnoses.  Here in the United States a physician who prescribes a pill must also assign a diagnosis.  It was this regulation that initially drove the creation of these spurious diagnoses and continues to drive the expansion of the system.  The problems involved in unusual/disturbing behavior are not suited to a medical model and the population presenting these problems has not been served well by this model.  I would certainly not be cranking out another diagnostic system.
 
In this context, however, it is interesting to note that the APA themselves in 1994 with the publication of DSM IV had this to say:

“It was suggested that the DSM-IV Classification be organized following a dimensional model rather than the categorical model used in DSM-III-R.  A dimensional system classifies clinical presentations based on quantification of attributes rather than the assignment to categories and works best in describing phenomena that are distributed continuously and that do not have clear boundaries.  Although dimensional systems increase reliability and communicate more clinical information (because they report clinical attributes that might be subthreshold in a categorical system), they also have serious limitations and thus far have been less useful than categorical systems in clinical practice and in stimulating research.  Numerical dimensional descriptions are much less familiar and vivid than are the categorical names for mental disorders.” (p xxii)

In other words, the APA is conceding that a dimensional quantification of attributes would be a better (more informative) system than the so-called diagnoses.  But they went
with the latter because the “diagnoses” are more vivid and familiar. In my view, vividity and familiarity are poor criteria for choosing a conceptual framework, and I believe that their primary agenda in this decision was the same primary agenda that they have emonstrated consistently for the past 60 years – the expansion of psychiatric business!

5.  With regards to your personal situations, I don’t know you and so can draw few conclusions.  You suggest that if I had had your life “…(Young, fit, decent wages, attractive young women everywhere, dozens of good mates, running around playing enemy and cleaning rifles” I would have been happy.  I’m not sure I could agree with that.  I think I might have been pretty miserable.  We’re all different!

6.  With regards to the efficacy of anti-depressants, studies consistently show that on average they are only very marginally more effective than placeboes!  See Irving Kirsch’s book The Emperor’s New Drugs. Don’t misunderstand me – I’m not encouraging you to stop taking the drugs.  That’s your own business.  I merely encourage people to study the side effects and make informed decisions.

7.  You express skepticism concerning my notion that depression is an adaptive mechanism – a “message,” as it were, from the organism, calling for change.  You ask me to justify this position, and I think this is a very good point.  I have some difficulty with it, however, because in my view the notion is almost self-evident.  Here’s how I see it.

Humans and other mammals and many other species have evolved to their present state of development with an emotional apparatus.  It seems unlikely that such a widespread
mechanism would have no adaptive value.  

In common with these other species, we are motivated to pursue good feelings (i.e. feelings that feel good) and to avoid unpleasant feelings.  So a feeling of hunger
motivates me to seek food; a feeling of thirst to seek water.  These are very specific feelings with very specific targets.  If I am attacked by an enemy or a predator, I might experience anger, which will encourage me to fight back, or fear, which will motivate me to run. Again, very specific.

The organism needs to be relatively active in order to stay in optimal condition.  So if we sit
around vegetating for lengthy periods, we get a message from our bodies.  The message comes in the form of a feeling: a feeling of depression.  We might use different words – “bored,” “fed up,” etc.. But it’s the same feeling – depression.

(In talking about messages being sent and received, I’m not subscribing to any kind of dualism.  I realize that what we are dealing with is different parts of an organism
interacting.)

And this feeling of depression is what motivates us to get up and get going.  Now the feeling of depression is a stimulus, and the natural response to this stimulus is to get
up and get going – to do something different.  But responses that are not reinforced, for whatever reason, tend towards extinction, and this is what has happened in the case of people who are habitually depressed.

Once again, thanks for coming in.  Please feel free to come back if there are any other points you would like to pursue further.

Obviously ‘feeling blue’ or upset because of a particular traceable event (or for a short period of time) is not depression, obviously someone who lacks self-esteem by attribute of their lifestyle is not necessarily depressed.  

With that out of the way, there are hundreds of papers publish showing a correlation between neurochemical imbalances and depression, (a cursory search on google scholar came up with about 105 000 results).  As an example ”The authors performed dexamethasone suppression tests (DST), TRH infusions, 72-hour urine collections, and lumbar punctures on a group of male depressed patients. Approximately 60% of the patients were DST positive and 33% had a blunted TSH response. Two biologic variables, the 8 a.m. postdexamethasone cortisol and the postprobenecid CSF 5-hydroxyindoleacetic acid (5-HIAA), accounted for over half of the variance in the behavioral measure, the Hamilton score. Plasma cortisol elevation was associated with high 3-methoxy-4-hydroxyphenyl glycol (MHPG) excretion; TSH blunting was associated with low urinary MHPG excretion. Comprehensive biologic measures showed certain significant interrelationships and correlations with the severity of depression.” (http://ukpmc.ac.uk/abstract/MED/6171169/reload=0;jsessionid=5TSqoLdimwZZfdDM5oKw.96 ) 

The fact that every bio/biochem/behaviouralbio course i have ever attended (and the various lectures i have watched on the topic from other universities) acknowledges this fact seems to imply that depression is indeed an illness and not purely environmental.  The view that severe, diagnosed depression is “… an instance of something going right.  Depression is a message from the organism calling for change.”  is totally unfounded.  Do you have any real references or mechanistic explanations to corroborate this view or is it purely opinion?  Off the top of my head i can think of several reasons this is an untenable position (the most obvious being the prevalence of suicidal ideation in severely depressed people).  

As for “The purpose of the DSM is to promote the false notion that depression is really an illness, and to legitimize the prescription of mood-altering drugs.”  I am assuming you propose an alternate diagnostic tool which can be applied consistently throughout the field?  

I personally have suffered from depression (I am an extremely fit, healthy 23 year old male; i eat extremely well and spent 4 years in RAINF; excluding me from all of your causative factors for depression) and it took me years to figure out the best approach in combating the problem.  

Eventually i picked an SNRI (with mild dopaminergic RI).  The irony of course, is that if you were to take the exact same drug (at the same dosage -minimum recommended), it would have little or no effect (barring the mild sleepiness and increase in appetite a few hours after taking it) however, in me, the drug is a virtually miraculous; dysphoria is gone, sleeplessness is gone, suicidal ideations are gone etc.  

Nothing has changed in my environment whatsoever (prior to taking the drug that is, obviously my QOL has seen a huge improvement since) and yet i finally feel ‘normal’ again.  Oh and by the way, if you had my life when i was severely depressed (Young, fit, decent wages, attractive young women everywhere, dozens of good mates, running around playing enemy and cleaning rifles) I could pretty safely say you would not have felt as i did.

You continue to reiterate your view that people who are talking about being in a poor mood for a short period of time constitute the majority of those suffering disorders such as MDD “The fact is that people sometimes get depressed”.  This is just blatantly incorrect.  The whole issue with MDD (As Aqua and others have stated) is that it is CONTINUOUS REGARDLESS OF LIFESTYLE CHANGES.  
In a nutshell: First you try CBT/lifestyle changes, if this fails totally; totally overhaul your environment/lifestyle.  If this has no results whatsoever and (>6 months later) your mood has been consistently depressed you need to look into another avenue – this is where drugs that imitate/alter the activity of neurotransmitters come in extremely handy.  P.S. Even though i feel as though it would be ironic (and god knows i love irony) if you were to suffer from (real) depression, i would never wish such an awful illness on anyone (I do however, hope you stub your toe every day for the next week).

You came in by quoting Amanda. But the quotation was considerably longer than Amanda’s comment. So I’m not sure what’s going on.

Please clarify.

Thanks for coming in. Sorry for the delay in getting back to you – I’ve been a little under the weather.

As I stated in the post, in my view depression is not an illness. Rather it is a message from our bodies to make some changes. If you attempt to walk into a burning building, the heat will almost literally push you back. Similarly if your life is plodding along in a certain direction and you feel really rotten about everything – well that’s your body telling you to change direction – do something different!

Now, as I’m sure you realize, I’m very much in a minority in this view. The disease notion is widely accepted, and billions of dollars are spent each year on its promotion. Most physicians accept the disease notion and prescribe drugs accordingly. In my view this is one of the great tragedies of the modern world.

But I’m not in your shoes. You have to do what’s best for you. And if you find the disease concept comforting and if the drugs seems to help you get by – then who am I to argue? I would, however, suggest that you keep an open mind. Look out for areas where you might be able to effect positive changes. Ask yourself what would you prefer to be doing, etc., etc..

You have gotten yourself stuck in the “either it’s an illness or I’m just no good” mindset. There’s another option: You are a normal person who operates in ways that have yielded payoffs in the past. Depressive behavior is frequently rewarded in our culture and we are all capable of succumbing to this kind of enticement, particularly if alternative modes of operating are not high in our repertoires.

Depression is normal. It is a message from the body to “get up and go.”

Once again, thanks for coming in, and please come back if you have other thoughts or concerns.

Lucy :
M

amanda :
Have all my medical certificates from my gp been lies then? My bosses are going to want to know what’s been going on for 6 months and my therapist spent twice that long saying I’m not pathetic and weak wIlled but I have an illness called depression. Maybe the. Suicidal idealisation does make sense after all. Not sick just useless./p>

amanda :
Have all my medical certificates from my gp been lies then? My bosses are going to want to know what’s been going on for 6 months and my therapist spent twice that long saying I’m not pathetic and weak wIlled but I have an illness called depression. Maybe the. Suicidal idealisation does make sense after all. Not sick just useless./p>