Should Depression Be A Diagnosis?
Posted by Dr. Vollmer on December 2, 2013
Should depression be a diagnosi? The late Charles Brenner MD says no, and I agree. Depression, like alcoholism, is a point of inquiry, a symptom of underlying dynamics which signal internal conflict and distress. Type I diabetes is a diagnosis. It suggests an underlying pathophysiology where the insulin production stops, yielding symptoms such as thirst and weight loss. The thirst directs the doctor to explore a known disease. Depression, like thirst, also directs the doctor to explore a disease, but unlike diabetes, we have not found that disease yet. Our ignorance, however, should not label depression a disease, when, in fact, it is a symptom. As a symptom, the doctor needs to remain curious about what underlies it.
Connor, fifty-two, complained that he was unhappy and did not understand why. He is married, neither happy nor unhappy with that, has a good job in finance, enjoys that, and has two college-age kids who do not live at home. He says he is at “loose ends.” What was striking about Connor was my sense of discord between his tone and how he appeared to me to be crestfallen. Tears came frequently to his eyes and he spoke slowly, with many pauses. The onset of his symptoms is always a curiosity, but Connor volunteered that he dates his problem to the fall, when his second child, his daughter, left for college. Until that time, Connor and Ashlynn were close and spent a lot of time together. Connor’s “unhappiness” on the one hand was a classic situation of loss, but on the other hand, indicated a time for inquiry into this new opportunity to find new and meaningful relationships. To say that Connor is “depressed” does not convey the transition he is going through as he sorts through his new emotional landscape. Yes, every mood is an opportunity for change, and as such, Connor is both held back by his mood, and propelled forward by the need to feel better. As with all symptoms, they are guideposts towards deeper understanding. A diagnosis is the end of that road. To have a diagnosis is to shut down curiosity and jump to treatment. This is both wrong and harmful. Connor might be helped by antidepressants, but he might also be helped by the understanding that loss triggered his “loose ends” and that his interior feels depleted, and so perhaps he needs to refuel.