Diagnosis: Depression
Depression as a diagnosis has not pushed quite so many of society’s hot buttons, but it is subject to the same controversies. For instance, until the third DSM came out in the seventies, many psychiatric diagnoses were strongly influenced by Freudian theory. Because the theory held that depression was caused primarily by a harsh, strict superego, and because a superego was not thought to be developed until the resolution of the Oedipal conflict, it was assumed that children could not be depressed. DSM-IH addressed that, and many other blind spots in the diagnosis business, by taking a phenomenological approach that DSM-IV has followed: if a symptom cluster was observed commonly enough to be a problem perhaps worth addressing, and if observers with the same training could reliably identify the same symptom cluster with the same patients, that symptom cluster was given a name. There might or might not be a good explanation, a theory, for why that particular group of symptoms seemed to occur reliably together. Certainly it was the hope of the compilers of the new DSM that a reliable classifica-tion system, in which we could all be sure we were counting and observing the same things, might lead to better explanations for the underlying mechanisms beneath the symptoms, and improvements in treatment.
But this approach has also had its drawbacks. It has certainly contributed to the medicalization of complex emotional/behavioral states, like alcoholism, depression, or Post-Traumatic Stress Disorder. It led insurance companies to go along with the idea that an expensive course of hospital-based treatment was appropriate for these conditions, contributing to our current backlash of attempts to overcontrol behavioral health care costs. It has led to absurd legal strategies by defendants who eschew respon-sibility for their actions. It can lead to patients hoping that the
cure for their condition will come about from a new pill, and that until the pill comes along there is nothing they can do to help themselves.