Major Depression
In the case of depression, the phenomenological approach has led to some hair-splitting in diagnosis that emphasizes artificial and unimportant distinctions, minimizing commonalities and contributing to the trivialization of research. Currendy, the DSM-IV recognizes several distinct depression-related diagnoses, which we will describe together with their reported epidemiological data. The caveat is that the formal requirements for a diagnosis are often rather arbitrary and the distinctions between the diagnoses may be more apparent than real. The most important of these diagnoses are Major Depression, Dysthymic Disorder, and Bipolar Disorder.
Major depression is a very serious condition. Usually the patient and family recognize that something is gravely wrong, but exactly what it is is not so easy to tell. In the simplest case, the patient feels, looks, and acts depressed, and tells people about it.
Nancy has major depression. Although she is able to hold down a responsible job and has raised a family successfully, most of the time she is miserable. She looks tense and sad. She is thin, shy, and worried. She’s hesitant to say what’s on her mind, though she is caring and intelligent. She constantly puts herself down. She believes she can’t handle any stress; in fact, she copes very well, but constantly fears that she’s messing up. She has recurrent migraines that force her to bed several times a month. She has to take a medication for these that costs $80 a dose, and her antidepressant medication costs $8 a day. Her family is on a tight budget, and her insurance doesn’t pay for
medication, so she blames herself for having to spend so much money on treatment.
Nancy describes her depression as a well. When it’s at its worst, she is stuck down in the mud at the bottom of the well. The mud is full of worms and rats, and it’s all she can do to keep from being eaten alive. When she’s feeling good, she’s out of the well, able to look around at life and see opportunities and joy. Most of the time, she’s partway down the well. Her view of life is restricted; she can see it’s there, and she remembers what it’s like to feel good, but she can’t quite reach it.