Depression constitutes the most common psychological problem nowadays. Great numbers of people who experience feelings and thoughts that are described as depressive are on the increase with two million people diagnosed each year in the U.K. alone (McKenzie, 2000). Depression, anxiety and loss of self esteem are also the most common symptoms among psychiatric outpatients (Frank, 1982). Involving diverse and wide populations, the experience of depression appears to be always at the risk of being misunderstood or misinterpreted. It could be argued that the term ‘depression is now so widely used that it is almost meaningless’ (Cohn, 1997: 107); nevertheless, this very popularity of the term and its spectrum of interpretations and meanings seem worthy of a closer examination.

The Oxford English dictionary defines depression as ‘(a) a pathological state of extreme dejection or melancholy, often with physical symptoms. (b) a reduction in vitality, vigour, or spirits’ (Thompson, 1997). Kraepelin, a German psychiatrist, was the first to use the term ‘depression’ medically as a neurosis in 1899. Nevertheless, modern day psychiatry classifies depression as a mood disorder. There are numerous arguments and counter-arguments in relation to whether depression needs to or can be understood medically or not and some of the main points are being reviewed in this dissertation. Depression first entered the psychiatric diagnostic statistical manual (DSM) over 50 years ago. Psychoanalysis was often the treatment then, yet many suffered in silence (Solomon, 2001). Nowadays, millions are treated often with antidepressants with positive results (ibid), whereas other research indicates that popular chemical treatments are not fruitful (Boseley, 2008).

In the most recent diagnostic and statistical manual of mental disorders (DSM IV), two types of depression are presented: depressive disorder and bipolar or manic depressive disorder. This dissertation focuses on the former. DMS IV postulate the following clinical criteria based on which depression is clinically diagnosed: depressive mood, lack of interest and pleasure in life, changes in sleep and/or eating patterns, fatigue, sense of worthlessness, excessive or inappropriate guilt and death thoughts and recurrent suicidal ideation or attempt (McKenzie, 2000). Another definition of severe or clinical depression, based on DSM IV symptomatology, is the following:

  • Persistently sad and/or anxious
  • Feelings of hopelessness and/or pessimism
  • Loss of interest or pleasure in hobbies and activities that were once enjoyed
  • Insomnia, early-morning awakening, or oversleeping
  • Appetite and/or weight loss or overeating and weight gain
  • Decreased energy and fatigue
  • Thoughts of death or suicide
  • Restlessness and irritability
  • Difficulty concentrating, remembering, and making decisions
  • Persistent physical symptoms that do not respond to treatment, such as headaches digestive disorders, and chronic pain

 

Clinical depression would be diagnosed if symptoms persist for at least two weeks. Diagnostic criteria for mental disorders are essentially descriptions of symptoms that fall into one of four following categories. In major depressive disorder for example, affective or mood symptoms include depressed mood and feelings of worthlessness or guilt. Behavioural symptoms include social withdrawal and agitation. Cognitive symptoms, or problems in thinking include difficulty with concentration or making decisions. Finally, somatic or physical symptoms include insomnia or hypersomnia. Depression can also be understood as ‘reactive’ when it appears as a response to a stressful life event; such as a crisis, an accident or a loss. On the other hand unexplained periods of depression are labeled ‘endogenous’, based on the assumption that the depressive trigger lies within the person’s mind or psyche. There is an increasing disuse of these two distinctions in the light of a more interpersonal way of understanding depression (Solomon, 2001). It appears that modern arguments over the nature and definition of depression fall under the tensions between personal triggers and interpersonal processes.