Chapter

When does depression become a mental disorder?

Mario Maj

in Philosophical Issues in Psychiatry II

Published on behalf of Oxford University Press

Published in print April 2012 | ISBN: 9780199642205
Published online February 2013 | e-ISBN: 9780191754777 | DOI: http://dx.doi.org/10.1093/med/9780199642205.003.0032

Series: International Perspectives in Philosophy & Psychiatry

When does depression become a mental disorder?

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Major depressive disorder is reported to be the most common mental disorder, with a lifetime prevalence in the community ranging from 10 to 25% in women and from 5 to 12% in men (American Psychiatric Association 1994). According to the World Health Organization, it will, by the year 2020, be the second leading cause of worldwide disability (Murrey and Lopez 1996), an estimate based on the above-mentioned data on its prevalence in the community and on a severity score according to which major depression is placed in the second most severe category of illness, the same category as paraplegia and blindness.

These figures are frequently quoted in the psychiatric literature, but are viewed by many, both outside and within the psychiatric field, with a substantial degree of skepticism.

From outside the psychiatric field, it has been pointed out that “determining when relatively common experiences such as… sadness… should be considered evidence of some disorder requires the setting of boundaries that are largely arbitrary, not scientific, unlike setting the boundaries for what constitutes cancer or pneumonia” (Kutchins and Kirk 1997). From within the psychiatric field, it has been stated that “based on the high prevalence rates identified in both the ECA and the NCS, it is reasonable to hypothesize that some syndromes in the community represent transient homeostatic responses to internal or external stimuli that do not represent true psychopathologic disorders” (Regier et al. 1998).

According to Horwitz and Wakefield (2007), “the DSM definition of major depressive disorder… fails to exclude from the disorder category intense sadness… that arises from the way human beings naturally respond to major losses.” As a consequence of this, normal sadness is sometimes treated as if it were depressive disorder, which “may undermine normal recovery… by disrupting normal coping processes and use of informal support networks.”

This argument is likely to be increasingly endorsed by the public opinion in the years to come, and it is therefore crucial for our profession to articulate a convincing response to the question “When does depression become a mental disorder?” In this paper, I will summarize three approaches to this issue, pointing out their weaknesses and the lessons we may take from each of them.

Chapter.  3871 words. 

Subjects: Psychiatry

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