The Evolution of Depression as a Diagnosis
If a man comes to my office and complains, “I am depressed,” a natural question for me to ask is, “What has caused his depression?” In other words, I might view his depression as a reaction to some cause. Forty years ago psychiatrists were likely to assume that this patient’s depression was a reaction to something bad going on in his life. Perhaps he was fired from his job or his wife had recently died. Psychiatrists are less likely to make such an assumption today. Rather, the man could be experi encing a disease, major depression, that designates something wrong in his body. If so, then depressive symptoms are a reaction to changes in the body. In this case, however, the idea of reaction does not quite fit. Better to view depressive symptoms as a manifestation of the disease the body is experiencing. Of course, even today some psychiatrists continue to view depression as a reaction to something bad in life. Psychiatry has grappled with the idea of depression as a reaction throughout its history. And psychiatry has changed its views dramatically during the past 40 years.