"clinical" depression ?
Q.The term 'clinical depression' is not, so far as I know, defined in the DSM, but is still widely used by mental health professionals. Right, but that's the point I was trying to make -- clinical depression = major depression. The latter is the more current term.
A.I think that dysthymic disorder would be considered "clinical" as well. ("Clinical" has never been a term of art AFAIK -- prior to DSM-III, I think it was called "depressive neurosis" or "involutional melancholia" or "manic-depressive psychosis" depending on specific characteristics.) Precisely. But isn't that why the term "clinical depression" is no longer in use? BPD could be considered clinical too. Everything's clinical now. At the moment, I have clinical breath. Time to brush my teeth. When I was first diagnosed, I remember my doctor saying "We used to call this clinical depression." I think he was trying to convince me that major depression was indeed major. He didn't need to convince me, but I probably gave him a victorola dog look that made him think I was either surprised or confused by what he was telling me. To be honest, it was the first time I'd heard the term "major depression," even though I knew I was pretty fucked up at the time. That's my sense too. After all, "clinical" means "in the context of a clinic" - clinic being a place where things are diagnosed and treated by health professionals. There is a whole spectrum of depression, like any other mental condition - it is up to the health professional whether treatment is called for. The objection raised to this procedure by Nemiah in his Adolf Meyer lecture, however, was that it tends to shift the focus from the patient as subject, a living person with problems and difficulties, to the illness as object, 'a thing in itself' -- as you put it: 'a clinical entity'. What the debate boils down to, I suppose - and here I had better put on some asbestos clothing - is whether one actually views depression as a physical illness. The Diagnostic and Statistical Manual doesn't exist in a social and economic vacuum, after all, and there is material advantage to be had from the 'medicalization' of human life. More importantly, the large pharmaceutical companies make money out of it. It's a multi-billion dollar industry. Diazepam may be one of the most widely prescribed drugs in the world. The so-called 'major tranquillizers' are a similar success story for the pharmaceutical industry. I accept your point about the DSM's avoidance of the discussion of cause and treatment. The DSM is a classificatory system - but it's used, for example, by clinical psychologists (who in the U.S. are already financially and conceptually dependent on psychiatrists), in order to fit in with the demands of the medical insurance companies. This in spite of the fact that the clinical psychologists' education has taught them to be wary of all classificatory systems. While it's clear that depression does contain physical and biological aspects, it also contains many psycho-social and existential features that distinguish it sharply from purely organic, or hereditary, illness. These features are not even recognised or mentioned by the DSM. I guess no one would dispute that mental health professionals are much more likely to be helpers, rather than controllers. They are most often kindly people who really do want to help. Nonetheless, the system and framework within which they operate is one that's built around concepts of disorder, dysfunction and control - and it was built by people and by market forces whose primary concern was not with the human individual. Within that system - of which the phrase 'clinical depression' is a characteristic one - patients are encouraged to see themselves as suffering from a biological illness that can be managed only by a professional 'expert', rather than to come to the realization that there is something they need to understand about themselves and their lives. Antidepressant medications can take us a part of the way, by relieving physical symptoms, and psychotherapy can also play a useful role - but we need to go the rest of the way by ourselves.
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