Depression

Depression, we are told by the World Health Organisation, is more disabling than angina, arthritis, asthma and diabetes. This may sound counter to what most people think, but it does raise the question, what is depression and what makes it a distinct illness? There is no shortage of definitions of depression. Extreme form of sadness is central to all.

I think three points need to be borne in mind in any discussion about depression.

First, it is an illness that has only relatively recently entered common parlance. I have a lucid memory stretching back to the late 1970s. Yet I do not recall common discussion of depression then. Now, over two decades later, it is discussed even in the villages of India and Pakistan. What has happened? Has depression increased, or have people found a single word to describe what were previously considered disparate symptoms, such as headaches, anxiety and sadness?

Second, depression has become a convenient and acceptable word to mask serious mental illness. What I mean is this: in some cases, what the person is suffering from is not depression, but a serious psychotic illness that affects the thought process. In other words, it is more respectable to admit to depression than to losing touch with reality.

Third, where the intense sadness is related to extreme life events, for example bereavement, loss of job and loss of house all occurring at once, can that be regarded as illness? Is it not normal to have extreme reactions to extreme events? In some cases, then ‘depression’ is not an illness but a reaction to life events. It is important to know this, because the solution lies in tackling the problems, not in taking tablets or making the person feel better when objectively their life situation has little to make them feel good about.

So I would say the medical term depression should be reserved for cases where extreme sadness is not based on life events or is totally out of proportion to any problems and where the thought process remains intact.