What we talk about when we talk about depression

I would love a dollar for every time someone has said to me that her/his depression has been caused by a “chemical imbalance in the brain,” as if this explained everything, including the necessary treatment (corrective chemicals in the form of antidepressants).

I have long been troubled by the ways we sometimes talk about depression—particularly when we describe it as a “disease,” as if it were as clearly identifiable and discrete a condition as chicken pox, or diabetes.

Yes, we need an agreed shorthand to describe a common set of experiences, and yes, we haven’t yet devised a better model than the medical model for talking about psychological experiences and ailments.  But still, we limit not only our understanding, but our ability to help, by limiting the way we talk about things.

So I was pleased to come across an article this week that proposes what an international team of researchers call twelve “subtypes” of depression.  I’m not sure they’re “subtypes” as such—they seem to be more a set of aetiologies—but nevertheless, the list widens the conversation about depression.  Depression is not like chicken pox or diabetes, with an identifiable pathogen or a verifiable, measurable set of physical processes—it is more like, say, a headache; that is, a symptom of some underlying thing that has gone wrong.

The twelve “subtypes” include illness, infection, long-term stress, loneliness, romantic rejection and grief, to name a few.  The beauty of the list is how manifestly more helpful it is than the old “exogenous” vs “endogenous” dichotomy that prevailed when I first began studying psychology.

If we think about what brings about an episode of depression, we can (a) understand the sufferer’s experience more clearly, (b) provide the sufferer with a clearer way of thinking about the experience, and (c) set about tailoring a response and “treatment”.  (I’m putting “treatment” in inverted commas because I’m still wary of thinking of what a psychologist does as being exactly analagous to what a doctor does.  What psychologists do generally relies far more on the therapeutic relationship than on the “treatment”).

I’m looking forward to seeing how this new proposed taxonomy might be received—and, I hope—advanced.