Okay, there was a hijack derailing a thread over in the Pit. So here we get to address this post. Which is basically asking “When is ‘depression’ a mental illness?” I figured I’d stick it here in IMHO because there will probably be losts of anecdotal information rather than just factual stuff for GQ.
So…
A few people addressed this in the Pit thread. Not all forms of depression qualify as “mental illness”. Following a tragedy, depression is a common, reasonable, and predictable response.
With clinical depression, the reasonable stimulus is vague or absent. You are suffering from acute despair, even though there isn’t necesarily any specific event or reason for it. It’s more of a chemical imbalance causing the profound emotional state.
Anybody else want to chime more infor than what I’ve got in my wee cranium. I know there are people here who know more about this than me.
I don’t believe clinical depression has to have ‘‘no reasonable stimulus.’’ I was diagnosed with major depressive disorder which is about as hard-core as you can get with depression–I’ve suffered for years, but my depressive disorder is a direct offshoot of PTSD, which has a very clear reasonable stimulus. None of my doctors has ever questioned why I’m depressed.
I realize this may be an uphill battle, but I don’t think there is a single psychological disorder or shadow thereof that doesn’t have to do with brain chemicals. It doesn’t make logical sense to me. If even very minor depressive episodes don’t have to do with brain chemistry, where are they coming from? Clearly our environment impacts those brain chemicals, but to say that brain chemicals have nothing to do with some cases of depression doesn’t make a lot of sense to me. Everything about our perception and emotion and thinking comes from the brain. There is not a moment of consciousness that doesn’t happen in the brain. If brain destruction occurs, consciousness ceases. It’s quite literally all in our heads.
Man, I have so much more to say, but I have an appointment to get to. Actually, I’ll ask this very question to my therapist today in session, and see what she thinks. I’m excited to see where this thread leads.
Depression is definitely a mental illness once it reaches DSM-IV criteria for one of the depressive disorders.
However, I wonder–why the aversion to calling someone who has subclinical depression “mentally ill”? Someone with a minor head cold that doesn’t require a doctor’s care is still called “ill.”
Generally I think the greatest distinction between ‘‘depressed’’ and ‘‘clinically depressed’’ is functionality and behavior. Psychologists use the DSM-IV which contains tons of psychological disorders but very detailed and specific behaviors that must be exhibited in order to glean a diagnosis. Since knowledge about the brain chemical side of things is currently limited, these conditions are diagnosed based on behavior, and the severity of the condition is diagnosed according to how well the sufferer can function.
Observe the requirements for clinical depression:
Notice none of these criteria refer to things like, ‘‘innapropriate seratonin levels in the brain’’ – they are based on behaviors and more easily observable criteria.
Now, as best I understand it, the severity of the condition is then determined by how well one is functioning. If a person exhibits some of these symptoms but is still going to work, participating in PTA meetings and going for the afternoon run, that person would have mild clinical depression. If a person is getting to work but coming in late, doesn’t participate in the PTA any more and only gets to run once a week, that could be called moderate clinical depression. If the person is missing days of work, unable to bathe, eat, get out of bed, and even exhibiting signs of psychosis (it happens), that would be severe clinical depression.
I could be totally wrong. I’m sure someone will be along to let me know whether I am.
I think the problem is mentally ill can have very different connotations depending on the source. ‘‘Mentally ill’’ to me is a political term used to describe people like my uncle, who is paranoid schizoaffective, unable to function on his own and court-mandated to take his medication so that he doesn’t kill anyone during a psychotic break. ‘‘Mentally ill’’ has been used as a government term requirement for garnering disability and state-sponsored medical coverage. I think part of the problem with’‘mentally ill’’ is it means different things to different subsets of people. Depression may very well be a ‘‘mental illness’’ by DSM standards, but by government standards it is almost always not.*
*There are exceptions, always, but it would take a LOT of work to be approved by the state (of Michigan, at least) as officially mentally ill on the basis of clinical depression alone.
I think many of us would like a clear cut reason as to why the human animal gets depressed. However, I am quite sure we know causal reasons why depression happens, and which neurotransmitters go with this thought and that…but science has yet to map our cognitive highways and byways in such a way to give us the “why” depression happens.
We have all sorts of medicinal aids to help is deal with neurochemical imbalances but few solid answers.
Thanks Olive for the DSM-IV criteria: I knew someone would post it sooner or later. I think the whole diagnosis and treatment of despressive diorders needs an overhaul. You have docs and APRN’s prescribing the whole gamut of medicines without helping the core issues. Therapy and medicine are good combinations, but a general practitioner giving a patient Zoloft and saying something like: See how that works for ya, and get back to me ain 6 months… Just doesn’t help the problem in my opinion.
Personally, I know people who have depressive tendencies and do quite well on meds, where others who have depressive episodes should not be on medications.
The death of a family member can lead to depression, a break-up with an SO, the War, our Gov’t…the list goes on and on…Labeling people is a slippery slope, I would not label my co-worker as mentall ill if she ishaving a bout of post pardem depression. If she is still depressed after a year…thats a different story.
I didn’t go into clinical psych for a reason, I stayed in the realm of environmental psychology, so I hope some of our eloved clinical dopers will come in and weigh in on this one. I’ll watch the thread as well.
I think that has a lot to do with the stigma commonly associated with mental illness. We (as a society) want to round up all the mentally ill people and either treat them (therapy and medication as needed) so that they are normal and can be treated like normal, healthy people, or else isolate them, so that they don’t contaminate us.
There’s the ‘begging-the-question’ version of the answer: Depression is ‘mental illness’ when the people who define ‘mental illness’ identify or describe it as ‘mental illness’.
There’s the ‘dis-ease’ version of the answer: Depression is ‘mental illness’ when it feels sufficiently awful as to be beyond the scope of ‘ordinary’.
There’s the ‘insufficient normative reasons’ version of the answer: Depression is ‘mental illness’ when there’s no contextual, historical, biological (other than biological that falls within the purview of psychiatry, that is), or other explanations for why the person would be feeling like that.
There’s the ‘hypothetical-neurological’ variation on ‘begging-the-question’: Depression is ‘mental illness’ when there’s a chemical imbalance in the brain of the sort that causes psychiatric clinical depression, as opposed to depression that isn’t caused by such a chemical imbalance.
The truth of the matter is that the field of psychiatry does not have a compellingly solid definition of a disease called “depression” as opposed to a description of its symptoms. Or, in plain English, they dont know what causes it, not in a “got-it-nailed” sense (they do have ideas, most of them now pertaining to serotonin and other aspects of neurotransmitter chemistry). The diagnosis is made on the basis of observable symptoms, as is the case with all psych dx.
So the diff between clinical depression and ‘regular’ depression is that someone — usually the psychiatrist, although some of think the opinion of the patient ought to count — decides that the depression that they’re seeing here is clinical depression and not ‘regular’ depression.
To throw yet more sand in the machine, the insurance companies will reimburse for clinical depression but not for “patient doesn’t have a psych diagnosis but would fee better with this treatment I’m recommending”, so if the patient is to receive the treatment and/or the facility is to receive reimbursement for the treatment, a clinical dx is kind of necessary here. And if the psychiatrist is of the opinion that involuntary incarceration is necessary in order to stop a suicide, the law makes no provision for “not mentally ill, just feeling like shit, but a danger to self as a consequence of feeling like shit”. Nope, the shrink can incarcerate you involuntarily for being mentally ill and a danger to self, but not just for being miserable and wanting to die. So once again a diagnosis of ‘clinical depression’ is going to go into the chart.
Doesn’t the assessment of whether someone is subclinical or clinical anything depend on their ability to function as a human being?
Somewhere, I got the idea that normal depression meant that the person was depressed but was still able to more or less go about their lives. Subclinical meant that they could get along but that their daily routine was clearly (and not just temporarily) impacted by their being depressed. Clinical depression meant that the person was not able to manage their life.
Of course, as AHunter3 said, the determination may be influenced by the medical and insurance needs of the patient, or other external factors.
That was the confusion in the Pit thread hijack. It started in this post.
True, you can be ill with the sniffles or ill with cystic fibrosis.
Yes, the girls became ill when their sense of self-esteem suffered a huge blow and they were betrayed by their “sisters” based on physical appearance. The hijack got convoluted when it suggested they had become “mentally ill” as a result, and sematically, that implies something different. It blurred the lines between a more temporary state and chronic illness. But it is still valid and there was nothing wrong with the news article as written. I had a wicked case of mono in first year and had tow withdraw from classes. I was back a year later though. Same thing. Got sick, got better, came.
A baseball players who breaks a finger is put on the “disabled list”. In that case “disabled” doesn’t at all mean the same thing as if the baseball player got hit by a train his legs were severed.
Um… I’m not sure what my point is here… :smack: I think it has something to do with semantics.
If I say that your feelings or your ideas are what they are “because of your mental illness”, the conventional implication for most people is “oh, in that case those ideas have no relevance, and those feelings aren’t empathy-worthy feelings… it’s not like there’s any kind of valid reason to think those things or feel like that, it’s just a bunch of ‘brain static’.”
It’s an incredibly ugly way to erase another person’s personhood.
That thread was the first time I’d seen the “Oh, everybody gets down every once in a while” applied to not take seriously those people who aren’t clinically depressed. Usually it’s those people who have the systemic problem who get blown off as trivial …
The distinction I’ve generally seen is “situational depression” vs. “clinical depression”. Which aren’t clear-cut distinctions – it’s certainly not uncommon for a situational depression to trigger a major depressive episode in people who have the predilection for depressive disorders.
My understanding of the distinction, with awareness that I’m just one of the people with the mental illness and not a medical professional: In terms of whether one should worry about things or whether medical treatment is warranted, it doesn’t matter whether a depression is situational (my dog died, my spouse ran off with the vacuum cleaner salesman, my friends all cruelly abandoned me as some sort of sick sorority game) or not; the known effects in the brain are pretty much the same. For people with “clinical depression”, the systemic disorder, those effects tend to either remain or recur. For normal people, eventually the grieving period (or other trigger for the depression; I know someone who wound up treated for post-partum depression, for example) ends, the brain goes back to ‘normal’, and those patterns do not recur without a new stimulus.
I can’t think of any time that would be an acceptable way of thinking. It’s like when your wife is really angry with you and you ask “Are you PMSing today?” With one fell swoop, you’ve tried to completely de-legitimize honest feelings. That ain’t right.
I thought there was also a difference between chronic and recurring episodes.
A buddy of mine and his wife ended their marriage and she left the country. His doctor put him on anti-depressants for several weeks, until he made the adjustment, came to terms with everything, and now he’s fine. So he was despondent enough to require medical care, so I guess it was a major depressive episode. However, he doesn’t have a depressive disorder. He hasn’t been depressed before then, he hasn’t been depressed since then, there is no family history of it, and he was never a danger to himself or anyone else.
A “depressive disorder” would be an ongoing problem (chronic and recurring), yes?
Exactly my point. The question was rhetorical and aimed at the OP. I probably should have made that clearer. As someone with bipolar disorder, I know all too well that many people think of “mentally ill” as only meaning “irredeemably crazy folks with no worth to society.”
To me, the OP’s question sounds like, “At what point do we get to slap that ‘irredeemably crazy, worthless piece of crap’ label on someone? 'Cause we don’t want to do it to any nice normal people who are just, you know, a little depressed for a good reason.” I really hope that wasn’t the OP’s goal, but I think that, intentionally or not, that the tendency of this semantic exercise is to reinforce the negative stereotypes and stigma associated with mental illness.
I’m almost positive this wasn’t the OP’s goal. It had more to do with fighting the ignorance of someone in the ‘‘sorority’’ BBQ pit thread.
I find the distinction between ‘‘depressed for a good reason’’ or ‘‘not’’ to be a bit troubling myself, but ‘‘mental illness’’ is a very slippery word. In psychological terms I’m pretty sure anything you can find in the DSM is considered a mental illness. According to NAMI (National Association for the Mentally Ill), mental illness is limited to schizophrenia, bipolar and major depressive disorder. According to disability legislature, mental illness is any psychological disorder that renders you unable to work.
But it’s dangerous to mark a distinction between ‘‘illnesses with no apparent cause’’ and ‘‘illnesses with cause’’ for exactly that stigmatization reason. I also find it problematic because obviously it has a cause even if it’s not clear what that cause is. All illnesses have a cause, but we don’t necessarily understand all those causes. Or something.
I don’t believe in the either/or thinking of some people, ‘‘Well some psych disorders are caused by neurological imbalance and others are caused by life situations.’’ It doesn’t work that way. Life situations cannot directly cause a psychological disorder. They can directly cause a neurological imbalance which can then directly cause a psychological disorder, but either way you’re dealing with brain chemistry. Sometimes the brain chemistry is messed up to begin with, other times something comes along to mess it up, but it’s always messed up regardless of the nature of the psych disorder.
And nothing about the DSM-IV suggests to me that psychologists truly give a hoot about why a person is depressed when it comes to diagnosis. It’s all about behavior, functionality and outwardly measurable indicators that have nothing to do with potential root causes.
Absolutely agreed. But I’ve been on the receiving end of it… IME, people do it precisely to delegitimize negative feelings that you know to be honest and requiring of your attention.
a boss who thought I’d “been having PMS” when I told him I’d leave the job if he didn’t solve certain problems he’d caused. The problems were perfectly real and everybody, even him, agreed that I had reason to be angry. But by sticking that label on it, he diminished the seriousness of my challenge and didn’t bother take it into account (I did leave).
another who accused me of “faking” an arm tomato-red and twice the size of the other, “because you don’t want to work”. At that point I was 3 months ahead in the project calendar, he couldn’t find any tasks to give me and yes, I’d been pointing that I didn’t see the reason to make me stay at work for 12 hours with nothing to do. But how do you fake a forearm twice the size of the other? It’s something visual, you can measure it with a tape!
It’s an excuse. And saying “bah, he’s depressed, don’t take him seriously” is another.
To my non-medical mind, “regular” depression goes away when the non-chemical cause for it goes away (or becomes distant enough); “medical” depression doesn’t get better without clinical intervention (pills, therapy or both).
I had a happy childhood and I’m close to all my family. I’ve received much unconditional love. I’ve never gone through any sort of trauma, ordeal, assault or incapacitation. And by age 33, I had everything I always wanted: a happy marriage, my own house, and a dream job.
At age 33, I met every one of the DSM-IV-TR criteria (well, except for the last one, fear of being abandoned) I was ready to sell my soul to the devil, if only I could curl up into a little ball and not go anywhere or do anything.
I had lost my will to live. There was no reason to feel so bad, yet I did.
I agree that bad situations exacerbate the problem. But not in my my case, as I didn’t have any. As for behavior and funtionality, I kept as tight a lid as I could on it, due to my work ethic and my privacy. At work, they may have noticed that I was a little quieter, but I’m quiet to begin with. I hoped it would just go away. I sought help only when I knew I couldn’t hide it much longer.
Now, at age 47 I have everything I’ve always wanted (except enough serotonin): the same marriage, house and job. But I have to resign myself to taking those little pink pills for the rest of my life.
