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Does Depression Exist?

If you call your sadness, irritability, loneliness, disappointments, and overwhelm "the mental disorder of depression," does calling all that pain make it "the mental disorder of depression"?

If you call your daughter "my little petunia," does calling her that make her a flower? No, it doesn't.

If you call your wife "the little woman," does calling her that mean that she is no longer six feet tall in her stockinged feet? No, it doesn't.

If you call your anguish "the mental disorder of depression," does calling it that make it a "mental disorder"? No, it doesn't.


To call a real thing by some other name doesn't transform that thing into the other thing. All you have done is attach a new label to the real thing. If you then begin watering your daughter because you believe that she is a flower or implore your wife to grow because "she has gotten so little," you have taken that labeling process far down a mistaken road and used metaphor, analogy, and other linguistic niceties to create unreality.

The American Psychiatric Association defines a "mental disorder" as "a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom." Does that "definition" make sense to you? First of all, it's impossible to know what it means, since it is built on piles of words and phrases that in turn need defining (and believability). Second, it is built to include anything and everything. Third, nothing psychological has to be going on at all in order to meet these criteria (notice all the "ors" in there; it could be a "psychological syndrome" or a "behavioral syndrome"). I think that any impartial observer would agree that nothing is really being defined here and that this is more a collection of words meant to cover every contingency than a real definition of a medical problem.

For something to be a genuine "mental disorder of depression," first we need a definition of "mental disorder" that makes sense (did that definition make sense to you?). Second, we need explanations of causes rather than descriptions of symptoms (that's all that's done now, a process of counting up "symptoms"). And third, we need a way to distinguish between predictable human reactions to life vs. something pseudo-medical (something distinguishing like, say, a medical test). We don't have any of this.

As long as so-called mental disorders are diagnosed on the basis of symptom pictures and not on the basis of explanations of causes, it is fair to say that mental health providers have no real clue what they are dealing with. That isn't to say that the chemicals they dispense may not have effects or that talk called "psychotherapy" may not help. But simply pinning the label of "mental disorder" on an array of symptoms is not a sensible way for society to deal with human distress.

What about antidepressants and psychotherapy? Chemicals have effects and they can alter a human being's experience of life. Chemicals can affect how your mind works. Chemicals can affect how you sleep. Chemicals can alter your moods. That a chemical called an antidepressant can change your mood in no way constitutes proof that you have a mental disorder called depression. All that it proves is that chemicals can have an effect on mood (and, yes, you may want those effects!). There is a fundamental difference between taking a drug because it is the appropriate treatment for a medical illness and taking a chemical because it can have an effect. This core distinction is regularly obscured in the world of "treating depression."

"Psychotherapy," too, can help remediate sadness for the simple reason that talking about your problems can help reduce your experience of distress. Psychotherapy works, when it works, because the right kind of talk can help reduce a person's experience of unhappiness. To put it simply, chemicals have effects and you may want those effects; talk can help and you may want that help. "Antidepressants" and "psychotherapy" can help not because they are the "treatment for the mental disorder of depression" but because chemical have effects and talk can help.

As soon as you employ the interesting linguistic tactic of calling every unwanted aspect of life abnormal, you are on the road to pathologizing everyday life. By making every unwanted experience a piece of pathology, it becomes possible to knit together "disorders" that have the look but not the reality of medical illness. This is what has happened in our "medicalize everything" culture. In fact, the word depression has virtually replaced unhappiness in our internal vocabularies. We feel sad but we call ourselves depressed. Having unconsciously made this linguistic switch, when we look for help we naturally turn to a "depression expert." We look to a pill or a therapist even if we're sad because we're having trouble paying our bills, because our career is not taking off, or because our relationship is on the skids. That is, even if our sadness is rooted in our circumstances, social forces cause us to name that sadness "depression" and to look for "help with our depression." People have been trained to call their sadness and misery "depression" by the many forces acting upon them, from the mental health industry to pharmaceutical companies to mass culture to advertising.

In the first part of my new book Rethinking Depression I explain how human unhappiness, anguish, misery, disappointments and other painful realities have been transformed through linguistics into the "mental disorder of depression." In the second part I present a complete program for dealing with all that unhappiness and misery, a program based on the principles of noimetic psychology, an improved and updated existential psychology.

So, does the "mental disorder of depression" really exist? The misery certainly exists; but does the "mental disorder"?



For more by Eric Maisel, Ph.D., click here.

For more on mental health, click here.